Foreign Studies

Greetings

My name is Thomas and I am a native German.   
I spent more than half of my life, namely 43 years, in Japan and can by now look back on about 35 years of “clinical experience” as an acupuncturist here.  Since 1995 I do run my own VERY LITTLE acupuncture clinic. “Thomas’ Acupuncture CLinic” (in Hayama, ca. 50 km from Tokyo)                 

Email: contact@einklang.com

***  MY Choice ***

As a therapist I am VERY reluctant to say this, but as a father of 4 children feel obliged to do so:
I
DO NOT help Trump supporters! I am not willing (and under no obligation) to help people who support someone, who publicly declared his (and therefore “their”) intention to kill my four children – as well as destroy the future of my yet unborn grandchildren.
That is MY personal decision and not subject to discussion.

I will list a few pieces of text here, but later put them also on the “Posts” page. I suppose, they can be more easily searched there.

  • Recent developments in Japan
  • English text pertaining to studies in Japan
  • German text ” (article only in English)
  • List of requests received so far (wonderous variety!)
  • Stories about and impressions from people who visited Japan:
  • Do’s and Don’ts (working on it)
  • List of helpful Japanese phrases (working on it)

Some notes on why I am trying to help potential observers (students)

*** I did set up a page (in Japanese) calling for help from (Japanese) practitioners willing to let foreigners observe in their clinic:

-> “Wanted (unfortunately so far not many people did respond …..)

These .. and those foreigners …

I tried a lot of things, to “get things going”, but with very limited success so far. Maybe my repeated calling upon academic societies and acupuncturist associations has contributed to the adoption of an “official policy” of accepting foreign observers at Japanese clinics, which has been accepted by the general assembly of the JSAM in 2009. After that it took another 3 years to FINALLY set up a (last time I looked, VERY SHORT) “list” of Japanese practitioners willing to let foreigners observe, which included until very recently NINE people. 

This was just too pitiful to look at, so I asked to include me in that list, although as a foreigner myself I do not belong there. I think, by now the list is 10 people long. Although I am very far from being “social”, I do have a list of a little over 30 contacts declaring their willingness to help.

Several years ago I also wrote to the government (in Japanese), suggesting that support and promotion of traditional heritage = like acupuncture is important to prevent its assimilation = disappearance as a result of Chinese efforts at “standardization”:

https://ameblo.jp/nyumein/entry-12545666376.html

Naturally, I did not get any answer.

The other day I wrote about this 99.8% of Japanese practitioners NOT wanting to accept foreigners, which may in part be due to a lack of recognition = meaning many Japanese practitioners do not know about this effort, to a number of national newspapers and TV stations:

webmaster@tv-asahi.co.jp Channel 10
tousho@yomiuri.com Yomiuri “tosho”
tokyo-koe@asahi.com Asahi News Tosho
ecntct@nikkei.co.jp Nikkei editorials
shakai@yomiuri.com Yomiuri, Shakai
opinion@japantimes.co.jp Letters to the Editor: Japan Times
health@nikkeibp.co.jp Nikkei Health
 

and some others.

When I tried to make an inquiry at the Japanese national TV = NHK, I was forced to identify myself in a (Japanese?) way, which is not me as described under above link “foreigners are not welcome” and in Japanese:

http://transcurio.blogspot.jp/2012/03/nhk.html

It IS very difficult to find something here. But I have succeeded in arranging a few things for a few people in the past …

Nevertheless, anyone interested in studying in Japan could also contact for example the following societies (maybe mentioning that you have seen my site; that could provide an extra stimulus for them to help …)

Japan Society of Acupuncture and Moxibustion   ->     http://www.jsam.jp/           ->   honbu@jsam.jp (I don’t know, whether he is still on the job; ask for: Mr. Hirokazu Inami)

Japan Acupuncture & Moxibustion Association    ->     http://www.harikyu.or.jp/   ->   info@harikyu.or.jp

Recent developments in Japan

Japanese acupuncture seems to be relatively little known around the world (see below section about the international symposium). 

Recently people have agreed, after my surely annoying pestering those in charge, that an “official” call for help (volunteers allowing foreigners observe their clinical practice) shall be put on the JSAM website and published in the society’s journal. Thus, the chances of foreigners to find places/opportunities to study in Japan will in the future probably better than they used to be. I will try to keep visitors of my site informed about the state of affairs. 

(* Actually, it seems that by just asking for help in this matter I also do make a lot of enemies among my fellow practitioners and some colleagues actually discouraged me from doing so …)

The person currently (I am afraid, this information is a little outdated!) in charge will probably know many more people than I do.

Mr. Hirokazu Inami (of the above mentioned society)

Good luck.

PS: If you feel, I could be of (more) help too, please don’t hesitate to contact me.

International symposium 

On June 12 the 2nd 2009 an international symposium on acupuncture (“evidence for the efficacy of acupuncture treatment for low back pain”) was held.

* Almost all the foreign speakers VERY frequently used the pair of terms:

real acupuncture” vs. “sham acupuncture“.

It turns out, that the definition of “real acupuncture” conceived by the speakers (the international community??) would be deep, ‘painful’ = de qi sensation eliciting needling, whereas most shallow needling without the de qi feeling would be considered “sham” (that sounds like “fake”). If that is true, most of the Japanese acupuncturists have performed fake acupuncture over the past 1,500 years treating millions of people! I DO NOT like that notion at all. The presentations made by the speakers as well as answers to questions from the floor also clearly indicated, that most invited speakers were NOT familiar with Japanese acupuncture at all or only very little.

English text pertaining to studies in Japan

A frequently asked question: Can I learn about acupuncture in Japan?

I have been asked this question not really “many times”, but a considerable number of times from all kind of different people with different backgrounds and intentions- and this number seems to be increasing. The answers I might be able to provide are, however, not very encouraging. Intellectually Japan still seems to be stuck in the “period of national seclusion”. That means, while China offers programs, classes, places in hospitals etc. where foreigners may have the chance to either observe or actively learn about Chinese acupuncture, Japan does not offer any such classes, or has schools, hospitals etc. providing anything remotely systematic for any possible candidate with an interest in learning (Japanese) acupuncture in Japan. Private acupuncturists too, seem to be (very) reluctant to give foreigners the opportunity to observe their treatment for a variety of reasons. These include the fear (I have been repeatedly told by colleagues, that foreigners = non-Japanese people are a frightening presence), that they will not be able to communicate with the foreigners, the assumption that they don’t have anything to “show”, the argument that patients would be very uncomfortable (afraid!!) when being watched by a foreigner (in Japan officially still called “alien”), or the possibility that the observers might start something that either embarrases or compromises the therapists, for example by urging him or her to sell particular products or introduce certain services. These things have happened!So, at the moment the best thing I can do, is privately ask people who might be willing to allow people to observe their treatments (I have already been told, that I “should not care for those (troublesome) foreigners, because it might be detrimental to my personal reputation”). Yet, recent developments in the “policies” of academic societies etc. seem to indicate a change in the situation (maybe I have even contributed to this change??), so that the hope to find people willing to cooperate with requests to be permitted to observe might (will?) improve in the near future. Among other things I have put up a page on my website asking (in Japanese) colleagues for their cooperation and a few already did so …Based on my personal experiences, I would like to help foreigners expressing their earnest desire to learn things here as best as I can. Although I cannot promise anything, please do not hesitate to ask me. Who knows, maybe we can arrange something ….. Recently, some of my efforts and the voice I publicly raised in the form of an article published in a Japanese journal – a rather liberal translation of that article follows below – also seem to start bearing fruit.

Foreign studies in Japan – my personal opinion

(English translation of an article written in Japanese published in the September (2008) edition of “Ido no Nihon” -> 

「見学」個人的な意見 ……. <- this is the published Japanese version)          

I came about 31 years ago to Japan in order to study Kyudo (Japanese archery). Having a Japanese lady write me a letter in Japanese I inquired in advance from Germany at the Japanese Kyudo Association, explaining my personal situation and politely asked whether that association could possibly introduce me to a Dojo (a place where martial arts are practiced), where I might study Japanese archery. Yet, the answer was, that I should first come to Japan, and “then we will see”. Once in Japan I visited several such practice halls, but had very great difficulties finding a place where the first response to my request was NOT “no thank you”. Finally, the priest Koun Suhara of the Enkakuji temple in Kitakamakura, with the help of people interpreting for me, offered some constructive and concrete advice that led me to study under master Tanigawa at the Kanagawa prefectural Budokan.          

In Japan I am beyond doubt an “alien” (the official word here for foreigner). A direct translation of the Japanese term would be “outsider”. Japanese people by contrast would be ”insider” (although they do not use THIS term to refer to themselves) and still very often consider mingling / communicating with those “outsiders” inappropriate. Outsiders may in fact and under certain circumstances be very entertaining and are welcome to leave their money as tourists, but considering them as “equal” seems to be still very difficult. I spent 30 years in this country and my probably marked lack in proficiency of the language certainly contributes to my feeling of alienation as an “alien” here in Japan.         

Even if somebody comes from abroad (Japanese: “on the other side of the sea” – which means exactly the rest of the world!) with a zeal of “studying xxx”, I have heard / been told several times in the past that they cannot be taught because of the language barrier. When I was still teaching English conversation a long time ago I noticed this phenomenon too: when the students are not familiar with the words in question, they easily become frightened and therefore did not make any progress. In the words of those students: “It would be embarrassing to make a mistake, so I become frightened.” Precisely for this reason they rather choose to fall silent than to use the wrong word. Yet, in Japan there is even a proverb that admonishes against this behavior, saying that “mistakes are the foundation of progress” or put into words more likely to be used by speakers of the English language: “practice makes perfect”.          

Acupuncture and moxibustion (oriental medicine in general) is an extremely specialized “intellectual property” (know-how), that has to be and should be ‘handed down’ (or better even, spread among the population) from teacher to pupil rather than learned from books. If anything, nowadays this intellectual property seems to be increasingly “marketed”. Indeed, the Chinese people, who care most of all about business, currently are aggressively marketing this intellectual property on a global scale, claiming to be the SOLE proprietor of this knowledge and thereby totally ignoring ALL achievements by ALL other countries, so that there seems to be very little room and opportunity for the Japanese (or other nationalities!) to present their view of the subject, neither in written nor in spoken form.   

Pride in the spirit of one’s craft         

If you are a craftsman – and I believe that practitioners of acupuncture and moxibustion are quite respectable craftsmen – you should take pride in the skills of your work. It is my personal opinion that many Japanese do not take sufficient pride in their skills. The skills involved in acupuncture and moxibustion globally promoted / marketed (displayed) by the Chinese people are doubtlessly of outstanding nature. Yet, personally I am under the impression, that “Chinese acupuncture” may not necessarily be the optimal technique for “modern man”. The majority of foreigners who had experienced Chinese acupuncture visiting my clinic reported, that they were very grateful for the painlessness of Japanese needling (sometimes including the absence of the “deqi” feeling, also often experienced as unpleasant)!          

My remarks here are NOT meant to indicate a discrimination between “China” and “Japan”. Basically I came to Japan because of my love for the Chinese philosophical background of Japanese cultural aspects (at that time Japanese archery). Some of the major influences during my puberty were related to philosophical concepts like they are found in the “I Ching”, in the writings of Lao Tsu or the Yin-Yang theory.     

Yet, the observation that scientific publications from China pertaining to acupuncture and moxibustion always give an efficacy of 90% and above, while they seem to be marked by a very poor reproducibility and a number of other bold statements (e.g., acupuncture without eliciting “de qi” does not work) have induced in me a more or less acute feeling of suspicion.          

In China, however, there is already a system in place that “helps” foreigners wishing to study acupuncture there. There seem to be classes for foreigners, specific schools that teach foreigners and directions toward universities and hospitals that allow foreigners to visit. Moreover, it seems to be possible to find out about these aspects through net searches from abroad. Often the per sonal history of foreign authors of articles about acupuncture list the phrase: “foreign studies in China”. Even if this may have only been 10 days, the usually reaction seems to the “fantastic” or “genuine”. In other words, “ foreign studies in China” is a label that carries a considerable <market-value>. On the other hand, the reaction to similar statements referring to foreign studies in Japan seem to elicit not much more than a half-hearted “hmmm”. That means, ‘foreign studies in Japan’ is an item of only little <market-value>. Personally, I believe this is an awful waste of intellectual property.

Before this background I some times receive inquires from foreigners about the possibility of studying in Japan, because my website happens to have pages in both English and German. The askers say: ‘I am already familiar with / have studied Chinese acupuncture, but would like to know more about JAPANESE acupuncture. Where and how can I study this subject, or to whom should I ask for help.         

Unfortunately, I am in most cases not able to answer those questions. Personally, I do not know that many practitioners. Several inquiries I made at different times at the Japanese Acupuncture and Moxibustion Society and similar professional societies always produced the same depressing answer: there is no authority in charge of this kind of information. This too is a great waste, I believe.         

Conversely, I have been asked by colleagues: “Why are you trying to help those foreigners? If you keep asking favors for those foreigners, the other practitioners in the field will come to dislike you for asking such trouble some things. Anyway, any foreigner who would like to study (look for people or institutions they might visit in Japan) should first do sufficient research (meaning internet searches).         

My response would be first, remembering the trouble I had when I came to Japan makes me WANT to help those on a quest for knowledge / skills. Second, the above mentioned “research” proves to be very difficult, because probably more than 90% of the large number of acupuncture related sites in Japan are written only in Japanese. Therefore it is very difficult for people who do not understand the Japanese language to find out things about Japan. I think, this means that in intellectual (in particular related to acupuncture) terms the period of national seclusion has not yet ended in Japan.  

Introducing Japanese acupuncture and moxibution to the world         

In the past I repeatedly expressed my personal opinion, that the Japanese people should show more pride in their tradition, skills and outstanding technology, promoting themselves on the global stage. That is, the Japanese intellectual property should be “marketed” more aggressively. For this purpose the following means might be helpful:

1.  actively publishing research papers

2.  accepting/teaching foreign “students”

3.  Japanese people playing active roles abroad.  

Current Japanese system         

In the current situation there is apparently no system for the acceptance of foreign students in place at any of the representative Japanese academic and professional societies. And as far as I know their establishment is also not planned. In the past it was already pointed out, that the number of possible applicants in Japan is too small for setting up a class. That is doubtlessly true.         

Yet, many possible forms are conceivable. For example, the academic societies could call upon their members and prepare a list of volunteers that would accept foreigners as visiting students. Then people would at least know who and where to ask. Practitioners who do not want to host foreign students could thus be spared the relevant trouble some and some times certainly annoying questions.         

Those who offered to accept foreign students could then further register more specific conditions under which they would be willing to accept foreigners. (Actually, I once asked a certain practitioner, whether he would be willing to show his skills to a foreigner and who then responded, “OK, that will be a xxx Yen fee.” Personally I was unspeakably disheartened by this statement, while the applicant considered that as a matter of course.)         

Some practitioners considering to host foreign students could be afraid, s/he might not understand the language. However, there are many high school or university students (working adults too) that are desperately looking for chances to speak English. Using these as volunteer interpreters would probably make both parties happy. People who may not be able to speak the language, but are well capable of writing, could take over any correspondence. Thus, I daresay that  “language-related” problems are only minor or non-existent.          

The Japanese Society of Acupuncture and Moxibustion should function in modern terms as the “global portal”, where people from all over the world  may have a look and then express their consent. The site should provide a broad range of information that foreigners might be looking for. This includes the above stated problem that the majority of Japanese acupuncture related sites are written ONLY in Japanese. Viewed from a global perspective Japan is still a black box (or maybe a black hole): although its presence is acknowledged, its contents still remains obscure …  

Academic achievements         

People accepting applicants for foreign studies must NOT BE scholars. Being craftsmen and taking pride in their craft is just perfect. The majority of people inquiring with me implicitly state that they are not looking for scholarship, but would like to watch craftsmen in action. Although a little learning could not do any harm, these people come in search for the Japanese craftsmanship and superior technology. Technology here refers to “manufacturing” things and thus means needles, therapeutic apparatuses etc.).

Picture on the left:

Left = sharp pencil mine , 0.5 mm Right from top injection needle Chinese needle Japanese needle Injection needles are, naturally, hollow tubes cut obliquely, so that their edge is very sharp and thus suitable for “cutting” into the flesh (vessels). Acupuncture needles on the other hand should have a slightly rounded shape, here in Japan called “pine needle shape”, because it should resemble the tip of pine leaves.  Although it is difficult to see on this picture (need a microscope), the Chinese needle appears to be simply “pointed”, whereas the Japanese needle gives the impression of being very slightly rounded.   

In Japan students are supposed to learn by “watching” their master, not by being “instructed”. I would like to appeal here to Japan as a country as well as the individual practitioners to open their heart (and country) and give people with an earnest desire to learn the chance to do so. And show (free of charge if possible!) the world that Japanese technology (engineering) and skills are not second to anybody. Please share this intellectual property with the world and thus put an end to the (intellectual) national seclusion.                                  

http://jsam.jp/jsam_domain/english/intro_index.htm

Interface

Before a practitioner can start treating people, s/he must first find out what is wrong. As far as that is possible at all. As a matter of common sense there are many ways to do that and I am not going into the details of examination techniques. However, I am under the impression, that the Chinese with their intellectual world domination in this area have inspired many westerners in believing, practicing something that is usually “handled (please observe the expression; there will be a few more instances of this kind of illuminating terms below)” a little differently in Japan.

Since I have not had the opportunity to observe things directly in mainland China, reading through (Chinese influenced) reports, research material etc., or also material from China, I also am under the impression, that the authors gather information by taking the pulse, inspect the tongue and a little something of that and from there draw their conclusions based on the classifications the Chinese love so much and/or select the points for their treatment based on the theoretical instructions of textbooks or the classics. It is of course laudable to know the textbooks and classics, but personally I seriously doubt, they can tell you anything about the patient you are currently treating. Just like the description of “pneumonia” in a textbook of medicine gives you an averaged, generalized model, but not the particular situation you encounter in patient “xxx”.

Although not all Japanese practitioners adhere to the practice I attempt to put into rather unusual words below and which a patient of mine once has called “poking around”, I prefer it and believe a substantial number of other (Japanese) practitioners could offer the world here something, that may not really make the EBM enthusiasts happy, but provides a sometimes very enlightening “close encounter of the Japanese kind”.

*************

Interface is a term usually used in relation to computer and machine technology. But I would like to express a few ideas pertaining to (physical) treatment, in particular acupuncture treatment, and borrow this expression for the purpose.

In the medical world it is common sense, that individual life forms, including single-celled microorganisms, plants, animals and man, have a body surface that forms the interface of this particular individual with the environment. Yet, in contrast to man-made devices, which are usually one out of a more or less large number of identical devices manufactured at a specific site with identical specifications, these life forms are always **UNIQUE**. Not one of these many “devices (let’s call them units below)” exactly matches any other device, even if they are of the same species, like for example “man”.

Each individual unit is slightly different, although may be not fundamentally. For that reason the interface between the unit and the environment at any given moment in time is subject to a unique, highly specific set of parameters influencing both the unit and its environment. And because the specifications for each unit are unique, the interaction between the particular unit and the environment occurring at their common interface – in man the skin – also is subject to unique changes. That means, that no other unit would react in exactly the same way to a given, reproducible parameter/influence, like temperature or pressure.

In computer technology the status of the various devices and their respective hard- and software can be checked and a “digital output” of the relevant data prepared. In medicine, here I refer in particular to acupuncture, “running diagnostics” is also largely a “digital” process, because the practitioner uses his/her fingers = digits to literally READ information from the body surface of people/patients. But in contrast to this process in computer technology the diagnostic process in acupuncture exceeds the unidimensional digital level and becomes a “sensual” holistic process, in that it includes visual (inspection), audio (hearing, listening) and chemical (smell, but only RARELY taste) parameters.

In relation to the “EBM frenzy” currently almost everybody is looking for “reproducible, digital readouts” of this information: like temperature, pressure, electrical resistance etc. However, to the best of my knowledge, even if there are devices under development that may be able to test and measure some of these parameters like pressure, which would be essential for examining the pulse, these devices are still very far from reliably and meaningfully measuring the parameters they are designed for. The human touch still exceeds their capabilities.

Even if there were devices that would satisfactorily measure ONE particular parameter, a human (erratic as that may be!) practitioner would still integrate all the different modalities of into one whole (“holistic”) picture quite different from what any machine would produce. In addition, the practitioner him/herself too is a unique unit, which naturally produces a unique and not completely reproducible output. THAT is for all scientifically/technically inclined researchers believing in the holiness of EBM a horrible concept.

Now, the interface used for data collection, namely the two layers of the skin of both patient and practitioner approaching and in most instances also coming into contact with each other, are not unlike a telephone. (This is a metaphor I like to use when I try to explain the situation to my patients and refer here only to palpation.)

On the one “hand” (please note THIS expression) the practitioner moves with his/her hand(s) over the body of the patient to collect = read the data written on the patient’s body surface. Although most patients are not really aware of them, for a practitioner with a little clinical experience there is a lot of information to read there, that will tell him/her about the past, present and future state/development(s) of the person under examination. This is like listening to that person talking on the other end of a telephone.

During the treatment on the other hand, for which the hands do not even have to be lifted off the body = cut the connection, the same hand(s) of the practitioner provides some input for the system “patient”. That is then like talking to the person on the other end of the telephone line.

Modern telecommunication technology uses wired networks, where cables are used to connect different devices, and wireless networks using electromagnetic waves and fields. In medicine nothing substantially has changed in the technological setup of the wired and wireless networks (only our understanding of their functioning is growing) since their inception = billions of years ago. Practitioners use the hardware components for the wired networks, like nerves, muscles, bones etc. in order to receive/transmit physical stimuli/information = like nerve impulses traveling along nerves, or moxibustion induced chemical changes/substances propagated via the chemical transport system “blood”. For the wireless networks practitioners tap into energies and information in and also propagated along LAN channels that work without having their own hardware, in the field of acupuncture these are often referred to as meridians or also channels (note the similarity).

Actually, I have been called for help in my capacity as an acupuncturist via mail. However, both patient and practitioner are unique individual units with their own unique specifications and therefore without exactly predictable reactions (to interventions). Thus, helping people over long distances is usually not working very well, because I as a practitioner have to do almost completely without data readouts from the malfunctioning unit (person). Therefore the attempts are in most cases bound to be unsuccessful. The advice would be: get a piece of real first-hand “human touch” experience up close …… again those expressions …

Actually received inquiries

Received mails inquiring about the possibility of observing / ‘studying’ acupuncture in Japan. About all of the people who wrote me, already have some sort of medical license and most also have clinical experience with acupuncture – almost exclusively the “Chinese style” acupuncture. Being not really convinced by that style, they want to learn something here in Japan.

It would be really great, if more Japanese practitioners would be willing to let these foreigners observe in their respective clinic.

Stories about and impressions from people who visited Japan:

From a beautiful lady from Australia, who lived at that time in China:

Letter of thanks