Japanese acupuncture

Japanese acupuncture is the family of needling styles that developed in Japan after acupuncture arrived from China. A 2008 paper by Schnyer and colleagues, written to design a trial of it, lists five features that set it apart from Chinese styles: an emphasis on palpation; gentler needling; thinner needles with milder, shallower stimulation; checking the effect of each step during the treatment and adjusting it on the patient’s response; and adjunctive techniques that reinforce the main treatment. This page sets out where the styles came from, the main ones, who may practise in Japan, and what trials of Japanese-style acupuncture report.

Where the Japanese styles came from

A 2010 history by Kobayashi and colleagues at Morinomiya College of Medical Arts and Sciences dates acupuncture in Japan to the sixth century, when Chinese medical books arrived from Wu. Ishitsu-rei, Japan’s first medical law, set up acupuncture doctors and students under the national government in 701. In the late sixteenth century private schools, ryu-ha, developed their own techniques: the school of Isai Misono tapped the needle in with a small hammer, mainly on the abdomen, and made abdominal palpation a diagnostic method that Japanese acupuncturists still use. The history records that the Edo period, when the country was closed to almost all foreign exchange for over 200 years, fostered developments unique to Japan.

The guide tube and shallow insertion

The same history credits Waichi Sugiyama, a blind acupuncturist of the Edo period, with the needle tube insertion method: the needle is placed inside a thin tube to insert it. The authors write that it allowed insertion without pain and encouraged the use of thinner needles, that many later techniques were built around the tube, and that Japanese students still learn it as their primary technique. Sugiyama opened a school teaching acupuncture and massage to the blind in 1680, and schools for the blind went on to teach acupuncture across the country.

A 2022 commentary by Birch and colleagues lays the needling methods in use on a scale by depth and stimulation. At one end are needles of 0.12 to 0.18 mm held on the skin without insertion, as in Japanese meridian therapy, or inserted 1 to 3 mm. At the other are needles of 0.20 mm or thicker inserted deeper and manipulated to provoke the sensation called deqi, which the commentary describes as the method taught in China and most Western schools; Needling and deqi covers that sensation. The Schnyer trial protocol specified needles of 0.16 mm inserted 1 to 2 mm through insertion tubes.

Meridian therapy (keiraku chiryo)

Kobayashi’s history places the origin of meridian therapy in a revival of traditional medicine in the 1930s, built on the Nan jing, a classic of around the first century, with pulse diagnosis deciding which points to treat. A 2021 essay by Stephen Birch, who teaches the style, says it had developed by the late 1930s and that it diagnoses only four patterns, named for the lung, spleen, liver and kidney, where one Chinese reference the essay tabulates, Wiseman and Feng’s 1998 dictionary, lists 34 patterns of the heart alone. The study group that built it left out a heart pattern because a passage in the Lingshu holds that the heart itself cannot become diseased without the spirit leaving and death following. Japanese practitioners call the pattern the sho and the act of choosing it sho kettei.

Toyohari

Toyohari is a school of meridian therapy that diagnoses the primary and secondary sho mainly from the radial pulse and palpation of the abdomen. A 2009 study by O’Brien and colleagues had two Toyohari practitioners examine the same 62 Australian adults separately. They agreed on the primary sho in 48% of cases and the secondary sho in 44%, and on pulse depth, speed and strength in 57% to 77%. A 2013 trial by the same group randomised 62 healthy volunteers to a Toyohari “root treatment”, in which the needle does not penetrate the skin, or to a sham, and reported that a cardiovascular measure, the subendocardial viability ratio, improved within the treatment group but not the sham group.

Shonishin

Shonishin is Japanese paediatric acupuncture without insertion. Kobayashi’s history records that a method of stimulating a child’s skin by rubbing and patting it with a special needle appeared from the Taisho era. A 2025 trial protocol by Bloem and colleagues at Amsterdam UMC describes it as stroking, pressing and tapping the skin down the back and the back of the legs, down the abdomen and the front and sides of the legs, and down the arms. The protocol, for children aged 6 to 18 with functional constipation, combines shonishin with an applicator-guided inserted needle and press needles, which Press needles covers; its technique was set from a literature review and a survey of 39 practitioners of shonishin and meridian therapy. It is non-randomised and has no control group, and its results had not been published when this page was written.

Ion pumping cords and Manaka’s style

Yoshio Manaka, a Japanese acupuncturist, built a style around palpation of diagnostic points on the front of the body, according to the Schnyer paper, which borrowed his use of abdominal findings for its trial protocol. A 2012 article in the trade magazine Acupuncture Today by Brette Luck describes his ion pumping cords: a copper wire with a black clip at one end, a red clip at the other and a diode in between. Luck writes that Manaka developed them to treat burns and then wrote further protocols for them, including for the extraordinary vessels. The article cites no trial; its evidence is the author’s own two cases.

Moxibustion in Japanese practice

Kobayashi’s history records that moxibustion became a treatment ordinary people gave themselves during the Edo period, and that the European word moxa comes from the Japanese mogusa. The Schnyer protocol used okyu: mugwort rolled into thread-sized pieces, set on a thin layer of herbal cream and lit with an incense stick, repeated until the patient felt warmth. Moxibustion covers the technique in general.

Who may practise acupuncture in Japan?

Under Japan’s Act No. 217 of 1947 on massage, acupuncture and moxibustion practitioners, anyone other than a physician who practises acupuncture or moxibustion for a living needs a hari-shi (acupuncturist) or kyu-shi (moxibustionist) licence: two separate licences, each granted by the Minister of Health, Labour and Welfare after at least three years at an accredited school and a national examination. A 2025 review by Kawai and colleagues adds that only physicians, dentists and these licensed practitioners may practise, and that most acupuncture is now given by the non-physicians. It counts 191,653 licensed acupuncturists in 2023, about 134,000 of them in clinical practice. The national examination has run once a year since 1993, after a 1988 revision moved the licence from prefectural governors to the state; about half its questions concern modern medicine. Schools must teach 94 credits, about 2,655 hours, and 12 universities offered four-year degrees in 2024.

What do trials of Japanese-style acupuncture report?

A 2023 systematic review by Masuyama and Yamashita found 108 randomised trials of acupuncture conducted in Japan up to 2019, 47 of them in the 2010s. It counts every trial run in Japan rather than a defined Japanese style, and it left out trials of non-insertive paediatric tools. Most risk-of-bias domains stayed rated high or unclear across the decades; only 9% of the 2010s trials were registered and 28% reported adverse events, and 69% of them reported positive results.

The contact needling trial touched the needle to points including CV12 (Zhongwan), CV04 (Guanyuan) and ST25 (Tianshu) without inserting it. The Ishiki programme combined inserted needles, a non-insertive needle (teishin), indirect moxibustion and hot packs, and its authors call for a randomised trial.

What the trials cannot settle

The 2022 Birch commentary points out that the non-penetrating and shallow needles used as shams in many acupuncture trials are close to the techniques Japanese styles use as treatment, and argues that such shams may not control for placebo effects at all; Sham acupuncture sets out the wider problem. The commentary also argues that a trial of one acupuncture method cannot support conclusions about acupuncture as a whole. The 2009 Toyohari study names a second limit: points are chosen from the sho, so a diagnosis two practitioners agree on in under half of patients leaves less confidence that each patient receives the intended treatment. The Bloem study in children and the confirmatory trial the Ishiki group proposes are the next results due.