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In
1951 Dr. Yoshio Nakatani presented his research and theory of
RYODORAKU Acupuncture. Dr. Nakatani had found that there were
a series of low electrical resistance points (or high electrical
conductivity) running longitudinally up and down the body. When
linked together these points closely matched the acupuncture meridians.
Dr. Nakatani called these lines (or meridians) "Ryodoraku"
(ryo = good, do` is (electro) conductive, raku
= line). The points along the Ryodoraku he named Ryodoten
Dr.
Nakatani was the first person to measure the electrical activity
of acupuncture points and the first to formulate diagnostic and
treatment criteria from these measurements. Nakatani was the first
recorded acupuncturist to use electrical stimulation of acupuncture
points. Point location and electrical stimulation has become the
norm for most acupuncturists world wide but the Ryodoraku detection,
analysis and point selection for electrical stimulation is much
less popular. This is unfortunate as Nakatani's concepts provide
an accurate pulse-organ diagnosis, accurate location of required
treatment points and a very time efficient treatment regimen (generally
only 7 seconds stimulation of each point is required. A classic
acupuncture treatment lasting an average of 30 minutes would only
take 2 - 3 minutes using Ryodoraku!)
The
indications for Ryodoraku are identical to those for acupuncture,
but the results are often faster. In particular acute pain and
acute traumatic swelling e.g. sports injury will often respond
during the initial treatment.
THEORY
A Ryodoraku unit called a "Neurometer" uses a constant
voltage of 12V (occasionally 21V will be used in ear acupuncture)
and a variable current (this current is set to 200uA for treatment)
. To provide consistency and avoid artefacts because of dryness/wetness
of skin a moist electrode is used to locate the points of lowered
electrical resistance i.e. Ryodoten or Electro permeable
Points (EPP).
The
moist electrode consists of a small cup containing a plug of cotton
wool soaked in saline (sometimes alcohol is used). This is run
lightly over the skin until a high reading is seen on the meter
i.e. this area of low resistance, high conductivity allows current
to flow. An increase of 20-50 uA is expected. . As in other forms
of electro acupuncture practice is required to achieve consistent
results. Too much pressure or repeated checking of a point can
change the electrical properties of the skin in that area and
lead to error. Computerised measuring Ryodoraku units are available
in Japan. These give a steady 3g electrode pressure to the skin.
This
EPP can then be located exactly by using the fine probe in the
two or three headed point locater on the Ryodoraku unit see
diag.
Nakatani
discovered that the number of electro permeable points not only
varied with any disease process but also with the voltage of the
detector probe. Most of the traditional acupoints could be located
if a 21 volt circuit was used. However if a 12 volt circuit was
used, there were other electrically conductive points over the
body, not associated with any specific acupuncture points. He
called these Responsive Ryodo-pointsor Reactive Electropermeable
points (REPPs). These points often correspond with
trigger points or Ah Shi (tender to touch) points. Nakatani theorised
that they occurred along tracts of the Autonomic Nervous system
and were representative of internal disorder/dysfunction and/or
disease.
Nakatani
showed that needling these REPP, and stimulating them for 7-10
sec with a 200uA charge would render them electrically inert
and produce symptom relief. Headaches, neck aches, back aches
and acute pains would often be relieved - sometimes in minutes,
sometimes over several days. This is a very effective form of
local or regional acupuncture but Nakatani developed it further.
Using
his knowledge of the Ryodoraku pathways Nakatani formalised Ryodoraku
acupuncture. He used the same concepts of the twelve paired acupuncture
meridians or organ systems (Heart, lungs, triple warmer,pericardium,
large intestine, small intestine on the upper limbs and gall
bladder, stomach, liver,kidney, bladder and spleen on the
lower limb ) and the two single midline meridians (anteriorly,
Conception Vessel and posteriorly, Governing Vessel). However
he did not use the classical names. He assigned the letters "H"
to each of the six Ryodoraku on the upper limbs numbering them
from one to six. Similarly he assigned the letter "F"
to each of the six Ryodoraku on the lower limbs, numbering
them from one to six. Thus H3 represented the Heart meridian on
the upper limb; F6 represented the stomach meridian on the lower
limb.
To
further confuse the issue (at least as far as traditional acupuncturists
were concerned) Nakatani did not use either the Chinese name
nor the more commonly accepted, international numbering of acupuncture
points. [He numbered his Ryodo points starting at the end of each
limb]. Acupuncture uses the Yin- Yang energy flow concepts
to number its acupuncture points. Thus energy flows outwards towards
the end of a limb along one meridian ad back to the trunk along
another meridian i.e. the meridians are paired off. In the paired
meridians Lung and Large Intestine energy starts on the trunk
in the Lung meridian so L1 (the first Lung meridian acupuncture
point)is on the anterior chest. The first point for the Large
Intestine meridian (LI. 1) is on the index finger. In Nakatani's
Ryodoraku system both H11 (the first Ryodo point on the large
intestine Ryodoraku) and H51 (the first Ryodo point on the lung
Ryodoraku) are on the finger tips.
Nakatani
believed this was a much simpler way of representing and teaching
acupuncture. No knowledge of the complex acupuncture nomenclature,
philosophy and mnemonics was required. In fact a therapist theoretically
did not even have to memorise the exact position of the acupuncture
points. He/She could use the Ryodoraku Neurometer to locate the
points.
In
a further departure from traditional acupuncture Nakatani compared
readings from Ryodoraku on the right side of the body with those
of the same Ryodoraku on the left side of the body. If one side
showed higher (or lower) reactivity than the other, he would use
a specific needling procedure to bring the EPP readings to the
same level. When the right and left paired Ryodoraku [eg. right
and left H1 (Lung) Ryodoraku] had the same electrical reactivity,
the body was balanced for that organ system.
Initially,
Nakatani measured the electrical resistance of each and every
EPP along a meridian, added them together and divided by the
total number of EPP. This gave him an average energy value
for that meridian. This was obviously very time consuming and,
eventually, Nakatani discovered that there was a point on each
meridian that was representative of the energy in that meridian.
He named this point a Representative Measuring Point (RMP).
Thus there are 24 RMP - six on each wrist and six on each foot.
These
twenty four points were measured and charted on a special chart,
the left side being compared with the right side for the paired
meridians.
LOCATION
OF REPRESENTATIVE MEASURING POINTS (RMP)
The
representative points for H1, H2, H3 (Lung, Pericardium and Heart
respectively) are found along the distal transverse skin crease
on the anterior (or palmarl) surface of the wrist. Each point
is a traditional acupuncture point eg. H3 is over L9 (Lung
9),
H2
= Pericardium7,
H3 = Heart 7,
H4 = Small Intestine 4,
H5 = Triple Warmer 4,
H6 = Large Intestine 5
See
Chart ..............
For
non acupuncturists Nakatani devised a simple measurement
technique for locating the wrist points:
Place
a thumb over the anterior(palmar) surface of the patient's wrist
at the distal skin crease. Place the middle finger on the
opposite (dorsal) side of the wrist. Hold thumb and middle finger
firm and withdraw. Place thumb and middle finger over either anterior
or dorsal surface of the wrist at the distal skin crease. There
should be an equal distance from radial or ulnar borders of the
wrist and the thumb/middle finger. The representative points H1,
and H3 anteriorly and H4, H6 dorsally are under the thumb and
middle fingers. H2 is centrally between H1, and H3. H5 is closer
to H4 than H6, being in the line of the ring finger.
Four
of the foot (F) representative points are traditional acupuncture
points. The other two are between acupuncture points but are on
the appropriate meridian. The F3 (Kidney) representative point
is on the kidney meridian at the postero-inferior tip of the medial
malleolus and the F6 (Stomach) representative point is on the
stomach meridian half way between Stomach 41 (S41) and Stomach
44 (St44) . See photos.
Nakatani determined empirically, from testing thousands of patients,
that the average/normal value for the Ryodoraku varied
1.
from one person to another
2.
from one Ryodoraku to another
3.
throughout the day
4.
with changes in environmental temperature
5.
body temperature.
He
devised a weighed scale on which the 24 representative readings
could be charted then a 1.4 cm ruler could be placed horizontally
to cover the maximum number of charted values and two parallel
lines drawn. Values within the lines were considered normal for
that individual. Values above the top line or below the bottom
line indicated a need for acupuncture needling in one or more
points along that Ryodoraku). Nakatani later simplified this ruler
technique. He discarded the 1.4.cm ruler concept and instead drew
one horizontal line just below the three highest readings and
one just above the three lowest readings. He then needled and
electrically stimulated points in each of the Ryodoraku outside
of the parallel lines i.e. the three highest and three lowest
.
Ryodoraku Patient Assessment Chart. This chart contains
(1) A chart originally devised by Nakatani for entering the values
obtained by measuring each of the 24 representative points for
the Ryodoraku.
(2)
Diagrams indicating the position of each of the representative
points.
(3)
Space to enter diagnosis/room temperature/body temperature
(4)
A table of commonly used points for sedation or tonification of
each Ryodoraku. Experienced acupuncturists will note these
points are the classical Luo -Connecting Points for transferring
energy from one meridian to include another. This table was devised
by Dr Gerald Gibb, a New Zealand rheumatologist, considered by
many to be the father of New Zealand acupuncture. Dr Gibb worked
with Nakatani in Japan for two years and is a mine of information
not only on Ryodoraku but also on every aspect of acupuncture.
TECHNIQUE
/ PROCEDURE for RYODORAKU ASSESSMENT AND TREATMENT.
(1.)Soak
cotton wool plug in saline and insert into cup on end of probe.
Leave approx 1mm protruding.
(2.)
Touch the hand electrode with the probe and adjust the meter to
200.
(3.)
Have patient hold the hand electrode.
(4.)
Run probe lightly over each of the 24 representative Ryodo points
and enter the value for each one on the Ryodoraku chart.
(5.)
On the chart draw a line just below the three highest readings
and another line just above the three lowest readings.
(6.)
For the three highest readings select one or more of the sedation
points for each Ryodoraku from the table below the Ryodoraku chart.
Similarly for the three lowest readings select one or more of
the tonification points for the respective Ryodoraku.
(7.)
Point by point insert an acupuncture needle into each of the selected
points and touch the metal part of the probe to the needle
allowing current to flow for seven seconds.
(8.)
Where symptoms or signs are localised run the cotton wool soaked
probe lightly over the skin within that area. Checking for any
REPPs (Reactive Electropermeable Points) with the dial set for
12 volts. Needle any REPPs found and apply the metal head of the
probe to the shaft of the needle for seven seconds.
TREATMENT
CONSIDERATIONS
Originally Nakatani followed the traditional Chinese acupuncture
concepts of sedating the high points and tonifying or stimulating
the low points. Thus stimulation involved inserting a needle superficially,
leaving it for 3 - 4 seconds then removing without any electrical
stimulation. Sedation required strong manual stimulation followed
by a 7 second burst of 200mA current. In many cases Nakatani found
that this differentiation was not needed and that electrical stimulation
for 7 seconds at 200m A helped both low and high points. The body
somehow only took in the amount of energy it needed.
The second modification involved the use of substitution points
instead of General Regulatory Points (GRP). Nakatani found that
the GRP points on his original charts and on Gibb's modification
were around fingertips and tips of toes - all very painful and
consequently not very popular with patients. He reasoned, and
later proved empirically, that other points could just as easily
be representative entry points for a meridian. These points were
located just distal to the elbow and the knee. As Kenyon ( Modern
Techniques of Acupuncture) says
If
Ryodoraku treatment is carried out using the chart points as indicated
then only the most tolerant patients will return for further
treatment. The use of so-called substitution points gets round
this problem. There is one for each meridian. On the arms they
are situated in a band around the top of the forearm at the level
of Large Intestine 10. On the leg they are situated in a band
around each calf at the level of Bladder 57 (i.e., at the level
of maximum girth of the calf,) The object of sedating or stimulating
any meridian by use of the same point, i.e. the substitution
points, is achieved entirely by the needling technique as described
above. For stimulation, superficial needling leaving the needle
in only for 3 seconds without electrical stimulation is used.
For sedation, deep needling with manual manipulation and the application
of a 200mA current for 10 seconds is used. The use of these
points makes Ryodoraku much more acceptable from the patient's
point of view. Lastly, local treatment is used on the REPPs detected
around the site of the patient's problem.
.......it
is remarkable that stimulation at 200mA which often cannot be
felt and is passed for such a short time can be so effective.
This is another finding in favour of an energy flow/meridian
mode of action as opposed to the more popular neurological and
neuro-endocrinological explanations which currently swamp academic
medical interest in acupuncture."
SPECIAL
EFFECT POINTS
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Tonification
Points
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Source
Points
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Lung
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L9
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Lung
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L9
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Large
Intestine
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Li11
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Large
Intestine
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Li4
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|
Stomach
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S41
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Stomach
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S42
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Spleen
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Sp2
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Spleen
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Sp3
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|
Heart
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H9
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Heart
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H7
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|
Small
Intestine
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Si3
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Small
Intestine
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Si4
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Bladder
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B67
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Bladder
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B64
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|
Kidney
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K7
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Kidney
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K3
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Pericardiu
m
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P9
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Pericardium
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P7
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Triple
Heater
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T3
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Triple Heater
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T4
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Gall
Bladder
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G43
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Gall
Bladder
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G40
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Liver
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Liv9
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Liver
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Liv3
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ASSOCIATED
POINTS
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LUO
POINTS
|
|
Lung
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B13
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Heart
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H5
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Pericardium
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B14
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Small
Intestine
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Si7
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|
Heart
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B15
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Bladder
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B58
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Liver
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B18
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Kidney
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K4
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Gall
Bladder
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B19
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Gall
Bladder
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G19
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Spleen
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B20
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Liver
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Liv5
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Stomach
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B21
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Lung
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L7
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|
Triple
Heater
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B22
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Large
Intestine
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Li6
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Kidney
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B23
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Pericardium
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P6
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|
Large
Intestine
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B25
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Triple
Energiser
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TE5
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|
Small
Intestine
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B27
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Spleen
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Sp4
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Bladder
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B28
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Stomach
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St40
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An
excellent computer programme for Ryodoraku has been written by
Dr. John A. Amaro from the International Academy of Clinical
Acupuncture. The illustrations in most of the webpages on
the AMAC site are from Amaro's programme (EMI). Not only is the
system easy to use, user-friendly and works on Windows 3.1 and
Windows 95, it is educational and informative for both acupuncturist
and patient.
It is available in Australia for approx A$$600 from
Arthur Rothwell,
International Academy of Clinical Acup.(Aus)
71,Hawthorn
Rd.,FOREST HILL,Vic. 3131
Ryodoraku
Neurometers are now manufactured in Australia and are available
from Arthur Rothwell. Current price is approx A$675 plus
handling.
There
is further information on Ryodoraku Acupuncture on the web at
http://www.osaka-med.ac.jp/~ane005
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