Shiatsu Diagnosis, Assessment, Pathology & Treatment

The purposeful intent of Japanese Shiatsu Treatment is to return the body mind to homeostasis and allow the body to heal itself, free of pain and disease. Oriental Medicine does not evaluate an illness purely based on the symptoms a person is showing, but rather, on complex patterns of disharmony in the body. these patterns are determined by either an excess (vacuity) or deficiency (stagnation) of ki.


The four pillars of Japanese Shiatsu medicine diagnosis are inquiry, listening, palpation or touch assessment, and visual diagnosis. Within this four categories are pulse diagnosis, tongue diagnosis, facial diagnosis, hara (abdominal) diagnosis, back diagnosis.


Palpation Assessment

There is a saying that in Shiatsu “treatment is diagnosis and diagnosis is treatment”. Palpation refers to analysis by feeling, particularly the wrist pulse, abdomen, and meridians points. When certain points are sensitive, it indicates certain imbalances. Lumps, rashes and other palpable imbalances can provide important information towards understanding underlying imbalances.


Pulse diagnosis is often the main form of assessment used by both acupuncturists & Shiatsu acupressure therapists. The various pulse qualities and their indications are numerous, but the basics can be understood very easily. There are three positions to read the pulse on each wrist, and three depths at each position. I check to see for qualities in the blood through pulse palpation- a pulse that is fast, strong, and close to the surface indicates heat. A pulse that is slow, deep, and thin indicates cold and deficiency. From the wrist to the elbow on the left hand is reflected the heart, liver, and kidney yin; on the right hand is the lung, spleen, and kidney yang.


Ruth Howard Shiatsu Hobart Tasmania

Ruth Howard giving a Shiatsu


Hara (abdominal) diagnosis is perhaps the most important form of assessment in Shiatsu. The Shiatsu session starts with the hara both for diagnosis and for centering. During hara diagnosis, the practitioner and client are hara to hara. Assessment and treatment, therefore, can happen on a deeper level, with one’s 'being' rather than just understanding on a mental level.


In general, the upper hara reflects the upper burner, the center hara reflects the middle burner, and the lower hara reflects the lower burner. Specific areas on the hara also reflect the condition of specific meridians.


When palpating the hara, the practitioner feels for two qualities in particular, called jitsu and kyo. Jitsu is yang. It is excess, stagnation, or hyperactivity of the meridian. Kyo is depletion of energy or hypoactivity of the meridian. In general Shiatsu is balancing for the meridian, and special techniques can be used to sedate a jitsu condition or nourish a kyo condition.


When any physical mental emotional or spiritual condition is jitsu, Shiatsu technique should be somewhat quicker and perhaps deeper. This causes the energy to disperse. People who tend toward jitsu conditions tend to be able to tolerate more pressure and benefit from it. Often, people suffer from hardness in the upper hara. This shows that the body’s center is off balance, probably due to excess thinking, dwelling on grief or other difficult emotions, or the lack of physical activity.


In the case of kyo, Shiatsu technique should be slower so holding points for a longer time is more nourishing. Kyo people tend to be more sensitive.


Understanding Pathology:


A. The Five Pathogenic Conditions From A Shiatsu Therapist Perspective


  1. Heat – Yang; symptoms can include a rapid pulse, fever, body chills, dehydration, inflammation, and a sore throat. If paired with an Interior patter, its symptoms can include a preference for cold drinks, clear urine, and a slow pulse.

  2. Cold – Yin; lack of movement, circulation, and/or energy. Generally speaking, yin is Cold. Its symptoms can include body aches, a tense pulse, fever, body chills, and headaches, nausea, stomach pain, vomiting, and diarrhea.

  3. Dry – Yang; lack of Fluids (yin), or the result of Heat

  4. Damp – Stagnation of Fluids; typically due to Yang Def. or Cold

  5. Wind – Movement, occurs with other pathologies; Internal and External Wind


Shiatsu assessment is organized by the concept of the Six Divisions or the Eight Principles:


Yin: Cold Deficiency Interior (Chronic) (Damp)


Yang: Heat Excess Exterior (Acute) (Dry)


Wind occurs with other pathologies (cold, heat, damp, or dry) and is either of an interior or exterior nature. Interior wind is usually due to liver imbalance.


B. Diet


The health or lack of health of one’s being is determined by diet. Diet includes food, of course, along with other sources of energy such as air and vibrations from the environment. If a person’s diet is warming, then diseases of heat will result. If the diet is cold, then diseases of hypofunction, dampness, and deficiency will result.

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