Plenary Lecture at the 1st International Ryodoraku Congress Oct. 9, 1988 Miyazaki Chairman Dr. T. Yamato (Japan) Introduction for Ryodoraku treatment. Masayoshi Hyodo, M. D. Department of Anesthesiology, Osaka Medical College, Takatsuki city, Osaka What is Rodoraku? In 1950, Yoshio Nakatani found a line similar to the kidney meridian, that had a series of points in which electroconductivity was higher than the surrounding area, when he was trying to measure skin resistance in general for edematous kidney inflammation cases. Then, he checked this phenomenon more carefully in ten kidney disease cases and observed a similar pattern. Healthy subjects did not show this phenomenon. This was restricted to kidey disease. Therefore, he named this line kidney Ryodoraku conductive, raku is line). (ryo is good, do is [electro] After this, he checked various visceral disorder cases in a simlar manner : he recognized a Ryodoraku corresponding to the classical lung meridian appearing in lung disease, a Ryodoraku corresponding on. to the classical stomach meridian appearing in stomach disease, and so Since the meridan point is a good electroconductive point, and Ryodoraku which are quite similar to classic meridians actually appear in various pathological conditions, Nakatani concluded that the meridian is a Ryodoraku phenomenon. Nakatani named meridian points by an easy-to-use method : for example, the merdian (Ryodoraku) of the hand is represented as H, the foot as F. The meridians are numbered consecutively Hi, H2, H3, etc. Namely, H1 Ryodoraku or lung Ryodoraku corresponds to classical lung meridian. H3 Rodoraku or Heart Ryodoraku corresponds to classical heart meridian. They are alike. But, not completely same. Ryodoraku were discovered experimentally by the measuring of electroconductivity on the skin. while classical meridians were drawn on the skin from the idea of conception. Recently, we re-examined this phenomena in the same way as Nakatani had investigated 30 years ago. This is a patient suffering from kidney disease (Fig. 1 ). The skin surface
Fig. 1 electroconductivity of the whole body was measured with Neurometer electrode. The whole body was stroked by a detecting electrode with identical pressure on the skin. When a point which has higher electroconductivity than surrounding area was found, that point was marked. we can notice same markers here and there on the foot and leg. These sites of the spots appeared just at the same sites of acupoint of classic kidney meridian. So, when these spots are connected with a line, a kidney meridian like line could be drawn. This is another kidney patient. In this case, these spots which correspond to the kidney meridian acupoits were only partly noticed. We investigated 8 kidney patients. In 3 patients, almost completely kidney meridian like lines were able to draw. In other 3 patients, partly alike lines were drawn. However, in other 2 patients, we could not draw these similar lines. This is a patient with stomach disease, A line just like as classic stomach meridian was able to obtain. In healthy subjects, no lines which corresponds to a meridian were discovered. In conclusion, Nakatani's Ryodoraku phenomenon was demonstrated with proof by this re -examination. Ryodoraku is a pathological phenomenon. Nakatani states that this mechanism can be explained by the viscero-skin-sympathetic nerve reflex. The impulses from the viscera radiate to the spinal cord; the reflex zones where they are then reflected on the skin surface via the efferent sympathetic nerves appear as a longitudinal connecting system (Fig. 2 ). Sympathetic nerve blocks such as stellate ganglion block for the hand and lumber sympathetic nerve block for the leg increase considerably the skin resistance in the related area
Fig. 2 and electropermeable points (REPP) or Ryodoraku phenomenon disappear. This is one example of the decreases in elecroconductivity at the representative measuring points on 6 Ryodorakus of one side arm after stellate ganglion block (Fig. 3 ). We can notice that there is no changes of electroconductivity on the opposite side, where no sympathetic block was performed. Fig. 3
Also, the administration of sympathetic nerve stimulants increase electroconductivity in general. Sympathetic blocking decreases the electroconductivity. As a result, Ryodoraku may be defined as the "functional route of the excitement of a series of related sympathetic neves which is caused by visceral discease" or "the linked pathway of the related reactive electropermeable points. When adequate stimulation to a acupoint which has remarkable electroconductivity is given, an impulse is induced afferently via the sympathetic nerve and autonomic nerve regulation of the viscera occurs according Mackenzie's Counter-Concept. As a result of this, electroconductivity at the acupoint is decreased; and the symptom is relieved. As a matter of fact, Nakatani defines Ryodoraku therapy as measuring skin sympathetic excitability by means of skin electroresistance and giving stimulation to approach to the normal excitability renge through the pathway of nerve reflex. Total Functional Adjustment and General Ryodoraku Regulation Therapy In oriental medicine, adjusting the basic and essential functions of the whole body in general by considering the physical constitution is called "total functional adjustment". In contrast, treating symptoms only locally called "local treatment". Balancing fullness and emptiness on meridians is, after all, total functional adjust. According to Ryodoraku, abnormalities on each meridian or Ryodoraku, can be observed objectively by the measurement of electroconductivity of certain points on the skin. Then, by stimulating the therapeutic points on the abnormal Ryodoraku, homeostasis occurs and restores its normalcy. Currently, the diagnosis of the disurbance of so-called autonomic nervous on each Ryodoraku system is imprecisely rendered. However, Ryodoraku recognizes abnormality and can treat them properly. In Ryodoraku theory, an abnormal Ryodoraku has either higher or lower electroconductivity, when compared with other Ryodoraku. For this purpose, one calculates the mean value of one Rodoraku by summerizing the amount of the electroconductive values of the reactive electropermeable the total number of reactive electro-permeable points (REPP) along a RyOdOrake, and dividing by the sum of points. In other words, there are twelve eletctro-permeable points (meridian points) along the LU H1 RyOdOrake. After calibrating the electroconductivity measuring device, one can obtain the electroconductive value for each meridian points and calculate the sum of the twelve electroconductive values. Then, the H1 RyOdOrake average electroconductive value can be obtained by dividing the sum by 12 (Fig. 4 ). Similary, one can calculate the average value for all of the 24 RyOdOrake. If the average value of H1 RyOdOraku is extremely higher than the others, H1 RyOdOraku is excited (ie, the HI sympathetic branch is excited). If extremely lower than the others, it is sedated. Now, if one gives a stimulation at a gilven point, a subtle change occurs in the electroconductivity of REPP in the entire body. By observing the changes of the 12 REPP on HI in this way, it was found that the REPP of H1 3 showed the average change of the 12 points. Therefore, each time one need not measure the values of 12 points. One can simply measure
a. A 2 5 7 p. A -"r 1 2 = 2JILA HI Ryodoraku Fig. 4 the Hi 3 electroconductive value and thus observe the average change of H1 electroconductivity. This point was named the "representative measuring point (RMP)" on H1. In this manner, each RMP was found on the 24 Ryodoraku. Intresting enough, most of these points corresponded to the classical primary meridian point of each meridian. An example of R-chart Fig. 5 for a whiplash injury patient
Ryodoraku Chart (R-chart) Readings from the meter at 24 representative measuring points in total are recorded on the Ryodoraku Chart. Figure 5 is an example of a whiplash injury, The left LU-H is 120 ga ; and the right LU-H is 135 g A, etc. Secondly, the sum of the 24 points' electro-conductive values are divided by 24. Then, the mean is given, However, clinically this calculation may be troublesome. Thus, a mean line roughly can be drawn. This figure shows a line of about 75 ga in mean value. Then, one can draw two lines with a 1.4 cm width from the midline (two lines being 0.7 cm apart from midline respectively). This width is called as the physilogical range. When the reading for each Ryodoraku deviates from the physiological range, that Ryodoraku is abnormal. Therefore, select the therapeutic point to excite or select according to the low column of the chart. Then, using them, perform general Ryodoraku regulation therapy. In the healthy subject, after eating or bowel movement, the electroconductivity on Ryodoraku changes. This allowance is a physiological range; the width of 1.4 cm is a statistical result. When all readings of electroconductivity on each Ryodoraku are within this physiological range, then, the autonomic nervous function is well balanced and healthy. Actually, patients' readings are quite scattered initially; however, with improvemint of the symptoms, the scattered points tend to meet the physiological range. Clinical statistical studies of many cases show what symptoms are indicated by abnormal readings of Ryodoraku. For instance, when KI-F3 Ryodoraku electroconductivity is low (depressed), the patient has less energy or impotent. When HC-H2 is higher, (excitation or hyperstate) the patients complain of upperback stiffness on seven out of ten cases. The statistical results may be seen in this "Ryodoraku symptom table" According to the table, Ryodoraku syndromes, one can try a socalled "before-quenstioning diagnosis." For instance, when HC-H and LU-H are higher and LV-F2 and KI-F3 lower, one can question the patient as follows : "have you had upper-back stiffness or impotency recently? " The symptom will be diagnosed with very good probability. This "before-questioning diagnosis" is a vely valuable aid in daily practice. According to the treatment, deviations from the normal physiological range are gradually diminished. Then, the various symptoms are actually relieved. These findings are valuable in judging the prognosis and therapeutic results, as well as the patient's psychological response. Ryodoraku therapy Ryodoraku therapy consists of 3 modalities of treatment. The first one is General Rugulating Point (GRP), which stimntates Tonic Points and Sedative Points. On each Ryodoraku, there are two kinds of points. One is the point which has the tendency to increase the excitability of the Ryodoraku and the other point has the tendency to decrease it. The former is called the Excitation or Tonic Point and the later the Dispersion or Sedative Point. Nakatani noticed that the Tonic Point corresponds to the excitation point applied for the emptiness symptoms and the Sedative Point corresponds to the despersion point applied for
the fullness symptoms as described in classical literature. As is seen figure 5, R-chart of one case of whiplash injury, the therapeutic points for each abnormal Ryodoraku are shown in the below column. The second is the local treatment. Electrical acupuncture (EAP) is most effective for local treatment. The third is the settled acupoints stmulation treatment. Therapeutic acupoints suited to the symptoms or diseases can be decided according to "prescription." This is described later. Electrical acupuncture (EAP) is performed with the needle as a stimulative electrode utilizing primarily direct current electricity. The indifferent electrode is held in the hand. In a localized pain syndrome, sufficient and prompt analgesic effects are usually obtained by up-and-down manipulation of a needle (sparrow's pecking manipulation). This sparrow's pecking is thought to achieve strong manual stimulation. When; different types of stimulation are used with the needle, e.g., heat or low frequency electric energy, the results differ greatly from simple manual mechanical stmulation. Among the many stimulative techniques mild direct current to the needle has proven the most adequate and effective for producing analgesia. Some physiological studies have shown that electric energy has an effect 10,000 times greater than that of mechanical energy. Electric energy is, therefore, most effectively used for nerve stimulation. Procedure for Electrical Acupuncture Therapy A cotton swab soaked in saline or alcohol solution is placed in the detecting probe. By contacting the moist electrode with the grip electrode, about 200 /IA current in a 12 volt power supply should be obtained when adjusting the calibration control. The patient grips the grip elecvode (cathode) in his hand. The detecting electrode is used to find the very point of maximum conduction. The highest electroconductive reading is the therapeutic point. Holding the needle holder firmly, press down slightly on the therapeutic point. Tap the plunger head with a finger tip. The needle will be inserted in the tissue. The dose of electricity is about 200 /IA with a 12 volt power supply for about seven seconds. If strong stimulation is required, "a sparrow's pecking" motion (up-and-down) with the plunger is indicated, one strok per second is an adequate frequency. Optimum Stimulation Dose The analgesic mechanisms of physical stimulation therapy are drastically different from that of local analgesics in pain relief. To obtain the most effective and desirable clinical results in stimulation therapy, one must consider three major principies of stimulant. The optimum results are based on the type and strength of the stmulation techniques as well as the susceptibility of the patient. When the type of stimulation is constant, "dose x susceptibility reaction". Therefore, one must acquire exprienced hand in order to determine the optmum dosage of stimulation on the basis of susceptibility. The standard dose for electrical acupuncture therapy is a seven second duration according to individual susceptibility with 200 A. However, this is only the standard and may be varied. When seriously considered, the optimum dose is a very complicated problem. However, the
purpose of stimulation physical therapy is to elicit an effective body response against the disease or disorder. In regard to this, the body has great tendency towards homeostasis; a slightly inadequate stimulative dose can be adjusted by the body itself. For the location of therapeutic acupoint, some oldfashioned clinicians insist that the point should be strictly taken from the anatomical aspect by measuring the exact distance from certain spot of the body. Occasionally, the patient is asked to assume a specific position in order to identify exact location. However, even though the precise acupuncture point is taken as mentioned above, practical difficulty is involved in hitting the true physiological or functional acupuncture point. Therefore, in practice, the therapeutic point is taken with reference to tenderness or induration by digital palpation. In Ryodoraku theory, physiologically true acupoint can be objectively found. According to Nakatani's reactive electro-permeable point, a relatively higher meter reading on the skin indicates the acupuncture points. Therefore, in Ryodoraku treatment, the anatomically exact location of each meridian point does not have great significance. This concept for finding acupuncture points can be applied to local treatment of the painful area or trigger points. For instance, to find the local therapeutic point for upper back stiffness, frozen shoulder, or lumbago, one need not necessarily look for the exact classical meridian points. Good results can be ontained by treating only the reactive electr-permeable points. The electro-permeable points, the spot of maximum conductance in the area, are located by the detecting electrode with 21 volt current. Conductivity at the electro-permeable point is related to sympathetic excitability. Conductivity is much greater at this point than in the surrounding area. When there is some abnormality underneath the skin or viscera, the sympathetic nerve excitability related to the skin surface is higher. As a result, the electro-permeable point is clearly discerned. Many points have relatively higher electro-conductivities when measured at 21 volts. However, only those exhibiting a conductivity higer than the surrronding area measured at 12 volts are named reactive electroconductivity points (REPP, Hann() Ryodo point). Electro-permeability is often influenced by perspiration on the skin. When using a metal detecting electrode on even mildly perspired skin, electropermeability is delicately changed. However, the electro-permeability is not changed significantly when using a moist electrode. This phenomenon should be noted because the excitation of the sweat gland is the state of cell depolarization. Therefore, heavy perspiration, by causing relatively higher electroconductivity, interferes with the search for REPPs. Some Suggestions on Locating the REPP. REPP is defined as the point that has higher electro-permeability than the surrounding area measured at 12 volts. Therefore, the absolute value ( "How much kt A" ) on the meter reading is unimpotant. Also, the exact borderline between "reactive electro-permbable points" and relatively high electro-permeable points cannot be set, as it is similarly difficult to distinguish clearly between healthy and sick people. As shown in figure 6, A to G points are all REPPs. Of course, A to G can all be used as therapeutic points, but general A,C,E, and
Fig. 6 F points are clinically taken as REPPs. For a first treatment or for very sensitive patients, treatment must be limited to the use of A and C points as therapeutic poins. REPPs are not clearly observable in some cases in 12 volts. In those instances, change the device to 21 volts or turn the calibration control clockwise at 12 volts. In contrast, if the meter reading is too high to recognize REPPs, decrease the control to reach the reading level. In general, electro conductivity is higher in upper part of the body : and lower in lower part of the body (Fig. 7 ). Therefore, if sound detector is used,we can find many REPPs in upper part of the body. Fig. 7
Basedow's Disease lateral to protuberance of larynx and on the pulse of the carotid artery. anterior margin of sternocleidomastoid muscle. depression above superior margin of manubrium. between trapezius muscle and sternocleidomastoid..origin of trapezius muscle. Hi8 Shaku-taku radial side of tendon of biceps brachii the cubital articular region. on Fig. 8
However, it is REPP that counts.. REPP is the site, where electrical conduction is much higher than surrounding area. REPP is often influenced by extraneous conditions that sometimes cause misjudgments. Perspiration changes electro-permeability as described before; scarring of the skin lessens eleftro permeability. In contrast, dermatitis, skin dressings, warming, or scabbing heightens electroconductivity. Also, after needling the skin, the point shows considerably higher electroconductivity as an artificial REPP. Electro-permeability tends to rise when the searching electrode is pressed strongly on the skin. Therefore, pressure applied by the searching electrode should be equal on every spot. Treatment according to the prescribed acupoints suited to each disease The illustrations show the therapeutic points specially allotted to each disease or symptom, integrated by the author in reference to various ancient and recent literatures. One example in Basedow's disease is shown in figure 8. Main and secondary points are represented, so that even laymen can readily practice as authorities. All points shown for each disease are not meant to be therapeutic ponts for one session. The most important meridian points are underlined. In the initial treatment, one should try only those ; adding or changing to other therapeutic points after evaluating the results. In order to locate the most important point, it is recommended to identify it with reference of REPP. DC electro therapy to that REPP gives satisfactory result, especially for painful diseases.