Pain Diagnosis Speaks to Docs
By Sara Calabro
Yoshito Mukaino wanted to talk shop with his colleagues. But the physician acupuncturist, in trying to discuss with fellow medical doctors how acupuncture alleviates pain, found himself without common language. Thus came the M-test, a diagnostic tool that’s easily explainable to mainstream clinicians. The M-test identifies from where in the body pain is stemming, allowing for precise, repeatable acupuncture treatments conducive to a hospital setting.
Mukaino is director of clinical East Asian medicine at Japan’s Fukuoka University Hospital, where acupuncture is a key component in patient care plans and in the curriculum—his M-test class is required for first-year medical students. He is making his second U.S. teaching appearance this October at Bastyr University. In response to demand from Western clinicians, the three-day seminar, formerly offered only to acupuncturists and naturopaths, is also open to medical doctors, osteopaths, chiropractors and nurse practitioners.
AcuTake recently caught up with Mukaino.
AcuTake: You originally trained as a medical doctor. What drew you to acupuncture?
Yoshito Mukaino: My father was an acupuncturist. I grew up watching him treat a lot of difficult cases, helping patients with pain but also things as wide ranging as fibroids and hepatitis. I went to medical school because I wanted to be able to diagnose diseases—in Japan, like the U.S., disease diagnosis it not within an acupuncturist’s scope of practice—and understand the mechanisms by which they progress. But I always knew that I would integrate acupuncture into my medical practice.
Japan has a long-standing acupuncture tradition of its own. Why did you choose to formally study in China opposed to your home country?
I was already studying Japanese acupuncture with my father, but at that time, in the late 1970s, there were limited opportunities in Japan to integrate acupuncture in a hospital setting. I knew that’s what I wanted to do. The Shanghai School of Traditional Chinese Medicine had a program to which it invited doctors from Japan to come and learn acupuncture at the university hospital. This was a big deal because relations between China and Japan at that time were not diplomatic. I was one of 14 doctors from Japan selected by the Chinese government to come train there.
Soon after returning from China you joined Fukuoka University School of Medicine in Japan. How has acupuncture been received by your physician colleagues?
When I first came to Fukuoka University, I was working as a nephrologist. But I was also teaching in the sports and health science department, which is where I started studying athletes and developed the idea for the M-test. It occurred to me that sports medicine is a field that speaks a similar language to that of meridian acupuncture. Physician receptivity is a critical piece of why the M-test developed as it did. I knew that in order for acupuncture to be accepted by Western doctors, it had to be standardized and repeatable. Customized acupuncture treatments, as are popular in private practice, don’t work well in a hospital setting. I created the M-test so that safe, high-quality treatments could be provided in a way that doctors could recognize.
How do you coordinate patient care with physicians?
Many of the doctors at Fukuoka University refer to me. I see a lot of patients from orthopedics and pain management, as well as gynecology, otolaryngology and others. In the area of pain management, I am sent a lot of the difficult cases where no clear pathology can be identified. From the doctor’s point of view, there is no problem, yet the patient is experiencing pain. Over time, the physicians at the hospital have gotten a better sense of what acupuncture can help with, so they are now sending me patients earlier in the course of care, before drastic interventions take place. This prevents many unnecessary invasive treatments and also saves the hospital money.
How exactly does the M-test work?
The M-test is a series of movements that assess a person’s acupuncture meridians. The goal is to identify movements that cause or aggravate pain or inhibit range of motion, which in turn indicates which meridians should be treated. It also serves as a useful measure of treatment outcomes, as patients repeat the movements at each visit. Once the affected meridians are determined, point selection is refined according to which ones change the pain or range of motion. The system primarily uses 24 five-phase points (two from each of the 12 meridians), which simplifies treatments and makes them easily repeatable. Luo-connecting, xi-cleft, back-shu and front-mu points may be called upon in more difficult cases.
Does the relative simplicity of this technique make it teachable to non-acupuncturist clinicians?
Three years ago, my class became required for first-year medical students at Fukuoka University School of Medicine. It is a practicum course that teaches them how to perform the M-test movements and select points. In addition, I often demonstrate the testing to my physician colleagues to help improve their understanding of how the movements correspond to meridians and acupuncture points. I also give seminars about six times a year throughout Japan. Normally about half of the attendees are medical doctors. Nurses also frequently attend.
You’re about to make your second U.S. teaching appearance.
Yes. My first U.S. seminar took place in San Diego in 2008 and was open only to acupuncturists. But based on increased interest from mainstream-medical clinicians, I am returning to the U.S. this year and opening it up not only to acupuncturists and naturopaths but also medical doctors, osteopaths, chiropractors and nurse practitioners. That seminar is taking place October 29-31 at Bastyr University in Washington, outside Seattle.
In recent years, you have almost completely eliminated the use of needles from your practice. Why?
I stopped using needles because I discovered that other methods covered broader areas and had a better effect. I became intrigued early in my career when I was using aquapuncture, the injection of water or saline solution into acupuncture points, and noticed a prolonged effect. The saline injections can be painful though, so I began using stickers that stimulate the skin. Because they cover a bigger surface area, they offer more stimulation to the skin. Plus, patients can use them at home. Overall, I’ve found the stickers have a greater effect than needles on M-test results and ultimately on patients’ pain.
Without needles, is what you do still considered acupuncture?
In Japan, any stimulation on acupuncture points is considered acupuncture. This is one of the reasons why many of the acupuncture studies performed in the U.S. are flawed. “Placebo” or “sham” acupuncture, where a needle is inserted very shallowly or just held against the skin, has a physiological effect; it’s not placebo.
In your book, Sports Acupuncture: The Meridian Test and Its Applications, you talk about how integrating the M-test into mainstream medicine supports the push for improvements in preventative healthcare. How so?
If we can detect problems earlier, we’re able to address them before drastic interventions are required. Having a patient perform a series of M-test movements followed by an acupuncture treatment is a safe, effective and low-cost method of preventing a problem early in its development. It also helps make people aware of their conditions and empowers them to utilize self-care techniques. For example, a patient who comes in complaining of wrist pain may be experiencing a general soreness throughout the whole area. But upon performing the M-test movements, it’s determined that the Small Intestine meridian (ulnar side) is affected while the Large Intestine meridian (radial) is not. This tells the acupuncturist which points to select and it gives the patient direction for how to address the pain through things like ergonomic adjustments or stretching.
Featured photo by Sara Calabro
Photos of Yoshito Mukaino courtesy of Yoshito Mukaino
M-test info graphic from Sports Acupuncture: The Meridian Test and Its Applications