The Primary Channel Balance – Part 2 5/5 (1)

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To read parts 1, 3 or 4 of The Primary Channel Balance series, click the links below:

Part 2: Modern Japanese and Chinese Approaches to Balancing Acupuncture Meridians

This is Part 2 of The Primary Channel Balance by Dr. Jake Fratkin. Reading part 1 will offer context.

Relationships of acupuncture meridians (channels) have been mapped out since the Nan Jing (100 CE). The essential premise is that qi (life energy) flows through twelve channels in a continuous sequence. This energy nourishes and invigorates all tissues along each pathway, including designated organs (zang-fu), blood flow, muscle, bone, etc. Health problems occur when that flow is either interrupted (blocked), or when the quality of the qi and blood is sub-standard. In the Nan Jing, pathway acupoints were described that allowed an intervention/manipulation of the channel, using needle or moxa. Channels could be controlled directly by reducing, supplementing, heating, or cooling. Or, points could be chosen that allowed connection to one or more other channels.

The Nan Jing establishes the importance of the acupuncture meridians network, describing its pathways as well as the locations and functions of the acupoints. It also described the basis of meridian balancing, that all channels need to have relatively equal amounts of qi, and that this balance can be achieved by using certain groups of acupuncture points to connect the channels directly.

The goal of the acupuncturist is to determine which channels have too much energy (excess), and which channels have too little energy (deficient), and then choose certain acupoints to rectify the channel flow. All the various schools of meridian balance follow this dictate, whether they originate in China, Taiwan, Japan, Vietnam, Korea, Europe or North America. This can be done by leading excess to deficiency with ion-pumping cords (in Manaka style), by adjusting each channel individually according to excess /deficiency with relevant acupoints, or by using specific points that can interface between two (or more) channels.

Proper Diagnosis

Obviously, the first requirement for meridian balance is proper diagnosis of which channels are out of balance, as either excess or deficiency. Traditionally, this was done by evaluation of the radial pulse on the wrist (or other locations), and later, in Japan, by skin or abdominal palpation. Our earlier Asian doctors were extremely sensitive and advanced in their pulse diagnostic abilities. I have seldom seen modern Western practitioners obtain the level required to make accurate diagnosis of specific meridian imbalances. Chinese herbalists, on the other hand, concentrate on whole pulse diagnosis, and are able to distinguish 28 aberrant pulses.

This is suitable for herbal prescribing, and many Westerners have mastered this level. But to distinguish excesses and deficiencies of all twelve of the meridians on the radial pulse is difficult. I used to teach meridian pulse diagnosis, and I feel I was as good as many at this. But after nine years of using AcuGraph, I am convinced that computer diagnosis is much more accurate, and more revealing of the subtleties of comparative meridian strength.

In any event, the idea of evaluating and treating meridian imbalances was in place at the time of the Nan Jing, and persisted through many centuries in Eastern Asia. By the time of the founding of the People’s Republic of China, however, the art of balancing acupuncture meridians disappeared. When China organized its TCM universities and medical schools in the 1950s, it put into place the acupuncture protocol based in zang-fu and Eight Category diagnosis and treatment. This dove-tailed with the curriculum organized by the TCM herbalists, allowing a unified teaching program. Any school of thought focusing on meridian therapy was therefore lost in mainland China, but certain schools survived outside in Japan, Taiwan, Hong Kong, Korea, Vietnam, and later, Europe and North America.

Keiraku Chiryo, Japanese Meridian Balancing

The revival and flowering of Nan Jing meridian balancing occurred in Japan in the 1930s, in a conscious effort by a group of dedicated acupuncturists. They called their system Keiraku Chiryo (School of Meridian Therapy). (For a more complete overview and history, see I followed this approach for 25 years, and studied with several of its leading modern-day proponents from Japan. There is a take-away from this approach that I now incorporate into the 3-Level Balance with AcuGraph. Whether we focus on the Divergent treatment (P.I.E. score below 70), or Primary Channel balance only (P.I.E. score above 70), I always look for the Keiraku Chiryo organization to determine the Primary Pattern (sho), the pattern underlying all the other imbalances.

In Keiraku Chiryo (KC), the Primary Pattern is determined by pulse diagnosis. It starts by determining which acupuncture meridians are deficient, and which are excess. On the AcuGraph screen, of course, we can visually see this for every channel. (We should just consider the blue and red bars, by the way, and not the split-purple bars, or greens.) KC determines a primary pattern, which basically is the origin behind all of the other channel imbalances. (The Worsley Five Element method is based on the KC system, and they call the Primary Pattern the Causative Factor.) KC feels that if we can identify this prime imbalance, we can fix all of the channel imbalances.

In classical Keiraku Chiryo, four patterns are possible, all restricted to the yin channels: Spleen, Lung, Kidney and Liver. (Heart and Pericardium were excluded.) Unlike the Worsley system, which considers Primary patterns (Causative Factor) to underlie a patient’s constitution throughout much of their lives, and subsequently, through most of their treatments, the reading on an AcuGraph patient reveals that the primary imbalance probably changes every two hours. Our AcuGraph reading is a snapshot of a moment in time, telling us what is out of balance now. If we address the present imbalance, even if it is only a two-hour window, this will allow a reset to occur during the following 24-hour period. When we restore the flow of qi, unobstructed, the body heals itself. 

We cannot say that today’s pattern in the acupuncture meridians reveals a deep constitutional statement, unless the pattern constantly repeats itself. We only know this by comparing our reading to previous readings. (Use the “Compare” icon on the bottom white bar.) Patients often ask to do another reading immediately following the treatment to see if there is improvement. I tell them it takes 24 hours for the repair to show itself, for the meridians to go through their 24-hour cycle.

Don’t Forget The Primary Pattern

In practice, I feel it is always important to make sure that a treatment for the KC Primary imbalance is included. If we are doing the 3-Level Balance (the Divergent treatment), it may be that the Primary Pattern is already included in our point recommendations, in which case we don’t have to add anything. If it is not included, we should add points to address it. If we are only focusing on a Primary Channel treatment, and not doing the complete 3-Level balance, then we definitely want to make sure that the Primary pattern is addressed.

How do we determine the Primary pattern? In a nutshell, we are looking for a specific pattern of deficient channels (blue) that belong to the yin channels, namely, HT, PC, SP, LU, KI, and LR. [For the moment, we ignore the yang channels (SI, TE, ST, LI, BL, GB)]. We are not looking for the most deficient yin blue bar, but rather, where the blue bars are in relationship to each other. 

acupuncture meridians in the 5 Elements view

This is easiest to visualize on the 5-elements chart pictured above. In this chart, there is a clockwise sequencing of elements, with yin channels on the inside of the circle and yang channels on the outside. Each channel is colored accorting to its element (fire=red, wood=green, etc.) and each channel is outlined with the color representing its status. For example, a deficient LR channel will be shown in green (wood) with a blue outline (deficient.)

In this presentation, we are looking for the most distally-clockwise deficient yin channel, most often preceded by another blue deficient yin channel. That is to say that typically, there will be two blue outlines in sequence. For example, a graph may show LR and KI being blue (deficient) and SP being blue or red. LR and KI are next to each other in the 5 Element sequence, with KI being the mother of LR. In this case, LR is the primary pattern. The last deficient channel (blue) on the clockwise cycle is the primary! This is easiest when two blues are together. Choose the last one most clockwise. If three blue bars are together, still, choose the most clockwise bar as the Primary Pattern. If no two blues are together, you can treat all of the blue bars, or concentrate on the most deficient. 

Another example, illustrated below. The 5-elements chart shows blue outlines for PC, SP, LR. (Remember: Ignore the reds, purples and yang channels.) In this example, PC and SP are in sequence, PC being the mother of SP. LR is off on its own. Spleen is therefore the furthest clockwise deficient channel.

acupuncture meridians in the 5 Elements view

Once we identify the Primary channel, our goal is to tonify it, and we can do that in numerous ways. The easiest is to use the tonification point of that channel, but we can also use the yuan-source point, or the horary point (the element point of the channel), e.g., the fire point of the Pericardium channel, or the water point of the Kidney channel. Strict followers of KC also tonify the mother channel of the affected channel, but I have found (through my own finger muscle-testing) that treating the primary alone is usually enough. When a Primary channel (according to KC) is not addressed in our more complete Divergent treatment, I would also add tonification of the Primary channel to the treatment. If we are doing a Primary Channel balance only, I would start by making sure the KC channel is included.

“Don’t Chase Every Meridian Imbalance”

Kodo Fukishima, one of the early masters of Keiraku Chiryo, advised “Don’t chase every meridian imbalance. If you focus on the primary, this will take care of all channels out of balance.” This tells us to how to do effective balancing of acupuncture meridians without treating every channel that is excess or deficient. Although I don’t simplify as much as Fukishima recommends, I avoid treating every imbalance, and instead concentrate on the most egregious. I will tonify the deficient primary channel according to KC; but I also tonify any other deeply deficient blue yin channel, and sedate the most egregious red excesses. This is contrary to Fukishima’s advice, but it is what I do.

Also, through clinical practice and using my O-ring muscle testing, I have found that if a meridian is excess or deficient on both sides, treating only one side actually treats both sides. In my opinion, it is unnecessary to treat both sides.


Let me repeat and summarize. If the P.I.E. score is above 70 (or even 65), I will choose to balance the Primary Channels only (without 8-Extra/Divergent). I do this by looking at the 5-element graph to determine the most clockwise yin deficiency (outlined in blue). Most primary patterns will show two adjacent yin channels being deficient (blue), and I chose the furthest clockwise channel. If SP, PC and LR show blue, the primary pattern is SP (not LR!) This is because PC comes right before SP on the 5-element diagram, and LR comes before PC.

So, having identified the Primary yin deficiency, I tonify that channel, usually with the tonification point. (I can also use the yuan-source point or the horary point.) However, in most cases, there are significant blues and reds on their chart. I will often identify other blues and scattered excess reds. I will choose the worst of the blues and reds, and try to balance with ion-pumping cords, if possible.

In my next post, we’ll look at some innovative ways to use ion pumping cords to move excess to deficiency within the acupuncture meridians.

Other Posts in this Series

To read parts 1, 3 or 4 of The Primary Channel Balance series, click the links below:

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Jake Paul Fratkin, OMD, L.Ac. trained in Korean and Japanese acupuncture since 1975, and Chinese herbal medicine since 1982. He is the author of Essential Chinese Formulas (2014), and Chinese Herbal Patent Medicines, The Clinical Desk Reference (2001). Jake practices in Boulder, Colorado, where he specializes in internal disorders, infections, and pediatrics.

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Dr. Jake P. Fratkin, DOM, L.Ac.

Trained in Korean and Japanese acupuncture since 1975, and Chinese herbal medicine since 1982, and has studied and taught qi gong and Yang family Taijiquan since 1974. He is the author of Chinese Herbal Patent Medicines, The Clinical Desk Reference and the editor-organizer of Wu and Fischer’s Practical Therapeutics of Traditional Chinese Medicine. He is currently completing TCM Case Studies in Autoimmune Disease with Dr. Zeng Sheng-ping for People’s Medical Publishing House, Beijing. He is the recipient of Acupuncturist of the Year, 1999, by the AAAOM and Teacher of the Year, 2006, American Association of Teachers of Acupuncture and Oriental Medicine (AATAOM). Dr. Fratkin lives and practices in Boulder, Colorado.

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