Headingley Karate Practical Martial Arts for Self Defence

Are there general principles specifying the most effective ways of combining pressure points? According to some there are principles, those provided by Traditional Chinese Medicine (TCM). According to a common understanding of this approach, the most effective combinations are often those that follow the Destructive Cycle of the five elements (wu3 xing2 in Chinese). There are other traditions, like within some styles of Jujitsu, where there is a rich knowledge of useful pressure point combinations, but inspiration is not taken from TCM. And there are other approaches where usefulness of different sequences might be determined purely from the openings created by the known physiological reflexes created by working different points, without reference to TCM or five elements. But five element theory is widely subscribed to among practitioners of Kyusho-Jitsu, and so we decided it would be fun and informative to test the usefulness of five element theory to Kyusho-Jitsu.

Whatever five element theory's effectiveness in a therapeutic context, its relevance to Kyusho-Jitsu is a separate question in need of independent verification. In the absence of a controlled investigation, it would be easy for the theory to appear to be useful, even if it were not (or even if it made precisely the wrong predictions), because it can easily be used post-hoc to provide rationalizations for effective kyusho and tuite moves (see Zoltan's study on the TCM-inspired use of 'colours' in tuite). Also, if observations are not made under controlled conditions, our own beliefs can strongly determine the outcome. Maybe you have noticed demonstrating to a class the "wrong" and "right" way of doing a move - when performing it the right way, maybe you noticed doing all sorts of other things (like putting in more oomf) to make sure the move worked! The tendencies of our movements and exertions of muscular force to follow our beliefs and desires can occur quite unconsciously. Thus, demonstrations of how activating one point sensitizes another may only work because of pre-existing beliefs. Alternatively, five element theory may appear useful precisely because it is!! In both our minds, this was an open question.

Five element sequences

According to five element theory as normally applied to Kyusho-Jitsu by martial artists, one of the most powerful principles in predicting effective pressure point combinations is the Destructive Cycle: Fire burns Metal, Metal cuts Wood, Wood digs into Earth, Earth absorbs Water, and Water extinguishes Fire. That is, if a point is activated by rubbing or striking, the most effective type of point to rub or strike next will often be a point associated with the next element in the Cycle. Something can only be more effective or most effective compared to something else. One vital question is, what should the comparison be? If I am to strike a person more than once, what sequences are SUB-optimal, purely from the point of view of five element theory? To answer this question, it will be useful to enumerate different possible sequences of the five elements.

We will, purely for reference purposes, label the destructive cycle as D, and describe going round it one step at a time D(1). If one follows the destructive cycle backwards, this is sometimes called the insulting sequence, and is labelled D(4), because it amounts to going round the destructive cycle four steps at a time. According to the DSI, one organization that subscribes to a version of TCM, cycles can be effective in both directions. (For those partial to mathematical formulations, this TCM principle can be stated: D(a) and D(b) are similarly effective if (a+b) = 0, modulo 5). Thus, D(1) and D(4) would be of similar effectiveness.

If one followed the Destructive Cycle from one element to the third one along, i.e. D(3), one would be following what is called the Creative Cycle. For example, after attacking Fire, one could attack Earth. Following the Creative Cycle backwards is D(2), and would be regarded by some as of similar effectiveness as D(3).

Finally, one could follow each element by itself. This is D(5), or equivalently, D(0). D(0) covers advice such as to attack the same meridian, or its paired meridian, repeatedly.

Let us consider the case of two successive strikes. I hit one point and then another point. Given my first hit, there are exactly five types of strikes I could make next: i.e. to each of the five elements. It turns out, rather nicely, that all those five possibilities are covered by the five D(n) sequences above. This follows from the fact that in the D(n) sequences above, n can take any value from 1 to 5, corresponding to each of the five elements. Thus, if five element theory is to offer any useful advice, there must be a way of specifying which of the D(n) sequences is best (under what conditions).

According to the DSI, ALL D(n) sequences can be effective, depending on whether the strikes are sedating or tonifying. That is, a strike to an element does harm by creating either a deficiency of qi (sedation) or an excess (tonification). One then needs an account of whether a strike is tonifying or sedating. According to the DSI, one way of tonifying is to strike with the qi flow, and one way of sedating is to strike against the qi flow. From a TCM perspective this is perhaps controversial; another account could be that any strike or attack with an intent to hurt would be sedating, and gentle massage with the right intent is tonifying. But either account will do for our purposes. Based on one line of reasoning inspired by TCM, a succession of strikes that were all tonifying (or all sedating) would cause maximum damage by following D(0) or the creative cycle, D(3), or its (near) equivalent D(2): sedating one element (e.g. metal) sedates the next one along in the creative cycle (e.g. water), as well as the next element back in the creative cycle (e.g. earth); a further sedation strike to either metal or water or earth would aggravate the imbalance. Following D(1) would actually be counter-productive: Sedating metal would increase the amount of qi in the wood meridians, according to the destructive cycle; so a sedation strike to wood would help remedy the imbalance. Conversely, if one attacked with alternating sedation and tonification strikes, then D(1) and D(4) would be the most effective; using D(0), D(3), or D(2) would be counter-productive from a martial point of view. We should emphasize that the above is just one line of reasoning that could be taken from a TCM perspective, because TCM is not so much a theory as a set of images, metaphors, and a language for expressing intuition. However, we believe we have taken what the DSI has told us to a logical conclusion.

Our comparison cycle

We took the Creative Cycle, D(3), for comparison (Fire produces Earth, Earth yields Metal, on Metal condenses Water, Water feeds Wood, and Wood feeds Fire). We chose the Creative Cycle on the grounds that in our experience attacking the same meridian or the same element twice, D(0), is often quoted as effective, almost as much as the destructive cycle, D(1), is. D(4) was rejected on the grounds some may see it as being of similar effectiveness as D(1) (the same cycle backwards). Further, on a version of the DSI logic (as we have reconstructed it), striking with the flow of qi consistently (or against it consistently) should lead to the Creative Cycle being MOST effective and the destructive cycle LEAST effective. This is an interesting prediction (whether the DSI subscribe to our reconstruction or not) to be contrasted with the general rule often held in the kyusho jitsu community: A good default sequence under any conditions is the Destructive Cycle. In this experiment, we pressed all points with the flow of qi and with the intent to hurt.

Principles to be controlled

There are other principles, which, for a first investigation, we simply controlled rather than investigated per se. The other principles we ensured that we did not use were:

1. The 24 hour (diurnal) cycle
2. The strange flows.
3. The use of tonification and sedation points.
4. The use of bo and yu (i.e. diagnostic and alarm) points.
5. The use of xicleft and horary points.
6. The use of connecting points.
7. The use of points that have an association with a particular element: i.e. fire, earth, metal, water, and wood points.
8. Quadrant theory. All the points we use will be in the same general quadrant of the body (upper torso, arm, neck, and head).

The Experiment

The main idea of the investigation was this: We tested a group of people naive to TCM. One of our club members (call him tori), with some knowledge of Kysusho-Jitsu but completely ignorant about TCM, pressed on points. He provided a standard amount of pressure, as best as he could, attempting to ignore uke's response so that the pressure he gave was independent of the response. His ignorance of TCM meant that variations in the accuracy and pressure of the technique were not systematically related to the predictions of TCM (a very real hazard if anybody knowledgeable of TCM were to act as tori). On a given uke, tori stimulated a 'set-up point', released it, and immediately stimulated a 'target point'. The uke gave a pain rating to the target point on a standardized scale. After this one target attack and pain rating, a given uke was not tested again for 20+ minutes, to allow the activation of the stimulated meridians to die down.

These sequences (of set-up followed by target points) differed along various dimensions, or as we say in the trade, 'variables'. The most important variable (call it sequence) was whether the sequence followed the Destructive Cycle or the Creative Cycle. A 'destructive sequence' followed the destructive cycle; a 'creative sequence' the Creative Cycle.

Another variable was the element of the target point, and there were five values that this variable could take. For a first go at data collection, we selected only one target point for each element. Thus, only the tendency of one single (e.g. wood) point to set-up one single (earth) point was tested. If the theory is very consistently true then the single point design should still work. But because this design could not give full vindication of the theory, it should be seen as an initial step in a more complete study.

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METHOD

Participants

The ukes were people participating in karate classes at the University of Sussex. Twenty eight people were tested on each element.

Design

As they practiced their basic punch, kick etc, Mike and tori walked round testing each in turn. First of all a given target element was chosen. Uke was tested twice: once on the destructive sequence and once on the creative sequence, seperated by at least 20 minutes. Here some 'counterbalancing' variables came in, the conditions of which each uke were randomly assigned to: order(half the ukes were tested with the destructive sequence first, half second); left/right (half the ukes were first tested on the right side and then the left side; the other half of the ukes were tested first left and then right). The creative and destructive sequences were applied on different sides of the body to ensure that there was no residual sensitivity (possible bruising etc) due to pressing the exactly the same spot twice. Tori followed destructive and creative sequences in random order throughout the session because his effectiveness in applying the technique might improve/deteriorate throughout the session. The process continued in different sessions until all five target elements had been tested.

Points used

Below is a table of the sequences:

Sequence	Destructive setup point	Creative setup point	Target point
1	Fire TW16	Earth St14	Metal LI10
2	Wood GB12	Fire TW16	Earth St14
3	Water K26	Wood GB12	Fire H2
4	Earth St14	Metal L2	Water K26
5	Metal L2	Water K26	Wood GB12

This list only contains 7 points: L2, LI10, St14, H2, K26, TW16, GB12

Note that each set-up point occured once in a creative sequence and once in a destructive sequence. This is a useful design feature because the pain rating to the target point may be partly determined by contrast to the pain produced by the set-up point. It is thus important that there is no systematic differences in pain produced by set-up points between the control and destructive sequences, and this design feature ensured that.

Instructions to subjects

As I am teaching you, two of my colleagues will approach you in the session a few times. They are interested in the use of pressure points in martial arts, and they are testing some theories about how different points elicit pain. If you don't want to participate that is fine, just say so to them when they approach you. If you have any medical conditions you should not participate. They will simply press one pressure point on you for about a second and then a second point immediately afterwards, also for about a second. You may not feel anything, or you may feel some more or less moderate pain for a second or so. You will be asked to give a pain rating to the second point; just ignore the first point. If you feel no pain, then give '0' for your pain rating. Now I want you to imagine some time you banged your shin or ankle, or stubbed a toe. Imagine a time when it was really very painful, so painful you wanted to sit down. If you can't remember a specific episode, that's fine, just imagine what it would be like. That amount of pain we call '10'. I will give you 10 seconds now to choose and clearly fix in your mind how much pain a '10' feels like .... that's good. If when you are pressed you feel that amount of pain, then say '10'. If half that amount of pain then say '5'; if twice that amount say '20', and so on.

Later in the session you will be approached again for another sequence of points, and the procedure will be repeated. The results are of great scientific and practical interest, so I hope you will participate. But please do not attempt to press any points on yourselves or your partner during this session.

Procedure

Before the experiment proper, tori was trained on the seven points until he could locate them quickly and accurately on different people on left and right sides without pressing on other points. Also, a procedure was determined for randomly allocating subjects to the four counterbalancing conditions (these conditions were: destructive sequence first-left hand side first, destructive second-left first, destructive second-left first, destructive second-left second). That is, a random number generator was used to generate a list of seven random permutations of the numbers 1 to 4. As each subject was picked from the class, he was assigned the next number in the list, assuring that all the counterbalancing conditions were used equally often and, crucially, still otherwise in random order.

As the class proceeded, tori took each subject aside privately, stuck a label on them determining the subject's condition, took the pain rating, and then indicated for them to rejoin the class. On classes in which the experiment was ongoing, no kyusho moves were practiced.

Some points on the logic of the experimental design

Just some points on experimental design for those without a scientific training. You may say: but different people are differently sensitive to pressure points. This is true, but as each uke is compared to himself on the destructive and creative sequences, a non-responder will give zero pain both times, everyone else should give some pain each time and we can see if there are any consistent differences between the conditions. You might say that people's sensitivity may vary with time (depending e.g. on their adrenalin release at that point in the session) and also that tori's effectiveness may vary systematically or randomly throughout the session, creating differences between the destructive and creative conditions. These factors whilst present do not undermine the logic of the experiment because of the random assignment of subjects to conditions. This means that there won't be any *systematic* difference between the destructive and creative sequences. Accounting for random differences between the conditions is exactly what the signficance testing statistics are for; indeed, without such statistics we wouldn't be able to conclude anything, any mean differences could just be random.

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RESULTS

This section will be difficult to follow completely for those without previous exposure to inferential statistics, even with the brief explanation given for each term. However, a comprehensible summary of the results is given in the Discussion. For the table below, we have tried to be thorough so that people can get a feel for various aspects of the data. In order that the wood can be seen for the trees, though, the important points will be highlighted after the table.

In the table below the mean pain ratings are listed according to the target element, and according to the following contrasts: whether the creative or destructive sequence was followed, whether it was the left or right side of the body, and whether it was the first time that uke was tested on that point or the second time (20+ minutes later). Standard deviations are given in parentheses (standard deviation is a measure of variability between different subjects: roughly 2/3 of people lie within one standard deviation of the mean). For each contrast, the mean difference is reported and the 95% confidence limit on the difference. To appreciate this concept, bear in the mind the distinction between a sample ( the set of people that we actually tested at a particular time) and the population (the set of all people and times we could have sampled from): We are really interested in the population, not in the random vagaries of a particular sample. The 95% confidence interval says (loosely) that we can be 95% sure that the true population value of the mean difference lies between the quoted lower limit (first number in parentheses) and the quoted upper limit (second number in parentheses). (This is not the technical definition but it captures how confidence intervals are best thought about.) If zero is included in the interval then we have no evidence that there is any population difference (i.e. a t-test would not be significant at the .05 level). The limits tell us that whatever population difference may exist, we are 95% sure that they don't lie outside the stated limits; e.g. to take the difference between the creative and destructive sequences on all the data, we have no evidence that the sequences caused different set-ups of the target points (zero contained within the interval), and whatever difference as there may be, we are sure it is not more than 0.5 of a pain rating (i.e. whatever effect as there may be is very small). That gives a measure of how sensitive our experiment is.

Because the data for some elements were not entirely normally distributed, Wilcoxon p's are also reported. This test does not require normally distributed data. If the quoted number is less than .05, there is evidence of a difference. It can be seen that the results produced by the Wilcoxon's are entirely consistent with those produced by the confidence intervals based on t-tests.

	Water	Wood	Earth	Fire	Metal	All
Creative	6.1 (3.7)	5.5 (4.0)	7.0 (2.1)	6.5 (2.3)	5.2 (1.9)	6.1 (1.6)
Destructive	5.6 (3.2)	5.4 (2.8)	7.0 (2.2)	6.3 (2.0)	5.5 (1.8)	6.0 (1.3)
Difference	0.5 (-0.4, 1.3)	0.1 (-0.9, 1.1)	0.1 (-0.6, 0.7)	0.2 (-0.6, 1.0)	-0.4 (-1.1, 0.4)	0.1 (-0.3, 0.5)
Wilcoxon p	0.31	0.82	0.64	0.69	0.39	0.50
Left	6.0 (3.1)	5.5 (3.0)	6.7 (1.9)	6.4 (2.0)	5.6 (2.0)	6.0 (1.3)
Right	5.8 (3.9)	5.5 (3.8)	7.3 (2.4)	6.4 (2.2)	5.1 (1.7)	6.0 (1.7)
Difference	0.3 (-0.6, 1.1)	0.0 (-1.0, 1.0)	-0.6 (-1.2, 0.0)	0.0 (-0.8, 0.8)	0.5 (-0.3, 1.3)	0.0 (-0.5, 0.5)
Wilcoxon p	0.67	0.53	0.10	0.97	0.14	0.93
First	5.3 (3.0)	5.3 (3.9)	6.8 (2.0)	6.0 (1.9)	5.1 (1.7)	5.7 (1.4)
Second	6.5 (3.8)	5.6 (2.8)	7.2 (2.4)	6.7 (2.3)	5.6 (2.0)	6.3 (1.5)
Difference	-1.3 (-2.0, -0.5)	-0.3 (-1.3, 0.7)	-0.4 (-1.0, 0.2)	-0.7 (-1.5, 0.0)	-0.6 (-1.3, 0.2)	-0.6 (-1.1, -0.2)
Wilcoxon p	0.0027	0.13	0.25	0.041	0.16	0.005
Average	5.9 (3.3)	5.5 (3.2)	7.0 (2.0)	6.4 (1.9)	5.4 (1.6)	6.0 (2.5)

Considering all the data, the lowest rating given by anyone was 1 (and the highest was 20). That is, there were no nonresponders in the sense of people who felt no pain. The average amount of pain was 6 (on a scale where 10 means "so much pain one wants to sit down"). If pressing activates points at all, then points should have been activated in this experiment.

Now lets consider various questions addressed by the results:

Does the destructive cycle activate points more than the creative cycle?

For none of the elements was there a significant difference between the creative and destructive sequences. Pooling all data together, there was still no difference. In all the data, we can be 95% sure that whatever the true population advantage of the destructive sequences over the creative sequences, it is not more than 0.3 on the pain rating scale. This is a tiny amount, a change in pain of 0.3/6 or 5 percent. Put another way, our data rules out the destructive rather than creative cycle resulting in a more than 5% increase in pain.

Are the left and right sides of the body equally sensitive?

For none of the elements was there a significant difference between the left and right hand sides of the body, and there was still no significant difference when all the data were pooled together.

Are people more sensitive on the second time they are tested?

Our data bear on another claim sometimes made by people inspired by TCM. It was probably George Dillman who introduced the notion that one should not train on both sides of the body in the same session, because stimulating one side of the body activates the other side. In our experiment, the same target point was pressed on opposite sides of the body in the same session. Consistent with the TCM claims, in the data as a whole, people gave higher pain ratings on the second test (6.3) than the first (5.7). The difference was significant in only some of the elements taken individually, but an analysis (Friedman and analysis of variance) indicated that the difference between first and second testing did not vary significantly across the different elements (p > 0.3) (finding an effect significant in one condition and not in another does not indicate that the conditions differ; that has to be specifically tested). That is, as far as we can tell, the difference could be treated as a general one across the elements.

One straight forward explanation of this second time of testing effect could be that tori simply got better at pressing the points over the course of the session. However, this explanation isn't plausible when we consider how pain ratings varied across successive subjects within the first lot of testing or within the second lot of testing: A regression of these pain ratings on subject order (1 to 28) showed that there was not a positive slope, if anything there was a negative slope. That is, there is no evidence that tori was getting better with practice during the session, or even just pressing harder with time.

A note on pooling across all data for the statistically minded

Within each element 28 different people were tested. Across elements, some of the people were the same and some were different depending on who turned up for each session. That is, the data could not simply be treated as a set of 140 independent observations. Thus, when the data were pooled, subjects were matched according to the order in which they were tested for each element. This ensured that the number of observations treated as independent by the analyses did not exceed the number of different subjects tested. It may be noted that when all the observations were treated as independent, the analyses produced virtually identical significance values and confidence limits as the matched subjects analyses.

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The major finding of this study was that there was no significant difference in pain rating of a point whether it was preceded by stimulation of a point as specified by the destructive cycle or as specified by the creative cycle.

It is sometimes argued that the strength of the cross point activation effect depends on whether the points have the same yin-yang polarity or a different one. In our selection of points, the successive points in each sequence had the following yin/yang values:

Target Point	Destructive Sequence	Creative Sequence
Water	yang-yin	yin-yin
Wood	yin-yang	yin-yang
Earth	yang-yang	yang-yang
Fire	yin-yin	yang-yin
Metal	yang-yang	yang-yang

For those who believe that keeping the successive strikes the same polarity, the Earth, Fire, and Metal cases would allow an advantage of the destructive over the creative cycle to show most clearly, and Earth and Metal would allow an advantage of the creative over the destructive cycle to show most clearly. For those who believe that crossing over between yin and yang is most effective, Wood and Water would allow an advantage of the destructive over the creative cycle to show most clearly, and Wood and Fire would allow an advantage of the Creative over the Destructive cycle to show most clearly. In fact, despite these opportunities, no advantage ever emerged for either cycle.

One might argue that it is only when striking points that the cycles produce their effects. This is possible and would require further investigation. However, the cycles are frequently cited when people grab, stroke or press particular points, often with less intent and penetration than used in our study. We find no evidence that even substantial presses to points activate other points according to the destructive as compared to the creative cycle.

One limitation of the study is that we used just one target point per element. It could be argued that the destructive cycle (or creative cycle) does not generally apply - perhaps they only apply to special points, or under special conditions. It IS clear that one can't simply list "destructive cycle" as a "player" that can be incorporated into any technique. If there are only special points to which the cycles apply, it would be interesting to see accounts of these points developed.

The study was sensitive and could pick up small effects. This is illustrated by finding that people gave a higher pain rating - by 0.6 of a pain unit on average - the second time they were tested rather than the first. Since the second time of testing was always on the opposite side of the body, this is consistent with the claim of cross side activation, at least of the same point. This is an interesting finding that deserves further investigation. We can't be sure its a cross side activation effect, because this study did not compare pain on a second testing between the same side and the opposite side. Thus, any mechanism that tends to lead to higher second pain ratings, regardless of side, is also consistent with the results. A prosaic explanation could be, for example, that on the first rating people were a bit macho and tried to show how tough they were. On the second rating may be they felt they had already proved themselves and gave a truer figure. (NOTE: This effect of second testing does not undermine the other comparisons - e.g. destructive vs creative - because each sequence occured equally often first as second. Further, an analysis of the difference between destructive and creative sequences on ONLY the first time of testing showed a nonsignificant result, p > 0.4.) A future experiment could look at stimulating the same or related point a second time on either the same side or the opposite side of the body to see if cross body activation is really important.

If cross body activation is important, the warning that one shouldn't train both sides of the body in the same session still does not follow from our data. One could increase pain a lot more than 0.6 of a unit simply by pressing harder! We appreciate, however, that the claim is that one should not train both sides of the body because of the disturbances that might follow to one's qi, and increased pain is not necessarily a symptom of this. On the other hand, to the extent that long traditions provide acceptable default answers, in Yawara jujitsu, a tradition of pressure point fighting going back hundreds of years, people train both sides of the body freely.

In the field of Kyusho-Jitsu the body of knowledge which constitutes TCM is often perceived as a single coherent set of principles. In reality this is not strictly true. TCM actually contains a number of inconsistencies, in particular those between five elements and the rest of the body of TCM (yin-yang polarity, fundamental substances, pernicious influences, principle patterns, organ functions, etc.). Five elements arose as a separate and distinct philosophical construct used to describe many different aspects of the natural world and human endeavour. It was not until the time of the Han Dynasty (206 BC - 220 AD) that the first known attempts to integrate five elements into the body of TCM were made. Since that time the various correspondences (and to a lesser extent the cycles) of five elements have repeatedly been amended in attempts to attain consistency between the two bodies of thought. However, it is fair to say that even now five elements rests somewhat uneasily as an overlay upon the principles of TCM. For instance, in five elements the heart corresponds to fire (yang) and the kidney to water (yin). In TCM, however, the kidneys are considered to be the foundation of both water (yin) and fire (yang) for all the other organs. There are yet other theories for the function of the points based on the flow of energy down the channels with different theories proposing flow in different directions. Modern clinicians do not necessarily have problems with these sort of contradictions. In terms of diagnosis some clinicians tend to favour the (strictly) TCM model (which seems to be more popular in China); others favour the five elements model (a view more popular in the West); yet more tend to use whichever of the various models that seems most applicable to the particular client being treated. (For further discussion relevant to these points see "Chinese Medicine: The Web that has no Weaver" by Ted J Kaptchuk and "Traditional Acupuncture: The Law of the Five Elements, 2nd edition" by Dianne M Connelly.)

Our view of five elements is that it is not a science that provides predictions and explanations of effects in kyusho jutsu. It is a set of metaphors and images and a language for expressing intuitions honed after years of training. Images can be very important for generating further ideas, possible moves. If the moves don't turn out to be effective, they can be rejected. If the moves are effective they can be added to ones repertoire, and in that way five elements serves a valuable function for those attracted to it. However, this function might well be performed, equally effectively, by other non-scientific methodologies.

Our results are consistent with the claim that it is not necessary to possess any knowledge of TCM theory in order to fully develop one's ability as a practitioner of Kyusho-Jitsu. This corresponds to our personal beliefs. But the data in no way undermine TCM more generally. Historically, Chinese medical theories were very useful in indicating WHICH points were useful ones for attacking. (They also specified times of the day best for attacking each point, although Vince Morris in his book "Kyusho Secrets" reports finding no correspondence between time of day and sensitivity of points). Mike employs TCM and five elements extensively in his Shiatsu practice. Our data simply call into question a particular use of TCM, a use that is not necessitated by the ideas of TCM itself.