The origins of Shiatsu

There are tens of millions of people in the world who know Shiatsu or have at least heard of it. All of them know that it is an oriental discipline, some place its origin in Japan, few really know its history. There are those who say that it is a millenary discipline, some claim instead that it is very recent and some say that it was born in China. With this article, we try to clarify the origins of this famous technique and how it developed over time to the present day.

History of Japanese medicine

To understand the origins of Shiatsu, you need to know a little about history. Shiatsu (指 圧) is a Japanese word that means “finger pressure“, so it seems obvious that it comes from Japan. It is still part of the Japanese health system, where it is studied and practised in a “scientific” way. Let’s go then to see how the medicine of the land of the Rising Sun developed over the centuries.

Japanese medicine is made up of three main currents: folk medicine, Chinese medicine, western medicine. Let’s look specifically at the three currents.

Folk medicine

Little is known about this ancient art, handed down orally. However, important writings such as the Kojiki, the Nihongi and the Fudoki, along with mythological tales, describe the functions of the two deities of health (Okoninushi and Skuna-Hikona-no-kami), diseases and their connection with evil spirits (which were considered the cause). Evidence of remedies such as sake (rice wine), liquorice, rhubarb, carrot, magnolia can be found. Bloodletting and bathing in thermal waters (of which Japan is abundant) was also used. It is a type of shamanic, folkloric medicine, linked to the Shinto religion, of an animist type.

These healing techniques were administered by female shamans called mikogami (child of the god), who interacted with the world of spirits and gods to cure diseases (but not only: they were also psychopomps and priestesses). They were figures that in ancient times roamed the villages or frequented the temples, performing sacred dances and playing the drum. Some of them were real mediums. These figures lose importance with the advent of Buddhism in Japan, but they do not completely disappear: still today we find practising shamans who transmit their initiatory art.

Chinese medicine

When the influx from China began to intensify in the Japanese archipelago, the culture of the Great Empire strongly influenced that of the land of the Rising Sun. Although we have testimonies of Chinese in Japan since the second century BCE it is only from the IV sec. CE that these import arts such as weaving, silkworm cultivation and medicine, including some texts. Despite this, the first foreign doctors in Japan were Koreans (the first was Kim Mu, called to treat the Emperor Ingyo in 414; another famous was Kam Jin, a Buddhist monk who arrived in Japan in 763), who spread Chinese medicine enriched with personal experiences and Indian Buddhist techniques. Chinese medicine itself has been strongly influenced by Indian and Tibetan medicine. It is fair to say that one of the main vehicles of Chinese medicine was Buddhism, especially the Chan school: from it derived the Japanese Buddhism Zen (XIII century) even if we could find some Chan teachings already in the Tendai Buddhism (VIII century).

From the VI-VII century, Japanese medical delegations were sent by Prince Shotoku to China to complete their training. Codes were written to regulate the medical art, on the path of study to be undertaken and the various specializations. The first was in 701, Taiho code, where the word Anma (indicating the art of massage) appears for the first time. The most famous code is the Ishinpo (The Core Prescriptions of Medicine) written by Yasuyori Tamba in 984. It is the oldest and most complete Japanese medical text surviving to this day. It contains important fragments and quotations from ancient Chinese texts which have unfortunately disappeared, of which we have knowledge thanks to this writing.

In addition, medical academies and provincial colleges were established, divided into 5 sections: pharmacy, massage, exorcism, acupuncture and medical art (internal medicine, surgery, paediatrics). The first hospital in Nara was born, that was the capital city at that time, built by the Empress Komyo. The elements of Chinese medicine were already evident: the Zo-Fou system (Zang-Fu in Chinese: organs and viscera, connected to the 12 ordinary meridians and to the 5 movements: water, wood, fire, earth, metal), the 3 Tsiao (Jiao in Chinese: heaters), yin and yang.

The first texts concerning the manual practices date back to the book Eiga-Monogatari (Tale of the Splendor) of the Heian period (794-1191), written in part by the female poet Akazome Emon, where the treatment with the hands with the name Hara-tori is mentioned. The manual techniques referred to in this text are the Koho-Anma and the Anpuku, from which the current Shiatsu largely derives.

Western medicine and modern times

With the arrival of the Portuguese in the 16th century and of the Dutch and Germans in the 17th, Japan gets in touch with various elements of Western medicine, assimilating them. Many Japanese people travel to Europe to complete their medical education. Despite this, in 1800 folk medicine flourished again, due to a strong Japanese nationalist movement. The love for Chinese medicine grows more and more and a truly fascinating medical syncretism is created, made of western science, popular superstition, Chinese culture. The peculiar characteristic of Japanese medicine of this era is the fact that, in contrast to the Chinese one, it has continued to deal with massages, moxibustion and acupuncture integrating them with studies in Western medicine. A major study on massages entitled Fujibayashi Ryōhaku is published.

In the final part of the Edo period (1602-1868), the practice of Anma and Anpuku are relegated almost exclusively to the blind. The emperor made this decision to allow these marginalized companies to have a job to live with. In doing so, massage loses much of its medical-scientific approach and, consequently, popularity. Fortunately, prominent figures were not lacking, such as Todo Yoshimasu (1702-1773), who wrote important treatises on Anma and Anpuku. The most interesting contribution for us is that concerning his theory on the abdomen: “the abdomen is the origin of life and also of every disease“. Because of this principle, he conferred great importance to the abdominal diagnosis (Fukushin) for the identification of the origin of the disorder and developed a mapping system of the abdominal areas, from which the Shizuto Masunaga himself, creator of Zen Shiatsu, was probably inspired.

Anpuku Zukai

Another important figure was the master Ota Shinsai who in 1827 published the important treatise Anpuku Zukai. Thanks to this text, republished with comments and explanations by Shizuto Masunaga in 1960, the importance of this therapeutic massage was rediscovered in later times. It states that through Anma and Anpuku techniques one was able to obtain curative results such as “improving the organic function, circulating the blood better, unblocking and revitalizing the joints, loosening the muscles and ligaments, revitalizing the skin, revitalising the skin, stimulating appetite and the quality of digestion, favouring the discharge of toxins ”.

At the beginning of the Meiji dynasty (1868), due to the total openness to the world and western culture desired by the emperor Mutsuhito, traditional practices were prohibited, therefore also the Anma and the Anpuku. Nevertheless, they continued to be used unofficially by the Japanese people. Japanese medicine is interested in the Western one, especially European and North American, which becomes a real fashion. In 1911 a law was issued that officially recognized the professional figure, regulating the method, of those who operated using acupuncture, Anma and moxibustion. This law left, fortunately, the possibility of practising other forms of unrecognized treatment, without the need to have an authorization from the local prefecture. This was particularly relevant in the birth and early development of the Shiatsu method.

Another fundamental element to consider for the history of manipulative arts in Japan was the spread, during the Taisho government (1912-1926), of three forms of manual care coming from North America that acted on the balance of the musculoskeletal system and the nervous system and in particular on the symptoms of the spine: ChiropracticOsteopathy and Spondylotherapy.

What happened later, we will explain it soon, but now it is necessary to make a clarification about the Sino-Japanese medicine.

Sino-Japanese medicine

Let’s see in concrete what it is. All the medical corpus “borrowed” from China is called by the Japanese Kanpo. In it we find the two main elements: Do In (Dao Yin in Chinese) or all self-healing techniques, such as self-massage, breathing exercises and meridian stretching; An Kyo (An Kiao in Chinese) instead are the techniques applied by an operator on a patient, whether they are manipulations, massages or breathing exercises and meridian stretching. The part of the An Kyo concerning the massage is called Anma (Anmo in Chinese).


Another very important massage technique that accompanies the Anma is the Anpuku (or Ampuku). It is an abdominal massage that has greatly influenced the Zen Shiatsu (Masunaga’s mother practised it). It is very old and comes from Chinese culture. It is based on the concept that our vital energy is born from the abdomen (Ki in Japanese and Qi in Chinese) and therefore it is the origin of life, but also of every disturbance that affects life itself. Through the abdominal massage, we can restore the balance in the flow of vital energy and restore the state of health. In fact, Ota had noticed that to tonify or disperse the Ki, constant steady pressure can be used, obtaining the same results as the Anma, which instead uses techniques such as rubbing and hammering. He also drafted a diagnosis map of the abdomen in 1830, to which Masunaga referred.

TCM and the cultural revolution

Ultimately, all this set of cultures, techniques, disciplines, such as folk medicine from Shinto, Chinese and Western medicine, ended up in this vast sea which is Japanese medicine, of which massage as a therapeutic art has always been an important element. The peculiarity of this medicine is that it is very much based on the classical Chinese one. In China, with the advent of Mao and the cultural revolution, many of the classical texts have been burned, prohibited, as many techniques and disciplines have been banned and forgotten. In the 1950s, Mao brought together a group of acupuncturists and asked them to “create” a more “scientific” Chinese medicine, able to stand up to the Western one and perhaps talk to each other. Thus was born the Traditional Chinese Medicine (TCM) which, unlike what it seems, is very recent.

Rigid maps are set up about acupoints and meridians of the acupuncture, techniques and theories are codified, flattening that enormous cauldron that is the classical medicine. The approach passes from that of adapting every single technique, diagnosis, manipulation to the person, to create protocols for each existing symptom, exactly as in Western medicine. Thus the original meaning of classical medicine is completely lost. We go from having a paid doctor when the patients were healthy (but regularly visiting him, receiving advice and teachings on diet, exercises and all that is necessary to stay healthy) to a system where the doctor is used only when you’re sick. From preventive medicine to curative medicine. The doctor was also a master of life and was the first to put into practice what he preached.

This fact is very important because Japan, despite having had periods of rejection of tradition, never reached the extreme of destroying and burning ancient texts. Thus we can find writings with philosophies, techniques and disciplines that we no longer find in China. This is very important because Masunaga, who brought Shiatsu back to its true origin and former glory, was able to study on these texts. All his theories and “discoveries“, such as meridian extensions, the importance of hara, the direction of ki along the meridians, etc., were extrapolated from classical Chinese medicine texts thanks to Japanese medicine.

Anmo and Tuina

Let’s look specifically at what Chinese techniques Shiatsu is based on. Anmo, from which the Anma derives, is composed of An (pressure) and Mo (circular grazing) and indicates all curative and non-curative Chinese manipulative techniques. But the Anmo in time has specialized in the “popular” massage (and then it becomes a typical massage of wellness centres) while the Tuina has become the discipline used in hospitals. It developed when Anmo began to decay and lose its healing effectiveness, and soon Tuina becomes the officially used manipulative discipline in China. Tui (pushing, but in the sense of pushing forward vertically, moving) and Na (grasping) are two techniques that give the name to the most important corpus of therapeutic manipulations of Chinese medicine.

Finger pressure

It is interesting to notice that what gives the name to the two most important Chinese massage techniques are pressure manoeuvers. It is about 1911 that in Japan attempts are made to separate the pressure act from other massage techniques, considering it a more effective healing method. Even in traditional Thai massage, it has recently been discovered that, in the so-called royal style, as used to treat the king’s family, acupressure techniques are used on specific points. It was a style kept secret until a few decades ago, only recently disclosed. As the Tuina is born to detach from the Anmo and recover the therapeutic side of the latter, so the Shiatsu is created with the purpose of bringing the techniques used in the Anma and in the Anpuku to their original function and dignity.

Thanks to the Japanese law that allowed the use of non-institutionalized healing techniques (as happened for Anma, acupuncture and moxibustion), this new, but actually very ancient, healing method is created. So, to conclude this paragraph, we can say that Shiatsu originates in the Kanpo, especially from the Anma and Anpuku techniques and specifically from acupressure, but it combines knowledge of western medicine, psychology and modern knowledge. But let’s take a detailed look at its development.


The first written records of the existence of a technique called “Shiatsu” seem to date back to when Master Tenpeki Tamai published in 1939 the book Shiatsu-hou which contains a detailed exposition of his technique. Even before the publication of the text, he used the word Shiatsu to present his work. It is thought that he did it to differentiate himself from traditional techniques (Anma and Anpuku), more for reasons of the name (the traditional techniques had by now been downgraded to popular and not very effective practices) than for a real difference of theory and practice with them. In addition, it combines knowledge of modern Western medicine not found in traditional techniques.

It was Tokujiro Namikoshi who made this technique famous in Japan and the West. He started the manual practice as a boy, trying to alleviate his mother’s rheumatic pains. In 1921 he studied physiotherapy with Kodagawa until he graduated. In 1940 he founded Japan Shiatsu College in Tokyo. His style was based on a scientific view of Shiatsu and had in common with traditional Chinese medicine the theory of tsubo, integrated into the stimulation of the so-called “Namikoshi points”.

Apart from this similarity, which in any case he “masks” by changing the names of the points, for all the rest his discipline is based on purely Western concepts. The study of anatomy and physiology is studied in depth in a scientific way, while there is no trace of all that is part of the Kanpo, such as the meridians, the theory of five movements, the concepts of Yin and Yang. The technique that takes its name was recognized by the Japanese Ministry of Health partially in 1955 and then fully in 1964. Currently, the Namikoshi school is widely studied and practised in Japan, at the same level as our physiotherapy: its therapeutic value is recognized and it is practised in hospitals.

Zen Shiatsu

Shizuto Masunaga, a student of Namikoshi, made a great turn at Shiatsu. Psychologist and scholar of Chinese medicine, he was initially a pupil of his mother, famous for the Anpuku, who was a disciple of Tenpeki Tamai. After studying with Namikoshi, he taught for ten years at Japan Shiatsu College. Later he also gave life to his school in 1968, the Iokai Shiatsu Center. The style he developed proposes a practice based on the treatment of energy lines and on the diagnosis of the abdomen and back, thus bringing Shiatsu back to the original connections with the Kanpo. In fact, he names his style Keiraku Shiatsu (Shiatsu of the meridians), which is then exported to the West under the name of Zen Shiatsu, thanks to his holistic and meditative method, which reflects the simplicity and spiritual approach of Japanese Buddhist monks.

Significant points of his technique are the use of the categories Kyo and Jitsu (deficient and excess) linked to the theory of Yin and Yang, the concept of “support” applied to bi-manual pressure, and the Makko-Ho exercises for the self-stretching of the meridians. Not limiting himself to this, Masunaga, as a great scholar of Chinese and Japanese medicine, elaborates a more thorough and complete theory of meridians than that of traditional Chinese medicine (TCM), born in the 1950s from the ashes of classical Chinese medicine. In fact, there are extensions of traditional meridians along the whole body: that is, every single part of the body is crossed by all 12 ordinary channels. This concept is found in fractal acupuncture, for example, which considers the body structured like a hologram. Every single part is an image of the whole.

Being a psychologist, Masunaga interprets the symptom mainly as a manifestation of the human being seen as a whole and not of a mere physiological aspect of the body. The recipient is seen as a person and not just as a physical body that shows a symptom. And this symptom becomes an expression both of properly physical functions but also of emotional and spiritual aspects. Shiatsu pressure is enhanced by perception and the sensitivity of the operator becomes fundamental to grasp the condition of each energy channel; the treatment of the abdomen acquires an even more decisive role in order to diagnose the psycho-physical condition of the recipient. All these elements are used in the treatment to appropriately stimulate some areas of the body and the meridians to induce a state of better overall and lasting energy balance.

Shiatsu and the Japanese health system

Few people know that in its home country, Shiatsu enjoys a privilege that is not granted to it in the West. From the legislative point of view, in fact, the Shiatsu was officially recognized in 1955 by the Japanese Ministry of Health, as a particular manipulative treatment, based on pressure, but it was initially framed in the Anma massage techniques. Only a decade later, in 1964, a new law defined it as a form of treatment that was completely autonomous and distinct from both the Anma and the Western massage practised in Japan. It is thanks to Tokujiro Namikoshi, as we have already said if Shiatsu has been officially recognized by the Japanese government; he had the merit of having been the first to give an essential didactic organization to the Shiatsu methodology.

Let’s see specifically what involves the study and practice of Shiatsu in Japan. First of all, to enter any Shiatsu college in the land of the Rising Sun it is necessary to have a high school diploma or its equivalent. Since the state exam will be in Japanese, it is necessary to know this language very well and colleges require certificates in this regard for non-native speakers. The course of studies is approximately 2200 hours divided into three years. Subjects such as anatomy, physiology, the study of various pathologies, as well as specific courses on Shiatsu, are addressed in-depth during the three years. It is therefore clear that this is a para-university course. Very different from the courses made in Italy (and in the rest of Europe) of 600-700 hours. Once the college is successfully completed, you must pass the state certification exam to become part of the Japanese health system, like physiotherapists, chiropractors, etc.