42 The Balance of Left and Right – Akabane Imbalances
The Balance of Left and
Right – Akabane Imbalances
By: Anne Abstract
Jeffres Channel theory is an important aspect of the clinical practice of acupuncture. A modern addition to channel theory is
the concept of Akabane, or left-right, channel imbalances. This article discusses the concept, diagnosis and treatment of
Keywords: Akabane imbalances.
Acupuncture,
C
channel theory, hannel theory is an important aspect of
Akabane acupuncture practice. Acupuncture has
imbalances, a direct effect on the flow of qi within
Kobe Akabane, an acupuncture channel, which then impacts
J.R. Worsley, the zang or fu associated with that channel. A
jing-well modern addition to channel theory is the Akabane
points, luo- test, which assesses the balance between the left
connecting and right sides of a channel. If this test indicates
points, back- balance it reflects that the two sides of the channel
shu points, are connected and communicating, which is
needle important for normal channel and organ function.
technique, The test originates from the work of Kobe
pulse Akabane, an innovative Japanese acupuncturist
diagnosis. who developed his technique in the 1940’s and
1950’s.1 He devised a simple method of measuring
the relative amounts of qi in each side of a given
acupuncture channel by moving a piece of
smouldering incense over the jing-well points of
each side and gauging the relative heat sensitivity
of the points.
Case study
A 57-year-old man in New York City presented
with pain posterior to his right lateral malleolus for
more than six months. This caused great discomfort
whilst walking, to the point where he felt quite
debilitated as he was unable to walk freely around
the city. He reported that he had originally suffered
an ankle sprain that had resulted in local pain, for
which he had received a local cortisone injection,
prolotherapy and acupuncture, but the injury only
seemed exacerbated. In terms of channel theory, he
had several issues affecting qi flow in his Bladder
channel, including an entry/exit block (a block in
flow from one channel to the next along the ying
qi cycle) between the Small Intestine and Bladder
channels, and qi deficiency due to depletion
of Kidney jing. Most important in terms of his
ankle pain, however, was a left/right (Akabane)
imbalance, which was identified in the first
treatment session and addressed over the course of
three treatments, after which he reported a dramatic
decrease in pain, and a marked improvement in his
ability to walk and function.
Journal of Chinese Medicine • Number 100 • October 2012
Indications of Akabane imbalance
Unilateral pain
The most common symptom of an Akabane imbalance
is one-sided pain, inflammation, or dysfunction that
affects a primary acupuncture channel and/or its
associated tendinomuscular channel. This type of
dysfunction is often due to direct physical trauma
or injury to the channel. Physical trauma causes
a disconnection between the qi flow of the left and
right sides of the channel, which leads to a difference
in the volume of qi within the two sides. For example,
a patient presented with intense, acute pain in her
right elbow, just proximal to the insertion of the
triceps tendon into the ulna - the area of Tianjing
SJ-10 - following a fall. Upon examination, it was found
that she had an Akabane imbalance, with a deficiency
of qi in her left Sanjiao channel and a relative excess of
qi in her right Sanjiao channel. Treating the Akabane
imbalance led to immediate relief of the pain. It is
important to understand, however, that it is not
always the excess or deficient side of the channel that
is painful, so it is necessary to perform the Akabane
test in order to determine if one side is more deficient
or excess than the other, whether treatment is needed,
and on which side. Akabane imbalances may be
present without any physical pain or dysfunction,
and may be identified through pulse diagnosis or by
routinely performing the Akabane test on all channels
as part of acupuncture treatment (as in J.R. Worsley-
style acupuncture).
Temperature difference
Another way to discover potential Akabane
imbalances is palpation; if one side of a channel feels
warmer (due to more qi in that side of the channel)
or cooler (less qi) than the other. This is most obvious
along the fingers and toes.
Journal of Chinese Medicine • Number 100 • October 2012
Case study
A 19-year-old man presented with severe left ankle
pain following an acute ankle sprain two days
previously. He reported that the pain was sharp
when walking, and upon inspection his left ankle
appeared swollen and slightly inflamed, and the
skin around the site of the sprain felt warmer on
palpation compared to the opposite side. The
Akabane balance was checked for all of his leg
channels, and imbalances were found on his
Bladder, Gall Bladder and Stomach channels, with
more qi on the left side of all these channels than
on the right. After tonifying the luo-connecting
points on the right side of the Bladder (Feiyang
BL-58), Gall Bladder (Guangming GB-37) and
Stomach (Fenglong ST-40) channels, he reported
much less pain upon standing and walking, and
upon palpation his ankles felt of equal temperature,
indicating a greater balance between the left and
right sides of those channels.
Pulse quality
Over years of practice and pulse-taking, the author
has noticed a distinct pulse quality that occurs when
there is an Akabane imbalance. The superficial aspect
of a given pulse position reflects the yang channel and
the deep aspect reflects the yin channel. For example,
the superficial aspect of the left guan (middle)
position correlates to the Gall Bladder channel, and
the deeper aspect correlates to the Liver channel.
Specific qualities felt in the superficial or deep aspect
of the pulse therefore reflect specific disharmonies
of the Gall Bladder or Liver channels respectively.
A normal pulse feels relatively smooth, like a sine
wave, reflecting a smooth and balanced flow of qi in
the channel. The pulse of a channel with an Akabane
imbalance has a distinct ‘notched-out’ quality – as if
half of the sine wave is missing in regular increments
(see Figure 1). This can feel something akin to railroad
ties or corduroy. One might conjecture that the normal
pulse is created by the flow of qi in the two sides of
an acupuncture channel, which together create the
full, smooth, sine-wave-like pulse. When there is an
Akabane imbalance, there is a substantial difference
in the volume between the qi in the left and right side
of a channel, which manifests as a distinctive lack
of smoothness of the pulse waveform. This may be
confused with a choppy pulse quality (see Figure 2),
but a choppy pulse differs in that its abnormalities
are more irregular and uneven (as expressed in
the classical description of a sick silkworm eating
a mulberry leaf). A choppy pulse is reflective of
conditions of the blood (blood deficiency or blood
stasis), and is felt when rolling the finger over a
pulse position from proximal to distal or vice versa,
The Balance of Left and Right – Akabane Imbalances 43
The most common symptom of an Akabane imbalance
is one-sided pain.
whereas the Akabane pulse is felt with the finger held
statically. When the Akabane imbalance in a particular
channel is successfully treated, the Akabane quality
in the pulse immediately disappears, and the pulse
returns to a normal form.
Figure 1: The Akabane pulse
Figure 2: The choppy pulse
The Akabane test
A jing-well point is a place where qi emanates, or
arises in the channel,2 and where the tendinomuscular,
or sinew, channel begins.1 Jing-well points therefore
reflect the energetics of both the tendinomuscular
and primary channels, and are easily accessible
points where the volume of qi in the channels can be
assessed. In the Akabane test, a traditional Japanese
incense stick is lit and moved back and forth over the
jing-well point of each channel with a constant rate
and at a set height over the point, while counting how
many passes it takes for heat to accumulate at the point
so that the point feels subjectively hot to the patient.
How quickly or slowly this happens is interpreted to
reflect the amount of qi in the point. If a channel has
more qi, it will get hot more quickly, and if it has less,
it will take longer to get hot. If both sides of a channel
are in balance, both of the the jing-well points of that
channel will get hot with the same number of passes
of the incense stick. In a normal channel this usually
takes between five to ten passes. The test can be used
to check single channels suspected of imbalance or
measure the relative balance of all 12 channels as part
of a systematic process of balancing the acupuncture
channels.
50 The Balance of Left and Right – Akabane Imbalances
FIgures 3 and 4
Figures 5 and 6
The Akabane technique
1. Light a stick of Japanese incense.
2. Starting on the left side, with one hand hold
the incense stick and with the other hold
the patient’s finger or toe steady and easily
accessible.
3. Move the lit end of the incense stick back and
forth over the jing-well point, maintaining an
equal distance and speed of movement for
all points (See Figure 3 and 4). The jing-well
points are located at the junction of two lines
drawn along the medial or lateral border of the
nail and the base of the nail, approximately 0.1
cun from the corner of the nail. Note that the
Pericardium channel is tested at the medial side
of the middle finger, and the Kidney channel at
the medial side of the little toe.
4. Count the number of times the incense moves
back and forth over the jing-well point.
5. When the patient says ‘hot’, take the incense
away from the point (See Figure 5).
6. Cover the jing-well point just measured with a
finger to diffuse the hot sensation (see Figure 6).
7. Note the finding in the patient chart. Always
chart left over right: for example, if checking
the Stomach channel, it might read: ST 12/12
(L/R).
8. Repeat the same procedure on the right side.
9. If there is an Akabane imbalance in a channel
(≥30 per cent difference in the two readings),
treat the imbalance following the guidelines
below.
10. 
Recheck the balance in that channel by re-
performing the Akabane test. If successfully
treated, the readings should be equal on
each side, or less than a 30 percent difference
between the sides.3
Journal of Chinese Medicine • Number 100 • October 2012
When first learning this technique, it can be helpful to
draw a small dot with small lines equidistant to the
jing-well point (i.e. on the nail and on the finger or
toe approximately two to three millimetres distal and
proximal to the point). Ultimately, the practitioner’s
ability to perform this test consistently - with the
same technique on both sides - is the most important
way to ensure that the results of the test are accurate.
Before starting this technique it is important to
educate the patient about the procedure and let them
know what to expect, as they will be gauging and
reporting the degree of heat at each point. Inform the
patient that to measure the relative amount of qi in
the two sides of the acupuncture channel you will be
passing a lit stick of incense over a point on each finger
or toe, and that their job is to let you know when they
feel it get hot. Tell them they will feel it gradually get
warm, and when it suddenly gets hot they should say
‘hot’, at which point you will take the incense away.
It is helpful to let them know that the incense will not
touch the skin – so it will not burn their skin.
Treating Akabane imbalances
Historic treatment by Kobe Akabane
Kobe Akabane developed a specific technique to treat
the left/right channel imbalances indicated by his test.
He would use back-shu points to balance the channels
by using moxibustion on the deficient side and needling
the excess side with intradermal needles (hinaishin),
which he invented to treat this condition in the 1950’s.4
Miki Shima’s Akabane treatment method
Miki Shima utilises a treatment technique similar to
Kobe Akabane to restore left/right channel balance,
applying moxa cones to - and occasionally needling
- the back-shu point of the affected channel on the
deficient side. Miki Shima has also expanded the use
of the Akabane technique to analyse the balance of the
divergent channels and extraordinary channels. His
approach not only looks at the left/right balance of
each channel, but also assesses the sum total of each
channel’s Akabane number (e.g. 10 strokes on the left
Kidney channel and five strokes on the right Kidney
channel, for a total of 15 strokes). This sum total is
then compared to its paired five phase channel (in the
example given this would be the Bladder) to assess
the channel divergences and against its paired eight
extraordinary channel (in the case of the Kidney this
would be the Lung channel, as these make up the
master and coupled points of the the Ren [Conception]
and and Yin Qiao [Motility] vessels). Miki Shima’s
treatment method for the divergent channel involves
tonifying the master point of the deficient channel
with a gold needle, and sedating the master point of
the excess channel with a silver needle.
Journal of Chinese Medicine • Number 100 • October 2012
Case study
A 68-year-old woman presented with severe
chronic pain in her left arm that extended from
her left forearm to her shoulder. The pain would
increase several times a day along with a throbbing
sensation and muscle tension and spasms. She
reported that there was no specific injury that she
could recall, and she had been diagnosed with
arthritis and bursitis in her left shoulder. Upon
examination, it was found that she had a severe
Akabane imbalance affecting her Large Intestine
channel, with a substantially greater amount of
qi in the left side of the channel compared to the
right. After tonifying the luo-connecting point on
her right Large Intestine channel (Pianli L.I.-6),
she reported an immediate decrease in pain in her
left arm. During subsequent visits over the next
few months for other health-issues, she reported a
complete remission of her shoulder pain following
the first acupuncture treatment.
J.R. Worsley's Akabane treatment method
The concept of Akabane imbalances was originally
introduced to European acupuncturists by Herbert
Schmidt from Germany, who studied with Akabane
and taught widely in Europe during the 1950’s and
1960’s.5 One European practitioner who used the
Akabane test extensively was J.R. Worsley. Although
it is unclear whether he learnt the technique directly
from Schmidt, Worsley utilised the technique
extensively, and developed a new method of
treatment. Worsley’s technique to correct Akabane
imbalances was to tonify the luo-connecting point
of the deficient side of the channel. This is a quick
and effective way to create balance in a channel, and
a technique that the author has used extensively.
Worsley’s method of tonification involves the
following specific needling technique: slowly insert
the needle upon the patient’s exhalation angled at 5
degrees towards the flow of the channel, obtain deqi,
turn the needle one-half clockwise, quickly withdraw
the needle and close the hole with a cotton-wool ball.
For example, if a practitioner finds an imbalance in
the Gall Bladder channel (notated as L/R 5/12),
they would tonify right Guangming GB-37, and then
repeat the Akabane test to ensure that the channel is
balanced (see Figure 7).
In practice, if an Akabane balance is not restored
following treatment, the practitioner should ensure
that they accurately applied the test using the same
speed, distance and technique on both sides of the
channel. Note that it is possible for Akabane imbalances
to extend over several channels, and to travel from
channel to channel with the flow of qi (following
the order of the Chinese clock). For example, if the
The Balance of Left and Right – Akabane Imbalances 51
Gall Bladder channel Left/Right = 5/12
Tonify Right Guangming
GB-37 to balance
Left Right
Figure 7: J.R.Worsley's treatment of Akabane imbalance of the
Gall Bladder channel
Gall Bladder channel has an Akabane imbalance, the
practitioner should also check the Sanjiao channel,
which precedes it in the flow of qi. If the Sanjiao
channel is also out of balance, the practitioner should
also check the Pericardium channel, and so on. It is
important to identify and treat the first channel along
flow of qi that is out of balance. That is, in the previous
example, if the Pericardium channel is balanced but
the Sanjiao and Gall Bladder channels are imbalanced,
treating the Sanjiao imbalance will usually resolve the
Gall Bladder imbalance as well. As another example,
a patient presents with pain along the lateral aspect of
the leg along the Stomach channel: The practitioner
suspects an Akabane imbalance, and the Akabane test
reveals a balance of 15/30 (L/R). The practitioner then
checks the Large Intestine channel, which precedes
the Stomach channel in the cycle of qi. The Large
The pulse of a channel with an Akabane imbalance
has a distinct ‘notched-out’ quality.
Intestine channel balance is 10/10, and as a result
the practitioner proceeds to treat the Akabane on the
Stomach channel (right Fenglong ST-40). Or take the
case of a patient who presents with pain in the left
arm that has been diagnosed as lateral epicondylitis.
The area of pain corresponds to the Large Intestine
channel, and the Akabane test reveals the channel
as 12/18 (L/R). The practitioner then tests the Lung
channel (which precedes the Large Intestine in the
cycle of qi) which measures as 10/15. Because of this,
the practitioner also checks the Liver channel, which
precedes the Lung channel in the cycle of the flow of
qi. The Liver channel measures 8/8, which indicates
balance. The practitioner therefore treats the Akabane
on the Lung channel (tonifying right Lieque LU-7),
and then rechecks the Akabane balance of the Lung
and Large Intestine channels, which are now both in
balance (Lung 11/11 and Large Intestine 14/14).
For stubborn imbalances within a channel, if
tonification of the luo-connecting point on the
52 The Balance of Left and Right – Akabane Imbalances Journal of Chinese Medicine • Number 100 • October 2012

deficient side does not work, then the practitioner can

also tonify the yuan-source point on the deficient side
and, if necessary, the back-shu point of the associated
zangfu on the deficient side, using the in-and-
out tonification needling described above. Rarely,
Akabane imbalances will not go back into balance
right away, but may take a few days to rebalance, or
may need to be treated again at the patient’s next visit.

Conclusion
Akabane imbalances are an important modern
addition to channel theory and acupuncture
treatment, and can be at the root of our patients’
complaints. They are a valuable imbalance to be able
to recognise and treat in clinical practice, and an
important addition to a modern practitioner’s tool kit.

Anne Jeffres, DAOM, LAc, has been a practitioner of TCM

and Five Element styles of acupuncture for 18 years. She
currently works as an acupuncturist and clinical researcher
specialising in oncology at Columbia University, and has
taught and guest-lectured in acupuncture and Chinese
herbal medicine at several acupuncture schools in the
US. Anne maintains a private practice in New York City.
Columbia University, 722 W. 168th St., Room 518, New York
NY 10032, Phone: (212) 542-0459, aj2485@columbia.edu

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