What is Hara Visceral Work?

Compiled by John G. Connor, M.Ac., L.Ac., Edited by Barbara Connor, M.Ac., L.Ac.

TABLE OF CONTENTS

Introduction

What is Hara Visceral Work?

Description of Visceral Manipulation

Integrating Acupuncture with Hara Visceral Work

Types of Visceral Restrictions

Evaluation and Treatment Techniques

Indications for Hara Visceral Work

Implications of Organ Dysfunction

Contraindications for Hara Visceral Work

References

INTRODUCTION

o       Barbara and I first became interested in Japanese hara abdominal diagnosis and treatment when we were in acupuncture school.  It gave us a deep appreciation for the importance of the hara or viscera in both diagnosis and treatment in Chinese Medicine.  In order to refine our sensitivity in this work we found it helpful to integrate the principles and techniques of visceral manipulation (also known as organ-specific fascial mobilization) with hara abdominal palpation. Therefore we took the Upledger Institute’s I-A, I-B and II Visceral Manipulation courses to enhance our palpatory and treatment skills in this area.  Hara visceral work, which integrates hara abdominal diagnosis and treatment with the gentle techniques of organ-specific fascial mobilization, is a wonderful complement to the acupuncture fascial energetics work of craniosacral acupuncture.

o       We have found that hara visceral work when used in conjunction with acupuncture and craniosacral therapy is an extremely effective tool for treating many disorders. We are constantly amazed at the results we are able to obtain combining these modalities.  We hope this article gives you a better understanding of what hara visceral work is and how it can benefit your health.

WHAT IS  HARA VISCERAL WORK ?
o      What is it about the abdomen or the hara that makes it so central to the practice of Japanese and Chinese Medicine?  Matsumoto and Birch describe the importance of the hara in Japanese Medicine as not only being a physical center but an energetic center as well.  In Japan the concept of hara is much larger than the simple idea of the abdomen or the belly.  It is part of a pervasive social and cultural concept, rooted in the Chinese classics and the practice of meditation. The classical Chinese Medical text, the Nan Jing, talks about the function of the abdomen or hara in treatment, in diagnosis and in the natural function of the body.   In the Nan Jing it states that “The source of the vital energies is the root origin of the 12 meridians, it is the ‘moving qi between the kidneys’ which is in the abdomen.”

o      Thus the abdomen is more than just the physical center in which the organs reside.  It is the residence of the source of the body’s energies, the energetic center from which life springs.  Understanding this is central to promoting the well being of the person. Even the pulse and its indications are “downstream” from the hara.  Thus, diagnosing and treating the hara is central to the practice of Oriental medicine.

o      In Chinese Medicine the hara is known as the Lower Dantian and is located about an inch below the navel.  The hara is the root of vital energy as well as the nervous system and muscular energy.  It is the furnace that produces life and at the same time it is the source of life regulating our physiological and spiritual well being.  It is seen as controlling the metabolism of the blood and the organs and producing the qi that flows along our meridians.

o      Together with Yin-Yang theory, Five Element theory constitutes the basis of Chinese Medical theory.  According to the Five Elements each organ is connected to a different emotion or personality trait.  Thus the Liver is connected to irritation, frustration, depression or anger as well as being confident and intuitive.  The Heart is connected to over-enthusiasm or sadness as well as radiating love and peace.  The Spleen is connected to over-possessiveness or worry as well as being sympathetic and supportive.  The Lungs are connected to grief or withdrawal from life as well as letting go of the past.  And the Kidneys are connected to fear, domination of others as well as having a firm will.  Thus treatment of the organs in hara visceral work helps address these emotional concerns as well as the physical ones.

o       The Japanese shiatsu therapist, Naoichi Kuzome, suggests using the following guidelines when treating the abdomen:
  §         Use the tips of the fingers.
  §         Apply pressure with the fingers perpendicular to the abdomen.
  §         Use the tips of the fingers.
  §         Use the tips of the fingers.
  §         Apply pressure with the fingers perpendicular to the abdomen.
  §         First touch the skin level, then press to deeper levels.
  §         Keep the patient relaxed, the patient’s legs stretched.
  §         The patient should have an empty bladder.
  §         Keep at the same level as the patient.
  §         Use no pillows, or only a head pillow.
  §         Have the patient lie face up, arms at the sides, legs extended.

DESCRIPTION OF VISCERAL MANIPULATION

 Visceral manipulation is a manual therapy developed by the French Osteopath, Jean-Pierre Barral, consisting of applying specific forces which stimulate the mobility and motility of the tissues.  In visceral manipulation one treats the fascia in between and around the organs.  All organs have articular surfaces so that they can glide and slide in relationship with one other.  It is mobility not position that determines dysfunction or pathology.  An organ in good health has physiological motion. Visceral Manipulation is specific for diminished movement of organs and in its application we are able to get motility and mobility back for each specific organ.  These gentle manipulations can not only improve the functioning of individual organs and systems, but the structural integrity of the entire body.

o       Barral describes visceral manipulation as a method of restarting the mobility or motility of an organ utilizing specific, gentle forces.  In other words, we provide a stimulus to which the body responds.  We simply manipulate to the point where the body can take over in order to achieve self-correction, not to force a correction on the body.  He feels that it matters very little if a particular articulation, organ or cranial bone is deformed or in an asymmetrical position.  What matters is whether it is mobile.  For example, a retroverted and fixed uterus is pathogenic; but a retroverted, mobile uterus is fully functional.

o       Both visceral manipulation and craniosacral therapy are fascial therapies. But sometimes we need to go deeper than acupuncture or craniosacral therapy will go.  In these circumstances we find hara visceral work to be very useful.

o       90% of neuro-muscular-skeletal problems have a visceral component to them.  We believe we can never make a lasting change as long as there is a fascial visceral problem at the bottom of a neuro-muscular-skeletal problem and we don’t address it.

o       Visceral restrictions result in a decrease in the mobility and motility of organs.  They can be caused by adhesions, fixations, etc.  All viscera should function properly without any restrictions.  Any restriction, fixation or adhesion to another structure, no matter how small, implies functional impairment of the organ. Hara visceral work helps restore this mobility and motility along with acupuncture.

INTEGRATING ACUPUNCTURE WITH HARA VISCERAL WORK

o       According to Barral in almost every case of nervous depression, the motility of the liver is affected.  The Liver, in Oriental medicine, is called the “sea of emotions” and is considered interdependent with the psyche.  He has found this connection valid in his own work.  He also acknowledges that from an energetic viewpoint, the Kidney is responsible for the deep layers of the body’s energies.  He finds that the kidney has a strong relationship to the liver; so strong, in fact, that liver dysfunction is generally an indication for treatment of the kidneys, and vice versa.

o       According to one commentator on the Nan Jing in order to understand the theory of the Source of Qi we need to palpate the abdomen. This is one of the reasons hara (abdominal) palpation and treatment is so important to the practice of Oriental medicine in Japan and why it was of concern to the classical authors.  The Nan Jing theory states that there is an energetic center to the body in the abdomen below the umbilicus.  This center has a physically central location and is the source of the body energetically.  Around this center revolve all the other types of energetic manifestations such as the meridians, the five yin organs and six yang organs.  It is the source of all movement in the body and is itself described as a moving qi.  Most frequently it is known as the “moving qi between the kidneys”.

o       Traditional Chinese Medicine (TCM) holds that the organs are invested with both essence and qi.  Organ qi provides the capacity for the organs to perform their functions.  Visceral motilityis a manifestation of such organ qi.  The meridians of TCM are energetic channels and they flow in the fascial tissue.  The meridians take advantage of the numerous fascial connections to infiltrate every region of the body; providing the essential interconnections between the various organs and tissues of the body.  Acupuncture’s role in hara visceral work is derived from this unique ability to regulate organ qi as well as move meridian qi.

o       Modern research has shown that the insertion of acupuncture needles to any point in the body can produce an increase in vasomotion throughout the body.  This conclusion has far reaching implications for the integration of acupuncture with hara visceral work. Because this means that the increase of microcirculation and vasomotion resulting from the acupuncture stimulation will 1) increase the oxygenation of the tissues, 2) will help flush toxins, 3) will help flush waste products and other accumulated particles and chemicals from the tissues and 4)  improve their overall function and thereby enhancing the overall effect of the hara visceral work.

o       It is also known that physiological activity can be increased or decreased by the small electrical currents stimulated by acupuncture.  And because of the nature of the connective tissues, it is possible that these effects could occur both locally, at the site of the needle insertion, or at a distance from the acupoint.  Barbara and I employ these principles, and those described above, in selecting acupuncture points which act to enhance our hara visceral work, and not only increase the mobility and motility of the organs themselves but also the overall health and well being of each patient. (For more information on the detailed workings of acupuncture we invite you to read our article entitled How Acupuncture Works.)

o       The Ling Shu (a classical Chinese Medical text) promotes the Triple Burner system as the groundwork for the body.  In effect it says the Triple Burner is the fascial system.  It is via the fascial system that acupuncture as well as organ specific visceral mobilization and craniosacral therapy works.  Bioelectricity and biomechanical energy can be conducted to any part of the body through the fascia.  The meridians are the energetics of the fascial system.  In visceral work we are also working with fascia.  Through the stimulation of acupoints we are creating an effect on the fascia of the body. Therefore working manually with the fascia through fascial specific organ mobilization or hara work and combining it with the energetics of acupuncture we are creating a powerful and useful combination for the treatment of many conditions.

o       The fascial system — being a continuous sheet of connective tissue — permits a virtual connection of all the cells of the body.  The Triple Burner system is the equivalent of the fascial plane in Chinese Medicine.  That is why when we insert an acupuncture needle anywhere in the body we are having an effect.  This is also how the Eight Extraordinary Vessels work and how Ah Shih points work.  Powerful points like St-36, Sp-6, P-6, LI-4 have a lot of energy associated with them — the idea being that there is more of a fascial influence at those points.  We use acupuncture to help break up the Qi Stagnation and/or Blood Stasis that often accompanies visceral restrictions.

TYPES OF VISCERAL RESTRICTIONS

o       Articular Restrictions (Adhesions and Fixations) – bring about a loss of mobility and motility because of the inefficient sliding of the organ on its surrounding structures.   A visceral restriction occurs when an organ loses part or all of its ability to move.
o       Adhesions – involve partial loss of movement. Adhesions may occur as the result of tissue damage to the abdomen or thorax  from surgery and other types of tissue damage including traumatic injury, hematomas, inflammatory diseases, intraperitoneal chemotherapy, radiation therapy, infections which cause abscesses, and scars. Adhesions cause two organs to stick to each other which changes the pressures in the abdominal cavity and creates a pulling and tension in the body which in turn creates a detrimental effect on all fascias and structures of the body.  All inflammatory symptoms present a risk of adhesion or a significant decrease in mobility.

§         According to a review on abdominal adhesions by Subhuti Dharmananda autopsy investigations indicated a 90% incidence of adhesions in patients with multiple surgeries, 70% incidence of adhesions in patients with a gynecologic surgery, a 50% incidence of adhesions with appendectomy, and a greater than 20% incidence of adhesions in patients with no surgical history. 
§         The most frequent problem with adhesions is a constriction of the small intestine, producing constipation.  Abdominal pain is another common symptom, caused when the bands of scar tissue bind up the internal organs so that movements pull on them.
§         Adhesions may also impair fertility in women by causing blockage of the fallopian tubes.  Adhesions involving the ovaries or fallopian tubes are responsible for 15-20 percent of female infertility cases.
§         At least one-third of women who suffer from pelvic pain have adhesions as a cause of or contributor to the pain.

o      Fixation – results in total loss of movement.

o       Ligamentous laxity – refers to loss of elasticity in the ligament from prolonged overstretching, usually secondary to adhesions.

o       Viscerospasm – may be caused by adhesions, emotions or food allergies. Gastritis is an example where the irritation causes a reflex restriction which leads to immobility.  This restriction can lead to a duodenal ulcer.  With viscerospasm motility is affected first.  Mobility is only decreased when the organ’s attachments are affected.

o       Trauma – according to Barral, refers in a general way to all bodily lesions resulting from any form of external assault.  The concept of trauma can be extended    to other thermal, chemical, physical or mechanical phenomena which cause injury.  Upon traumatic impact, a large part of the applied energy is transmitted by vibrations traversing the soft and osseous tissue.  Strong, abrupt impact causes vibratory waves capable of producing significant lesions.  Certain lesions may be located far from the point of impact.  Even in the case of lateral cranial impact osteopaths often find that shock waves affect abdominal organs such as the liver, spleen and kidneys. In another example he explains that the viscera are not spared the effects of falls on the buttocks.  Prolapse of the kidney is often caused or worsened by this type of impact.

EVALUATION  AND TREATMENT TECHNIQUES

o       Examination and diagnosis is done by assessing the motility and mobility of the specific visceral organs.  In doing hara visceral work we determine three-dimensionally where the tensions are, then we work with those tensions, determining in which directions they are oriented. We then use the various techniques to release those tensions.  Hara visceral work is not Treatmentsing forces in our hands.  It is Treatmentsing the tensional forces in the body.  We have to go in deeply a lot of the time, but we do not go in hard.  A restriction attracts the hand of the practitioner.  As Barral says “The body hugs the lesion”.  Therefore the body side bends or moves towards that area, organ, artery or nerve where there is a tension or restriction.  80% of the time the following tests will enable us to quickly find the main restriction.

o       Physiologic motion can be divided into two components: mobility and motility.
§         Mobility is the visible extrinsic movement of a structure in response to its environment.  This motion is in response either to the somatic nervous system (gross physical movement) or to the motion of the diaphragm during breathing.  In mobility, we as the practitioner move the organ from one place to another. 

§         Motility is the innate intrinsic motion of a structure, occurring independently of the causes of mobility.  Many viscera possess an intrinsic motion of low frequency and low amplitude, generally invisible to the naked eye.  In motility we are more passive and wait for the organ to exhibit its more inherent subtle energetic rhythm. The motility of an organ is affected in a few ways.  Restrictions in the surrounding tissues can cause adhesions or fixations which change the axes, upset the symmetry and decrease the amplitude of motility.  Of all the visceral techniques, motility is the one that interacts most with the patient’s energy.

o       Every cycle of motility has 2 phases: expir and inspir.  The frequency is 6-7 cycles/minute.  Expir is the movement of an organ closer to the median axis and inspir is the movement of an organ away from it. In the case of organs located on the median axis, inspir moves them anteriorly while expir moves them posteriorly.  Motility is a very subtle movement, but it is not the same movement as the craniosacral rhythm.  It is independent and separate from the craniosacral rhythm.  (For more information on the craniosacral rhythm please refer to our article entitled What is Craniosacral Acupuncture?)

o       In local and general listening techniques we let the body and the tissues “speak”.  We listen to the tissues and follow the movements. Inhibition and local listening are the heart of general listening.  The body creates compensations and adaptations in response to restrictions.  Listening involves feeling the three-dimensional vectors and forces of the organs and tissues and “stacking” them.  We engage that space, creating a mechanical dialogue so-to speak, until the person’s body figures out how to use that force.  We want to be very specific and at the same time go deep, being gentle, not hard.

o       Local listening is performed on a specific area such as the thorax or lower abdomen, and enables us to determine the exact location of a restriction. It is indispensable in hara visceral work. Barral feels that the body knows where its own problems lie, and draws the practitioner’s hand to that area.

o       Induction technique is a technique for normalizing motility, combining listening and direct action.  Induction works better on tissues which are primarily muscular as opposed to ligamentous.

o       Inhibition – temporarily stops the attraction into the listening line.  Inhibition techniques consist of inhibiting tensions in the tissues by gentle pressure.

INDICATIONS FOR HARA VISCERAL WORK

o       Hysterectomy always creates adhesions which create postural changes and tension in the vertebral column, etc.
o       Adhesions may impair fertility in women by causing blockage of the fallopian tubes
o       Impotency in men is helped by treating the left kidney.
o       Visceral manipulation of the bladder is particularly effective for incontinence. e.g. if the bladder is stuck up against the pubic bone the bladder neck can not move normally.
o       Decreased hepatic metabolism, biliary stasis, nervous depression, decreased immune responses and periarthritis of the right shoulder – are all primary indications for hepatic manipulation.
o       Hiatal hernia responds very well to visceral manipulation.
o       The stomach is an organ for which many problems can be resolved by visceral manipulation.
o       Duodenal ulcers, following surgery of the small intestine, appendectomy – are all indications for visceral manipulation.  Mobility of the duodenum is essential for correct digestion.
o       Constipation due to mechanical origins – responds very well to visceral manipulation.
o       A spasmodic colon, also known as IBS, is a good indication for our manipulations.
o       Recurring urinary tract infections are the most characteristic indication for visceral work.
o       Surgical procedures often cause restrictions of the peritoneum.  Laparoscopy often causes anterior peritoneal adhesions which can lead to many problems

o       Other indications for visceral work include cases of uterine malpositioning, dyspareunia linked with bladder problems, ptosis and restriction of the bladder and surrounding organs, low back pain, sciatica and other musculoskeletal disorder of the lower extremities.  Barral believes that lower back problems, particularly in women, are usually secondary to the problems of urogenital organ position rather than to disc problems.

IMPLICATIONS OF ORGAN DYSFUNCTION

o       Tension in the liver will pull on the right diaphragm which in turn pulls down the pleura which connects to the cervical area, clavicle and first rib causing a pull on the right shoulder. 2) The liver is also related to the phrenic nerve which innervates a large part of the diaphragm.  3) A decrease in the motion of the liver can cause a patient to feel tired, whereas when the mobility or motility of the liver is improved the patient will typically feel invigorated within 2 to 3 days.

o       Adhesions between the kidney and psoas muscle will cause contraction of the psoas muscle which causes the femoral head to be pulled into the acetabulum causing increased pressure in the side of the joint adversely affecting the supply of nutrients to the cartilage.  As a result the cartilage will start to disappear and become arthrotic.  It can also side bend the lumbar part of the vertebral column and the disc will compress to one side and you will get neurological complication the opposite leg.

o       Problems with the fascia in the stomach can cause problems in C-3 and C-4 vertebrae (and also to T-5 and T-9) of the neck via the phrenic nerve.  2) If the stomach is constantly under tension HCl is stimulated.

o       The pleura can pull on the peritoneum which can pull on the psoas muscle which can in turn cause low back pain.  2) Restrictions in the peritoneum can also have a very big influence on the physiology of the uterus.

o       According to Barral a urogenital problem can render a leg or foot joint more susceptible to injury, and vice versa.  The most frequent restrictions are those of the inferior tibiofibular joint, navicular and fifth metatarsal.  2) Barral also notes that segments of the lumbar spine, sacrum and coccyx are typically affected in urogenital disorders.

o       Arthritic problems in the cervical spine can be due to pleural tensions.

o       Pain in the tenth rib area is often due to inserting of the diaphragm to the hepatic flexure on the back sides of the left phrenico-colico ligament.

o       Dysfunctional articulation in the visceral system affects the vagus nerve which connects to the membranous system in the head and can result in left and right sided headaches or migraines.

o       If someone has pain in the hip with each step it may be due to the exchange of fascial fibers of the transverse acetabular ligament with the fascia of the bladder.

o       Uterine restrictions can contribute to uterine fibroids.

CONTRAINDICATIONS FOR HARA VISCERAL WORK

o       Infections – visceral mobilization increases vascularization and it can throw a person into a crisis.  The bladder is an exception.
o       Any abnormal, sudden or acute pain is a contraindication for hara visceral work.
o       Any induration, tumor or mass.  When these are sensitive, even if not painful, they may represent such problems as salpingitis, adnexitis, ectopic pregnancy or ovarian cysts.  Whether malignant or benign, a bleeding tumor is a contraindication for any direct technique because of the significant risk of increased hemorrhage.
o       Fevers – visceral mobilization increases vascularization and it can throw a person into a crisis.
o       Cancers – the risk is very, very high that visceral mobilization might throw a person with cancer into crisis.
o       Pregnancy, abdominal aortic aneurysm, duodenal ulcers beginning to perforate, gallstones, IUDs and fractures are all contraindications for hara visceral work.
o       Be very cautious when a kidney is painful or sensitive and also easy to palpate.  Never manipulate a kidney when there is fever or blood in the urine.
o       All hemorrhagic symptoms necessitate much care and a precise diagnosis.  Do not proceed if you have any doubts.

REFERENCES

Barral, Jean-Pierre, The Thorax, Seattle: Eastland Press, 1997
Barral, Jean-Pierre, Urogenital Manipulation, Seattle: Eastland Press, 1993
Barral, Jean-Pierre, Visceral Manipulation II, Seattle: Eastland Press, 1999
Barral, Jean-Pierre & Alain Croibier, Trauma, Seattle: Eastland Press, 1999
Barral, Jean-Pierre & Mercier Pierre, Visceral Manipulation, Seattle: Eastland Press, 1997
Birch, Stephen, L.Ac., Ph.D, notes from seminar given at Northwest Institute of Acupuncture and Oriental Medicine entitled “The Kozato Study Method: Pulse and touch as Feedback and Study Methods” March, 1995
De Koning, A.J., D.O., Visceral Manipulation IA Class Notes, Dec. 1999
De Koning, A.J., D.O., Visceral Manipulation II Class Notes, Feb. 2002
Dettmann Ahern, Dee, Visceral Manipulation IB Class Notes, Aug. 2001
Dharmananda, Subhuti, Ph.D., “Abdominal Adhesions: Prevention and Treatment”, Portland, OR: Institute for Traditional Medicine, May, 2003
Holland, Alex, L.Ac., notes given at the Northwest Institute of Acupuncture and Oriental Medicine, Neuro-Muscular-Skeletal class, May 15, 1995 & March 18, 1996
Lade, Arnie, Energetic Healing, Twin Lakes, WI: Lotus Press, 1998
Legge, David, D.O., Dip TCM, Close to the Bone, Woy Woy, NSW Australia: Sydney College Publications, 1990
Lowen, Frank, M.T., Visceral Manipulation 1A Study Guide, The Upledger Institute, 1998
Lowen, Frank, M.T., Visceral Manipulation 1B Study Guide, The Upledger Institute, 1998
Maciocia, Giovanni, The Foundations of Chinese Medicine, Edinburgh: Churchill, Livingstone 1989
Matsumoto, Kiiko and Stephen Birch, Hara Diagnosis: Reflections on the Sea, Brookline, MA: Paradigm Publications 1988
Milne, Hugh, The Heart of Listening, Berkeley: North Atlantic Books, 1995
Netter, Frank, M.D., Atlas of Human Anatomy, New Jersey: CIBA-GEIGY Corporation, 1989
Ross, Jeremy, Acupuncture Point Combinations, Edinburgh: Churchill Livingstone, 1995
Weizenbaum, Sharon, notes from seminar given at Northwest Institute of Acupuncture and Oriental Medicine entitled, “Acupuncture, Gynecology and Abdominal Diagnosis” August, 1995
Wexler, Gail, R.P.T., C.V.M.I, & Lowen, Frank, M.T., Visceral Manipulation II Study Guide, The Upledger Institute, 2000

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Compassionate Acupuncture and Healing Arts, providing craniosacral acupuncture, herbal and nutritional medicine in Durham, North Carolina. Phone number 919-309-7753.

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