A massage therapist’s practice is typically dominated by clients seeking to relieve some form of pain. Shiatsu is an effective, non-invasive massage style based on both Traditional Chinese Medicine (TCM) theory and Japanese massage techniques. The essence of this form of acupressure is the combination of diagnosis and therapy, allowing for a tailored treatment. While diagnosing a client’s condition in terms of Western medicine is beyond a massage therapist’s scope of practice, assessing a client’s imbalance in terms of TCM is well within a bodyworker’s realm.

Studying TCM theory is crucial for learning how to make an accurate diagnosis for shiatsu treatment. While this task looms large, a simplified guide in differentiating between excessive and deficient conditions can serve as solid starting point. In TCM, health is akin to balance. The energetic meridians traverse the entire body, and a balanced flow of energy within these meridians is analogous to a body free of pain. There is an old Chinese saying which roughly translates to:

“Where there is blockage, there is pain; where there is no blockage, there is no pain.”

A blocked meridian is an unbalanced meridian. While a majority of painful conditions are due to blockages within the meridian, there are many imbalances that can precipitate such a blockage. It is the Shiatsu practitioner’s job to uncover the primary imbalance causing the client’s pain. Once a proper assessment is made, a plan can easily be devised and applied to correct the imbalance. In the Institute’s Shiatsu Anma continuing education program, massage techniques to balance excess and deficient states are demonstrated. Choosing whether the primary causative imbalance is deficient or excessive in nature is the first step in choosing a treatment approach.


A meridian blockage is considered to be an excessive imbalance. There are three main substances capable of congesting a meridian: qi (energy), blood or phlegm.

  1. Qi Blockage: Although a blockage of qi can lead to blood congestion, qi congestion is associated more with distention rather than pain. If the pain is due to qi congestion, it moves around and will appear and then disappear. A pattern involving qi congestion typically involves depression, mood swings, frequent sighing and other emotional symptoms.
  2. Blood Blockage: When it comes to painful conditions, blood congestion is almost always the culprit. Characteristics of pain due to blood congestion are pain that is fixed in one location, stabbing or piercing pain, pain aggravated by direct pressure, dark color in the area of pain and pain that worsens with inactivity.
  3. Phlegm Blockage: Phlegm congestion is rarely responsible for pain, as it is mostly associated with internal organ disharmonies such as certain types of tumors, mucous congestion in the nose or lungs, obesity or gastrointestinal problems. An exception is headache, which can be due to phlegm congestion when the entire head feels heavy, the client is dizzy or nauseous, has low appetite and feels as if a vice is squeezing their head.


Although a majority of painful conditions are excessive cases of blood congestion, uncovering the reason for the congestion will give the practitioner a more accurate assessment of excess or deficiency. Because blood congestion can either be caused by an excessive condition or by a deficient condition, identifying the underlying imbalance is important for devising the best treatment plan. When aspects of both excess and deficiency are present, a practitioner must choose the most dominant pattern.
In general, a predominant presentation of excess is treated with dispersal and invigoration techniques, while a predominant presentation of deficiency is treated with warming and tonification techniques.

Blood Congestion Causes

While there are many causes of blood congestion causing pain, the ones most encountered in clinical practice include:

  • Qi Congestion – An excessive condition, this is a common precursor to blood congestion. A basic premise within TCM is that qi moves blood, so if qi stagnates, eventually the blood will stagnate too. (See the above section for recognizing qi blockage.)
  • Traumatic Injury – An excessive condition, the force of a local trauma causes a structural change that typically results in blood congestion. (See the above section for recognizing blood blockage.)
  • Deficiency of Qi – A deficient condition, deficiency of qi that persists over an extended period of time may cause stasis of blood as the qi becomes too weak to move blood. Qi deficiency typically manifests with low energy, breathlessness, weak voice, loose stool, spontaneous sweating, and pain that worsens as the day progresses. This type of pain can improve with applied pressure.
  • Blood Deficiency – A deficient condition, blood deficiency that persists over an extended period of time will cause qi deficiency. When the qi is too weak to move blood, blood congestion results. Blood deficiency typically manifests with pale complexion and lips, tightened and easily injured tendons, dizziness, poor memory, blurry vision, insomnia, amenorrhea and anxiety.

As taught in the Institute’s Shiatsu Anma course, Shiatsu techniques differ, with dispersal and invigoration methods used for excessive imbalances, while tonification and warming methods are used for deficient imbalances. Practitioners of Asian bodywork who master this differentiation can really utilize the strengths of TCM; by tailoring each treatment to their client, enhancing a massage’s therapeutic value and successfully ridding their clients of pain.

Recommended Study:

Shiatsu Anma


Maciocia, Giovanni, The Foundations of Chinese Medicine, Churchill Livingstone, New York, NY, 1989.

www.altmedicine.about.com, Blood Stagnation, Cathy Wong, About, Inc., 2007.

www.davidbole.com, Sports Medicine: A Chinese Medical Perspective, David N. Bole, PhD, AP, 2007.