Oketsu and TCM – Chinese medicine

oketsu and traffic congestion from mud

Oketsu is a term used in Japanese acupuncture.

Kiiko Matsumoto and David Euler’s Clinical Strategies Vol 1, pp40-43 describes it much more fully than here. This page is not intended to be a comprehensive account of it.

Since I often use the treatment for it and describe it to patients, some have asked for a page on it here.

It has a relationship to Blood Stasis in Chinese medicine. To my mind, Blood stasis is a more extreme form, whereas Oketsu covers an earlier stage as Blood starts to congeal or flow more slowly. However, in cases of Blood stagnation I use the treatment for Oketsu first before using strategies from Chinese medicine.

Oketsu is a Liver syndrome. The Liver stores Blood and releases it during exercise and for digestion and so on. Oketsu shows the Liver isn’t functioning as it should. Not surprisingly, indications for Oketsu occur in important areas associated with the Wood phase and Liver energy.

If you cannot get Western medical concepts out of your head, try to think of Oketsu perhaps as an early stage of portal vein congestion. Everything then backs up, both in the abdomen (right as well as left, including right hypochondrium), but eventually in the chest too. Looked at from this point of view, imagine if you could clear this! How many other possible conditions would improve: indeed, they might never occur!

The Theory

Blood is the mother of Qi. Acupuncture uses Qi, so if Blood cannot flow and perform its ‘mothering’ function, Qi will be harder to treat.

Hence it is one of the first actions in Matsumoto acupuncture strategy to release or dis-inhibit Blood from flowing slowly, which means treating Oketsu.

Because Hara diagnosis is so important in Japanese medicine (although it is also important in Chinese medicine), it is imperative, for any kind of healing, to ensure  the Hara is free from Oketsu. (To  understand more about the Japanese concept of the Hara, I recommend ‘Hara Diagnosis : Reflections on the Sea, by Matsumoto and Birch.)

Below are examples of symptoms associated with Oketsu.

Please note! You don’t need all of them to be diagnosed with Oketsu! In its early stages you might notice NO such symptoms, or only one or two, mildly.

Diagnosis of Oketsu – signs and symptoms

  • Digestive tract issues including constipation, pain, acidity, reflux, ulcer, colitis. All these suggest food is not properly forming into Blood, and that there may be blockages or other problems digesting food. Either way, Blood is not forming as it should, so is unable to flow as it should.
  • Allergies to food: other allergies that impede free circulation of qi.
  • Slow to recover from ill-health. More usually the illness will have been prolonged, slowing everything down, exhausting the body’s energy. As Qi slows, so does Blood.
  • Slow recovery includes slow healing from injury or accident, surgery or shock. Scars may arise from poor healing, but scars also block acupuncture channels impeding the free flow of Qi.
  • Haemorrhoids and varicose veins are obvious signs of Oketsu. Blood is pooling, unable to flow.
  • Menstrual problems with heavy bleeding, dark blood or clots and pain are another sign. However, a lack of periods might indicate it too.
  • Regular or frequent headaches, especially if right-sided or at the back of the head, around the occiput. Migraines and ‘heavy’ heads.
  • C7/T1 area may feel stiff or painful. Over time the flesh here may thicken and feel lumpy or more solid.
  • As the heart tries harder to push the blood round there may be hypertension or even palpitations.
  • Arteriosclerosis, stroke (pre and/or post)
  • The digestion and Lungs are intimately inter-connected and so Lung problems may occur such as skin problems and breathing difficulties, including asthma and TB
  • Chronic infections including of the vagina or bladder: also of toenails and athlete’s foot
  • A history of ongoing ill-health, treated with daily or at least regular (Western) medication, such as steroids, anti-inflammatories or painkillers. Often, because of the medication, the patient doesn’t get the pain or problem for which the medication is given, but there will be secondary effects at a ‘deeper’ level. (See our pages on Suppression and on Primary and Seconday Actions.)
  • A history of backache and sciatica
  • Energy deficiency. Frequent tiredness. Dizziness.
  • Lowered immunity to infection.


Psychological problems can cause or come from Oketsu

  • Ongoing anxiety
  • Depression
  • Neurosis
  • Forgetfulness
  • Insomnia and a feeling of always being sleepy


Although these are mental or emotional states, it is a ‘given’ in this health-view that they can cause physical states because they obstruct the free flow of Qi, not least round the five elements or five phases.

It works the other way round too. Physical blocks, say in the flow of qi along the acupuncture channels, can lead to mental or emotional symptoms arising from the zang fu organs associated with those channels.

Physical symptoms

Specific areas on the body help to diagnose Oketsu.

Finger pressure at these areas reveals either lumpiness or pain or discomfort which eases on treatment, along often with similar signs elsewhere that do not relate to Oketsu.

Sometimes treatment for Oketsu seems to make huge changes. If you don’t perform the Oketsu treatment, other conditions may not improve until you do perform treatment for Oketsu.

If only we needed just one treatment for Oketsu! But usually, except in young healthy people without much prior disease, I need to do Oketsu almost every time I see a patient, or at least until the patient’s health has much improved.

  • In the left abdomen, test the area around Kidney 15 and Stomach 26 or 27. So any ongoing tightness or pressure pain to the left of , and slightly below the umbilicus can suggest oketsu.
  • On the right back the area around Bladder 17 and 18, both shu and Huatuo-jiaji points.
  • Right occiput: a pain here or from pressure also points to Oketsu.


Other, observable signs of Oketsu include

  • weak circulation to the peripheries,
  • darker skin colour (eg on hands, fingers, or lips and under eyes – for example if there are bags under the eyes)
  • hot flushes with cold hands and cold back

Treatment of Oketsu

Three main points and a host of subsidiary strategies treat Oketsu.


Liver 4
Liver 4 – Copyright Acupuncture-Points.org
  • Liver 4 (left) (the Japanese use a point slightly distal to the location of Chinese Liver 4 shown in image above)
  • Lung 5 (left – Japanese position is somewhat lateral to Chinese Lung 5; almost half-way to LI11)
  • A point between LI and TB channels at the level of between LI10 and LI11 (bilateral) (known as Master Nagano’s immune point)


(Note: a treatment point’s location may be slightly different from the point described in the literature. If so, use the point that works!)

First, palpate then release the diagnostic point. Now press the first treatment point to discover where and in what direction it releases or reduces the discomfort or sensation at the diagnostic point. Then needle the treatment point exactly in the direction and to the depth found when testing. Then re-test the diagnostic point.

Sometimes just one treatment point makes a substantial contribution and no more is needed. This contribution evidence comes from testing other diagnostic points, not necessarily associated with Oketsu.

In other words, releasing oketsu reduces other problems.

This supports the statement in Matsumoto and Euler’s Clinical Strategies that “Without the free flow of Qi and Blood, treatments are less effective and the healing process will be hindered.” (P43)

Jonathan Brand colours

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2 Responses

  1. Thank you so much for your humour and TCM knowledge! I’ve just bought all your books and I’m enjoying Qi Stagnation book. I’m back on the ACV and have felt the benefit within days.

    Have you written anything on (Peri)Menopause at all? And what about a Points book? Great to hear of practitioners experience with points which can sometimes greatly differ from historical texts.

    Many thanks again for your contribution. Please keep writing!

    1. Thanks, Cathy, for your praise! I hope the books are useful.

      As yet I have no pages specifically on (peri)menopause. It’s on the to-do list, however!

      I don’t plan a points book at the moment. Partly this is because over time I’m adding pages on individual points to the site, and partly because there are some great books out there already.

      Thanks again!

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