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Shiatsu Certification

Approved for 8 Online Continuing Education Units/Credits (CEU's) for Pennsylvania Licensed Massage Therapists

Receive Your 8 CEU's Now

Approved for 8 Online CEU's for Pennsylvania Licensed Massage Therapists. Cost $100.00 / Certificates Awarded Upon Completion.

Please allow time for your purchase to process. We will contact you via email with instructions to access the online course as soon as your payment is complete. Please make sure your email address is correct. Thank you for your patience. 


Shiatsu is a Japanese type of bodywork that grew out of the human need to touch others and to make others feel better by being touched. It makes use of the ancient connection of human beings to the earth, to the universe, and to each other. It involves art and science, theory and practice, and intellect and intuition.

In Japanese, shi means “finger” and atsu means “pressure,” so shiatsu is literally “finger pressure.” However, shiatsu involves much more than the practitioner simply placing fingers on the client’s body. Shiatsu is based on the same principles as acupuncture, which is part of traditional Chinese medicine. Traditional Chinese medicine views the entire human being as body, mind, and spirit. Every living thing is part of the greater continuum of its environment, the earth, and the universe. Qi (pronounced “chee”) is the Chinese term for the energy or force that gives and maintains life. Qi is also the body’s “energy,” which can be thought of as vitality or vigor. Optimally, Qi flows within living creatures in a balanced, harmonious way, sustaining health. If Qi is not flowing properly, disharmony and lack of balance result in pain, discomfort, or other disorders.1

Qi (Ki, pronounced “kee,” is the Japanese term) flows in specific streams in the body called channels or meridians. These channels are connected to the organs of the body and share the name of the organ. Examples are the Lung Channel, Large Intestine Channel, Stomach Channel, and Spleen Channel. The organs and channels have physical, mental, psychologic, emotional, and spiritual functions in the body, and the balanced flow of Qi in the channels sustains these functions2 (Figure 16-1).


FIGURE 16-1 ​Channels of Qi flow in the body. (From Anderson SK: The practice of shiatsu, St. Louis, 2008, Mosby.)

When the flow of Qi is disrupted for any of many possible reasons, it can be brought back into equilibrium by addressing either the entire channel or points along the channels. The points are where the Qi is accessed easily. Acupuncturists insert needles into the points to balance Qi. Shiatsu practitioners use their own Qi (Ki) through manual techniques such as thumb and finger pressure to support and stabilize the client’s Qi. Some types of shiatsu focus mainly on addressing points; other types address the entire channel.

The goal of shiatsu is to help rebalance the client’s energy and alleviate discomfort. Shiatsu typically is performed on a futon (mat) on the floor, covered by a single sheet. Small pillows or bolsters can be used to support the client comfortably. Shiatsu can also be performed with the client lying on a massage table or sitting in a chair. 302Relaxing music can be played. Hand cleaner, such as witch hazel or diluted alcohol, and a hand towel are also placed within easy reach. The cleaner can be used by the practitioner to freshen up the client’s feet or to clean the hands before working on the client’s face.

Because of the nature of the techniques used, such as stretches and joint mobilizations, the practitioner and client need to wear comfortable, loose-fitting shirts and pants. Drawstring or elastic-waist pants work the best. Jeans and pants with zippers should not be worn because they inhibit movement and the zippers can pinch the skin during certain shiatsu techniques. Skirts and shorts should not be worn by either the practitioner or the client. Because of the movements of the practitioner and the stretches and joint mobilizations the client will experience, skirts and shorts may be too revealing.

If the practitioner has long hair, it should be tied back during the treatment to ensure that it does not drag across the client or become distracting to the practitioner. Fingernails should be short, and rings, watches, bracelets, dangling necklaces, or dangling (noisy) earrings should not be worn during the treatment. Shiatsu can be done in bare feet as long as the feet are clean or in clean socks.

The practitioner should ask the client to remove a belt, if one is being worn, for the treatment so that leg stretches and hip mobilization techniques can be performed more easily. The client should also remove any bracelets, necklaces, or watches that may interfere with the treatment.


Shiatsu does not require lubricants. Techniques used include palpation, physical manipulation, stretches, and joint mobilizations. In addition to finger pressure the shiatsu practitioner may use pressure from the thumbs, palms, forearms, elbows, knees, and feet during the course of the treatment. The shiatsu practitioner’s strength comes from the center of the body (abdomen and hips) and is transmitted outward through the extremities. However, the physical movements a practitioner uses are guided by foundational knowledge, perceptions, and insight gained by trusting intuition (Figure 16-2).


Shiatsu has roots that extend deep into millennia of traditional Chinese medicine. Its techniques come from systems 304developed by common people, imperial physicians, blind practitioners, and physicians for the samurai. Once they have learned these historical techniques, contemporary practitioners also contribute their own unique methods and ideas.

One of the oldest forms of body treatments in Asia, An Wu, developed in China more than 5000 years ago. An Wu resembled Western massage. It consisted of pressing, gliding, stretching, and percussing the body. The practitioner used thumbs, fingers, forearms, elbows, knees, and feet on the points along the channels of Qi flow.

At the same time, traditional Chinese medicine concepts were being developed. In brief, the ancient Chinese viewed themselves as part of nature and the universe around them, with Qi as a unifying factor. Because of the view that health and disease were both on a continuum of Qi flow, An Wu and traditional Chinese medicine naturally developed together. As ancient practitioners worked with Chinese medicine and physical manipulation techniques on the body, they became their culture’s physicians. Gradually, An Wu came to be known as Anmo, which began to become popular as a medical treatment.

By the fifth century, Anmo had developed into a more sophisticated system of theory, diagnosis, and treatment and had spread to other Asian countries such as Korea, Japan, and India. Throughout the ages, as more and more physicians palpated and massaged patients, they pinpointed the effects of pressing certain locations on Qi channels. These locations on Qi channels were narrowed down into points. Over time, pressure on these points became more and more precise, until needles were finally inserted, which gave birth to acupuncture. The points were named, numbered, and classified in the system that is still used today. This system is common to both acupuncture and shiatsu.

Acupuncture gradually took over in China as the primary form of medicine. However, palpatory and massage techniques remained important foundational methods. During the sixth century ad, monks from China traveling to Japan brought with them combinations of Chinese philosophies that included Buddhism, Taoism, and Confucianism. They also brought knowledge of Chinese medicine. Trading between China and Japan opened up more communication between the two countries, and Japanese students were sent to China to learn more about Chinese culture and medicine.

Acupuncture and Anmo, with their basis in Qi, were readily infused into Japanese culture. As the years progressed, acupuncture remained relatively the same as when it arrived in Japan. However, Anmo was modified and refined to fit Japanese culture and gradually evolved into Anma (Amma). Japan’s early history was marked by the presence of many warring states and no unified central government. By 1185, these states were known as shogunates, and their leaders were called shoguns. They had highly trained, armed men called samurai to fight their battles. The fighting techniques the samurai used are the origins of modern Japanese martial arts. The medical practitioners in Japan were expected to keep these men healthy and fit. Anma became a mixture of the original Anmo techniques imported from China and techniques specifically developed for samurai needs.

During the Edo period (1602-1868) Anma reached its height of popularity. New Anma techniques and methods were developed, schools were established, and texts were written to teach Anma. The shogunates had been organized into a functioning country ruled by one shogun appointed by Japan’s emperor. Along the way, the samurai lost most of their importance. Over time, their fighting techniques meshed more with Buddhist, Tao, and Confucian philosophies than with actual combat, and the modern martial arts were born.

During the mid-1800s, the power of the shoguns fell. The Meiji period of Japan (1868-1912) saw an overhaul of the Japanese government, which was re-created in a Western framework. Western medicine dominated, and traditional medicine was relegated to the realm of folk medicine. The therapeutic value of Anma and Asian medicine was rejected, although segments of the population still retained their attachment to these practices. Also during this time Western massage therapy was introduced to Japan.

By the beginning of the 1900s, Anma had lost so much credibility that it was considered shady employment. The practitioners of the true art of Anma sought a way to distinguish themselves from charlatans and “body shampooers.” A new name was needed, and in 1919, Tamai Tempaku published a book called Shiatsu Ho, which translates as “finger pressure method.” This text united Anma and Western anatomy and physiology and used concepts from Ampuku (a type of abdominal massage) and Do-In (self-massage).

Shiatsu began to develop differently from established techniques and principles used in authentic Anma. Shiatsu practitioners started merging Western techniques from chiropractic medicine and massage therapy with conventional Anma methods. Western medicine concepts such as anatomy, physiology, and psychology were used along with traditional Chinese medicine theory.

In 1925 the Shiatsu Therapists’ Association was formed to promote shiatsu as a legitimate profession and to distinguish it from Anma. Also in 1925 Tokujiro Namikoshi (1905-2000) founded the Clinic of Pressure Therapy in Hokkaido, Japan. As a child, Namikoshi discovered his gift for manual therapy by helping alleviate his mother’s rheumatoid arthritis symptoms. He went on to study Anma and Western massage therapy. Because he studied both subjects, his focus was to practice shiatsu within a Western structure. Instead of emphasizing the study of channels, he concentrated on the physical structure of the body and the nervous system, and stressed the anatomic locations of points. The Namikoshi style of shiatsu involves application of methodical patterns of pressure along the points. In the succeeding years, both the conventional and Western (Namikoshi) styles of shiatsu were taught and practiced. In 1940 Namikoshi opened the Japan Shiatsu Institute in Tokyo, which helped further awareness of shiatsu as a valid profession.


In 1955 the Japanese government officially recognized shiatsu as a part of Anma. This was the first legal sanction of shiatsu. In 1957 Namikoshi’s Japan Shiatsu Institute was licensed as the Japan Shiatsu School by the minister of health and welfare. The school proved to be enormously popular, and Namikoshi’s son Toru went on to teach shiatsu in Europe and the United States, thus helping spread shiatsu beyond Japan’s borders.46

Because shiatsu is a mixture of traditional and modern concepts and techniques, innovation is inherent in this type of bodywork. Many modern derivatives exist. Following is a brief explanation of the most common types of shiatsu currently practiced. All styles of shiatsu involve working with Qi in some way to bring about balance in the client’s body (Box 16-1).

Shiatsu is a Japanese form of bodywork. Based on the same principles as acupuncture, it is performed on a fully-clothed client on a futon on the floor. Instead of using needles to change Qi (Ki) flow in the client’s channels to alleviate pain and other discomforts, shiatsu practitioners use their palms, fingers, thumbs, forearms, elbows, knees, and feet to apply pressure. Shiatsu has a long and interesting history involving traditional Chinese medicine, shoguns, and Eastern philosophy. Today, many different forms of shiatsu are practiced, such as Namikoshi, Zen, Ohashiatsu, Five Element, and macrobiotic or barefoot shiatsu.

Western anatomy, physiology, and pathology are important foundational topics in the study of shiatsu. Equally important is traditional Chinese medicine, which includes Yin and Yang, Qi, and the Five Elements. The channels the Qi (Ki) flows through are connected to organs of the body, and most of them are named for these organs. The channels are in Yin-Yang pairs, and each pair of channels corresponds to one of the Five Elements.

Many different techniques are used in shiatsu. Basic ones include palming, thumbing, fingertip work, dragon’s mouth, simple stretches, and range-of-motion techniques for the joints. The Four Methods of Assessment are methods the practitioner uses to determine what the client needs. During the course of the treatment session, the practitioner uses his or her Ki connection with the client, touch sensitivity, and intuition to know what techniques to apply along which channels to make the treatment customized for the individual client.

See this technique in practice

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Receive Your 8 CEU's Now

Approved for 8 Online CEU's for Pennsylvania Licensed Massage Therapists. Cost $100.00 / Certificates Awarded Upon Completion.

Please allow time for your purchase to process. We will contact you via email with instructions to access the online course as soon as your payment is complete. Please make sure your email address is correct. Thank you for your patience.