therapists, requires practitioners to hold a Diploma in Shiatsu and Oriental Therapies HLT52215 (or equivalent), to undertake a minimum of 20 hours continuing professional education annually and hold a current first aid certificate (12). The same (HLT52215) course may also be recognised by other associations as qualifying for Oriental (TCM) Remedial Massage Therapy. The HLT52215 curriculum covers a range of shiatsu and traditional oriental/Chinese medicine modalities. While the curriculum focuses on the application of acupressure and massage, students are also trained in traditional Chinese medicine diagnosis and the application of moxibustion, cupping, self-acupressure, oriental diet, corrective exercises, lifestyle, relaxation, breathing techniques and meditation (7). Shiatsu draws on traditional Chinese philosophies and theories such as Yin and Yang, the energy meridians, the five elements and the concept of Ki. The therapist aims to identify and correct imbalances in the flow of Ki, or energy in a recipients meridians to promote self-healing (11, 13). A shiatsu session typically begins with a clinical history followed by an examination to formulate a traditional Chinese medicine diagnosis that is used to individualise the therapy (11, 13, 14). Examination methods include palpation (ampuku) of the hara (abdomen) or back, pulse, tongue and face diagnosis to assess the relative constitutional and energetic qualities of the internal organs and their related meridians (11). Shiatsu massage is a derivative of traditional Japanese (Anma or Amna) massage that has its origins in traditional Chinese (Tuina) massage. There are various styles of shiatsu practiced in Australia and include: barefoot (macrobiotic) shiatsu, healing shiatsu, Jin Shin Do, Namikoshi (or Nippon shiatsu), ohashiatsu, quantum shiatsu, Tao shiatsu, tsubo therapy, Zen shiatsu, and watsu (water shiatsu). Like Anma and Tuina massage, shiatsu massage employs a wide range of traditional techniques. Some are vigorous (e.g. kneading, rubbing, tapping and shaking) while other techniques involve slow and firm or quick and gentle movements (e.g. pressure, stroking, stretches, rotations of the limbs and joints, simple structural alignments and muscle release techniques) (9, 11). All styles, however, Research Protocol HTANALYSTS | NHMRC | EVIDENCE EVALUATION ON THE CLINICAL EFFECTIVENESS OF SHIATSU 10 have commonality in their underpinning traditional Chinese medicine and the use of body weight and physical pressure in one way or another when delivering a shiatsu massage (15). Under standard terminologies published by the WHO (16), ‘Traditional Chinese Tuina’ is the term used when referring to massage therapy that has its foundations in traditional Chinese medicine, including shiatsu. The term shiatsu, however, is also listed as an alternate word for acupressure, demonstrating that the two terms may be used interchangeably within the literature. Terminology is also specified for a number of components of practice used by shiatsu practitioners in Australia (see Table 1). Table 1 Description of common components of practice used in shiatsu therapy Component of practice taught and used by certified Australian shiatsu therapists (HLT52215) a Corresponding WHO traditional medicine terminology (TRM)b WHO TRM Codes Shiatsu massage Traditional Chinese Tuina: the branch of traditional Chinese medicine concerned with the principles and clinical use of Tuina (massage) therapy 0.0.18 Shiatsu massage techniques Massage: rubbing, kneading, or percussion of the soft tissues and joints of the body with the hands, usually performed by one person on another, esp. to relieve tension or pain 4.2.326 Manipulation: the term used when describing a wide range of manual therapy techniques (see manual for details) 4.2.327 – 4.2.344 Tapping technique: a manipulation performed by tapping with the tips of fingers held together 4.2.346 Acupressure Finger Pressure: a manipulation performed by pressing acupuncture points with the finger or thumb instead of needling, also known as shiatsu 4.2.347 Moxibustion Moxibustion: a therapeutic procedure involving ignited material (usually moxa) to apply heat to certain points or areas of the body surface 5.2.0 – 5.2.39 Cupping Cupping: suction by using a vacuumised cup or jar 5.3.0 – 5.3.11 Source: a. https://training.gov.au/Training/Details/HLT52215 (see Core units HLTSHU001, HLTSHU002, HLTSHU003, HLTSHU004, HLTSHU005, HLTSHU006, HLTSHU007, HLTSHU008, HLTSHU009) b. World Health Organization international standard terminologies on traditional medicine in the Western Pacific Region (16) Acupressure Acupressure is the application of pressure on the traditional Chinese medicine acupuncture (tsubo) points (10, 17). Acupressure is applied to specific points by the use of finger, hand, elbow, foot, and/or acupressure band or bead (10). Like shiatsu, acupressure has its roots in traditional Chinese medicine. However, acupressure is only one component of shiatsu therapy. Some authors note that while similar, there are differences in both the technique and philosophy of shiatsu and acupressure (10, 14, 17). While others, including the WHO International Standard Terminologies for Traditional Medicine in the Western Pacific Region (16), use the terms interchangeably (7, 17, 18). For the purpose of