Nishi Shiki health exercises

1. Introduction

Version followed: the 1927 system of Katsuzō Nishi (西勝造, 1884–1959) as the Japanese encyclopaedia entries summarise it. That means the "six great rules" (六大法則) preceded by preparatory exercises, together with the diet and skin practices, as given in the Britannica Japan concise entry on Kotobank. The four-principle model called "Tetrapathy" (テトラパシー) comes from Japanese Wikipedia. Descriptive detail of the exercises comes from English Wikipedia. Nishi's own 1935 lecture text is reprinted on the Nishi-kai headquarters site. Later variants, such as Mitsuo Kōda's "Nishi-style Kōda therapy" (西式甲田療法), are noted only where clients may meet them. [source: Kotobank/Britannica; ja.wikipedia; en.wikipedia; nishishiki.jp]

What it is. Nishi Shiki (西式健康法, also called 西医学, "Nishi medicine", and 西式強健術) is a Japanese self-practice health system. Nishi was a civil engineer, and in 1927 he was chief technical engineer on Tokyo's first subway. He published the system that same year. The Britannica Japan entry describes it as a combination of three things: exercise therapy (six core exercises after a set of preparatory ones), diet therapy (drinking raw, unboiled water, persimmon-leaf infusion, raw food) and physical therapy ("naked therapy" and hot-and-cold alternating baths). Nishi also wrote a book on Nishi-style fasting (西式断食療法, 1933). Japanese Wikipedia says Upton Sinclair's The Fasting Cure influenced him. [source: Kotobank/Britannica; en.wikipedia Katsuzō Nishi; NDL record; ja.wikipedia]

Core idea of how change happens, as the system states it. These are claims, not established findings.

The exercises correct distortion of the spine and improve capillary circulation, and so prevent and treat illness. Britannica Japan reports that regular long-term practice is said to bring health and longevity. [source: Kotobank/Britannica]
Health rests on four principles: nutrition, limbs, skin and mind. They are pictured as the corners of a regular tetrahedron, with mind governing the other three. Limb exercises are claimed to regenerate the "glomus" (グローミュ) vessels. [source: ja.wikipedia]
In his 1935 lecture, Nishi stressed that digestion, combustion and excretion matter as much as what is eaten. [source: nishishiki.jp lecture reprint]
One book chapter on Nishi describes his view of the heart as a tank rather than a pump. This conflicts with established cardiovascular physiology. [source: Shinchosha page for Yamazaki 2007; synthesis for the physiology remark]

Status for a psychotherapist. Nishi Shiki is not a psychotherapy and not a treatment for any physical disease. No independent controlled studies of the system as a whole were found. English Wikipedia describes its effects as "purported". [source: en.wikipedia Nishi Shiki; uncertain: not verified for the absence of trials] No teacher-training route or credential that would qualify a psychotherapist to teach it was found. [uncertain: not verified] This guide therefore covers the psychotherapist working alongside a client who practises Nishi Shiki or is drawn to it, or alongside a Nishi-kai instructor, an aikido teacher or the client's physician. The six exercises are described at a descriptive level as published. They are not prescribed.

2. Framework

The system's own structure (as published).

Six core exercises, described as preceded by eleven preparatory exercises, practised as a daily routine. Britannica Japan says morning and evening. [source: Kotobank/Britannica]
Four principles (Tetrapathy). [source: ja.wikipedia]
- Nutrition: mainly raw vegetables, avoiding excess, with fasting and raw-food therapy.
- Limbs: supine "up-down" and "fan-shaped" movements, aimed at what Nishi called foot deformities, and the capillary exercise.
- Skin: hot-cold bathing and naked therapy.
- Mind: side-to-side swaying combined with self-affirmation of "good, capable, virtuous" (良・能・善), and prolonged palms-together and relaxed-posture practices.
In his 1935 lecture, Nishi divided his teaching into three tiers. A strengthening method (強健術) was for the basically healthy. A health-maintenance method (強健法) was for people with hidden ailments. The everyday health method (西式健康法) covered daily habits. [source: nishishiki.jp lecture reprint]
Historically, the method was spread through lectures given by the 大日本西会 (Greater Japan Nishi Association). Today the 西式健康法西会本部 (Nishi-kai headquarters) runs the official site, operated by 株式会社西式サービス. Abroad, Nishi-kai groups are reported in Hawaii, linked to the early spread of aikido there. [source: nishishiki.jp; ja.wikipedia; en.wikipedia]
Some exercises, notably the goldfish exercise, entered aikido practice through Nishi's teaching at the Aikikai Hombu Dojo. Masatomi Ikeda's Genki Kai partly incorporates the system. [source: en.wikipedia Nishi Shiki; en.wikipedia Katsuzō Nishi]
The system publishes no phases, session counts or progression criteria comparable to a therapy protocol. [uncertain: not verified in a full primary text]

Psychotherapist's working frame [synthesis]. This is a frame for working alongside the practice, not a Nishi protocol.

Phase A: understand and screen. Learn which elements the client practises or plans to practise and where they learned them (book, Nishi-kai lecture, Kōda-style clinic, aikido dojo, online video, family). Screen for eating-disorder risk, cardiac and other medical risk, pregnancy, musculoskeletal conditions and medication. Ask whether the client is reducing medical care in favour of the method. Move on once you know what is being practised and the risk is clear.
Phase B: clearance and informed choice. For any fasting, raw-food, cold-water or medically relevant element, the client discusses it with their physician, and you coordinate with consent. You stay neutral about the gentle exercises and are clear that the method is not a substitute for medical treatment. Move on when medical input is in place, or the client has made an informed decision about the low-risk elements only.
Phase C: monitor and integrate. In ordinary psychotherapy sessions, use the client's experience of the practice as material: body awareness, discipline and meaning, family or cultural ties, hope. Track mood, eating, weight concerns and compulsivity.
Phase D: review. At planned reviews, ask what the practice gives the client, what it costs them, and whether it still serves their goals. Watch for adverse effects and pass them to the medical team.

No published session count applies to this frame. Use the frequency of the underlying psychotherapy.

3. Guiding principles

Attribute every health claim to the system. Practical meaning: say "Nishi taught that…" or "the method claims…", never "this improves your circulation". [source: en.wikipedia; Kotobank; synthesis]
Not a treatment for physical disease. Practical meaning: never support stopping, delaying or replacing medical care. If a client is doing that, raise it directly and involve their doctor with consent. [synthesis]
No prescriptions from the therapist. Practical meaning: you do not set exercise counts, durations, bath temperatures, fasting periods or diets. Refer those questions to the client's physician or the system's own instructors. [synthesis]
Eating-disorder caution comes first. Practical meaning: screen before any discussion of fasting, small meals or raw-food regimes. With any eating-disorder history, dieting of any kind, fasting included, is not recommended because it can trigger relapse. [source: WebMD/Hahn]
Medical clearance for heat, cold and fasting. Practical meaning: anyone with heart disease, cardiac history or heart-rate-lowering medication such as beta blockers sees a doctor before cold immersion. [source: American Heart Association News]
Respect the tradition without endorsing its theory. Practical meaning: Nishi linked religion and medicine (宗教医学一体論), and the system has ties to aikido's ki culture. Treat these as the tradition's views, held with respect, not as physiology. [source: ja.wikipedia; en.wikipedia]
Teaching authority lies with the tradition. Practical meaning: for how an exercise is properly done, the client goes to Nishi-kai materials or an experienced instructor, not to you. [source: nishishiki.jp; synthesis]
Curiosity about meaning. Practical meaning: systems like this often carry a story of self-rescue after medicine "gave up", as in Nishi's own biography. Explore what that story means for the client. [source: ja.wikipedia; Monex column; synthesis]
Watch for compulsion and body-image use. Practical meaning: rigid daily routines and "purification" language can feed perfectionism, health anxiety or orthorexic patterns. Track this. [synthesis]
No touch by the therapist. Practical meaning: the published exercises are solo. You do not position or assist the client's body. Body-psychotherapy codes require informed consent before any touch, a right to refuse or end it at any time, and they never permit sexual touch. [source: USABP Code of Ethics; synthesis]

4. Intervention inventory

Part A covers the system's own practices, described as published so you can understand and discuss them. They are not instructions to the client, and the descriptions are qualitative. The system's published counts, durations and temperatures are left out on purpose. Part B covers the psychotherapist's own interventions [synthesis]. Translations from Japanese are the author's own and are marked "(translation)".

Part A. The six great rules (六大法則) and preparatory exercises

Britannica Japan lists the six as: flat bed, hard half-cylindrical pillow, goldfish, raising and shaking the limbs, palms-and-soles together, and back-abdomen movement. They are preceded by eleven preparatory exercises. The 1935 lecture reprint names the rules as 平床, 硬枕, 金魚, 毛管 and 触手 ("tentacle"). It shows only five names, which may be a transcription inconsistency. [source: Kotobank/Britannica; nishishiki.jp; uncertain: the preparatory exercises are not individually described in the sources; not verified]

A1. Flat bed (平床寝台, heishō shindai)

Purpose as claimed: sleeping on a flat, hard surface is linked to the system's aim of correcting spinal distortion. [source: en.wikipedia; Kotobank/Britannica]
Description as published: sleeping on a flat, hard bed rather than soft bedding. A mid-20th-century Japanese essay that refers to Nishi recalls advice to sleep on boards. [source: en.wikipedia; Doshisha essay PDF]
Therapist steps [synthesis]:
1. Ask how the client sleeps now and whether the change is new.
2. Ask about back, hip or neck conditions, pregnancy, osteoporosis, pressure-sore risk and chronic pain. If any apply, suggest the client asks their doctor or physiotherapist before changing their sleep surface.
3. Track sleep quality as you would in any therapy. A worse night's sleep matters more for mood than adherence to a rule.
Example language (illustrative): "Nishi taught that a flat, firm bed helps the spine. I can't tell you whether that's true for your back. Your doctor or physio can. What I'm interested in is how you're sleeping."
Watch for: new pain, broken sleep, or the client pushing on despite discomfort because "the rule says so". A rigid rule held against bodily signals is clinically relevant. Working: sleep is stable or better and the client holds the practice flexibly.

A2. Hard pillow (硬枕利用, kōchin riyō)

Purpose as claimed: supporting the neck vertebrae, as part of spinal correction. [source: Kotobank/Britannica; synthesis for "neck" wording]
Description as published: a hard, half-cylindrical pillow, which Britannica Japan says is wooden, used with the hardest possible bed. [source: Kotobank/Britannica; en.wikipedia]
Therapist steps [synthesis]:
1. Ask about neck pain, cervical spine conditions, past neck injury and dizziness.
2. If any are present, the client checks with a physician or physiotherapist before using it.
3. Do not demonstrate or adjust a pillow position on the client.
Example language (illustrative): "The hard pillow is one of Nishi's six rules. Because your neck has troubled you since the accident, it's worth asking your physio first. Would you be OK if I wrote that down as something to check?"
Watch for: neck pain, headache, tingling in the arms or poor sleep. Pass these to the client's doctor. Working: no new symptoms, and the client chooses freely whether to continue.

A3. Goldfish exercise (金魚運動, kingyo undō)

Purpose as claimed: linked to spinal alignment, and it is the best-known Nishi exercise. It is also practised in some aikido dojos. [source: en.wikipedia Nishi Shiki; en.wikipedia Katsuzō Nishi]
Description as published: lying down and wriggling or swinging the body and hips from side to side like a swimming fish. [source: Kotobank/Britannica; en.wikipedia]
Therapist steps [synthesis]:
1. If the client mentions it, ask where they learned it (aikido dojo, book, video) and how it feels.
2. Screen for lumbar or hip problems, recent surgery and pregnancy. Advise checking with a physician or physiotherapist where any apply.
3. If the client finds it calming, explore that experience in session as body-awareness material. Do not lead it yourself.
Example language (illustrative): "You said the fish exercise feels like your body 'unknotting'. What do you notice afterwards: in your breathing, your mood, your thoughts?"
Watch for: back or hip pain, dizziness, or use of the exercise as a ritual to neutralise anxiety (a compulsive pattern). Working: the client reports it as pleasant and optional, and links it to calmer states.

A4. Capillary exercise (毛管運動, mōkan undō)

Purpose as claimed: improving capillary circulation and, in the system's theory, regenerating glomus vessels. It also belongs to the limbs principle. [source: Kotobank/Britannica; ja.wikipedia]
Description as published: lying on the back, raising the arms and legs above the level of the heart and shaking them finely. [source: Kotobank/Britannica; en.wikipedia]
Therapist steps [synthesis]:
1. Treat the circulation claim as Nishi's theory. Do not repeat it as fact.
2. Ask about blood-pressure problems, cardiac conditions, glaucoma, reflux, shoulder or hip problems and pregnancy. Suggest medical advice where relevant.
3. If a client hopes the exercise will treat a circulatory disease, say plainly that it is not a treatment and keep the medical team involved.
Example language (illustrative): "Nishi believed shaking the limbs helps the small blood vessels. There isn't good evidence for that, and it isn't a treatment for your circulation problem. If you enjoy it, that's your choice. Let's keep your vascular team in the loop."
Watch for: light-headedness, palpitations, joint pain, or a client relying on it in place of prescribed treatment. Working: it stays an add-on and medical care continues.

A5. Palms-and-soles exercise (合掌合蹠運動, gasshō gasseki undō)

Purpose as claimed: within the system, linked to the pelvis and lower limbs. Wikipedia reports the system's claim that its flexibility exercises diagnose internal organs, including sexual organs. [source: en.wikipedia; uncertain: which organ claim belongs to which exercise is not verified]
Description as published: lying on the back with the palms pressed together and the soles pressed together, then moving them back and forth. [source: Kotobank/Britannica; en.wikipedia]
Therapist steps [synthesis]:
1. Screen for hip, knee and groin problems, recent pelvic surgery and pregnancy, and advise medical or physiotherapy advice where relevant.
2. Note that the open-hip supine posture can feel exposing for some clients with sexual-trauma histories. Discuss this only if the client raises discomfort. Never suggest doing it in session.
Example language (illustrative): "Some people find lying with the knees open uncomfortable, physically or emotionally. You're entitled to skip anything that feels wrong. Nothing in your recovery depends on it."
Watch for: hip or groin pain, or dissociation or intrusive memories during the posture. If either appears, work with it as trauma material and suggest the client stops that exercise. Working: no symptoms, and choice is preserved.

A6. Back-abdomen exercise (背腹運動, hifuku undō)

Purpose as claimed: coordinated movement of back and abdomen. In the mind principle, side-to-side swaying is paired with self-affirmation (良・能・善, "good, capable, virtuous" (translation)). [source: Kotobank/Britannica; ja.wikipedia]
Description as published: sitting Japanese-style (kneeling) and swaying the upper body from the hips, coordinated with pushing the abdomen out and drawing it in. [source: en.wikipedia]
Therapist steps [synthesis]:
1. Screen for knee problems (kneeling), lumbar problems, abdominal surgery, hernia and pregnancy.
2. Explore the affirmation element. Do the phrases support self-compassion, or do they become self-pressure ("I must be good")?
3. If the client wants a seated, rhythmic calming practice, consider evidence-based alternatives within your competence alongside it, such as relaxation or mindfulness-based practices.
Example language (illustrative): "When you say 'good, capable, virtuous' while swaying, what tone of voice is it in your head: encouraging, or demanding?"
Watch for: knee or back pain, abdominal discomfort, dizziness, and affirmations turning into perfectionistic self-criticism. Working: the client describes steadiness and kinder self-talk.

A7. Mind-principle practices (palms-together and relaxed-posture practices)

Purpose as claimed: the mind principle governs the other three principles. Japanese Wikipedia lists prolonged palms-together (合掌) and relaxed-posture (弛緩態勢) practices. Nishi's thought joined religion and medicine (宗教医学一体論). [source: ja.wikipedia]
Description as published: sustained holding of the palms together, and sustained relaxed postures. The published durations are not given here. [source: ja.wikipedia]
Therapist steps [synthesis]:
1. Treat the religious and philosophical framing as the tradition's own. Ask what it means to the client.
2. Prolonged still postures can raise trauma material or dissociation in some clients, so ask how the client experiences them.
3. Respect devotional meaning. Do not turn it into a technique in session.
Example language (illustrative): "For Nishi, health and spiritual life weren't separate. Does that fit how you see it?"
Watch for: dissociation, scrupulosity or spiritual self-blame ("I got ill because my practice was impure"). Working: the practice is a source of meaning and calm, not guilt.

A8. Fasting (断食, Nishi-style fasting therapy)

Purpose as claimed: part of the nutrition principle. Nishi wrote a 1933 book, 西式断食療法：心身改造 (Nishi-style fasting therapy: remaking mind and body (translation)). He adapted Upton Sinclair's ideas into a method he considered suited to Japanese people. His 1935 lecture says fasting may sometimes be necessary. [source: NDL record; ja.wikipedia; nishishiki.jp]
Description: no fasting schedule is given here. Fasting belongs under medical supervision only. [synthesis]
Therapist steps [synthesis]:
1. Ask whether the client fasts, how often, and who supervises it.
2. Screen for current or past eating disorders, diabetes and medication (especially insulin or other glucose-lowering drugs), pregnancy, breastfeeding, low body weight, being under 18, and older age with frailty.
3. If there is any eating-disorder history, advise against fasting. The article in the sources reports that dieting of any kind can trigger relapse. Involve the eating-disorder team with consent. [source: WebMD/Hahn]
4. If there is no such history, the client still discusses fasting with their physician before starting. You do not set or approve schedules.
5. Keep the topic open in later sessions.
Example language (illustrative): "I'm not going to advise you on fasting itself. That's for your doctor. Because you've had times when restricting food got out of hand, I'm worried this could pull you back there. Can we look at that together?"
Watch for: the warning signs the sources describe: skipped meals, restricted food groups, avoiding social eating, guilt around food, "good" or "bad" food labels, distrust of hunger and fullness, and bingeing after fasting. Also watch for dizziness, fainting, low mood, irritability and sleep disruption. [source: WebMD/Hahn; synthesis for the physical signs] Working (if the client fasts under medical care): no restriction creep, social eating intact, and mood stable.

A9. Small meals, breakfast omission and raw-food eating (少食; 生食療法)

Purpose as claimed: mainly raw vegetables and avoiding excess (the nutrition principle). In the later Kōda variant, a singer and direct disciple of Kōda promotes a small or skipped breakfast, arguing that the morning is the body's time for elimination. [source: ja.wikipedia; Monex column, 2008]
Description: no diet plan is given. [synthesis]
Therapist steps [synthesis]:
1. Screen for eating-disorder risk as in A8, including orthorexic preoccupation with "pure" or "raw" eating.
2. For children, adolescents, pregnancy, breastfeeding and chronic illness, the client or family consults a doctor or registered dietitian about nutritional adequacy.
3. Explore the meanings attached to eating little: control, purity, discipline, identification with a teacher.
Example language (illustrative): "When you eat less in the morning, what's the feeling: lightness, pride, relief, fear of what happens if you don't?"
Watch for: weight loss the client hides or celebrates, rigid food rules, social withdrawal around meals, and parents applying the regime to children. Working: eating stays flexible and food is not tied to moral worth.

A10. Raw (unboiled) water and persimmon-leaf infusion (生水; 柿の葉茶)

Purpose as claimed: Britannica Japan lists these under diet therapy. Nishi's biography describes drinking unboiled water, which his doctors had forbidden, as central to his own recovery. [source: Kotobank/Britannica; ja.wikipedia]
Therapist steps [synthesis]:
1. Where water safety is uncertain, or the client is immunocompromised, the client checks with their doctor. Untreated water can carry infection risk.
2. Ask whether infusions or supplements are taken alongside prescribed medication, and suggest checking with a pharmacist.
Example language (illustrative): "Your pharmacist can tell you quickly whether the leaf tea is fine with your tablets. Would you be willing to ask?"
Watch for: gastrointestinal illness, or replacing medication with infusions. Working: medication and practice coexist with the pharmacist's knowledge.

A11. Hot-cold alternating bathing (温冷浴, onreiyoku)

Purpose as claimed: part of the skin principle. Promoters say it balances the autonomic nervous system and clears the mind. [source: ja.wikipedia; Kotobank/Britannica; Monex column]
Description: alternating cold and hot immersion. Promoters publish sequences and water temperatures, which are not given here. [source: Monex column]
Therapist steps [synthesis unless cited]:
1. Screen for heart disease or cardiac history, high or low blood pressure, heart-rate-lowering medication such as beta blockers, pregnancy, alcohol use, epilepsy, Raynaud's, and older age.
2. Explain cold shock in plain terms. Sudden cold immersion raises breathing rate, heart rate and blood pressure. It can cause an involuntary gasp, and the first moments are the most dangerous. [source: American Heart Association News]
3. The client gets medical advice before starting, especially with a cardiac history or heart medication. Never do this alone. [source: American Heart Association News]
4. Never bathe after alcohol or when unwell. [synthesis]
Example language (illustrative): "Cold water triggers a big jump in heart rate and blood pressure. With your heart medication, the American Heart Association advice is to talk to your doctor before trying it. Would you do that before your next bath?"
Watch for: chest pain, palpitations, breathlessness, fainting or confusion. These need urgent medical help. Also watch for self-punishing use ("I deserve the cold") and an escalating search for intensity. Working: the practice is medically cleared and moderate, and it is felt as refreshing rather than punishing.

A12. Naked therapy (裸療法, raryōhō)

Purpose as claimed: skin "detoxification" (the skin principle), by exposing the skin to air. [source: ja.wikipedia; Kotobank/Britannica; uncertain: the detailed procedure is not verified]
Therapist steps [synthesis]:
1. This is a private, home practice. It is never done in or near a therapy session, and the therapist is never present.
2. Ask about chilling, which matters for older, frail or cardiac clients and for children, and about any shame or body-image feelings it brings up.
3. In families, check that children are not exposed to adult nudity, or to cold, in ways that raise safeguarding concerns. Follow your local safeguarding procedures.
Example language (illustrative): "How do you feel in your body when you do the air-bathing? Some people feel free, and some feel exposed."
Watch for: chills or illness, distress, and safeguarding indicators. Working: the practice is private, chosen, and without distress.

A13. The system's diagnostic and disease claims

Content: the system claims its flexibility exercises reveal the state of internal organs, linking them with the spine and stomach, sexual organs and sciatic nerve, kidneys, liver, intestines and urinary organs. Nishi's 1935 lecture linked constipation to brain haemorrhage. Britannica Japan reports a claim that the exercises prevent and treat illness. [source: en.wikipedia; nishishiki.jp; Kotobank/Britannica]
Evidence status: no independent evidence supporting these diagnostic or curative claims was found. Treat them as unvalidated. [uncertain: not verified]
Therapist steps [synthesis]:
1. If a client is using the exercises to self-diagnose ("I can't do the fish well, so my liver is bad"), gently separate the experience of difficulty from medical conclusions.
2. Encourage a medical assessment for any symptom of concern.
3. With health anxiety, treat this checking as a safety behaviour within your usual approach.
Example language (illustrative): "The stiffness tells us something about your muscles today. It can't tell us about your liver. If you're worried about your liver, that's a question for your GP, and we can look at the worry itself here."
Watch for: health-anxious checking, delays in seeking care, and catastrophic interpretation. Working: less checking, and appropriate medical consultation.

Part B. The psychotherapist's interventions [synthesis]

B1. Practice-mapping interview

Purpose: find out exactly which Nishi elements the client uses, the source of their information, and the hopes attached. Use it at intake or when the method comes up.
Steps:
1. List the elements: six rules, preparatory exercises, fasting, small meals or raw food, raw water or infusions, hot-cold baths, naked therapy, mind practices.
2. Note the source: Nishi-kai materials, a Kōda-style clinic or book, an aikido or Genki Kai dojo, family tradition, or online.
3. Ask what problem the client hopes it will solve.
4. Ask whether any medical treatment has been reduced or stopped.
Example language (illustrative): "Tell me what a typical Nishi day looks like for you, and what you hope it's doing."
Watch for: vagueness about fasting, secrecy, and hope pinned on curing a physical illness. Working: a clear, shared map of the practice.

B2. Eating-disorder and compulsive-exercise screen

Purpose: decide whether any dietary or fasting element is unsafe for this client. Use it before any discussion of fasting or diet.
Steps:
1. Ask about past and present restriction, bingeing, purging, weight and shape concerns, and compulsive or driven exercise.
2. Use a validated screening instrument your service already uses, without improvising items.
3. If risk is present, follow your eating-disorder pathway and coordinate with the GP or eating-disorder team.
Example language (illustrative): "Before we talk about the eating side of Nishi, can I ask a few questions about your relationship with food and your body? I ask everyone who's considering fasting."
Watch for: the warning signs listed in A8 [source: WebMD/Hahn], and exercise kept up despite injury or illness. Working: risk is identified and the plan matches it.

B3. Medical clearance and collaboration

Purpose: keep physical safety with the people competent to judge it. Use it for any fasting, diet change, cold or heat exposure, or physical condition.
Steps:
1. With written consent, write briefly to the GP or specialist. Name the elements the client practises, without endorsing them, and ask for their view.
2. Encourage the client to raise the questions themselves.
3. Record the advice and revisit it.
Example language (illustrative): "Would it be OK if I let Dr X know you're planning the hot-cold baths? I'd like your heart team to be part of this decision."
Watch for: reluctance to tell the doctor, which is often fear of disapproval. Explore it. Working: the medical team knows, and their advice is integrated.

B4. Exploring hope, meaning and the self-rescue story

Purpose: Nishi's own story is of a sickly youth whom doctors expected to die before 20. He did the opposite of medical advice and recovered. Clients may identify with this. Use B4 when distrust of medicine or a strong rescue narrative appears. [source: ja.wikipedia; Monex column]
Steps:
1. Reflect the client's experiences of feeling failed by medicine.
2. Validate the wish for agency.
3. Separate agency, which is healthy, from rejecting effective care, which is risky.
4. Explore family or cultural ties to the method.
Example language (illustrative): "It sounds like doing Nishi gives you back a sense that your health is in your hands. I want to keep that. Can we also keep the treatments that are working?"
Watch for: splitting ("natural is good, medicine is poison") and grief over illness that the practice is masking. Working: the client holds both the practice and medical care.

B5. Body image, perfectionism and compulsion monitoring

Purpose: daily rule-bound regimes can become compulsive. Use B5 throughout.
Steps:
1. Ask periodically what happens when the client misses a practice.
2. Look for guilt, anxiety, and "making up" for missed practice.
3. Formulate any compulsive pattern and treat it with your usual evidence-based approach.
Example language (illustrative): "What happens inside when you skip a day?"
Watch for: distress or punishment after missed practice, escalation, and moral language about purity. Working: the practice is flexible and missing it causes little distress.

B6. Integrating movement and body experiences into therapy

Purpose: use the client's experience of the practice as therapeutic material for interoception, emotion regulation and self-relation. Use it when the client finds the practice meaningful.
Steps:
1. Invite description of sensations, emotions and images during or after practice.
2. Link these to therapy themes.
3. Do not lead the Nishi exercises in session and do not touch. If your training covers body-oriented psychotherapy, follow your profession's code. Body-psychotherapy codes require informed consent before touch, ongoing review of consent, the right to refuse at any time, and never sexual touch. [source: USABP Code of Ethics; EABP Ethics Guidelines; APA Ethics Code]
Example language (illustrative): "When you stood up after the back-abdomen swaying, you said you felt 'upright inside'. Where else in life would you like that feeling?"
Watch for: dissociation and trauma memories during supine or kneeling postures. Working: richer body awareness that the client can use.

B7. Recognising adverse effects and passing them on

Purpose: catch physical and psychological harm early. Use it throughout.
Steps:
1. Ask about new pain, dizziness, fainting, palpitations, infections, weight change and mood change.
2. For red flags (chest pain, fainting, breathlessness, confusion), advise urgent medical care.
3. With consent, pass non-urgent concerns to the GP and record them.
Example language (illustrative): "Fainting after the cold bath is something your doctor needs to know about today. Can we call now?"
Watch for: minimisation ("it's the toxins coming out"). Detox framings can make clients dismiss real symptoms. Working: symptoms are reported promptly.

B8. Working with the tradition: instructors, dojos and cultural context

Purpose: respect where teaching authority lies. That is the Nishi-kai headquarters (西会本部) and its materials, aikido and Genki Kai teachers for the exercises they use, and physicians for Kōda-style regimes. Use B8 when a client is joining classes. [source: nishishiki.jp; en.wikipedia]
Steps:
1. With consent, and only if useful, talk with the instructor about safety concerns, such as an injury or eating-disorder risk.
2. Ask the client how instructors respond to someone who opts out of an element.
3. Note any group pressure to abandon medical care.
Example language (illustrative): "Would your teacher be OK with you skipping the fasting part? How do they handle people who do only the exercises?"
Watch for: high-control group features, such as pressure, isolation from doctors, or costly escalating programmes. Working: the client takes part selectively and freely.

5. Handling problems

Most of this section is [synthesis]. The Nishi sources do not address psychotherapy problems.

The client wants the method to treat a physical disease. Say clearly and kindly that it is not a treatment for any physical disease and that its curative claims are unsupported. Keep the medical team involved (B3, B4). If the client stops effective treatment, document it, share the concern with the physician with consent, and keep the relationship open rather than issuing ultimatums.
The client asks you for a fasting plan, durations or bath temperatures. Decline. Explain that this is outside your competence and is for their physician. Offer to help them prepare questions for the doctor.
A fasting or raw-food regime in someone with eating-disorder history. Advise against it, citing relapse risk [source: WebMD/Hahn]. Follow your eating-disorder pathway. If a historical Japanese medical fasting programme is cited (for example, Tohoku University's fasting therapy for psychosomatic disease, published in 1976, which listed "dysorexia nervosa" among its indications), explain that it is a different programme from Nishi Shiki and is not part of current eating-disorder care. [source: Suzuki et al. 1976 abstract; synthesis for the current-care statement]
The client cites fasting studies as proof. Trials of supervised fasting followed by diets in other contexts (for example, a 1991 Lancet trial in rheumatoid arthritis) did not test Nishi Shiki. They were medically supervised and used alongside conventional treatment. [source: Kjeldsen-Kragh et al. 1991 abstract]
Non-adherence and guilt. If a client feels ashamed about not keeping up the six rules, treat it as a perfectionism and self-criticism theme, not as a failure of therapy (B5).
Overwhelm or dissociation during practice. Advise pausing that element. Use grounding within your competence, and work through the material in therapy (B6).
Rupture: the client feels you disapprove of their tradition. Repair it. Acknowledge the value they find in the practice, restate that your concern is safety, not belief, and invite their view.
A family imposes the regime on a child or adolescent. Assess nutritional and physical safety with the paediatric team. Hear the young person's own view (assent). Follow safeguarding procedures if there is restriction, cold exposure or nudity that raises concern.
Adverse physical effects are reframed as "healing crisis" or detox. Name the reframing. Insist that medical assessment comes first (B7).
Group pressure. If a class or clinic pressures the client to drop medicine or escalate fasting, explore it, support the client's autonomy, and consider coercive-control dynamics.
Competence boundary. If you lack training in body-oriented work, keep to discussion and integration. Do not demonstrate or guide the exercises, and never touch. Professional codes require practising within competence and referring appropriately. [source: APA Ethics Code]

Sources

Web sources

Books and articles cited

Nishi, Katsuzō (1933). 西式断食療法：心身改造. Tokyo: Jitsugyo no Nihon-sha.
Nishi, Katsuzō (1936). Nishi System of Health Engineering (Kessinger reprint). [as listed on Wikipedia; uncertain: not verified]
Nishi, Katsuzō (1997). Live Longer the Nishi Health System Way. [as listed on Wikipedia; uncertain: not verified]
Yamazaki, Mitsuo (2007). 『健康の天才たち』. Shinchosha Shinsho (ch. 5 on Nishi).
Suzuki, J., Yamauchi, Y., Horikawa, M., & Yamagata, S. (1976). Fasting therapy for psychosomatic diseases with special reference to its indication and therapeutic mechanism. Tohoku Journal of Experimental Medicine, 118 (suppl.).
Kjeldsen-Kragh, J., et al. (1991). Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. The Lancet, 338(8772).
Hahn, S., et al. (2023). Intermittent fasting: consider the risks of disordered eating for your patient. Clinical Diabetes and Endocrinology. [as cited by WebMD; uncertain: not verified]

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