Shiatsu With The Elderly (Bill Palmer)

As we get older our energy levels decline. Change takes energy and as you get older it becomes more difficult to adapt. So it makes sense to start preparing for old age long before it arrives!

Human life can be divided into three parts: the  growing-up period, the working period, which includes bringing up children, and a third stage, which in Western cultures is called ‘retirement’. Retired people may go on a few holidays, take up some hobbies and join some clubs but many people have lost the core reason for their life and age rapidly. In contrast, several other cultures view this third period as an opportunity for spiritual development.

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In this article, I would like to describe working with people in this third stage, when they are still active and still able to change. The beginning of this stage is a window of opportunity to develop spiritual capacities before it’s too late and I find the context of Shiatsu therapy ideal for developing these more Yin capacities.

The Degeneration of the Yang

As we get older the manifest (Yang) functions of the organism tend to degenerate. Most approaches to dealing with old age focus of trying to maintain the Yang, focusing on keeping the body looking young. My feeling is that this sets one up for failure. For most of us, it is inevitable that the physical aspect of our being degenerates with age. However, the message of this article is that the underlying, quintessential (Yin) aspects of our energy do not need to dissipate. In fact, this is the time they can fully develop and supercede the physical functions.

To show this, it is useful to review the physical aspect of our energy functions and to see how this aspect degenerates with age. We will then see how the Yin faculties can develop even when the physical side is in decline.

Degeneration of the Yang Ming-Tai Yin

This group of functions maintains the tone of the organism by ingesting ordered energy, such as food, and expelling disordered energy such as heat and faeces.  Ordered energy can build tissue and fill the flesh, so the end result is well toned flesh and a feeling of expansiveness and full expression.

When these functions degenerate, the skin shrivels and the support given by muscle tone and the internal organs is withdrawn. A person’s posture tends to stoop and their voice tends to contract.

The essential energy produced by these functions is expansiveness, which generates warmth and commands respect. But unless this capacity of Radiance is developed, the physical changes transmit the message that this person is a helpless victim and other people tend to lose their respect for them.

Degeneration of the Tai Yang-Shao Yin

This group of functions maintains the responsiveness of the organism, facilitating excitation and movement.

When these functions degenerate, the body tends to freeze into immobility and it becomes harder to spark excitement. The experience of this frozen quality is timidity and fear of movement.

However, the essential energy is not movement but responsiveness and, if this capacity is developed then the person takes on the serenity of still water rather than fearfully frozen ice. The person is still responsive, just as a pond will ripple if a stone is dropped into it, but internal drives no longer cause continual movement. I like to call this state Equanimity.

Degeneration of the Shao Yang-Jue Yin

These energies maintain the resilience of the organism, the ability to bend with the wind without breaking and to spring back after a shock.

In old age this resilience naturally diminishes. An elderly person becomes less flexible, more rigid and set in their ways. Physically this effects joints, muscles and connective tissue. Also, the mind has a tendency to become less able to accommodate new ideas. In general, the elderly are slower to regain their balance after a shock or an illness and less able to retain their balance physically.

However, the essential capacity underlying resilience is not strength or flexibility but inclusiveness. Shock is produced when we cannot accept something. So phobias, prejudice and pride increase our tendency to be shocked. Physical trauma is also caused by disconnection. If the whole body can roll with the force of the shock then the force turns into movement and not into injury.

Developing the capacity for inclusiveness, or Benevolence,  means that we can retain our capacity of resilience and we become less shockable, even when the joints and the muscles become less flexible.

Developing the Yin Capacities

We have seen how the degeneration of the physically manifest aspects of our energy lead to the symptoms of old age which are disrespected in our Western society: contraction, fearfulness and inflexibility.

Because our society values youth and physicality so highly, not much attention is paid to the development of the Yin, spiritual capacities.  But I find that elderly people who have developed these faculties  are more at peace with themselves. Other people respect them and they feel they have a valuable place in society.

It is natural for the Yin capacities to become stronger in old age, so if we focus on developing these instead of trying to hold on to the diminishing Yang, then we are swimming with the river of life rather than against the current.

In actual fact, by doing this, we get a bonus. The Yang is also supported because we are spending less of our energy on internal conflict and pretence, so more of our diminishing supply of energy is available for the Yang capacities.

The three Yin capacities identified above are Radiance, Equanimity and Benevolence.


Equanimity is  a property of the Shen. If emotions and other manifestations of energy are seen as the waves on the sea, then the Shen is the water. It is the underlying fabric of reality. I think this is the same concept as Sunyata in Buddhist philosophy.  The point is that if your sense of identity is based in the Shen rather than the waves of emotion, then your foundation cannot be disturbed.

Meditation is the traditional practice which moves the centre of identity from the emotions to the Shen. So an important part of learning to be old is to regularly practice some form of meditation. A form of physical meditation, originating in Tibet, called Outer Rushen  can be naturally included in the environment of Shiatsu therapy . Outer Rushen is a form of spontaneous movement, which starts from stillness and ends in stillness. It  embodies the ripples of the energetic pond, responding to disturbance in a way that  satisfies the energy, allowing it to come back to serenity.


Benevolence has a special meaning here. If we are irritated by someone, it is often because they remind us of a part of ourselves with which we are uncomfortable. This viewpoint is very useful, because one can see people who would normally annoy you as a valuable opportunity to get to know a part of yourself that you have been avoiding. The ability to see the value in everyone and everything that happens is what I am calling Benevolence.

As we get older, it gets more difficult to face our own shadow because it takes courage and energy. Instead, we tend to project that shadow more violently onto other people. This manifests as prejudice, arrogance, irritability and  phobias, which tend to drive people away, creating feelings of isolation and  insecurity.

If we have spent time understanding and facing ourselves, then we feel benevolent towards others; we know they are like us and our knowledge of ourselves promotes empathy with others. If we have plumbed our own depths, faced our own monsters and understood them, then we are not shocked by other people.

Benevolence also applies to ourselves. As old age develops, life becomes more difficult but, if one has developed benevolence, then one can see these challenges as opportunities for embracing and integrating more of the world.

The other advantage of benevolence is that people feel good around it. They respect it and are profoundly influenced by it. Thus Benevolence is a property of the Hun, the part of us that influences others and is carried forward into the future by being incorporated into other people. Benevolence transforms irritation into empathy that smooths the flow of life.

Shiatsu develops Benevolence because it encompasses the Kyo as well as the Jitsu. The Kyo can be seen as that part of ourselves that we avoid, so contacting the Kyo is a physical way of embracing our shadows and integrating them into our sense of self.


As we get older our energy tends to contract. The attention turns inward and the Qi follows. The Lung Qi becomes weak, so that the skin loses its flexibility and sensitivity. Also energy stops nourishing the limbs and retreats into the centre, so the limbs become stiff and weak. Many of the physical symptoms of old age are due to this contractive direction of energy.

Radiance is the opposite. It is outward flowing, expansive energy. If we are radiant then our attention is on the outer world, not on ourselves. We are receptive to new input and our posture is open and expressive.

Developing Radiance has a much more physical effect than either Equanimity or Benevolence. Radiance maintains the Lung Qi,  and the Tai Yin as a whole, and keeps the skin and the limbs nourished and flexible, reducing many of the symptoms of old age.

Radiance is a property of the Po, the Sensation Soul.  Bodywork, and especially Shiatsu,  encourages Radiance because it  develops awareness of sensations, which keeps us in touch with the outer world, gives us fresh input and keeps our creativity alive.

Dealing with the Issues of Old Age

I believe that we need to start training for old age long before we get there! Dealing with the issues of old age is much easier if one has developed the three Yin capacities.

Firstly, one is respected for these capacities and one respects oneself, rather than being frustrated and disrespected for the growing lack of the Yang, and the relative physical disability that is inevitable.

Secondly, specific techniques for dealing with the illnesses and symptoms of old age are made easier by the disciplines and practice needed for developing the Yin capacities.

Chronic Pain

Stephen Levine developed an approach to dealing with pain which involved teaching patients  techniques of meditation and visualisation. As he pointed out, if you contract in response to pain, then it’s like clenching your hand around a hot coal, the pain just gets worse. So expansiveness, radiance and acceptance which are the Yin capacities developed  by the Tai Yin are a practical method of dealing with serious pain.

Levine’s approach involved a visualisation of the pain and a relaxation of the tissues surrounding it  so that the pain could spread through the body rather than being compressed into one place. He found that this technique changed the experience of pain, reducing its intensity to a point that the patient could accept it without the need for powerful narcotics. I find this approach very effective but it is sometimes difficult to teach people the techniques involved if they are already aged and in serious pain. If a person has already learned techniques of body awareness and meditation, then these can be powerful resources in times of serious illness.

Arthritis and Instability

Arthritis is a natural part of getting older but, if one responds to it by reducing movement and taking pain killers then one loses awareness of the joints and this can cause further irritation, inflammation and  progression of the condition. Losing awareness of one’s body causes a feeling of instability that further reduces our ability to move.

The medical profession recognise this and advises patients to keep mobile. However, many people interpret this as  ‘doing exercise’, like going to the gym,  jogging or doing yoga classes. While not harmful in themselves, these forms of exercise can be just as detrimental to arthritic joints as inaction. This is because the patient has not learned to move their joints in a way that avoids internal irritation.

The key to learning this skill is the Yin capacity of Benevolence, applied to one’s own body. Instead of thinking of an exercise as a task to be performed, one starts to think of it as a framework for exploration. The first attitude focuses on the external target to be attained, such as a Yoga Position. The second attitude uses the exercise as an environment to develop awareness and to maintain movement. You do not judge yourself against an external goal, instead you value your body as it is. You  are setting yourself up to succeed rather than to fail and this maintains flexibility and movement without internal conflict.

A very useful application of this approach is learning to move the proximal side of joints as well as the distal. People from Europe, North America and Australia tend to hold the proximal side of a joint still while the distal side performs the action. This can provide more speed and power in the movement, but it also causes internal friction in the joints. If one learns to move the proximal side of a joint, then the movement becomes smoother and internal conflict is reduced. I have had several patients who have completely halted the progression of rheumatoid arthritis by learning this technique.

Osteoporosis, Nervous System Degeneration and Fear

Fear is a common part of old age. Fear of change, fear of movement, fear of death. Osteoporosis can reduce the strength of bones, so one becomes nervous that they will break. The nervous system reduces its capacity to adapt, so one becomes afraid of  new situations. The tendency is to freeze into stillness.

Developing Equanimity allows one to let go of these fears and to meet the unknown without paralysis. One becomes more like still water rather than frozen ice; able to ripple in response to change but without the fear of breaking.

I think of death as the end of a long process of release and letting go. If one is holding on to the past and  grasping for the remnants of the yang then death is a threat. If one can melt, become Water and embrace the Yin then death can become the culmination of a spiritual process of  liberation.


© Bill Palmer (