Shiatsu, massage, seitai and relaxation in Japan

01Name by name

"National licence" here means a licence granted by the Minister of Health, Labour and Welfare.

Shiatsu

Shiatsu falls within the national licence of Anma Massage Shiatsu Practitioner. Without that licence, it cannot be practised as a business.

• National licence: yes — Anma Massage Shiatsu Practitioner (あん摩マッサージ指圧師)
• Legal basis: Act No. 217 of 1947, Article 1 — persons other than physicians who intend to practise anma, massage or shiatsu, acupuncture or moxibustion as a business must obtain the corresponding licence.
• What a licence holder may do: practise anma, massage and shiatsu as a business. Anyone opening a practice must notify the authorities within ten days (Article 9-2).
• What is not allowed: surgery or giving medicines (Article 4); treating the site of a dislocation or fracture without a physician's consent (Article 5). Practising without a licence is punishable by a fine of up to 500,000 yen (Article 13-7).
• How to check: the qualification stated on the sign, and inside the premises the notice of notification and the licence (or a document giving its details). Some practitioners also wear the optional licence holder's card (MHLW leaflet).

Massage and anma

In Japanese law, massage stands alongside shiatsu, and practising it as a business needs the same licence. But in Japan the word "massage" on a sign or menu does not always mean licensed work.

• National licence: yes — the same Anma Massage Shiatsu Practitioner licence
• Legal basis: Act No. 217 of 1947, Article 1
• Worth knowing: the Ministry of Health, Labour and Welfare's leaflet lists "foot massage" among practices with no national qualification system. In a 2005 written answer, the Cabinet said that advertising "massage" at premises where massage is not performed may mislead people and "cannot be overlooked from a public-health standpoint", and that the Ministry asks prefectural officials to give the necessary guidance. The 2025 advertising guideline records the same concern.
• How to check: as for shiatsu.

Acupuncture and moxibustion (hari and kyu)

Each requires its own national licence: Acupuncturist (はり師) and Moxibustionist (きゅう師).

• National licence: yes — two separate licences
• Legal basis: Act No. 217 of 1947, Article 1
• What is not allowed: surgery or giving medicines (Article 4). Practising without a licence is punishable by a fine (Article 13-7).
• How to check: as for shiatsu — the sign, the notices inside and the licence.

Judo therapy (sekkotsu-in and seikotsu-in)

Judo therapy (柔道整復) is practised by holders of the national Judo Therapist licence, under a different Act from the one covering Anma Massage Shiatsu Practitioners.

• National licence: yes — Judo Therapist (柔道整復師)
• Legal basis: Judo Therapists Act (Act No. 19 of 1970), Article 15 — except for physicians, no one other than a Judo Therapist may practise judo therapy as a business.
• What is not allowed: surgery or giving medicines (Article 16); treating the site of a dislocation or fracture without a physician's consent, except as first aid (Article 17).
• Names: a ministerial notice allows judo therapy practices to advertise "honetsugi" or "sekkotsu" (bone-setting) (Ministry of Health and Welfare Public Notice No. 70 of 1999). Sekkotsu-in and seikotsu-in are the usual names for Judo Therapists' practices.
• How to check: ask at reception whether your practitioner holds the Judo Therapist licence. Practices must be notified within ten days of opening (Article 19).

Seitai

Seitai (整体) is a Japanese term used for a variety of hands-on practices. There is no national licence for it, and what is offered "varies from business to business" (Consumer Affairs Agency, 2017).

• National licence: none (MHLW leaflet: "so-called seitai, chiropractic, relaxation, foot massage and others, for which there is no national qualification system")
• Legal basis: no Act sets out a qualification or scope for seitai. What applies is Article 12 of Act No. 217 of 1947 (quasi-medical practices) and the Supreme Court's reading of it (see sections 02 and 03).
• What is and is not allowed: seitai is not banned across the board. Practices that risk harming health are prohibited, however, and practising work that objectively amounts to shiatsu or similar without a licence breaches Article 1 (Ministry reply Ihatsu No. 467 of 1960).
• How to check: someone working under the name seitai may hold a different national licence. Rather than judging by the name, ask about the qualification of the person who will see you.

Chiropractic

Whatever its status in other countries, chiropractic has no national licence in Japan. In 1991 the then Ministry of Health and Welfare set out how it should be handled to prevent accidents.

• National licence: none (MHLW leaflet). "Chiropractor" is not a national title in Japan.
• Legal basis: no Act sets out a qualification or scope. The handling is set out in Notice Iji No. 58 of 28 June 1991, "Handling of quasi-medical practices", issued by the Medical Affairs Division. The Cabinet referred to this notice again in a 2019 written answer.
• What the notice says
  • Conditions clearly diagnosed by a physician, such as disc herniation, osteoporosis and atlantoaxial subluxation, are "not appropriate" for chiropractic.
  • "The thrust technique, which applies a sudden rotational and extension manoeuvre to the cervical spine, carries a high risk of injuring the patient's body, and such high-risk acts need to be prohibited."
  • If symptoms worsen, or do not ease after long or frequent sessions, the person should "stop the sessions and promptly undergo a thorough examination at a medical institution".
  • Exaggerated advertising, "in particular advertising claiming medical efficacy such as curing cancer", is subject to regulation.
• How to check: a practitioner may hold a different national licence. Ask for its exact title.

Relaxation

The Consumer Affairs Agency describes relaxation massage as "aimed at relaxing tension of mind and body". There is no national licence for it.

• National licence: none (MHLW leaflet)
• Legal basis: no Act sets out a qualification or scope. In a 2019 written answer, the Cabinet stated that the Ministry of Economy, Trade and Industry oversees health-related industries "including the relaxation industry", "on the premise of compliance with relevant laws including" Act No. 217 of 1947.
• What is not allowed: whatever the name, practising work that objectively amounts to anma, massage or shiatsu without a licence breaches Article 1. The Ministry of Health, Labour and Welfare's 2025 advertising guideline calls "inappropriate" any wording that may lead people to think licensed work is being offered, and says that wording about addressing symptoms such as "back pain" or "stiff shoulders and fatigue" should not be used. (This part of the guideline covers providers outside the licence system and encourages voluntary compliance.)
• How to check: there is no national licence to check. You can ask whether the practitioner holds any other national licence.

Momihogushi

"Momihogushi" (もみほぐし, roughly "kneading and loosening") is not a term set out in Japanese law or in any national qualification (no match in the e-Gov database of Japanese laws).

• National licence: none by that name
• How it is judged: by what is actually done, as with the other names. If the work amounts to anma, massage or shiatsu and is practised as a business, the licence under Article 1 is required.
• How to check: ask whether the practitioner holds a national licence and, if so, its exact title.

Head spa

No law sets out "head spa", and there is no national licence by that name (no match in the e-Gov database of Japanese laws).

• National licence: none by that name
• How it is judged: by what is actually done. If the work amounts to anma, massage or shiatsu and is practised as a business, the licence under Article 1 is required.
• How to check: as for momihogushi.

02What the law sets out (where a breach begins)

Practices outside the licence system are not banned across the board. A breach arises in cases such as these:

1. Practising as a business, without a licence, work that objectively amounts to anma, massage, shiatsu, acupuncture or moxibustion (Act No. 217 of 1947, Articles 1 and 13-7; Ministry reply Ihatsu No. 467). The same applies to judo therapy (Judo Therapists Act, Articles 15 and 29).
2. Practising as a business any other quasi-medical practice that risks harming people's health (Act No. 217 of 1947, Articles 12 and 13-7; Supreme Court, 27 January 1960).
3. Doing anything that amounts to the practice of medicine. Under Article 17 of the Medical Practitioners' Act, "no person other than a physician shall engage in medical practice"; the penalty is imprisonment of up to three years, a fine of up to one million yen, or both (Article 31).
4. Representing a service as markedly better than it really is (Act against Unjustifiable Premiums and Misleading Representations, Article 5(i)). This applies to every business, and the authorities may require "materials showing reasonable grounds" for the claim (Article 7(2)).

Advertising by licensed practices is limited by law to set items, such as the practitioner's status and the name of the practice (Act No. 217 of 1947, Article 7; Judo Therapists Act, Article 24).

03The Supreme Court judgment

On 27 January 1960 the Grand Bench of the Supreme Court ruled on Articles 12 and 14 of the law then in force. It held that their prohibition and punishment of quasi-medical practices "must be understood as limited to business conduct that risks harming people's health". In a 2019 written answer, the Cabinet said it reads quasi-medical practices under the current Act in the same way, and that whether such a risk exists "is judged comprehensively from the specific manner of the conduct".

In the same year as the judgment, the then Ministry of Health and Welfare stated that the judgment did not rule on anma, acupuncture, moxibustion or judo therapy (Notice Ihatsu No. 247-1). The same notice reads the prohibition as applying where a practice poses "even the slightest risk of harm to the human body from a medical point of view".

04Sudden manipulation of the neck: what the authorities have said

Among techniques applied to the neck, the 1991 notice singles out the thrust technique, a sudden rotational and extension manoeuvre of the cervical spine, as a "high-risk act".

• Notice Iji No. 58 (1991): "In particular, the thrust technique, which applies a sudden rotational and extension manoeuvre to the cervical spine, carries a high risk of injuring the patient's body, and such high-risk acts need to be prohibited." A rotational and extension manoeuvre means twisting the neck while bending it backwards.
• The same notice says that where a physician has clearly diagnosed conditions of the neck or spine, such as atlantoaxial subluxation, spinal instability or spinal canal stenosis, chiropractic is not appropriate.
• Consumer Affairs Agency (26 May 2017): its summary of 1,483 accident reports involving hands-on practices without a legal qualification system includes a section headed "accidents involving neck treatment". One case describes severe pain and numbness in the hand after the person's head was grasped and pulled. It is based on a report, and a causal link to the session has not been confirmed (the reports include cases where the facts and the causal link had not been confirmed).
• National Consumer Affairs Center of Japan (2 August 2012): in consultations about harm from hands-on practices, the neck was the main site of harm in 135 cases (17.8%), with a high share of "nerve and spinal cord injuries", a category that also covers fractures and sprains of the spine. These figures cover all hands-on practices, licensed ones included.
• Consumer Affairs Agency advice: people with an illness (for example "heart disease, cervical spinal stenosis, osteoporosis") should consult a physician before a session; tell the practitioner at once about any pain or discomfort; and see a doctor as soon as possible if you feel unwell afterwards.

Even licensed work may not suit every condition. In the same 2012 report, the National Consumer Affairs Center noted complaints about sessions with licensed Anma Massage Shiatsu Practitioners and Judo Therapists too, and asked them to prevent harm to health.

05How to check (signs, notices and wording)

• Signs and notices: the Ministry of Health, Labour and Welfare points to the national qualification stated on the sign, the notice of notification and the licence (or a document giving its details) displayed inside, and the licence holder's card. The card is optional, so not having one does not on its own mean someone is unlicensed.
• Wording: licensed practices may state their qualification, for example "Anma Massage Shiatsu Practitioner (national licence holder)" (advertising guideline, 2025). Seitai-shi, chiropractor and "certified by the ○○ association" are not national titles.
• The full steps are on our page How to choose a nationally licensed practitioner in Japan.

06If something goes wrong

• If you feel unwell: see a medical institution first. The Consumer Affairs Agency advises telling the business and consulting a doctor as soon as possible.
• Refunds and other disputes: visitors can call the Consumer Hotline for Tourists, run by the National Consumer Affairs Center of Japan, on 03-5449-0906 (Monday to Friday, 10:00–12:00 and 13:00–16:00; closed on weekends, national holidays and 29 December–3 January). It answers in English, Chinese, Korean, Thai, Vietnamese, French and Japanese. It handles consumer issues only and cannot advise on illness or injury. Callers in Japanese can also use Consumer Hotline 188.
• Questions about a practitioner's licence or premises: the local public health centre (MHLW leaflet).