The characteristic of Shiatsu as defined by Namikoshi is to apply pressure using only the fingers, palms and thumbs on points related to the central and autonomic nervous systems.

Masanuga, who identified reflections of the acupuncture channels in the arms and legs, considered that a shiatsu treatment should:

a) involve the whole body,
b) require a focused practitioner sensitive to the energy distributions of the body, and
c) provide an extra dimension of connection and support (using both hands where one ‘listens’ and the other acts).

In both styles, however, the essence of shiatsu is “Diagnosis and Therapy combined”. “Diagnosis and Therapy combined” is the ability of the practitioners to use their sensory organs (palms, fingers, and thumbs) to detect disharmonies in the energetic components of the body, (such as stiffness or slackness at or within its surface), and to perform empirically established routines to correct these problems. To acquire this skill takes considerable experience. The defining difference between shiatsu therapy and modern and Kampo medicine (also known as Traditional Chinese Medicine (TCM), such as acupuncture and moxibustion) is this “Diagnosis and Therapy combined”.