The technique combines hydrotherapy floating and immersion with shiatsu and other massage techniques. In Japan, shiatsu is regulated but oil massage and Thai massage are not. Tui na () is a form of massage akin to acupressure (from which shiatsu evolved). It is used by acupuncturists as well as massage and Shiatsu therapists. "Shiatsu" derives from a Japanese massage modality called "anma". She is now a shiatsu massage therapist, operating out of her home. Practices such as moxibustion and shiatsu enjoy enormous popularity in the West. To examine a patient, a shiatsu practitioner uses palpation and, sometimes, pulse diagnosis. He called this new form of aquatic bodywork Watsu, a contraction of Water Shiatsu. He founded Zen Shiatsu and the Iokai Shiatsu Center school. Kramer claims to be skilled in shiatsu technique and relieves her aching neck. She also became certified in the alternative medicine Shiatsu and "took some other directions". In the Japanese language, "shiatsu" means "finger pressure". There is insufficient evidence that "shiatsu" is an effective medical treatment. He identified as a minimalist and slept on a portable Shiatsu pad.