TOKYO—There’s a saying in Japan, Nama byoho wa kega no moto. That is, Half-baked knowledge of the martial arts is the cause of great injury.

It turns out the same is true in the realm of Japan’s fetish subculture. Half-baked knowledge of BDSM is also the cause of great injury—especially with ropes.

Japan’s fetish scene has blossomed in recent years and become part of the popular culture. A member of Japanese Prime Minister Shinzo Abe’s cabinet appears to have frequented S&M bars, and even the HBO series Girls had an episode set in a Tokyo bondage club.

However, as the fetish scene has grown, so have the number of injuries, and in a culture of shame many go unreported.

For decades there has been one man in Japan’s BDSM underground who has acted as the “Doctor House” of dungeonland, offering treatment to the masters, slaves, and dabblers who have done damage to themselves or their partners: Golden-san, also known as Golden Rule S.M. or Doctor Golden, is calling for a “gentler, wiser, and kinder BDSM.”

Doctor Golden, who is an S&M practitioner and also a chiropractor, has been taking care of people, mainly women, injured in the pursuit of their pleasure for over two decades. Next month, the book he lovingly edited and oversaw, The Illustrated Manual Of (Japanese) Bondage: Avoiding Risk Edition, should finally be available in bookstores.

In a mere 129 pages, the safety essentials for binding your partner or client with rope are explained in great detail, with easy to understand illustrations. The sexy cover and comic book nudity inside don’t exactly make it a great coffee table book, unless that coffee table is located inside a shady bar frequented by Japanese politicians or your own home dungeon. But it’s a volume that is long overdue.

The Daily Beast interviewed the Doctor about the need for such a book and spoke with one of his patients and friends, the diminutive fashion photographer, clothing designer, and dominatrix, Leh, aged 28.

Doctor Golden lives alone in a small flat inside of Tokyo, with one giant rack in the front room for rope tying. He was born in the 1950s but keeps his exact age and his full identity secret—although he’s a well-known blogger and writer of the fetish scene.

He contracted juvenile rheumatoid arthritis as a boy and when a judo therapist was able to cure his pain, he went to study under him.

The Doctor first became acquainted with Japan’s sexual underworld in 1999 at an orgy held at a luxury hotel. It was also a commercial event for which lawyers, doctors, and accountants paid the stiff cost of 50,000 yen ($500) to join. At the event, he was introduced to a nearly naked woman who confessed that her left hand was limp after an accident during her bondage act. He treated it and she was better after a few sessions. That was the beginning of his part-time life as an S&M chiropractor.

The Doctor’s home is what the Japanese call “the temple of last resort” for those who went a little too far. Many come to him rather than see an M.D.; he’s treated over 430 people since 2000. And there are reasons they’d rather visit his home than a hospital.

“Women in Japan are embarrassed to admit that their boyfriend ties them up or that they like it,” the Doctor says. “Men are ashamed to admit their dominatrix injured them. Some are not sure Japan’s national health insurance will cover their injuries. Things like damaged nipples are not easy to explain.

“There are many reasons those who are in the fetish world as a business hesitate to go see a real doctor—shame and fear for their professional reputation,” the Doctor says. “They also worry that the police will treat the case as an assault rather than an accident between two consenting adults. Of course, the issue of losing face is huge too.

“People in the industry, professional dominatrixes or performers in the BDSM scene, don’t want to talk about accidents. They fear losing trust and reputation if their accidents come out in the open, so they’ve been trying to keep it under wraps,” the Doctor explains. “I felt that it’s insincere to not show this side of our world beforehand, just like they show those videos of car crashes at driving schools. So if getting treatment is embarrassing for people, the best thing is preventive medicine—knowing when to stop and how to do things right.”

Leh adds, “It really looks bad as a dominatrix when you injure your slave… or as the submissive when you get injured. Sometimes both parties are at fault.”

A few years ago Leh herself was injured in a bondage show and the Doctor cured her in a few sessions.

It’s not surprising that kinbaku (rope-tying) results in injury, if you know your history, the Doctor explains.

“The roots of kinbaku come from the arrest techniques used by the police of the Edo Era [which lasted into the mid-19th century]. The police used to be very brutal. It wasn’t a democratic country back then and the cops were often just as likely to execute criminals as they were to arrest them. The authorities cut off their little finger sometimes so criminals would have a weaker grip on their swords. If people had a criminal record that would be tattooed on their faces. If police did just arrest them, they’d tie the criminals up—using rope.

“You don’t need steel handcuffs if you tie the ropes right so that the knots don’t move around,” says the Doctor. “It’s very effective if you run the rope across the vital points and places where the blood circulates. Since it was originally a technique to capture criminals, it sometimes resulted in limb necrosis. Of course, converting this into a form of pleasure would cause accidents.”

According to the Doctor, it was in the Meiji era, as Japan modernized in the late 19th and early 20th centuries, that kinbaku was adapted for entertainment and sensual delight. Over time, the masters worked out the safest ways to apply the ropes, but not everyone learns the ropes of the art with the diligence required.

The Doctor has been trying to change that in the last two years, giving lectures at clubs, at meet-ups of S&M adherents, and conducting safety seminars. He almost always refuses to take money for his medical work—and is offended by how many men won’t take responsibility for the damages.

“There are some injuries too much for me to handle. There are a lot of cases where the men who injure the women aren’t willing to pay the medical fees,” he says. “Since it was a consensual act and the accidents weren’t planned, they should hold 50 percent of the responsibility. The injured women are subject to a life of disability.”

Rope-related injuries aren’t the only thing BDSM practitioners have to worry about. People get whiplash, neck problems, burns from hot candle wax, jaw problems from biting the rope too hard, dislocated shoulders, elbows, knees, and nerve issues. Candles are often used for setting the mood in BDSM and dripping the hot wax on a naked body is classic stimulation, but it can result in burns.

Basic knowledge of anatomy also helps. “For example, the further you go down the ribcage, the weaker the bones get,” the Doctor explains. “If you tie someone around the lower ribs, they can get fractured or broken.”

Good to know.

You might wonder, if S&M is so dangerous, especially the rope-tying—why do it?

“The ropes, the whips, the candles, the role-playing—it’s all about mutual pleasure. Sometimes it’s love,” says the Doctor. “One thing I have to say is that I’m against dividing people into who is M and who is S and so on. S&M isn’t anything special.”

(The S derives from the name of the Marquis de Sade, seen as glorifying the infliction of pain for purposes of arousal, the M from the 19th century Austrian writer Leopold von Sacher-Masoch, who arranged to serve his mistress as a slave. His most famous book is Venus in Furs. And while we’re sorting acronyms, BDSM covers bondage, discipline, sadism, and masochism.)

“When couples come to me for advice,” says the Doctor, “I tell them to develop the woman’s erogenous zones and learn rhythm. People good at sex are usually good with musical instruments. They can do different things with their hands at the same time and they have good rhythm and a sense of push and pull. In sex, the dynamism of the rhythms and timing is so important. Japanese people need to have a better sex life, so I want to make BDSM better, promote it, and make couples happy. If you don’t know a woman’s body and tie them up, you’re not going to have decent sex.”

It’s not only bad techniques that cause accidents, he points out. “Things go wrong because people don’t know enough about the other person’s body; they’re selfish. It’s not all about the reaction or the live performance aspect of it. There needs to be an awareness of how it feels for the other person and compassion. Both sides need to talk. There may be a master-servant relationship but we are all the masters of our own lives. You’ve got to carefully enjoy how the session unfolds,” he says philosophically.

In the West, there has been for obvious reasons a view of kinbaku as demeaning to women and the ropes as symbols of oppression (although it shows signs of becoming mainstream kink). The works of the photographer Nobuyoshi Araki, which often depict naked Japanese women tied up in contorted positions, are controversial even in Japan. Is the whole thing misogynist?

Leh disagrees.

“Everyone’s BDSM is different and everyone’s rope-play objective—what they hope to get out of it—is different. Yes, stereotypically it’s older, kinky guys tying up women. Tying them in sexual positions or even getting off from humiliating or controlling the girls in those positions.

“For me,” says Leh, “from a woman’s perspective that does nothing for me sexually. It was from a purely artistic perspective that I started learning kinbaku. When I’m on the tying side of rope play, I see it as an art form. I prefer to tie the girls in elegant poses and in sets which set the mood and create stories. Abandoned houses, rooftops, bamboo gardens. I really love seeing the girls’ happy reactions when I show them the pictures I take later. Of course during the shoot, it may be a sexually stimulating experience for the girls if they have masochistic or submissive tendencies.

“I also know this because I have masochistic tendencies. When I get tied up I experience what’s called nawayoi—being drunk on ropes. It’s like being high. You let go, empty your head, and leave yourself in the hands of another. There’s a real sense of trust and romance in that. At the end of the session you really don’t want to be untied. You want to stay tied to your play partner. The act of binding a person is not easy. After all, you cannot connect unless you understand loneliness and transient love.”

Love indeed is a naughty knotty thing. And the good doctor has taken a step in making sure that those love-knots are tied a little more safely, the candle burns a little farther from the skin.