In 1988 Stephen Birch and Junko Ida encountered Toyohari in Japan and persuaded Fukushima to send a young practitioner to Boston in the US to start teaching
By the early 1990s programs to study Toyohari were being run in Boston, New York and in the later 1990s in Connecticut, Seattle, Washington DC, Florida leading to establishment of the Toyohari Association of North America (TANA)
In 1997 Birch and Ida moved to Holland and started teaching Toyohari in Amsterdam in 1999 assisted by senior Japanese teachers, leading to the establishment of the European Branch of the Toyohari Association (EBTA)
Toyohari programs were started in Australia-New Zealand in 2003 leading to the establishment of the Australasian Branch of the Toyohari Association (ABTA)
Highly experienced Toyohari practitioner-teachers (each with 20-60 years of experience) travelled to the US and Europe and later to Australasia to assist with teaching. Among them were Akihiro Takai, Toshio Yanagishita, Shozo Takahashi, Koryo Nakada, Shuho Taniuchi
Other Japanese teachers also travelled to assist with teaching including Michio Murakami, Yutaka Shinoda, see link 1.3 for a complete list with pictures of the teachers
Toyohari is the largest traditional Japanese acupuncture Association outside of Japan with members across North America, Europe, the Middle East, Australia, New Zealand