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[Objective]We report herein the use of acupuncture to counteract gait disturbance in a patient with Parkinson's disease (PD). A portable gait rhythmogram was used to objectively demonstrate gait improvements. <BR>[Case]Case:A 72-year-old woman, who a 64 experienced a tremor of the right hand and was diagnosed with PD. Symptoms improved with anti-PD medication, but at 71 years old, she experienced heaviness of the neck and shoulders and stiffness of the anterior thighs, and her step length decreased. Acupuncture therapy was initiated to relieve these symptoms. <BR>Present illness:On examination, she presented a wobbly gait, cold feet, and reported frequent falling. Heaviness in the neck and shoulders extended from the neck to the suprascapular region, and increasing heaviness resulted in a forward-flexed posture and decreased step length. Muscle hypertonia of the quadriceps muscles was bilaterally observed, explaining the perceived stiffness in the thighs. She was at stage III on the Hoehn and Yahr Scale. <BR>Acupuncture therapy:Acupuncture therapy was performed weekly for 12 weeks to alleviate the muscle hypertonia associated with muscular rigidity. Acupuncture points comprised the points in the muscle hypertonia where tenderness was observed, including BL 10, DU 16, ST 32, SP 10 and ST 34. <BR>Evaluation:A portable gait rhythmogram was used to measure the ground reaction force (GRF), velocity and step length. Dynamic balance functions and PD symptoms, were respectively evaluated using the Timed Up and Go Test (TUGT) and Unified Parkinson's Disease Rating Scale (UPDRS). Evaluations were conducted on initial examination and after the 12th therapy session.<BR>[Results]After the fourth session, perceived stiffness in the neck, shoulder region and thighs decreased. all frequency decreased from 5 times/day to 3times/day (4th session) and then once/day (7th session). There were no falls after the 8th session. Reduction in gait disturbance was objectively observed as follows:Increases were observed in GRF (0.15 to 0.17 m/s 2), gait velocity (49 to 53m/min), and step length (47 to 49 cm), while TUGT time decreased (11.8 to 9.5 s). Improvements in PD symptoms were also observed with decreased UPDRS score (41 to 28 points).<BR>[Discussion and Conclusion]The use of acupuncture therapy achieved improvements in Parkinson-related gait disturbance (objectively demonstrated using a portable gait rhythmogram). Acupuncture improved not only gait disorder but also other PD symptoms.
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[Objective]To analyze and understand cases of adverse effects of acupuncture and moxibustion published in medical journals between 2007 and 2011.<BR>[Methodology]We searched relevant articles with the Web of Japan Medical Abstracts Society and PubMed. We used keywords for acupuncture, moxibustion and related adverse events.<BR>[Results]We located 39 papers reporting 39 cases that occurred in Japan:infection (7 cases), organ injury (11), foreign body or needle breakage (8), neurological damage (6), cutaneous disease (1), adverse effects of moxibustion (4), and others (2). As for cases published in foreign countries, we located 60 relevant papers:infection (19 cases including 2 outbreaks), organ injury (13), foreign body or needle breakage (5), neurological damage (9), cutaneous disease (5), adverse effects of moxibustion (2), and others (7).<BR>[Conclusion]Although causal relationship has not been established in some cases, occurrences of infection, organ injury, and needle breakage/foreign body are still as high as they were before. This suggests that continual feedback to acupuncturists of information on safety is necessary.
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[Objective]To aleviate incidents and prevent medical accidents in acupuncture and moxibustion therapy, we constructed an incident report (IR) system at the Center of Acupuncture Science, Meiji University of Integrative Medicine.<BR>[Methods]The IR system was operated with the center staff as reporters. The staff reported incidents when encountered or found. The cases of incidents were added up per item, and the contents of incidents fed back per month to staff and students. The feedback was given orally at a morning assembly, and a feedback poster was put up.<BR>[Results]There were 146 cases from July 2004 to September 2005. The contents of incidents were 96 cases concerning the environment of treatment, 0for incidents before treatment and 50 during or after treatment. The largest number of incidents in the environment of treatment was 66 cases for inappropriate disposal of instruments. The largest number of incidents during or after treatment was 12 cases in nearly forgetting to remove acupuncture needles from the body.<BR>[Discussion]Ten mean cases per month occurred as incidents. However, it was clear that the incidents in most cases could have been prevented if the acupuncturist had been noticed and took measures to deal with the situation. To prevent medical accidents, we consider a need to continuously feed back the contents of incidents to instructors and students and call them to their attention.
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The skin has a special significance in acupuncture. In acupuncture, the skin is both a site of both examination and treatment while providing an interface for information exchange with the external world. Various findings that appear on the body surface should not simply be understood as dermatologic findings, but considered as a reflection of the internal condition of the body, the external world and the mental condition. From this perspective, although acupuncture treatment use only simple stimuli, such as needles, and stimulate only specific sites on the body surface, they can produce therapeutic effects and regulate physical and mental functions<BR>In this symposium, we reviewed the relationship between skin and acupuncture by examining acupuncture and moxibustion treatments for specific dermatologic diseases and their clinical effects. As a result, we were able to reaffirm the above relationship from the perspective of an acupuncturist.<BR>The methods and clinical effects of acupuncture and moxibustion treatment were introduced for atopic dermatitis (by Egawa), tinea unguium (by Dr. Menjou), and the dermatologic symptoms of connective tissue diseases (by Dr. Kasuya). Moreover, Dr. Kagawa presented his research results related to the effects of acupunctural stimulation on the condition of the skin. Based on these research results, the possible effects of acupuncture treatment were discussed based on extensive application in fields such as dermatology, cosmetics, and anti-ageing. Regarding the significance of the skin (body surface) within the practice of acupuncture, it was reconfirmed that the skin reflects the condition of the organs and the mind, and examination of the skin may elucidate both mental and physical health. In addition, we also discussed the body surface as a site of both examination and treatment, and investigated the efficacy, potential for further development, and significance of acupuncture, which connect the skin with systemic functions.
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Continued from the previous year's theme of our workshop, we collected various information and ideas for safer acupuncture practice. Subjects and presentations of the present workshop were as follows:<BR>1. Literature review of papers on adverse events published between 2003and 2006<BR> 1) Papers in domestic journals (by Ishizaki and Egawa)<BR> 2) Papers in foreign journals (by Yamashita and Umeda)<BR>2. Debate on wearing sterilized fingerstall or glove<BR> 1) Present status of the use of fingerstall in acupuncture practice (by Katai and Minowa)<BR> 2) Practical side of clinical education of acupuncture using fingerstall (by Hatakeyama and Furuya)<BR> 3) Problem of using individual fingerstalls in acupuncture practice (by Handa and Miyamoto)<BR>We will continue to provide information and discuss solutions in order to reach a common understanding and specific methods for safer acupuncture practice.
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[Aim] Diffuse pan-bronchiolitis (DPB) causes severe respiratory dysfunction and severely limits a patient's daily activities. Case: This paper reports a case of a DPB patient whose respiratory symptoms were successfully improved by acupuncture. In a case report in January 2002, a 62-year-old male visited the Department of Respiratory Internal Medicine at Gifu University Hospital, complaining of cough, pumlent sputum and dyspnea on exercise. His general condition had worsened despite ordinary medical treatment. Thus acupuncture was added to the treatment in August, 2001. Intervention: The patient received acupuncture treatments once a week for 50 weeks. The acupuncture treatment was based on the Chinese medicine theory. Measurements: Outcome measures were respiratory symptoms using the Fletcher-Hugh-Jones (F-H-J) classification, 6-minute walking distance (6 MWD), blood test, arterial blood gas and pulmonary function tests. Computed tomography (CT) was assessed. Each evaluation was done after 15 weeks and 50 weeks later.<br>[Results] After 15 weeks of acupuncture treatment, cough, pumlent sputum, walking distance, the Borg scale and respiratory function were significantly improved compared with the baseline. Moreover, the effect of the acupuncture treatment continued for 50 weeks.<br>[Conclusion] This suggests that acupuncture treatment was effective in treating the advanced case of DPB.
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We have been collecting various ideas on safer acupuncture practice from participants in our workshop as well as members of the committee. Subjects and presentations of the present workshop were as follows:<br>1. Forgotten needles<br> 1) Ideas of prevention based on a questionnaire survey (Egawa and Ishizaki)<br> 2) Effect of incident reporting system (Yamashita)<br>2. Cleaner method of needle insertion and Oshide (needle-supporting fingers)<br> 1) Merits and demerits of sterilized fingerstall and glove (Miyamoto)<br> 2) History of the clean needle development (Umeda)<br> 3) A novel clean acupuncture needle device (Imai and Ishizaki)<br>Although there was not enough time for discussion, we collected some useful ideas from the participants. A novel clean needle invented by Imai gave a strong impression to the audience. We should continue to discuss a diverse impact when such new devices and concepts become widespread in traditional acupuncture practices. We welcome more ideas and opinions from relevant facilities, clinics and fields in order to further improve safety of acupuncture.
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[Aim] Acupuncture has traditionally been used in Japan in the treatment of bronchial asthma and is being increasingly applied. However, although there are many published studies on acupuncture and asthma, few meet the scientific criteria necessary to prove the effectiveness of acupuncture. Therefore, this study presents the clinical results of acupuncture treatment for adult bronchial asthma.<BR>[Design] Single-subject research design (N-of-1 method).<BR>[Setting] Department of Internal Medicine, Acupuncture and Moxibustion Center, Meiji University of Oriental Medicine, Japan.<BR>[Participants] Six patients of both genders (mean age, 49.0 years old) with moderate-to-severe persistent bronchial asthma.<BR>[Intervention] Six patients received 10 sessions of acupuncture treatment (once per week) for 10 weeks. The basic combination of meridian points for the treatment of the patients were LU 1 (Zhongfu), LU 5 (Chize), LU 9 (Taiyan), CV4 (Guanyuan), CV 12 (Zhongwan), BL 13 (Feishu), BL20 (Pishu) and BL23 (Shenshu).<BR>[Measurements] Primary outcome was the symptom of asthma at the end of the 10 treatment sessions. Secondary outcomes were the Dyspnea Visual Analogue Scale (DVAS), respiratory function, Peak Expiratory Flow Rate (PEFR), blood, the use of asthma drugs. The effect of the intervention on eosinophils in blood was assessed.<BR>[Main results] Late effects of asthma patients showed significantly better results compared with the base line on outcome measures after the 10 weeks. In this study, symptoms of asthma and dyspnea VAS in patients with asthma were significantly improved by acupuncture.<BR>[Conclusion] This study indicated that acupuncture was effective in asthma symptoms and respiratory functions.
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We continued reviewing published evidence and information regarding the safety of acupuncture. Subjects in 2005 were as follows : <BR>1. Safety during acupuncture stimulation<BR>2. Quality and strength of acupuncture needle<BR>3. Sterilization and storage of equipments<BR>4. Hygienic handling of equipments<BR>5. Relevant notices from the Government<BR>6. Standards of notification regarding hygienic practice and contaminated wastes<BR>We hope that the information here will influence the future school education, clinical practice, manual editing and research activities.
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[Objective] The effect of indirect moxibustion on cold symptoms was examined in elderly subjects living in a nursing home.<BR>[Design] A single-case experimental design that enables clinical trials in small a number of subjects was used in this study.<BR>[Methods] Two elderly subjects living in a nursing house participated for 16 weeks. The experimental periods were allocated at random as treatment periods and control periods of eight weeks each. During the treatment periods, subjects were treated with indirect moxibustion GV 14 and BL 12 (both sides) 3 units each, 3 times a week. Rating scores with 4 and/or 5 grades were used to evaluate common cold symptoms.<BR>[Results] Concerning the presence of common cold, there were no significant differences between the treatment and control periods. Moreover, concerning common cold symptoms, there were no significant differences between treatment and control periods.<BR>[Conclusion] Effects of an indirect moxibustion on the common cold symptoms were not detected in this study. We speculated that the living environment of these subjects and the intensity of stimulation were factors. Furthermore, we suspected that a single-case experimental design was unsuitable for common cold research.
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[Purpose] We report a case treated by acupuncture in a health care facility for the elderly to evaluate the effect of acupuncture on severe pulmonary emphysema.<BR>[Case and methods] A 88 year-old man visited Meiji University of Oriental Medicine Hospital with dyspnea in March 2000 and was diagnosed with pulmonary emphysema. He was hospitalized in October 2002 because his chronic respiratory failure was worsening : oxygen therapy was started. After discharge from hospital, he entered a health care facility for the elderly and acupuncture treatment for lumbago was initiated. Thereafter, acupuncture treatment for dyspnea and stiff shoulder started. He was determined to be grade V according to Fletcher-Hugh-Jones classification of dyspnea. Spirometry of the patient before acupuncture for dyspnea showed 88.0 % in %VC, 38.2 % in FEV 1 %, and 30 % in %FEV 1, and the patient was diagnosed with chronic obstructive pulmonary disease of serious grade. Acupuncture treatment was performed once or twice a week, and acupuncture treatment for dyspnea was performed 21 times (total of 33 treatments).<BR>[Results] Subjective symptoms of lumbago, stagger of the legs, and shoulder stiffness were evaluated with Numerical Scale or Pain Scale. The state of dyspnea was evaluated with Numerical Scale and Borg Scale, and exercise tolerance was evaluated with 6 min of walking. After 33 acupuncture treatments, dyspnea on exertion, exercise tolerance, and the findings of spirometry were not improved. But dyspnea on rest had disappeared with improvement in lumbago, stagger of the legs, and shoulder stiffness. These results indicate that acupuncture as a general treatment is effective for the improvement of dyspnea, especially in elderly patients whose general state of health is not good because of restriction in their ability to exercise in the course of daily life due to dyspnea of exercise such as lumbago, stagger of the legs, and shoulder stiffness.
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Emphysema with bronchial asthma (BA) in chronic obstructive pulmonary disease (COPD) causes severe respiratory dysfunction and severely limits a patient's daily activities. This paper reports the case of a COPD patient whose respiratory symptoms were successfully improved with acupuncture. In July 1998, a 69-year-old male visited the Department of Respiratory Internal Medicine at Gifu University Hospital, complaining of dyspnea on exercise, and asthma attacks. His general condition had worsened despite strictly controlled medication and home oxygen therapy (HOT). Acupuncture was thus added to these treatments from ******. Before initiating the acupuncture treatment, the severity of dyspnea in the patient was diagnosed as level III (Severe), according to the GOLD classification. Spirometry showed severely disturbed respiratory function (%VC: 90.7%, FEV<sub>1</sub>%: 35.1%, %FEV<sub>1</sub>: 38.2%, V 25: 0.20 L/S). The basic combination of meridian points used in this case included LU 1 (Zhongfu), LU 5 (Chize), LU 9 (Taiyan), CV 4 (Guanyuan), CV 12 (Zhongwan), CV 22 (Tiantu), ST 40 (Fenglong), BL 13 (Feishu), BL 23 (Shenshu) and KI 3 (Fuliu). The patient received acupuncture treatments once a week for 10 weeks. Respiratory function and symptoms were measured. After 10 weeks of acupuncture treatment, asthma attacks, walking distance, the Borg scale and respiratory functions were significantly improved compared with the baseline. This suggests that acupuncture treatment was effective in treating advanced cases of both asthma and COPD.
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Episodic angioedema with eosinophilia (EAE) is an idiopathic condition characterized by recurrent symptoms such as angioedema, urticaria, and eosinophilia. We report a case of a 25-year-old woman with the non-episodic variant of this condition (NEAE) who was treated with acupuncture.<br>The patient presented with a two-week history of generalized itching and angioedema. Erythema, bilateral limb edema, and swelling and pain of both wrists and ankles were noted. As antiallergic medication administered for several days was ineffective, she was admitted to our hospital. Hematologic investigations revealed a white blood cell count of 11850/mm<sup>3</sup> with 64.2% eosinophils (7610/mm<sup>3</sup>). Histopathologic examination of a cutaneous biopsy specimen indicated an eosinophilic infiltration localized around blood vessels in the superficial dermal layers. NEAE was diagnosed on the basis of these findings. Acupuncture treatment was performed according to Traditional Chinese Medical theory. Itching was alleviated following acupuncture treatments and relapsed on days when acupuncture was not administered. However, edema and itching gradually diminished between acupuncture treatments, in parallel with resolution of the peripheral eosinophilia. In this case, acupuncture treatment was effective for alleviating itching in NEAE.
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Knowledge and procedures regarding safe acupuncture practices often include conjecture and anecdotes lack-ing scientific evidence. In order to improve the safety standards of acupuncture, we should collect, scrutinize, and apply evidence on the safe management of acupuncture. We, the Committee for Safe Acupuncture, have commenced collecting and reviewing relevant evidence published. Subjects in 2004 were as follows : <BR>1. The present situation of safety education and damages (by Katai) <BR>2. Hand washing and finger disinfection (by Ishizaki) <BR>3. Disinfection of the needle insertion area (by Umeda) <BR>4. Procedures of needle insertion and removal (by Miyamoto) <BR>5. Safe insertion depth (by Yamashita) <BR>6. Environmental sanitation (by Egawa) <BR>We hope that the knowledge and questions which come to light through the present work will influence school education, clinical practice, manual editing and research activities.
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We updated safety information on acupuncture and moxibustion, focusing on adverse events. Case reports published between 1998 and 2002 were searched, using “Ichushi Web” (Web version of <I>Japana Centra Medio Medicina</I>) and “PubMed”. Thirtysix cases of acupunctureassociated adverse events (13 infections, 11 dermatological problems, 6 organ injuries or foreign bodies, 5 nerve injuries etc.) and nine cases of moxibustionassociated adverse events (6 dermatological problems etc.) were located. Most cases were published in academic journals in the field of modern Western medicine, which clinical acupuncturists usually do not read. Therefore, our committee should play a role of collecting safety information and performing the feedback for the acupuncturists.<BR>We also summarize the contents of the Workshop held by our committee on June 6, 2003. The most controversial issue was determining an appropriate method of needle insertion in terms of infection control. More evidence is needed for establishing a good manual for safety acupuncture.
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The tender points treatment has been widely used for both treatment and diagnosis, but there have been very few studies that have examined its diagnostic usefulness. Thus, the purpose of this study was to clarify the diagnostic importance of tender points. The subject was a patient who had osteoarthritis of the knee of Meiji University of Oriental Medicine Hospital. The relationship between pressure pain thresholds (PPTs) and symptoms in osteoarthritis of the knee (painful knee motion) were evaluated with the Japanese Orthopaedic Association scale (JOA scale), a knee scale and the subject's knee pain diary (starting pain, flexion pain, walking pain and total pain Wong-Baker faces pain rating scale). After 40 acupuncture treatments, improvement was noted in the symptoms and PPTs. The changes in PPTs were related to the symptoms of the knee (flexion and walking pain). This suggests that changes in PPTs (around the knee) are a useful indicator for evaluating knee pain.
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Chronic obstructive pulmonary disease (COPD) causes severe respiratory dysfunction and severely limits patients' daily activities. We report a case of the patient with COPD whose respiratory symptoms were successfully improved by acupuncture. A 70-year-old man visited Meiji University of Oriental Medicine Hospital complaining of dyspnea during exercise on _??_. Despite strictly controlled medication and a regimen of home oxygen therapy (HOT), his general condition continued to worsen. Then a series of acupuncture treatment was started on _??_. The severity of dyspnea of the patient before acupuncture treatment was determined as level V according to Hugh-Jones classification, and spirometry showed severely disturbed respiratory functions (%VC: 63.5%, FEV<sub>1</sub>%: 29.4%, PEFR: 84.8 1/min in the morning and 93.5 1/min at night). The basic combination of meridian points for the treatment of the case was LU1 (Zhongfu), CV12 (Zhongwan), CV4 (Guanyuan), LU5 (Chize), and BL13 (Feishu). The acupuncture needles were retained for ten minutes in each session. The single-subject research design (A-B-A method) was applied to detect the specific effect of the acupuncture treatment on the respiratory functions or the symptoms of the subject. “A” and “B” mean “treatment period” and “no treatment period” respectively. After 60 acupuncture treatments during a 14-month period, both the respiratory symptoms and the VAS for dyspnea showed improvement, which were specifically observed during the intervention period. Improvement was also reflected in the level of the Hugh-Jones classification and respiratory function test. It was suggested that acupuncture treatment might be effective for advanced cases of COPD.
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With the purpose of clarifying the influence of density and height of moxa cones on the quantity and quality of direct moxibustion stimulation, temperature changes at the bottom of moxa cones the size of a “rice grain” were measured with a thermocouple on an asbestos board.<br>As a result, the mean peak temperature of each density group (height of 5mm, bottom diameter of 3mm) was between 140°C and 160°C. There was a significant linear regression between density (mg/11.8mm<sup>3</sup>) and heating temperature duration above 45°C (seconds) (y=1.9+3.2x, r=0.92, p<0.0001). There was no significant difference in the velocity of temperature increase (32-45°C) between two groups of cones of different height and the same density, meaning there is no evidence to indicate that tall moxa cones make patients feel mild heat.<br>From the results obtained in this experiment, the density of the moxa cone was found to be one of the most important factors affecting direct moxibustion treatment.
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We examined relation between mucosal findings of tongue and gastric mucosal lesion by comparison photographic findings of tongue with gastroendoscopic findings of stomach. Subjects of this study were 115 cases undergoing gastroendoscopic examination in our hospital. The state of tongue surface was evaluated by thickness and color of tongue coating and tongue fissure. Especially, the tongue area was divided into 9 sections in order to investigate distribution of coating and fissure. The cases showing thick coating at the lateral sections of tongue were significantly numerous in patients who had gastric ulcer, compared with the cases in those who had no gastric ulcer. From these results, it was suggested that inspection of tongue mucosa could become one of the useful examination of oriental medicine for gastrointestinal disease.
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We examined the effects of acupuncture stimulation (ACP-S) to the bilateral Quchi points (Q-P) on insulin secretion with or without electric stimulation (E-S) after an oral glucose load of 75g. This study was performed for 9 healthy volunteers classified into 5 group, a group of ACP-S to Q-P without E-S, a group of ACP-S to Q-P with E-S, a group of ACP-S to the bilateral points 1.5cm laterally apart from Q-P (P apart from Q) without E-S, a group of ACP-S to P apart from Q-P with E-S and a group of no ACP-S. Values of blood suger and serum insulin were determined before and 30min, 60min and 120min after an oral glucose administration. The value of serum insulin at 30min after oral glucose load and the total insulin values during the oral glucose tolerance test were significantly higher in a group of ACP-S to Q-P without E-S compared with those in the other group. These results suggested that acupuncture stimulation to Quchi points might increase insulin secretion.