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[Objective] To clarify the utilization of characteristics and reactions of acupuncture points, and the frequency of using acupuncture points in acupuncture and moxibustion treatment in Japan.[Methods] We conducted a questionnaire survey involving members of the Japan Society for Oriental Medicine and those of the Japan Society of Acupuncture Course in Universities. The contents of the questions included age, sex, profession, length of clinical experience of acupuncture/moxibustion, treatment method, utilization of characteristics and reactions of acupuncture points, and frequency of using acupuncture points in both acupuncture and moxibustion treatment.[Results] The number of valid questionnaires was 59 (59 for acupuncture treatment and 50 for moxibustion treatment). The respondents were as follows : average age of 52 ± 12 years, 45 males and 14 females, 13 medical doctors and 46 acupuncturists, clinical experience of 21.1 ± 11.5 years. Most practitioners utilized ill ness-specific features of acupuncture points, de qi, and reactions they feel with their needling and pressing hands. Ten acupuncture points were used in 50% of patients in acupuncture treatment, and ST 36 and SP 6 were the most frequently used. On the other hand, no single acupuncture point was used in more than 50% of patients in moxibustion treatment. Thirteen acupuncture points were used in 30% of patients in moxibustion treatment, and BL 23, SP 6, and ST 36 were the most frequently used.[Conclusion] Our survey clarified the usage of acupuncture points in acupuncture and moxibustion treatment in Japan.
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Ikki-Ryo was a moxibustion clinic established as part of a national project facility that belonged to the Uchihara Training Camp (1938-1945) for the Japanese Youth Volunteer Brigade for Reclamation of Manchuria and Mongolia. Since such a case is extremely rare in the modern medical history of Japan, this article summarizes the information on Ikki-Ryo obtained through documents collection and analysis, interviews, and fieldwork investigation. Ikki-Ryo was proposed by acupuncturists Bunshi Shirota and Kyohei Tanaka, and was established under the directorship of Kanji Kato. It played a role in the clinical practice and training of moxibustion techniques. The data suggests that Ikki-Ryo provided advantageous clinical effects in the promotion of good health and in the treatment of some diseases (e.g. enuresis, suspected tuberculosis) for the trainees, while it is indicated that this clinic had a certain geographical, organizational, and emotional distance from other medical or healthcare departments at the camp. Although the role of moxibustion has changed throughout history, the concept and activities of Ikki-Ryo are still thought-provoking from the perspective of the diversity, versatility, complementarity, and sustainability of healthcare tools.
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The Japan-Korea Workshop on Acupuncture and EBM is an academic exchange between the Japan Society of Acupuncture and Moxibustion (JSAM) and the Korean Acupuncture and Moxibustion Medical Society (KAMMS). The theme of the 9th and 10th Workshop was clinical practice guidelines (CPG). Three Korean and two Japanese speakers presented in the 9th Workshop held at Osaka, and two in each country did in the 10th at Jecheon, Korea. Since Korea has already developed some Korean Medicine CPGs, the present state and protocols for improvement process were reported. On the other hand, Japan has not developed such CPGs on acupuncture. The Japanese speakers therefore presented results of a survey on Japanese CPGs that include “acupuncture-moxibustion” as a treatment option and quality assessment of those CPGs. Although there are some differences on circumstances surrounding acupuncture practice between Japan and Korea, it was a good opportunity to obtain useful information for developing CPG on acupuncture in Japan and to discuss on this issue with Korean researchers preceding in this area. We reaffirmed the need for continued academic exchange between JSAM and KAAMS.
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The "Japanese Orthopaedic Association (JOA) Clinical Practice Guidelines on the Management of Low Back Pain 2019, 2nd Edition" was published in May, 2019. We found multiple issues of serious misinformation on acupuncture; these included, but are not limited to inappropriate conclusions due to errors in literature selection, data extraction and data input. Accordingly we point out each error and provide the correct information. 1. A published paper of meta-analysis of randomized controlled trials (RCTs) on Japanese acupuncture for low back pain in Japanese patients is ignored. 2. Regarding acupuncture for acute low back pain, some RCT data has been incorrectly inputted and analyzed. The wrong numbers have been mistakenly inserted into the analysis software (plus instead of minus) leading to the opposite and incorrect conclusion that acupuncture is not superior to the control group. Furthermore, in a meta-analysis on the effect of acupuncture on functional disorder, data on pain are incorrectly inputted and analyzed. 3. The Guidelines' meta-analysis on acupuncture for chronic low back pain included five RCT papers. The papers included acupuncture (1 article), auricular point acupressure (2 articles), laser acupuncture (1 article) and acupressure backrest (1 article). Only one article in the meta-analysis used needle-inserting acupuncture, therefore, this is not a meta-analysis on acupuncture. There are also many errors in data input. Moreover, there is mislabeling of the forest plot figures: Figure 7 is incorrectly labelled "pain", but actually shows data on "functional disorder" (Figure 8), and vice versa. 4. A published paper of meta-analysis on the cost-effectiveness of acupuncture is ignored. Additionally, although a paper of "meta-analysis on the health economic effects of yoga" is cited, the health economic effects of yoga are not actually addressed or mentioned in that paper. Although the Guidelines state they have fully complied with "Minds Manual for Guideline Development 2014" (Minds: Medical Information Network Distribution Service, Japan Council for Quality Health Care), they did not set up a systematic review team, and do not state whether or not they organized an external review committee. Such circumstances may have contributed to the serious errors in the Guidelines. Because we have also recognized many errors regarding other therapies addressed in the Guidelines, we fear that the present Guidelines may destroy the credibility of the entire clinical practice guidelines published in Japan. We strongly hope that a corrected and revised version is published as soon as possible.
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[Objective]To assess the effect of press tack needle (PTN) acupuncture in treating insomnia.<BR>[Design]Sham-controlled, double-blinded n-of-1 trial with three phases, (A) no treatment, (B) real PTN, and (C) sham PTN.<BR>[Setting]Morinomiya University of Medical Sciences (Suminoe-ku, Osaka City)<BR>[Participants]Four subjects experiencing insomnia with 6 or more points on the Pittsburgh Sleep Quality Index (PSQI). They were randomly assigned to groups A-B-A-C (n=2) or A-C-A-B (n=2).<BR>[Interventions]PTN with lengths of 0.6 mm were used on HT 7, PC 6, and SP 6 during phase B, while sham PTN without needle tips were used on the same points during phase C. Both real and sham PTN were administered twice a week.<BR>[Main Outcomes]Primary outcomes were sleeping hours and the number of nocturnal awakenings recorded in a sleep diary. Secondary outcomes included PSQI, Profile of Mood States (POMS), Stress Visual Analogue Scale (Stress VAS) and Sleep Quality Index measured by ActiSleep. <BR>[Main Results]We mainly assessed one patient with sleep-onset insomnia of 8 points or more (PSQI) before intervention. With the real PTN, the number of nocturnal awakenings decreased (1.6±0.9 for real vs. 3.6 ± 1.3for sham). Sleeping hours did not change significantly (Real 426 ± 49.3min, vs Sham 450 ± 60.0 min). Waking after sleep onset (65 ±14.7 min for real vs. 129 ± 39.5 min for sham) and sleep efficiency (82.8 ± 3%for real vs. 68.6 ± 4.3%for sham) estimated by ActiSleep also improved during the period of real PTN. Regarding T points for POMS, there was a difference between real (51) and sham (67) for "confusion;"however, blinding was unsuccessful and the wash-out period was not long enough.<BR>[Conclusion]Although we need further validations, due to some methodological flaws, the present results suggest that PTN acupuncture is clinically useful for some patients suffering from insomnia.
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In The 63rd Annual Congress of JSAM (Ehime 2014), the Committee for Safe Acupuncture of Research Department in the Japan Society of Acupuncture and Moxibustion (JSAM) conducted a workshop entitled "The Regional Anatomy Q&A for safety needling"which provided information on organ damage and neurological injuries that may occur after acupuncture treatments. This workshop stated the need for improvements in safe practices of acupuncture.<BR>This workshop was divided into three parts:(1) results of questionnaire surveys conducted in Japan for acupuncturists on their clinical experience of adverse events and for orthopaedic doctors on their clinical experience of patients who suffered adverse events after acupuncture treatment;(2) a literature search of severe adverse events e.g., pneumothorax and neurological injuries, associated with acupuncture treatment in Japan;(3) the regional anatomy of the upper part of the body, which is based on several anatomical studies on acupoints. <BR>The incidence of severe adverse events is considered to be very low during all acupuncture treatments;however, the real incidence is estimated to be higher than the number of case reports in the literature. In order to prevent severe adverse events, regional anatomical knowledge of needling points is very important, and furthermore, safe needling techniques are required. <BR>We hope that this workshop can aid in enhancing the knowledge and techniques and contribute to safe practices of acupuncture.
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Acupuncture and moxibustion are not fully or well-utilized in the medical system, particularly in the hospitals of Japan. If they were more commonly practiced in hospitals, disorders and disease conditions that are not improved by modern Western medicine might be better treated. In addition, collaboration between acupuncturist and Western medical doctors would promote the research of acupuncture, moxibustion, and related techniques.<br>However, to achieve these aims, improvements in the quality of acupuncture and moxibustion education would be needed. Also, hospitals that are presently using acupuncture and moxibustion for routine treatment would have to demonstrate their usefulness and how this is contributing to patients' health.<br>Having acupuncture and moxibustion therapists (AMT), as a defined occupation in hospitals, was proposed in 1981, although this has not yet been realized. However, we believe that hospital AMTs would be necessary for the progress of acupuncture and moxibustion, as well as for national health care and the medical system in Japan.
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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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[Introduction]This symposium was organized for the adoption of the Tokyo Declaration for Japanese Acupuncture and Moxibustion at the final meeting of the congress and was composed of three subjects that were supposed to become a framework for the declaration draft.<BR>[Subjects] 1. History of acupuncture in Japan 2. Analysis of the present circumstances 3. Tasks for the future<BR>The first subject was an explanation of important matters in acupuncture development in Japan, based on the key note lecture given prior to this symposium. The second subject was analysis from both aspects of research studies and clinical situations. The third subject was to be suggestions for further development of acupuncture after revealing present problems. <BR>There are more or less many issues in the acupuncture field;clinical practice, education, research and clinical training, but these issues may not have been approached either systematically or generally before. Whereas, in the light of opinions gathered from many others, many future issues came apparent through the three subjects of this symposium. In conclusion, the goal was to find a strategy that would make Japanese acupuncture become a prevailing therapy in the future more than what it is today.
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[Objective]Using cotton to cover needle shafts when removing acupuncture needles is recommended in order to prevent blood contamination. However, the effect of risk reduction has not been confirmed by experimental studies. We, therefore, observed spreads of fluorescent agent, assumed as blood, with or without alcohol cotton to avoid direct contact between fingers and needle shaft. <BR>[Methods]Subjects were two blind acupuncturists and two acupuncture students. We asked them to insert acupuncture needles to people who played a role of a patient. Of the five acupoints needled, we put the fluorescent agent to one point, and asked the subjects to remove the needles. After all the needles were removed, we took photographs of all points needled and the subjects'hands in order to assess the spread of the fluorescent agent. 'We performed two sessions. In Session A, the subjects used alcohol cotton to cover a needle shaft so that their fingers did not contact the needles directly. In Session B, they did not use alcohol cotton. The subjects were not told that we used the fluorescent agent.<BR>[Results](1) In the forearm of those who were needled, adhesion of the fluorescent agent was not seen in three out of four subjects, in Session A. (2) In two of the four subjects who inserted the needles, the adhesion area of the fluorescent agent in the needle-supporting hands was smaller in Session A compared with Session B. (3) In three of the four subjects who inserted the needles, the adhesion area of the fluorescent agent in the needle-stimulating hands was smaller in Session A compared with Session B.<BR>[Conclusion]It is suggested that covering needle shaft with alcohol cotton during needle withdrawal suppresses the spread of blood contamination.
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[Objective]To motivate acupuncture school teachers to introduce higher-quality methodology in clinical acupuncture research.<BR>[Methods]Twenty-eight teachers from 18 acupuncture schools participated in the simulated randomized, subject and evaluator-blinded, and sham-controlled trial of acupuncture for low back pain. Twenty of them played a role as subjects, four of them were raters, and another four were therapists. Before and after conducting the trial, all the participants were asked several questions using the Visual Analogue Scale (VAS) regarding necessity of Evidence-Based Medicine (EBM) in acupuncture and their level of understanding of several terms related to a Randomized Controlled Trial (RCT),<BR>[Results]After the simulated RCT, the understanding level of all terms related to RCT increased significantly ("RCT":from 58.0 ± 27.2 to 75.5 ± 25.7, "informed consent":from 88.1 ± 15.4 to 99.2 ± 10, "recruitment":from 43.0 ± 41.0 to 74.8 ± 31.3, "random allocation":from 55.5 ± 35.0 to 78.7 ± 25.8, "masking":from 54.7 ± 35.0 to 79.0 ± 26.0) (mean ±SD). Nineteen teachers answered that they would try to conduct RCT and introduce it to their education program.<BR>[Conclusion]The results suggest that the practice of simulated RCT is effective in understanding RCT and motivating acupuncture teachers to introduce it to their education program.
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<i>Objective</i>: It has been reported that essential oils used in aromatherapy effect the nervous, immune and endocrine systems. The purpose of this study was to assess the effects of essential oils on the cardiovascular system in healthy human subjects.<br> <i>Methods</i>: Rosemary essential oil, which reportedly has a vasopressor-like effect, and lavender essential oil which reportedly has a depressor-like effect, were administered to sixty subjects divided into rosemary, lavender, or control groups. Blood pressure and heart rate were measured after two-minutes of smelling. Data were compared among the three groups.<br> <i>Result</i>: Heart rate increased in the rosemary group. In addition to blood pressure and heart rate increased in subjects who expressed a negative impression from smelling a specific essential oils.<br> <i>Conclusion</i>: The results suggest that fragrance preference affects the therapeutic effects of aromatherapy.<br>
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On this coming June 12, 2009, the 2nd JSAM International Symposium on Evidence-based Acupuncture on "Evidence of the Effectiveness of Acupuncture for Low Back Pain"is to be held in Saitama. We briefly outline the background and expected controversial points in this symposium.<BR>There are three sessions including 1) Present status of RCT research on low back pain, 2) Treatment method for low back pain in China, Korea and Japan based on the database research, and 3) Sham acupuncture. When we assess the effectiveness of acupuncture for low back pain within the realm of Evidence-Based Medicine, the following discussions may be expected:<BR> 1) Therapeutic effect of sham needling -are we able to distinguish placebo effect?<BR> 2) Masking using sham needle -are we able to conduct double-blind trials on acupuncture?<BR> 3) Specific treatment technique -which factors contribute to "more effective acupuncture technique"?<BR>Most of invited speakers are specialists who published their papers on RCT or sham needle in top medical journals in the world. We hope that issues, such as working together with other medical professionals and reflecting evidence to medical policies, to be tackled in the future for the development of acupuncture will become clearer in this symposium.
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<i>Objective</i>: In order to assess usefulness, applicability and problems of aromatherapy in the modern medical practice.<br> <i>Method</i>: We conducted a questionnaire survey on the recognition and utilization of complementary and alternative medicine (CAM) and medical aromatherapy in a professional school of acupuncture and Judo-therapy in Osaka City. The respondents were 866 students at the school.<br> <i>Results</i>: We found that 97.1% of the respondents had experienced at least one CAM therapy and 25.8% had aromatherapy. Compared to male students, more female students used aromatherapy. Perceived effectiveness of aromatherapy for purpose of the use ranged between 73.8% and 89.2%. Approximately 70.0% of the respondents were interested in medical aromatherapy, and 89.4% expected this therapy for psychosomatic/mental diseases. Main problems pointed out were collecting more scientific evidence and reducing the costs.<br> <i>Conclusion</i>: The results suggest that aromatherapy may become more widespread and one of the options to make the current clinical practice more satisfactory for patients.<br>
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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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Unresolved problems remain in the clinical research methodology of acupuncture. In particular, the creation of placebo group in randomized controlled trial (RCT) is controversial: sham and / or minimal acupuncture may appear more powerful than placebo treatments in trials. Hence, in the future more emphasis should be placed on pragmatic RCTs, which compare typical treatment vs typical treatment plus acupuncture.<br> In order to more effectively integrate acupuncture therapy into modern Western medicine, evidence of efficacy, safety and cost-effectiveness should be clearly shown from both rational and clinical points of view. At the same time, we should reassess whether or not the present research methodology appropriately evaluates the essence of acupuncture therapy.<br>
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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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Acupuncture, which was originated and developed in the East Asian countries, has been globalized today. In Japan, acupuncture is more popular than the West, but lagging behind in terms of medical policy, research funding and evidence-based clinical research. Evidence-based approach such as randomized controlled trial has brought new developments in acupuncture research scene. On the other hand, clinical implication of acupuncture “system” seems to have been underestimated in evidence-based clinical research until recently.<br>
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In the present paper, the author reviews acupuncture clinical practice and the research scene in Western countries, and discusses problems in Japanese acupuncture.<BR>The use of acupuncture is increasing in the West, but many more people have received this treatment in Japan. Although regulations on acupuncture depend on the country, many EU countries limit acupuncture practice to medical doctors. Regarding the style and theory of acupuncture, Traditional Chinese Medicine is overwhelmingly dominant in the world.<BR>In recent years, the worldwide prevalence of the concept of evidence-based medicine (EBM) has facilitated randomized controlled trials on acupuncture in the West. However, there is a bigproblem in setting a sham acupuncture group. Pragmatic clinical trials should be considered more in the future.<BR>If the researchers of “Japanese acupuncture” pursue only reductionistic research methodology, they might lose something important that traditional medicine has brought for many years. Although we should employ the concept of EBM, we, at the same time, should discuss what Japanese acupuncture is and how we evaluate the aspect of the “art” of acupuncture medicine more intensely.
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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.