Report of 2009 WFAS University Cooperation Working Committee and WFAS Standard Working Committee / 全日本鍼灸学会雑誌

The WFAS University Cooperation Working Committee and WFAS Standard Working Committee were held during 2009 WFAS World Acupuncture Congress at European Parliament in Strasbourg, France on 6 November 2009. Publishing an International Textbook of Acupuncture and Moxibustion was proposed in the WFAS University Cooperation Working Committee. Also establishing Making WFAS standards on acupuncture needles, nomenclature and location of auricular points, manipulation of moxibustion, and manipulation of scalp acupuncture were discussed and proposed in the WFAS Standard Working Committee.

Report of 2009 WFAS General Assembly and Acupuncture Congress / 全日本鍼灸学会雑誌

The Fifth Session of the Sixth Executive Committee (EC), the Seventh General Assembly (GA), and the First Session of the Seventh EC and 2009 World Acupuncture Congress of the World Federation of Acupuncture-Moxibustion societies (WFAS) were held at European parliament in Strasbourg, France on 3-7 November 2009.<BR>New EC members for the year of 2009-2013were elected in the GA. The Seventh EC commenced and now consists of 49 members. Host countries for the future meetings were also approved.<BR>In the Seventh EC, the Japan Society of Acupuncture and Moxibustion (JSAM) made a proposal regarding WFAS administrative duties. It consisted of eight items, and among them, the request for making the minutes of EC meetings was most important because WFAS EC meeting minutes have never been sent to the EC members except once, for the Bali, Indonesia meeting in 2006.<BR>Papers regarding acupuncture education, legislation, traditional research and scientific research were also presented in the academic meeting.<BR>JSAM will continue to support the enhancement of the academic level of WFAS and make any necessary proposals toward the further development of WFAS.

Controversial Issues in Clinical Research (Especially Randomized Controlled Trial) on Acupuncture for Low Back Pain / 全日本鍼灸学会雑誌

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.

Acupuncture Moving Toward Globalization: the Status Quo and Prospects / 日本補完代替医療学会誌

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>

Cancer and acupuncture & moxibustion2 / 全日本鍼灸学会雑誌

The very first session of the symposium on ‘cancer and acupuncture’ was held at the 53^rd Annual Conference of the Japan Society of Acupuncture and Moxibustion (JSAM). It suggested the efficacy and potential of acupuncture and moxibustion not only for cancer but also for cancer patients. This is the second session for further discussion. In recent years, acupuncture and moxibustion treatment for cancer patients has come to the world's attention, and many reports about its expediency and beneficial effect have been conducted in Japan and in the world. However, the adaptation range of acupuncture and moxibustion treatment for cancer is still limited because there is not enough evidence, so compilations of more sufficient case reports or research for presentation and effects in preventing relapse of cancer are required to prove its reliability. Acupuncture and moxibustion are used as one of the medical treatments directed at relieving symptoms and life-sustaining treatment in hospitals today. Earlier, frequent acupuncture treatment led to significant efficacy for cancer patients, and it is also reported that the number of lymphocytes increases in sequential acupuncture treatment but the number tends to return in a short time after cessation of treatment. Sequential autonomic immune therapy over a long term revealed several significant effects as follows; lymphocyte activation while the lymphocyte count remained, increase of cytokine (IL 12, IFNγ, TNFα, etc.) production and Th 1, Th 1/Th 2, immunostimulatory activity effect, reduction of tumor markers down to or close to normal, reduction or resolve of malignant neoplasm and recurrence prevention for unoperated cancer patients, QOL improvement with symptoms relief and life prolongation. In this seminar, it suggested that acupuncture and moxibustion are potential and appropriate treatments for cancer and further research in this field is required.

Acupuncture Moving Toward Globalization: the Status Quo and Prospects / 日本補完代替医療学会誌

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>

Report on the 1st Japan-Korea Workshop on Acupuncture and EBM-Proposal of Clinical Trials for the Future Japan-Korea Collaboration- / 全日本鍼灸学会雑誌

The first Japan-Korea workshop on acupuncture and EBM was held on June 4, 2004 at Chiba in the 53rd annual scientific meeting of the JSAM. The purpose of this workshop was to exchange the experiences of clinical researches on acupuncture and moxibustion therapies, and to find out the issues and their solutions for developing the excellent clinical research to establish strong evidence. The final purpose was to develop aprotocol for the collaborative work between both countries.<BR>Drs. Kawakita (JSAM) and Jang (KAMS) chaired the workshop. Three speakers from Japan (Drs Takahashi, Nabeta, and Tsukayama) and three Korean speakers (Drs Seo, Lee and Moon) presented their data on the clinical researches of acupuncture, moxibustion and bee-venom injection. After their paper presentations, various issues were discussed on their research methodology for establishing more strong evidence of acupuncture.We got interesting new findings and understood various issues for conducting clinical researches especially RCT.<BR>Although we could not develop a protocol for the collaborative research in this workshop, it was very fruitful workshop as the first step for the future Japan-Korea collaborative clinical study. The most important product of this workshop was we could understand each other and we confirmed the necessity of the future collaborative clinical research on acupuncture.

Autonomic Responses due to Transcutaneous Electrical Nerve Stimulation Apparatus CONVALES / 日本温泉気候物理医学会雑誌

This study was conducted to observe autonomic nervous system reactions in the cardiovascular system caused by the new transcutaneous electrical nerve stimulation apparatus CONVALES^®<br>Autonomic functions were evaluated before and after stimulation of 10 male students between 19 and 42 years of age. The dynamic observation method of autonomic functions proposed by Nishijo et al. was used for evaluating autonomic responses. The activity levels of both the sympathetic and parasympathetic systems were found to increased after stimulation. Neither significant changes in blood pressure nor adverse effects of stimulation were observed.<br>These results suggest that the apparatus used in this study causes autonomic responses similar to those caused by acupuncture with shallow needling during exhalation phase while sitting, or by laser acupuncture. This study also suggested that this therapeutic method is safe for short periods.

Multi-Center Randomized Controlled Trial of Acupuncture with Electric Stimulation and Acupuncture-like Transcutaneous Electrical Nerve Stimulation for Lumbago / 全日本鍼灸学会雑誌

[Objective] To compare the effectiveness of electro-acupuncture with that of transcutaneous electrical nerve stimulation (TENS) in the treatment of lower back pain and to investigate problems with conducting rigorous trials in Japan. [Design] A multi-center, randomized, observer-blinded, controlled trial with two parallel arms. [Setting] Four medical facilities affiliated with universities or colleges in Japan. [Subjects and methods] Low back pain patients without sciatica suffering for at least two weeks were randomly assigned to either an acupuncture with electro stimulation group (Group A) or a TENS group (Group T). Plans called to recruit 80 patients in the protocol. Patients in both groups were treated twice a week for 2 weeks with 1 Hz electro-stimulation for 15 minutes. Visual analogue scale (VAS) of pain relief and the scores recommended by the Japanese Orthopaedic Association (JOA Score) were measured. Primary endpoint was improvement of pain that was assessed from the changes in VAS. [Results] Three patients were withdrawn after one-week run-in period and one patient was withdrawn from Group A during treatment the period. Consequently, 31 in group A and 33 in group T completed the trials and were available for evaluation. There was no difference between the groups in primary endpoint and JOA scores. [Discussion] Problem of patient recruitment should be resolved by strategically selecting facilities or by advertising for participants. Future investigation with attentive trials using adequate intervention is required to conclude whether or not acupuncture exceeds TENS in efficacy. [Conclusion] There was no statistical difference between electro-acupuncture and TENS for lumbago in this study.

Six Cases of Hemifacial Spasm Treated with Electro-Acupuncture Therapy / 全日本鍼灸学会雑誌

Patients with hemifacial spasm (HFS) sometimes visit acupuncture practitioners for treatment. We can find descriptions of acupuncture procedures and methods for treating facial spasm in textbooks of clinical acupuncture. However, there is almost to literature that presents data on the actual responses of HFS patients to acupuncture. Therefore, we cannot judge satisfactorily whether acupuncture is suitable for treating of HFS at this time.<BR>Six HFS patients (37 to 56 years old) who had not responded to conventional medical treatment were treated with electro-acupuncture therapy (EAT). EAT was applied to facial muscles for twenty minutes once or twice a week.EAT was continued until the patient dropped out or changed treatment. The period of treatment ranged from one month to one year. After a course of weekly treatments, ranging from one week to one month, the frequency and degree of spasms decreased in five of the six patients. No serious adverse events due to the treatments were observed.<BR>It seems that EAT is safe and produces a gentle anticonvulsant effect. Therefore, it is conceivable that EAT could be applicable for HFS. Thus, if the treatment with microvascular decompression or botulinum toxin is contraindicated, EAT may possibly be an alternative.

Evidence-Based Complementary and Alternative Medicine / 日本東洋医学雑誌

We introduce the current research on complementary and alternative medicine (CAM) in the West, which we refer to as Evidence-based CAM (EBCAM), and discuss its characteristics, problems, and perspectives. Compared with the common attitude of CAM researchers in Japan, that of EBCAM researchers is more objective and often self-critical. EBCAM research is still developing because randomized controlled trials on CAM have many methodological flaws. Caution should be employed in interpreting provisional conclusions of relevant systematic reviews. CAM researchers in Japan should view the case report method from a perspective other than efficacy. Also, they will have to prepare evidence in response to demands from CAM consumers. Priority of research subjects from various kinds of CAM should be decided according to their popularity. Therefore, a large-scale survey on CAM use in Japan is essential.

Influence of Acupuncture Stimuli(in Superficial Needling, during Exhalation Phase and in Sitting Position) on Finger Floor Distance / 日本温泉気候物理医学会雑誌

Therapeutic effects of two methods (1) an acupuncture technique using superficial needling applied during exhalation in the sitting position and (2) a low output laser irradiation technique applied during exhalation in the sitting position, were studied using an indicator represented by the distance between the finger tip and floor obtained when a subject bends forward from the standing position.<br>1. The acupuncture technique using superficial needling applied during exhalation in the sitting position significantly improved the distance between the finger tip and floor as compared with that before application (p<0.05).<br>2. The low output laser irradiation technique applied during exhalation in the sitting position improved the distance between the finger tip and floor as compared with that before application (p<0.01). No significant difference in the distance between the finger tip and floor were observed in the non-irradiated group.<br>3. Considering the therapeutic effects from application at various regions of the body, the acupuncture technique improved the distance between the finer tip and floor when it was applied to Waiguan (TE5) (p<0.05) and Zusanli (S36) (p<0.02)

Effect of Acupuncture Treatment on Frozen Shoulder. A Case Study / 全日本鍼灸学会雑誌

A series of cases underwent acupuncture treatment for frozen shoulder at our clinic.<br>1. Twenty-one cases of frozen shoulder were collected.<br>2. Fifteen cases (71%) Showed improvement in pain and activities of daily life (ADL) during the course of acupuncture treatment.<br>3. Temporary relief from pain during motion (67%), pain during rest (44%), and pain during the night (56%) was obtained after acupuncture treatment.<br>4. Patients whose pain was not reduced after treatment tended to drop out.<br>Acupuncture treatment for frozen shoulder was effective for reducing pain, and it is expected to prevent contracture when combined with exercise.

Scientific Approach for Acupuncture / 全日本鍼灸学会雑誌

Techniques for acupuncture and moxibustion can be expressed by three factors: when, and how to stimulate. This paper offers a clear scientific explanation “how” or the Acupuncture techniques of tonification and sedation that have been passed down.<br>Primary nervous responses to acupuncture can be classified into two specific types: restraining of the functions of the sympathetic nervous system's β-receptor system and accelerating the functions of the parasympathetic nervous system.<br>Respiratory rhythm is closely related to the functions of the parasympathetic nervous system. Changes in the functions of the autonomic nervous system due to changes in posture are related to the sympathetic nervous system.<br>Stimuli to the skin or subcutaneous tissue can induce responses using the parasympathetic nervous system as a centrifugal path, while stimuli to the fascia or muscles can induce responses using the sympathetic nervous system in the same way. It was discovered that to effectively obtain such responses, the parasympathetic nervous system should be stimulated shallowly while the patient is sitting and expiring, whereas the sympathetic nervous system should be stimulated deeply while the patient is supine.