A Case of Recurrent Nausea with Vomiting for Past Sixteen Years Successfully Treated with a Kampo Formulation Shimbuto / 日本東洋医学雑誌

We herein report a 36-year-old male patient, who complained of persistent and recurrent nausea with vomiting for 16 years in spite of various standard treatments, was successfully treated with Kampo formulation Shimbuto, which selected based on the left para-navel tender point. We speculated that the clinical disorder in this case was related to suitai i.e. water imbalance syndrome in Kampo medicine. However, there has never been such a case report in the field of Kampo, and no related papers have been found in the standard database Medline. We believe this report is valuable from the viewpoint of therapeutics in both Western and Kampo medicine.

Three Cases of Febrile Diseases Successfully Treated with a Kampo Formulation Shimbuto / 日本東洋医学雑誌

We herein report three patients who complained atypical febrile diseases associated with painful whole body (Case 1), general fatigue (Case 2), and a sense of general discomfort (Case 3). All cases were not accompanied by dizziness and a shaky feeling which are commonly associated in shimbuto-sho i.e. indication of shimbuto, but presented severe tenderness at the left paraumbilical region which was suggested as indicative point of shimbuto by Yoshiko Takagi. We made a diagnosis in these three cases as shimbuto-sho based on the Takagi's tender point. Through these clinical experiences we propose that a new type of shimbuto-sho, which are completely different from the fixed idea of inherited knowledge. This new type of shimbuto-sho consists of following signs ; fever with chill, floating and feeble pulse, no sweating, general fatigue or body pain, and severe pain at Takagi's tender point.

Evidence-based medicine research on low-back pain with sham-acupuncture controlled design and the analysis on dynamic acupoint positioning / 中国针灸

To explore the positioning of acupoints, a research was done with PubMed for system reviews and clinical trials on treatment of low-back pain with sham-acupuncture controlled design from January 1, 2010 to October 27, 2017. Six system reviews and 12 sham-controlled acupuncture random trials were found. The statistical difference was not found in all the 6 trials with standard acupoint compared with the sham-acupuncture among the 8 penetrating skin sham-control trials. The statistical difference was found in the two trials with penetrating skin sham control, who was used individualized treatment, twirling for arrival or palpation for point. It is considered that sham-acupuncture penetrating skin is not a placebo, and needling with standard or dynamic acupoint may reduce low-back pain, and dynamic acupoint positioning may be better than standard acupoint positioning.

Two Cases of Mental Disorder with the Tender Point at the Left Paraumbilical Region two Fingerbreadths Away from the Umbilicus were Successfully Treated with Shimbuto / 日本東洋医学雑誌

Two cases of mental disorder with the tender point at the left paraumbilical region two fingerbreadths away from the umbilicus were successfully treated with shimbuto. These cases appeared shimbuto symptoms corresponding to the provisions of the early yang stage pattern and the middle yin stage pattern in the classic textbook ‘Shanhanglun'. The pathogenesis of these cases of the patients who improved with shimbuto would be qi and fluid intimidating. The tender point at the left paraumbilical region by palpation is considered as ‘Huangshu KI 16' of kidney meridian in ‘WHO Standard Acupuncture Point Locations in the Western Pacific Region'. This tender point is a very useful diagnostic sign to prescribe for simbuto. It suggests that an acupuncture point on the meridian and collateral theory might appear the condition of three yin and three yang disease in ‘Shanhanglun' and be useful to choose Kampo medicine.

Discussing the relationship among thepoint, tender point and myofascial trigger point / 中国针灸

The conception and the history ofpoint, tender point and myofascial trigger point are described in the paper. All of three kinds of point are the reaction of musculoskeletal pain and visceral diseases. Theoretically,point originates from the theory of muscle region of meridian, tender point from the theory of soft tissue and muscles and myofascial trigger point from the theory of muscular fasciae. Anatomically,point is localized in the muscle region of meridian, on the boundary between muscles, tender point is on the muscular attachment to skeleton (the starting and ending points) and myofascial trigger point is on the motor point of neuromuscles. Pathologically,point reflects the disorders of soft tissue and internal organ, tender point reflects the disorders of soft tissue and myofascial trigger point reflects the disorders of soft tissue and few disorders of internal organ. To identify the relationship among them is very significant in the target treatment with acupuncture.

A Case of Trigeminal Neuralgia Effectively Treated with Jidabokuippo: Hint from Past Injury and Tender Point / 日本東洋医学雑誌

A thirty-eight-year old woman with facial pain was diagnosed with trigeminal neuralgia, and treated with conventional carbamazepine therapy. Although the pain was alleviated to a certain degree, she visited our clinic to receive Kampo therapy. Judging from her facial injury in an accident thirty years ago, jidabokuippo was administered in addition to carbamazepine. The trigeminal neuralgia was then relieved, and Takagi's tender point in her abdomen was also reduced or disappeared. She could finally stop carbamazepine therapy. This case suggests that neuralgia patients with previous injury and Takagi's tender point can be treated with jidabokuippo.

Rheumatoid arthritis treated with acupoint application of:a rando-mized controlled trial / 中国针灸

<p><b>OBJECTIVE</b>To observe the clinical efficacy differences on rheumatoid arthritis treated with acupoint application of(preparation ofmedicine), tender point herbal application and leflunomide.</p><p><b>METHODS</b>Ninety-six patients were randomized into an acupoint herbal application group, a tender point herbal application group and a leflunomide group, 32 cases in each one. In the acupoint herbal application group,paste was used at Dazhui (GV 14), Mingmen (GV 4), Zusanli (ST 36) and the local points on themeridians around the knee joint. In the tender point herbal application group, the self-preparedmedicine was used at tender points, 4 to 6 h each time, at the interval of 7 days. In the leflunomide group, leflunomide was applied for oral administration, 50 mg on each of the first 3 days, once a day; 20 mg each time 3 days later, once a day. The treatment for 1 month made one session in the three groups, and continuous three sessions of treatment were required. The clinical symptoms, laboratory indices such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF) and the total score of symptoms were observed before and after treatment in the patients of three groups. The efficacy was evaluated in the 3 groups.</p><p><b>RESULTS</b>The total effective rate was 87.5% (28/32) in the acupoint herbal application group and was 90.6% (29/32) in the leflunomide group, better than 68.8% (22/32) in the tender point herbal application group (both<0.05). After treatment, the clinical symptoms, laboratory indices and the total score of symptoms were all improved as compared with those before treatment in the three groups (all<0.05). Among the three groups, the results of pain, swelling, tenderness and the total score of symptoms as well as ESR and RF in the acupoint herbal application group and the leflunomide group were all better than those in the tender point herbal application group (<0.05,<0.01). Blister and pruritus occurred in 2 cases in each of the acupoint herbal application group and the tender point herbal application group. Nausea and poor appetites in 2 cases, dizziness and lassitude in 1 case and skin rashes in 1 case occurred in the leflunomide group.</p><p><b>CONCLUSIONS</b>The improvements in the symptoms of rheumatoid arthritis and laboratory indices in the acupoint herbal application ofare better than those in the treatment with tender point herbal application. The efficacy of it is similar to that of leflunomide, without adverse reactions such as nausea, poor appetite, dizziness and lassitude.</p>

Improvement in Dropped Head Syndrome (DHS) Following Corticosteroid Injections on the Tender Points at the Upper Thoracic Spine : A Case Report / The Japanese Journal of Rehabilitation Medicine

　An 83-year-old woman presented with dropped head syndrome (DHS), that had been progressing during the previous 6 months. She had no history of neuromuscular diseases and, on examination, no neuromuscular abnormalities were observed except for isolated weakness of the neck extensors, mainly of the semispinalis cervicis. On the paravertebral sites of the T1-T5 spine on both sides, a total of eight points with marked tenderness were noted, four on each side. These eight points coincided with the anatomically narrow spaces through which the posterior rami emerged from their deep exits in the spine (i.e., the intervertebral foramina) to the superficial paravertebral sites, where they bifurcated into the lateral and medial branches, the latter innervating the semispinalis cervicis. Repeated local corticosteroid injections once a week on these eight tender points, with 3.3 mg Decadron (dexamethasone sodium phosphate) mixed with 20 mL of 0.5% xylocaine divided among the eight tender points, improved DHS in 3 months. This case suggests that the anatomically narrow pathway of the medial branches of the posterior rami at the upper thoracic spine could induce inflammations of the passing nerves, resulting in neck extensor weakness.

Effect of trigger point acupuncture treatment in older patients with chronic low back pain: randomized controlled trial / 全日本鍼灸学会雑誌

[Objective]To compare the efficacies of three types of acupuncture modalities on the pain magnitude and disability of chronic low back pain (LBP).<BR>[Design]Single blind randomized controlled trial, three parallel arms.<BR>[Setting]Outpatients of the Meiji University of Integrative Medicine Hospital.<BR>[Subjects]Thirty-nine elderly patients (24 females, 15 males;age 71.2 ± 7.7) who suffered from LBP for at least six months.<BR>[Interventions]Subjects were randomly allocated to one of three groups. Tender point group (TeP, n = 13) received to the tender point. Trigger point acupuncture group (TrP, n = 13) received to the trigger points. Sham acupuncture group (SM, n = 13) mimicked needling without insertion of the needle in the trigger point. Acupuncture sessions were performed once a week for five weeks. <BR>[Main Outcome Measures]Pain intensity (visual analogue scale:VAS) and QOL (Roland-Morris Disability Questionnaire:RDQ). <BR>[Results]At the end of the treatment period, significant improvement was observed on pain intensity and QOL in the TrP group alone (p < 0.01). However, there were significant differences in pain at the three month follow-up.<BR>[Conclusion]These results suggest that trigger point acupuncture has a long-term effect on treatment for low back pain in aged patients.

The Effect of Trigger Point Acupuncture Treatment on Chronic Neck and Shoulder Pain-Questionnaire and Acupuncture Treatment for Unversity Students- / 全日本鍼灸学会雑誌

[Purpose] This study investigated shoulder stiffness in university students and compared three different treatment procedures for shoulder stiffness.<BR>[Method] The questionnaire (7 items) was distributed to 30 university students with a 3-month history of shoulder stiffness treated by three different treatments procedures. There were no abnormal findings on neuro logical examination.<BR>[Result] The questionnaire response rate was 64.6%. The overall prevalence of shoulder stiffness was 61.9%, most patients had asthenopia and headache along with shoulder stiffness. However, immediately after the tender point and sham treatment periods, there were no remarkable clinical effect on shoulder stiffness, whereas after trigger point treatment, there were remarkable clinical effects on shoulder stiffness, as evaluated by the visual analogue scale.<BR>[Conclusion] These results suggest that trigger point acupuncture treatment may be more effective for shoul- der stiffness in university students than other acupuncture treatments

A Controlled Clinical Trial Comparing Trigger Point Acupuncture with Tender Point Acupuncture Treatments for Chronic Low Back Pain-A Pilot Study on 9 Elderly Patients- / 全日本鍼灸学会雑誌

[Objective] Although there is some evidence for the efficacy of trigger point acupuncture and tender point acupuncture treatments for chronic low back pain, differences between the therapeutic effect of trigger point needling and that of tender point needling remain unclear. We compared the therapeutic effects of trigger point acupuncture and tender point acupuncture treatment for chronic low pack pain in elderly patients.<BR>[Design] Single-blind clinical controlled trial, quasi-randomized, 2 parallel arms.<BR>[Methods] Nine patients, aged 65 or over, with chronic low back pain for at least 6 months were alternately allocated to the trigger point needling group (n=4) or tender point needling group (n=5). Patients received treatments once a week for five weeks. Outcome measures were pain intensity (Visual Analog Scale : VAS) and pain disability (Roland-Morris Disability Questionnaire : RDQ).<BR>[Results] After the treatment period, VAS and RDQ values had improved significantly in the trigger point group, but there were no significant improvements in the tender point group.<BR>[Conclusion] Differences in improvement between the trigger point and tender point groups seem to suggest that the trigger point needling was different from tender meridian point needling in respect to the therapeutic effect. Further studies are necessary to fully assess the efficacy of this treatment for chronic low back pain using a blinded or placebo control group.

Effect of Acupuncture Treatment on a Fibromyalgia-like Syndrome Patient / 全日本鍼灸学会雑誌

Case Report : Acupuncture therapy for a fibromyalgia-like syndrome (FMS-like) patient. A 44-year-old woman complained of widespread pain, fatigue and poor quality sleep. Effects of acupuncture treatment were evaluated using a visual analogue scale (VAS), pain disability assessment scale (PDAS) and pressure pain thresholds (PPT) at tender sites of FMS. After 13 whole body acupuncture treatments PPT, VAS and PDAS were almost unchanged. However, three FMS-specific acupuncture treatments (eletroacupuncture at characteristic tender sites of FMS) increased PPT and improved VAS and PDAS. These results suggest that FMS-specific acu-puncture treatment may relieve widespread pain and fatigue symptoms in FMS-like patients.

Relationships between Clinical Symptoms and Pressure Pain Thresholds in Patients with Osteoarthritis of the Knee Joints / 全日本鍼灸学会雑誌

Treatment of tender points has widely been used for diagnosis and treatment, but there are few studies elucidating the usefulness of this approach to diagnosing knee pain. This study investigated the diagnostic importance of tender points. The symptoms and the pressure pain threshold (PPT) in osteoarthritis of the knee (pain and motion of knee joint) were measured in 45 patients being treated at the Acupuncture Center of Meiji University of Oriental Medicine. The change in PPT was related to symptoms of knee pain (staircase and flexion pain). It is suggested that changes in PPT around the knee joints are a useful indicator for evaluating knee pain.

Electrical Activities Detected from the Experimentally-induced Trigger Points in Human Subjects / 全日本鍼灸学会雑誌

Electrical activities detected from the experimentally-induced trigger points in human subjects.<BR>Objectives : To examine the pathogenic mechanisms of the trigger points, electrical activities were recorded from the experimentally-induced trigger points.<BR>Methods : Nine healthy volunteers who gave informed consent were used. The adjustable loads were set around the third finger and repetitive eccentric contraction was loaded on the extensor digital muscles. The subjects were asked to keep the position as long as possible. The loadings (about 10s) were continued until his all-out effort and were repeated 3 times with 5 min resting periods. The electrical activities in the skin, fascia and muscle of the trigger point and non-tender region of palpable band and 10mm outside the band were recorded on the second day after the eccentric exercise.<BR>Results : Repetitive eccentric exercise produced a trigger point within the palpable band, which developed on the second day after the exercise. Electrical activities were detected only when the electrode tip was located in or near the fascia of the trigger point and there were subjective dull pain sensations. When the radial nerve was blocked by lidocaine, the needle EMG activity could not be recorded.<BR>Conclusions : These results suggest that the EMG activities are the result of nociceptive reflex, and the sensitized nociceptors in the fascia of the palpable band might be a substrate for the trigger point.

Relationships Between Pressure Pain Thresholds and Clinical Symptoms in Acupuncture and Moxibustion Therapy. A Case of Osteoarthritis of the Knee Joints / 全日本鍼灸学会雑誌

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.

Examination of an Eccentric Contraction-induced Trigger Point Model Using Human Subjects / 全日本鍼灸学会雑誌

The nature of an experimental trigger point model produced by eccentric exercise was examined in seven healthy volunteers who gave their informed consent. Adjustable loads were set around the third finger and the subjects were asked to keep the position as long as possible. The loadings (about 10s) were continued until his all-out effort and were carried out 3 times interspersed with 5 min rest periods. Pressure pain thresholds (PPT) and deep pain thresholds (DPT) before exercise, and on the 2nd and 7th day after the exercise, were measured in the skin, fascia and muscles. On the 2nd day after the exercise, the PPT of the restricted area of the taut band was the minimum. A similar reduction of the DPT was observed only in the fascia of the restricted area. These results suggest that the present experimental model is useful for the further investigation of trigger points.

Suppressive effects on human flexion reflex induced by different pressure intensities and stimulation sites / 全日本鍼灸学会雑誌

Different intensities of pressure were applied to various tender or non-tender points and the suppressive effects on the flexion reflex were examined in 21 healthy humans (18-26 years), who gave informed consent. The sural nerve was stimulated transcutaneously with trains of 5 pulses at intervals of 13 sec (1.05-1.10x T, T : threshold) and evoked EMGs were recorded from the biceps femoralis muscle. Tender points in the contralateral forearm were detected by careful palpation, and conditioning pressure stimulation was applied at variousintensities by a push-pull gauge for 78 sec. Pressure applied to tender points induced slightly greater suppression of evoked EMGs than that to non-tender points (C statistics : time series analysis), although the difference was not significant (group comparison). Pressure intensities of ten and 50 % of pain tolerance pressure seemed to be adequate for suppression of EMGs in both tender and non-tender points. These results suggest that suppression of flexion reflex by pressure application in humans may be mediated by tactile and pain-related afferent fibers and the importance of adequate stimulus intensity for the induction of analgesic effects.

Effects of thermal stimulation on the flexion reflex in human subjects / 全日本鍼灸学会雑誌

Effect of thermal stimulation on the flexion reflex as a pain index was examined in healthy human subjects who gave informed consent (n=9, male, mean age 26 ± 8 years old). The evoked electromyogram (EMG) of biceps femoral muscle elicited by transcutaneous electrical stimulation of the sural nerve (5 trains of pulses at 100 Hz delivered at intervals of 13 sec) was successively recorded. The subjective pain sensation elicited by nerve stimulation was simultaneously recorded by the visual analogue scale (VAS) method. Significant correlation coefficients between the amplitudes of evoked EMGs and the stimulus intensity (r=0.791, P< 0.01), and the VAS value (r=0.724, P < 0.01) were observed. Conditioning hot water immersion of the hand (47 °C, 156s) tended to reduce the amplitudes of evoked EMGs, although change was not significant (P=0.678, Kruskal-Wallis test). However, C-statistics, a simple time series analysis method, demonstrated significant trends in several trials. These results suggest that the flexion reflex used in the present study is useful for pain research in human subjects and C-statistics are also useful for analyzing the effect on each individual.