A Multicenter Prospective Survey of Adverse Events Associated with Acupuncture and Moxibustion in Japan.

Background: There have been only a few prospective surveys on adverse events (AEs) in Japanese-style acupuncture practice, and these surveys were conducted only in a single college acupuncture clinic. Objective: The goal of this research was to assess the safety of acupuncture and moxibustion performed in educational facilities in Japan. Materials and Methods: This was a multicenter prospective survey, using paper reporting forms. It was conducted in eight acupuncture clinics affiliated with educational institutions. The subjects were outpatients attending the clinics. The main outcome measure was the number of reported adverse events. The study was conducted for 5-7 months at each facility between October 2014 and June 2015. Participating acupuncture practitioners were instructed to self-report AEs observed during and after treatment; patients were interviewed upon treatment completion. For returning patients, treatment was preceded by an interview survey regarding the AEs identified after the previous treatment session. A specialized 4-sheet questionnaire was used. Results: Two hundred and thirty-two acupuncture practitioners participated, 2180 patients received treatment, and there were 14,039 sessions, overall. In total, 847 (6.03%) AEs were reported. The most common AEs included subcutaneous bleeding and hematomas (370, 2.64%), followed by discomfort (109, 0.78%) and residual pain at insertion points (94, 0.67%). No infections or serious AEs were reported. Conclusions: Acupuncture and moxibustion performed in educational facilities in Japan were safe because most of the AEs reported were mild and transient. However, the risk cannot be defined definitely because the survey sample size was too small.

Contribution of adenosine to the increase in skeletal muscle blood flow caused by manual acupuncture in rats.

BACKGROUND AND AIM: Adenosine is believed to play an important role in local acupuncture analgesia. The aim of this study was to investigate the contribution of adenosine to the increase in skeletal muscle blood flow (MBF) caused by manual acupuncture (MA). METHODS: Thirty-two male Sprague-Dawley rats (310-360 g) were anaesthetised and divided into four equal groups (n=8 each): Saline, Saline+MA, Theophylline, and Theophylline+MA. In the two MA groups, the sparrow-pecking MA technique was applied at 30 repetitions per min for 1 min to a depth of 15-18 mm using a stainless steel acupuncture needle (0.20×40 mm). The stimulus point was located on the right tibialis anterior (TA) muscle 7-8 mm below the knee. Animals in the two theophylline groups were intra-arterially injected with 8-(p-sulphophenyl) theophylline, a non-selective adenosine receptor antagonist, at a dose of 30 mg/kg before MA. Animals in the two saline groups received control saline. Fluorescent microspheres (15 µm in diameter, yellow-green fluorescent) were used for MBF measurement in all four groups. RESULTS: MA of the TA muscle significantly increased MBF (Saline+MA vs Saline: p=0.001; Saline+MA vs Theophylline: p=0.008). Pre-treatment with theophylline appeared to inhibit this increase (Theophylline vs Theophylline+MA; p=1.000). MBF in the Theophylline+MA group was 43% lower than in the Saline+MA group, although this was not significantly different (p=0.104). CONCLUSIONS: The results suggest that adenosine leads to an increase in MBF caused by MA. Adenosine may play a role in acupuncture analgesia by washing out algesic substances. Further studies are needed in order to elucidate the precise mechanism.

Contributions of nitric oxide and prostaglandins to the local increase in muscle blood flow following manual acupuncture in rats.

OBJECTIVE: To investigate the contributions of nitric oxide (NO) and prostaglandins (PGs) to the increase in local muscle blood flow (MBF) observed following manual acupuncture (MA). METHODS: Male Sprague-Dawley rats (n=112; 250-310 g) were injected intraperitoneally with a non-selective NO synthase inhibitor (NG-nitro-L-arginine methyl ester hydrochloride: L-NAME; 10, 50 or 500 mg/kg), a non-selective cyclo-oxygenase inhibitor (indomethacin; 10, 50 or 500 mg/kg), a combination of L-NAME and indomethacin (500 mg/kg each) or saline only under urethane anaesthesia (1.2 g/kg). We used the sparrow pecking technique for 1 min with a stainless steel acupuncture needle (0.20×30 mm) as the acupuncture stimulation method. The stimulus point was on the right tibialis anterior muscle. (51)Chromium-labelled microspheres were used for MBF measurement. RESULTS: MA increased MBF in the saline-injected group (p<0.001). This increase was partially inhibited by L-NAME in a dose-dependent manner (p>0.05, p<0.05 and p<0.001 for 10, 50 and 500 mg/kg, respectively). On the other hand, indomethacin did not suppress the increase (p>0.05 each for 10, 50 and 500 mg/kg). No significant difference was observed between the inhibitory effects of combined administration of L-NAME and indomethacin and single administration of L-NAME (p>0.05). CONCLUSIONS: These results suggest that NO is a major factor in the MA-induced increase in MBF, while PGs do not contribute significantly to this increase. As complete inhibition was not achieved by administration of L-NAME±indomethacin, it appears that non-NO and non-PG vasodilators are additionally involved.

Participation of calcitonin gene related peptide released via axon reflex in the local increase in muscle blood flow following manual acupuncture.

OBJECTIVE: The purpose of this study was to determine how calcitonin gene related peptide (CGRP) via axon reflex participates in increasing local muscle blood flow (MBF) following manual acupuncture (MA). METHODS: Male Sprague-Dawley rats (N=56, 270-350 g) were used. We examined (1) the effects of MA on MBF in the tibialis anterior (TA) muscle in normal rats; (2) the effects of MA on MBF in the TA injected with saline or hCGRP8-37 (low: 2×10(-4) mol/litre; high: 2×10(-3) mol/litre), a competitive CGRP receptor antagonist, in rats; and (3) the effects of MA on MBF in the TA in capsaicin-treated rats. The capsaicin-treated rats were injected with capsaicin dissolved in an ethanol solution within 24 h after birth (50 mg/kg subcutaneously). MA was applied to the right TA for 1 min. (51)Cr-labelled microspheres (15 µm in diameter) were used to measure MBF. RESULTS: MA significantly increased MBF without changing arterial blood pressure in normal rats (p<0.05). MA also significantly increased MBF in saline-injected, low hCGRP8-37-injected and high hCGRP8-37-injected rats (p<0.001, 005 and 0.05, respectively). The increases in low and high hCGRP8-37-injected rats were lower than those in saline-injected rats, but the difference was not significant. However, MA did not significantly increase MBF in capsaicin-treated rats (p=0.38). CONCLUSIONS: We obtained conflicting results, suggesting that the participation of CGRP released via axon reflex may be limited to a local increase in MBF following MA.

Effects of manual acupuncture on motor evoked potentials induced by transcranial magnetic stimulation in human / 全日本鍼灸学会雑誌

[Objective]The purpose of this study was to investigate the effects of manual acupuncture stimulation (MA) on motor evoked potential (MEP) induced by transcranial magnetic stimulation (TMS).<BR>[Methods]The subjects were 10 healthy volunteers who gave oral and written informed consent. Experiment 1. MEPs were induced from the right abductor digiti minimi muscle (rADM) by TMS with a circular coil to the left cortex motor area and were measured before and after MA to the right LI4 (right Hoku point), left LI4 (left Hoku point), right LR3(right Taichong point) or left LR3(left Taichong point). A sparrow pecking technique (1 Hz for 1 minute) with a stainless steel needle (40 mm long, 0.18 mm in diameter, Seirin co., Inc, Shizuoka) was used for MA. The subjects received the same experiments four times with MA to different acupoints on a different day. Experiment 2. MEPs were measured during imaging of rADM and lADM contraction and immediately after noxious pinch stimulation to the skin on the right LI4 and left LI4 and right LR3and left LR3respectively. Repeated measure two-way ANOVA was used for statistical analysis to compare between all groups. Repeated measure one-way ANOVA and multiple comparison (Dunnett's test) were applied to time point data in each group.<BR>[Results]MA to the left LI4 or right LR3was significantly decreased MEP (P < 0.01, respectively). In the right LI4, there was a tendency to decrease of MEP, but not significantly (P = 0.26). Most subjects answered feeling severe or strong acupuncture needle sensation. MEPs were significantly increased by imaging of contraction and noxious stimulation (P < 0.001 and P < 0.01, respectively).<BR>[Conclusion]These results suggested a possibility that distant acupuncture stimulation would suppress motor activity via several roots and that an acupuncture inhibited effect was compensated by facilitation arising from the concentration to the stimulated hand.

Effects of manual acupuncture with sparrow pecking on muscle blood flow of normal and denervated hindlimb in rats.

INTRODUCTION: In clinical practice, it has been thought that acupuncture might serve to wash out pain-generating metabolic end-products by improving blood circulation in muscles. We investigated the effects of manual acupuncture (MA) on muscle blood flow (MBF) of normal and denervated hindlimbs in rats. METHOD: Sprague-Dawley rats (n=100) anaesthetised with urethane (1.2g/kg ip) were used. Manual acupuncture with sparrow pecking (SP) at different doses (1, 10 or 30 pecks) was given to the right ventral hindlimb muscles (tibial anterior and extensor digitorum longus muscles) or the right dorsal hindlimb muscles (gastrocnemius, plantaris and soleus muscles). MBF with or without MA was measured using the radiolabelled microsphere technique. The blood pressure was recorded through the right common carotid artery until MBF measurement started. Denervation of hindlimb was conducted by cutting the sciatic and femoral nerves. RESULTS: In normal rats, significantly increased MBF after MA were observed only in muscles which were penetrated by an acupuncture needle. The size of the increase depended on the number of times of pecking and seemed to be sustained at least until 60 minutes after MA. However, the increase was observed after both acute and chronic denervation. On the other hand, the mean arterial blood pressure (MAP) did not change significantly before, during or after MA. CONCLUSION: These results suggest that MA could increase muscle blood flow locally in a dose-dependent manner and that this increase may be caused by local vasodilators, as well as the axon reflex. A further study is needed to elucidate the mechanism.

How do acupuncture and moxibustion act? - Focusing on the progress in Japanese acupuncture research -.

The mechanisms of action of acupuncture and moxibustion as reported by Japanese researchers are reviewed. The endogenous opioid-mediated mechanisms of electroacupuncture (EA) as used in China are well understood, but these are only one component of all mechanisms of acupuncture. These studies emphasize the similarity of the analgesic action of EA to various sensory inputs to the pain inhibition mechanisms. In Japanese acupuncture therapy, careful detection of the acupuncture points and fine needling technique with comfortable subjective sensation are considered important. The role of polymodal receptors (PMR) has been stressed based on the facts that PMRs are responsive to both acupuncture and moxibustion stimuli, thermal sensitivity is essential in moxibustion therapy, and the characteristics of acupuncture points and trigger points are similar to those of sensitized PMRs. Acupuncture and moxibustion are also known to affect neurons in the brain reward systems and blood flow in skin, muscle, and nerve. Axon reflexes mediated by PMRs might be a possible mechanism for the immediate action of acupuncture and moxibustion. Reports on the curative effects of acupuncture on various digestive and urological disorders are also reviewed briefly.

Effect of moxibustion on dopaminergic and serotonergic systems of rat nucleus accumbens.

Acupuncture and moxibustion are traditional medical treatments that have come to play important roles in complementary and alternative medicines. Moxibustion also has a long history as a folk remedy in Japan, particularly due to the technical simplicity and selective efficacy on certain types of disease and distress. This study examined the effects of moxibustion focusing on the brain reward system, particularly in the nucleus accumbens. The effects of moxibustion stimulation at various sites and frequencies on monoamine levels of adult male Sprague-Dawley rats were examined using high-preformance liquid chromatography of dissected nucleus accumbens tissues. The rats weighing 290-310 g were divided into 3 groups according to the moxibustion point used: hindlimb, lumbar or parietal points. Each group was further divided into 3 subgroups, with stimulation for 10 consecutive days, for 1 day, or sham treatment (control). On each day of stimulation, 5 moxibustion cones with a peak temperature of 200 degrees C were applied consecutively. Stimulation of any point on 1 day only did not change dopamine or serotonin levels, but lumbar stimulation significantly increased the metabolic turnover of dopamine. Conversely, stimulation for 10 consecutive days resulted in significantly decreased serotonin levels for hindlimb and parietal stimulations, and significantly increased 5-hydroxyindolacetic acid/serotonin ratio for hindlimb stimulation. These results suggest that the metabolic turnover of serotonin release may be accentuated by moxibustion in a reward-related brain area. Moxibustion over consecutive days, especially that to peripheral regions, appears most efficient to influence on monoamine levels in the nucleus accumbens.

Alterations in the function of cerebral dopaminergic and serotonergic systems following electroacupuncture and moxibustion applications: possible correlates with their antistress and psychosomatic actions.

Alterations in cerebral monoamines following application of electroacupuncture were investigated using conscious rats with and without application of restraining stress. The dopamine and serotonin levels were significantly decreased in the nucleus accumbens, caudate putamen, and lateral hypothalamus and increased in the dorsal raphe nucleus by restraining stress. On the other hand, application of electroacupuncture on the lumbar and hindlimb segments eliminated the above changes in dopamine, while the changes in serotonin were attenuated by lumbar and hindlimb electroacupuncture. However, the effects of hindlimb electroacupuncture were greater than those of lumbar electroacupuncture. These results clearly indicate that lumbar and hindlimb electroacupuncture stimulations have differential effects on brain monoaminergic neurons in rats exposed to restraining stress. Moxa burning stimulation was applied to the lumbar and hindlimb segments of rats without restraining stress. The dopamine level was significantly increased in the midbrain substantia nigra-ventrotegmental area by hindlimb moxibusion. On the other hand, the serotonin levels were significantly increased in the nucleus amygdala by lumber moxibusion and decreased in the nucleus accumbens by hindlimb moxibusion. The present results indicate that electroacupuncture applied to the lumbar and hindlimb segments has an antistress effect, while the application of moxibustion to the lumbar and hindlimb segments was likely to stimulate the functions of mesocortical and mesolimbic dopaminergic and serotonergic neurons. We suggest that functional alterations in cerebral dopaminergic and serotonergic neurons are involved in the clinical efficacy of electroacupuncture and moxibustion, especially because of their antistress and psychosomatic actions.