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Volume 1, Special Edition ･ February 2010
Foreword – Current Japanese Acupuncture and Moxibustion
History of Japanese Acupuncture
Characteristics of Japanese Acupuncture and Moxibustion
Basic Research into Japanese Acupuncture and Moxibusiton- Somatosensory Stimuli including Acupuncture Modulate Blood Flow via the Autonomic Rﬂexes- Correlation between Nocicepetion and Acupuncture & Moxibustion- Basic Research into Japanese Moxibusiton
Clinical Trials on Acupuncture in Japan
Japanese Acupuncture Schools and their Characteristics
Acupuncture in Japan - Clinical Applications
Manufacturing Process and Characteristics of Modern Acupuncture Needles
Manufacturing Process of Classical Acupuncture Needles
Intorduction of Modern Moxibustion
Manufacturing Process and Characteristics of Classical Moxa
Current Status of Acupuncture in Japan
Japanese Acupuncture Educational and Licensure System
Acupuncture Practice in Dentistry in JapanSports Acupuncture & Moxibustion – Review
Treatment of Local Distance Sites for Diseases of the Locomotor System
Japanese Minimal Acupuncture
Safety Issue on Acupuncture and Moxibustion in Japan
Academic Societies related to Japanese Acupuncture and Moxibustion
Journals of Japanese Acupuncture and Moxibustion
Medical Insurance in Japan
Welcome to the Museum of Traditional Medicine!

www.kaim.us

US$30.00 per copy

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The Journal of
Kampo, Acupuncture andIntegrative Medicine(KAIM)
Research on Theory, Practice and Integration

EXECUTIVE EDITOR

Shuji Goto
Chairman, GOTO College ofMedical Arts & Sciences
Tokyo, JapanEDITOR-IN-CHIEF

Donald Lauda, Ph.D.
Dean Emeritus, College of Health &Human Services
California State University-Long Beach
CA, U.S.A.

ASSOCIATE EDITORS
Shuichi Katai
Ibaragi-ken, Japan

Hiromichi Yasui
Tokyo, Japan

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Volume 1, Special Edition ･ February 2010
TABLE OF CONTENTS
1 Foreword

Shuji Goto, Executive Editor

2 History of Japanese Acupuncture and Moxibustion

Hiromichi Yasui, Japan Institute of TCM Research

10 Characteristics of Japanese Acupuncture and Moxibustion

Shuichi Katai, Tsukuba University of Technology

14 Basic Research into Japanese Acupuncture and Moxibustion
15 Somatosensory Stimuli including Acupuncture Modulate Blood Flow
Shinjiro Yamaguchi
via the Autonomic Reflexes
19 Correlation between Nocicepetion and Acupuncture and Moxibustion
Yukihito Sugawara

29 Basic Research into Japanese Moxibustion – Introduction -Shigekatsu Aizawa

36 Clinical Trials on Acupuncture in Japan

Shoko Masuyama, Hitoshi Yamashita, Hiroshi Tsukayama

40 Japanese Acupuncture Schools and their Characteristics

Hiromichi Yasui

46 Acupuncture in Japan – Clinical Applications (the first half)

Shuichi Katai, Hiromichi Yasui

EDITORIAL STAFF

Hiroshi Tsukayama
Hitoshi Yamashita
Naoya Ono
Noboru Mitsuhata
Yoshiro Sahashi

EDITORIAL BOARD
Denmei Shuto
Hajime Haimoto
Hideaki Yamaguchi
Hidemi Takahashi
Katsutoshi Terasawa
Kazushi Nishijo
Keigo Nakata
Keishi Yoshikawa
Koji Ebe
Shohachi Tanzawa
Tadashi Yano
Takahisa Ushiroyama
Tomomasa Moriyama
Toshihiko Hanawa
Yoichiro Ebe
Yoshiharu Motoo
Yoshiro Yase

PUBLISHER

Shuji Goto
International Institute of Health andHuman Services, Berkeley
2550 Shattuck Avenue, Berkeley
California 94704-2724, U.S.A.
Website: www.kaim.us
E-mail: info@kaim.us

59 Manufacturing Process and Characteristics of Modern Acupuncture
Needles
61 Manufacturing Process of Classical Acupuncture Needles
63 Introduction of Modern Moxibustion
65 Manufacturing Process and Characteristics of Classical Moxa
67 Acupuncture in Japan – Clinical Applications (the latter half)
76 Current Status of Acupuncture in Japan

Tadashi Yano

82 Japanese Acupuncture Educational and Licensure System
84 Acupuncture Practice in Dentistry in Japan

Shuji Goto
Atushi Fukushima

85 Sports Acupuncture & Moxibustion - Reviews

Eiji Furuya

87 Treatment of Local Distance Sites for Diseases of the Locomotor System

Takayoshi Ogawa

91 Japanese Minimal Acupuncture

Noboru Mitsuhata

94 Safety Issue on Acupuncture and Moxibustion in Japan

Hitoshi Yamashita, Hiroshi Tsukayama

98 Academic Societies related to Japanese Acupuncture and Moxibustion

Shuichi Katai

102 Journals of Japanese Acupuncture and Moxibustion
105 Medical Insurance in Japan

Noboru Mitsuhata
Naoya Ono

123 Welcome to the Museum of Traditional Medicine!

Morinomiya College of Medical Arts and Sciences

MISSIONTo disseminate peer-reviewed information on the use of acupuncture and herbs, and integration with western
medicine, based on research from an international perspective; thereby stimulating further research, applicationof documented therapeutic measures; and facilitating dialogue among health care practitioners worldwide.

No part of this publication may be reproduced, translated, stored in a retrieval system, or transmitted
in any form or by any other means, electronic, mechanical or by photo-copying without permission inwriting to International Institute of Health and Human Services.

KAIM Editorial Members
Donald Lauda
Ph.D.
Dean Emeritus, College of
Health & Human Services
California State University,
Long Beach, CA, U.S.A.

Shuji Goto

Ph.D.
Chairman, GOTO College
ofMedicalArts&
Sciences; Chairman, Tokyo
Eisei Gakuen College;
Chairman, Acupuncture
and Integrative Medicine
College, Berkeley, U.S.A.

Hiromichi Yasui,

MD
Director of Yasui Clinic;
Director, Japan Instituteof
TCM
Rese arch;
Academic and educational
adviser of GOTO College;
Gest-Professor of Tian
Jing College of TCM,
China; Chief Researcher,Int’l Institute of HealthServices, Berkeley, U.S.A.

Katai Shuichi
L.Ac., Ph.D.
Professor,
Course of Acupunctureand Moxibustion,
Department of Health,
Faculty of Health Science,
Tsukuba University ofTechnology(National
University Corporation)

Hitoshi Yamashita,

LicAc, Ph.D.
Professo r & Chair ofDepartment of
Acupuncture, Morinomiya
University of Medical
ciences; Board Member of
The Japan Society of
Acupuncture andMoxibustion

Hiroshi Tsukayama

L.Ac., Ph.D.
Professor,
Course of Acupunctureand Moxibustion,
Department of Health,
Faculty of Health Science,
Tsukuba University ofTechnology(National
University Corporation)

Naoya Ono

L. Ac., M. Med. Sc.
Ph. D. Candidate
Department of Health
Informatics, Division of
Health Administration,
School of Public Health，Graduate School of Medicine,
Kyoto University

Mihoh Koga

MD
Division of General
Medicine, Division ofClinical Pharmacology &Therapeutics，
Jikei University School of
MedicineToshiaki MAKINO
Ph.D.
Associate Professo r
Department ofPharmacognosy，
Nagoya City Univercity
Graduate
SchoolofPharmaceutical Sciences

Noboru Mitsuhata
L.Ac
Te aching Certificate
Program for L.Ac.,
Tokyo
Eisei
GakuenCollege, GOTO College ofMedical Arts & Sciences

For subscriptions, pleasecontact our Subscription Customer Service representative at 3
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)
Address: 2550 Shattuck Avenue, Berkeley, California 94704-2724, U.S.A.

E-mail: info@kaim.us

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Foreword

Current Japanese Acupuncture and Moxibustion
This special issue on Current Japanese Acupuncture and Moxibustion follows our earlier publicationof Current Kampo Medicine.
Since the 1990s, the popularity of Complementary and Alternative Medicine (CAM) has been
growing in Europe and in North America. CAM is practiced primarily in the form of acupuncture andKampo medicine in Japan today, although acupuncture and related traditional therapies such as moxa
and traditional amma massage are at present less commonly used than Western medicine.
We who are involved with acupuncture are confident that these forms of Asian medicine which havebeen contributing to better health in Japan since they were first introduced from China 1300 years ago,
have an important role to play in Japanese medicine today. We also believe that the introduction andpopularization of acupuncture and related forms of healthcare can help to improve and sustain health incountries and cultures where these methods of treatment are not well known or widely practiced.
Through these publications our editorial staff intends to provide information on the results ofresearch in Eastern medicine, including acupuncture and Kampo medicine. We hope that this information
will be of use internationally, and that the traditions of acupuncture that have been nourished in Japan,
will spread and flourish in countries throughout the world.
In Japan today there are two major approaches to acupuncture. First, is traditional acupuncture,
which arrived from China 3,000 years ago and modified over time so that it is now uniquely Japanese.
Secondly, it is an approach strongly influenced by Western medicine and scientific thinking, which during
the 60 years following World War II has made tremendous progress in the scientific study of acupuncture
and its effects. Each of these approaches has its strengths and weaknesses.
The former is based on subtle therapeutic stimulation and care. This form of acupuncture
integrates readily into the patient's activities, and can have a profoundly positive effect on daily life. The
latter was developed to promote the use of acupuncture within the context of modern Western medicine.
Research in this area is intended to provide a clear scientific basis for the use of acupuncture in
conjunction with Western medical treatment in hospitals and clinics. In countries where Western
medicine is firmly established as "the" medical system, this scientific approach to acupuncture isparticularly useful, and the painstaking clinical research to clarify the relationship between acupunctureand Western medicine is bearing fruit.
Today we face medical conditions such as lifestyle diseases and end-of-life issues that will be
extremely difficult to resolve if we rely solely on modern living and Western medicine. In this context,
therapeutic methods that recognaize the value and significance of acupuncture can be of great service tothe medical community worldwide. It is our hope that acupuncture from Japan, on the eastern edge ofAsia, will continue to contribute to good health and vibrant life for all people.

Shuji Goto, Ph.D.
Executive Editor
Chairman, Acupuncture and Integrative Medicine College, Berkeley, U.S.A.
Chairman, International Institute of Health and Human Services, Berkeley, U.S.A.
Chairman, GOTO College of Medical Arts & Sciences, Tokyo, Japan
President, The Japan Society of Acupuncture and Moxibustion (JSAM), Tokyo, JapanThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

1

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

History of Japanese Acupuncture andMoxibustion
Hiromichi Yasui
Japan Institute of TCM Research
Acupuncture is a traditional form of medicine
originating in ancient China and introduced to Japan
about 1500 years ago. The historical development of
this medical technology was quite different in Japan
than in its "home" country of China. The island
civilization of Japan added unique theories andtreatment methods to the practice of acupuncture.
This article will explore the history and some of theunique characteristics of acupuncture in Japan.
Introduction and acupuncture to Japan

It is believed that acupuncture had been
introduced into Japan by the 5th Century AD, during
the waves of migration into Japan from the Korean
Peninsula. The immigrants brought with them
Chinese technology and writings, and it was throughthem that the native Japanese first learned about
Chinese medicine, including acupuncture. In 562, theChinese monk, Zhi Cong, traveled eastward by sea,
carrying with him medical treatises on herbal
medicine and acupuncture meridians, including theMing Tang Tu (Illustrated Manual of Channels,
Collaterals and Acupuncture Points). This is the firstformally recorded introduction of acupuncture to
Japan. In the 7th Century, in addition to sending
ambassadors to the courts of the Sui Dynasty and theTang Dynasty, the Japanese government also sent
students to study various facets of Chinese culture. A
number of those students studied Chinese medicine
before returning home to Japan.
In 701, the Japanese government implemented
formal legislation (including the medical system) thatemulated the system being used at that time in Tang,
China. They established a curriculum for medical
education, with textbooks including such classics as
the Huang Di Nei Jing, as well as the Jia Yi Jing,
which was the first book devoted entirely toacupuncture and moxibustion; and also included
charts and graphs of the acupuncture meridians.
Students studied acupuncture and moxibustion theory2in the Huang Di Nei Jing, becoming familiar with theacupuncture points from the annotated charts andgraphs of the meridians, and learned the practicalapplications of moxibustion and acupuncture in the Jia
Yi Jing. The acupuncture curriculum required six
years of study.
Becausethis
medicalsystemwasgovernment-controlled, its administration rested in
the hands of the nobility who were in charge of thenational government until the end of the 12th
Century. At that point, control was seized by thesamurai class, and the capitol was shifted from Kyoto
to Kamakura, although the form of the medical system
continued unchanged. Around that time, acupuncture
and moxibustion entered a slow decline and little
information remains about the techniques practiced
during that period. The great physician priest Shozen
Kajiwara (1266-1337), in his massive two volume
medical encyclopedia compiled from 1302 through1327, made almost no mention of meridians,
acupuncture points, or moxibustion; although theencyclopedia includes detailed illustrations of humananatomy from Sung China. That situation remained
unchanged until the 16th Century when acupuncture
began to return to favor.
Early flowering

In the 15th Century, the second military governmentof Japan (the Ashikaga Shogunate) placed great
importance on trade with Ming China. The government
dispatched numerous trading ships, and there was also
considerable private shipping back and forth between
Japan and China. This resulted not only in a remarkableincrease in Chinese goods entering Japan, but also an
increase in the number of people traveling between thetwo countries. Many Japanese crossed the sea to China
in order to study medicine, including some who learned
acupuncture and then returned home to become famous
acupuncturists in Japan.
At the end of the 16th Century there were several
developments that had never occurred before in
Japan's relations with the Asian continent. First was
the Japanese invasion of the Korean peninsula, led by
Toyotomi Hideyoshi. While in Korea, the invaders
were exposed to unfamiliar elements of East Asian

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

culture (including medical writings). They also
encountered a wide range of technological skills andmet the practitioners of those skills, including
physicians. The imported technology of wood block
movable type, which contributed greatly to theprinting industry that subsequently developed inJapan, also permitted the publication of more medical
literature.
Another contributing factor was the gradualdecline of the Ming Dynasty in China. Invasion by the
Manchu forces (who subsequently founded the Qing
Dynasty in China) caused a flood of refugees to thesouth. A few of these refugees (20,000 to 30,000)
traveled as far as Japan where they were welcomed by
the newly established Tokugawa Shogunate (1603).
Those refugees included a number of highly skilled
physicians who commenced to teach the latest
developments in Chinese medicine to their Japanesecontemporaries.
Those teachings had a major impact on
acupuncture in Japan in the late 16th and early 17th
Century and led to numerous splits and divisions.
Soon more than ten competing "schools" ofacupuncture treatment had appeared. These divisions
developed in part because teachings from China
arrived piecemeal. Each school kept its own techniques
secret from all others.
The schools of acupuncture at this time werestrongly influenced by the classical medical text Nan
Jing (Classic of Difficult Issues). There were those who
gave particular weight to abdominal diagnosis andtherapy, those who focused on worms within the bodyas a source of disease; those influenced by Buddhist
medicine; those that emphasize treatment at specificacupuncture points; those who notated theacupuncture points by symbology, and those who
expressed the indications of disease in Japanesetraditional verse (waka).
In 1536, the Nan Jing became available as Japan's
second medical publication. Soon after this, schools
strongly influenced by this text, began to appear. The
content of the Nan Jing with regard to the concept of"reinforcing" and "reducing" was particularly
well-received by Japanese at that time. The concepts
focusing on abdominal diagnosis and therapy are notwell understood, but may have been popular for two
reasons. One, was that techniques for abdominal
massage were already known at the time, particularly
among Buddhist monks, and were understood toprovide definite effects. Second, was that theanatomical diagrams in all of the Shozen medical
treatises were connected to the anatomical notationsin the Nan Jing, and these points were projected onto
the surface of the abdomen, leading to the idea thattreatment could be directly applied to the pictured
sites. Fig. 1 shows a chart from this period for
abdominal examination.
(Each organ was assigned
to a specific region of theabdomen. bnormalities weredetected by palpation, andtreatment was performedby driving in needles witha small mallet.) The schoolsthat focused on the abdomen
continued to exist for several centuries. The otherschools apparently persisted into the mid-17th
Century.
Independent development

In the first half of the 17th Century, exiles from the
Chinese mainland brought current developments in
Chinese-style acupuncture to Japan. At the same time
there was increased study of classic medical texts suchas the Huang Di Nei Jing. That interest was further
spurred by the introduction of Chang Jing Yue's
classic text, the Lei-Jing, in Japan in 1624. From thatpoint onward, study of the classic texts made up amajor stream of traditional Chinese medicine (TCM)
research in Japan.
In the middle of the 17th Century, a man of genius
appeared who changed the course of acupuncture
history in Japan. That man was Waichi Sugiyama(1610-1694). Sugiyama, who was samurai by birth,
contracted smallpox when he was a small child andlost his sight. As a young man he gave up his samurai
status and began the study of acupuncture. His
experiences during his search to become a skilledacupuncturist are legendary. For example, it is said
that his prayers to the goddess Benten were rewarded

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

3

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010by the goddess, who gave him the gift of superior
acupuncture technique.
Sugiyama took the massive system of Chinese
acupuncture and summarized it in concepts that were
easily understandable in Japan. Based on his own
experience, he simplified and clarified therapeutics.
He also introduced two techniques that reduced thepain of acupuncture: the use of the kudabari, a guidetube that simplified needle insertion, and the use ofpine needles as acupuncture needles. He taught all of
those techniques at his acupuncture schools. He also
succeeded in broadening the occupations available tothe blind and visually impaired. Subsequently,
acupuncture, moxibustion, and massage became
important occupations for the blind in Japan; atradition which has continued into the present.
Sugiyama's work won the support of the Tokugawa
Shogunate, support which was continued for the next
200 years.
We also have documents from a few European
travelers of the time, recording their impressions ofcontemporary Japanese acupuncture. From 1674 to
1676, the Dutch trader Willem ten Rhijne served as thephysician to the Dutch trading post outside of Nagasaki.
(At that time, Nagasaki was Japan's primaryinternational trading port, and the Netherlands was the
only Western country permitted to trade in Japan.) In
his subsequent treatise, Dissertatio de Arthritide, hedevoted many pages to acupuncture and moxibustion,
providing Europe's first introduction to these forms of
medical treatment (Fig. 2, 3, 4, 5).

Portrait of Willem ten Rhijne

4"Article about Arthritis" by Rhijne

The year 1690 marked the arrival in Japan ofEngelbert Kaempfer (1651-1716), who studied
multiple aspects of Japanese culture, including
medicine, and later wrote a book titled Amoenitatum
Exoticarum (1712). This was his only work publishedduring his lifetime. After his death it was translated
into English, edited, and included in the larger volume
The History of Japan, published in London in 1727.
The text contained a discussion of acupuncture.
Kaempfer described acupuncture treatment for the
specific condition of "senki"
which involved abdominal
pain of unknown cause.His
work included illustrationsof three types of Japanese
acupuncture needles (Fig. 6).
He also provided a detailed
description of moxibustion in
the treatise Moxa in China
and Japan.
That description gives us information on how moxa
was used at the time. (Moxa powder approximately thesame volume as half a grain of rice was burned directlyon the skin. This was the origin of moxa as it ispracticed in Japan today.) Kaempfer was surprised tofind that the area treated was often considerably
removed from the afflicted area. He described asituation in which an upset stomach and loss ofappetite was treated by moxibustion on both shoulders,after which the condition was relieved and thepatient's appetite returned.

Acupucture needle used thenChart of Meridian points

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

He also witnessed moxibustion along the spine as aneffective treatment for pain in the side, and theapplication of moxa between the thumb and index
finger to treat toothache. He found all of thesetreatments astonishing, although from our present-day
perspective, they do not seem particularly strange. As
an aside, the English term "moxibustion" was derived
from the Japanese "mogusa" (moxa). Kaempfer's bookwas widely distributed at the time of its publication as
an introduction to moxibustion (Fig. 7).

The use of moxa began to increase at the end of the
16th century. Because it was simpler thanacupuncture, which required specialized knowledge
and technical skill, moxibustion became widespread asa form of folk medicine, and numerous volumes were
written on its use in the home. In his book, Kaempfer
commented that it was impossible to find a Japaneseperson who did not show some scarring frommoxibustion.
This form of folk medicine, which was widespreadbut not practiced to a particularly high standard, wasagain returned to professional hands by a movement
initiated in the late 17th Century and extending into
the middle of the 18th Century under the leadership of
Konzan Goto (1659-1733). Goto was a highly
knowledgeable physician who primarily used
traditional Chinese medicine therapy, but frequently
relied on folk medicine, now referred to ascomplementary and alternative medicine, (CAM). He
placedparticularimportanceon
diagnosing
abnormalities in the flow of qi energy within the bodyand frequently prescribed a course of hot springs andmoxibustion therapy to improve this qi energy flow. As

a result of his work, even doctors who specialized in
drug treatment began to occasionally use moxibustion.
This led to even greater use of moxibustion among thecommon people, and different regions developed theirown characteristic forms of moxa therapy (usuallyassociated with a specific Shinto shrine or Buddhist
temple). Those methods, which were based on theexperience of the people of each local region, were latercollected for publication by several different scholars.
The Chinese acupuncture system was vast andcomplex, which made it very difficult for Japanese
students of that time to fully understand its potential.
This problem was addressed with skill anddetermination by a number of Japanese specialists
who succeeded in reforming and simplifying themassive Chinese system for Japanese use. This ability
to codify a vast and complicated system into somethingsmaller and more easily understandable, which
historically has characterized the Japanese people,
resulted during the late 17th and early 18th centuries
in the authorship of numerous small and practicaltexts on moxibustion and acupuncture. Fig. 6 shows
one of those, The Handy Book of Acupuncture,published in 1718 (Fig. 8).

The popularization of these simple texts in Japan
was paralleled by a movement to publish more difficult
Chinese medical materials (the classics as well as
numerous treatises on medical theory and texts on
moxibustion and acupuncture) accompanied bynotations and commentary in the Japanese vernacular.
An industry even developed around this specialized
work. This approach to the explication of foreign texts
was in itself uniquely Japanese.
Research on the meridians and acupuncture points
also flourished. Such research was particularly in

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

5

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

demand because of the difficulty of identifying meridianshailed in Europe as an importantand acupuncture points on the human body. In the final

treatment technique, wasanalysis, however, progress in this field came when the

introduced to Japan by thenotations and commentaries on classic Chinese texts ofDutch translators at Nagasaki,

moxibustion and acupuncture were actually confirmed

and was of considerable interest

by investigation through practical use. Such research

to Japanese physicians.

continued uninterrupted from the 16th to the 19th

The year 1776 in Japan marked

centuries. Much of it was documented in writing.

the arrival of Dr. Carl PeterIn the 18th Century a man by the name of Todo

Thunberg (1743-1828) (Fig. 9),

Yoshimasu developed a revolutionary idea in the field

who accompanied the Dutch director of the Nagasakiof traditional Chinese medicine therapy; he proposed

trading post on his visit to the capital in Edo (nowthat patients be treated without reference to theTokyo), one of the world's great cities at that time.

traditional medical theories of yin, yang, and the five

Thunberg spent some time in Edo, where he met withagents. From that point onward, Japanese TCM

a number of the best physicians in Japan, taught themdiverged considerably from traditional medicine as

the techniques of bloodletting, and trained them for apracticed in China.

short time in the implementation of this therapy.
theMeanwhile, a book written in China on the(1706-1764)

treatment of acute filthy disease "Sha zhang", adeveloped and began to practice an acupuncturecholera-like disease reached Japan in the mid-17th

methodology that was not based on traditional medical

Century. It also contained a description of bloodletting.

theories. Suganuma's techniques did not depend onSome

the meridians or on the concepts of reinforcing andinterested in this Chinese approach to bloodletting andreducing. Instead, he treated patients using only 70

began to use it in treating a variety of diseases. Thisacupuncture points. Although his ideas did not become

led to modification of the European techniques inwidespread, they had considerable impact on his

Japan, soon resulting in the development of a uniquecontemporaries in the world of moxibustion andform of bloodletting that came into widespread use inacupuncture.

Japan during the 17th and 18th Centuries.

Stimulated
acupuncturist

byYoshimasu's

Shukeithinking,

SuganumaJapanese

medicalpractitioners

becameAt the same time that Yoshimasu was propounding

Neo-Confucianism was first introduced in Japan

his ideas, Dutch physicians were beginning to visit

toward the end of the 16th Century. The Tokugawa

Japan, bringing with them a few high-quality Dutch

Shogunate considered this philosophy as a pillar of its

medical texts that were read and translated byown existence. However, the philosophy had many

progressive Japanese physicians. The first of these

detractors, and around the turn of the 18th Century

works to be translated and published was Johann

there was a popular movement to return to the

Adam

been

essentials of traditional Confucian thought. The

translated from the original German into Dutch underactivities of Yoshimasu and his colleagues were one

the title Ontleedkundige Tafelen. The publication of

result of these changes.

Kulmus'anatomy

text

which

had

this book in Japanese provided a view of medicine very

At the end of that century, a popular text on

different from traditional TCM-based understanding,critical investigation from the Qing Dynasty in China

and focused attention on Europe. Japanese physicians

was introduced to Japan. Medicine was among thebegan with the study of anatomy and surgery, andfields influenced by this book, and as a result a criticallater extended their interest to Dutch medical

investigative approach to research became popular.

treatises on internal medicine and other areas ofTextual criticism was widely applied to classics such as

clinical therapeutics.

the Huang Di Nei Jing and the Shang Han Lun, and in

At about this time, bloodletting, which was being
6

some cases corrected texts were prepared and

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

published. This movement was sparked by individuals

treatises for him, so in the field of moxibustion andof the time and later received government approval.

acupuncture, he read Ishizaka's Concise Discourse on

Government-sponsored medical research laboratories

Acupuncture and Moxibustion as translated by Junzo

were established and became centers of both research

Mima. Subsequently, on a visit to Edo with the Dutch

and teaching. Meanwhile, a copy of the Tai Su Jing, a

director of the Nagasaki trading post, Dr. Siebold had

portion of the Huang Di Nei Jing that was no longer

the opportunity to meet and exchange experiences

available in China and believed lost, was found in anwith Dr. Ishizaka.

old Buddhist temple in Kyoto. This discovery further
encouraged research in the classic texts.

Decline and restoration

Worthy of mention in the context ofmoxibustion

andacupuncture

education during this period was ahumanfigureshowing

the

cast

in

meridians

copperandacupuncture points. (The original
prototype, made in China in 1026,was

subsequently

modelswere

lost.)

Such

enthusiasticallywelcomed by medical scholars of thetime, and in the 17th Century, a
new mold was made and additional
figurines were cast (Fig. 10).

Until the middle of the 19th Century, moxibustion
and acupuncture played a consistently unchanged roleinthepracticeofJapanesephysicians,

while

technological advances and academic developments
contributed to better health for the common people.
With the Meiji Restoration in 1868, the reins ofgovernment were transferred from the Tokugawa
Shogunate to a new imperial government headed by
the Emperor Meiji. This also brought changes to the
medical world, since all of the medical institutions that
had operated under the Tokugawa Shogunate weretaken over by the new government. The German
medical system was adopted, and schools of medicine

With the advent of the 19th Century, the Japanesestudy of Dutch medicine intensified, and numerous
specialized texts were translated into Japanese. Moredoctors began to rely increasingly on their own
experience, and some even began to question theconcepts of Chinese medicine. It was in this context
that Sotetsu Ishizaka (1770-1841) devised a systemthat was centered around the traditional theories ofmoxibustion and acupuncture but that also
incorporated Western medical thought in asubordinate role.
In 1823, Dr. Philipp Franz von Siebold (1796-1866)
came to Nagasaki as physician
to the Dutch trading post there(Fig. 11). Dr. Siebold trained
numerous Japanese students
in Western medicine, while atthe same time studying Japanesetraditional medicine himself.
His method was to have hiswere established along German lines. This left only

disciples translate outstanding Japanese medical

continued to provide employment for the blind. The

one generation of physicians practicing traditional
medicine. Their occupation was effectively brought toan end since most traditional physicians passed on
their knowledge and their practice to younger family
members. Under the new system their children andgrandchildren could not become certified physicians
regardless of how well they were trained in traditional
medicine. Those who wished to become doctors wererequired first to study Western medicine and then passan examination in order to become a medical
practitioner.
The various forms of traditional medicine both
Kampo (herbal medicine) and acupuncture, wereconsidered to be "non-mainstream" and were removed
frompublicmoxibustion

view.
and

However,thepracticesofacupuncture

wereallowedtocontinue as long as the practitioner was licensed by
the

local

government.

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

These

occupations

also

7

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

weretreating General Zhukov (formerly of the USSR

considered of high importance at schools for the

military and General of Minister of Defense) for

visually impaired.

trigeminal neuralgia.

subjects

of

After

moxibustion

being

government

so

and

severelyandacupuncture

restrictedcompletelybyexcludedtheThese two schools of thought are the central forces

fromin Japanese acupuncture today, although there are

mainstream medicine, acupuncture took more than

numerous small unaffiliated groups as well.

half a century to recover. During that period, however,

Their activities were temporarily curtailed bya small number of highly gifted acupuncturists

World War II. After the war, the defeated Japanesecontinued to practice away from public notice.

nation was given democracy by the occupying Allied

One of these was Ken Sawada (1877-1938), whose

Powers(GHQ).

However,

the

GHQ

was

not

work was discovered and brought to the attention of

sympathetic to acupuncture. The department that was

the world by a journalist investigating traditionalcharged with reforming the Japanese medical system

medicine. Dr. Sawada's method, called "Tai Chi

was the Public Health and Welfare Section (PHW)

Therapy", depended primarily on observation andunder the command of Brigadier General C. F. Sams.

palpation to diagnose abnormalities of the organs andGeneral Sams attempted to obliterate the historic andmedians, which were then treated with moxibustion.

uniquely Japanese treatment method of acupuncture

Sawada focused primarily on acupuncture points infromthe back, but emphasized that for every disease there

recommending to the Japanese Ministry of Health andwas a characteristic acupuncture point that could be

Welfare that "Medical treatment should be performed

used. Sawada's methodology was widely disseminatedprimarily by physicians, and other occupations such as

by his gifted disciples, a group of practitioners who

acupuncturist and massage therapist should bebecamecentralTheyunreservedly prohibited." This recommendation came

includedtheShirota

as a great shock to the acupuncture world, and a

popularizedcoalition of acupuncturists, physicians, physiologists,(1900-1974),

toJapanesehighlywho

acupuncture.

successful

systemized

Bunshi
andwithin

the

world

of

Japanese

medicine,

members of the National Diet, and those involved with

Sawada's therapeutic techniques.
The 1930s saw the formation of another large

schools for the blind began to work together to opposefromthe GHQ recommendation and to find a better solution.

notations on the classic texts, this group developed a

In the end General Sams was convinced of thesystem that placed primary emphasis on meridian

importance"kyo-jitsu"

traditional form of medical treatment was allowed to

group

of

acupuncturists.

(deficiency

Workingandmostlyexcess)diagnosis.

Treatment was performed by supplementing theofacupuncture

in

Japan

and

this

continue.

deficiency or eliminating the excess so that balance

After the war a number of new movements began

could be restored. They named this methodology

to develop within Japanese acupuncture. The Ministry"Meridian Therapy". The central members of thisof Health and Welfare established a system of formalgroup, who provided guidance for the others andeducation for the purpose of becoming a credentialed

established the Meridian Therapy system, were

acupuncturist,

several young acupuncturists in their 20s and 30s. In

schooling (3 years) in a specialized educational

particular, Sodo Okabe (1907-1984) possessed brilliant

institution, to be followed by a certification test

technical skill and contributed greatly to the perfection

administered by the local government (later changedof the technical side of this system. In 1973 Dr. Okabe

to a national certification examination). Candidates

was invited to visit what was then the Soviet Union,

who passed the examination were credentialed aswhere he received grateful thanks after successfully

acupuncturists.

8

stipulating

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)aspecificamountofVolume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

There were also new developments in clinicalpracticeandinresearch.

SomegroupsofSince some Japanese practitioners wished to pursue thismethodology in Japan, formal schooling in TCM was

acupuncturists, in response to the GHQ statement

established.

Activecommunication

with

Chinesethat acupuncture was "an unscientific and barbaric

specialists is ongoing, excellent Japanese educators haveform of treatment," chose to focus primarily on

emerged, and this system is currently gaining inscientific methodology. Dr. Shirota, as mentioned

popularity.

above, denied the absolute authority of traditional

At present there are a number of different

medical theory. He proposed that the measurement ofacupuncture systems in practice in Japan, each with its

electrical resistance could be used to detect theown special characteristics. Any attempt to use these

acupuncture points that were responsive in a specificsystems without understanding their historical context

disease, after which the disease could be treated byinvites erroneous and unreliable results, since while

stimulating those points with acupuncture andclosely related in some ways, these systems also havemoxibustion.

points on which they differ profoundly.

Advancesinelectrophysiology

contributed to this theory, but applications to the

The current situation of Japanese acupuncture

meridians had to wait until a discovery by Yoshio

cannot be explained through one-dimensional thinking.

Nakatani in 1950 that resulted in the development ofHowever, this multiplicity is in itself one of the

Ryodoraku

newcharacteristics of acupuncture in Japan. While future

developments, groups of acupuncturists who weredevelopment of acupuncture throughout the world willinterested in meridian therapy, continued their

be greatly influenced by changes in Chinese TCM, it

research, producing large volumes of results to prove

seems

the existence of the meridians.

moxibustion and acupuncture in Japan will also play a

Acupuncture.

Parallelingthese

In the 1970s, information on a newly systematizedapproach to TCM arrived in Japan from China.

likelythattheuniquecharacteristics

ofsignificant contribution in the international developmentof this traditional approach to better health.

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

9Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Characteristics of Japanese Acupunctureand Moxibustion
Shuichi Katai
Department of Acupuncture and Moxibustion
Tsukuba University of Techonology

Su Wen (Plain Questions) and Ling Shu (Spiritual
Pivot) have been the original texts on which thissystem was based.
The term "Orient" as it is perceived in the West,suggests a very extensive area including the Near East

1. Japanese Acupuncture and Moxibustion -and the entire Asian region. If that is so, the oriental

Definition
When talking about Japanese acupuncture andmoxibustion, several perspectives have to be taken
into consideration. For example, the most easily

medical system should also comprise such various
Asian medical systems as Ibn Sina, Ayurvedic
medicine, Mongolian medicine, Tibetan medicine andChinese medicine.

understood aspect would be a classification based on

Otherwise it could be asked why the term

differences in therapy. Also, classifications based on

traditional Chinese medicine is not used. While today's

differences in theory, misperceptions or conceptual

Chinese medicine is based on the classics Su Wen anddifferences are also conceivable classification criteria.

Ling Shu, it can also be comprehended as a

It might also be possible to discuss the subject asreorganized system formed following the foundation ofviewed from differences in the tools used for

the People's Republic of China in 1949. The influences

acupuncture and moxibustion. Moreover, it should alsoof this system later propagated through East Asia andbe possible to differentiate Japanese acupuncture andagain modified in the various regions just as it

moxibustion as compared to Chinese and Korean

happened after the emergence of its original form in

medicine.

China. Thus, during the transitions in Chinese history,

The English designation for needles used as tools

in the process of the propagation from the old China tois generally "needle", but when the notion of amodern China, this medical system can be viewed astreatment performed with these needles is included, ahaving emerged, changing under the influence of

numberlike

acupuncture,

modern Chinese culture. In other words, the term

acupuncture

treatment,

Chinese medicine today must be said to designate aneedling, needle therapy, and needling method are

medical system that is different from the oriental

used. Here, the English term acupuncture in the sense

medicine developed 2,000 years ago in China. In thisof therapy is used.

sense, Chinese medicine can be comprehended as aofincoherent

acupuncture

therapy,terms

Again, the term "oriental medicine" is frequently

form of Asian medicine. And, when speaking ofused in Japan in the sense of comparing oriental

oriental medicine, the term should implicate East

medicine to western medicine, but its meaning

Asian medicine. Accordingly, if the term is to be usedremains in fact, rather unclear. Usually the use ofin the above mentioned context, East Asian Medicine

orientalwould probably be appropriate.

medicine

impliesthemedicalsystemdeveloped 2,000 years ago by the Han people native to
the Yellow River basin in China. It later spreadthroughout the various Asian regions, where it wasunder the influence of the culture of the countries it
had been propagated to. It underwent modifications
specific to that particular country and thus developed
to the present day. This system was introduced toJapan in the 6th century. The Yellow Emperor'sClassic of Internal Medicine comprising the sections
10

2. Acupuncture practice in modern JapanThe acupuncture of East Asian medicine was firstmentioned in the "Nine Needle Twelve Sources
Chapter" of the "Ling Shu" (Spiritual Pivot), where
nine different types of needles and the basics of theirclinicalapplication

were

described.

This

has

undergone a multitude of changes over the past 2,000
years. In particular, the changes that occurred under

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

the influence of western science in the 19th century,1) Tools, Stimulation Method and Stimulation Sitedefine what is today called acupuncture. Thus,(a) Differences in tools

acupuncture has to be defined in such a way that it

Generally, the needles used in Japan are thinnercannot mean only the needling techniques handed

than those used in Chinese medicine. The mostdown from ancient times, but also has to indicate

frequently used needles in Japan have a diameter

physical stimulation in general that is administered invaryingorder to elicit effective body responses in order tofrequently used in China have diameters between

promote healing of diseases.

0.32-0.38 mm. This clearly shows that the needles

The acupuncture performed in Japan based on thisbetween0.16-0.20

mm,

while

needlesused in Japan are much thinner.

definition can be classified variously. For example:

There is not a unanimous view regarding theaccording to the stimulation site (scalp acupuncture,reason for the use of such thin needles in Japan (orear acupuncture, hand acupuncture, intradermal

why they have become so thin). Probably, they were

acupuncture),(contact

made so thin because of the hypersensitive nature of

insertions,

the Japanese people. Acupuncture and moxibustion

thrusting and lifting, electrical pulse stimulation,

are considered to have spread among the general

tappingtherapy),

population in Japan about 400 years ago. Conceivably,

differences in therapeutic concepts (tender pointin the process of the popularization, this modality has

therapy, ashi point therapy, blood letting, Ryodoraku,

been adapted to suit the constitution of the Japanesetrigger point therapy, pediatric acupuncture), etc.

and thus led to the use of weaker stimulation doses as

the

type

acupuncture, needle
needling,ofstimulation

retaining,

fire

singleneedling,

SSP

well as the development of thinner needles. Whenthinner needles were used, they would bend more

3. Characteristics of Japanese acupuncture
As mentioned above, Japanese acupuncture has

easily upon insertion, so a twirling insertion method

several classification approaches. Any one of them,using both hands had to be devised for the insertion of

however, may have common characteristics.

filiform needles. For the Chinese twirling method, both
Japanese

hands are not used. There is no necessity to do so.

acupuncture, as compared to Chinese and Korean

Thinner needles led to changes in Japan by inevitableacupuncture, may be characterized by its use of very

consequences. Additionally, to prevent pain upon

weak stimuli. Generally, factors determining theinsertion, approximately 300 years ago, the use of astimulus quantity of acupuncture and moxibustion

guide tube was suggested that led to the development

include the tools used, the stimulation method andof a uniquely Japanese guide tube needling technique.

stimulation site (site on the body). Moreover, bothAt that time the head of a pestle-shaped needle

quality and amount of applied tools and the stimulation

was inserted by tapping with a wooden hammer, amethod determine the quantity of the stimulus.

technique called tapping needle; or else the purely

One

of

the

characteristics

of

the

Also, the information obtained through palpation

manual twirling needle technique, not relying on tools,

among the four examination methods, are considered

was performed. The needling technique using a guideparticularly significant for the comprehension of the

tube developed later into the mainstream Japanesepathological condition, determination of stimulationneedling technique. Painless insertion, safety, andsites, and stimulation dose etc. may be cited as otherease of insertion of this technique can probably becharacteristics. A brief description pertaining to tools,cited as reasons for this development. It can be

stimulation method, and stimulation site is presented

assumed the tapping needle technique inspired the

below.

development of this guide tube needling technique.

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

11

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010(c) Differences in stimulation sites(b) Differences in needling techniques
The stimulation method varies depending on the

Differences in stimulation sites refer to where on

insertion and stimulation technique after insertion.

the body the stimuli are applied. In other words, it

The acupuncture performed in Japan includes adepends on which acupoints are chosen, and at thevariety of techniques from contact needling, using only

same time, the depth of the needling. The stimulationskin contact stimulation but no perforation of the skin,dose varies with the insertion depth.

over subcutaneous needling, where the needles are

Regarding the amount of stimulation derived from

inserted very shallow into the subcutaneous tissues tothe differences in stimulation site, it is generally

intramuscular needling techniques. The techniques

understood that local needling stimulates the bodymay employ just stroking of the skin, or a methodvery effectively (i.e. the amount of stimulation iswhere the needles are placed and retained in place

greater). Clinical consideration demonstrates that thefrom several to ten or more minutes, thrusting andstimulation

lifting

distance from the relevant local area.

stimulationor

low-frequency

electric

intensity

decreaseswithincreasing

However, there is no definite proof that local

stimulation, etc. This means that many different
contact

stimulation of affected areas represents the strongest

acupuncture, single insertions, thrusting and lifting,possible input. On the contrary, the consideration thatelectrical pulse stimulation, tapping needling, fire

remote stimulation is required to provide powerfulneedling, and SSP therapy are employed.

therapeutic effects warrants further investigations.

techniques,

like

the

above

mentioned

Among these techniques, contact stimulation of
the skin and stimulation at extremely shallow levels

2) The importance of obtaining information throughappear to be characteristically Japanese stimulation

palpationtechniques that differ from those employed in China or

The author discussed the subject of palpation an

Korea. The use of these "subtle stimuli" also relates

article entitled, “Considering the Therapist’s Hand”

the characteristics of Japanese acupuncture very well.

published in the Journal of Kampo, Acupuncture and

The INSHIN (round needle = yuan zhen) and

Integrative Medicine, Vol. 1, No. 1, Spring 2006, pp.

TEISHIN (spoon needle = chi zhen) included in the

25-26. It provides excellent information to support this"nine needle types" would be the suitable tools forarticle.

these techniques. These are seldom used in China and

The second characteristic of Japanese acupuncture

Korea. Yet, the practice of acupuncture by groups

andmoxibustionisusing minimal stimulation methods in Japan based on

information

traditional concepts, considers them to be of great

examination, treatment, and finally the evaluation ofimportance, in particular for tonification as treatment

the results.

obtainedtheimportancethroughplacedpalpationonduringof deficiency conditions. These are considered to beeffective methods for patients with emotional problems(a) Examination
The foundation for an examination are the four

including stress.
On the international front, although some papers

basic diagnostic procedures of inspection, listening,on RCT clinical trials of acupuncture needles show

smelling, questioning, and palpation; but Japanesethat

contact

acupuncture and moxibustion places particularly greatused,importance on pulse diagnosis and channel palpation.

stimulations differ from the placebo effect and can be

Although I will not discuss pulse diagnosis here,

viewed as a historical perspective of Japanesechannel palpation is not restricted to palpation of theacupuncture and moxibustion.

channels; but should be defined as also includingintervention

acupuncture

12orstimulations
shallowwhenneedling

were

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

palpation of the entire body to look for reactions. Since

In other words, the palpatory findings allow one tothe final purpose of acupuncture and moxibustion isevaluate the severity of the patient's condition, degree

the therapeutic stimulation of the body surface, it isof changes, prognosis and the time of the final stage ofnecessary to perform acupuncture and moxibustion

the treatment.

treatment empirically. As a result, this is an effective
method to determine stimulation sites, stimulation
purpose and needling stimulation dose.

4. Why has palpation developed in Japan?
The views regarding why palpation has developed
so far in Japan are probably divided. Yet, it is(b) Therapy

generally

For the basic treatment the needles are held withthe pressing hand which is brought into close contact
with the skin. This prevents bending or breakage ofthe needles and further helps to prevent pain that mayotherwise occur due to inadvertent movements.
Moreover, the pressing hand is also important insensing the arrival of the Qi feeling. It helps
understand the development of therapeutic effects andpossible

to

say

that

acupuncture,

moxibustion, and massage (Anma) found widespread
application among the general population from theEdo period to the early Showa period. Subsequently, ina process of adaptation to the sensitive disposition of
the Japanese, the employed needles became thinner,
the moxa cones smaller, and the Anma stimulation
softer. In other words, the stimulation dose applied

allows one to determine the timing for removal of theduring treatment may be said to have been reduced.

needles. Also, in case there are any changes occuringYet, naturally, therapeutic effects were not decreased,in skin or connective tissue reactions, the pressing

but rather effects of the same magnitude werehand can feel them. These facts indicate the necessity

expected. The result was, thatof palpation during the treatment (including thefeeling with the pressing hand).

*

Stimulation

sites

had

to

be

selected

appropriately in order to guarantee that a even a small
stimulus dose is effective. For this purpose, palpatory(c) Evaluation of the effects

skills to identify suitable sites were demanded.

Therapeutic effects are likewise evaluated after
removing the needles through palpation. Although it is
not easy to precisely remember the condition prior to
the needling, experienced therapists evaluate thetherapeutic effects based on differences in thepalpatory feeling before and after the treatment. At
the end of the treatment, it is possible to determine if
further needling is required, if the duration of thestimulation should be extended, or the stimulation
methodchanged.

Naturally,

through

cumulative

*

This

kind

of

subtletechniquesisarepresentative example for the Japanese treatment.
The development was brought about by the culture
and climate from the Edo period to the early Showa
period that evaluated dexterity of the hands positively.
*

And

also,

a

worldwide

unparalleledhealthcare culture developed, when from the middle of
the Edo period, visually impaired persons started to
bear

the

responsibility

foracupunctureandeffects and the attainment of changes finally leading

moxibustion treatment. For visually impaired persons,up to the targeted condition, it is also possible to judge

palpation is the basis for determining the treatment

when to finish the treatment cycle itself.

sites and as mentioned above, as a consequence madeLeading this argument even further, cumulativeevaluation of therapeutic results will in this way
affect the establishment of the treatment plan
during the first visit of the next patient.

it necessary to perform the entire treatment process
guided by skillful palpation.
These circumstances led to a unique developmentof palpation skills in Japan.

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

13

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Basic Research into Japanese Acupuncture– Mechanisims of action with acupuncture –KAIM Editorial Department

Over the years, patients have experienced (and acupuncture providers have observed and recorded) the
amelioration of physical pain, improvement in a variety of psychosomatic complaints, and recovery ofphysical condition that can be provided by acupuncture treatment. What accounts for the success ofacupuncture in these situations? A variety of theories have been developed over the last 2000 years, andhave been described in the historical context of yin-yang five phase metaphysics, ki-ketsu-sui (ki energy,
blood, and body fluids) and zang fu organ theory, and meridian system theory.
These inferences regarding disease-related subjective changes as experienced by patients and noted bytreatment providers have been explained in detail from an acupuncture perspective, and placed within thecontext of yin-yang five phase metaphysics and meridian system theory. Unfortunately, acupuncturists'
findings have yet not been adequately described from the perspective of scientific mechanisms of action.
However, beginning in the last half of the 20th century and extending into the 21st century, researchhas begun into the mechanism of the actions of acupuncture. When acupuncture stimulus is applied topercutaneous and subcutaneous receptors (primarily polymodal receptors), and this stimulus is mediatedby the nervous system to act on the mechanism of endogenous analgesia, it raise the endogenous opioid
level and also activates the autonomic nervous system, the endocrine system, and the immune system.
The result is a variety of physiological changes, including analgesia, recovery of organ function, promotionof local and systemic circulation, and the relaxation of muscular tension.
Within the broad field of research into the efficacy of acupuncture in Japan, we focus in particular on
work by Dr. Shinjiro Yamaguchi regarding the effects of blood flow of physical sensory stimului as
mediated by the autonomic nervous response. We also provide here an in-depth look at the studies being
conducted by Dr. Yukihito Sugawara on acupuncture stimulus and nociceptors.

14

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

– Somatosensory stimuli including acupuncture
modulate blood flow via the autonomic
reflexes –excitation of the cholinergic nerve fibers originating inShinjiro Yamaguchi
Acupuncture & Massage Research Information Center

extracellular

Somatosensory stimuli including acupuncture elicit
reflex autonomic responses that affect functions in the
cardiovascular system and other organs (Sato et al.,1997). An analysis of the neural mechanisms of
inducedautonomic

reflexresponses(somato-autonomic reflex) is essential in developing ascientific understanding of the mechanism underlying
the effects of acupuncture therapy.
This article reviews recent studies performed
by Japanese researchers regarding vascular reflex
responses induced by somatosensory stimuli including
acupuncture.

basalisofMeynert;acetylcholine

(Ach)

NBM)

releasesincortex,theresulting in an increase in cortical blood flow,

Uchida et al. (2000) demonstrated the effect ofacupuncture-like stimulation for 1 min to various skinareas on cortical blood flow measured using a laser
Doppler flowmeter in anesthetized rats. The results
clearly showed that the increase in cerebral blood flow,
independent of systemic blood pressure, elicited byacupuncture stimulation is a reflex response in which
the afferent nerve pathway is composed of somaticgroups III and IV afferent nerves, and efferent nerve
pathway includes intrinsic cholinergic vasodilators
As proven by Hotta et al. (2002), ischemia-induced

There has been great progress in research on
cardiovascular responses induced by natural somatic
stimuli using anesthetized animals in order toeliminate emotional factors. It has been shown that
sympathetic rather than parasympathetic nerves playa major role in somato-cardiovascular reflexes. In
somato-cardiovascular responses, the brain stem plays
an important role as the reflex center. Although spinal
segmental stimulation elicits spinal reflex components,
such components are usually depressed by descending
inhibitory pathways from the brain under a central
system

Acupuncture-like stimulation

originating in the NBM.

Characteristics of somato-cardiovascular reflex

nervousnucleus

independent of metabolic vasodilation.

Introduction

somaticallythe magnocellular nucleus of the basal forebrain (the(CNS)

intactcondition.

delayed death of rat cortical neurons can be protectedby preventing a blood flow decrease in widespreadcortices via NBM-originating vasodilative activation.
Therefore, it appears that continuous acupuncture
stimulation prevents cerebral infarction though its
vasodilative effect in the cerebral cortex.
Effects of somatosensory stimuli on peripheral blood flow

Sympathetic reflex
The effect of electro-acupuncture stimulation (EAS)
to a hindpaw (0.1-10 mA, 20 Hz, 30 s) on muscle bloodflow measured by laser Doppler flowmetry and on

Whenmean arterial pressure (MAP) was investigated byanesthetized rats are in a CNS-intact condition,

Noguchi et al. (1999). EAS to a hindpaw at a strength

somatic afferent stimulation of limbs is particularly

sufficient to excite group III and IV afferent fibers, caneffective in producing cardiovascular responses. Limb

produce a reflex increase and/or decrease in muscle

somatic afferent fibers seem to have specific synaptic

blood flow. They clarified that two types of responses

connections to the CNS.

are induced passively by pressor response via a

Effects of somatosensory stimuli on cerebral blood flowsplanchnic sympathetic activity, and/or directly by an

Background

activation of muscle sympathetic nerves.

Recent studies by Sato and colleagues (Sato andAre small vessels such as arterioles affected by

Sato, 1992) have shown that cortical cerebral blood

somatic afferent stimulation including EAS? The

flow is regulated by intracranial nerves. Particularly,

authors' group (Takagi et al., 2005) investigated the

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

effects of EAS of the hindpaw and the dorsal Th13-L1
level area on the mesenteric microhemodynamics inanesthetized rats using an intravital microscope
system. We observed that the hindpaw EAS evoked
intensity-dependent pressor responses and an increasein blood flow velocity, measured by the dual-sensor
method developed by the authors, in mesentericprecapillary arterioles, while the dorsal EAS evoked
depressor responses and a decrease in blood flow
velocity.

Occasional

butnotablereflexvasoconstrictions in the mesenteric terminal arteriole
by EAS of both sites were observable on the image
under

the

intravital

microscope.

These

vasoconstrictive responses were not affected by theadministration of an alpha-adrenergic blocker. Our
study

directlychanges

atdemonstrated

the

level

of

that

hemodynamic

precapillaryarterioles

accompanying EAS either on the hindpaw or the back,mainly depend on the changes of systemic arterialpressure regardless of stimulation current intensities.
Moreover, the results in our study suggest somereceptors other than alpha-adrenergic receptor might
be involved in the mechanism of EAS-induced
vasoconstriction in the mesenteric arteriole.
Sato

et

al.

(1996)

demonstrated

that

acupuncture-like simulation induced catecholamine
secretion from the adrenal medulla via activation of
the adrenal sympathetic nerves in anesthetized rats.
To examine whether such somatically induced
catecholamine is effective on microvascular tone, theauthors investigated the effects of 10 min (3 mA) of

Figure 1: Effects of adrenalectomy on precapillaryarteriolar constriction (a) and pressor response (b)induced by electrical stimulation (ES) of the back skin
(3 mA, 20 Hz, intermittent, 10 min) in anesthetized
rats. The open bar shows the responses to ES in the
intact rats. The closed bar shows the responses
induced by ES in the bilateral adrenalectomized rats.
*p<0.05, **p<0.01; statistical significant is obtained
between the pre-stimulus values and the values at 4-5
min (a) and 2-3 min (b) after onset of the stimulus.
+p<0.05, ++p<0.01; statistical significance is expressed
between responses in two groups. (Modified from
Yamaguchi et al. 2002)

Nitric oxide
It is well known that nitric oxide (NO) is aphysiologically active substance producing various
functions. NO, especially, plays an important role invasodilation in arterioles.

electrical stimulation of the dorsal skin area (Th5-12

In the knee joint, blood flow is known to belevel) on the mesenteric arterioles in anesthetized rats

modulated mainly by sympathetic postganglionicusing an intravital microscope system (Yamaguchi etfibers, but recently the release or induction of NOal., 2002). Electrical stimulation of the skin for 10 min

synthesis in response to electrical stimulation has also

evoked a decrease in the diameter of arterioles. In the

been suggested. Therefore, direct observation of theadrenalectomized group, electrical stimulation of the

microcirculation is needed to further understand theskin for 10 min elicited a slight increase in themechanism by which blood flow is regulated bydiameter (Fig. 1). It is therefore suggested that thesomatic afferent stimulation. The author's groupconstriction of the mesenteric precapillary arterioles(Loaiza et al., 2002) observed the effects of EAS (5 mA,

induced by the stimulation for 10 min was mediated by

0.5 ms, 5 Hz, 30 min) to the vastus medialis muscle on

humoral adrenaline and noradrenaline released by

MAP and the knee joint microcirculation using asomato-adrenal medullary reflex.

real-time confocal laser-scanning microscope system.

16

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Significant and persistent increases in arteriolar
diameter and MAP, were observed after EAS to themuscle. EAS to the vastus medialis in the presence ofN(omega)-nitro-L-arginine methyl ester (L-NAME)
produced a strong decrease in diameter of the knee
joint arterioles under the baseline with a simultaneous
increase in MAP. EAS to the skin did not producechanges in arteriolar diameter while a slight increasein

MAP overthebaselineoccurred

after thestimulaitons. EAS to the muscle after neuromuscular
blockade did not produce significant changes indiameter, while an increase in MAP was still observed,
which suggests that muscle contraction is required to
produce vasodilatation (Fig. 2). These responses
suggestthatadynamic

balancebetweentheautonomic nervous system and the release of NO is theprimary mechanism mediating the EAS effects onknee joint microcirculation.

Figure 2: Summarized data on the changes in joint
capsule arteriolar diameter in anesthetized rats. The
values were registered at 30 min of observation in thecontrol (non-stimulated) and L-NAME group and at
the end of the stimulus in the elactro-acupuncture
stimulation (EAS) to vastus medialis muscle, EAS to
the muscle + L-NAME, EAS to the muscle + relaxantand EAS to skin groups. Statistical significance isindicated as *p<0.05, **p<0.01 when compared to thepre-stimulus values, and +p<0.05, ++p<0.01 whencompared to the control group. (Modified from Loaiza
et al. 2002)

Axon reflex
When an axon reflex is induced by cutaneous

stimulation, the excited afferent terminal releases
vasodilative
substances,such
ascalcitonin
gene-related peptide (CGRP).
The contribution of CGRP to antidromic vasodilationof skeletal muscle blood flow following electricalstimulation of muscle afferent was investigated by Satoand colleagues using anesthetized rats. They concluded
that antidromic vasodilation in skeletal muscles
following stimulation of unmyelinated C afferents in
dorsal roots is independent of systemic blood pressure
and is mediated essentially by CGRP. They describedthat this CGRP-related antidromic vasodilation isprobably important in the clinical improvement ofskeletal muscle blood flow caused by physical therapy
such as acupuncture.
The authors assessed by measurement of two
different hemodynamic parameters: muscle blood flowusing a laser Doppler flowmeter; and the changes indiameter of the muscle arterioles observed directly using
an intravital microscope system in order to examine theeffects of electrical stimulation (5 V, 20 Hz, 30 s) to thesaphenous nerve on microcirculation of the gracilis
muscle in anesthetized rats (Loaiza et al., 2002). We
found that ipsilateral nerve ES produced vasodilative
responses in the muscle accompanied by increases inmuscle blood flow independently of the sympathetic
nerve activity. Furthermore, CGRP was found to be
directly involved in the reflex neural regulation of themusclemicrocirculation,whichsuggeststheparticipation of an axon reflex mechanism (Fig.3).

Figure 3: Effect of ipsilateral electrical stimulation(ES) of the saphenous nerve on gracillis muscle
arteriolar diameter in the absence and presence of

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

topical CGRP8-37. Representative photographs of two
different arterioles, observed pre- and post-stimulus
are illustrated. (Modified from Loaiza et al. 2002)
Conclusions
1. The cerebral blood flow response induced byacupuncture-like stimulation of a forepaw in rats,
independent of MAP, is a reflex response whose
afferents are group III and IV somatic afferent
fibers, and whose efferents are cholinergic fibers
originating in the NBM.
2. The somatically induced peripheral circulatory
regulation system consists of three types ofmechanisms as follows.
(1) Hemodynamics in the region of interest isaffected by systemic circulatory changes inducedby the somatic afferent stimulation.
(2) The observed blood vessels are directly affectedby activating the autonomic efferent nerve fibers
including nonadrenergic, noncholinergic fiberthat can release NO.
(3) Vasodilative response induced by the CGRP
through activating the primary afferent fibers(axon reflex).
These physiological findings may support theeffectiveness of acupuncture therapy on patients withcirculatory disturbances.
References
1. Sato A, Sato Y, Schmidt RF: The impact ofsomatosensory input on autonomic functions. Rev
Physiol Biochem Pharmacol 130: 1-328, 1997
2. Sato A, Sato Y: Regulation of regional cerebral
blood flow by cholinergic fibers originating in thebasal forebrain. Neurosci Res 14: 242-274, 199218

3. Uchida S, Kagitani F, Suzuki A, Aikawa Y: Effect ofacupuncture-like stimulation on cortical cerebral
blood flow in anesthetized rats., Jpn J Physiol 50:
495-507, 2000
4. Hotta H, Uchida S, Kagitani F: Effects ofstimulating the nucleus basalis of Meynert onblood flow and delayed neuronal death following
transient ischemia in the rat cerebral cortex. Jpn J
Physiol 52: 383-393, 2002
5. Noguchi E, Ohsawa H, Kobayashi S, Shimura M,
Uchida S, Sato Y: The effect of electro-acupuncture
stimulation on the muscle blood flow of thehindlimb in anesthetized rats, J Auton Nerv Syst
75: 78-86, 1999
6. Takagi K, Yamaguchi S, Ito M, Ohshima N: Effects
of electroacupuncture stimulation applied to limb
and
back
on
mesentericmicrovascularhemodynamics. Jpn J Physiol 55: 191-203, 2005.
Epub 2005 Sep 7
7. Yamaguchi S, Ito M, Ohshima N: Effects ofelectrical stimulation of the dorsal skin on
systemicandmesentericmicrovascularhemodynamics in anesthetized rats. Jpn J Physiol
52: 257-65, 2002
8. Loaiza LA, Yamaguchi S, Ito M, Ohshima N:
Electro-acupuncture
stimulationtomuscleafferents in anesthetized rats modulates the bloodflow to the knee joint through autonomic reflexes
and nitric oxide. Auton Neurosci. 97: 103-9, 2002
9. Sato A, Sato Y, Shimura M, Uchida S: Calcitonin
gene-related peptide produces skeletal muscle
vasodilation following antidromic stimulation of
unmyelinated afferents in the dorsal root in rats.
Neurosci Lett 283: 137-140, 2000.
10. Loaiza LA, Yamaguchi S, Ito M, Ohshima N:
Vasodilatation of muscle microvessels induced bysomatic afferent stimulation is mediated bycalcitonin gene-related peptide release in the rat.
Neurosci Lett 333: 136-40, 2002

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

– Correlation between Nocicepetion andAcupuncture and Moxibustion –Yukihito Sugawara
Department of Basic Medical Research
Tokyo Eisei Gakuen College
I. Introduction
Acupuncture and moxibustion therapy is aprimitive stimulation therapy during which either
needles are inserted into the tissue or moxa is burnedon the skin, thereby causing minor damage to thetissue and skin. These stimuli can alleviate pain andelicit various reactions from the autonomous nervous
system, but at the same time the stimuli themselvesalso produce a pain sensation and thus excite
nociceptors. In a manner of speaking, this would be
like "using pain to kill pain", where a basic negative
feedback mechanism can be considered to underlie theinduction of the effects brought about by theacupuncture and moxibustion stimulation1,2,3).
Acupuncture and moxibustion is characterized bystimulation of specific sites called acupoints, but its
applications are extremely varied. Although thistreatment form cannot easily be defined, the stimulus
modalities can be classified as mechanical nociceptive
and thermal nociceptive stimuli. In the end thesestimuli cause some degree of local tissue lesions, therelease of various algesic substances or their relevant
modulator substances, or else the production andrelease of neuropeptides. From this point of view it isnecessary to consider this modality to act as a chemical
stimulus.
Moreover, these stimuli excite nociceptors,
activating endogenous analgesic mechanism4,5,6,7) andlead to the manifestation of various effects on theautonomous nervous and endocrine systems6), or elsethey may also influence the immune system7) and forthis reason acupuncture and moxibustion have beenused since ancient times to cure all kinds of complaints
and symptoms.
On the other hand, in our research department,with Mr. Kazuhiro Goto as the leading figure, we have
employed microneurography for the purpose of
studying the correlation between the activity of humannociceptors and pain in order to directly record humanperipheral nervous activity. Among cutaneous anddeep afferent neuronal activities we recorded theactivity of C-fiber thermomechanical nociceptors(synonymous with C-fiber polymodal nociceptor,
C-fiber mechanical heat nociceptor: CMH) 8,9,10,11) andA-fiber nociceptors 8,12,13) and thereby investigated thecorrelation between pain and acupuncture andmoxibustion stimulation.
In the present paper the correlation between pain
and acupuncture or moxibustion stimulation will be
discussed, while adding some of the insights
pertaining to the activity of human nociceptors
obtained through microneurography.
II. Characteristics and application of microneurography
Peripheral nerve activity in non-sedated humans wasrecorded using microneurography and systematicallyresearched by the Swedish researcher Hagbarth,
Vallbo14) et al. and in Japan by Honno et al.15).
This method employs percutaneous unanethetized
insertion of tungsten microelectrodes that are isolatedwith the exception of a few μm at their tip to directly
record the potential action of nerves. In this way thecorrelation between the activities of human skinmechanoreceptors16), sympathetic nerves of muscles17),
muscle spindles, tendon organs and otherproprioceptors on the one hand; and pyramidal muscle
activity on the other hand18); as well as the nerve
activity of afferent C-fibers from the skin andsympathetic activity19,20,21) etc. were analyzed.

Figure 1
Figure 1 shows a diagram of this method. A
tungsten recording microelectrode with an impedanceof several MΩ to over ten MΩ is used for the recordingof the action potentials, while the indifferent electrode

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010is attached nearby on the skin as a disk-shaped earth
electrode. The signals were amplified using ahigh-impedance type amplifier and a DC amplifier andthen observed on the cathode ray tube of an
oscilloscope. The data were recorded at all times
during the observation.
The electrode was inserted percutaneously above
nerve trunks. To determine a suitable location for theinsertion of the electrode, the course of the nerve canbe confirmed in advance by applying electric stimuli to
it. At this time the motor nerve conduction velocity(MCV) or the sensory nerve conduction velocity (SCV)
at the site for the insertion was determined by using
the evoked wave forms obtained during themeasurement as an index to make the approach of theelectrode to the nerve still more reliable.
The electrode was then advanced by hand towards
the nerve. The occurrence of a transient unusual
sensation confirmed that its tip had reached the nerve
trunk. Simultaneously, the output of the characteristic
nerve activity via a sound monitor was also possible.
When the tip of the electrode had reached a muscularbranch, a deep, diffuse, dull pain ran through the depthof the muscle; or in case of reaching a dermal branch atransient feeling of superficial numbness occurred.
In this way, the derived action potentials of thenerves are in the beginning action potentials of several
units, but through subtle and very carefulmanipulation of the inserted electrode the discharge ofsingle units or cluster discharge with a very good S/Nratio are isolated. During this process, first the activityof afferent nerve fibers of the relevant peripheral
receptive field is probed and then the nerve conduction
velocity measured by applying electrical stimulation tothis receptive field. Or alternatively, by applying
variousstimuli(mechanicalstimuli,musclecontraction of stretch stimuli, heat stimuli andchemical stimuli) the activity of the particular unit isqualitatively identified. Moreover, regarding theactivity of postganglionic sympathetic fibers or similarefferent nervous activities, a variety of load tests of theautonomic nervous systems are performed, or else theorigins of nervous activities related to heart rate,
breathing or sweating etc. are determined.
In this way, recorded nerve activity, in particular20

the activity of primary afferent cutaneous nerve
terminals, can be analyzed in direct comparison with
the intensity of the sensory responses experienced by
the subjects. Through stimulus-response analysis it ispossible to measure the intensity of the direct
subjective sensory responses. Moreover, during
research into acupuncture and moxibustion it is not
only possible to analyze what kind of primary afferent
terminals the acupuncture or moxibustion stimulation
produces analgesic effects and elicits various responsesof the autonomous nervous system, but it is also
considered possible to examine through analysis of theexcitation of peripheral receptors in the skin or
muscles at the site of acupoints, what kind of
peripheral receptors the so-called "de qi phenomenon"
are related. Thus, the application of microelectrodes isa very useful tool for research into human peripheral
nerve activity within the field of studies pertaining toacupuncture and moxibustion. In the present paper wehave focused in particular on acupuncture ormoxibustion stimulation induced activity of primaryafferent terminals in the skin and discuss the results,
adding the insights we have gained.
III. Input system for acupuncture or moxibustion
stimuli (correlation to the nociceptor system)
Assuming that acupuncture and moxibustion
stimulation in itself produces some minor lesions of
the peripheral tissues, in particular in case of needlingstimulation, the insertion or mechanical manipulationof the inserted needle(s) may elicit beside the prickpain a peculiar abnormal sensation called "de qi(tokki)". There are a variety of different patterns
associated with this de qi sensation, but in any case its
characteristics are close to the sensation of pain. Basedon these facts, the likelihood of the possibility
increases, that the peripheral receptors excited by theacupuncture or moxibustion stimuli are rather
nociceptive
receptors
than
non-nociceptive,
proprioceptors. These considerations suggest, andbased on considerations of the input system throughwhich the acupuncture or moxibustion stimulation
acts, that cutaneous and subcutaneous nociceptors are
representative for the polymodal nociceptors playing
the most important role here.

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

1) Polymodal nociceptors(CMH) following electrical, mechanical and thermal

Afferent fibers transmitting nociception include

stimulation8).

C-fibers and A-fibers. On the other hand, polymodal

In case of single discharge recordings from CMH,

nociceptors are widely distributed throughout thethe threshold within the receptive field in response toentire body and serve as the most importantelectrical stimulation is considerably lower than the

nociceptors within the input systems of the bodily

electrical threshold of C-fibers stimulated via nerve

defense22).

trunks, so that pain sensations are negligible. The

One property of polymodal nociceptors is, thatthreshold for mechanical and heat stimulation has amorphologically they are free nerve endings andwide distribution range (Figure 3), so that firing

widely distributed throughout the body, spreading

activity is observed even from comparatively low

antennas that pick up abnormal stimuli applied to thestimulation intensities.

body. Moreover, the modality of the stimuli has a low
specificity, so that they may react to mechanicalstimuli, heat stimuli, or the chemical stimuli provided
by endogenous algesic substances. Thus they arecharacterized by the advantage that they do not
distinguish between the nature of the stimuli as longas it is a nociceptive stimulus. Further, the excitability
in response to stimuli has a wide range from thenon-nociceptive

level

to

the

nociceptive

level,

throughout which these receptors respond strongly
and thus cause the body to sensitively react toabnormalstimuli.

Thismeans,

that

these

characteristics are marked by a high input sensitivityof the body's warning system, so that they also encode
signals caused by abnormal stimuli, even if thosestimuli are not necessarily associated with irreversible
tissue damage.

Figure 3
Again, the average temperature in case of thermal
stimulationwas

41-42°C

andthecategories

corresponding to the subjects subjective sensation of
the intensity of the thermal stimulation were at"warm" or "hot" levels. When CMH are in this way
classified as nociceptive receptors, the ranges for theindividual stimulation types are very wide and one of
their characteristics can be said to be their firing
activity

rangingfrom

non-nociceptive

stimulus

intensities.
The firing of the CMH increases depending on theintensity of the nociceptive stimuli. Tentatively they
encode the intensity of the sensation comparatively
accurate and thus enable central discrimination ofboth localization and intensity23,24,25,26,27).
For example, when the tentative characteristics of
CMH in their response to the stimulus intensity in

Figure 2
Figure 2 shows the evoked firing of humancutaneousC-fiberthermomechanicalnociceptors

case

of

thermalstimulationisexamined,anapproximate dependency of the firing activity on
stimulation intensity is observed (Figure 4).

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Figure 4
However, in this case the temporal intervals
between repetitions become shorter, so that it isinfluenced by preceding stimuli. In particular, inconnection with strong preceding stimulus a low
correlation to the firing frequency is observed,
characterized by a lower reproducibility of theexcitation than from other cutaneous sensory receptors10)11). Accordingly, the function of CMHs is to transmit
the algesic sensory information, but regarding theintensity of the nociceptive input, the transmission isneither necessarily continuous nor true. The CMH arethus considered to serve mainly the transmission ofearly information pertaining to conditions potentiallyharmful to the body.
Moreover, the changes in the tissue induced by thenociceptive stimulus is transmitted and the conditionof the tissue conversely modifies the receptors
themselves, so that they are considered to fulfill their
original purpose as polymodal receptors within the
biological defense.

On the other hand, needling stimulation easily
excites the CMH (Figure 5). If a series of acupuncture
manipulations have been performed within the CMH
receptive field, simply erecting the needle tube there
after positioning the pressing hand induces firing
activity. Next, the performance of needle tapping toinsert it through the skin results in a transient,dynamic firing, whereas for the needling techniquecalled thrusting and lifting, where the needle is moved
up and down as if in pecking movements, it also
induces dynamic firing activity. With this kind ofthrusting and lifting stimulation, single unit firing
activities show a firing frequency of more than 10
impulses per second, but in most cases the subject does
not experience any tingling prick pain.
In spite of the fact that such a series ofmanipulations induces high frequency CMH firing, it
does not cause the subject any pain. Since theacupuncture stimulus itself is a punctuate mechanicalstimulus, it is difficult to obtain peripheral or central
spatial summation. For example, this indicates thateven if the CMH would be firing, it does notnecessarily mean that this will lead to the perceptionof a "de qi" sensation.
Also, thick fibers are simultaneously excitedthrough the pressing hand or movement of the needle,
which are considered to be related to pain inhibition,
also suggesting a correlation to the manifestation ofeffects of acupuncture stimulation brought about by
retaining the needles, intradermal needles or shallow
needling just piercing the skin.

Figure 6
Figure 5
22

Figure 6 shows the firing activity of CMH when an

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010acupuncture stimulation of constant frequency isfiring activity is observed even after 3 repeatedapplied using a thrusting and lifting stimulation

applications. This means that the receptive field at thedevice. Continuous stimulation period was 30 seconds,site of the moxa treatment has not sustained

thrusting and lifting frequency 7.4 Hz and amplitude

destructive lesions by the moxibustion stimulus.

2.4 mm; the upper and lower row show the firing
activity of the same unit.
The firing pattern shown in the upper row shows astrong dynamic activity during the starting phase of
the thrusting and lifting. After that the stimulation
frequency was not followed, but rather a static firing
activity continued. Moreover, the lower row shows only
early phase dynamic firing activity, which is a patternlacking the static firing components observed during
the latter half. With neither of these two patterns did
the subject feel any pain, but reported only a sensationof vibration.
These differences in firing pattern, in spite oforiginating from the same CMH firing activity, areeasily influenced by preceding stimuli and areconsidered to be the manifestation of a fatigue
phenomenon. Also, applying acupuncture stimulation
frequently results in the development of flares orswelling in the vicinity of the needled site. This isconsidered to be the result of neurogenic inflammation
causedbytheexcitation

of

these

polymodal

nociceptors1,2,28).
In this respect, attention has been paid to theaction of polymodal receptors as effectors, where theexcitation of these polymodal receptors serves as
retrograde stimulus; while in the manner of axonreflexes from the free nerve endings in the vicinity
substance P or CGRP (calcitonin gene-related peptide)and similar neuropeptides are released, hypotheticallycausing inflammatory reactions like vasodilatation orplasma exudation29).
On the other hand, moxibustion stimulationinduces a high firing frequency of the CMH. Figure 7
shows the CMH firing activity induced when in thevicinity of a mechanically stimulated receptive fieldwith the relevant sensitivity moxibustion is repeatedly
performed in a different receptive field30).
Direct moxibustion with small cones of moxa with atemperature of 60 - 70°C produced a strong nociceptive
thermal stimulus and cause a local burn, but CMH

Figure 7
During the first
application ofmoxibustion, theskin temperaturereached an averagepeak of 62°C,
whereupon thenumber of CMP
firing impulses andinstantaneous firing
frequency alsoreached aconsiderably highfrequency (average
37 imp and 49.4 Hz)
Figure 8
and the subject felt a strong thermal pain. Yet,following the second application, even though the peaktemperature reached during the moxibustion wasapproximately the same, a CHM firing desensitization
is observed and the thermal pain sensation of subject
is attenuated (Figure 8).
The attenuation of the thermal pain sensation thus
observed after repeated application of moxa treatment
is considered to represent a fatigue phenomenon25).
Moreover, the high CMH firing frequency observed
during the first moxa application may be expected tocause a central inhibition via the DNIC: diffuse
noxious inhibitory control) 31).

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2) A-fiber nociceptors
Human cutaneous nociceptors also include apartfrom the C-fiber polymodal nociceptor Aδ afferent
nerve fibers8,9,12,32).
Among the records obtained so far from humancutaneous afferent nerve fibers the number of units
with a conduction velocity in the Aδ range are extremely
few. This is also due to the fact that their proportion
among the fibers within nerve trunks is compared to
the CMH units low33). Among these, again, units areclassified as units responding to both mechanical andthermal stimulation (A-fiber mechano-heat nociceptor:
AMH) and receptors with a high threshold responding
to mechanical stimulation only (high thresholdmechanoreceptor: HTM) (Table 1) 34,35).
CMH
C.V.(m/s)

HTM

AMH

0.96±0.17(n=239)

19.2±8.4(n=11)23.5±10.2(n=15)24.1±21.9(n=180)29.1±12.6(n=239)

23.0±14.9(n=15)

MechanicalThreshold (mN)
ThermalThreshold (℃)

41.8±2.7(n=130)

CMH: C Mechano Heat Nociceptor

49.1±1.4(n=12)(mean ±S.D.)

HTM: High Threshold Mechano Nociceptor
AMH: A Mechano Heat Nociceptor

Table 1
The receptive fields of these units show a
distribution of either single or multiple points
sensitively responding to mechanical stimulation
within cutaneous areas of fixed size, where the areas
between the individual points have a high thresholdfor mechanical stimulation, or are not responsive at all.
The terminals of these receptors have several branches
within specified areas and form points responding
sensitively to mechanical stimulation which areconsidered to be distinctly separate from thesurrounding areas.
Morphological studies of high threshold mechanicalreceptors in hairy skin of cats clearly showed, thataxons surrounded by Schwann cells are distributed
among the terminals and the nerve endings are
surrounded by keratinocytes. This increases thethreshold toward stimulation and is considered todefine the localization.
The characteristics of HTM and AMH receptors in

24

response to mechanical stimulation show in any case,slowly-adapting firing patterns, transmitting intensity
or variation components of nociceptive stimulation to
the skin centrally. Both show about the same thresholdfor mechanical stimulation, which are at the sametime of a similar magnitude of the threshold formechanicalstimulationof
CMH.
Originallynociceptors of A-fibers are thought to transmit the
primary pain caused by nociceptive mechanicalstimulation36). The localization of piercing the skin bytapping acupuncture needles is very distinct, so in thatcase it provokes stabbing pain, a high frequency firing
activity of the AMH is induced9).
On the other hand, burning the skin surface withmoxa through direct moxibustion is a stimulation
method definitely causing burns of the skin, in whichcase, the response of the AMH to the thermal stimulus
is very important. Namely, the response of the AMH to
the thermal stimulus is distinctly different from theresponse of the CMH. One of these properties has been
demonstrated in units classified as type 1 AMH in
hairy skin of monkeys and other animals33,37,38), thatare characterized by an extremely high threshold
temperature for nociceptive thermal stimuli (Table 1).
In human AMH, the
units

that

respondtothermal stimulation fromthe very beginning reactat temperatures of 48 52°C. The firing starts
after temperatures havereached this range andthe subjects experience astrongthermalpain

sensation (Figure 9).
Figure 9
Again, depending on the unit, there are also somethat do not show any firing during the initial phase oftrials with repeated thermal stimulation, but after
several preceding thermal stimuli of 50°C, causing thedevelopment of a mild degree of rubescence on the skinsurface, the receptive field becomes sensitized to thethermal stimulation, after which the onset of firing isobserved. Moreover, through repeated thermal

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

stimulation, the relevant excitability is temporarily
obtained so that the units show an obvious increase in
firing in response to the thermal stimulation. In someunits, high frequencies of up to 50 times per second
may be observed (Figure 10) 9,13,33,34).

Figure 10
This degree of sensitization of the AMH in responseto thermal stimulation which may be called dramatic
does not occur in CMH. Here, both firing frequency
and the degree of sensitization can be said to be
distinctly different from that of the CMH10).
Examination of the correlation between the firing
activity of the AMH in response to thermal stimulationand the subjective sensation of heat pain in thesubjects showed only a moderate degree of firing
activity during the initial phase of a stimulation trial
at a time when the excitability just started to develop,
but this did not clearly correspond to a cross-modality
matching induced appearance of subjective thermal
pain sensation. However, with an increasing number ofrepetitions of the stimulation the firing activity of theAMH units gradually increased, while both thesubjective thermal pain sensation and fluctuations in
the firing of the units showed parallel variations thatallowed recognition of a clear correlation between
firing frequency and changes in the expressions used
to describe the thermal pain sensation (Figure 11).
In this way the AMH are sensitized and thethermal pain is localized, allowing accuratetransmission of its intensity. Moreover, this also
indicates a central input of the hypersensitivity
information appearing after the development of burns
in response to the thermal stimulation13,36).

Figure 113) Nociceptors in deep tissues
Needling stimulation does not only excite
nociceptors in the skin, but also nociceptors
distributed in deep tissues like muscles or tendons andthe like. In particular, the excitation of small diameter
afferent fibers from deep tissue is more likely to elicit
responses from the autonomic nervous or endocrine
systems than it did in case of the skin, so that it has
been pointed out, that the deep nociceptors are rather
more likely to feed their information into theautonomic nervous or endocrine systems than thesomatic nervous system1). Moreover, for the
manifestation of acupuncture analgesic effects,
excitation of the deep tissue nociceptors is considered
to be important2).
Units responding to needle stimulation of
nociceptive fibers derived from human deep tissues(muscles) have the following characteristics39).
All of the recorded units had conduction velocity in
the Aδ range and spontaneous firing was not observedin any of these units. Further, areas from which firing
could be evoked by electrical stimulation and theirrespective depths were markedly limited, andcompared with the identification of cutaneous sensory
receptive fields, their positions were not easy todetermine. Also, they did respond only to mechanicalstimulation within a restricted scope while in thepresence of responses from proprioceptors, they did not
respond to mild muscle contraction, stretching, or else
vibrational stimulation. In response to pressure
stimuli the firing increases depending in an intensity
dependent manner. A good correlation is observed withThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

25

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

the intensity of the sensation following pressure
stimulation reported by the subjects. This can beconsidered to represent the transmission of sensory
information pertaining to nociceptive mechanicalstimulation.
Although this pertains only to a portion of the units,
injection of the points most sensitive to mechanicalstimulation with bradykinin (2 ml of a 1μg/ml solution)
also induces firing and the pain induced by thebradykinin and reported by the subjects also increases inparallel with an increase in the firing frequency. The
subsequent gradual decrease indicates a high probability
that these are polymodal receptors (Figure 12A).

Figure 12Upon performance of needling stimulation of thereceptive fields of this type of muscular Aδ units, thatis thrusting and lifting manipulation of muscles, theseunits definitely display a firing activity and inparticular a synchronous high frequency firing wasobserved when the subjects experienced a de qi
sensation. This observation shows the involvement ofthese units in the manifestation of de qi upon needlingstimulation (Figure 12B).
Up to now the activity of C-fiber nociceptors has notbeen recorded from human deep tissue afferent nervesusing microneurography nor found to be mentioned in
the literature. In animal experiments, the activity of
deep tissue C-fiber nociceptors in muscles and joints
has been recorded and numerous relevant research
reports40,41) have been published. This suggests thepossibility that regarding the recording of activities
from human deep tissues there is some form of bias
with the recording method using microneurography.

26

Since deep tissues are much less likely to be
exposed to stimulation than the skin, the spatial
distribution of the receptors themselves is conceivably
narrower. Moreover, another possibility is theexistence of silent nociceptors that under normal
conditions are not sensitive to stimulation, that havebeen detected in muscles, joints, internal organs or the
skin42,43,44）.
These nociceptors are normally present in aconcealed condition. In case of tissue lesions or
inflammation acquiring excitability, after which theyshow excitability even for mechanical stimulation forwhich they had so far not been sensitive, are calledchemo-specific nociceptors, or else noted as sleeping
nociceptors. Through recruitment of the excitation of
this
type
of
nociceptors
hyperalgesiaorhypersensitivity can conceivably develop in thepresence of inflammation45,46,47）.
Accordingly, by creating minor tissue injuries
through needling or moxibustion stimulation, theexcitability of this new type of nociceptors is recruitedand may be considered to carry hidden possibilities of
having various effects on the body's defense system.
IV. Conclusions
The
correlation
betweenacupunctureandmoxibustion stimulation has been described. Any ofthese stimuli probably uses cutaneous or deep tissue
nociceptors as their main input system. Throughexcitation of these nociceptors, a negative feedback
mechanisms exerts various effects on the body's defense
system. Conceivably this can have a variety of effects,
for example, the manifestations of an endogenous
analgesic mechanism, triggering of responses from theautonomic or endocrine systems, or else modulation of
the immune system. Moreover, these stimuli
themselves produce some minor degree of tissue injury,
leading to the release of algesic substances ormodulators and their stimulation then cause retrograde
stimulation of the receptors, subsequently probably
exerting effects on the axon reflexes of terminals in thevicinity.
Furthermore,throughneurogenic
inflammation the excitability of a new type of so farsilent nociceptors is recruited, that then conceivably
leads to both peripheral and central summation effects.

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Through these mechanisms acupuncture andmoxibustion are considered to cause via minor
stimulation of the body surface, various clinical effects.
V. References
1) Kenji Kitagawa: Correlation between acupuncture
and moxibustion stimulation and peripheral
reception mechanisms; Japanese Journal of
Physiology 51: 303-315, 1989
2) Kawakita K & Goto K: Role of polymodal receptor
in the acupuncture-mediated endogeneous pain
inhibitory systems. Kumazawa T, Kruger L,
Mizumura K (eds). Prog Brain Res 113: 507-523,
1996
3) Takao Kumazawa: Regarding the modes of actionof acupuncture anesthesia, Clinical Physiology 8:
413-419, 1978
4) Sadao Aikawa: Physiology of acupunctureanaesthesia and pain. Keio Medical 50: 463-478,
1973
5) Sjolund B, Terenius L, et al: Increase CSF levelsof endrophins after electroacupuncture. Acta
Physiol Scand 100: 382-384, 1977.
6) Takao Kumazawa: Pain and polymodal receptors.
Japanese Journal of Physiology 51: 1-15, 1989
7) Kumazawa T: Opioids and autonomic functions
under abnormal environments. Environ Biol Med
32: 1-20, 1988.
8) Kazuhiro Goto, Yutaka Kagoshima: Activity ofhuman cutaneous C-fibers and Aδ fibers.
Collection of abstracts of the 4th Research
Conference on Pain 4, 1982
9) Kazuhiro Goto, Yutaka Kagoshima, others:
Research into the afferent nerve activities ofhuman cutaneous C-fibers and Aδ fibers. Journalof the Japan Society of Acupuncture andMoxibustion 32: 1-9, 1983
10) Kazuhiro Goto, Yutaka Kagoshima, others:
Polymodal receptor activity and pain sensation inhuman cutaneous C-fibers; Collection of abstractsof the 5th Research Conference on Pain 5, 1983
11) Kazuhiro
Goto,
Kazuo
Sakurai,others:Fatigability of human cutaneous C-fibers in
response to thermal stimulation. Journal of theJapanese Association for Study of Pain 2:1, 1987

12) Kazuhiro Goto, Kazuo Sakurai, others: Responseof human cutaneous A-fiber nociceptors tothermal stimulation. Journal of the Japanese
Association for Study of Pain 5:3, 1990
13) Kazuhiro Goto, Kazuo Sakurai, others: Afferent
nerve activity of human cutaneous C / Aδ fiber
nociceptors. Clinical Encephalography 34: 81-85,
199214) Hagbarth KE & Vallbo AB: Mechanoreceptor
activity
recorded
percutaneously
withsemi-microelectrodes in human peripheral nerves.
Acta Physiol Scand 69: 121-122, 196715) Mano T, Mitarai G, et al: Vibratory sensitivity ofhuman muscle spindle, In: Vibratory stimuli andthe tonic vibration reflex (Watanabe S eds),
Saikon, Tokyo, 1977, 101-110．
16) Knibestol M & Vallbo AB: Single unit analysis ofmechanoreceptor activity from the human glabrous
skin. Acta Physiol Scand 80: 178-195, 1970
17) Hagbarth KE & Vallbo AB: Pulse and respirationgrouping of sympathetic impulses in humanmuscle nerves. Acta Physiol Scand 74: 96-108, 1968．
18) Hagbarth KE & Vallbo AB: Single unit recordings
from muscle nerves in human subject. Acta
Physiol Scand 76: 321-334. 321-334, 1969．
19) Hallin RG & Torebjork HE: C-fiber components inelectrically evoked compound potentials recorded
from human median nerve fascicles in situ. A
preliminary report. Acta Soc Med Upsal 75: 77-80,
1970a．
20) Hallin RG & Torebjork HE: Afferent and efferent
C unit recorded from human skin nerves in situ. A
preliminary report. Acta Soc Med Upsal 75:
277-281, 1970b．
21) Torebjork HE: Afferent C unit responding tomechanical, thermal and chemical stimuli inhuman non-glabrous skin. Acta Physiol Scand 92:
374-390, 1974．
22) Kumazawa T & Perl ER: Primate cutaneous
sensory unit with unmyelinated (C) afferent fibers.
J Neurophysiol 40: 1325-1338, 1977．
23) Gybels J, Handwerker HO, et al: A comparison
between the discharges of human nociceptive
nerve fibers and the subject’s ratings of his
sensation. J Physiol (London) 292: 193-206, 1979．

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 201024) LaMotte RH, Thalhammer JG, et al: Peripheral

high threshold mechanoreceptors with myelinatedneural mechanisms of cutaneous hyperalgesia

axons by repeated heating. J Physiol(Lond) 265:

following mild injury by heat. J Neurosci 2:549-563, 1977．
36) Zotterman Y: Studies in the peripheral nervous

765-781, 1982．
25) LaMotte RH, Torebjork HE, et al: Time intensity
profilesofcutaneous

pain

in

normalandmechanism of pain. Acta Med Scand 80: 185-242,
1933．

hyperalgesic skin: a comparison with C-fiber37) Treede R-D, Meyer RA, et al: Evidence for two

nociceptor activities in monkey and human. J

different heat transduction mechanisms in human

Neurophysiol 51: 1434-1450, 1984．

peripheral nerves. Physiol Rev 59: 919-957, 1979．

26) LaMotte

RH,

Lundberg

LE,

et

al:

Pain,

38) Treede R-D, Meyer RA, et al: Evidence for two

hyperalgesia and activity in nociceptive C unit indifferent

humans after intradermal injection of capsaicin. J

nociceptive primary afferents innervating monkey

heattransduction

mechanisms

inPhysiol (London) 448: 749-764, 1992．

skin. J Physiol (Lomdon) 483: 747-758, 1995．

27) Torebjork HE, LaMotte RH, et al: Peripheral

39) Kazuhiro Goto, Kazuo Sakurai, others: Response

neural correlates of magnitude of cutaneous painof thin human intramuscular afferent fibers (Aδ)

and hyperalgesia: simultaneous recording into thermal stimulation. Journal of the Japanesehuman of sensory judgments of pain and evoked
response

in

nociceptors

with

C-fibers.

J

different receptor sites for algesic sgents at the

Neurophysiol 51: 325-339, 1984．
28) Jansen G, Lundberg T, et al: Acupuncture andsensory neuropeptides incease cutaneous bloodflow in rats. Neurosci Lett 97: 305-309, 1989．
29) Kenis P: Identification of the unmyelinatedendings of muscular group - afferent units. Pflug
Arch 362: 141-146, 1976．
41) Kumazawa T & Mizumura K: Thin fiber receptors
responding

tomechanicalandthermalsensory nerve which evoked plasma extravasation

stimulation in the skeletal muscle of the dog. J

in response to antidromic stimulation. Neurosci

physiol(London) 273: 179-194, 1977．
42) Handwerker HO, Kilo S, et al: Unresponsive

Lett 2: 137-141, 1981．
30) Goto K, Aizawa S, et al: Hyperalgesia andsensitivity of nociceptive C fiber unit in human
after moxibustion stimuli. Pain Res 12: 99-108,
31) Le Bars D, Dickenson AH, et al: Diffuse noxious
inhibitory controls(DNIC). I Effects on dorsal hornneurons in the rat. Pain 6: 283-304, 1979
32) Adriaensen

afferent nerve fiber in the sural nerve of the rat. J
Physiol(London) 435: 229-242, 1991．
43) Handwerker HO, Forster C, et al: Discharge
patterns of human C-fiber induced by itching and

1997．

H,

Gybels

J,

et

al:

Response

properties of thin myelinated (A-δ) fiber in humanskin Nerves. J Neurophysiol 49: 111-122, 1983．
33) Ochoa J & Maire WGP: Normal sural nerve inman: Ultrastructure and number of fibers and cell.
Acta Neuropathol 13: 197-216, 1969．
34) Campbell JN, Meyer RA, et al: Sensitization of
myelinated nociceptive afferents that innervatemonkey hand. J Neurophysiol 42: 1669-1679,
1979．

burning stimuli. J Neurophysiol 66: 307-315, 1991．
44) Meyer RA, Davis KD, et al: Mechanicallyinsensitive afferents(MIAs) in cutaneous nerves ofmonkey. Brain Res 516: 252-261, 1991．
45) Davis KD, Meyer RA, et al: Chemosensitivity andsensitization
innervateofthenociceptive
hairy

skin

afferentsofthatmonkey.

J

Neurophysiol 69: 1071-1081, 1993．
46) Lang E, Novak A, et al: Chemosensitivity of fineafferents from rat skin in vitro. J Neurophysiol
63: 887-901, 1990．
47) Schmelz M, Schmidt R, et al: Sensitization ofinsensitive branches of C nociceptors in human35) Fitzgerald M ＆ Lynn B: The sensitization of28

Association for Study of Pain 3: 1, 1988
40) Hiss E ＆ Mense S: Evidence for the existence ofskin. J Physiol(London) 480: 389-394, 1994．

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Basic Research into Japanese Moxibustion– Introduction –Shigekatsu Aizawa
Department of Basic Medical Research
Tokyo Eisei Gakuen College
Introduction
Therapy forms using heat stimulation of the skinare considered to have developed independently innumerous locations all over the world. Up to thepresent day a treatment modality closely resembling
its original form is still used clinically in Japan and
China. In particular, in Japan subtle changes havebeen made to adjust it to the characteristics of thepeople, numerous different forms of moxibustion havebeen contrived and are currently in use. Particularly
noteworthy is form of moxibustion used currently inJapan. It is considered to have originated in Japan. It
is seldom used in China, where the moxa is burned
directly on the skin: direct moxibustion. This form ofmoxibustion differs from indirect moxibustion, wherean attenuated heat stimulus is used like in stickmoxibustion as a representative form of this treatment
modality. It is considered not only to apply local
warming, but rather also exerting considerable effects
on distant sites like acupuncture. Yet, directmoxibustion causes, even if only temporarily,
moxibustion marks. The heat stimulus when compared
to indirect moxibustion is fairly strong and the
preparation of the small moxa cones requires someskill so that recently its use has declined. It has not yet
been properly investigated from the standpoint of
which of these forms is the more effective one andwhether there are possible differences in indications.
Here I would like to present a brief summary of theresearch into moxibustion as it is performed in Japan,
crude materials, the manufacturing process and theinfluence moxibustion has on the body.
Moxa raw material, manufacture, quality
The region of Ibukiyama has been famous as a
growing district for moxa, but Oda conducted adetailed investigation of the subject and reported thefollowing.1) There are two sites called Ibukiyama: one
in Shiga prefecture and another in Tochigi prefecture,both of which are famous production sites of moxa. The

noted production site called Ibukiyama, that has been
famous since the Heian period, is located in Tochigi
prefecture, whereas Shiga emerged as a growing
region following the Azuchi-Momoyama period. The
Ibuki moxa varieties of both Tochigi and Shiga havetheir respective characteristics not found in the otherlocation. Both Ibukiyama regions have a place called'Shimeji ga Hara' and both regions have similar
Buddhistic legends. By the Edo period, the Shiga
region flourished, while the Tochigi region declined.
Again, regarding the raw mugwort (yomogi) material
botanical investigations were performed showing thatmost of the yomogi material from the Niigata, Toyama
and Ishikawa prefectures was Artemisia princes Pamp,
while some of it was oo-yomogi (yama yomogi =Artemisia Montana Pamp., whereas all the materials
from Shiga prefecture was reportedly of the yomogi
variety.2) Regarding the growing conditions for yomogi,
Aizawa et al. compared yomogi grown in sunlight andin shade and reported that the yomogi grown insunlight is the better suited variety.3) Regarding the
manufacturing equipment Oda has conducted adetailed investigation. The investigation included suchaspects as structure, size, power and scale ofmanufacture for the various types of machinery usedduring the yomogi manufacture. In particular, therough stones for stone mortars are obtained fromquarries from the upstream region of Itoigawa city in
Niigata prefecture of which hornblende andesite or
enstatite hornblende andesite materials are reportedly
the main products. Reportedly each manufactory uses
these stones in particular forms.4)
Classified by their use, there are about 10 different
product types. The moxa used for indirect moxibustionor needle warming moxibustion contains besides theprincipal component of the T-shaped cilia a fairamount of fragments of leaves or stalks, while superior
quality products for direct moxibustion does notcontain any impurities. Aizawa used electron
microscopy for his related examinations and publisheda detailed report. This showed that the previously
known T-shaped cilia themselves also show differencesamong high and low grade products and are related to
the feel of the material when forming the little moxa
cones.5) Moreover, according to previous hypotheses,

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the temperature characteristics and fragrance of highgrade moxa was considered due to the fat and oilcontent in the cilia, but the above mentioned report by
Aizawa and the below described report by Shimomura
showed6), that is a mistake in that high grade moxa
almost does not contain any oils or fats. It seems
highly likely, that the fragrance of the moxa is due tothe essential oils contained in the stalk cells of the
T-shaped trichome.

Photo: Comparison of T-shaped cilia of high and low
grade products (1: low 2: medium 3: superior)catechols. Comparing the ratios by weight of theheptatriacontene and tannins among the various moxa
varieties for a given moxa weight showed that the ratio
by weight for heptatriacontene is approximately thesame in all moxa varieties. However, the tannin
content varies with the product quality, being low inthe highest grade moxa and increased with increasingcoarseness of the moxa. The combustion temperature –time curve for moxa treated to extract the lipophiliccomponents und untreated moxa showed, that there
were no differences in peak temperature, but for moxa
from which the lipophilic components were extracted,
the time required after ignition of the moxa to reachthe peak temperature from 25°C increased andremoving the heptatriacontene tended to makecombustion more difficult. These workers thus
reported that heptatriacontene affects the time for therise in temperature in the combustion temperature –time curve.10)
Temperature
treatment
Reports

characteristics
pertaining

duringmoxibustion

thetemperaturetocharacteristics observed during direct moxibustion
Essential oil components of moxa
Nakao et a. reported that the moxa leaves containapproximately 0.02% essential oils of which the main
component, comprising 50%, is cineol, followed by
thujone, sesquiterpene alcohol and similar compounds,
where the fragrance of moxa is most likely due to thesecomponents.7) Yet, these reports deal mainly with themoxa leaves and are not the results of an analysis
performed using therapeutic moxa material. Generally,moxa is said to contain tricosanol, hentricontane,arachinacohol, thujone and similar substances. In
recent years, Toda et al. have identified n-non-acosane
andn-hentriacontaneusingliquidgas
chromatography8) and the results of their essential oil
component analysis of commercially available moxa
(highest, high, normal grade) showed that the highest
grade product contains lower saturated aliphatichydrocarbons, but in high and normal grade products
reportedly higher levels of saturated aliphatichydrocarbons are present.9)
Kobayashi et al. isolated from moxa a new tannin
composed of the lipophilic heptatriacontene and30

have been published for a long time11), but few papers
dealt with the amount of heat generated by the moxa
and the large size of the temperature measurement
probe did not allow exact measurements. Aizawa etal.12) and Sugeta et al.13) reported on their use of
microscopic

thermocouples

tomeasurethetemperature characteristics on and below the skin ofmice. They reported that in contrast to what was
believed

in

the

past,

skin

temperaturewassignificantly higher than 60℃, while the subcutaneoustemperature was lower than the temperature on theskin and even continuous performance of moxibustion
did

not

produceanincreaseintemperature

proportional to the number of moxa cones burned.
Commonly the fact that moxibustion treatment using
low grade moxa felt hot was ascribed to a large amountof heat generated. Yet, quite recently, Aizawa's
research showed that the difference in the amount ofheat generated by different qualities of moxa is
minimal and the effect is more likely due to differencesin heat sensation and the burning technique.14)

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Figures: Moxibustion temperature curve

The left graph is for warming moxibustion

temperature characteristics of moxibustion using amoxa tube or moxibustion on pedestals of intervening
materials and reported considerable differences
depending on products used regarding thetemperature and its sustenance. Onishi reported thatwith indirect moxibustion, also used as frequently as
warming moxibustion, it is not only the warming effect,
but the components of the material used as pedestal
may possibly also exert some effect.17)

The right graph is for needle warming moxibustion(vertical axis indicates Temperature (°C), and horizontal
axis indicates Time (s).)

The upper left is Ogonzan; the upper right is Kamaya; thelower left is Ibuki; and the lower right is Miyabi.
(vertical axis indicates Temperature (°C), and horizontal
axis indicates Time (s).)

The upper left is Burdock root; the right is Bulrush; andthe lower left is Absorbent cotton.
(vertical axis indicates Temperature (°C), and horizontal
axis indicates Time (s).)

Considerable research has been conducted into
warming moxibustion or indirect moxibustion. Ozaki15)
and Ueda16) performed a detailed examination of the

Tissue changes at the site of moxibustion treatment
Aizawa et al. observed the effects of directmoxibustion on mouse skin over a period of 14 days
following treatment and found that after application of
three moxa cones the skin had recovered almost to its
normal state after 14 days, without moxa scar. In thecase of treatment using 20 cones there was some
hypertrophy of the epidermis after 14 days, but after
about 20 days the skin was considered to haverecovered almost to its normal state.18) Menjo et al.
electron microscopically observed morphologicalchanges in cutaneous collagen microfibrils using bothelectron and light microscopy. He found that the local
alterations were the most marked, where the greater
the amount of moxa was and these effects did notdisappear even after 24 hours. This is a highlyinteresting fact when considering the influence of thetemperature reached during moxibustion treatment on
the body. Moreover, the heat stimulus provided bymoxa treatment on the one hand and burns on theother hand may be considered to differ in the degree of
their invasiveness for the body and will need further
study in the future. The effects of moxa treatment areconsidered to be mediated via local inflammatory
reactions, but it should be taken into account that theterm inflammation could imply that the effects of
inexplicable heat stimulation may also be considered
as being included in the moxibustion effects.19) In thisrespect, this report was very interesting. In otherwords, burns in general and burns caused by
moxibustion are completely different regarding thedegree of invasiveness and size. Accordingly, theinflammatory reaction alone caused by a simple burn
cannot conceivably be considered to have the effects
moxibustion does. Rather, the heat stimulus applied

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during the moxibustion is considered to be important.
Influence of moxibustion on blood circulation
There are also many reports dealing with local anddistant changes in blood flow. Takeda et al. haveinvestigated the changes in local and distantcutaneous blood flow depending on the number ofapplied moxa cones and found that the application of asingle moxa cone may produce locally a maximal
increase of 580%, while application of 10 cones
resulted in an increase of 720%. The stimulus intensity
dependent increase in blood flow and sequentialchanges subsequently gradually decreased andreturned reportedly after about 30 minutes to thecontrol value set for the experimental time.
Almost no changes are observed in the peripheral
blood flow after application of 1 cone, but moxibustion
using 3 to 10 cones produced a transient reduction inblood flow that subsequently returned close to thecontrol value, after which a tendency towards a slightincrease was reportedly observed.20) Ueda et al.
applied various types of warming moxibustion to theforearm to examine the temperature characteristics
and then used the laser Doppler method and athermocouple thermometer to observe the changes indermal blood flow both locally and on the dorsum of
the hand as a distant reference site. In case ofmoxibustion on pedestals, the duration of the hightemperature phase was short and the temperature
curve cone-shaped, where the peak temperature variedwith product type. For moxibustion using moxa tubes,
the duration temperature was long and wasmaintained near the peak temperature with thetemperature curve trapezoidal. Locally at the site ofmoxibustion an increase in blood flow was observedwith all forms warming moxibustion, but the rate ofincrease depended on the peak temperature andquantity of the stimulus. Moreover, it was reported,that no obvious changes were observed in the
periphery both in dermal blood flow and temperature.
Yet, the rate of increase in blood flow increased with
the quantity of the stimulus, but very strong warming
moxibustion sometimes caused burns. There aremarked individual differences in the rate of increase inblood flow and intensity of thermal pain sensation.

32

Thus, these authors stated that it is important during
clinical application of warming moxibustion to choosea type of warming moxa which provides a suitable
quantity of stimulus within a scope not causingburns.16)
Regarding indirect moxibustion, Matsuhata et al.
performed "ginger moxibustion" on Ashi no sanri(zusanli, ST36) and observed the effects on the bloodflow through the lower extremity and deep plantar
tissue temperature. Local blood flow through the lower
extremity increased over a period of 2 to 4 minutes
following the stimulation, but no changes wereobserved on the contralateral side.21) They also
reported to have observed no changes in deep tissue
temperature at the site of measurement. Recently,
warming moxibustion providing a mild heat sensation
tends to be favored, but there are certain differences
pertaining to the changes caused in blood flow bydirect and indirect moxibustion. Regarding the otheractions, similar differences may well be expected. The
lighthearted concept of moxibustion being the use ofmoxa, or else whatever is warm may also be called
moxibustion needs to be revised. It seems necessary toinvestigate the different actions of direct, warming andindirect moxibustion.
Immune system, blood etc.
Furuya et al. performed moxibustion on mice toobserve changes in phagocytosis using the carbon
clearance method and reported an increase.22) Effects
on blood coagulation capacity have been reported by
Sakamoto et al., observing a slight increase in liverfunction and obvious effects on the clotting system.23)
Okazaki et al. examined the influence on blood clotting
capacity and observed a tendency toward activation of
the coagulation induced by burning a single cone ofmoxa, but intermittent continuous moxibustion
apparently did not maintain this increase. Moreover,platelet aggregation tended to be inhibited over a
period of 1.5 hours after application of 5 mg of moxa,
while after application of 15 mg of moxa a tendency
towards ATP release over a period of 1 hour, as well asa tendency towards shortening of the lag time by 1 to 5
hours was observed. ADP induced platelet aggregation
after application of 15 mg of moxa showed a tendency

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

towards continued elevation over a period of 24 hours,
while the moxa application produced in both the 5 and
15 mg treatment groups an apparent increase in ATP
after 1 and 3 hours respectively. The above results
showed that a single application of moxa produced
responses in the platelet system of mice that were notobserved after intermittent continuous moxibustion
stimulation, so that in case of a repeated moxa
stimulation the effects may be considered todisappear.24)
Matsukuma et al. applied an amount of moxa usedduring daily clinical practice in humans (0.3 mg ofmoxa, 5 cones) for the treatment of adjuvant arthritis
in rats on a point corresponding to Ashi no sanri(zusanlin, ST36) in humans and reportedly observed
an anti-inflammatory effect.25)
While the amount of moxa usually used in clinicalpractice on humans when applied during researchusing normal animals is relatively greater, no obvious
changes were obtained. In contrast, in research using
animal disease models the amount of moxa usuallyused during daily clinical practice in humans produced
observable effects. Thus, since the stimuli ofacupuncture and moxibustion are very subtle, it may
conceivably be difficult to demonstrate their effects
during experiments using normal animals.
hsp
After maintaining the subcutaneous temperaturefor 15 minutes at 45℃ and within the muscle layer at
39-40℃ following the application of moxibustion,
extraction of proteins from the gluteal regional muscle
samples obtained after 3 and 24 hours showed that 3
hours after the performance of moxibustion on rats
hsp70 and hsp71 were detected. Immediately after themoxibustion and 24 hours after it hsp71 was detectedin the rats, hsp70 was not observed. Hsp71 wasobserved, however, in the control rats. Heat shockproteins (hsp) are synthesized as one form ofphysiological stress proteins. This suggests that the
local application of heat in the form of moxa
stimulation leads to the synthesis of hsp and thus
exerts a physiological effect.26) 27)
These reports indicate that hsp are involved in themodes of action of moxibustion so that warming

moxibustion provides a method of increasing hsp. Yet,
while methods to increase hsp concentration generally
require a certain degree of equipment and time,
moxibustion can be considered to be a very simple
method to achieve an increase in hsp concentration.
Anti-ageing
Sakamoto et al. investigated the effects ofmoxibustion treatment on age induced locomotor
ataxia using Marshall's method applied to 4- and9-month old Wistar female rats, treating the animals
continuously at a rate of once per week with a total
amount of moxa of 15 mg/body on points corresponding
to Hyakue (Baihui, GV20) and Keimon (Jingmen,
GB25). Regarding the vigor, no significant
improvements in the locomotor ataxia were observed,
the moxa treatment caused some improvements inlocomotor ataxia regarding success.28) 29) 30) 31)
Since anti-ageing has recently become a common
topic, this report suggests that moxibustion treatment
may be expected to have some anti-ageing effects.
Antioxidation
For a methanol extract of moxa and the combustion
products of moxa, radical, eliminating effects havebeen observed.32)
Activity differs depending on the type of moxa,
where the radical eliminating activity of warming
moxa was weak, but that of moxa for directmoxibustion strong. Based on these results, it wasconsidered that the inhibiting activity of moxa for
direct moxibustion of lipoperoxidation is stronger thanthat of warming moxa.33)
The above described results show that there aredifferences between direct moxibustion and warming
moxibustion. As described above, the differences in theeffects of direct, warming and indirect moxibustion are
considered to require further thorough investigation.
Closing remarks
It is not easy to introduce all the researchpertaining to the entire scope of moxibustion induced
actions. Research into the both ancient and modern
treatment modality of moxibustion is progressing withresults used in treatment form for people of the world.

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

It is my goal to finish my research results in the hopethat this treatment form may be helpful for promoting
health.
References
1) Ryuzo Oda: Studies of Moxa (II) - About Mt. Ibuki-, Journal of the Japan Society of Acupunctureand Moxibustion 35(1): 66-72, 1985
2) Ryuzo Oda: Studies of Moxa. (I) The Latest Processof Manufacture in Moxa and Its Raw Material,
Journal of the Japan Society of Acupuncture andMoxibustion 33(3): 427-430, 1984
3) Shibekatsu A. et al.: Fundamental Study of Moxa
(Report I) Comparison with Altemisia vulgaris
grown in the sunlight and in the shade, Journal of
the Japan Society of Acupuncture andMoxibustion 31(1): 27-33, 1982
4) Ryuzo Oda: Studies of Moxa (part 3) a study ofmillstones used in producing moxa, Journal of theJapan Society of Acupuncture and Moxibustion
43(2): 135-141, 1993
5) Shibekatsu A. et al.: Fundamental Study of Moxa
(Report II) - Morphological Changes in the
Producing Stage of Moxa / Morphological
Differences in the Quality of Moxa -, Journal of
the Japan Society of Acupuncture andMoxibustion 32(3): 242-249, 1983
6) Tsutomu S. et al.: Pharmacognostical Studies on
the Artemisiae Folium., Journal of Natural
Medicines 20(2): 84-91, 1966
7) Manzo Nakao, Chuzo Shibue: Regarding thecomponents of mugwort leaves, Journal of
Pharmacology 44: 636-643, 1924
8) Shizuo T. et al.: Research on Essential Oil of Moxa
(No. 1), Journal of the Japan Society of
Acupuncture and Moxibustion 38(3): 330-333, 1988
9) Shizuo T. et al.: Research on Essential Oil of Moxa
(No. 2), Journal of the Japan Society of
Acupuncture and Moxibustion 40(4): 380-382, 1990
10) Kazuko Kobayashi: Organic Components of Moxa
Analyzed by NMR Spectroscopy, The Bulletin of
Meiji University of Oriental Medicine 3: 45-51, 1987
11) Katsusuke Serizawa: The Science of Acupunctureand Moxibustion, Theory, 2nd Edition, Ishiyaku
Shuppan: 17-28, 1964

34

12) Shigekatsu A. et al.: Effect of moxibustion on skintissue - Changes of skin temperature duringmoxibustion - Journal of the Japan Society of
Acupuncture and Moxibustion 35(2): 105-110, 1985
13) Ryoujin S. et al.: A Study on TemperatureChanges in vivo with Moxibustions, Journal of
the Japan Society of Acupuncture andMoxibustion 38(3): 326-329, 1988
14) Shigekatsu Aizawa: Characteristics of moxa andresearch into its use for thermal stimulation,
Journal of the Japan Society of Acupuncture andMoxibustion 57 (3): 290, 2007
15) Akihiro Ozaki: A Special Quality of Themal
Stimulus on the Indirect Moxibustion, The
Bulletin of Meiji University of Oriental Medicine
3: 85-99, 198716) Tomofumi Ueda, Yoshiko
Egawa,
Takao
Kawahara, Shunji Koike, Masame Sakamoto:Temperature
characteristics
ofwarming
moxibustion and comparison of hemodynamics –local and peripheral changes depending on
different varieties, Tokyo Eisei Gakuen College,
Department of Oriental Medicine, collection of
graduation theses 10: 89-100, 200217) Motoyo O. et al.: Research on indirect moxibustion,
Journal of the Japan Society of Acupuncture andMoxibustion 38（4）: 420-422, 1988
18) Shigekatsu Aizawa: Temperature in the epidermis
and dermis as well as the thereby induced tissuechanges at sites treated by moxibustion in mice,
Educational promotion group of Vocational school,
Research Bulletin: 207-218, 1983
19) Yuki Menjo et al.: Ultrastructural Changes ofCollagen Fibrils in Mouse Dermal Connective
Tissue after Moxibustion Treatment, Acta
Anatomica Nipponica 77: 7-15, 200220) Shinichi Takeda, Miki Menuma, Kenji Hasegawa,
Takahiro
Katsumata,Shigekatsu
Aizawa:Investigation pertaining to methods of skintemperature measurement at combustion sites,
Journal of the Japan Society of Acupuncture andMoxibustion 51(3): 418, 200121) Izuru Matsuhata, Koji Hisashita: Regarding theinfluence of ginger moxibustion on lower
extremity blood flow and the deep tissue
temperature in the sole of the foot, Journal of the

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Japan Society of Acupuncture and Moxibustion
54: 402, 2004
22) Eiji F. et al.: Effects of Moxibustion on the
Phagocytic Activity in Mice (report I) TIMECOURSE FOR CHAGE IN PHAGOCYTIC
ACTIVITY AFTER SINGLE MOXIBUSTION,
Journal of the Japan Society of Acupuncture andMoxibustion 31(1): 34-41, 1982
23) Hideharu Sakamoto, Masako O. et al.: Effect ofMultiple Moxibustion on Blood Coagulation inMice, Journal of the Japan Society of Acupunctureand Moxibustion 36(3): 152-157, 198624) Masako Okazaki, Mayumi Y. et al.: Effect of Single
Moxibustion on Platelet Aggregation andATP-release in Mice, Journal of the Japan Society of
Acupuncture and Moxibustion 38(2): 188-194, 198725) Hideaki M. et al.: Anti-inflammatory Effect ofMoxibustion on Adjuvant-Induced Arthritis,
Journal of Japanese Association of Physical
Medicine Balneology and Climatology 68(3):181-188, 2005
26) Kobayashi K. et al.: The Appearance ofHeat-Shock Proteins (hsp) by Moxibustion, The
Bulletin of Meiji University of Oriental Medicine
4: 67-71, 1988
27) Kazuko K. et al.: Relationship between
Acupuncture and Stress Proteins, Journal of theJapan Society of Acupuncture and Moxibustion
39(3): 338-341, 1989

28) Hideharu Sakamoto: Effects of moxibustion
stimulation on ageing phenomena (second report)– Effects relating to recovery from locomotor
ataxia (1), Journal of the Japan Society of
Acupuncture and Moxibustion, 37(3): 153-158,
198729) Hideharu S. et al.: Effect of Moxibustion on Aged
Rats (Report 3) Reversal from Movement
Disorders of Aged Animals (2), Journal of theJapan Society of Acupuncture and Moxibustion
37(3): 159-163, 198730) Hideharu Sakamoto: Effect of Moxibustion on
Aged Rats (Report IV): Reversal from Movement
Disorders and Recovering the Regular Cyclicity,
Journal of the Japan Society of Acupuncture andMoxibustion 38(2): 195-201, 198831) Hideharu Sakamoto: Effect of Moxibustion on
Aged Rats (Report V) Reversal from Movement
Disorders of Aged Animals (3), Journal of theJapan Society of Acupuncture and Moxibustion
38(3): 314-319, 198832) Motoyo O. et al.: Effects of Moxa andMoxibustion-products on superoxide, Journal of
the Japan Society of Acupuncture andMoxibustion 40(2): 228-231, 1990
33) Motoyo O. et al.: A Study on Radical Scavenging
Effects of Moxa, Journal of the Japan Society of
Acupuncture and Moxibustion 40(4): 377-379,
1990

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Clinical Trials on Acupuncture in Japan
Shoko Masuyama1), Hitoshi Yamashita1)
Hiroshi Tsukayama2)
1) Department of Acupuncture, Morinomiya University of
Medical Sciences, Osaka, Japan
2) Center for Integrative Medicine, Tsukuba University ofTechnology, Tsukuba, Japan

3. Results
We located 87 RCTs/CCTs on acupuncture
conducted in Japan. In fact, some clinical trials werereported in the 1960’s, most of which papers, however,were unavailable. Consequently, whether these papers
are of independent trial or duplicates was not clear.
Therefore, trials after CCT by Kinoshita published in1969 will be analyzed in this paper.

1. Introduction
The concept of evidence-based medicine (EBM) has
permeated Japanese clinical research on acupuncture
and moxibustion, and the number of randomized
controlled trials (RCT) is also increasing in Japan. For
RCTs conducted in Japan, some reviews were
published 1-3). However, data has not been updated forseveral years. Therefore, we reviewed and evaluated

The 87 trails were RCTs or CCTs conducted during
1969 through 2007 and their abstracts have been

the relevant papers in order to identify the current
status of clinical trials on acupuncture conducted inJapan and to assess the quality of them.

11 were reported in English. Eighty-one trials wereparallel-armed, and 6 were cross-over trials. There

2. Methods
We performed a literature search by using “Ichushi(Japana Centra Revuo Medicina) Web”, PubMed,
reviewing papers already published2,3), and our own
files. In using Ichushi Web and PubMed, we used the
keywords “acupuncture” and limited to RCT or quasi-RCT.
We included only controlled clinical trials (CCTs) or
RCTs which were conducted in Japan, published before
2008, focusing on the effect of acupuncture forpatients. Cross-over RCTs were included. We

published in journals as full paper or abstract. These
trials do not contain experimental RCTs which stressedor loaded healthy volunteers or athletes. If we
included trials using healthy subjects or athletes, thenumber of trials would have been more than 150.
Of the 87 trials, 76 were reported in Japanese, andwere 5 multi-center RCTs.
between 4 and 170.

Sample size ranged

RCT on acupuncture was conducted at a relatively
early stage. This may be because of the influence of Dr.
Kosei Takahashi and Oubu-Kai. However, there wasno publication of clinical trial on acupuncture between
1990 and 1996, after which the number of clinical trials
increased again, especially after 2000. (Fig. 2)

excluded experimental studies which stressed or
loaded healthy subjects/athletes, N of 1 trials, trials on
moxibustion.

Aftereliminating

duplications,

weextracted data from the located papers, and assessed
sample size, randomization, blinding, language, type ofcontrol group, modified Jadad score, and so on. (Fig. 1)

Most of the trials were published in acupuncture
journals. While some trials used more than 100
subjects, the sample size has not been increasing evenafter 2000. Most of the trials used patients withmusculoskeletal problems such as low back pain orneck and shoulder pain. (Fig. 3, Table 1)
At the early stage, until the 1980s, clinical trials
were mainly conducted and published by practicing

36

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010acupuncturists, but after the 1990s, the authors aremainly acupuncturists who work for a university or
school. (Fig. 4)

If we look at the average Jadad score (Table 2) ineach decade, the quality of the trials improved
gradually. However, even after 2000, the Jadad scoreis 0 in some trials. Sample size decreased after the
1980s. The reason for low quality has two aspects: oneis that the trial itself is poor, and the other is thatreporting methods are poor, but actually both may bepoor in the trials of zero score. (Fig. 6,7)

At an early stage, trials focused on comparison ofdifferent styles of acupuncture, and then shifted tocomparison of acupuncture with sham needling after
2000. This may be related to the author’s acupuncture
affiliation because it is difficult to set the no treatment
or sham needling group for practicing acupuncturists.
(Fig. 5)

There were 5 multi-center RCTs. However, thesample size is not very large, and average Jadad scoreis 2.2. This means that the quality of multi-center

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

RCTs on acupuncture in Japan is not necessarily high.
(Table 3)

literature was written by Strom in 19744). In contrast,
it deserves special mention that RCT literature waspublished in the 1960s in Japan. Although far more
RCT literature on acupuncture has been published inEuropean countries and the U.S. than in Japan, there
were

some

practitioners

inacupunctureandmoxibustion who had interest in RCT from earlier
times and implemented it in Japan. Then-RCTs were
performed by private-practice acupuncturists andmoxibustionists under the guidance of scholars ofuniversities. In the latter half of 1990s and onward,
most of the RCTs have begun to be conducted byacupuncturists

andmoxibustionists

working

inuniversities. This may have caused a rise after 2000
in the number of RCTs comparing acupuncture withsham needling.
Through the evaluation of the trials we found someproblems withcontrolled clinical trials in Japan. The
trials on acupuncture in Japan are not easy accessible
from overseas, because most of the reports are written
in Japanese and published in domestic acupuncture
journals.

There were some inappropriate papers,such as duplicate publications or so-called “salami”
papersto increase the number of literature entries byfragmentation of data. Data fragmentation, which

4. Discussion
We summarize the points as follows: RCTs or CCTs

may be seen in other countries, is a major impedimenton acupuncture in Japan suddenly increased after

for literature reviews to get muddled and also an

2000.

by

objectionable act as a researcher. Overall, we have anpracticing acupuncturists, and then mainly by school

impression that acupuncture RCTs in Japan tends toacupuncturists after 1990s.

be

They

once

were

conducted

mainlyInitially, they focused mainly on comparison of

conducted

consideration.

tooWe

easilyproposewithout
that

carefulacupuncture

different styles of acupuncture, then shifted toschools/societies in Japan strengthen the functions ofcomparison of acupuncture with sham needling after

their Institutional Review Board for better quality of

2000. Most trials assessed the effect of acupuncture

clinical trials on acupuncture in Japan.

for musculoskeletal conditions. The quality of the

In conclusion, the number of RCTs on acupuncture

trials is improving slightly, but generally not very

and moxibustion is growing, whereas the quality is

high.

not necessarily high. Thus we consider it necessary toThe

resultof

PubMedsearch(Keyword:cope with the tasks ahead; quality improvement,

acupuncture, Limits: randomized controlled trial)

adequate

as of December 31, 2007 showed that the earliest

publications accessible from abroad.

38

controlgroup

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

setting,andEnglishVolume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

References

3) Tsutani K, Suyama S. Nippon-no sinkyu RCT1) Shichido T. Shinkyu no rinsyo-hyouka(32). Ido nodata-base(JRC-RCT)[Acupuncture RCT database in

Nippon [The Journal of Japanese Acupuncture &Japan].

Moxibustion] 1996; 55(7): 95-102.

http://jhes.umin.ac.jp/JAC-RCT/020605/JAC-AT21.pdf;

2) Tsukayama H, Yamashita H. Systematic review of2002 Mar 31.

clinical trials on acupuncture in the Japanese

4) Strom H. Acupuncture treatment of post-tonsillectomy

literature. Clin Acupunct Orient Med 2002; 3:

pain. The analgesic effect compared with blind

105-113.

puncture. Ugeskr Laeger 1974; 136: 1855-1856.

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Japanese Acupuncture Schools andtheir Characteristics

Wen, Ling Shu, Nan Jing, and Zhen Jiu Jia Yi Jing.

Hiromichi Yasui
Japan Institute of TCM Research

diagnosis of channel excess of deficiencies, which were

The Chinese medical system and techniques werereduction. The techniques of this school rely mainly on

introduced to Japan approximately 1,300 years ago.

the use of command points on arms and legs for the

Since then, the Japanese have cherished it as theirtreatment.

own medical system, using the relevant knowledge andcharacteristics, this school has been called theskills in their clinical practice. Acupuncture and"Channel therapy school".

These relied predominately on pulse diagnosis and thethen treated with appropriate reinforcement orWithreferencetothetherapeutic

moxibustion have been handed down alongside withAnother school is called the "Taikyoku Therapy

pharmacotherapy as important pillars supporting thephenomenon" which relies on the diagnosis of

medical system in an unbroken tradition to theimbalances in the five phases determined by the four

present day. During this process, Chinese theory anddiagnostic methods and subsequently the therapeutictechniques

only

adjustment of that balance. The name of this school,foundations. A number of unique Japanese concepts

the Sawada style, is derived from the name of its

were developed and put into practice. Those practicing

founder, Ken Sawada. This style uses considerable

acupuncture

moxibustion.

remained,

and

but

were

moxibustion

notformedtheindividual

schools and transmitted the advantages of their

Still another style (at that time being the latest

schools. Some of these traits are still preserved today.

kind of scholarly attainment) is based on the

These have been handed down as the Japaneseknowledge of physiology and tries to adjust imbalances

acupuncturein the autonomic nervous system using acupunctureandmoxibustion

traditionfromand moxibustion. At one of the leading centers ofgeneration to generation.
Based on a decision by the new Meiji government

academism at the time, the faculty of physiology atin 1868, acupuncture and moxibustion were set apart

Kyoto University provided the foundation for this style

from medicine in schools. Their preservation andwhich relied on a scientific basis. Although there is no

development have been maintained by acupuncturists.

specific name for this style, it could be called the

Even then, the treatment modality was not directly

scientific style.

endorsed by western medicine. However, the tradition

Besides the mentioned styles, there have been

was kept alive. Yet, the characteristics developed bynumerous acupuncturists guided by their individual

previous generations of the various schools graduallytheories and techniques but which did not develop into

faded.

formal styles.

By the 1930’s, some acupuncturists felt that it was

Japanese acupuncture and moxibustion developed

their duty to develop this traditional medicine. They

under

these

circumstances

throughmutualgathered like-minded people and started to investigate

cooperation. Yet, the situation changed drasticallythe potential of acupuncture and moxibustion. They

after Japan engaged in World War II.

read of course, the Chinese classics, but also JapaneseDuring the occupation following the war, thebooks on acupuncture and moxibustion. Using thisSupreme Commander of the Allied Powers (GHQ)information, they developed their own style. A newproceeded with a reform of the Japanese medicalgroup of schools was formed. The concepts of thosesystem. In that process, it considered the elimination

schools have been inherited by modern Japaneseof acupuncture and moxibustion and made theacupuncture and moxibustion. The acupuncture andrelevant recommendations to the Japanese Ministry ofmoxibustion of that time can grossly be classified into

Health and Welfare. Please refer to the articles

the following three forms.

"Japanese Acupuncture and Moxibustion under theFirst, a system based primarily on classics like Su
40

Rule of GHQ after World War II" by Okutsu appearing

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

in previous editions of the Journal of KAIM regarding

and Chinese medical schools and then returned to

the reasons for this move.

Japan. These people practice Chinese acupuncture andThanks to the efforts of many people, anmoxibustion and have achieved many remarkable

understanding by the GHQ was achieved andresults. Collectively, they are called the Chinese

acupuncture and moxibustion was thus fortunately

school.

sparedtriggeredits

obliteration.

majorchangesConversely,
in

the

this

event

awareness

Currently, many people practice acupuncture andofmoxibustion based on their own unique concepts outside

acupuncturists. Some people considered scientificof these established schools, so that their style cannot be

evidence of the effects of acupuncture and moxibustion

identified as any of the aforementioned specific styles.

necessary, and therefore, started to measure the

However, each of the above described schools has distinct

electrical resistance of the skin and endeavored tocharacteristics, comprehension of which, will contributeverify the effects of acupuncture and moxibustion

to a deepening of the understanding of Japaneseusing modern scientific methods. Thus the newscientific (neo-scientific) school was founded.
Conversely, the schools emphasizing deficiency
and excess of the channels, believed that the relevant
theoretical foundations should be strengthened andthus put even more effort into the study of the classics.
They maintained the position that therapeutic theories
and skills, as well as the subjective evaluation of theefficacy, should be measured using a different scale.
The members of this school, who originally had alreadybeen practicing channel based therapy, started to
study not only channel therapy, but also included
far-reaching research of the classics in general. For
this reason, the school is sometimes termed the classic
school.
By

the1960s,

theinfluenceof

Chineseacupuncture and moxibustion reached Japan from
China and started to spread through the Japanese
acupuncture and moxibustion community bringing
about numerous significant changes. In particular,
President Nixon's China visit and the simultaneous
world-wide coverage of news about acupuncture
anesthesia, shocked the Japanese acupuncture andmoxibustion community. Chinese acupuncture related
literature was imported via Hong Kong. Japanese
researchers thoroughly worked through this material,
undeterred by the fact that everything was written in
Chinese, in order to incorporate this knowledge into
their own clinical practice. A significant number ofacupuncturists went to China to study acupuncture
and moxibustion in their medical research facilities

acupuncture and moxibustion.
Brief outline of the contents of each school
1. Channel therapy style
This style was introduced in the 1930s by
acupuncturists in their 20s and its theoretical andclinical maturation later developed in parallel with thegrowth of these practitioners. They considered Chineseclassics like Su Wen, Ling Shu, Nan Jing, and Zhen

Jiu Jia Yi Jing to be the foundation of acupuncture andmoxibustion. They attempted to comprehend thecontents of these books from a modern point of viewand based their clinical practice accordingly on theseprinciples.
These practitioners placed particular emphasis on
the diagnosis of deficiency and excess conditions of thechannels (jing mai). For that purpose they performed
meticulous pulse diagnoses and palpation of thechannels to determine which of the channels were in astate of either excess or deficiency. Accordingly,
treating the conditions by administering a suitablereduction of reinforcement treatment. They alsostudied the therapeutic techniques described in theclassics and tried to revive their use.
This required that the acupuncturists who were
trying to do so had to be in command of extraordinary
skills. The members of this school acquired extremely
high level skills. In particular Sorei Yanagidani, Keiri
Inoue, Sodo Okabe and others are representatives ofthis style and at the same time known for theiroutstanding technical skills.

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Therapeutically, they followed the instruction

establishment of channel therapy were also trying togiven in a paragraph of the "69th difficult issue" of thereach even deeper levels of understanding. The result

Nan Jing, which advises to reinforce the mother in

was the development of forms different for eachcase of deficiency and reduce the child in case ofindividual.
The basic form of channel therapy is to identify

excess. This forms the foundation of the therapy

any imbalances there might be of the channels,

advocated by this school.
Following this principle, they selected acupoints

carefully placing one needle at a time and applying

for reinforcing or reducing, based on the identification

either reinforcement or reduction in order to correctof conditions of deficiency or excess in certain

the imbalance. The needling techniques applied herechannels. This may take either the form of selecting

have been handed down since the time of the Yellow

acupoints for reinforcing or reducing conditions ofEmperor's Classic of Internal Medicine (Huang Di Nei

deficiency or excess in a single channel and reinforcingJing). For example, a needle had to be inserted at aorexcessive

particular point to specified tenths of an inch (fen),

channels. A summarization of the acupoints forretained for respiratory cycles and various techniques

reinforcing or reducing of a single channel is presented

had to be applied for either the reinforcement or

below.

reduction. Even today, this procedure is carried on andreducing

multiple

deficiencies,or

has not changed its place as the “mainstream of< Table 1 >Acupoints used for reinforcing or reducing in case of
deficiency or excess of the various channels

channel therapy”.
Sodo Okabe’s new method

Excess / Deficiency

Sodo Okabe (1907-1984) is one of the founders ofHand Tai Yin Lung Channel:

LU5 / LU9

the above mentioned channel therapy and had been a

Hand Yang Ming Large Intestine Channel:

L12 / LI11

distinguished person in command of the most

Leg Yang Ming Stomach Channel:

ST45 / ST41

outstanding technical skills. In the latter half of theHand Tai Yin Spleen Channel:

SP5 / SP2

1960, he suddenly developed a new system and

Hand Shao Yin Heart Channel:

HT7 / HT9

introduced it into his therapy. This was characterized

Hand Tai Yang Small Intestine Channel:

HT3 / SI3by

Leg Tai Yang Bladder Channel:

BL64 / BL67

distributed over the entire body. Moreover, he also

Leg Sho Yin Kidney Channel:

KI1 / KI7

needled some of the five transporting points on the

Hand Jue Yin Pericard Channel:

PC7 / PC9four extremities to achieve reinforcement or reduction.

Hand Shao Yang Tripple Warmer Channel:

TE10 / TE3

Okabe himself did not elaborate on this method, andHand Shao Yang Gallbladder Channel:

GB38 / GB43

while neither his family nor his students received any

Leg Jue Yin Liver Channel:

LR2 / LR8explanation they used this method for their treatment.

This table provides only the principle. In actual
clinical practice, suitable points are selected fromamong the listed ones, or depending on the conditions,additional points are used. Since the acupoints are
sometimes selected depending on symptoms, thetherapy

becomesquite

complexandrequiresexperience to achieve good results.

42

involvedinneedlesatvariouskey

acupoints

An explanation of the method is presented below:
Initially the patient assumes a dorsal position for
the treatment. The therapist starts then needling fromthe head. GV20, BL2, GB6, ST5, CV12, ST25, CV4.
Depending on the status of repletion or deficiency ofthe channels, essential points on the arms and legs arealso needled. At this point, the question arises, whichof the channels is deficient, whereas it is not really of
any concern as to which channel is replete (rare).

Various forms of channel therapy
Individuals

insertingtheresearchandAccordingly, assuming that the kidney channel has
been diagnosed as deficient, LU5 on the arms, KI10The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

and KI7 on the legs are needled. Other points are

perform his treatment at his place and wished he wereneedled similarly and the needles retained. On the legs

able to perform a similar treatment himself. Sawada

ST36 and SP6 are added.

systemized a number of acupoints as commonly used

After retaining the needles for 15 to 20 minutes

points and thus established a holistic therapy. Basedthey are removed and the patient is instructed toon this concept, the various parts of the body cannot beassume a prone position. The therapist then stands

considered apart from the whole and their very

next to the back of the patient and starts needlingpresence necessitated that they have some correlationfrom the head downwards. GB20, BL10, GB21, several

with the whole. Sawada used the following basic(for example BL13, BL15, BL17, BL23, BL52 andpoints.

under certain circumstances BL32) as well as BL40*

abdomen: CV12

are needled and the needles retained for 15 to 20*

back: GV12

minutes.

*

low back: BL20, BL23, BL32

The treatment is then completed by removing the*arms: LI11, left TE4

needles. Treatment duration is a little less than one*

legs: KI3

hour. The patients should relax mind and body

Shirota made some minor revisions, omitting theregardless of the kind of disease treated, returning

left TE4 and K13 points, often adding GV20 on thehome with a feeling of exhilaration.

head and among the back shu points (BL15, BL17) andFor this treatment the patient rests while thesimilar points. Currently, Shirota's method is stillneedles are retained, which has relaxing effects onfrequently used. While Sawada applied moxibustion toboth mind and body. Moreover, during the treatment

all points, Shirota used acupuncture and moxibustion

period, the conditions of excess and deficiency are

as required by the circumstances. Moreover, by adding

either reduced or reinforced by needling importantor removing points to or from the set of basic points, hepoints on the arms and legs and thus allow the balance

described the application of his holistic treatment for atopointsnumber of representative diseases (Bunshi Shirota:

appropriate for the condition at hand are not used too

Clinical Practice of Acupuncture and Moxibustion

much or too little, after the treatment, the satisfaction

Based Mainly on Case Studies Vol I, pp. 60-66,

of the patient is very great.

Sogensha Inc., 1966).

berestored.

Since

the

therapeutic

2. Schools originating from the Taikyoku Therapy(Tai-ji Therapy)
Ken Sawada (1877-1938) had extraordinary skills,
but was an unknown acupuncturist. His rise to fame
was the result of a journalist introducing him in themass media. Mr. Sawada was a master of inspection.

These concepts gained wide acceptance, butcurrently more scientific methods have become themainstream, so that they ceased to be the central topic
of academic conferences. Yet, when thinking about thereal nature of acupuncture and moxibustion, they arestill important.

Apparently he could often identify the symptoms of the

3. Scientific schools

patients who entered his consultation room without

Among the scientific schools there are numerous
schools which differ slightly from each other. Westernscientific elements were introduced in Japan toacupuncture and moxibustion in the 1930s. Professorof physiology Hidetsurumaru Ishikawa at the medical
faculty of Kyoto University, started to study
acupuncture and moxibustion via his research into
autonomous nervous function until he died in 1947.
Individuals like his students Kazuo Komai and Yoshio

asking them any questions. Yet, he did not justvaguely stare at the patients, but rather inspected andpalpated the condition of specific back shu points to
examine which organs and viscera or channels were
disturbed and then applied moxibustion to thenecessary points distributed over the entire body. Thiswas called his Taikyoku Therapy (Tai-ji Therapy).
Bunshi Shirota (1900-1974) observed Mr. Sawada

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Nakatani, who had developed the Ryodo Raku system,
were also outstanding researchers in the field ofacupuncture and moxibustion. In Tokyo, Takeshi
Itakura conducted research at the Toho ResearchLaboratory with content that could be comprehended
by western scientists too.
After World War II, the GHQ ruling Japan tried
to eradicate acupuncture and moxibustion, but at thistime Ishikawa and Itakura used scientific evidence tooppose that movement. Ishikawa's son, Tachio, who
was a professor of pathology at Kanazawa University,
continued the research into acupuncture andmoxibustion according to his father's dying wish. He
investigated the correlation between acupoints and theelectrical resistance of the skin and subsequently
called points of low electrical resistance "electrodermal
points". Through a detailed examination of theelectrodermal point patterns associated with various
disease, he was able to develop a map.
Bunshi Shirota practiced the Taikyoku Therapy of
Ken Sawada which he developed himself into a holistic
therapy, yet sought in addition to his practice scientificexplanations. For this he was intrigued by Ishikawa
electrodermal points, so that he started commuting toKanazawa to conduct joint research with Dr.
Ishikawa. As a result, he found that the electrodermal
points often also represent therapeutic points andtherefore used them for his treatments. On his way
back from his trip to Kanazawa he frequently stopped
at the house of Shiro Hosono in Kyoto. Hosono was aphysician noted for his skilled use of Kampo medicine
and the first pioneer promoting the establishment of
the scientific foundation of Kampo. Simultaneously healso used acupuncture. They frequently spent thenight discussing acupuncture and moxibustion related
topics and gained a lot from each other. The most
famous discovery of these two people is probably"carotid sinus needling". This is a technique where theneedles are inserted so that they come in contact withthe carotid sinus, retained in this position for
approximately ten seconds and then removed.
Recently, progress has been made in research on the
carotid sinus in which sympathetic nerves have
surgically been removed from its vicinity. This
provided the observation, that this procedure may be

44particularly beneficial for patients with asthma. They
found that inserting a needle here could achieve
similar effects as the surgical procedure, and it became
clear, that the maneuver had other effects too.
Among the channel therapy schools were also
scientifically orientated schools. Masao Maruyama
observed in certain patients that a specific sensation
occurred, that followed upon needling the courses of
the channels as they are described in the classics. He
then needled the source points of each channel andrecorded the resulting feeling in the form of a map.
This proved to coincide almost completely with thedescriptions in the classics. This treatise was latertranslated into Chinese. The phenomenon he had
discovered was called the "Xun jing gan chuan
phenomenon".
Attempts to apply western science to acupuncture
were made in the field of research as well as in clinics.
The use of additional electrical stimulation may becited here as an example. The technique has also beenused in acupuncture anesthesia and could successfully
be applied to various neurological diseases anddiseases associated with pain. It is still widely used
today. However, in Japan many acupuncturists
consider it to be the wrong course and do not appraise
it at all.
From the latter half of the 1990s, the concept of
EBM became established in the medical world which
affected acupuncture and moxibustion. Evaluations oftherapies were not acknowledged any longer as they
had in the past based on subjective views, but had to
be based on evidence. This resulted in a situation,
where preference is given to therapies anybody can
perform by following certain protocols and a tendency
toward disregard of mastership.
Yet, something should be noted here. ManyJapanese acupuncturists generally do not insert theneedles very deep, so that this depth often is about thesame used with sham acupuncture. Regarding
research into acupuncture, controlled studies are used,in particular, comparing ordinary treatment withsham acupuncture. Yet, sham acupuncture itself may
be a valuable treatment, so that some Japanese
acupuncturists consider this research method asrather meaningless.

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

5. Other schools

4. Chinese medical schools
Since the latter half of the 1960s, the new Chinese
medicine has been introduced to Japan from China in theform of books. During the 1970s American President,
Richard Nixon, visited China His news about
acupuncture anesthesia amazed the world. Since then
the number of people starting to study Chinese medicine
has been increasing in Japan and study groups were
established everywhere. Some of the researchers ofJapanese acupuncture and moxibustion went to China to
study Chinese acupuncture. When they returned toJapan they used the Chinese style for their treatment
and made efforts to spread those methods. In 1990
Chinese medicine was included in the standardized
teaching material of Japanese schools for acupuncture
and moxibustion and students had to become familiar
with this knowledge before their graduation.
Not all new acupuncturists are familiar with
Chinese medicine based acupuncture and moxibustion
therapy, but the relevant knowledge built up during
their training will in some form or other be integrated
into their clinical practice. Naturally, there is also a
substantial number of acupuncturists who specialize in
Chinese medicine. This Chinese medicine has alreadybecome established in Japan and may be said to haveformed one particular school.

In Japan, there are also several other concepts
and therapies. For example, "pediatric acupuncture"
has spread mainly in the area around Osaka and ischaracterized in that the needles here do not
penetrate into the body, but stimulate specificacupoints on the surface of the skin. Or else the skinis stroked along the channels in this therapy. This isa special skill and not a school, but represents one ofJapan's unique acupuncture techniques.
Micropuncture to let blood has been in wide use
in Japan for about 250 years. Recent research has
been conducted by the "Nihon Shiraku Gakkai"(Japanese Blood Letting Society) and actively
announced during

relevant conferences. Many

conditions can dramatically improve through this"Shiraku" (blood letting). Moreover, the "Dashin"method, that had its origin about 400 years ago,
seems to have experienced a revival and there iscurrently a group of practitioners who use it.
Since acupuncture and moxibustion treatment
is largely influenced by the technical skills of thepractitioner, it may be stated that there are as manystyles as there are practitioners of acupuncture andmoxibustion.

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Acupuncture in Japan - Clinical Applications

was based on tradition, a Japanese form of acupuncture andShuichi Katai, Hiromichi Yasui
Committee of Japanese Acupuncture - Annual Report

moxibustion integrating new concepts emerged. Continuing
to the present, this was the time in which the foundations ofIntroduction

modern acupuncture and moxibustion were laid.

The skills and theory of acupuncture and moxibustion

Compared with today, western medicine at that time had

are based on experience. Both contain many things thatnot yet achieved a satisfactory level of proficiency. Thiscannot be verified through case series studies or randomized

allowed for an abundance of experiences with acupuncture

controlled clinical trials. The clinical abilities of a single

and moxibustion for the treatment of many different diseases.

excellent acupuncturist may exceed the clinical experiences

Today, acupuncture and moxibustion are used mainly for theof 100 people. Attempts at imitating the therapy performed

treatment of pain, but are used as an excellent therapy

by really outstanding acupuncturists often do not yield thesame results. Follow-up studies have revealed that the skillsof acupuncturists are very important. In contrast to theapplication of drugs, with acupuncture and moxibustion, theskills of the individual therapist plays an extremely importantrole. Clinical trials are an effective method to verify theefficacy of acupuncture and moxibustion. Although certain
aspects defy verification using this methodology, they should
not be considered ineffective.

applicable to disease in all fields of medicine. The fact that it
is not only described in the literature, but proven in practiceas well, demonstrates its value in today’s health care system.
These experiences have not lost their validity to the present
day.
Similar to China, Japan produced a number ofacupuncture and moxibustion masters and the work of thesepeople has been driving the development of Japanese styleacupunctureandmoxibustion.

Verification

of

the

methodology of these masters, as well as an analysis of their

Acupuncturists in command of outstanding skills may
be called masters (sensei). It should be noted that the clinicalpractice of masters in this art cannot be elucidated using
research methodologiesNote1).

clinics, are a task for future research. What follows is areview of modern medical research, including case studies
that

are

representative

examplesoftheoriginal

characteristics of Japanese acupuncture and moxibustion.

Following the Meiji restoration in 1968, the new
government

decidedtoadopt

Germanmedicine.

Subsequently, acupuncture and moxibustion were entrusted

Note 1)
Genzo

Kanbe

had

been

a

masterofneedleto acupuncturists and not to physicians. Yet, for this very

manufacturing during the latter half of the 20th century inreason the influence of western medicine decreased, so thatJapan. He needled each individual using carefully hand-madethe original form of the tradition was handed down andneedles. These were used by outstanding acupuncturists ofprovided the foundation for its present status.

the age who achieved excellent therapeutic results.

This situation prevailed for about half a century, during

When Kanbe lost his home during a bombardment of

which time the search for a new perspective was pursued.

Tokyo by the American army during World War II in

The new government, with its policy of national prosperity

December 1945, he stayed temporarily at the house ofand defense, prepared the ground for the cultivation of folk

relatives in the suburbs of Tokyo. His intense work schedule

medicine in its attempt to maintain the health of the people

led to the development of acute pneumonia. At that time,and provide a means of improving the health of the young.

antibiotics, like penicillin, had not yet found widespread

Acupuncture is considered to be an extremely powerful tool

application in Japan. Before he lost consciousness due to thefor this purpose.

high fever, he fortunately told the famous acupuncturist Sodo

In the 1920s, a sudden burst of new activities occurred

Okabe about his condition. Hearing about this emergency,

in the field of acupuncture and moxibustion. Even though it

Okabe rushed to Kanbe, but his consciousness had already46

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

become so clouded that he could not answer Okabe's

He said he had been so absorbed in the treatment that he didquestioning. Okabe observed the symptoms, checked the

not remember. Yet, he said, that under similar circumstances,pulse and then started his treatment.

he would not needle the trunk. Deducting from thisKanbe describes his recollections of the event in his
state of clouded consciousness as follows.

statement, I presume that he had carefully tonified andsedated the relevant command points on the arms and legs.

"Each individual needle placed by master Okabe was

The clinical practice of masters frequently takes thisvery effective. I was under the impression that a thick needle

form. The skills of master Okabe could not be reproduced by

had struck an evil lump that made me cough up phlegm.

anybody else, so that a large number of artists and politicians

Next, more phlegm came up. Following the expectoration ofof that time became his patients. He also went to Moscow to

the phlegm I started to feel better and the fever fell. I was

treat General Zukov of former Russia. The famoues Japanese

told that he had used 50 mm gold needles with a diameter ofpainter, Taikan Yokoyama loved his needles throughout his

0.2 mm, but to me they had felt like very thick needles. This

life.

event made me painfully aware that with increasing skill,even application of very thin needles can evoke the feeling ofThe clinical applications in other specialized fields thanthick needles. After my complete recovery I asked master

those discussed here are also reported in the Journal of

Okabe where exactly he had needled me.

Kampo, Acupuncture and Integrative Medicine.

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Clinical Application:
Stress and Shoulder Stiffness

understoodand regardless of whether he recognizes this or not,will suffer from stress induced mental and physicalfatigue. Stressors are influenced by both the physicaland mental aspects of our living environment, where asomatic reaction to stress could be the development of
duodenal

ulcers,gastrointestinal

discomfort, or similar symptoms related to thedigestive

organs,hypertension

andsimilarcardiovascular symptoms, headache, shoulder stiffness,dizziness, easy susceptibility to catching cold andsimilar indefinite complaints, cerebral stroke orintracerebral hemorrhage, myocardial infarction, andlike problems. Moreover, diabetes or obesity andsimilar lifestyle-related diseases are also included inthis category and considered to be possible etiologic
factors or exciting causes.
While under stress many people also suffer frompsychological

as

the

outwardresponse to negative stimulations affecting both mind

Modern man is subjected to a wide variety of stress,

andinterpreted

manifestation of "physically strained conditions" in

I. Introduction

gastric

iftroubles.

Motivation,

vitalityand body. Specifically, this refers to physical tension or
stiffness, or on the contrary, may also mean the lack oftension. This represents the conditions of deficiency orexcess as they are identified by palpation in oriental
medicine. The stress concept put forward by Selye may,in fact, be considered to be very close to the oriental
medical concept of mind-body unity.
If a person becomes stressed, the site where thisperson feels to be afflicted. (i.e., where the stress finds
its physical manifestation), differs among people andcountries. In Japan, these conditions generally become
manifest in the form of "shoulder stiffness" marked
mainly by tensioning of the shoulders (trapezius
muscles).

TheshoulderstiffnesstheJapanesecomplain about should be understood in this context as
a distorted condition characterized by both physicaland mental problems.
1. What is shoulder stiffness?

and"Kata-Kori, or shoulder stiffness" refers to an

perseverance may be reduced. Afflicted persons could

increased tension and therefore hardening of thetend to brooding and often develop depressive moods. A

shoulder muscles that is felt as pain or discomfort.

marked feeling of exhaustion is then experienced on a

Anatomically, this is the shoulder region around thedaily base.

shoulder joint. The oriental medical term also refers toThus, psychosomatic problems develop when under

this region around the shoulder joint. Yet, in Japan the

stress. Actually, oriental medicine tends to detect theterm "shoulder stiffness" generally refers to a region

close correlation between mind and body. The sevencentering on the central fibers of the trapezius muscles

emotions: joy, anger, worry, anxiety, sadness, fear, andon top of the shoulders. The term "koru = become stiff,

frightsuffer stiffness", expressed by the character "凝る"may

becomecausative

factorsforthedevelopment of human diseases. They affect thefunctioning of both the internal organs as well as
physical functions and may lead to physical problems.
The reverse also holds true. That is the basis for theconcept of mind-body unity.
The term "stress" (stressed conditions) induced by avariety of stressors is often used in the sense of being
under "mental pressure". Yet, the original meaning of
this term is "distorted condition" and would be better

48

usually meaning a stiffening and thus hardening of themuscles (sometimes also involving the skin andconnective tissue). Accordingly, shoulder stiffnessrefers mainly to symptoms of tensioning of the
trapezius muscles and their vicinity.
However, the patients who actually come fortreatment of shoulder stiffness complain about afeeling of distension, stiffness or tension over a region
extending from the neck to the shoulders, the

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

andtimes; and the combination neck - nape once. The necksometimes the upper portions of the arms. In severe- shoulder is not found at all. Moreover, in the Ling

cases, symptoms may even be associated with

Shu the respective number of appearances of theseheadache, tinnitus, dizziness, and a general feeling ofcharacters is 54, 39, 1 and 1 time. In the Shang Han

fatigue or marked weariness, so that patients may

Lun the term nape - back appears 4 times, neck - nape

become unable to lead a normal daily life or work

seven times and head - nape six times. The term neckinterscapularregion,theanterior

chest,

Considering the above described scope, the muscles

seems to refer to the anterior neck, while nape means

included in the category of shoulder stiffness may beposterior neck. Further, the terms shoulder and nape

all the muscles of the neck, interscapular region,in expressions describing pathological conditions

scapular region, anterior chest, and upper arm. They

appears in the Sun Wen and Ling Shu in the form of

may give rise to pain or tension causing thediseases are located in the shoulders and back,development of a feeling of heaviness that will thenshoulder - back pain, internal pulling pain on shoulder

lead to the complaint of "shoulder stiffness".

and nape, shoulder - nape heat, interscapular pain,

Scrutinizing the classics reveals that the term

nape - shoulder pain, etc., while in the Shang Han Lun"shoulder stiffness" is not mentioned in the Su Wen or

terms like strong pain, strong tension, or simply strong

Ling Shu. Yet, in the section "Gyokuki Shinzo Ron",are found.

section No. 19 in the Su Wen, expressions like

In Japan during the Edo period, expressions close"internal pull on shoulder and neck" or "shoulder neckto the modern term shoulder stiffness, are found thatheat" are found that indicate symptoms involving thewere based on the etiologic factors cited in the Sunregion from the neck to the shoulders

Wen and Ling Shu. The book Shinkyu Choho Ki (1718,

Wind cold has been cited as a cause for thisby Masatoyo Hongo) cites: “When the shoulders hurt,

condition. This is derived form the latter half of ait may be due to phlegm, or else to cold wind, but often

famous passage stating, "Wind is the chief of many

indicates an stagnation of Qi and Blood and in

diseases." In the chapter on the channels in the Ling

acupuncture and moxibustion therapy for various

Shu, section 10 under "greater yang of the leg bladderdiseases, under the heading 'genpeki'.” Pain in thechannel ... in the primary disease of the channel, theshoulders certainly refers to shoulder stiffness and thedisease penetrates to the head and causes pain, it is as

relevant passage is followed by a detailed explanation

if the eyes would fall out, the nape might fall off andof the treatment for shoulder stiffness.

the back hurts. In this section, the phrase "like theIt should be noted in particular that phlegm andnape might fall off" could partially coincide with thewind cold are cited as causes for shoulder pain.

modern concept of shoulder stiffness. In the Shang

Moreover, the pathologic condition is considered to be a

Han Lu,in the section on differential diagnosis of pulse

stagnation of Qi and Blood. The term 'genpeki'

patterns for the greater yang diseases (section five), it

resembles aggregation-accumulation and is a generalsays: "In case of a greater yang disease the pulse willterm referring to either a mass in the hypochondrial or

float, there is stiffness and pain of head and neck andumbilical region or a lump in the chest and shoulder

chills.” The phrase seems to indicate the development

and nape stiffness (either of which are derived fromof shoulder stiffness during the early phase of a cold.

the Lexicon of Kampo Terminology), but here theIncidentally, in the Sun Wen, the character for

Choho Ki adopts only the latter meaning.

shoulder is found 37 times, the character for nape 38

Thus, 'kata-kori = shoulder stiffness' is not only atimes and the combination shoulder – nape threefeeling of tension and stiffness in the region around

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

the shoulder joint, but may also be a symptom

to be so, the depressive moods and fatigue etc. that

resulting from Qi and Blood stagnation caused by wind,Japanese people experience may still depend on thecold, dampness and phlegm. In this case thebackground formed by the characteristic Japanese

stagnation of Qi and Blood often results in thenatural environment, social structure, and humansimultaneous development of the entire body involving

relationships. These factors relate to the moods when

fatigue or suffering. Severe shoulder stiffness may

experiencing

thus lead to systemic problems.

feelings of fatigue accompanying the daily work or

muscletensioning

associated

with

about

study, so that for Japanese people the expression

shoulder stiffness there are in addition to the physicalkata-kori seems to be most suitable. The typicalsymptoms of shoulder stiffening, associated depressive

Japanese communication technique where a wordmoods, stress of human relationships, feelings of social

meaning physical fatigue should be used to express

entrapment, etc. that often serve as supplementary

mental problems is very intriguing.

Yet,

when

Japanese

peoplecomplainmeans of complaining about one’s personal condition
to others. For example, within social groups formed by

2. The condition of shoulder stiffness

companies, fatigue caused by human relationships

This refers to what the therapist can objectively

may be expressed as, "I have stiff shoulders”. In

feel (beginning with the muscles) and the pathologicalparticular, when people are keenly aware of other incondition of the patient's soft tissues. Classifying thesecases where the human relationship is not going well,findings into excess and deficiency, they would indicate

the expression "I get stiff shoulders whenever A isa state of excess. The patient may feel the condition ofaround," used by the affected people clearly, shows this.

stiffness himself, but s/he may also just feel someA representative expressions used for the complaining

localized pain or discomfort. Yet, if that feelingis, "I am tired" or "I have had enough." In addition tointensifies, it does not remain a localized subjective

that, the term "shoulder stiffness" is a skillful way offeeling of discomfort, but may develop into a feeling of

expressing the physical and mental fatigue notfatigue, loss of motivation or similar feelings ofrestricted only to the physical fatigue and is usually

discomfort affecting the entire body. The following

well understood in this sense by the listener.

table shows what patients and therapists feel fromIn this way various psychosomatic signs areinterlaced in a complex way and kata-kori, in its senseof both physical and mental fatigue, seems to be antheir respective point of view when faced withkata-kori (Table 1).

expression unique to the Japanese society that is not

Table 1

observed elsewhere abroad. However, the mental

Patient's

subjective

experiences

andtherapists

feeling of depression, interpersonal relations induced

objective findings in the presence of shoulder stiffness

stress and a feeling of social entrapment are also

(1) Subjective symptoms in patients with shoulder

known in other cultures outside Japan. They too will
most probably have some forms of expression that
correlate people's complaints of physical discomfort tothese psychological aspects. For example, in the final

stiffness
Local ..... pain, tenderness, feeling of distension,
heaviness, stiffness, fatigue, discomfort etc.
Systemic ..... generalized fatigue and discomfort,

analysis, the term headache may in American andfatigue,European societies possibly assume the meaning of

motivation, irritability, difficulties rising in thekata-kori = shoulder stiffness. Yet, even if this is said

weariness,

physicalheaviness,

lack

of

morning, depressive moods, hopelessness etc.
(2) Conditions the therapist can objectively identify in

50

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the presence of shoulder stiffness (classified into

(2)

excess and deficiency)

intervertebral discitis, periarthritis humeroscapularis

Excess.....

tension,swelling,

indurations,distension, hardness, etc.
lack elasticity, chilliness, getting moist etc.

shoulders include, as stated already above, not only
neck and shoulders, but may also extend over theentire back. The condition could affect a wide area,ofandcervicalsimilarsprains,
conditions,the cervical and thoracic vertebra as well as theneck, shoulders and chest may be either directly cause

The locations where patients complain about stiff

regionshoulder)orshoulder joint as the skeletal elements forming the

3. Sites of shoulder stiffnessa(frozenspondylosis

deformations, injuries, sprains, inflammation, etc. of

Deficiency ..... skin or connective tissue, muscles

including

Cervicaltheneck,thetrapezius,

semispinal, splenius, sternocleidomastoideus, scaleni,
levator scapulae muscles, in the scapular andinterscapular regions the supraspinatus, infraspinatus,
teres major, teres minor, latissimus dorsi, greaterrhomboid, lesser rhomboid muscles, the crector
muscles; or else in the anterior thoracic region the
pectoralis major, pectoralis minor, triceps brachii
muscles, etc. Figure 1 illustrates this. Moreover, in thetreatment of shoulder stiffness, general acupoints are
selected by palpating the affected region or specifictherapeutic acupoints that may include many local
points like GV20, BL10, GB20, GB21, TE15 etc.
Moreover, points on the arms include LI11, LI10, TE5,
LI4, HT3, LIV3, KI6, GB40. The acupoints lying
within the range indicated in the figure may
conceivably serve as therapeutic points, when they
have been identified as such through palpation in thepresence of relevant complaints.
4. Causes for shoulder stiffness

or conceivably lead secondarily to the development ofshoulder stiffness.
Yet, shoulder stiffness is not solely due to themusclesandskeletalelements

presenceofcomprisingtheshoulder locally.
(3)

In

the

headache,eyestrain,

astigmatism, dental caries, inflammation of thetemporomandibular joint, malocclusion, throat pain,
tinnitus, hardness of hearing and similar problems ofthe various organs of the head (in particular organs
related to the special senses) patients often complain
simultaneously also about shoulder stiffness. Whilethese causes undoubtedly may lead to shoulder
stiffness, the etiologic factors causing these conditions
may at the same time also induce shoulder stiffness
directly. Conversely, shoulder stiffness may also be acausative factor in the development of these symptoms
and possibly also modify the said symptoms.
(4) Shoulder stiffness caused by problems of thevarious internal organs. Patients with asthma or
cardiacdiseases,

digestive

organslikethegastrointestinal tract or liver, gynecologic or urologic
problems and the like affections of internal organs
may simultaneously cause one to complain about
shoulder stiffness.

What kind of factors cause shoulder stiffness?

(5) Anxiety, anger, stress and similar mental problems

The first cause that comes to mind is:can cause shoulder stiffness as well.

(1) Fatigue of the muscles forming the shoulder belt or(6) From a characteristically oriental medical point ofpoor posture, resulting in excessive or continuous

view wind, cold or damp evil and similar external

exertion of the muscles of the neck, shoulders andaffections, or else

arms that will lead to problems with the local muscles

phlegm are also conceivable.

of the shoulder.

7) The presence of chilling, hot flashes or dizziness,shoulder stiffness caused by

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

listlessness or heaviness of the legs, edema, insomnia

regions.

and similar indefinite complaints patients may

3. Examine the upper and lower extremities for

simultaneously lead patients to complain of shoulder

swelling and tender spots with reference to thestiffness. An imbalance of the autonomic nervous

channels.

system considered to be a causative factor for

Check through palpation of the shoulder region, its

indefinite complaints, has also been suggested as a

vicinity and more distant areas with reference to thepossible cause for shoulder stiffness.

course of the channels and the muscles along thechannels and the nervous system for sites showing

II. Approach to the determination of therapeutic
points for shoulder stiffness
1. Identification of painful or stiff regions
For the treatment of shoulder stiffness it is first of
all necessary to identify the painful or stiff regions.
These may be found by: (1) instructing the patient toflex the neck anteriorly, posteriorly or laterally, rotate
it or flex it obliquely, assume a position of the limp(s)that usually induces the pain or stiffness in order toclearly identify the painful or stiff regions; (2) when
there is pain or stiffness of the muscles, it is necessary

signs of deficiency or excess. The most distant regions
are the upper and lower extremities.
4. Palpate the abdomen, lumbar and sacral vertebrae
for tension and tenderness.
Due to the correlation with the autonomic nervous
system and the inner organs’ reactive sites of theabdomen, lumbar and sacral vertebrae may be related
to shoulder stiffness and thus serve as sites fortherapeutic stimulation. Palpate these regions andcheck for relevant reactions.

to identify the involved muscle(s). Clearly define,III. Basic concepts of acupuncture, moxibustion

which of the above mentioned muscles of the neck,and massage treatment

shoulder, chest, and arm are involved. Pain, swelling

1. Most basic concepts during the identification ofor tenderness may also be observed in other tissues

pathologic musculoskeletal conditions to be treated:than the muscles; and (3) for example tendons,(1) Is it solely a problem of the locomotor system?

ligaments, connective tissue, skin etc., in which case the(2) Should an involvement of various organs, distantrespective painful or stiff regions need to be identified.

organs and tissues be considered?

Among these (2) and (3) are achieved through palpation,(3) Is the condition due to extrinsic pathogenic factors?

but in particular, (3) requires very careful palpation in(4) Is there a strong influence of mental, psychologic

order to identify the affected regions.

problems?
The treatment will differ depending on these

2. Search for sites of swelling or pain in the local area(above, below, left, right, anterior, posterior).
Once the site of the complaint has been clearly
identified, its vicinity has to be palpated for swellingand pain. Again, not only swelling and pain, but also
indurations or indentations, and areas of decreased
sensitivity are checked. This is required in order to
identify the areas to be treated.
Figure 1 shows that the head, neck, interscapularregion and anterior chest are conceivable adjacent52

considerations.
2. Establishing the therapy(1) Treatment of local pain or stiffness
Perform an anamnesis of local pain or stiffness, or
ask the patient to assume the painful posture to
identify the relevant regions and then treat the
involved sites directly.
A major portion of the current acupuncture andmoxibustion treatment is directed locally at the

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

shoulder stiffness and needling of the tensioned
muscles. In the book Shinkyu Chouho Ki of the Edo
period, the following passage is found.

(2) Treatment of related but not local sites(therapies exploiting the somato-visceral reflex,
back shu and anterior mu points)"First, massage and twist the shoulder with the

When pain in muscles, and the like connective

hands, stroking downwards and open the flow of Qitissues or referred pain, has been induced via thebefore needling. Deep needling may be a mistake. In

somato-visceral reflex, the site of the pain is treatedother words, indiscriminate needling may injure thelocally, but at the same time, the organs and other

patient. For the needling the needles should be retained

causative factors of the condition are also treated.

between skin and muscles. At least, the muscles should(3) Treatment of distant sites

not be needled. Do not use needle twirling on theTreatment follows the pathologic condition.

shoulders and back. Stone needles should be used. Use

Treatment according to disease patterna needling tube and flick the needle in, so that it drains* Performed referring to the course of nerves, channels,

Qi and Blood. This will have a quick effect. Also, thethe muscles along the channels, special effect points,

tube should be thrust. This will inevitably lead toclinical experience etc.

bleeding and thus eliminate the pathogenic Qi. In* Selection of points based on the identification of theancient times they used the tip of stones to pierce sites

oriental medical disease pattern, performance ofof pain or numbness, disrupt the channels, eliminate

tonification and sedation.

the evil influences, and thus the acupuncture classics* In general clinical practice, the filiform needle andstated the use of stone needles to drain pus and blood."

manual stimulation are used.

(cited from the Shinkyu Chouho Ki).

* Intradermal or press-needles are often used, if after

The intent is not to pierce the muscles, but rather

the above described treatment pain remains, in order

insert the needles shallowly, or else perform blood

to prolong the therapeutic effects.

letting for cases, as described above where wind evil has* Network vessel pricking is also effective, but ininvaded Qi and Blood and thus led to their stagnation.

Japan it is not generally used.

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Clinical Application:
Cerebrovascular Disorders

renaissance of the application of acupuncture andmoxibustion for diseases already being treated with

Cerebrovascular disorders were quite prevalent inJapan, but with the medical progress in recent years,
their

incidence

began

to

decrease

after

1965.

Currently, they rank third as the cause of death, after
malignant neoplasms and heart diseases. Yet, theirprevalence is rising. Annually, one in 400,000 people
have the disease in some form, and among these,
130,000 die from it. The number of patients withsequelaeisapproximately

1.4

to

1.5

million.

Previously, the cause for stroke was often cerebral
hemorrhage, but today the incidence of cerebral
infarction increases1,2).
This disease, regardless of whether it has beencaused by hemorrhage or infarction, is an indication
for acupuncture treatment. During the acute phase,modern western medicine is currently used for thetreatment and acupuncture is not considered to be anindication. This treatment modality is administered ina small number of special cases.
However, in times when medical care was not as
good as it is today, treatment during the early stages,
often had to rely on acupuncture. Diagnosis had notbeen as exact as it is today so that the treatment ofstroke was based on clinical symptoms. Patients, only
a few days after their attack, presented an indication
for acupuncture treatment. Before the concepts ofrehabilitationwere

generally

acknowledged,

acupuncture had already been applied for such
purposesNote1). The methodology applied at that time
wasatraditional

Japaneseone.

Subsequently,

therapies based on unique new views, were added.
Concepts of modern medicine of the day were also
integrated and thus a fairly coherent treatment
proposed.

Later,

duetotreatment

increasingly

centered on western medicine, the application ofacupuncture gradually declined.
Completely new developments in the treatment ofstroke occurred in the 1990’s when Chinese "Xing Nao
Kai Qao Fa" (activating the brain and opening theorifices method - Note2 and Zhu's scalp acupuncture Note3) were introduced in Japan. At the same time, a54

western

medicalmethods

andrehabilitation,heightened the interest in this therapeutic modality.
A brief introduction to the treatment of these
diseaseswithacupunctureandmoxibustionasperformed in recent years in Japan is presented below.
1. Acute stage
Western

medicaltreatment

receives

priority

during the acute stage of stroke. During this stage
there will be almost no occasions to use acupuncture
and moxibustion treatment, but Prof. Akao at the Gifu
University Hospital, has treated many stroke patientsduringtheacupuncture

acute
and

stage

and

moxibustion

also

performed

treatment

whenwestern medical treatment alone did not produce
sufficient effects. He reported that he has observed
comparatively quick improvement in consciousness
among these patients3). For this purpose, the "Xing
Nao Kai Qao Fa" method, in particular for GV26,
appeared to be effective for people with impaired
consciousness and blood letting performed at the well
points traditionally performed in Japan, has also beenfound to be effective.
Bunshi Shirota (1900-1974), who had a great dealof experience with treating stroke patients during theacute stage, stated: "perform minimal blood letting at
GV20 , BL7 , and additionally at the well points of both
hands and feet. When patients feel irritated, thehealthy side should not be moved, micropuncturingperformed for blood letting at GB12 of the healthy sideand the use of cupping to drain some blood should be
performed. Many patients will calm down after thistreatment." He indicated needling at GB20, GB12,
LI10, LI4, GB34, ST36, LI3 (single insertion, depth 1-2cm)4). The beneficial effects of blood letting performedat the well points during the acute stage has been
pointed out by many acupuncturists, one of whom
spent half of his life on research into the effects ofblood letting, Kunimasa Kudo (1918-1889). He also
recommended this method based on a wealth of clinicalexperience5). Generally this treatment form is not
used.

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

2. Transition from the acute to the chronic stage

as well as shiatsu, were the only treatment forms that

During this stage, one usually waits for thefulfilled this role. Rehabilitation is an independentcondition to stabilize and then initiates rehabilitation

therapeutic system and not related to acupuncture andtherapy, but it is also an indication for acupuncture

moxibustion, but a combination of these treatment

and moxibustion treatment.

forms produces even better effects. Today, efforts are

Shirota used the same treatment as applied
during the acute stage several days after the attack

made to propose even better therapies achieved by a
combination of these different modalities.

and added his "Doshi" technique. He also described theMethodologically there is no way that acupuncture

application of moxibustion on GV20, CV12, LI10,

and moxibustion can be applied to the site of the stroke

GB34 and the Sawada style KI34).

lesion itself, and in practice, this is not possible either.

Yet, the most efficient treatment during this stage

Nevertheless, when symptoms typical for the affected

appears to be the "Xing Nao Kai Qao Fa" method

region are observed, the therapy may be directed atdeveloped by Prof. Xue-Min Shi. This treatment shouldthose symptoms. In particular the "Xing Nao Kai Qao

be initiated as early as possible and it is desirable toFa" explains in detail the treatment of symptoms

beginmoxibustion

including impairment of consciousness, hemilateraltreatment as soon as symptoms have been stabilized

motor or sensory paralysis, central facial paralysis,throughShidysphasia,

articulation

disorders,disordersoffrequently visits Japan and has instructed many

deglutition,

disturbancesof(visualfield

Japanese acupuncturists in this technique. In several

defects),

hospitals he has actually treated patients himself.

application of this method allows for treatment of

Direct observation of the dramatic improvement hasthese symptoms. The basic points used for the "Xingsurprised Japanese acupuncturists. After receiving his

Nao Kai Qao Fa" method are as follows. On thesetutelage, many acupuncturists in Japan perform thispoints, lifting-thrusting, twirling, reinforcement or

treatment.

reduction techniques are used for the needling. For

with

the

westernacupuncture
medicalandtreatment.

Prof.

Since the introduction of this treatment, themethod today is applied in facilities with experienced

andurinary

visionincontinence.

Practical

other associated symptoms, other necessary points
may be added6).

acupuncturists. People observing for the first time howhemiplegic patients with complete paralysis of either

Main points: PC6, GV26, SP6

an arm or a leg start moving the affected arm or leg

Supplementary points: HT1, LU5, BL40, GB20, GB12,

immediately after the treatment cannot conceal their

BL10astonishment.

Other points added depending on the presence of

However, among Japanese rehabilitative medical

associated symptoms:societies and academic societies of acupuncture and* central facial paralysis: GB20, EX-HN5, ST7,

moxibustion, a consensus has not been reached as topenetrating needling from ST4 to ST6, LI4 on

when acupuncture and moxibustion treatment should

healthy side
* pes equinovarus: ST41, penetrating needlingbe started.

from GB40 to KI6* motor aphasia: blood letting at EX-HN12,

3. Chronic stage
Currently,

treatment

of

this

diseasewith

acupuncture and moxibustion is restricted in Japan

EX-HN13* receptive aphasia: penetrating needling fromalmost entirely to this stage. The introduction of

GV23 to GV20, GB20, HT7

rehabilitation concepts is a comparatively recent event* disturbances of vision: GB20

and up to that time no such concepts had been

* hearing impairment (hearing loss): GB20, TE21,

available. Among them, acupuncture and moxibustion

SI19, GB2

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* disordersofarticulationordeglutition

in a comparatively quick recovery of motor function.

(pseudobulbar paralysis): GB20 or TE176, GB12

However, at some point in time, the effectiveness of* urinary incontinence: PC6, GV26 or EX-HN3,

this method decreases and requires moxa treatment ofpenetrating needling from GV23 to GV20, KI3,

specific points on the entire body. At that time, the use

CV2.

of 5 half grain sized moxa cones each on GB21, LI15,
BL10, LI11, LI10, LI8, PC5, GB31, ST36, ST41 is

Shirotareported

increasing

the

of

indicated. The description includes records of thepointsusedforacupuncture

moxibustion following the

10th

and

progress in stroke patients actually treated in this way

day after the attack,including patients from one week to several years afteralso including important points on the paralyzed side.

the attack. These records contain descriptions that are

In patients with dysarthria, he added GV15 or GV16.

noteworthy even today7).

therapeutic

numberContinued performance of micropuncturing for blood

Manyexperienceswith

acupunctureandletting is also said to be beneficial. He further reported

moxibustion treatment have been gathered and thepuncturing areas on the back of the neck or shoulders

above described example is definitely not unique.

marked by blood congestion and the application of

Yamada stated that the three main purposes of

cupping to drain some of the blood, as well as theacupuncture and moxibustion treatment during thatsuitability of the use of well points GV20, or thestage are: (1) recovery of basic functions as a part of"clearing of nutrient" method etc.

the rehabilitative measures like exercise therapy, (2)The treatment for the chronic stage recommended
by Shirota is as follows4).

prevention of various complications, and (3) alleviationof pain8).
The chronic stage is often associated with pain andAcupuncture: GV20, GB12, LI10, LI4, GB34, ST36,

patients frequently experience extremely severe pain.

LR3, BL2, BL10, TE15, BL15, BL18, BL25, BL32,

Acupuncture is effective for central pain like thalamic

GB30 on the affected sidepain, but its efficacy for the various forms of peripheral

Moxibustion:

pain on the paralyzed side in patients with hemiplegia,

CV12, CV9, GV12, TE15, BL25,

LI11, GB34, GV20

are an even better indication. In particular, pain of the

Only on the affected side: LU1, ST27, SI11, SI10, LI15,

shoulder joint is encountered frequently and many

LI10, LI4, TE4, PC7, GB31, Kampu, ST36, LR4, GB40

patients stop walking because of the pain that is(half rice grain size, 3 to 5 cone on each point)

triggered during walking. For this condition, Prof. Shi
states that he needles LI15, Kengairyo and Kennairyo

During this stage, moxibustion is also effective.

in order to promote the flow in the local channels andIsaburo Fukaya (1900-1974), who dedicated his entire

punctures painful spots for blood letting in attempts tolife to the research and clinical application ofdissolve blood stasis and alleviate pain. Kitamura

moxibustion, has written his treatment records in theneedled "ashi" (tender) points to treat pain upon

form of a diary and published this as a book entitledelevation of the arm and subsequently achieved an

Stories About Healing Diseases with Moxibustion. In

improved ROM through active and passive exercise.

this

of

He did not treat just the shoulder simply because it ismoxibustion on the fingertips for stroke induced

painful, but also needled points like BL62 or GB26,

hemiplegia. For example, apply moxa for paralysis of

ST36, SP9 and GB34; and thus reportedly achieved

the arm using points at the fingertips on the affected

alleviation of the shoulder pain8).

book,

he

recommended

theapplicationside (approximately 3-4 mm on the midline proximal to

Spasticity too is a great problem. Prof. Xue-Min

the edge of the nail). If the patient feels the heat, use

Shi has pointed out that slightly stronger stimulation

only one moxa cone. If he/she does not feel the heat,of LI14 for flexion and contractures of hands anduse several cones. This treatment reportedly resulted
56

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

fingers induces instant relaxation6). Moreover, in casereportedly led to an amazing degree of alleviation4).

of spasticity of the biceps muscle, Kitamura also used

In the collection of essays by Shirota, Records ofmotor points of that muscle and applied electric

Clinical Acupuncture and Moxibustion, he emphasizes

current of an intensity that does not induce joint

the importance of persistent and careful treatment,

movements and a frequency of 30 Hz for a period of 5

describing it as follows. "After a long time after aminutes, followed by 2 minutes of rest and thenstroke, local treatment of the late effects is particularly

repeated these cycles three times. Thus he reportedly

important. The muscles, nerves and blood vessels that

achieved, although only temporarily, some relief of the

supply the affected area need special attention. In

spasticity. Based on the principle of reciprocalorder to improve their function, careful treatment

innervation, heof theshould be given. Treatment of the arms is importantantagonist is also beneficial8). These therapies arewhen the goal is to regain the ability to use a brush oreffective immediately after their application, but thechopsticks. Yet, treatment of the legs is also required.

effects do not last very long and thus require repeatedEven minor improvements in the condition of the legs

treatment and exercise therapy should preferably behelp to make walking easier. When walking becomes

performed while the therapeutic effect lasts. It iseasier, the maintenance of equilibrium improves andimportant that the patient remembers the relevant

thus stabilizes the entire body. Even if 1 or 2 years

sensations.

have passed since the attack, treatment will graduallystated that

stimulation

Although the number of case reports describing

lead to improvements. Although it may not be possible

stroke patients is not small, the number of suchto expect a full recovery, it should be sufficient toreports coupled with reports on detailed western

achieve a certain degree of improvement. The patient's

medical examination is not high. Acupuncturists likejoy will thereby be increased."10)

Shirota of about one generation ago, published a large
number of case reports, attesting to the abundance ofNote 1:clinical experiences, but many of these records are

The concepts of rehabilitation were clarified innevertheless incomplete by modern medical standards.

Japan in the 1950s. Later, after many deliberations,

Yet, in recent years, the number of reports providing

the Japanese Association of Rehabilitation Medicine

findings of both medical systems has been increasing.

(JARM) was founded in 1963. In the same year, theFor example, Yukimachi, et al. started to treat afirst school for the training of physiotherapists and72-year old woman and a 76-year old man (both ofoccupational therapists was opened. Three years later,which were diagnosed with lacunar infarction based on

in 1966, the first graduates left that school and the

MRI findings) with acupuncture and moxibustion fromfirst state examination was held. This created the first

the first week of hospitalization. Patient management

generation

was performed based on western medicine and these

therapists and led to the foundation of the Japanesepatients reportedly healed without any late effects9).

Physical Therapy Association and the Japanese

There are not yet any clear statements regarding

Associationofofphysiotherapists

Occupational

andoccupational

Therapists.

Later,

the long-term prognosis when acupuncture andrehabilitation was integrated into medical care andmoxibustion therapy are used for the treatment ofplayed an important role in the various fields ofpatients with this disease. Shirota reported that

medicine. Since acupuncture and moxibustion on thepersistent treatment resulted in patients regaining theother hand remained outside the framework of medical

power to power to write, and patients who had

care, the treatment of late effects of stroke that used todifficulties to walk, found it easier to walk. Also,be an indication for acupuncture and moxibustion, felltreating patients with contractures and fixed joints in

into the category of rehabilitation, so treatment by

the same way as patients with RA or neuralgia, has

acupuncturists decreased.

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Note 2:

References:

The Xing Nao Kai Qao Fa ("Xing Nao Kai Qiao" =1. Ministry of Health, Labor and Welfare: 2001,

XNKQ, activating the brain and opening the orifices)

Estimated

method was developed by Professor Xue-Min Shi at therehabilitation

First Teaching Hospital of Tianjin University of TCM.
This therapy, which adds new views to the traditional
theories and is applied from the acute stage of a stroke tothe sequelae developing during the chronic stage, is anepoch-making

techniqueimprovements

immediately

allowing
after

the

dramatic
treatment.

Professor Shi himself introduced this technique in Japanand there is a Japanese textbook which describes thismethod. It is being practiced in many medical facilities.
Note 3:
Zhu's scalp acupuncture is a therapy that has beendeveloped by Professor Ming-Qing Zhu at Beijing
University of Traditional Chinese Medicine (which has
absorbed the former Beijing College of TCM). Various
therapeutic areas are used on the scalp and stimulated
by needling, applying a unique technique. The
technique is applied not only for the treatment ofstroke, but also for a wide spectrum of otherneurological diseases. Professor Zhu himself has
introduced this technique in Japan and there is aJapanese textbook which describes this method. It isbeing practiced in a number of medical facilities.

vital
of

statistics(determinate),

cerebrovasculardisorders,

http://www.mhlw.go.jp/toukei/saikin/hw/jinkou/ka
kutei01/hyo4.html
2. Ministry of Health, Labor and Welfare: 2002,

General conditions of the patients, total numberofpatients

with

the

main

disabilities,

http://www.mhlw.go.jp/toukei/saikin/hw/kanja/kan
ja99/5.html
3. Akao M.: Round-table discussion "Acupuncture

therapy for cerebral stroke", Ido no Nihon, No. 714,
p25-36, 2003
4. Shirota

B.:

Practical

acupuncture

therapy

centering on descriptions of clinical case reports(Vol. one), p252-279, Sogen Publisher, 1966
5. Kudo K.: Illustrated Blood Letting Therapy,
p93-96, Shizen Publisher, 1980
6. Xue-Min Shi: Pictoral explanation of acupuncture

therapy for cerebrovascular disorders, Oriental
Medicine Publisher, 1991
7. Fukaya I.: Stories About Healing Diseases with

Moxibustion, Collection Nos 1 through 12, Shinkyu
no Sekai Publisher, 1972

(The section of clinical applications continues on page 67)

58

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Manufacturing Process and Characteristics of Modern Acupuncture Needles
1. History of disposable acupuncture needles (Single use acupuncture needle)
Disposable acupuncture needles (hereafter referred to as “single use acupuncture needles”) were firstmass-produced and introduced to the market by Seirin Corporation in 1978. Subsequently, China money andthe funds of Chinese companies were invested for the manufacture in about 1995 and the sales started on a fullscale around 1997. These needles are packaged in blister packs. About ten brands are now sold on the world
markets. This has accelerated the use of single use acupuncture needles.
Importance of single use acupuncture needles is adequate sterilization being ensured and needle points
uniformly shaped. This makes the techniques of acupuncturists to be transmitted as they are, resulting intherapy efficacy. Since the single use acupuncture needle is a medical tool, it is required to satisfy international
legal requirements. Adequate sterilization is an important issue and counts of living microbes including
bacteria, attached to the product, that are likely to propagate need to be reduced to the least possible. Thus, themanufacture has to be carried out under a specifically clean environment. Following is the manufacturing
process of single use acupuncture needles.
2. Manufacturing process of disposable acupuncture needles(1) incoming inspection(2) process of setting straight(3) process flow inspection

All Seirin needles are manufactured from highquality raw materials made to specifications
established by adding our company’s original
requirements to the specifications of stainlesssteel wires prescribed by JIS standards
applicable to wires made in Japan. No effort isspared to perform the trace control of stainlesswires that were used.

By
havingestablishedinimitablestraightening technologies, we performstraight line processing without damaging
surfaces and carry out wire materials
processing, which forms the basis ofneedles with high roundness.

Measurements are made of the true wire
diameters, cut dimensions, etc. of cut
parts on which straight line processing
was performed and standard size cutting
operationwascompleted,
therebycontrolling conditions where uniform
needlepoint processing can be carried out
in subsequent processes.

(4) grinding process(5) process flow inspection(6) washing process

After completion of needlepoint operation,
in-process inspections are performed, witheach production lot as a unit, thus severely
checking needle lengths in terms ofaccuracy requirements. Then needles flow
to the cleaning process, which is the nextone.

Cleaning work is performed in a numberof stages to prevent oil, foreign objects,
etc. from adhering to needles. Distilledwater cleaning is carried out in a cleanbooth for which strict environmental
control is conducted, and final cleaning is
performed by a dust-free dryer. In thiswork setup, no human hand comes into
contact with needles.

Seirin’s original needlepoint technology isutilized to finish products into uniform,
rounded, and smooth forms that serve tominimize pains.

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010(7) process flow inspection(8) assemnly process and inspection of auto-assembly machine

A magnifying microscope is used to carefully
check the needlepoint condition, with eachproduction lot as a unit.

Inspection devices are installed in all automatic assembly line sections
where no human hand comes into contact with needles. Thus uniform
disposable acupuncture needles are assembled.

(9) process flow inspection(10) packaging process, packing machine and automatic inspection

Items such as the needlepoint condition, theadhesion strength of joints between needle shafts
and needle tubes, and the drawing tension
between needle shafts and needle bodies are
subjected to in-process inspections, with eachproduction lot as a unit, thereby achieving thequality suitable for the next process.

An automatic packaging machine for packing individual needles is used to strictly
control the sealing condition capable of steadfastly maintaining sterility.
Inspection devices including an image processing apparatus are used to makesure that no defects are overlooked.

(11) process flow inspection(12) process of diminishing germs(13) product warehouse

In-process inspections are performed, with eachproduction lot as a unit, to check the indication
condition, the sealing condition, etc., thereby
providing products with air-tightness capable ofsteadfastly maintaining product sterility suitable
for the sterilization process, which is the next one.

The environment in the production
processes
arecontrolledonathoroughgoing basis, and sterilization
validation is performed, thereby reliably
ensuring sterility.

Products are managed in a room
subjected to controlled air conditioning.

(14) shipping inspection(15) numbered lot

Final functional inspections are performed
including the confirmation of the in-processinspections conducted in all production
processes. Also, culture examinations forbiological indicators are conducted.

The production lot number and the expiration date are printed on the back of eachblister package formed in the packaging process. By searching for production lot
numbers, it is possible to clarify data ranging from shipment inspection histories tosterilization histories and to stainless wire purchase histories. Any product for whichsuch production lot trace is unclear is not allowed to be distributed even if it has
passed shipment inspection.

(16) shipping(Materials provided by SEIRIN CORPORATION)
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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Manufacturing
ProcessofClassical
Acupuncture Needles (since the Ancient
Period of Edo)
I. Introduction
Thin needles commonly used in the Japanese
acupuncture have been manufactured since the Edo
Periodup up to the present. Attitude toward sanitaryaffairs, however, changed over time and the method ofneedle manufacturing maintained since the Edo Period
was forced to undergo changes. Moreover, with the end of
the Edo culture that supported the technique of needle
manufacturing, manufacturers of long standing have
faced difficulty finding successors. This report will
introduce the manufacturing process of acupunctureneedles that has been handed down to the present fromthe Edo Period. In preparing the report, Aoki Jitui
Shouten, which has a history of 140 years inmanufacturing acupuncture needles since the end of theEdo era, provided cooperation.
II. Manufacturing process of needles
1. Needle handle
The manufacturing method of needle handles
underwent a great change. Many years ago, handles
were all made of processed pure silver. To make a handle,
a pipe was made with a block or ingot of pure silver(Photos 1 and 2), which was processed into a shape ofplate (Photo 3), and then passed through a die (Photo 4).
A die is a modern tool. Many years ago, a tool withequivalent functions was made uniquely using the samematerial as the one used for Japanese swords (Photos 5
and 6). Patterns were elaborately handcrafted on ahandle which was very time consuming for the artist(Photo 7). Presently, seamless pipes of stainless steel orbrass are manufactured and these are processed to makehandles (Photo 8).
2. Needle body
A needle body is the most important part of a needle,
but there were almost no changes made in its
manufacturing method. Or rather this is the part for
which manufacturers do not want to make alterations.
This section will mainly describe the manufacturing
process of a silver needle (for a gold needle, the process isalmost identical). A needle made of pure silver is too soft
to prick the skin skillfully, and when pricking the skin,
the needle gets bent in the guide tube and its tip does notadequately cleave the skin to get into. To give hardness,different metals are blended. Alloy composition withcopper, or brass, or others depend on manufacturers.
Metals are mixed by an electrical furnace, whereas it wasdone by an air blasting unit called Fuigo (Photo 9) many
years agro.
As a first step, a thick cylindrical block is made, andthen it is extended by little by little. It is not shaved off,
but stretched thinly (Photos 10 & 11). At the initial stage,a machine is used, but when the silver alloy becomes acertain diameter, the machine is stopped and a craft-man
extends it manually with a pair of pliers. This process isabsolutely necessary and it is in this process to get rid ofsomething bad, which requires technical skills of thecraft-man. The tool used is a diamond die (a hole is madein the center of the diamond) (Photo 12). In the earlydays, diamonds were not available, so the tool with anarrow hole as in Photo 5 and Photo 6 was used. A pieceof silver alloy is elongated to the required diameter,
which is cut to the specified gauge, and pressed to attach
to the handle.
Initially, materials used to make the body were gold,
silver and iron in old days, whereas gold, silver andstainless steel are now used. Iron rusts easily, so since
the development of stainless steel, iron has been replacedwith stainless steel.
3. Attachment of a handle to a body
A handle and a body are attached by presswork, but
it was done so by soldering in the past. A piece of solder
alloy with unique blending was made in a plate shape(Photo 13) and cut thinly, and then the thinly cut solder
was run into a heated pipe in which the body was placed
and attached after cooling. The autoclave popularity
created a thermal problem in soldering and the calking
technique by presswork is now employed.
4. Needle tip
In the early days, natural whetstone was used togrind the tip (Photo 14). At present, the tip is sharpened
on a whetstone attached to the grinder. A tip sharpening
process can be finished in four steps. This is the mostdifficult process and challenging to the craftsman. There
are reasons why this process is used. Aoki Jitui Shouten
produces needles that are used in a guide tube (“pineneedle type”) and needles as “nenshin” that do not use a
guide tube (“willow leave type”). The tips of these two
types of needles have quite different shapes. There aredemands from clinicians that the tip should be mademore round (“oval type”), or that they need more
sharp-pointed tips (sharp-pointed tip, “noge type”) and

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the Jitui Shouten is responding to their requirements.
However, only manual work can fully satisfy theirrequirements as described above. What makes thebiggest difference between automated production andmanual production is this process.
5. Needle guide tube
In the early years, a guide tube was made throughthe process of hammering a piece of pure silver plate to around tube. To make a square guide tube, edges of theplate were rasped off to make it octagon. At present, aguide tube is produced by pulling a tube from a die
specially made for the purpose (Photo 15 & 16).
Materials used are three kinds of metals, gold (20K),
pure silver, and stainless steel (Photo 17).
Photo 1

Photo 5Photo 2

III. Summary
The manufacturing process described above ishighly appraised among clinicians as the manualtechnique for making needles by a craftsman, rather
than the method of making needles mechanically. Aoki
Jitui Shouten has more orders received for needles ofsilver than those of stainless steel. There are two typesof needles available for selection in Japan of today: lessexpensive needles and more expensive needles
produced according to the requirement of clinicians.
Less expensive needles have one disadvantage in thatclinicians have to carefully pre-sterilize the needles
and dispose them once used.

Photo 3

Photo 6

Photo 4

Photo 7

Photo 8

Photo 9Photo 10

Photo 11

Photo 12

Photo 13

Photo 14

Photo 15

Photo 16

Photo 17

(Contents and photos provided by Aoki Jitsui Shoten)

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Introduction of Modern Moxibustion
The Modern Moxibustion

Moxa
Easy to light andlong lasting quiality
Moxa be wrappedwith Washi (Japan
paper)
With Sennenkyu,
you can performgentle moxibustion
without directcontact of moxa
with the skin.

Essence of Mugwort
Heat and active components contained in moxa
penetrate into your moxibustion points.

SENNENKYU

How to burn Sennenkyu

Characteristics of Sennenkyu* "Moxa" burned for moxibustion is prepared fromthe medicinal herb "mugwort".
* With Sennenkyu, you can perform gentle
moxibustion without direct contact of moxa withthe skin.
* Heat and the active components of mugwort
contained in moxa penetrate to moxibustion points
through the aeration pores.

How to peel
off the adhesive paper

1) Peel off the adhesive (ground) paper at thebottom of the holder.
2) Light moxa at its top with a match or a lighter.
3) Attach Sennenkyu gently and securely to themoxibustion points .
4) As moxa burns gradually, you will begin to feel theheat after about 4 minutes, and the fire goes out
shortly after you eventually feel sharp heat.
5) Since the effect of moxibustion continues evenafter the fire goes out, keep Sennen-kyu in place
until the holder cools.

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The aeration pore

Relaxation by fragrances

Heat and the active components of mugwort
contained in moxa penetrate to moxibustion points
through the aeration pores.

Milder type moxibustion with the bottom linedwith Japan paper. Much gentler on your skin.

Our product line introduced most recently is moxa
formulated fragrances of fruits and flowers. Its
exquisite and delicate fragrances put your heart at
rest, leading to complete relaxation.
Pleasant scents are said to have relaxation effects
of freeing mind and body and the moxa that used to
be for therapy has now begun to be recognizedespecially among young generations as a productfor relaxation.

“Japan paper” absorbs excess moisture from theskin surface and prevents skin troubles such as low
temperature burns.It absorbs skin surface moisture
only from the moxibustion spot. Strain of the skinsurface is diminished with still the same thermal
penetration onto the moxibustion points.

The Self-Heating Moxa (SENNENKYU TAIYO)
Pyrogen
The exothermic agent isused to gradually heat
the moxibustion points
without fire consumption.

Japan
paper

Moxa
Essence of Mugwort

The “moxa sheet”
contains an active
component ofmugwort andpenetrates into theskin with heat

How to Use

1) Be sure to open the package just before use.
2) Peel the air-blocking seal off of the protrusion. Heat will be
generated and, after about 20 to 30 minutes, reaches the efficienttemperature.
3) Peel the seal off of the bottom part (skin contact surface).Firmly
apply the moxibustion to the predetermined the moxibustion
points.The sufficient temperature (about 40 to 45 C°) will "lastabout 3 hours".
4) Be sure to remove the burned moxa after it loses the heat andcools down.
(Contents and photos provided by Senefa Corporation)

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Manufacturing Process and Characteristics
of Classical Moxa
<Moxa raw materials> Moxa is made from the leaf ofthe mugwort (Artemisia vulgaris), using the dense
white hairs on the bottom side of the leaf. Althoughmugwort is common throughout Japan, the plants thatgrow in areas of high snowfall are considered to provide
the best-quality raw material for moxa. The areas
around the Ibuki mountain range in Shiga Prefecture
and in the mountains of Toyama and Niigata in westernJapan produce particularly large mugwort leaves with
optimal characteristics for moxa production. Large
leaves mean fewer stems, which in turn reduces theamount of stem impurities introduced during theprocess of separating the fine hairs from the back ofeach leaf. This improves the yield rate and decreases
production costs.
<Harvesting mugwort> Mugwort leaves are gathered<Grinding> Grindstones are used to separate thefrom mid-May until early August. The harvested leaves

impurities from the fine hairs that will be used in theare pulled from the stems and spread on a straw mat or

moxa. This process uses three different types ofother surface to dry naturally in the sun for 5 days.

grindstone, which differ by the number and depth ofDuring this time, the leaves are carefully turned once orgrooves in the stones, and by the weight of the upper

twice daily (a process termed "reversing heaven andstone. Grindstones 1, 2, and 3 are used in grinding

earth") to ensure uniform drying. The dried mugwort isdirect moxibustion, Grindstones 1 and No. 2 are used

stored until the beginning of winter in the mountains,when the air becomes dryer than during the hot, humid
summer months.
<Drying by heating> Moxa production is begun in late

for applications in which moxa is burned on the headofaninserted

acupunctureneedle,and

only

Grindstone 1 is used for indirect moxibustion.

At that point, the sun-dried mugwort is

The grindstones are constructed in pairs, with one

dried by heating to remove any remaining water. If theupper stone and one lower stone. The upper stone

leaves are not adequately dried, it is very difficult toturns, the lower stone is fixed in position, and theseparate impurities from the moxa later in the

mugwort is introduced through a hole in the upperproduction process, and the resulting moxa will not be ofstone. The stone used in grindstones for moxa

high quality. This is why moxa is manufactured during

production should be neither hard and fine-grained or

November.

the winter, when the humidity is low and better drying
can be achieved. We use special drying rooms heatedwith natural gas, and blowers to disperse the hot dry air
throughout the room. For moxa that will be used directly

soft and coarse-grained; the best stone is hard andcoarse-grained. Fine-grained hard stone produces
moxa fibers that are too finely powdered and will noton the skin (direct moxibustion), the leaves are dried for

stick together, while rough-grained soft stone yields

about 20 hours. For applications in which a thin sheet ofpoorly cut fibers and coarse, uneven moxa. For well-cut

paper or similar substance is placed on the skin and the

mugwort, with minimal damage to the fine hairs frommoxa is then positioned on that sheet (indirect

the leaves, the best grindstones are made frommoxibustion), the leaves are dried for about 12 hours.

volcanic rock.

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<Tohmi Winnower> The coarse moxa that was obtained
from the Nagadoshi is further purified by filtering
through a Tohmi in order to produce high-grade point
acupuncture moxa. This device works much like the
Nagadoshi, turning and mixing the coarse moxa toseparate impurities, except that instead of a turning
cylinder, the Tohmi is equipped with large revolving
plates that turn within an unmoving bamboo cylinder.
Coarse moxa is poured in through an opening at the topof the device. The rotating plates mix the contents of thecylinder, so that the impurities fly out through the<Nagadoshi> At the end of the grinding process thedried leaves have been reduced to powder. However,
impurities such as leaf and stem pieces remain. The
moxa is separated from the impurities by sieving
through a device called the "nagadoshi". Within thisdevice is a cylinder made from a bamboo screen,
similar to the screens used to make sushi rolls, butlarger. The powdered mugwort is turned and mixed
within that cylinder, and then passes through a sieve.
The bamboo screen is set at an angle, with thepowdered mugwort introduced through the top of thecylinder. As the cylinder turns, the powdered
impurities are gradually thrown out through thespaces between the bamboo screens, leaving only moxaby the time the product reaches the exit point at thebottom. The yield rate for coarse moxa at this point is10-15% in comparison to the dried leaves. The moxa is
now suitable for use in indirect moxibustion andacupuncture needle head applications.

bamboo screen, and only purified high-quality moxa
remains within the Tohmi. The time required for thiswinnowing process depends on the quality of thedesired product: about 6 hours for direct moxibustion,
and about 12 hours for the highest-grade directmoxibustion.

The

yield

rate

at

this

stage

is

approximately 4% of the original dried leaf.

<Regulating quality> The finished moxa may differ inquality depending on the weather conditions at thetime of production, so sorting and blending are
performed to insure uniform quality before the productis shipped. Moxa manufacturing is concluded by theend of March, when winter is drawing to a close in themountains.
(Contents and photos provided by Yamasho Co., Ltd.)66

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Clinical Application:
Trigenimal Neuralgia
Trigeminal

neuralgia

letting blood from these vessels by puncturing themwith the tip of No. 4-5 needles. This kind of bloodisalancinating

painoccurring in the area innervated by the trigeminal
nerve that continues for short periods of time and isfrequent in the elderly. The pain usually lasts only afew seconds, occurs suddenly and then disappears
suddenly.

Western

pharmacotherapy,

medicalsurgicalapproaches

treatment

andincludenerve

blocks; but neither of these treatment forms is 100%
effective. Acupuncture and moxibustion treatment iseffective, but the condition still remains intractable.
Nevertheless, when various treatments have been
tried without providing any relief, it may be possible toinduce some relief, or in some cases, even cure thecondition. Several treatment forms have been tried.
Bunshi Shirota recommended and performed thefollowing treatment1).
First, treat the acuppoints CV12, BL20, GV12,
TE15, LI11, GV34, etc. with acupuncture andmoxibustion for the purpose of adjusting the generalbody condition.
For the treatment of the first branch, the ocularnerve (causing pain of the upper eyelid, forehead up to
the vertex; eye socket, eye bulb, tip of the nose, nasal
cavity), the acupoints BL2, GB14, TE23, GB3, GB16,
BL10, etc. on the affected side are needled, while thepoint BL2 is also needled on the healthy side.
Moxibustion:

GB16, GB5, TE22, GB12, TE17,

BL10, Sawada style LI4 and similar points are treatedwith moxibustion. In case of a neuralgia of the firstbranch in particular acupuncture and moxibustion
treatment of the point BL10 should not be forgotten.
This may induce a sudden relief of the pain.
For the treatment of the second branch, themaxillary nerve (pain in the lower eyelid, buccal region,
upper lips, nasal wings, anterior portion of the parietal
bone, upper row of the teeth. Pain of the pallate, nasal

letting frequently induces a sudden relief of the pain.
For the treatment of the third branch, themandibular nerve

(pain

in

the

mentalregion,mandibular region, inferior dental alveoli, external ear,parietal region etc.) ST7, ST6, ST5, ST4, Ikoten, GB2,
etc. are needled on the affected side, while moxibustion
is applied to GB2, TE17, L97, Sawada style LI4, etc.
For the treatment of the second and third branch,needling of SI18, ST7, ST5, etc. on the healthy side or
somewhat strong manipulation on the affected sidecan provide some relief of the pain.
In Meridian Therapy (channel based treatment)
deficiency and repletion of the various channels areadjusted and reactive points treated with acupuncture
and moxibustion. Sodo Okabe reported the following.
The first branch of the trigeminal nerve is governed by
the bladder and stomach channels, the second branch
by the stomach, gallbladder and tripple heater
channels and the third branch by the large intestineand stomach channels. Reactive points for the firstbranch include BL2, for the second branch ST1 AND
ST2, Shihaku and for the third branch ST5, ST6 AND
CV24. Needle retaining is probably most suitable forthe treatment of trigeminal neuralgia. From theaffected painful regions stiffness and muscle tension
spreads over the parietal region, covering neck,shoulder

and

back.

Searching

these

areas

for

indurations and tenderness allows to select thetreatment points and needles have to be retained here
until the pain disappears2).
Okabe determined the basic acupoints required forthe treatment of this disease and conducted histreatment following the relevant pattern. He stated
the following "Select reactive points from among thebasic points including GB14, ST1, BL2, GB3, ST7,
LI20, ST6, SI18, CV24, Iko, ST9, LI18, BL10, GB20,

cavity etc.) on the affected side GB3, ST7, SI18, ST3,

GB21, BL12, GV14, BL11, BL43 and LI15 for the

LI20, etc. are needled, TE22, SI19, GB5, TE17, LI10,

treatment."

etc. are treated with moxibustion. Furthermore, if

The relevant patterns can be divided into two

there are any fine visible vessels micropuncturing intypes. The first type is the greater hand yin pattern,

the buccal region, it could be beneficial to attempt

for which SP4, ST44, LI10, LI11, ST36, LI4, LU7 and

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similar points are selected. The second type, the lesser
foot yin pattern, for which KI10, KI7 and KI3, etc. are

Okabe was invited in February 1973 to theneedled. The point LI15 is effective for facial edema(former) Soviet Union and went to Moskow toand should be treated with a large number of moxa

treat

cones.

trigeminal neuralgia. At that time his patient was

GeneralZhukov,who

sufferedfromOkabe also stated the following. "Even for diseases

about 77 years old. The trigeminal neuralgiaof the upper half of the body the conditions will notreportedly affected the entire left side of the face

improve properly unless the patterns for liver, kidney,

and neck the patient had been in pain for about 5lung and spleen deficiency are adequately identified.

years. Okabe needled important points for the

Local treatment alone certainly does have some effect,

first, second and third branch of the nerve to a

but will not lead to a general improvement. Both indepth of about 2-3 mm while tonifying both kidneycases of trigeminal neuralgia as well as paralysis, theand liver channels. He said that in these cases thechannels on both the affected and healthy side have to

area

be needled in order to adjust them, even if the affected

importantarea is limited to one side of the body."3)experience, that needling of the neck can provide

from theandneck

upwards

believes,

based

is

extremelyonpersonal

considerable relief of the facial pain. Thus, theReferences
１

２
３
４

condition of General Zhukov improved constantly

Shirota B.: Practical Acupuncture andday by day and Okabe returned to Japan three

Moxibustion Therapy Based on Case Reports,months later. In September he went again to theVol. 1, p.385-394, Sogensha 1966

Soviet Union, spent about 2 weeks there and the

Okabe S.: Channel Therapy with Acupuncture

treatment

and Moxibustion p.119-121, Sekibundo 1974

recovery4). This story was derived from an essay

Okabe S.: The Essence of Acupuncture andcollection written by Okabe himself. It shows, that

Moxibustion Therapy, p.90, Sekibundo 1983

he apparently diagnosed a foot lesser yin pattern,

Publication group for an anthology of works intonified the correlated liver channel, and needledmemory of Sodo Okabe: Okabe S.: p.84-89,

important points on the face.

resulted

Tosho Printing Company, Limited 1985

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Clinical Application:
Facial Palsy (Bell's Palsy)

the bladder channel like BL2, gallbladder channel
GB6 and EX-HN5, small intestine SI18, stomach

Bell's palsy is a good indication for acupuncture
and moxibustion treatment. In this condition theseverity of the paralysis symptoms during the first few
days of the disease are an indicator of the prognosis.
Yet, in about 60% of the cases it heals without any
treatment, so that even if acupuncture and moxibustion
is effective, it would be difficult to express the degree towhich this treatment modality contributes to therecovery. Nevertheless many patients seek acupuncture
and moxibustion treatment, when western medical
therapy have been ineffective. Currently, in the absenceof therapies based on hard evidence, acupuncture andmoxibustion treatment has been proven worth a try
during all stages of the disease.
The earlier the treatment with acupuncture andmoxibustion starts, the better the prognosis. In
particular daily treatments should be administeredover several days following the onset. In many cases inwhich a certain degree of paralysis remains even after
a course of several months, complete recovery many
not be possible.
Bunshi Shirota recommended mainly adjusting
the general physical condition with moxibustion andthe use of acupuncture as a local treatment. Patientswere instructed to perform daily moxibustion at home.
Acupuncture:BL2, GB14, TE23, GB3, SI18, ST3, ST4, Ikoten, ST6,
ST5, ST7, TE17, BL10, GB20, TE15, BL18, LI11.
Moxibustion:
CV12, GV12, BL12, BL18, BL20, LI10, GV34, GB2,
TE22, GB2, GB16.
For the face thin No. 2-3 needles are used andinserted superficially (to a depth of up to 1 cm).
Occasionally,

threadlike

moxibustion

is

also

performed1).
Sodo Okabe made the following statement"Considering that the face is the affected body partsuggests the occurrence of anomalies in the brighteryang channels of both foot and hand. For this reason,
essential points on these channels should be added forthe treatment of the roots. For the face, acupoints ofchannel ST1, ST4, ST5, ST7 and LI20, large intestine
channel Geiko, etc. are selected depending on thesymptoms. At the same time stiffness of the neck andshoulder on the affected side and tenderness should be
noted. In particular, the region in front of and behindthe sternocleidomasteiod muscle should be checked forindurations and tenderness. Selecting points here isimportant in order to relieve increased tension andstiffness over the shoulders and back.
Needles should be inserted superficially to a depthof 1 to 2 mm and retained for a while. Hemorrhage isparticularly likely to occur on the face, so that shallow
needling should be a matter of course, while
indurations and tender areas on the neck allow
somewhat deeper needling. In general, if the limbs arecool, care should be taken to warm them. The face isparticularly related to both arms and legs, so thatwarming arms and legs can be considered an
important point for a successful treatment."2)
Isaburo Fukaya did not use any needles, but only
moxibustion for his treatment. He chose histherapeutic points not on the face, but mainly on theback, including GV14, GV12, SI14, BL18, BL15, BL14,
GB20, BL20 and similar points and applied threeextremely small moxa cones (half the size of a ricegrain) each on these points. Targeting tenderacupoints the disappearance of tenderness or
indurations during the treatment decreased therelevance of those points for the treatment. The point
Saninko on the leg was always selected. Usuallymoxibustion is not done on the face, but when
palpation revealed a reaction, points like SI19 or GV20
were treated with moxibustion. Sometimes it isnecessary to apply moxibustion several dozen times
until its heat is felt3). He reported several cases inwhich he achieved a complete cure with this method.
Besides ordinary acupuncture and moxibustion
treatment, electroacupuncture is also frequently used
for this disease. Umeda reported that strong electric
stimulation in new cases within 2 weeks after onset
may lead to nerve degeneration and thus may
aggravate the condition, so that for the treatment
during this period only shallow needling should be

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used4). Tsukayama also reported that during the earlyphase mostly needle retaining was used, while

References
1

2

sequelae of facial paralysis with asynchronoustransdermal low frequency electrization (AET)6).
Moreover, micropuncturing to let blood is also very

3

effective for this disease. In particular, if there are any
fine visible vessels micropuncturing in the buccal

4moxibustion treatment is effective, but compared toBell's palsy the effectiveness is insufficient.

AcupunctureandOkabe S.: The Essence of Acupuncture andMoxibustion Therapy p 96-97, Sekibundo 1983
Fukaya I.: Stories about Healing Diseases with
Moxibustion, Collections No. 1 to 10, Shinkyu no
Sekai Publisher, 1972
Tsuta Y., Hosokawa Y., Umeda T., et al.: Treatment
of Facial Palsy; Shinkyu Osaka Vol.13, No.1 54-72
1997

5

Ordinary needles would be sufficient for this purpose,but there are only very few reports on this form of

the herpes zoster virus, causing the Ramsay Hunt
syndrome marked by poor prognosis. Acupuncture andPractical

1, p. 292-296, Sogensha 1966

reported they achieved improvements in various
evaluation scores treating patients suffering frommicropuncturing.
Among the diseases causing facial palsy there isalso a viral infection of the geniculate ganglion withB.:

Moxibustion Therapy Based on Case Reports, Vol.

electroacupuncture was often used once the paralysis
had become fixed to a certain degree5). Arai et al.

region on the affected side should always be used to let
blood. Even a minimal amount will be effective.

Shirota

Yoshida N., Tsukayama H., Okada A., et al.:Diagnosis and Treatment of Facial Pain and Palsy;
Ido no Nihon 59(10) 7-20, 2000

6

Arai C., Yamaguchi S., Omata H., et al.: On the
Effectivenessof

Acupuncture

TreatmentofPatients with Sequelae of Facial Palsy, Summary
Collection of the 54th Conference of the Japan
Society of Acupuncture and Moxibustion, No. 201,
2005

Generally, needles need to be inserted to a depth of 3 toClinical Application:
Low Back Pain

5 cm, but when the patient has a fever like during a

Low back pain can have various causes, anddepending on the cause, requires the corresponding
specific treatment. Acupuncture and moxibustion
treatment is suitable for low back pain of any origin.
Shirota frequently used the following treatment
points for both acupuncture and moxibustion.
CV12, ST27, BL20, BL23, GB25 (Sawada style), BL25,
GV3 (waist), BL32, Onodera's gluteal point, Kampu,
GV34, LR4.

cold or immediately thereafter, needling for low backpain to a depth of 1.5 to 2 cm will be sufficiently
effective. If in these cases the entire back musculature
is tender, scatter pricking targeting the muscles along
the second line of the bladder channel from top tobottom often elicits a needle sensation (Hibiki) andproduces an immediate, marked effect.
Among the forms of low back is also one thatoriginates from neurasthenia and requires the use of
the acupoints GV20, BL10, BL11, GV12, etc. Without

Occasionally BL18 may be required. GB26 or

calming the central nervous system in this way,

GB28 can also be required. In either case, spots ofimprovements are rather unlikely. Subdermal needles

marked tenderness or induration are needled. In casemay be unexpectedly effective for pain of the lumbarof a strained back (acute myofascular low back pain),myofasciae causing pain while lying in bed. In caseapplication of acupuncture and moxibustion close toblood network vessels are visible in the lumbar region,

the vertebra at the level of BL26 can be very effective.

blood letting from these can be markedly effective1).

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Keiraku Chiryo (meridian therapy) is performed in

The results were evaluated based on VAS, andaccordance with the descriptions in the classics. For

according to the JOA score, superior improvements

example, the text Shinkyu Choho Ki (1718), publishedwere observed in the groups A, B and C, but not in

about 300 years ago in Japan, states that "greatergroup D3). This showed that either therapy is effective

yang low back pain is pain extending from the nape ofso some degree, while further studies will be required

the neck to buttocks, rendering the back heavy.

to determine which of these is superior.

Brighter yang low back pain prevents the patient fromlooking to the sides and suffer from stiffness. Lesser

As in this study, low frequency electroacupunctureyang low back pain feels like a needle piercing the skinis currently widely used in Japan and produces

and prevents the patient from assuming a supine

considerably good therapeutic results. The use of

position. Greater yin low back pain feels feverish andvarious other new therapies for the treatment of low

like a tree in the back, leading to leakage of urine.

back pain have also been reported. A therapy using

Lesser yin low back pain is like a bent bow, causing

trigger points is one of those and has alreadysilentanddeveloped in Japan into an established treatment form.

treatment

Research showed that it yields better results than

discomfort."

moxibustion

Currently,

therapists

acupuncture

perform

theirreferring to this description.

simply the treatment of tender points4).

Sodo Okabe said, "The waist is the pivot of the

Moxibustion, warming needle, intradermal needles,

entire body. Here six channels are involved. Among

pricking of the network vessels and Ryodoraku andthese, treatment of the lesser yang channel is ofmany other treatment forms are also practiced, but

central importance. In case of a strained back notthere are few publications in the form of case reports.

overly long after the onset of the symptoms, strong
reactions are found along the bladder channel, but in

References

prolonged cases the condition will be difficult to cure

1. Shirota

Practical

B.:

Acupunctureandunless the lesser yang channel is treated. Immediately

Moxibustion Therapy Based on Case Reports,

after the onset of the pain, when the patient is unable

Vol. 2, p.6-17,

to move, treatment of the acupoint Chufu of the liver

Sogensha 1966

2. Okabe S.: The Essence of Acupuncture andMoxibustion Therapy p. 123, Sekibundo 1983

channel is beneficial."2)
The "Taikyoku Therapy" developed by Ken Sawada

3. Kawase Y., Ishigami T., Nakamura H., et al.:and further improved by Shirota is currently practiced

Acupuncture

in Japan. Kase, et al. used Taikyoku Therapy andmultifacility randomized comparative trial using

conducted the following research.

sham acupuncture as a control, Journal of the

A total of 64 patients with low back pain weredivided into four groups:

therapy

for

low

back

pain

–

Japan Society of Acupuncture and Moxibustion 56(2) 140-149, 2006

Group A: receiving Taikyoku Therapy + low
frequency electroacupuncture;

4. Hirota S., Katsumi Y.: Comparative trial using
trigger point therapy and treatment of tenderGroup B: only Taikyoku Therapy;

points for patients with chronic low back pain,

Group C: only low frequency electroacupuncture;

Journal of the Japan Society of Acupuncture andGroup D: sham acupuncture.

Moxibustion 56 (1) 68-74, 2006

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Clinical Application:
Osteoarthrosis of the Kneecollecting fluid, in which case he reportedly applied atreatment generally promoting water management2).

Osteoarthrosis of the knee is a disease that rarely
required treatment in Japan until 1950. Two reasonsfor this are conceivable. The first was the rarity of
progressive aging of the population, where increasing
age is associated with the development of degenerative
diseases. The other reason was that the Japanesepeople at that time spent a major part of their daily lifeon tatamis (mats) and had the habit of sitting with
their legs tucked under. This life style required
simultaneously maximum bending and stretching of
the knee joints, the use of the muscles around the knee
joint in order to stand up from the sitting position. In
other words, they were training themselves. Later, theincidence of this disease increased in association withthe westernization of the life style of the Japanesepeople. In conjunction with the expected, even moreadvanced aging of the population, its incidence willprobably continue to increase in the future. Patientsusually consult orthopedists and undergo a variety oftherapies, but currently there is still no decisive
treatment. Acupuncture and moxibustion is one
extremely valuable therapy and recommended inparticular during the early stages of the disease.
BunshiShirotahas

usedacupunctureandmoxibustion to treat this disease and reported to haveachieved a cure within a period of 2-3 months. This
claim does not apply to cases with progressive
deformation.

He

recommended

thefollowing

acupoints: ST34, SP10, EX-LE5, LR8, ST36, GB34,
BL55, etc.; but in actual practice he often applied
acupuncture locally to the knee and performed wholebody treatment with moxibustion and thus obtained
his results1).
Sodo Okabe selected points above and below thepainful area on channels passing through it. If thepainful area itself was warm (feverish), he drained thepathogenic heat, while if the region was cool, heapplied a large number of moxa cones. Since
improvements often cannot be obtained by local
treatment alone, he treated the patients according to
the presenting pattern. The knees tend to be prone to72

Currently, the therapy for this disease is based on
the experiences of leaders in this field like the above
mentioned therapists. Nakao asserts that it isnecessary to pay careful attention to the point
selection depending on the painful or injured area inorder to obtain correspondingly good therapeutic
results3).
Ochi expresses his view that representative
acupoints for the treatment of this disease would be
ST36, SP9, GV34, GV31, EX-LE4 (inside), Shitsugan(outside), BL40, SP10, ST34, ST32, etc. among which
the appropriate points for the treatment at hand are
selected. Moreover, in order to examine the importanceof a combination therapy comprising acupuncture andexercise therapy, the following trial was performed.
Forty-eight patients (12 men and 36 women) for whomroentgenography

identified

in

the

early

or

intermediate stage of the disease were included in the
study. They were divided into three groups: Group A:
18 patients (acupuncture, SSP combination therapy);
Group B: 20 patients (acupuncture, SSP, exercise
combination therapy); and Group C: 10 patients (onlyexercise therapy). The therapeutic results as evaluatedwith the JOA score and measurements of muscle
strength with a sthenometer showed that in the fourthweek after treatment began, a reduction of the pain
had been achieved in groups A and B, while anincrease in knee extensor power was observed ingroups B and C. Based on these results, it was statedthat a combination of acupuncture and exercise
therapy produces even better results4).
Besides ordinary acupuncture a number of othertreatment forms have also been tried.
Low frequency electroacupuncture is frequently
used. Furukawa et al. applied a 50 Hz stimulus to theknee joint region and reported on the observed
course5,6).

Concerning

pain

the

treatmentwasreportedly effective regardless of the grade, but
improvements of the activities of daily living arereportedly difficult to achieve in cases of advanced
gonarthrosis.
The warming needle method too is an effective

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

treatment form. Tanaka has presented the method fortreatment with the warming needle in supine positionchoosing the points ST32 (rectus femoris muscle),
SP10 (vastus medialis muscle), Kampu (vastus
lateralis muscle), Shitsugai (articular space), SP9 andGV34, and in the prone position KI10 (articular space),
BL55 (triceps muscle of the calf), SP9 (triceps muscleof the calf), Soto Chokuritsu (biceps femoris muscle)
and the Chokuritsu (semimembraneous muscle)7).
Moxibustion is an effective treatment for thisdisease, but so far there are few written reports on it.
Recently, Uryu, et al. used sham moxibustion in acontrolled clinical trial (CCT) to examine the effects ofwarming moxibustion He divided the patients into a
warming moxibustion and a sham moxibustion groupand reported the treatment to be effective for the
pain8).
Kuroiwa, et al. reported the practical application of
trigger points during acupuncture treatment. The useof single points was rare and they reasoned that it isnecessary to use several points during the acupuncture
treatment in order to guarantee adequate relaxation of
the muscles9).
Otherwise network vessel pricking is also effective.
In particular in cases of marked swelling of the knee
joint dramatic effects are seen. Therefore many
therapists do use this modality, but the number ofreports is small.

References
1. Shirota B.: Practical Acupuncture and Moxibustion
Therapy Based on Case Reports, Vol. 2, p.6-17,
Sogensha 1966
2. Okabe S.: The Essence of Acupuncture andMoxibustion Therapy p. 123, Sekibundo 1983
3. Nakao M.: Acupuncture and moxibustion treatment
for osteoarthritis of the knee (4) − case reports
classified by painful region - Ido no Nihon, Vol. 532,
p.15-26, 1986
4. Ochi H.: Acupuncture and moxibustion treatment
for gonalgia (osteoarthrosis of the knee), Ido no
Nihon, Vol. 664, p.16-26, 1999
5. Yamaguchi S., et al.: Effects of low frequency
stimulation for osteoarthrosis of the knee (firstreport), Journal of the Japanese Society Of
Balneology, Climatology and Physical Medicine,Vol. 54 (3) 155-160, 1991
6. Komazaki Y., Shinjiro Yamaguchi, Jun Hamada,others: Low frequency stimulation for osteoarthrosisof the knee, Ido no Nihon, Vol. 585, 1993
7. Tanaka H.: Introduction to the warming moxa (9) –therapy (3), gonalgia, Ido no Nihon, Vol.508, 1986
8. Uryu N., Katsumi Y., Itoi M., et al.: Effects ofwarming moxa therapy osteoarthrosis of the knee,
Summary Collection of the 54th Conference of theJapan Society of Acupuncture and Moxibustion,
No. 150, 2005
9. Kuroiwa K., Sakai S., Morita Y.: Introduction toacupuncture treatment using trigger points forshoulder, low back and knee [1], approach togonalgia (Vol.1), Ido no Nihon, 18-24 No. 634,
1997

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Clinical Application:
Periarthritis Humeroscapularis
Periarthritis

acupoints, BL41, BL43, GB21 and similar points on
the back constitute the main therapeutic points2).

humeroscapularisisadiseaseoccurring mainly in people in their 50s characterized bypain in the shoulder joint and limitation of movement.
In Japan it has been termed "Fifty-age shoulder"because it develops mainly after that age. The western
medical approach to the pain is rest, administration ofanalgesics,

andinjectionofsteroids

orsodiumhyaluronate into the synovial sac. This treatment iscombined as early as possible with exercise therapy
within a range that does not cause pain.
It is a good indication for acupuncture andmoxibustion

treatment

which

is

often

markedlyeffective. Shirota stated that mild cases of the condition
may heal within a period of 2 to 3 weeks, while
moderately severe cases may require 1 to 1.5 months. In
severe cases, the treatment may require more than 3months. Yet, a cure is usually achieved within a periodof 3 months. Treatment may consist solely ofmoxibustion, but a combination of acupuncture andmoxibustion reportedly will accelerate the cure. He
recommends the following treatment.
GV12, TE15, BL43, SI11, SI10, LI15, LI15, LU1,
LU3, LI11, LU4, LU6.
In patients with spontaneous pain, the acupoints
BL10, BL11, SI6, etc. on the affected side are often
required. In order to alleviate spontaneous pain andlimitations of movement at an early stage, obvious
tender spots around the shoulder joint were needledshallowly as required. Intradermal needles were also
applied1).
moxibustion

Fukayaonly.

treatedHe

thisdiseasewithcarefully

observed

themovements of the muscles related to the shoulder
joint, searched for tender spots within these muscle
groups, and palpated for indurations. Mostly he used
SI11, SI9, SI10, LI14, TE12 and on the front side LU1,
LU2, LU3 and LU4. In particular, Ketsubon, or spots
a little lateral of it, is a famous moxibustion point forthetreatment

of

this

supplementing

theaction74

condition.
ofsuch as presented below:
Patient:

A 58-year old woman with a limited

range of motion of the left arm and associated pain.
She visited a local physician because the arm was
uncomfortably painful during the night and treatedwith injections that were completely ineffective. She
also underwent shiatsu and moxibustion treatment,
but the condition nevertheless remained unchanged.
Fukaya applied seven cones half the size of a rice grain
to the acupoints GB21, BL41, SI11, TE12 and SI9.
When he instructed the patient to raise her arm, thepatient replied, "I cannot possibly be able to raise myarm so quickly. Besides, moving it will be painful."Shedid not even try to raise the arm. I told her, "Thestiffened muscles have been relaxed, so you will beable to raise the arm painlessly, so please raise it."
When the patient doubtfully tried to raise the arm, itwent up smoothly. When requested to turn it onto herback, she could effortlessly turn the arm. Yet, she still
felt pain at the shoulder joint. When the patient was
requested to assume a slightly oblique posture,

Acupuncture and moxibustion:

IsaburoFukaya has reported highly interesting case studies

Otherwise,

aforementioned

pressure a short distance lateral of ST12, an
excruciatingly painful spot was revealed. Pressure on
the point LU1 elicited the same kind of pain. Following
application of seven cones of moxa as described aboveon these two points, the patient could rotate the arm
easily. Delighted, the patient raised and rotated herarm. Fukaya made the following comments regarding
this case. "The patient should be afforded this kind ofrelief from the pain in exchange for enduring the very
hot moxibustion. However, this patient was not yet
cured. On the following day there was a relapse but
she now had developed faith that the moxibustion
treatment would work so the treatment could becontinued. For a patient with these symptoms, first
apply moxibustion to important points for thetreatment of this disease. Repeat this treatment andthen check for the remaining pain. Then you may look
for the next therapeutic points. Regarding the point
selection, good effects will not be obtained unless there
is marked tenderness. This is very important2).

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Although this disease is marked by lesions of theSI3 on the affected side. For the regional treatment,

shoulder joint, it can often be cured by using acupoints

the shoulder pain point, SI9 and irregular reactiveon the legs. In the 1950s, Sorei Yanagiya, a leader ofspots are needled.

Japanese acupuncture and moxibustion at that time,

E. If GB26 on the affected side is very tender, needle

was once asked during a lecture to treat theTE5 and GB41.

periarthritis humeroscapularis of one of person in theF. If the shoulder joint pain streches over a wide area,

audience. Checking the pulse of that person heretain the needles in ST38 and BL57 (in Chinese

predicted, "This will be cured by the great needling

medicine penetrating needling from ST38 to BL57 ismethod," and needled Fukuryu on both sides. When heused, but separate needling is also effective).

next needled Gokoku on the left, the patient could liftThus, for the treatment of this disease thethe right arm higher than had been possible so far.

channels passing through the region of the shoulder

That had been a feat of agility of about 2-3 minutes3).

joint are frequently taken into consideration.

This is just one example, but many acupuncturists
take a similar approach.

Tanaka palpates for reactive spots on the channels
associated

with

the

painfulareas

orchannels

Nishida takes the meridians, channels, andassociated with the relevant meridians, channels andcollateral channels into account that pass through thecollateral channels (for example the greater yangvicinity of the shoulder joint and performs thesmall intestine channel and the greater yang bladderfollowing type of treatment4). First, regarding thechannel, or the brighter yang stomach channel and thesequence of the treatment, he uses acupoints on thegreater yin spleen channel) and says that the selection

legs, next points on the arms or else remoteof very painful points is beneficial5).

extraordinary points and then finally selects points

Sakamoto pricks network vessels if present andaround the shoulder joint, extraordinary points orthen applies cupping for nocturnal pain. Moreover, heirregular reactive spots (Aze points).

says that in particular for the kidney yang deficiency

A. In case of pain on the anterior side of the shoulder

type aggravated by cooling the regional application (tojoint, use the acupoints SP9 or SP8 of the greater yin

the shoulder joint) of warming needles is also

spleen channel of the foot associated with the greater

beneficial5).

yin lung channel of the hand. Needle LU5 next andfinally perform a regional treatment.

References

B. In case of pain on the lateral side of the shoulder

1. Shirota B.: Practical Acupuncture and Moxibustion

joint, use the acupoints ST38 of the stomach channel

Therapy Based on Case Reports, Vol. 2, p. 252-279,

associated with the brighter yang large intestine

Sogensha 1966

channel of the hand and then needle strongly tender

2. Fukaya I.: Stories about Healing Diseases withpoints among LI11, LI10, or LI4 of the large intenstine

Moxibustion, Collections No. 1 to 12, Shinkyu nochannel of the hand.
C. In case of pain on the posterior side of the shoulder
joint, first needle GB34 of the lesser yang gallbladderchannel of the foot associated with the lesser yang
triple heater channel of the hand, then needle TE5,
and finally TE14 and TE13 in the region of theshoulder joint.
D. In case of pain under the shoulder joint, first needle
BL57 of the greater yang bladder channel of the footassociated with the greater yang small intestine
channel of the hand on the affected side, next selectSekai Publisher, 1972
3. Uechi S.: Acupuncture and Moxibustion of the
Showa Period, pp 263-264, Sekibundo, 1985
4. Nishida K.: Record of personal experiences withoriental medicine 4, acupuncture and moxibustion
treatment of shoulder joint disorders, Ido no Nihon,
Vol. 633 pp 38-56, 1997
5. Tanaka S., Matsuura H., Watanabe G., Okumura Y.,
Sakamoto T.: Effective approach to frozen shoulder
Shinkyu Osaka Vol.8 No.1, pp 4-15, 1992

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

insurance. The only exceptions are cases of: ① low

Current Status of Acupuncture in Japan
Tadashi Yano
Health Medicine Department
Meiji University of Oriental Medicine

The history of acupuncture therapy in Japan dates
back to the year 562 CE, when the physician/monk Zhi
Cong brought books on Buddhism and acupuncture
China.

This

was

the

beginningoftheacupuncture tradition in Japan.
Chinese traditional medicine was changed overtime in Japan to adapt to the physical characteristicsof the Japanese people while also incorporating someelements of Western medicine and native Kampo
medicine. It developed gradually into a uniquely
Japanese approach to traditional medicine. However,in the Meiji Era, the government abolished Kampo
medicine and established German medicine as thebasis for Japanese mainstream medical practice.
Acupuncture education continued to be permitted, but
only as employment training for the visually impaired,and acupuncture was positioned well outside themedical mainstream. That positioning and educational
system has continued into the present day.
This article will provide a short overview of thehistory and current status of acupuncture in Japan, in
hopes that the information provided here will lead to
improved understanding of Japanese acupuncture
therapy.

modern medicine provides little hope of relief. Thoseconditions can be covered by national health insurance
if the doctor signs a form certifying that the condition
cannot be cured by orthodox medicine. However, since
only a few Japanese physicians understand theacupuncture system, it can be quite difficult to obtainacupuncture therapy under national health insurance
even for patients who have these approved conditions.
3. The licensing system for acupuncturists andmoxibustionists
A license is required in order toperform

acupuncture or moxibustion therapy. This is because
acupuncturists and moxibustionists have legislated
statusinJapan.

acupuncturists

The

and

professional

moxibustionists

statusisoflegallyprotected, and since their right to independently
operate a business is assured, they are able to open an
acupuncture clinic. However, legislation assures thatno one other than a physician can perform moxibustion
and acupuncture therapy [in such a facility], whichmeans that moxibustion and acupuncture may not be
performed by non-physician health care practitioners.
Thus, licensed acupuncturists and moxibustionists
are free to start a business. However, they are strictly

2. The position of acupuncture therapy
In Japan today, the use of acupuncture within a
medical institution is prohibited. This means that
acupuncture is effectively positioned outside theprimary medical system as "unorthodox" medicine.
Acupuncture is considered to be "free" treatment
meaning that it does not come under the jurisdiction ofnational health insurance, and therefore the services
and fees are not regulated by the government.
Generally, acupuncture must be paid for directly by
the patient, rather than being covered by health76

neuralgia, ④ rheumatoid arthritis, ⑤ cervicobrachial
syndrome, and ⑥ cervical sprain, where mainstream

1. Introduction

fromback pain, ② age-related shoulder pain or stiffness, ③

prohibitedfromperforming

moxibustionor

acupuncture within a medical facility alongsideorthodox mainstream medicine, and their access tonational health insurance coverage for their patients isstrictly limited.
Acupuncturists

andmoxibustionists

arecredentialed by the national government. Thosestudents who qualify for college entrance examinations
must study at a designated school for three years (fouryears for university students) and earn specific credits
in order to qualify for the national examination. Those

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

students who pass the national examination andmay include some acupuncturists and moxibustionists

receive a license are permitted to perform acupuncture

who are not currently practicing. According to a survey

and moxibustion therapy. Nearly all examinees apply

by Fujii and colleagues1), approximately 26.5% of thatsimultaneously for both the acupuncturist license andnumber are not actually engaged in the practice oftheacupuncture/moxibustion.

moxibustionist

candidateislicense,designated

and

as

an

the

successful"acupuncturea/

moxibustionist" (or simply "acupuncturist") in Japan.

The register of enrolled (licensed) acupuncturists
and moxibustionists showed 127,018 acupuncturists
and 125,868 moxibustionists in Japan as of September
2005. However, these figures represent the number of
persons in the enrollment register, and do not indicate
the number of acupuncturists and moxibustionists
who are actually working in the industry. The trueofacupuncturists

andmoxibustionists

currently employed in clinical moxibustion andacupuncture is unknown, but a 2004 report on healthand sanitation administrative operations by the
Ministry of Health, Labor, and Welfare showed a totalof 76,643 acupuncturists and 75,100 moxibustionists
at that time (Table 1).

Acupuncture,thenumber of acupuncture clinics providing related formsof alternative medicine showed 14,993 clinics offeringoffering traditional amma massage and shiatsupressure-point massage as well as moxibustion andacupuncture in Japan (2004 report on health andsanitation administrative operations by the Ministryof Health, Labor, and Welfare)2), for a total of 48,594
clinics providing moxibustion and acupuncture.
Based on these findings, we can estimate a total of
approximately

55,000acupuncture/moxibustionists

actively practicing in Japan today.
5. Clients seeking moxibustion and acupuncture
therapy
Table 2 shows the frequency with which people
who had medical complaints ("yusosha") selectedvarious

types

of

1992

1994

1996

1998

2000

2002

2004

treatment options for

12055

12481

13166

13455

14216

14008

14993

their

moxibustion
Amma, shiatsu,

intomoxibustion and acupuncture, and 33,601 clinics

4. Number of acupuncturists and moxibustionists

numberInvestigation

symptoms,

according to a 2001
28624

29451

30850

31434

32024

32722

33601

basic national healthacupuncture,

surveymoxibustion

Forms of treatment
such
and

Japan.

asamma,

Table 1 Annual trends in working acupuncturists andmassage,moxibustionists

accounted for 7.4% of the total. The term ”yusosha”,(2004 report on health and sanitation administrative

meaning people who had subjective symptoms, wasoperations by the Ministry of Health, Labor, andintroduced as an index for health status among the

Welfare)Japanese people. The 2001 survey found 4,0552,000

The totals from the Ministry of Health, Labor, andshiatsu,inacupuncture/moxibustion

yusosha, 322 out of every 1000 individuals. It was

Welfare are for all acupuncturists and moxibustionists

estimated

who registered with their public health center, andpatients

thatapproximately

received

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

300,000

treatment

of

these

at

an
77

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010acupuncture/moxibustion/massage clinic. It was also

did not focus specifically on the situation regarding

reported that approximately 7% of all sick and injured

moxibustion and acupuncture therapy, the author andpersons sought out such alternative clinics for theircolleagues performed an annual interview survey

treatment.

during March in each of the four years from 2003
through 2006. This nationwide survey

Hospital or

Over-the-counter

Amma,

Other

No

mainstream

drugs

acupuncture,therapies

treatment

medicalpoulticesorclinic
49.7%

19.9%

used a random sampling of 2000 men

moxibustion,

and women 20 years of age or older

etc.

(2000 names collected from 157 regions

7.4%

3.7%

across Japan, including 122 cities or

21.8%

municipal wards and 35 towns or villages). This survey
Table 2 Treatment options selected by yusosha

also excluded patients in hospitals and extended-care(2001 survey of health status in Japan)

facilities. The response rate differed somewhat from

These indicators in all cases relate to the situation
for patients receiving treatment. However, since judo
therapy was included in the category of "Amma,
acupuncture, moxibustion, etc.", these figures do notprovideanaccurate

pictureofthestatusofacupuncture/moxibustion therapy.
A nationwide survey of the use of complementary
andalternative

medicine(CAM),

includingmoxibustion and acupuncture, was initiated by
Yamashita

3)in April 2001. For their survey,

Yamashita and colleagues used RDD (Random Digit
Dialing)andayear to year, but was approximately 68%. The primaryreasons for non-response included change of residence,long-term absence, short-term absence, unknown
address, and refusal to respond.
The results of this survey clearly showed that 6%
to 7% of Japanese persons 20 years of age or older
visited an acupuncture/moxibustion clinic during theyear (Table 3). Results for the March 2004 survey
showed a lower level of such clinic visits, but still
within the range of significant error for the March
2003 figures.

telephoneMarchquestionnaire. Their subjects were

2003

March
2004

March
2005

March
2006

persons 20 to 79 years of age who

No. of responses

1,420

1.338

1,337

1,346

were not residing in a hospital or

Consultation rate

6.4%

4.7%

6.4%

6.7%

extended care facility. The survey was

Response rate

71%

66.9%

66.9%

67.3%

continued until 1000 subjects had been contacted.
Even though the response rate was only 23%, thissurvey was notable because it was the first such
survey of CAM to be performed in Japan. The resultsofthesurveyshowednutritional

drinksTable 3 Moxibustion and acupuncture consultation
rates and response rates
Both the findings by Yamashita and colleagues andandthose from our own studies, showed that moxibustion

supplements to be in first place, used by 43% of

and acupuncture therapy accounted for approximately

respondents while moxibustion and acupuncture were

6% to 7% of the annual response to medical

reportedly used by 6.7%.

complaints.

Because the survey by Yamashita and colleagues

If we can determine the mean number oftreatments per patient, then we can also calculate the78

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

total number of patient treatments given. Assuming atreatment rate of 6% gives us an estimated 6 million
patients treated. If we also assume an average of 5treatments per patient, then the total number ofpatient treatments would be 6 million × 5 times, or
total of 30 million treatments. A treatment rate of 6.5%
would be 32.5 million treatments, and a treatment rateof 7.0% would indicate 3.5 million treatments.
Acupuncture/moxibustion clinics can provide a
broad spectrum of care, fromhealth maintenanceand wellness care to the treatment of presymptomatic
illness, treatment of disease, and improvement ofquality of life for chronic disease patients. However,
unfortunately acupuncture/moxibustion therapy iscurrently used in only 6% to 7% of cases. If we candetermine why this use rate remains so low, and thenremedy at least some of the reasons for that low use,

Table 4: EQ-5D

Men

Women

Mobility(%)(%)

No problems

81.5

76.4

Some problems

18.5

23.6

No problems

93.0

95.2

Some problems

7.0

4.8

No problems

77.3

77.4

Some problems

22.7

22.6

None

39.9

31.2

Moderate or above

60.1

68.8

None

79.4

73.2

Moderate or above

20.6

26.8

Self-care

Usual activities

Pain/discomfort

Anxiety/depression

acupuncture/moxibustion therapy could experience aEuro-Qol expresses health status as a numericalnew spurt of growth and development in Japan.

value (the functional value or Tariff Score), providing a
6. Health status in those patients who seek out
acupuncture/moxibustion therapy, and their reasonsfor seeking such treatment
In a survey of health status in patients seeking
acupuncture/moxibustion

therapy,

Takanoandcolleagues4) performed a survey based on the Euro-Qol
measure of quality of life (a measure of healthindicators developed in Europe). The survey was
designed as a random sampling of 2210 patients acrosshealth indicator that is used internationally. Healthstatus is assessed on a scale from +1.00 to -0.594, withperfect health scored as 1.0, death as 0.0, and "worse
than death" as -0.594. In addition, since the survey
sheet consists of the 5 separate categories of ①
mobility,②

self-care,

③

usual

activities,④

pain/discomfort, and ⑤ anxiety/depression, patient
responses can give an insight into health status ineach of these different categories.
The surveys by Takano et al.4) and by Ishizaki etJapan, performed through 101 clinics operated byal.5) show that pain and discomfort play a major role ingraduates of Meiji University of Oriental Medicine.

the health status of many patients who seek out

From the 1230 valid responses obtained, the meanacupuncture and/or moxibustion treatment. Thisfunctional value (Tariff Score) was reported to be 0.782

suggests that a primary use of acupuncture and± 0.22 (mean ± SD). Using these materials, Ishizaki

moxibustion in Japan is for relief from pain andanddiscomfort.

colleagues5)

reviewed

theEuro-Qol

EQ-5D

domains (① mobility, ② self-care, ③ usual activities,④ pain/discomfort, and ⑤ anxiety/depression). They
found that "④ pain/discomfort" was a significant factor
for

a

high

percentageofpatients

acupuncture/moxibustion therapy (Table 4).

seekingA

reviewofthepatient's

objectives

inacupuncture/moxibustion

treatment

showedthat

81.6% of complaints involve the musculoskeletal
system. The next most common reasons for seeking
treatment were malaise (6.9%), relaxation/wellness(5.1%), and headache (4.8%). The review by Yamashita

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

79

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

et al. 3) showed musculoskeletal complaints accounting

effects can be expected to provide benefits in diseasefor 79.1% of the total. The review by Takano et al. also

prevention

showedrelaxation.

apreponderanceofmusculoskeletal(healthmaintenance),wellness,andcomplaints, particularly low back pain (59.8%),

However, regardless of these potential benefits, theshoulder stiffness (59.1%), neck stiffness (43.3%), legsituation remains that acupuncture/moxibustion ispain (24.8%), shoulder pain (22.7%), and knee pain

currently used in Japan almost exclusively for the(20.7%).

treatment of chronic musculoskeletal complaints. In

Most

of

the

patients

visiting

contrast,

there

are

countries

overseas

where

acupuncture/moxibustion clinics were seeking relief

acupuncture is being used relatively widely in thefrom musculoskeletal complaints, or improvement intreatment

musculoskeletal symptoms. There were very few visitscomplaints8). In the United States, acupuncture clinics

for other reasons. These findings suggest thatreport that musculoskeletal complaints account forawarenessof

only 33.9% of treatments9). This suggests that the

somewhat

focus primarily on musculoskeletal disorders may be

of

the

potential

acupuncture/moxibustionisbenefits

generally

restricted in Japan. There are a number of factors thatofallergic

rhinitisandpsychiatricspecific to Japan.

may contribute to this situation, including the fact
that

most

of

the

current

acupuncture/moxibustion

patients

specifically

turn

to

7. New developments in acupuncture/moxibustion

for

the

therapycomplaints of low back pain, shoulder stiffness, and

As

noted

above,

in

Japan

the

use

of

arthralgia, and the fact that all of the six conditions for

acupuncture/moxibustion tends to be limited to thewhich acupuncture/moxibustion therapy is covered bytreatment

national health insurance fall under the category ofcharacterized by regressive changes. However, a broad

musculoskeletal disease.

range of recent developments promises to add new life andHowever, this is not all that acupuncture patientsofmusculoskeletal

diseases

that

are

direction to acupuncture/moxibustion therapy (Fig. 1).

hope for when they seek out acupuncture/moxibustion
therapy. According to a report by Yano and colleagues(based on the same materials as the Takano andIshizakireports)6),

thelargestnumberofPreventative
acupuncture
Wellness
acupuncture

acupuncture/moxibustion patients hoped for "relief
from symptoms" (70.4%), followed by "disease cure"Sports acupuncture

Acupuncture
therapy(49.2%), "disease prevention (health maintenance)"

Cosmetic
acupuncture

Acupuncture for
women

Industrial
acupuncture(49.2%), "greater wellness" (32.5%), and "relaxation"(24.5%). These results suggest that, in addition to adesire for symptomatic relief and human from disease,

Fig. １ Areas of Specialization formany acupuncture/moxibustion patients are also

Acupuncture Therapy

interested

in

preventative

medicine(healthmaintenance), wellness, and relaxation.
Goals such as these can be achieved in the processof acupuncture/moxibustion therapy. For example,
there are reports that approximately 80% of patients
"feel

in

a

better

mood"

after

treatment

withacupuncture/moxibustion7).

Thissuggests

that

acupuncture/moxibustion patients experience a rangeof beneficial effects from treatment, and that those80

Acupuncture and moxibustion use a holistic
approach based on patient-centered medicine. The
treatment does not involve drugs, but instead utilizes
healing principles that encourage the body's innate
power to heal itself. We are now approaching a point
where applications based on acupuncture/moxibustion
therapy could produce major developments in a variety of
medical fields. Current areas of activity include sports
acupuncture and acupuncture specifically addressing

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

women's health issues. Other areas with strong potential
for development include pediatric acupuncture,industrial acupuncture (health keeper), cosmetic
acupuncture, and acupuncture for presymptomaticconditions.
Sports acupuncture is a specialized field that
focuses on preventing injuries and improving athletic
performance through conditioning. There is currently
a movement underway, in cooperation with regional
health clubs and educational institutions, for Japan toestablish its own "trainer system" to provide healthmanagement for competitive athletes throughacupuncture/moxibustion
therapy.
Also,
recentadvances in gender-specific medicine have brought
into sharp relief the need for treatment methods
designed specifically to match the various stages of awoman's life cycle. This includes child-rearing, and theneed for robust mental and physical development of
the child along with good health for the mother.
Other areas where we expect to see development
are industrial acupuncture (health keeper), cosmetic
acupuncture,andpresymptomatic
medicine
acupuncture. Industrial acupuncture (health keeper),still in the testing stage at present, will be a
specialized field focusing on the maintenance andpromotion of good health and the prevention of disease
in working populations. This is a newly developing
area intended to complement industrial medicine andtraditional mainstream medicine. The specialized areaof cosmetic acupuncture, now being developed incollaboration with esthetic treatment, is based onhealing and health management, in conjunction withthe long-standing interest in the promotion of good
health in this area, and is designed to be incorporated
into a complete program. An area of particular interestis presymptomatic acupuncture. This area, which
focuses on the prevention of lifestyle diseases and themaintenance and promotion of good health, ispotentially the most important of all of the new areas.
There is thus great potential for growth inacupuncture/moxibustion therapy. It is to be hopedthat these developments will occur in specialized fields
and will be securely grounded in evidence-based
medicine (EBM), and that further research to provide
such evidence will be actively pursued.

References
1) Fujii R., Yubita T., Yoshiizumi T., et al.: Employment
trends and issues for the visually impaired in theacupuncture, moxibustion, and massage industries -research into economic self-reliance support for thevisually impaired, National Institute of Vocational
Rehabilitation, Japan Organization for Employment of
the Elderly and Persons with Disabilities (independentadministrative

organization),

ReportofResearch

Review No. 69, 2005.
2) Ministry of Health, Labor, and Welfare: 2004 report on
public health administration and service, number ofworkersinhealth-care-related

occupations,

URL:

www.mhlw.go.jo/toukei/saikin/hw/eisei/04/kekka3.html
3) Yamashita H., Tsukayama H., Sugishita C.: Popularity ofcomplementary and alternative medicine in Japan, atelephone survey, Complement Ther Med: 10;84-93, 2002
4) Takano M., Fukuda F., Ishizaki N., et al.: Cross-sectional
researchonextentofsatisfaction

withacupuncture/moxibustion treatment among patients ofacupuncture/moxibustion clinics, Japan Society of
Acupuncture and Moxibustion, 55(2); 562-574, 2002.
5) Ishizaki N., Takano M., Fukuda F., et al.: Using EuroQol
ED-5D to assess health status among patients at
acupuncture/moxibustion clinics, Health and Welfare
Statistics, 49(8), 20-25, 2002.
6) Yano T., Takano M., Ishizaki N., et al.: Report of healthsurvey and questionnaire on acupuncture/moxibustion
therapy,

ClinicalResearchon

Wellness-focused

Acupuncture/ moxibustion Therapy, Foundation forTraining and Licensure Examination of Asian Medical
Treatment Methods, 79-92, 2002.
7) Yano T., Mori K., Yukimachi T.: Acupuncture, moxibustion,and stress relief, Japan Society of Acupuncture andMoxibustion, 43(4): 1-11, 1993.
8) White A., Ernst E.: Public usage of Acupuncture in the West.
In; Ernst E. and White A. (ed), Acupuncture, a scientificappraisal, Oxford Butterworth Heinemann, 5-7, 1999
9) Tsuru H., Ishizaki N., Taniguchi K.: Analysis of 2967
patients at Meiji College of Oriental Medicine (US)Clinic (1996-1999), Meiji Shinkyu Igaku (Journal of
Meiji University of Oriental Medicine) 61-81, 2003.

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Japanese Acupuncture Educational and
Licensure System
Shuji Goto
The Japanese acupuncture educational andlicensure system seems quite unique from a global andhistorical viewpoint. Considering the expected
increase of important role in future health care,
Japanese acupuncture and moxibustion therpy should
be further improved and exemplified.
1. Licensing system
Only licensed physicians, licensed acupuncturists,and licensed moxibustionists may provide acupuncture
and moxibustion treatment in Japan.
The license of an acupuncturist or moxibustionist is
specific to that person and to that field of practice.
(Legislation No. 217, Article 1, December 20, 1947)

2. License requirements
Applicants must have graduated from anacupuncture and moxibustion school recognized by theJapanese Ministry for Health, Labor, and Welfare(MHLW) or from a university or college (or in the caseof the visually impaired, from a school for the blind ora center for the visually impaired) recognized by the
Ministry of Education, Culture, Sports, Science, andTechnology. These graduates must also pass an
examination by the MHLW.
3. Current status of the national examination
At present the national examination is given under
the auspices of the MHLW, and is administered by theFoundation for Training and Licensing Examination inAmma Massage-Acupressure, Acupuncture, andMoxibustion.

the fairness of this examination for visually impaired
applicants who are permitted the use of Braille andtape recordings, and who are allowed extra time tocomplete the examination (1.5 times longer than forsighted students). The ratio of sighted to visually
impaired examinees is approximately 9:1.
The examination covers the following areas.
Topics for the acupuncturist examination (general
medical treatment, sanitation, public health, related
legislation, anatomy, physiology, general pathology,
introduction to clinical medicine, particulars of clinicalmedicine, rehabilitation medicine, general theory ofEastern medicine, general theory of the meridians andacupuncture points, clinical theory in Eastern
medicine, and acupuncture theory)
Topics for the moxibustionist examination (general
medical treatment, sanitation, public health, related
legislation, anatomy, physiology, general pathology,
introduction to clinical medicine, particulars of clinicalmedicine, rehabilitation medicine, general theory ofEastern medicine, general theory of the meridians andacupuncture points, clinical theory in Eastern
medicine, and moxibustion theory)
Recent pass rates are shown below.

2005
2006
2007
2008

Foundation for Training and Licensing Examination in Amma
Massage-Acupressure, Acupuncture, and Moxibustion
http://www15.ocn.ne.jp/~ahaki/index.html

The first national examination was given in 1993,
and examinations have been offered annually sincethen. The examination, which is given at 50 locations
throughout Japan, consists of 160 multiple-choicequestions. A score of 60 is required to pass.
The national examination does not include
practicum testing which is left to the discretion of eachschool. A number of provisions are made to increase82

No. ofExaminees

No.
PassedPass rate(%)

Acupuncture

4271

3396

79.5

Moxibustion

4271

3382

79.2

Year

2009

Acupuncture

4707

3789

80.5

Moxibustion

4704

3785

80.5

Acupuncture

5275

4068

77.1

Moxibustion

5261

4072

77.4

Acupuncture

5561

4347

78.2

Moxibustion

5539

4344

78.4

Acupuncture

5354

4216

78.7

Moxibustion

5320

4171

78.4

4. Current status of education
1) In April 2005, there were 71 acupuncture schools forthe sighted in Japan, of which 43 (2 universities and
41 private vocational schools) were members of the
Oriental Medicine College Association and 28 were
unaffiliated. In 1999, there were only 28 schools
throughout Japan, but this number has increased
since the system was reformed in 2000.

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

There are 69 schools in Japan for the visually impaired(1 junior college and 68 publicly funded schools for theblind or centers for the visually impaired), withapproximately 300 students.
These schools offer a 3-year program in preparation
for the acupuncturist/moxibustionist examination, withthe option of also studying simultaneously for theexamination for Amma massage/shiatsu massage
therapist. Students also have the option of enrolling in
the program preparing for the Amma massage/shiatsu
massage therapist examination only.
The schools for sighted students have anenrollment capacity of approximately 8000 students inprograms preparing for theacupuncturist andmoxibustionist examination.
The 3-year program includes the following
required courses and credits (hours).
Basic studies
Basics of scientific thought, social studies 14 credits
Foundation for field-specific studies
Structure and function of the human body 13 credits(anatomy, physiology)
Advances in disease prevention and recovery 12 credits(pathology, sanitation, rehabilitation medicine, introduction
to clinical medicine, and particulars of clinical medicine)
Philosophy of acupuncture and moxibustion in relation to
health, medical treatment, and welfare 2 credits (general
medical treatment, and related legislation)
Field-specific studies
Basic acupuncture 8 credits
Clinical acupuncture 12 credits
Acupuncture in society 2 credits
Practicum (including hands-on clinical experience) 16
credits
General studies 10 credits
Total 86 credits (equivalent to approximately 2800 hours)
Credits are calculated on the basis of specifications
established for Japanese universities (1 lecture credit = 15
to 30 hours, 1 seminar credit = 30 to 45 hours, 1 practicum
credit = 45 hours).
The current curriculum was expanded in 2004, andat the same time the credit system was introduced andthe former lists of categories and detailed descriptionsof course contents were eliminated. These changes
were made in order to encourage original thinking,creativity, and independence in each school.
The Oriental Medicine College Association and the
National Association of Presidents of Schools for theBlind are working together to develop educationalguidelines, publish standard textbooks, standardize
educational content, and maintain high standards ofquality.
Oriental Medicine College Association
http://www.toyoryoho.or.jp/index.php

5. Current status of students and graduates
Results of two surveys performed by the Oriental
Medicine College Association
First survey performed in 1998
Second survey performed in 2001
1) The ratio of women students rose in 2001
(male-female ratio 1.67:1, in comparison to 1.97:1 in1998). The most common age range for male students
was 25 to 29 (61.4% in 2001, down from 72.8% in 1998).
The ratio of male students was lower for all age groups
in the 2001 survey. The most common age range forfemale students was 21 to 24 (43.1% in 2001, incomparison to 36.1% in 1998). The ratio of women alsorose in the group 25 to 29 years of age (from 26.6% in1998 to 30.9% in 2001), while decreasing in all otherage brackets. The largest number of students was in
the group 25 to 29 years of age, with the largest
number of men in their late 20s and the largest
number of women in their early 20s. Mean age ofstudents was 32.9 years in the second study, nearly thesame as the first study (32.6).
2) The 2001 survey showed 84.5% of graduatespracticing professionally, nearly the same as the 1998
study (84.2%). A higher percentage of male graduates(87.3%) were in professional practice than their female
counterparts (80.4%). The most common age grouprepresented was 40 to 44 years of age (87.2%).
Graduates not in professional practice accounted for
14.7% of the total, down slightly from the first survey(15.1%). A major change was noted in working
circumstances. Considerably more graduates wererunning their own practice in 2001 (32.4%) than in1998 (21.4%). Those working alone accounted for
71.5% of the total in 2001, down from 86% in 1998,
while the percentage with 1 employee rose from 5.6%
in 1998 to 12.3% in 2001. The average number ofpatients treated per day by self-employed practitioners
was 9.6, down from 11.1 patients per day in 1998.
Graduates who were employed by a clinic or
hospital accounted for 30.4% of the total, up
significantly from 19.4% in 1998.

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Acupuncture Practice in Dentistry in Japan

2. Indications for acupuncture-moxibustion in dentistry

Atushi Fukushima

The use of acupuncture is not limited only to

Director of Acupuncture-Moxibustion Center
Fukushima Dental Clinic
Guest Lecturer at Oriental Medicine
Toho University Medical Center

anesthesia for dental extraction and analgesia inpatients suffering dental pain. It is now extended tothe treatment of oral diseases as shown below.
1) Diseases of oral mucosa:

1. History of Acupuncture-Moxibustion in Dentistry inJapan
In 1972, James Reston of New York Times, areporter on President Nixon’s trip to China reported to
the world the beneficial effects of acupuncture
anesthesia. This led to an increased awareness ofacupuncture treatment in Japan, further leading toadvances in researches and the introduction ofacupuncture-moxibustion in various clinical sites.
The Japan Dental Society of Oriental Medicine
serves as a major center for providing education on theuseoforiental

medicineandpractical

acupuncture-moxibustion training in dentistry Some
dental universities include this education in theircurriculum. The Society was formed in 1979 when

Recurrent stomatitis,

stomatitis herpetica, herpes zoster, oral candidosis,
lichen planus, leukoplakia
2) Diseases of lips: Angular stomatitis, chronic cheilitis
3) Diseases of Tongue: Geographical tongue, medianrhomboid glossitis, glossalgia
4) Diseases of salivary glands: Salivary calculi, dry
mouth5) Diseases of nervous system: Trigeminal neuralgia,
facial nerve paralysis
6) Disease of jaw joints: Jaw (temporomandibular) joint
disorder, jaw joint dislocation
7) Oral and maxillofacial inflammation: Pericoronitis
of wisdom tooth
Acupuncture-moxibustion
especially

for

the

treatmentdiseases

exertsforits

WHO issued the statement of recommendation to its

efficacy

which

member states for positive use of acupuncture as part

therapeutic modalities of modern medicine have notof modern medicine. Kunio Matudaira, the firstbeen established, such as diseases of oral mucosa,chairman of the Society was the first dental surgeon

nerves, dry mouth, and jaw joints.

who introduced acupuncture into clinical dentistry,

3. Future Vision for Acupuncture-Moxibustion inpracticing acupuncture in the form of anesthesia andDentistry

pain relief in patients undergoing dental extraction or

Acupuncture-moxibustion currently practiced inthose with other dental problems. Akira Fukuoka, theJapan, which was introduced to Japan from ancientsecond chairman of the Society promoted further

China, is classified into three groups:

clinical applications of oriental medicine in dentistry.

(1) traditional acupuncture-moxibustion advanced inMichizo Matsuo, the third chairman of the Society,Japan with its own style;made a great contribution in nurturing the Society to(2) acupuncture-moxibustion of Western medicine

the present nationwide organization. Koichi Okamura,nature based on anatomy, physiology, and pathology;

the fourth president of the Society, deepened ties withandChina from the viewpoint of integration of traditional(3) acupuncture-moxibustion of traditional Chinese

Chinese and Western medicine. The Society’s history is

medicine. In order to respond to a variety of intractable

now taken over by incumbent president Koichi

oral diseases, it is desirable that remedial procedures

Okamura. The membership is comprised mainly ofwith acupuncture-moxibustion be established based onclinicians (as of 2008, 900 members), many of whomscientificareadvantages of oriental-Western medicine.

tryingtowillingly

administer

acupuncture

grounds

built

treatment.

84

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

by

the

integrationofVolume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010Sports Acupuncture & Moxibustion - Reviews
Eiji Furuya, Ph.D.
Director of Kuretake College
Oriental Medicine Clinical Laboratory
1. Introduction
Sports are most often played for the simple fact thatpeople need exercise to stay in good physical condition
and/or promote health. In fact, sports encompass a
broad range of activities from the ones that are played
just for fun to the competitive ones that are performed
to athletes’ potential limits of physical as well as mental
abilities. However, injuries and other adverse effects
resulting from overuse and/or improper training, should
not be overlooked. Acupuncture and moxibustion
treatment have a history with sports injuries in theJapanese sports field. They have been used as asupportive measure for alleviating pain or discomfort
associated with sports activities. Despite this history, noorganization exists in Japan to handle matters of sports
acupuncture and moxibustion. Present practitioners
treat sports injuries on their own accord.
The firm positioning of sports acupuncture andmoxibustion started when their usefulness wereintroduced in a presentation entitled “Application of
Acupuncture and Moxibustion to Enhance Competitive
Abilities” which was presented at the preparatory
meeting set up in 1992 for the conference of sports
acupuncture and moxibustion, medical science given at
the 95 Fukuoka Conference of the 18th Universiade andthe University Sports Research Conference held as partof Universiade. The therapeutic effects of acupuncture
treatments presented in these conferences and thefact-finding surveys on the treatment of sports injuries
with acupuncture and moxibustion for each event were
published as a book of literature abstracts1). On thisoccasion, the Japan Society of Acupuncture andMoxibustion has became actively involved in various

athletes has become a therapy movement for NationalSports Festivals and the National High School
Championships’ since 1998. This gives the practitioners

more opportunities to be active.
2. What ae Sports Acupuncture and Moxibustion?
Sports acupuncture and moxibustion can beconsidered as one of the conditioning tools that provide
athletes the optimum physical condition including quick
recovery from fatigue and the application to training aswell as alleviate symptoms they complain 6）. The use of
the procedures is dependent on the intensity of
trainingthe trainers give in competitive sports, but it isintended for all persons engaged in sports. If
acupuncture and moxibustion treatment are used tokeep athletes at their best, leading to the prevention ofsports injuries, it will help to enhance quality of sports.
This is an important role of sports acupuncture andmoxibustion and is an inherited concept of oriental
medicine of “treat mibyo”, or the concept of preventive
medicine3), 4).
3. Clinical Research
The National Sports Festival is Japan’s largest
sports competition. The author et al. developed thecondition adjustment for athletes with acupuncture
treatment at the sailing competition sites upon requestfrom the Japan Sailing Federation. The conditioning
levels were compared before and after the treatmentusing the visual analog scale (VAS). The treatment,
which was administered as desired by the athletes
regardless of before or after the competition, alleviatedmyofascial low back pain and muscle fatigue of cervix
shoulder and back7). After the treatment, they said
“this is the way to go” and showed enthusiasm for thecompetition.

activities aiming to build up clinical evidence and many
symposiums have been held to discuss a variety of
topics: administering treatment for the state ofpre-symptomatic condition before onset of a disease(”mibyo”), exercises, acupuncture and moxibustion2), thecurrent status and problems of sports acupuncture andmoxibustion3), and research on sports acupuncture andmoxibustion. Introducing practitioners to appropriate
information to help the “condition adjustment” for86

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Aside from this, the effects of press tack needle(PTN) were investigated against sham needle in arandomized control trial. PTN, a very short needle witha shape similar to a thumbtack, has the advantage that
athletes can continue their sports with the PTN inplace. The effects against the model of muscle fatigue
were investigated through isotonic exercise of theupper arm flexor muscle group.The exercises werecarried out two times with a break taken in between
and the decreased number of repeated motions gained
from the exercises was compared between the twogroups (PTN group and sham group). After the firstexercise, PTN was left indwelled and then the exercise
was resumed, which showed less decrease in thenumber of repeated motions compared to a shamneedle8). In regard to the effects of PTN for muscle
soreness developing a day after the race, investigations
were made with PTNs indwelled during the race in thelower back region for a triathlon race, and in lower
extremities for a marathon race. Needles were
indwelled just before the start of the race. The
occurrence of muscle soreness on the following day was
suppressed in two groups9),10). The results suggest that
PTN be used for conditioning for athletes.
4. Education System
The education system for sports acupuncture andmoxibustion is yet to be established. This is because
there is no comprehensive program available for the
subjects from elite athletes to amateur athletes. The
basic of sports is to move the muscles in the body to agreater or lesser extent. Therefore, analysis of body
movements andcorresponding acupuncture andmoxibustion treatments are applicable for all persons
who play sports. What is required for the education isthe content that enables practitioners to achieve
accountability on safety, mutual interactions, andadverse effects.
5. Conclusion
Scientific validation of sports acupuncture andmoxibustion is not adequate. Validation is needed incooperation with all medical fields for each of the
sports fields. As well as the evidence of the effects ofacupuncture and moxibustion, those of sports injury
prevention and sports conditioning need to beaccumulated. They will provide valuable input for theuse of acupuncture and moxibustion treatment insports medicine. Expertise in Western medicine,
physiological changes with physical activity, and themechanism of acupuncture and moxibustion together
with treatment techniques are also necessary for
sports acupuncture and moxibustion.
Referense:
1) FISU/CESU Conference The 18th Universiade 1995
Fukuoka. Acupuncture in Sports-Abstracts.
2) Moriyama T.: Treatment to Protect Health, PhysicalFitness for the Health, Acupuncture & Moxibustion.
JSAM, 2000; 50(1):59-82.
3) Miyamoto T, Katayama K.: Present State andProblem of the Sports Acupuncture andMoxibustion.JSAM.2000; 50(1):83-102.
4) Miyamoto T, Furuya E, et al.: Symposium Researchon Acupuncture and Moxibustion in the Sports
Field. JSAM, 2008;58(2):166-178.
5) Asahiyama K.: Oriental Sports Therapy Handbook．
In: Hukubayashi T(ed). Kanagawa. Ido no Nippon.
2001:289-295
6) Matsushita M, Asahiyama K, et al.: Usefulness ofacupuncture / Moxibustion in the activities of sports
trainers. Osaka Journal of Clinical Acupunctureand Moxibustion, 2007; Vol.23.No.1:9-32.
7) Furuya E, Kaneko Y, et al.: Examinetion ofCondition Adjustment following Acupuncture
Treatment for Competitive Sailors at the NationalSports Festival. JSAM, 2006; 56(2):166-174.
8) Furuya E, Kaneko Y, et al.: Effect of Press Tack
Needle on Recoverry of Muscle Fatigue by
Randomized Controlled Trial-sham contlloed
study-2009; 59(4):68-76.
9) Kaneko Y, Furuya E, et al.: The Effects of Press Tack
Needle Treatment on Muscle Soreness after
Triathlon Race- Sham-controlled Study-. JAM 2009;
1: 22-30.
10) Miyamoto T, Hamada J, et al.: Effect ofAcupuncture using Press Tack Needle on Muscle
Pain and Stiffness after Marathon Race-Double
Blind Randomized Control Trial-. Kanpo Med. 2003;
Vol.54(5):939-944.

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Treatment of Local and Distance Sites for
Diseases of the Locomotor System–Indications and limitations of local therapy,
indications and limitations of distant therapy–
Coordinator: Takayoshi Ogawa
Tokyo Eisei Gakuen
Shuichi Katai
Tsukuba University of Techonology
Shoji Shinohara
Meiji University of Integrative Medicine
I. Introduction
Phrases like "simultaneous treatment of root andtip" regarding acupuncture and moxibustion therapy
indicate that in almost all cases treatment of the region
where the symptoms are located (treatment of theincidental = locally) and treatment of acupoints on
meridians located at a distance where there are no
symptoms, or that are used for the regulation of qi andblood (treatment of the fundamental), or treatment of
acupoints known through experience to be effective forthe particular condition are combined. While in casesof diseases of internal organs or metabolic diseases
determination of specific locations is difficult, therefore,
the function of distant needling therapy and local
treatment of diseases of the locomotor system may be
the subject of debate. Moreover, in order to examine
which of these different treatment forms is safer andmore efficient, symposia were held on the 51st annual
conference of the Japan Society of Acupuncture andMoxibustion (in Ibaragi), the 52nd conference (inKagawa) and the 53rd conference (in Chiba), spanningthe period of these three years.
II. Efficiency of distant needling
Local treatment is performed on the soft tissues in
the region of the symptoms, making the mechanisms ofthe therapeutic effects easy to understand., For
example, the relief of excessive muscle tension is easy
to understand. However,mechanisms in the case of
distant needling and its efficacy still remain difficult tounderstand. At the 52nd conference a symposium washeld to examine the efficacy of distant needling. Mr.
Shinohara from the Meiji University of Integrative
Medicine, conducted an experiment using intradermal
needles on spring points of the relevant meridiansversus sham acupuncture and spring points of othermeridians, demonstrating the efficacy of channel sinew
and distant needling therapy. Dr. Katai from the
National University Corporation Tsukuba University
used the point Chikuhin (zhubin KI9) as well as
treatment of the arms and legs in patients with low
back pain or cervical pain and showed that distantneedling alone is also highly effective. Dr. Shiraishi
from the Oriental Medical Research Institute used thepoint Ichu (weizhong, BL40) among the four command
points and showed that the reactions it elicited at
Jinyu (shenshu, BL23) were even more marked thanthose obtained by direct stimulation of Jinyu directly,
suggesting the effectiveness of distant needling. Mr.
Keiji Yoshikawa from the teaching staff training
institute within the Department of Physical Therapy of
the National University Corporation Tsukuba
University, reported the effectiveness of local
treatment and its contraindications, indicating that
distant needling therapy is associated with a highdegree of unreliability and low reproducibility, andtherefore did not acknowledge its necessity.
Regarding the question of whether to perform both
"local treatment and distant needle therapy" Mr.
Shinohara, while selecting mainly distant sites,
performed

local

treatmentincases,when

manifestations of blood stasis and phlegm wererestricted to certain regions. Dr. Katai used ocal
treatment in case distant needling therapy had beenineffective and Mr. Yoshikawa had decided not to use
distant needle therapy at all. Dr. Shiraishi did not deny
the benefits of local therapy, but emphasized his
opinion, that depending on the selected region
stimulation of distant sites is capable of modulating
the elicited reactions. In particular the effects obtainedby stimulating distant sites would be enhanced, if theretained needles are in addition stimulated electrically,
indicating that an explanation based solely on distantneedling effects mediated via the nervous system
would be difficult. Mr. Tomomasa Moriyama of the
National University Corporation Tsukuba University
reported results, suggesting that the treatment at
distant sites may be effective from a point of view of
movement physiology because of the regulation ofmuscle force alignment.

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Therefore, the consensus isthat "stimulation of
distant sites" is also effective for the treatment ofdiseases of the locomotor system. Mr. Yoshikawa
considered the reported evidence of the other three
speakers insufficient and thought, that the definitionof local and distant sites needs to be revised. Even if
the site at which the symptoms are located isconsidered local, the contact of the needles with skinand muscles may also be considered a local contact, or
could it be considered to be a stimulus of the entire
dermatome, muscle bundle or even the entire muscle?
Also, when the needle stimulation is considered to betransmitted to the central nervous system after being
picked up by some form of receptor sensory nerves, it
may be related in some form or other to the autonomic
nervous system etc. If that is true, then what used tohave been considered local mechanisms could possibly
be the mode of action initiated by distant sites.
III. Definition of local and distant needling therapy
A questionnaire was conducted among members of
the society,who have been enrolled in it for many years
to investigate the definitions and the mechanisms
imagined to be underlying the therapeutic effects aswell as the basis for choosing different treatment
modalities. Mr. Ogawa of the Tokyo Eisei Gakuen
College reported that there were no significant
differences pertaining to the definition of local anddistant schools of thought. The concept of "local sites"
was imagined mostly as meaning the location oftenderness, sites at which a radiating sensation may
be elicited or the affected sites themselves, while"distant sites" referred to regions, from wherereactions in meridians, nerves, reactive spots, tenderspots, or even systemic reactions may be induced orsome other form of active sites.
Moreover, based on the results of the above
mentioned questionnaire, the definition of local anddistant sites was determined as follows.
Local sites:
Sites of tenderness accompanying the manifestationof the symptoms, sites of injury, or from where aradiating sensation (like the conduction of a nerve
impulse) can be elicited and the site of lesion itself.
Stimulation applied for therapeutic purpose at these88

sites provides relief of excessive muscle tension,
thereby alleviating nerve entrapment, triggers axonreflexes and has in addition, psychological effects
associated with the provision of treatment of affectedparts.
Distant sites:
Not restricted to the site of symptom manifestation,
treatment applied to sites located along the course of
the meridians can be expected to elicit a generalized
reactions (autonomic nervous system regulation,
central nervous system response etc.), where thestimulation of the relevant sites may not only havetherapeutic purpose, but can be expected to havegeneralized effects.
IV. Mechanisms of distant needling therapy
At the 52nd and 53rd conferences the mechanisms
underlying therapeutic effects were examined. Mr.
Shinohara investigated the effects of intradermal
needles for the treatment of delayed pain based on achannel sinew model and observed that exercise load of
the biceps brachii muscle lowered the tenderness
threshold along the lung meridian, indicating thepossibility of the appearance of selective peripheral
reactive spots during the development of delayed
muscle pain that can be used as therapeutic points. He
also mentioned that at clinically useful acupoints it
might behighly likely that hypersensitivity
phenomena emerge during the generation ofexperimentally induced pain, which provides
experimental evidence for the distant needling therapy.
Dr. Shiraishi showed, following his line of thought fromthe previous conference, that experimental results of
distant needling applied to stimulate Ichu (weizhong,BL40), Shozan (chengshan, BL57), Hiyo (feiyang,
BL58),
Konron(kunlun,BL60),
Yoryosen(yanglingquan, GB34) are capable of producing avariety of changes in the reaction observed at Jinyu(shenshu, BL23) in patients with low back pain. This
does not necessarily require stimulation of points
located on the same meridian, but showed that it ispossible to modify the reactivity within certain zones.
Furthermore, the needling effects from the skinmodifying the input system neuroanatomically are notspecific or selective. This indicated that local treatment

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010is not necessarily required and the treatment at
distant sites can be expected to have sufficient clinicaleffects.
Mr. Akihiro Ozaki from the Meiji University ofIntegrative Medicine made a presentation based on
results from human and animal experiments showingthat needling both in close proximity and at distantsites have the effect of inhibiting kinetic reflexes, sothat both local and distant sites were found to beeffective. The stimulus information provided both inclose proximity of the lesion and at distant sites thenconverges onto the same neuron and is thereupon
subject to modulation, so that the differences in
information processing at the neuronal level may bestrongly involved in the manifestation of different
effects. Investigations of the differences in the effects
obtained through local and distant treatment may thus
also need to take into account differences in the input
forms other than the site of stimulation, symptom
patterns etc. They need to be discussed
comprehensively. Mr. Moriyama expounded on thebasis of biomechanics indicating that a poor condition
at a certain distant location may influence prevailing
local conditions. He introduced the meridian test as
one useful method to find poor local conditions that
may be difficult to be realized by the patient
him/herself, but nevertheless could lead to thedevelopment of disorders. That means that the
microscopic observation employed during examinationand treatment may require a macroscopic point of view
including the entire body into its field of vision, so thatthe above mentioned two different ways of looking at a
certain object should not be separated.Only together
can they represent the essential concept of treatment.
From the audience, questions were asked anddiscussed, indicating that the mechanisms of analgesia
in case of needling nerves and muscle cannot yet beunderstood, or that the effects of both local and distanttreatment are based on the same mechanisms, thus
making their clarification a task for the future.
Mr. Katsuhiro Yamada of The Japan School of
Acupuncture, Moxibustion and Physiotherapy reported
that treatment of distant sites in cases of inflammatory
lesions associated with tissue injury, localized muscle
spasms or structural causes seems to have little

potential to improve the condition, while local
treatment is effective here. Yet, the local treatment
may in certain cases also aggravate the condition.
Mr. Kawakita from the Meiji University ofIntegrative Medicine reported that regarding
inhibition of pain the DNIC (diffuse noxious inhibitory
controls) phenomenon and involvement of humoral
factors like endorphin in the manifestation of pain
phenomena are both activated regardless of where on
the entire body the stimulation is applied, while axonreflexes occur only locally at the site of the stimulation.
Mr. Ozawa from the National University
Corporation Tsukuba University explained that theneedling stimulation produces locally at the site of thestimulation via axon reflexes an increase in blood flow
and at the same time via spinal reflexes or supraspinal
reflexes various responses in various internal organ
effectors. Also, he stated that the mode of action varies
depending on differences in the site of stimulation andtype of effector.
V. Pathologic conditions for which treatment at local
and distant sites is effective:
A questionnaire was conducted among 41
authoritative people in this field representing thedifferent treatment styles. The results showed that
local treatment was considered to be effective forconditions including diseases of the locomotor system,bruises, sprains, external injuries etc. where the local
symptoms are clearly defined and the site of the lesions
is often restricted locally, whereas stimulation at
distant sites seemed to be effective for conditions otherthan diseases of the locomotor organs, like diseases ofthe viscera and bowels, and employed in case local
treatment had been ineffective, or in cases where thepoint selection was based on more than 70% onclassical meridian theory.
VI. Conclusions
Throughout the three symposia, treatment of local
and distant sites was considered separately whilecommon concepts were thought to have been found.
The effectiveness of local treatment for diseases of thelocomotor system and its clinical significance wasrecognized. The mechanisms of distant needling

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therapy and its effectiveness were also acknowledged.
In particular, it was acknowledged that needling of thearms or legs induces systemic responses throughsupraspinal reflexes, so that in case the affected areas
is located on the arms or legs, the locally placed needles
do not only elicit a local, but also a generalized
response. Moreover, in case the affected region is
located on the trunk, it was generally agreed that there
is a high probability for the need to also needle thearms and legs. However, while researchers in the fieldof basic research emphasized the common aspects(non-specific responses), suggesting just needling
anywhere, even if performed by beginners, would still
be effective, because this can be called an inherently
human physiologic response. Because of the very
presence of this response, acupuncture andmoxibustion therapy has been used continuously over
several thousand years. Further in-depth research is
required in order to enhance the effectiveness ofacupuncture and moxibustion specific effects
superimposed on the above mentioned non-specificresponse, or else to establish still more effective
therapies.

90

The differences between the conditions for which
either the treatment of local or distant sites is effective
or specific could also be clarified to a certain extent, but
it cannot be denied, that this is still only the beginning.
For example, in case of low back or leg pain needling of
Ichu (weizhong, BL40) or similar points on the legs has
a completely different significance, even if the results
were the same, depending on whether this site isneedled, because it is the site of symptom
manifestation, or whether a reactive spot has been
needled in order to cure the low back as the causativesite for the low back or leg pain. Although these
symposia helped to clarify this point, the expectations
based on the initially planned scope, covering not only
the muscular and skeletal systems, but that also
included internal organs or metabolic systems in thescope to be clarified were not met. In-depth research isgoing to be continued and similar symposia will be
held.
Responsibility for the wording:
Takuro Ogawa, Major course of clinical education,
Tokyo Eisei Gakuen College,

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Japanese Minimal Acupuncture

inserted parallel to the skin surface for a length ofNoboru Mitsuhata
Tokyo Eisei Gakuen College

Currently, the most popular form of acupuncture
therapyuses

filiform

needles

insertedafew

centimeters so that the needle tip reaches the muscle
layer, but there are also other therapy forms, where theneedle is inserted only up to the subcutaneous layer orabout 2-3 mm. After that, a little cushion is placed
between the needle handle and the skin and the entire
intradermal needle covered and fastened with adhesive
tape (Figure 2). Although there are differences basedon symptoms and hygienic conditions, the needles are
generally retained for periods of time varying from a
few hours to a week.

does not penetrate the skin at all and stimulates only
the skin, which are nevertheless able to produce
therapeutic results for a variety of symptoms. Amongthese therapy forms those that stimulate superficial
skin layers, namely the "intradermal needle therapy",
the"thumbtack

needletherapy"or"pediatricacupuncture therapy" use specially shaped needles.
Here I would like to introduce the application of theirwidespread use among Japanese acupuncturists.
1. Intradermal needle therapy
Intradermal needles were developed around 1952
by Kobe Akabane based on his daily clinical experience
with needles for mild stimulation of the skin surface
over a prolonged period of time. These needles have athickness of approximately 0.14 mm and a length ofabout 5 mm. The handle of these small, thin needles isformed either in the shape of a small ring (ring type) or
as a plate (flat type) and designed in such a waythat
they do not advance further into the body by error(Figure 1).

This treatment form is often combined withordinary treatment using filiform needles, but there isalso research4) into the independent use of intradermal
needle therapy for osteoarthrosis of the knee or
periarthritis humeroscapularis and similar complaints
relating to the locomotor system. Again, there havealso been case reports dealing with the treatment ofobstetric diseases5), depression and other conditions.
Moreover, thanks to the simplicity of the insertion
method physicians perform this intradermal needle
therapy in conjunction with the prescription of Kampo
medicines and report it to be effective7).
2. Thumbtack needle therapy
Thumbtack needles are also considered to be a formof intradermal needle, but are thus named, because
their shape which resembles that of thumbtacks(Figure 3). Thickness of the needle is about 0.2 mm andlength about 1 mm. The insertion technique for theseneedles is similar to that of intradermal needles andthey are also fastened with adhesive tape, but in some

The needle handle is grasped with a pair oftweezers, the portion of the skin where the needle shallproducts the needles are already incorporated in thetape.

be inserted stretched a little and the needle then92

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

maldigestion or diarrhea and similar gastrointestinal
symptoms, enuresis etc. 11-15).

Since the insertion technique is even simpler thanthat of the intradermal needles, thumbtack needle
therapy has been frequently used in sports andreportedly achieved a significant inhibition of thedevelopment of muscle soreness following sports

4. Conclusion
Currently the use of filiform needles constitutes theusual form of "acupuncture therapy" and is, I believe,

events8).
Reportedly, they also havebeen used for the

associated with an established image of "inserting"needles or being pricked. However, about 2,000 years

treatment of collateral symptoms like low back pain etc.
in patients on maintenance dialysis9) and to promote

ago the "round-pointed needle" (round needle) or the"spoon needle" were acknowledged among the nine

lactation in puerperal women10).

classical needles mentioned in China. Cearly they were

3. Pediatric acupuncture therapy

not meant to be inserted. Treatment forms using suchslight stimulation of the skin as intradermal needle

It is not clear when pediatric acupuncture therapy
was first performed as a special treatment form, but it

therapy and pediatric acupuncture therapy are
performed as an integral part of modern Japanesewas mentioned in texts dating back about 250 years11).

acupuncture and moxibustion therapy. Thus, thisToday specialized pediatric acupuncture therapy is
performed mainly in the Kansai region. Moreover,activities are conducted promoting skin stimulating

should make clear that acupuncture therapy is not
restricted to the practice of inserting needles to a depthof a few centimeters into the body.

methods based on the concepts of pediatricacupuncture therapy using a spoon that can easily be

In recent years, treatment with shallow needlingsometimes serves as a control (placebo) group during

applied by the parents.

clinical and basic research into acupuncture, but in

There are various systems of, and methods
employed, in pediatric acupuncture therapy (Figure 4),

Japan minimal acupuncture stimulation too is
considered to be effective, so that the above mentioned

all of which use only light tapping or stroking of theskin surface as stimulation and avoid penetration ofresearch design cannot really be considered a suitablemeans for detecting the effects of acupuncture.

the skin. The stimulated regions often include theentire body, but predominantly stimulated areas varydepending on the symptoms. Treatment requires

Reference
1) Akabane K., Method of Hinaishin, Ido no Nippon

considerations to prevent overstimulation and isusually of short duration of about 10 minutes.

Sha, 1964
2) Suzuki S.

This kind of treatment is performed in children
from infancy to school age. It is used in particular for
fretfulness (pediatric neurosis), respiratory symptoms

moxibustion therapies (only in Japanese), Ido no
Nipponsha, 2006
3) Tanioka M.: The Daishi style pediatric acupuncture,accompanying

rhinitisorpharyngotonsillitis,

et

al.:

Usefulacupuncture

and(only in Japanese), Rokuzen Publishing, 2005

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

93

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 20104) Shinohara S.i, Clinical Effects of Acupuncture(Intradermal Needles) based on the Muscle
Meridians for the Complaints on the Joints andMuscles during Movements, The Bulletin of Meiji
University of Oriental Medicine, Vol.26, p65-80, 2000
5) Eda M., TANIGUCHI S.: Shortening of labor timeusing intradermal needles), (only in Japanese), Ido
no Nippon, No.592, p12-18, 1996) Murata K.: A case or recurrent depression – a trial
with intradermal needles), (only in Japanese), Ido
no Nippon, No.729, p62-67, 2004
7) Kawachi A., Intra-Dermal Needling approach tourinary calculus, Osaka journal of clinical11) Ozaki T et al.: Pediatric acupuncture therapy – thepractice of Yoneyama style pediatric acupuncture,
(only

in

Japanese),

Clinicalacupuncture&

moxibustion, Vol.16 No.2, p38-44, 2001
12) Okuda I.: Summary of pediatric acupuncture, (onlyin Japanese), Osaka journal of clinical acupuncture& moxibustion, Vol.14 No.1, p34-38, 1998
13) Yamagata Y.: Impressions of pediatric acupuncture,(only in Japanese), Osaka journal of clinicalacupuncture & moxibustion, Vol.14 No.1, p41-43,
199814) Sugihara Y.: Pediatric acupuncture starts with theacupuncture & moxibustion, Vol.21 No.1, 2005
8) Kaneko Y., Furuya E. et al., The Effect of Tack
Needle Treatment on Muscle Soreness after

education of the mother, (only in Japanese), Osaka

Traiathlon Race － Placebo-controlled Study －Journal of the Japan Society of Acupuncture and15) Ozaki T.: Examples of therapeutic effects using

Moxibustion Vol.56 No.2, P158-165, 2006
9) Okuno Y. et al.: Effects of acupuncture treatment inenuresis, (only in Japanese), Osaka journal ofpatients on maintenance dialysis – therapeutic
experiences using thumbtack needles in 32 patients,(only in Japanese), Journal of The Japan Society ofModern Acupuncture and Moxibustion Research,
Vol.3 No.1, p19-27, 2003
10) Tatsunami T. et al.: Acupoint therapy for the promotionof lactation, (only in Japanese), The Japanese journal for
midwives, Vol.50 No.7, p84-87, 199694

journal of clinical acupuncture & moxibustion,
Vol.14 No.1, p44-47, 1998
mainly pediatric acupuncture for the treatment ofclinical acupuncture & moxibustion, Vol.14 No.1,
p48-50, 1998
16) Japan College Association of Oriental Medicine:
Acupuncture and moxibustion techniques < Basics>, Ido no Nippon Sha, p98-104, 1992
17) Japan College Association of Oriental Medicine:
Acupuncture and moxibustion theory, Ido no
Nippon Sha, p15-17, 2002

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

SafetyIssue
on
Acupuncture
Moxibustion in Japan
HitoshiYamashita1),

HiroshiandWe have reviewed case report papers in order toTsukayama2)

1) Department of Acupuncture, Morinomiya University of
Medical Sciences, Osaka, Japan
2) Center for Integrative Medicine, Tsukuba University ofTechnology, Tsukuba, Japan

1. Introduction
Evidence-Based

Medicine(EBM)

becamepopularized in the medical field in 1990s whensubstantial randomized control trials (RCT) on
efficacy were actively performed. Against this positive
trend, even in these years, methodology showed theleast development in clinical research on safety ofacupuncture and moxibustion. For example, although
it has been publicized that “the incidence of side
effectsfromthepracticeofacupunctureandmoxibustion is none”, data of side effects based onwell planned and systematic research have not beenpresented. There are, indeed, various case reports on
infections

thatdeveloped

after

2. Case reports

acupuncture

treatments. There are, however, almost no papers
released that clearly show the evidence of thesecausal relationships.

grasp the incidences in Japan of adverse events
associated withacupuncture treatment. Our review

results showed that medical journals carried 120
articlesreporting

about

150

adverseeventsassociated with acupuncture treatment in Japan
during the period of the latter half of 1980s and 2002
(Table 1) 1,2) (Note: An adverse event is defined as anunfavorable medical event which occurred during or
after

the

treatment

regardlessofcausalrelationships)3). The most reported adverse event was
pneumothorax.

In

the

recentyears,

however,pneumothorax does not have novelty for a journal
article and the number of the case reports relating to
the adverse event has been reduced. In contrast, thenumber of cases handling liability insurance tocompensate pneumothorax resulted from the acts ofacupuncture and moxibustion in Japan is as highest
as ever in Japan4). As far as infections are concerned,
a diversified range of infections from abscess,bacterial infections to hepatitis B were reported;
although

for

most

of

these

adverseevents,cause-effect relationships have not been clarified..

Generally, arguments of safety of acupuncture
and moxibustion often took place on the basis of
anecdotal evidence, such as case reports on adverse
events and various experiences of individuals. It was
only after the latter half of

the1990s that clinicalresearch other than case reports on safety ofacupuncture and moxibustion, began to appear in
medical journals on a full scale and actively
discussed.

As for “embedding needles” practiced by a few
acupuncture and moxibustion therapists, the Japan
Acupuncture & Moxibustion Association submitted arequest to the then Ministry of Health and Welfare in
1976 to issue its directions to prohibit embedding
needles. However, fragments of needles embedded
before the order of prohibition (some after the order)
caused unique adverse events such as organ injury,
foreign body, localized argyria and others. On theThis report will provide case reports, prospective

other hand, many reports on accidents of needle

surveys and data from RCT on the basis of the

breakage and organ or spinal injury were seen until

strength

the first half of 1990s. In recent years, reports ofofevidence

anddiscuss

acupuncture and moxibustion in Japan.

94

safetyofthese cases and liability compensation cases have

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

decreased1,2,4). It can be considered that the decreasemeasures.

is closely related to the wide use of disposable needles

acupuncture and moxibustion treatments was known,in Japan.

which

Cases

of

adverseeventsresultedfrommoxibustion are shown in Table 22,5). Moxibustion is,of course, performed by acupuncture and moxibustion
therapists in Japan. However, there is a significant
number of cases in Japan in which patients use moxa
cones at home according to the instructions byacupuncture and moxibustion therapists or people doThefacilitatedtotal

numbertheofcalculation

recipientsofofincidence

frequencies of adverse events. As a result, adverse
events were reported・recorded as Table 3 shows6,7). If
the denominator or the total number of recipients ofacupuncture and moxibustion treatments is taken
into account, it can be said that serious adverse
events will rarely occur in the standard acupuncture
practice.

self-treatment by using large moxa cones (mass ofSubsequently,

weconductedathoroughmoxa) according to the oral tradition without seeing

prospective survey over four months to gain theacupuncture and moxibustion therapists. In manyfrequencies of mild adverse reactions (side effects)

serious cases of malignant tumor or pulmonarythat patients can experience in daily acupuncture

edema, moxa cones were used excessively on patients’practice. The results are shown in Table 48). Fatigue

own judgment. It is highly controversial thatand drowsiness occurred most frequently at the

self-treatment that does not have guidance from, or is

initial treatment and bleeding and subcutaneous

not practiced by the therapist of acupuncture andbleeding had higher rates of frequency when applying

moxibustion,

current to needles8). Pain when pricking was claimed

shouldbecalled“moxibustion

treatment”

at a high rate of frequency among younger subjects or
women9). Any of these adverse reactions were

3. Prospective surveys
As introduced above, it will not be appropriate
from the view points of publication bias, retrospective
descriptions, recall bias, and an unknown total
number of treatment sessions, to argue the safety oftransitory and no medical procedures were taken.

It

has been confirmed in this survey that most of theside effects, which were frequently encountered in theacupuncture treatments, were mild cases.

acupuncture and moxibustion based on case reports.

4. RCTs

With these points in mind, since 1992 we have

There could be many cases of adverse events recorded

required reports on adverse events to be submitted toin the prospective surveys that actually did not have

Tsukuba College of Technology Clinic (present Center

any

for Integrative Medicine, Tsukuba University oftreatment. In order to assess how many specificTechnology) in order to obtain more reliable data on

adverse reactions to penetration of the skin aresafety of acupuncture and moxibustion. In thisincluded in reported adverse events in case reports

prospective

and prospective surveys, we performed a literature

information

gatheringsystem,acausalassociation

with

the

acupuncturesemi-structured report form has been used, enabling

review of

the collection of necessary information for studying

osteoarthritis of the knee (knee OA) by way ofcause-effect relations and recurrence prevention

example10).

published

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

RCTs

on

acupuncture

for

95

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

We searched for papers on RCT of acupuncture for

References

knee OA, using two data sources: PubMed and1) Yamashita H., Tsukayama H., White A.R., Tanno Y.,

Japana Centra Revuo Medicina (Igaku Chuo Zasshi).

Sugishita C., Ernst E.: Systematic review of adverse

Of the twelve RCT papers located, seven included

eventsinformation on adverse events.

Joint swelling, local

inflammation, hematoma and back pain occurred
more often in the dummy electroacupuncture or
minimal acupuncture group.

following

acupuncture:

theJapanese

literature. Complement Ther Med 2001; 9: 98-104.
2) Yamashita H., Egawa M., Umeda T., Miyamoto T.,
Ishizaki N., Katai S.: Update of adverse events
associated with acupuncture and moxibustion in

Therefore, it is likely

Japan (1998-2002) and controversy over infectionthat many non-specific or unconnected “adverse

control in acupuncture treatment. J Jpn Soc

events of acupuncture”are reported in published caseAcupunct Moxibust 2004; 54: 55-64.
3) Beam Jr T.R., Gilbert D.N., Kunin C.M.: Generalreports and prospective surveys10).

guidelines

for

the

clinicalevaluationofanti-infective drug products. Clin Infect Dis 1992;

5. Conclusion
In a series of surveys introduced above, it has
been confirmed that the incidence of serious side
effects (adverse reactions) is rare in the acupuncture
and moxibustion clinic. On the other hand, since mild

15(Suppl 1): S5-S32.
4) Fujiwara Y.: Shinkyu massage ni okeru Iryo Kago
Genba kara no Houkoku. San-No Shoji, Osaka, 2004.
5) Yamashita H., Egawa M., Miyamoto T., Umeda T.,
Tani M., Nabeta R., et al.: Japanese literature survey

side effects are common, it is essential to informon risks and safety of acupuncture and moxibustion

patients about information relating to these side(4) - adverse events in moxibustion treatment -. J

effects. Moreover, it is fact that serious adverse

Jpn Soc Acupunct Moxibust 2000; 50: 713-718.

events exist, such as pneumothorax and spinal injury,

6) Yamashita H., Tsukayama H., Tanno Y., Nishijo K.:

althoughlimited,likelydue

totherapists’negligence. Thus, as well as education and training26),
it is also important to develop error-prevention

Adverse events related to acupuncture. JAMA 1998;
280: 1563-1564.
7) Yamashita H., Tsukayama H., Tanno Y., Nishijo K.:
Adverse events in acupuncture and moxibustion

system, like incident reporting, to prevent avoidable

treatment: a six-year survey at a national clinic inadverse events30).

Japan. J Altern Complement Med 1999; 5: 229-236.
8) Yamashita H., Tsukayama H., Hori N., Kimura T.,

The

Japan

Societyand

Tanno Y.: Incidence of adverse reactions associatedMoxibustion (JSAM), a largest academic body ofwith acupuncture. J Altern Complement Med 2000;

acupuncture

6: 345-350.

and

of

Acupuncture

moxibustion

in

Japan

has

established the Committee for Safe Acupuncture to
study safety of these treatments and promote
education. We consider that a professional body like9) Yamashita H., Tsukayama H., Sugishita C.: Local
adverse reactions commonly seen in Japanese-style
medical acupuncture practice. Clin Acupunct Orient
Med 2001; 2: 132-137.

JSAM should assume roles of undertaking analyses of10) Yamashita H., Masuyama S., Otsuki K., Tsukayama

reported individual adverse events, verifying theirH.: Safety of acupuncture for osteoarthritis of thecausal relationships, giving feedback of the results toknee – a review of randomised controlled trials,

members, and shaping the safety education before

focusing on specific reactions to acupuncture.

and after graduation.

Acupunct Med 2006; 24(Suppl): S49-52.

96

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Table 1

Published case reports of adverse events

associated with acupuncture in Japan1,2)Type

Diagnosis or symptom

Comments(Number of cases in parentheses)

Organ injuries
Pneumothorax

Organ injuries
or foreign bodies(26),

arterial

injury(3),

cardiactamponade (3), renal injury (2) and pseudoaneurysm (1).

Many of the cases were

Foreign bodies

causedbyaccidental

breakageor(3), needle
embeddingretroperitoneum (2), paravertebral muscle (2), ventricle prohibited
Needlefragment(s)

in

the

urinary

tract(1), lung and diaphragm (1), liver (1), maxilla (1), cervicalneedles.

interspinous ligament (1), hip joint (1), abdominal aortic
aneurysm (1) and nucha (1).

Bacterial infections
Abscess

Infection(6),

septicaemia(6),spinalinfection(4),

erysipelas (3), streptococcal toxic shock-like syndrome (2: Causal relationship withand
one fatal), pyothorax or pyohemothorax (2: one fatal), acupuncture
skull tuberculosis (1), infected atrial myxoma (1) and infection
established.
local redness (1).

is

not

Viral infections
Acute hepatitis B (12).

Central nervous system
Spinal cord injury (18), subarachnoid hemorrhage (5),Neurologicalproblems

subdural hematoma (1), epidural hematoma (1), and Many of the cases werecaused by embedding
medullary lesion (1),.

Peripheral nerves

needles.

Peripheral nerve injury (3).

Pigmentation
Dermatologicalproblems

Localized argyria (15) and cutaneous chromatosis (1).

Localized

OtherscausedargyriabywasembeddingContact dermatitis (4), lichen planus (2), nodular lesion silver needles.
(2), growth of tumor (1), and skin sarcoid (1).
Subcutaneous bleeding (2), syncope (1) and asthmatic

Other problems

death (which might have been associated with emotional
stress of the first-time acupuncture treatment) (1: fatal).

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Academic Societies related to Japanese
Acupuncture and Moxibustion

Shuichi Katai
Department of Acupuncture and Moxibustion
Tsukuba University of Techonology

In contrast to China and Korea, oriental medicine
in Japan requires independent licenses for Kampo(pharmacotherapy),

acupuncture,anma-massage-shiatsu(Anma).

moxibustion,
Kampo,

using

decoctions, can only be performed by physicians witha western medical doctor's license, while acupuncture
and moxibustion can only be administered by people
who graduated from senior high school and lateraacupuncturists that are affiliated with academic
societies covering various areas of Western and Asian
medicine. Also, some societies maintain an academic
society with an official name, some of these groups

I. Introduction

completedanimals. Thus, there are a significant number of

3-yeareducation

at

one

of

the

are not formally recognized organizations. Some exist
solely for research in a specific area. This is areflection of the historical circumstances pertaining
to acupuncture and moxibustion. Taking these facts
into consideration, an accurate description of thesituation pertaining to academic research into
Japanese acupuncture and moxibustion requires thatthe study groups callingthemselves academic

societies are also included in this report.

educational facilities specified by either the Ministry

II.

of

Acupuncture and Moxibustion

Education,

Culture,Sports,ScienceandAcademic

Societies

relatedtoJapanese

Technology; or the Ministry of Health, Labor andWelfare.

Subsequently,

practitioners

must(1) Academic societies pursuing academic research on

successfully pass the relevant state examinations toacupuncture and moxibustion

obtain their licenses. Acupuncture, moxibustion and

1. The Japan Society of Acupuncture and Moxibustionanma are classified within the framework of the

2. Society for Traditional Japanese Medicine

Japanese medical care system (that is treatment

3. Japan Traditional Acupuncture & Moxibustion Society

using western medicine) as “quasi” medical actions.

4. Japan Society of Ryodoraku Medicine

Academicsocieties

relatedtoJapanese

acupuncture and moxibustion reflect this situation in
Japanese acupuncture and moxibustion and cover
several different fields of learning.
For

example,

there

are

academicsocieties

pursuing general academic research on acupuncture
and moxibustion; but there are also societies that

5. Japan Society of Oriental Medical Physical Therapy
6. Japan Eastern Medical Association
7.Japan Conference of Clinical Acupuncture
Moxibustion
8. The Japan Society of Acupuncture & Moxibustion
History
9. Oriental Medicine and the Pain Clinic

focus on academic research and on acupuncture and(2)moxibustion pertaining to certain specific fields andresearch,

related areas. Moreover, among some of thesemoxibustionsocieties, acupuncturists play the predominant role,

1. The Japan Society for Oriental Medicine

and in others, physicians do so. Additionally, the2. Japan Dental Society of Oriental Medicine

research into acupuncture and moxibustion covers a

3. Japan Society of Veterinary Acupuncture

wide range of topics ranging from clinical application

4. The Japanese Society of Balneology, Climatology

to basic research. The basic research covers a wide

Academicsocieties

includingpursuing

academicacupuncture

and Physical Medicine

variety of topics ranging from bibliographic research

5. Japan Society of Neurovegetative Researchof classical texts specific for acupuncture and6. Japanese Society of Psychosomatic Medicine

moxibustion, to physiologic research performed on

7. Physiological Society of Japan98

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III. Japanese Acupuncture and Moxibustion Societies

This society is based on the theoretical and practical

Japanese acupuncture moxibustion societies infoundations of channel therapy. In the same year,

Japan consists mostly of members who are engaged in

Keiri Inoue, Shohaku Honma and others establishedresearch relating to acupuncture and moxibustion.

“The Acunpunture and Moxibustion Classics Study

These societies hold an annual conference in whichGroup. Also, in 1943, Hakko Baba established themembers are given opportunities to present papers on

Japanese Society for Research into Acupoints.

the results of their research. The regulations of these

The "Su Wen", "Ling Shu" and "Nan Jing"

societies provide a clause concerning the publication

served as the original texts, pulse diagnosis wasof a journal as a place for presenting research results.

the central examination method and the therapy
was based on Kampo diagnosis (zuisho chiryo = sui

1.

The

Japan

Societyof

Acupuncture

andMoxibustion (members: 3100 )zheng zhi liao). Clinically, the instruction given in
sections 69 and 75 of the "Nan Jing" provide theRegarding acupuncture and moxibustion, thetheoretical basis for the therapy, point selection forJapan Society of Acupuncture and Moxibustion is thereinforcement or reduction depending on states of

only corporate academic society. Organizations are

deficiency or excess in the twelve channels; andapproved by the Ministry of Education, Culture,thus are the foundation of the therapy. The

Sports, Science and Technology and meet certain

channel or Meridian concept is considered to be of

criteria. This society has 3,100 members, which

the greatest importance, and the existence of "qi",makes it the largest society among individual

on which this concept is based, is included in thisacademic

forexplanation. The understanding of human beings

acupuncture and moxibustion. When its former

and views regarding the significance of theorganizational form is included, the society can look

relevant concepts differ somewhat from modernback on a 55-year history.

scientific perspectives. After the war, this groupsocieties

andresearchgroupsMembers include university researchers who
research the classics, acupuncture and moxibustion

provided the leading theories for, and support of,Japanese acupuncture and moxibustion.

from the point of view of modern physiology, andothers that use the Chinese medical approach. As a“The Journal of Traditional Japanese Medicine”
is published quarterly.

result, the fields under investigation span a very wide
spectrum. This society can rightfully be considered to

3.

Japan

Traditional

Acupuncture

assume core responsibility for research on JapaneseM o x i b u sti o n So cie ty ( m e mbe r s : 8 00 )&This society, which forms the center hub for theacupuncture and moxibustion.
assumedactivities of groups like the Society for Traditional

responsibilities of the Chairman. The publication ofJapanese Medicine, the acupuncture and moxibustion“Journal of The Japan Society of Acupuncture andclassics study group, or the "Meishin Kai" for the

Moxibustion” is available to its members 5 times apurpose of cross-school academic research intoyear.

traditional

As

of

June

2008,

Shuji

Goto

acupunctureandmoxibustion,was

Traditional

Acupuncture&

established in 1973.
2. Society for Traditional Japanese Medicine(members: 1,500)
The

Japan

The

Japan

Moxibustion Society deals mainly with academic andTraditional

Acupuncture&

clinical research into Japanese acupuncture andMoxibustion Society was established in 1940 by Sorei

moxibustion based on a classical point of view. There

Yanagiya, Keiri Inoue, Sodo Okabe, and others.

are approximately 20 different groups studying

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010classical Japanese acupuncture and moxibustion andand moxibustion. However, aiming to make themore than half of these are affiliated with this society.

physiologicalMany of these groups center their activities onwestern medicine (especially neurophysiology), theclinical research, but there are also groups that

Society engages in scientific research.

pursue the study of historical texts like the "Koten
acupuncture and moxibustion study group" or theTheinterpretations“Journal

of

The

based

JapaneseonmodernSocietyof

Ryodoraku Medicine” is issued quarterly.

"Japan Naikei Medicine Study Group". Since the1970s, acupuncture and moxibustion have been

5. Japan Society of Oriental Medical Physicalresearched in a scientific way and has been affected

Therapyby Chinese medicine, leading to the formation of new

The Society was initially named the Japan Society

groups. This trend placed great importance onof Practitioners in Acupuncture, Moxibustion andtraditional comparative pulse diagnosis, or a system

Massage (Japan Society for All Acupuncturists). In

based mainly on the "Nan Jing", concentrating on

the establishment, Katsusuke Serizawa, Professor

pulse

Emeritus at University of Tsukuba played andifferentiation,

diagnosis

andabdominal

important role. Serizawa’s effort to try to definediagnosis.
As from April 2009, Shuichi Katai, Associate

acupuncture and moxibustion stimulation as a kind

Editor of this journal, has assumed responsibilities ofof physical stimulation led to the addition of “Physicalthe Chairman.

Therapy” in the Society’s official name. The Society is

The bi-annual journal of “Traditional Acupuncture

run mainly by members with impaired vision, notably
membershipand Moxibustion” is published for its members.

ofacupuncturists

andtraditional

Japanese masseurs with impaired vision is high4.

Japanese

Societyof

Ryodoraku

Medicine

other academic societies.

(members: around 800)
This society is engaged in research based on thetheory discovered by Yoshio Nakatani in 1950
demonstrating that low electrical resistance points
demonstrate special affinity with the acupuncture
meridians. The Society was established in 1960. For atime, the Society was divided into two: one managedbyphysicians,

and

the

other

managedbyacupuncturist and moxibustionists. Now the 800
members’ activities are organized as one society.
Approximately half of the members are physicians
and

the

other

half

are

acupuncturists

andmoxibustionists.
Nakatani is a physiologist, and his Ryodoraku issaid to be based on a physiological theory, involving
especially autonomic neurology.

The concepts ofacupuncture channels, acupuncture points in thescience of acupuncture and moxibustion have greatly
influenced the Ryodoraku theory. Modalities oftreatment in Ryodoraku are the use of acupuncture100

compare to the total membership and compared to

As the wording of Physical Therapy indicates, theSociety uses thermograph in their attempts toelucidate the efficacy of acupuncture and moxibustionand has published many reports on the effects ofacupuncture and moxibustion in terms of physicaltherapy.
The annual “Journal of the Japanese Society ofOriental Physical Therapy” is issued to its members.
6. Japan Eastern Medical Association
The predecessor organization was inaugurated in1973 mainly for physicians who had completed an
acupuncture and moxibustion seminar. At the time ofthe establishment, Yoshio Manaka served as president.
In 1983, the organization took the form of the current
Japan Eastern Medical Association. The purpose of
the Association is to provide opportunities to present
the results of general academic research that includes
the integration of the three following elements:

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

traditional Chinese medicine, Japanese Kampo, andmodern Western medicine. The Association holds anannual academic conference providing an appropriate
venue for the members` research.
The Association is characterized by active support
in scholarly training and professional guidance
especially for the activities of The Promotion
Foundation of Oriental Medicine. The Promotion
Foundation of Oriental Medicine defines its mission as
conveying information and educating physicians andhealthcare personnel education on oriental medicine.
The Association publishes the journal of “Eastern
Medicine.”drawn from classical writings of oriental medicine inChina and Japan, especially those of acupuncture andmoxibustion. In regard to the Yellow Emperor’s Classic
of Internal Medicine (Huangdi Neijing), and the Ling
Shu, new studies and discussions are conducted every
year. The Society issues the annual journal of “TheJapan Society of Acupuncture & Moxibustion History.
9. Oriental Medicine and the Pain Clinic
Oriental Medicine and the Pain Clinic were
established by Masayoshi Hyodo of Osaka Medical
College. Initially this society was a study group in the
Medicine of Acupuncture & Moxibustion of the

7.

Japan

ConferenceofClinicalAcupuncture

Department of Anesthesiology at Osaka Medical

Moxibustion

College, but is now conducting activities as an“Nihon Shin-Kyu Hiden (cutaneous electricalpotential) Study Group” has developed into the present
Japan Conference of Clinical Acupuncture andMoxibustion. The regulation of the Conference
maintains “the purpose of contributing to theimprovement in the quality of acupuncturists andmoxibustionists engaged in clinical practice and to theadvancement and dissemination of acupuncture andmoxibustion treatments through studying clinicalcases, conducting clinical research, and exchanging
information”. The Japan Conference was initiallyformed as a study group of Nihon Shin-Kyu Hiden in
1960, and changed its name to Nihon Shin-Kyu Hiden
Gakkai in 1975 and then became the present Japan
Conference of Clinical Acupuncture and Moxibustionin 1983.
The Conference issues the tri-annual journal of“Clinical Acupuncture and Moxibustion” which
includes seminar information and articles of casereports.

academic body. Hyodo noticed the pain relieving
efficacy of needles as an anesthesiologist and madevarious investigations concerning the action. The
activities of the organization used to focus essentiallyon headaches. Currently, however, its main activities
are research on the relationship between Western
medicine, oriental medicine and on mutual integrative
research.
The society issues the annual journal of “Oriental
Medicine and the Pain Clinic”.
10. The Japan Society for Oriental Medicine(members: 8600)
This society represents Japanese Kampo medicine
and is the most authoritative society concerning
herbology

inJapan.

Establishedtobroadencommunication among practitioners and to foster
cooperation among researchers, its primary goal wasto advance Kampo medicine in 1950 by medical doctors,

8. The Japan Society of Acupuncture & Moxibustion

pharmacologists,

Historypracticing this medicine. Its sphere of activity includes

This society is engaged in research on classicalwritings by means of philology.

The Society wasandacupuncturists

who

were

Kampo Medicine, acupuncture and most areas related
to Kampo Medicine.

inaugurated in 1993 as the Japan Society of

The official journal, “Kampo Medicine” features

Acupuncture & Moxibustion Clinical Philology anddissertations, theses, case reports, records of lectures

renamed as The Japan Society of Acupuncture &about Kampo Medicine and articles on acupuncture;

Moxibustion History in 2004. Research subjects are

and is published 4 times a year.

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Journals of Japanese Acupuncture andMoxibustion

Noboru Mitsuhata
Tokyo Eisei Gakuen College

Journal of the Japan Society of Acupuncture andMoxibustion
Published five times ayear for members of The
Japan
Societyof
Acupuncture
andMoxibustion. Deals withbasic and clinical research
results
pertaining
toevidence for the efficacy ofacupunctureandmoxibustion as well as casereports. Moreover, as an
online journal it offers thejournal's content in English. http://www.jsam.jp/

Oriental Acupuncture and Moxibustion Medicine
Meridian Therapy
Published four times ayear for members of Society
for Traditional Japanese
Medicine. Contents forbeginners dealing with casereports about meridian
therapy or ways to study
pulse diagnosis as well as
methods to study theclassics. The text is notavailable in English.

102

Published four times ayear for members ofJapanese
Societyof
Ryodoraku
Medicine.
Publishes research into
physiologic vital reactions
elicitedby
Ryodoraku
therapy and case reports.
http://www.jsrm.gr.jo/

Journal of the Society of Physical Therapy of the Japan
Eastern Medical Association
The contents of theconferences
hostedbyJapan Society of Oriental
Medical Physical Therapy
ispublishedinthismagazine once annually for
its members. The text is notavailable in English.

Oriental Medicine

Traditional Acupuncture and Moxibustion Journal of
the Japan Society
Published twice a year
for members of Japan
Traditional Acupuncture &Moxibustion
Society.
Publishes research into
medical classics, clinicalresearch etc. and contents
based on the topics ofacademic conferences heldby this society. The text is
not available in English.

Journal of the Japan Autonomic Nervous System
Society

Published four times ayear for members ofJapan Eastern Medical
Association.
Publishesbasic
research
intoacupunctureandmoxibustion and Kampo
as well as case reports.
The text is not available
in English.

Clinical Acupuncture and Moxibustion
Published three times ayear.

Publishesthecontents of the seminars
held by Japan ConferenceofClinicalMoxibustion

Acupuncture
and

case

reports based on modern
medical views. The text is
not available in English.

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Collection of academic papers of the Japan Society of
Acupuncture & Moxibustion History
Published once a year
for members of the Japan
Society of Acupuncture &Moxibustion

History.

Publishes

the

texts

prepared for lectures heldat academic conferences ofthis society. The text is notavailable in English.

Ido no Nippon
Monthlymagazinepublished by “Ido no
Nippon Sha”, a publisher
that has the longest history
in Japan for therapeutic
professionalsofacupuncture, moxibustion,anma, massage and shiatsu.
This magazine carries job
information as well as casereports and research reports. No English introductory
explanations are available.

Oriental Medicine and the Pain Clinic
Publishes

mainlyKampo

Shinkyu OSAKA

medicine,

acupuncture

Journalandquarterly

moxibustion for painful
case

nerve

reports

blockbyUniversity

affection, and researchandpublished
Morinomiya
ofMedicalSciences, a training school inofOsaka for acupuncture andinjection.

moxibustion

The text is not available

This

in English.

professionals.

magazine

carries

articles of round-table talks

http://www.osaka-med.ac.jp/~ane013/TOPEINDEX-J.html

Kampo Medicine

and case reports.
No English introductory explanations are available.

Chui Rinsho

Official journal of theacupuncture.

Journalpublished
quarterly to introduce
current TCM in China. The
magazine carries articles
written by authorities in
China, theoretical research
by Japanese, case reports,
explanationofKampo
prescriptions, and latest
news from China

Articles written in Japanese with attached English(for example, the therapy of SARS).

summary. Started in 1949, published 4 times a year.

No English introductory explanations are available.

Japanese

Societyfor

Oriental

Medicine.

The

most authoritative journal
in

this

field.

Includesdissertations, theses, casereports, record of lectures
about

Kampo

and

some

Medicine,

articleson

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Keiraku Shin Ryo

Bulletin of Meiji University of Integrative Medicine

Monthlymagazinepublished by Toyo Hari
Medical Association for themembers of this association.
The mag azine ca rr ies
a r ticle s
co ve ring
introduction of lectures
relating to classics of suchas “Nangyo” and casereports.
No
Englishintroductory explanations
are available.

Yearlybulletinpublishedby
Meiji
University of Integrative
Medicine. Articles cover
the contents of research
performed
intheuniversity. It has been
made
to
an
onlinejournalsince
2009.
Englishintroductory
explanationsareavailable.

Kikan Naikei

Bulletin of Kansan University of Health Sciences

JournalYearly bulletin publishedby Kansai University of
Health Sciences. Articles
cover the contents ofresearch performed in theuniversity. The bulletinswere previously publishedbyKansaiShinkyu
Daigaku (University) andKansai College of Oriental
Medicine.

published

quarterly by Nihon Naikei
Igaku Kai. The articles
coverclassic

researchmainly of “Kotei Naikei”.
No English introductory
explanationsareavailable.

Henseki

Oriental Medical
Moxibustion

PublishedbyClassic
Acupuncture
andMoxibustion Research Group(Koten Shinkyu Kenkyukai)
for the members. Articles
cover contents of research andtrainings held by this group.
No English introductory
explanations are available.

Toyo Ryoho Gakko Kyokai Academic Journal
Articles cover the contentsof research papers presented
at the academic conference ofJapan College Association ofOriental Medicine. Contentsof research were preparedby students before obtaining
license, but cover a wide
range of basic research toclassics.
No
Englishintroductory explanations areavailable.

104

JournalofAcupuncture&This bimonthly journal
was first published in
February 2008 by Midori
Shobo. The journal covers
not just case reports but
also
acupunctureandmoxibustion
techniquesand various trends in thefield. Contents introduction
in English is not included.

Weekly “Ahaki World”“Ahaki World” is an e-mail newsletter issued
weekly by Human World. This is the first e-mailnewsletter offered in the acupuncture andmoxibustion world. Free registration is accepted. The
newsletter introduces the clinical practice, theinsurance coverage, and a series of acupuncture andmoxibustion related articles of such as in-home care,
as well as news on the industry.
http://www.human-world.co.jp/

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Medical Insurance in Japan
Naoya Ono
L. Ac., M. Med. Sc., Ph.D. Candidate, Department of Health Informatics, Division of Health Administration,
School of Public Health, Graduate School of Medicine, Kyoto University

Foreword
The practice of Kampo medicine in Japan is sustained by the country’s medical system. The reason that
Kampo medicine is so widely used for medical purposes is due to its acceptance by medical insurance. The medical
system in Japan is not the same as that in other countries. With a unique Japanese framework, and operated
through the political support of the Health, Labor and Welfare Ministry; the Japanese medical system hassustained the health of the Japanese people. When considering the role played by Kampo medicine in Japanese
healthcare, it is extremely important to look at how Kampo medicine is managed within the medical system.
As noted in other parts of this journal, the reasons that physicians educated in Western medicine can practiceKampo medicine are (1) drugs used in Kampo medicine can be dispensed easily, and (2) the existence of 148 typesof these drugs which have a high level of compliance in their use. After learning a certain degree of traditional
medical concepts, physicians introduce these drugs into their own clinical practice. Utilizing these drugs, and theinsurance system that sustains their operation, they perform clinical tests and independent research, including
research based on the accumulation of case studies and comparative studies.
Meanwhile, there are medical institutions, though not many, which provide medical treatment based on
Kampo medicine, at their own expense. In particular, there are many places that use herbal medicine astherapeutic drugs. While more than 160 types of herbal medicine are accepted by healthcare insurance, it isfinancially difficult for herbal medicine to be used with health insurance treatment. This is due to such problems
as their excessively low cost, the fact that they require a great deal of manpower and shelf space, and the difficulty
in securing pharmacists who posses a high degree of knowledge in this area. While providing medical treatment at
one’s own expense is much simpler than providing health insurance treatment, it is another form of Kampo
medicine practiced in Japan.
This article, written by Ono, explains the medical system in Japan. The overall theme is much larger than
Kampo medicine, and has very little to do with clinical Kampo medicine. Nevertheless, we have included it to letreaders know that medical treatment is based on this system. This article also contains information that will be
useful to people who intend to study about the Japanese medical system.
Editorial Staff

1. History of Development of the Medical System(1) Medical Security System and Social Security
Broadly defined, Social Security in Japan includes
protection and pensions for victims of war. Narrowly
defined, it means public assistance (livelihood
assistance), social welfare (for the physically disabled,
mentally disabled, elderly, children, single mothers,etc.), social insurance (medical insurance, annuity
insurance,
nursing
insurance,
unemployment
insurance, industrial injury insurance, etc.) and publichealth (tuberculosis, infectious disease, drug-related
measures,waterworks
anddrainage,waste
management, etc.). Other than exceptional cases suchas people who receive livelihood assistance based on
low income (0.8% of the total Japanese population), allJapanese citizens currently have a form of medical
insurance, which is one of the medical services
guaranteed to all Japanese citizens.

(2) History of the Medical Security System① Structure of Universal Health Insurance System
The history of medical insurance in Japan dates backto the establishment of the Health Insurance Law in1922. This law became institutionalized for employees
at factories and elsewhere, amid the rise of the labor
movement during the development period of
capitalism at the beginning of the 20th century.
Subsequently, in 1938, the system of national healthinsurance was established for individual proprietors
and farmers. As a result, in 1945 approximately 60% of
the Japanese population had medical insurance.
However, with the chaos of World War II, it became
impossible to provide sufficient healthcare to people,
and the system was in danger of collapsing. With theeconomic and social reconstruction after the war, theconstruction of a genuine system of social security
began. And the system of medical insurance, which
had been on the brink of collapse, was also
reconstructed.

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The national treasury assumed the burden of
government-managed health insurance in 1954. In
1963 a 3-year period of health insurance provision
which had been in place thus far was abolished, thetime limitation on insurance during recuperation waseliminated, and plans to improve health insurance
were discussed.
Meanwhile, based on revisions in 1954, themanagement of national health insurance wasrevamped from the regular Blue Cross system
conducted by individual cities, towns and villages, topublic management by municipalities. In addition, it
became compulsive for municipalities managing
national medical insurance to make this insurance
available to residents. In order to stabilize the financesof national health insurance, based on revisions in
1955, a system of national treasury assistanceequivalent to 20% of recuperation expenses becamelaw.
Under such conditions, the National Health
Insurance Law was completely revised in 1958, and a
yearly plan was decided for the realization of universal
health insurance over a period of four years. In 1961, asystem of national health insurance was put into effectin all municipalities for individual proprietors andfarmers who did not have employee’s health insurance.
The result was universal health insurance in Japan,
based on employee’s health insurance and national
health insurance. After that, it became compulsive for
all Japanese citizens to have either employee’s healthinsurance or national health insurance – both of which
are forms of social insurance.
② Establishment of Healthcare System for the
RetiredIt is a qualification requirement that people
receiving employee’s health insurance in Japan be
employed at a place of business enumerated in the law.
After an employee retires because he or she hasreached retirement age or for another reason, that
employee is no longer employed at the place ofbusiness, and as a general rule will no longer receive
employee’s health insurance – but instead will receive
national health insurance.
The level of health insurance for such aged retirees
drops at a time when their need for healthcare is on
the rise, resulting in the problem whereby they must
depend on the national treasury and national healthinsurance premiums to pay their healthcare expenses.
For this reason, a medical care system for the retired
was established in 1984 to ensure fairness in theprovision of healthcare and the burden of its costs
throughout the lifetime of people who receive
employee’s health insurance, and to correct
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irrationality between medical care systems. While therate increases at which healthcare is provided to aged
retirees who formerly had employee’s health insurance
but who have since begun receiving national healthinsurance, this system pays for that healthcare by the
insurance premiums from retirees who had been
receiving employee’s health insurance and bycontributions from employee’s insurance.
③ Establishment of Health Insurance System for the
Elderly
As mentioned above, due to the relationshipbetween employee’s insurance and National Health
Insurance, the percentage of elderly people who have
National Health Insurance increases as society ages.
Furthermore, as the structure of employment inJapanese society changes from primary industry to
secondary industry, and from secondary industry totertiary industry, the younger segment of society
switches to employee’s insurance rather than National
Health Insurance. As a result, the age composition of
insurants with National Health Insurance has
gradually risen. In 1998, the average age of people
with an insurance policy was 51.3 years for National
Health Insurance through municipalities, 36.9 years
for government-managed health insurance, and 33.6
years for union-managed health insurance. The
percentage breakdown for elderly people with healthinsurance is 25.3% for National Health Insurance
through municipalities, 5.7% for government-managed
health insurance and 2.8% union-managed for healthinsurance.
If the situation by which the age composition of
insurants is made light of is projected into insurance
area of finance, if there were no system of adjustment
between types of coverage, the higher the age
composition in a system of insurance the more difficult
it becomes to finance that system. And overall the
insurance premium revenue obtained from elderly
people is not as large as that obtained from theyounger segment. Meanwhile, as far as expenses areconcerned, since the per-person healthcare costs forthe elderly is five times that of the younger segment,
as the percentage of elderly people increases soincrease healthcare costs. (As a result, in 1999,
healthcare costs for the elderly accounted for 38%, or
11.8 trillion yen, of the total of 30.9 trillion yen innational healthcare costs. What’s more, the percentageof healthcare costs for the elderly increases each year.)Also, in 1973, based on revisions in the Elderly
Welfare Law, a system was established whereby
so-called free healthcare costs for the elderly (theamount for which the individual elderly person is
responsible under healthcare insurance), are paid for
at public expense. With the subsequent rapid increase

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in healthcare costs for the elderly, there has been morepressure for the financing of National Health
Insurance.
For this reason, the difference in age composition
among insurers that comes with the aging of society
has been corrected – and from the viewpoint of
spreading the burden of healthcare costs for theelderly fairly among the Japanese people a healthservice system for the elderly was established in 1983.
Also, health and medical treatment measuresprovide for the treatment of disease – and based on theknowledge that comprehensive measures for thehealth of the elderly have been lacking, not only does
the health service system for the elderly deal withproblems of finance, but it also has to do withcomprehensive insurance for the elderly, which
includes measures for preventing and detecting
disease early on, during the prime of life, so that theincreasing number of elderly people can live healthy
lives.
④ Establishment of a System of Nursing Insurance
As society ages there has been a sudden increasein the number of people who require nurses, including
those who are bedridden and those who suffer fromdementia. Meanwhile, changes in social conditions,
including the growing number of nuclear families andthe social advancement of women, have witnessed adecrease in the function of nursing provided byfamilies.
However, since nursing service for the elderly wasformerly provided under two different types ofcoverage – welfare coverage for the elderly andinsurance coverage for the elderly – there was adisproportion in the burden of cost and usage
procedure, so that the situation was inadequate forcomprehensive nursing measures. For this reason, sothat elderly people who require nursing or care will beable to lead meaningful lives in accordance with theirown ability, a system of nursing insurance coverage
was established in April 2004, to provide
comprehensive
service,includinginsurance,
healthcare and welfare services, based on user
selection.
⑤ Maintenance of the System for Healthcare
Provision
The modern healthcare system in Japan began in
1874 with the establishment of the medical system.
The National Healthcare Law was subsequently
established in 1942, and with the difference between
hospitals and clinics being clarified, a system for
permitting physicians to establish clinics was put into
effect.

After the war, in 1948, the Healthcare Law, on
which the system for healthcare provision in Japan isbased, was established. Also, with the Doctor and
Dental Practitioner Law being gradually put into place,there has been a quantitative expansion of healthcare
provision for acute medical treatment.
Subsequently, with changes in the structure ofdisease and the aging of society, there has been areview of the system of healthcare provision.
In 1985, a healthcare planning system byprefecture was introduced for the purposes of revising
the system of healthcare provision locally as part of
the first round of revisions of the Healthcare Law, andobtaining the cooperation of healthcare facilities. Also,an adequate number of hospital beds have beenrealized.
In 1992, the Healthcare Law was revised a second
time for the purposes of (1) realizing conceptual
regulations for providing healthcare, and (2) thesystemizing the function of medical facilities withtechnologically advanced hospitals and extended careunits having been systematized.
Furthermore, when the Healthcare Law wasrevised for a third time in 1997, (1) informed consent
regulations were realized, (2) extended care units wereexpanded into clinics, (3) community health support
hospitals were systematized, and (4) the system of
healthcare planning was reviewed.
When the Healthcare Law was revised for a thirdtime in 2000, (1) a distinction was made between beds
for general patients and beds used for the purpose ofrecuperation, and the provision of healthcare waspromoted to suit the condition of the individual
patient; (2) there was an easing of required
regulations; (3) there was a securing of the observanceof hospital arrangement standards; and (4) measures
were adopted for easing advertising regulations.
2. Structure of Disease
The structure of disease in Japan has changed
from acute infectious disease to chronic lifestyledisease, based on such things as improvement innourishment, higher hygienic standards, advances inmedicine and medical technology, and changes inhealth awareness. In view of the annual transition in
the percentage of cases of hospitalized treatment,
there has been a remarkable decrease in infectious andparasitical diseases, with a drastic increase in diseaseofcirculatoryorgan
systems,
including
cerebrovascular trouble, as well as neoplasm such as
cancer. Also, death ratio according to cause of deathindicates a sudden decrease in the death rate fromThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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tuberculosis, and an increase in the death rate from
cerebrovascular disease and malignant growths.
3. Healthcare Costs(1) Total Healthcare Costs and Their Breakdown
National healthcare costs in Japan are on an
upward trend, even under conditions of slumping
economy. Healthcare costs reached 30,933,700 million
yen in 1999, or 244,200 yen per person.
This notion of national healthcare costs represents
the cost for treating ailments among the Japanese
population at medical facilities over a 1-year period.
These costs are calculated based on expenditures for
public healthcare insurance. Included in national
healthcare costs are medical treatment fees, theresponsibility of patients to pay for a portion of thecosts, the cost of providing medicine, nursing costs,
and transportation costs. However, expenses fornormal birth, expenses required for medical checkups
for the maintenance and promotion of health, expenses
for amenity bed, and a portion of the construction costs
for public medical institutions are not included. Also,
as a general rule, since healthcare costs are free ofconsumption tax, there are no taxes for their expense.
In Japan, the details of medical practice, theadministering of medication and medical examinations
appear in statements submitted by medical
institutions as the foundation of a progress payment
system based on a nationally standardized medical
treatment fee bill used by both hospitals and clinics.
And so, by totaling up the amount paid based on
medical fee statements, the particulars and monetaryamounts of medical treatment performed at medical
facilities are understood on the national level. And
based on such social insurance statistics, national
healthcare costs are determined with the addition ofdata other than social insurance, including healthcare
costs paid for at public expense.
Including the cost of purchasing medicine, publichealth expenses (including medical checkups andvaccinations), managerial and operational costs, andresearch and development costs, this corresponds tothe total healthcare costs of the OECD. Total
healthcare costs in Japan (1998) are 7.4% of the GDP,
which ranks number 18 among nations belonging to
the OECD. However, in terms of monetary amount,
this represents 283,558 million dollars, second only to
the 1,125,555 million dollars of the United States. The
per-capita healthcare cost is 2,242 dollars for Japan(ninth), with Germany at 2,697 dollars (fifth), France
at 2,324 dollars (eighth), and the Netherlands at 2,172
dollars (tenth) – which means that there is not such a
big difference in per-capita healthcare cost among
these nations.

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Looking at the breakdown of healthcare costs inJapan in terms of national healthcare costs (fiscal
1999) by consultation type, general consultation costs
involving admittance to the hospital account for 36.8%,
dental clinics account for 8.2%, dispensing pharmacies
account for 7.8%, costs for meals and medical
preparations when patients are admitted to thehospital account for 3.5%, health service facilities forthe recuperation of the elderly account for 2.5%, andhome nursing and medical costs for the elderly accountfor 0.3%.
Breaking things down by category of expense at
medical institutions (fiscal 1998), personnel costs
involving healthcare attendants account for 50.9%, thecost of medical supplies accounts for 19.4%, the cost of
medical materials accounts for 6.1%, and consignment
expenses account for 5.2%. By fiscal resources (fiscal
1999), public expenses account for 32.9%, the cost of
insurance premiums accounts for 52.5%, with othercosts accounting for 14.7%.
(2) Healthcare Costs for the Elderly
Healthcare costs for people of the age of 70 andolder (including bedridden people between the ages of
65 and 70) (hereinafter referred to as “healthcare
costs for the elderly”) reached 11,804 billion yen in
fiscal 1999. The trend for increasing healthcare costs
for the elderly is remarkable, with these costs
accounting for 38% of total national healthcare costs.
Breaking down national healthcare costs by maincauses for this increase, increase in populationaccounted for 0.2% of the 3.7% increase in fiscal 1999,
the aging population (change in the population
composition by age level) accounted for 1.6%, withother increases (change in the structure of disease,advances in healthcare, etc.) accounting for 1.9% of thetotal increase – which means that the effect of aging isgreat. Also, while the total cost of national healthcare
increased by 3.7%, the increase in healthcare costs foryoung people was 1.0%, with the increase inhealthcare costs for the elderly at 8.4%.
The reasons that the cost of healthcare for theelderly causes healthcare costs to increase are becauseof the increase in the population of elderly people, andbecause of the fact that per-capita healthcare costs forthe elderly are five times greater than the costs ofhealthcare for young people. When comparing thedifference between healthcare costs for the young andold in Japan to that in American and European
countries based on data from the OECD, the differencein Germany is 2.68 times (1994) and the difference inFrance is 3.00 times (1993), so that the difference
between the young and old is generally between 2 and4 times – which means that this difference is higher in

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Japan than in Western countries. In Japanconsideration must be given to the fact that the costs ofnursing have traditionally been calculated ashealthcare
costs,duetoso-called“socialhospitalization,” whereby people are hospitalized at
medical institutions due to such factors as outdated
nursing services provided to the elderly, although
medical treatment might not be necessary.
The cause of high healthcare costs for the elderly
has to do with each of the three elements of healthcare
cost per capita. Among the three elements, the“consultation rate” is an index indicating how often aperson with healthcare insurance is seen at a medical
institution per month. In this case, the number of
instances of consultation is the same as the number ofbills for medical treatment issued by medical
institutions, with one bill per patient issued by each
medical institution. The consultation rate for theelderly is 6.2 times that of young people for patients
who are hospitalized, and 2.6 times that of young
people for outpatients.
The next element, “number of days per instance,”
is the average of the actual number of days of
consultation per month as indicated in the
consultation fee statements from medical institutions.
The number of days per instance for elderly people is
1.3 times greater than that number for young people
who are hospitalized, and 1.4 times greater than that
number for young people who are outpatients.
The “per-day consultation cost,” which is theconsultation cost (billed to the medical insurance eachmonth) divided by the actual number of days ofdiagnosis and treatment, means the unit price of
healthcare service. This per-day consultation cost for
the elderly is 0.9 times greater than that for young
people who are hospitalized, which means that it isless for the elderly than for the young. The per-day
consultation cost for outpatients is 1.2 times greaterfor the elderly than it is for young people.
As indicated above, the reason that the cost ofhealthcare for the elderly is higher than it is for young
people is due to the fact that the consultation rate forthe elderly is much higher than it is for young people,
both for patients who are hospitalized and for
outpatients. Amid this situation it is surmised thatelderly people, who have numerous adult lifestylediseases such as diabetes and high blood pressure,frequently consult physicians at medical institutions.
Furthermore, with the free access in the Japanese
healthcare system which enables patients to choose
the medical institution where he or she will consult aphysician, it is believed that other reasons include thefact that there is a smaller percentage of elderly people

who take the responsibility of healthcare costs uponthemselves, and the fact that the excessive number ofhospital beds and outdated nursing services promoteso-called social hospitalization.
Of course, the average life expectancy in Japan is
77 years for men and 84 years for women, both ofwhich are the highest in the world. With the average
healthy life for men and women in Japan at 74.5 years,
the WHO, both in quality and equality, ranks theJapanese insurance and healthcare systems number
one in the world. However, with the further advance of
aging in the future, it is estimated that national
healthcare costs will reach 81 trillion yen in 2025, 45
trillion yen, or 56%, of which will be accounted for byhealthcare costs for the elderly. These national
healthcare costs account for 12.5% of the national
income, for an increase of approximately 1.7 times thatof the 7.5% figure for 2000.
Before there is a sudden rise of healthcare costs forthe elderly, it is important for Japan to establish
measures for the prevention of disease and general
healthcare, keeping in mind the matter of lifestyledisease. In addition, Japan faces the urgent task ofreforming the system of healthcare for the elderly.
4. System for Providing Healthcare(1) Amnesty for the System of Providing Healthcare inJapan
The system for providing healthcare in Japan has
the following nine features. (1) There is a system inplace by which physicians and dentists are free toestablish clinics if they notify the prefectural governorof that establishment. (2) Hospital doctors are working
doctors. (3) There are no restrictions on consultation
fees. (4) There is a high percentage (approximately
80% of the number of facilities) of private hospitals(medical corporations); there is a high percentage ofsmall and mid-sized hospitals with 200 beds or less(approximately 70% of the number of facilities). (5)Some clinics have beds, and clinics are equipped withmedical equipment and facilities. (6) Hospitals takeoutpatients, and the consultation rate for thosepatients is high. (7) It is prohibited for hospitals or
clinics to operate for profit. (8) People are free tochoose the medical institution where they will consult
a physician. (9) On the average, patients in Japanremain hospitalized for more days than patients inmany of the other countries belonging to the OECD;
Japanese hospitals have more beds per patient thanmany of the other countries belonging to the OECD;
Japanese hospitals have a fewer number of physicians
and nurses on staff per bed than many of the othercountries belonging to the OECD.

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010(2) Medical Facilities
Broadly speaking, medical facilities can be divided
into three categories: hospitals, clinics and maternity
clinics.
Hospitals are medical facilities that have at least
twenty beds, and must receive permission from theprefectural governor to be established.
Some hospitals, known as “technologicallyadvanced hospitals,” provide advanced healthcare, andbased on an application submitted by the individual
hospital are individually approved by the Ministry of
Health, Labor and Welfare to perform development,
evaluation and training in advanced healthcare.
Specifically speaking, these include university
hospitals and national cancer centers, with 82 such
facilities having been approved as of April 2002.
Also, from the viewpoint that family doctors anddentists should be supported in order to ensure
healthcare in local regions, there exists a system of“hospitals supporting local healthcare,” approved by
the prefectural governor. As a condition for being
approved, hospitals supporting local healthcare must
provide healthcare to referred patients, provide
support to local healthcare facilities by such means as
the joint-utilization of facilities and equipment andmaking facilities and equipment openly available,
provide emergency medical care, and train healthcare
attendants in the local region. As of April 2002, there
were 35 facilities that had been so approved.
Clinics either are medical facilities that have nobeds at all or have hospitalization facilities of 19 beds
or less. If a physician or a dentist opens a clinic, he or
she must notify the prefectural governor (the mayor of
the city or special district where the public healthcenter is set up). If a person other than a physician or adentist opens the clinic, he or she must receive
permission from the prefectural governor (the mayor of
the city or special district where the public healthcenter is set up).
Maternity clinics are medical facilities that either
have no beds at all or have hospitalization facilities of
9 beds or less, and where midwives work. If a midwife
opens a clinic, she must notify the prefectural governor(the mayor of the city or special district where thepublic health center is set up). If a person other than a
midwife opens a clinic, that person must receive
permission from the prefectural governor (the mayor of
the city or special district where the public healthcenter is set up). The prefectural governor must grant
permission to a facility that so applies if its structuralequipment and stationed personnel conform to acertain standard. However, the prefectural governor
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might not grant permission for the establishment ofsuch a facility if the person applying for permission
intends to operate that facility for profit.
(3) Healthcare Attendants
The number of doctors and dentists in Japan is on
an upward trend each year, and as of 2000 there were
255,792 doctors and 90,857 dentists. While this is lessper capita than those numbers for other advanced
nations, Japan achieved the target of having “150doctors and 50 dentists per 100,000 people by 1985,”
which was set in 1970. In order to ease the excessive
number of personnel in the future, the university
admission capacity has been decreased.
And in efforts to improve quality and raise thelevel of clinical ability, clinical training for graduates
was systemized and enhanced.
The number of nursing personnel per capita inJapan is on the same level as that in other advanced
nations, but the number of nurses per hospital bed
remains low. According to the forecast regarding
recipients of nursing services in December 2000,
demand at the end of 2001 will exceed supply byapproximately 35,000 people due to such factors as therealization of a more cordial system of nursing,
improvements in working conditions, and the carrying
into effect of a system of nursing insurance coverage.
However, it is forecasted that supply and demand willbalance out at about 1,300,000 people by 2005.
There are two types of nurses. One is the so-calledassociate nurse, who receives a license after passing atest offered by the prefectural governor. The other isthe regular nurse, who receives a license after passing
a test offered by the minister of health, labor andwelfare. The former changing to the latter and theimprovement of quality have become issues.
(4) Healthcare Corporations
According to the Healthcare Law, a hospital, or aclinic where doctors and/or dentists work, or a
corporation or foundation that intends to establish ahealth service facility for the elderly may make thatfacility into a healthcare corporation. The approval of
the prefectural governor (or the minister of healthlabor and welfare, for two or more businesses) is
required to establish a healthcare corporation. As
conditions for approval to establish a hospital, theestablisher must have a capital adequacy ratio of 20%
or more, and there must be three directors, one
inspector, and as a general rule the chief director must
be a doctor or a dentist.
A healthcare corporation is prohibited from having
a dividend of surplus, and any contingent business is

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limited to being within the scope of the training ofhealthcare practitioners. What’s more, as a generalrule business for profit is prohibited.
Healthcare corporations are subject to thefollowing taxes: corporation tax (the same tax rate as a
joint stock company) and enterprise tax (anything
having to do with social health insurance treatment
rewards is tax-free, and tax rate reductions apply toanything having to do with diagnosis and treatment
chosen at the discretion of the patient).
Included among healthcare corporations are“specified healthcare corporations” which, based on theSpecial Taxations Measures Law, are approved by theminister of finance as a corporation which meets
certain conditions, including operating a business
which has a high level of public interest, and/or which
is publicly managed. Also included among healthcare
corporations are “special healthcare corporations”
which, based on the Special Taxations Measures Law,
are approved by the prefectural governor for meetingthe same conditions. Special healthcare corporations
receive corporation tax rate reductions. And special
healthcare corporations are allowed to operate certain
types of business for profit.
(5) Evaluation of Medical Practice
Against a backdrop of increased popularawareness for healthcare and rising concern among
affiliates for the quality of healthcare, the Project for
the Evaluation of Hospitals by a Third Party was
carried into effect in 1997.
Through this evaluation project, the quality ofdiagnosis and treatment, nursing, and other careprovided by a medical institution, patient satisfaction
and the situation of management are evaluated by theJapan Council for Quality Health Care, as a third
party from a neutral standpoint, based on a requestfrom the hospital. If the results of the evaluation are ofa certain standard or above, a certificate of approval isissued to the hospital. Although hospitals are notrequired to undergo this evaluation, 725 hospitals hadreceived a certificate of approval as of August 2002.
From the viewpoint of improving the quality ofhealthcare, progress can be expected from theevaluation of medical practice by a third party. But inorder to promote this trend hospitals are now allowed
to publicize the results of their healthcare evaluation.
And through revisions of healthcare fees in 2002, theinclusion of palliative care has become a condition for
approval by the Japan Council for Quality Health Careand for ISO certification.

5. Healthcare Insurance Coverage(1) Classification of Coverage① Employee’s InsuranceA) Beneficiaries and Insurers
Depending on the beneficiaries to whom thecoverage applies, types of healthcare insurance areroughly divided into employee’s insurance (occupation
insurance) for employees and their families, andNational Health Insurance (regional insurance) for
people engaged in the agriculture and fishingindustries and individual proprietors.
And depending on the difference in beneficiaries,
employee’s insurance is divided into health insurance(union-managed
healthinsurance
andgovernment-managed health insurance), seaman’s
insurance and insurance for the different kinds ofmutual aid unions. Health insurance coverage forgeneral employees is the biggest, accounting for
approximately 55% of all subscribers. Under thesystem of health insurance coverage, offices of thenational government, corporate offices (including
offices), and private offices engaged in certain types ofbusiness which regularly employ five or more people
are offices of compulsive application, and all employees
who work at those offices are compulsion application
insurants. Nearly all types of businesses are deemedbusinesses to which this insurance applies. Classifying
health insurance coverage from the point of view of
insurers, this insurance can be divided into
government-managed health insurance that is
managed directly by the government, andunion-managed health insurance that is managed by ahealth insurance union established individually or
jointly by the owner or owners of the business.

Union-managed Health Insurance

Health insurance unions are public corporations
not affiliated with the government, and are
established individually or jointly by the owner orowners of businesses which employee 300 people ormore per one or two or more places of business.
(Actually an individual union has 700 or more people,
while an integrate union has 3,000 or more people – inorder to secure its ability to diffuse risk.) Healthinsurance unions are made up of business owners,
employees of places of businesses who have employee’s
insurance, and people who have arbitrary insurance.
Health insurance unions manage the union members
who are insured and the heath insurance itself. Since acertain number of subscribers are needed to establish
a health insurance union because of the necessity todiffuse risk, union-managed insurance is mainly forpeople who are insured through large corporations.
The number of health insurance unions at the end of
March 2001 was 1,756.

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Government-managed Health Insurance

The government manages the health insurance ofpeople with insurance that is not managed by a union.
Government-managed health insurance is mainly for
employees of small and medium-sized businesses who
have insurance.

Other Types of Employee’s Insurance

The mutual aid union is a system of healthcare
insurance coverage that was established for special
occupations to serve people with seaman’s insurance
and civil servants.
People insured under the system of seaman’s
insurance include captains and crewmembers ofvessels which meet certain requirements. This type of
insurance, which is managed by the government,
accounts for 0.2% of all subscribers (as of the end of
March 2000).
Mutual aid unions provide coverage for workers inspecific occupations, including civil servants. This
coverage is divided according to specific occupation.
Currently there are three types of mutual aid unions.
These are mutual aid unions for employees of thenational government, mutual aid unions for employees
of local governments, and mutual aid unions for
personnel of private schools. Mutual aid unions
account for 7.9% of all subscribers (as of the end of
March 2000).

Benefit Rate

The benefit rate for healthcare benefits is 80% for
the insurant, 80% if a family member is hospitalized,
and 70% for outpatient treatment. However, after
April 2003, all of these will be 70%, with 30% as a
co-payment. (The benefit rate for infants under three
years old is 80%.)
For union-managed health insurance, in order toreduce the co-payment of insurants, authorization has
been granted by the Ministry of Health, Labor andWelfare to arbitrarily apply fringe benefits beyond thebenefits stipulated by law, according to the financial
situation of each individual union.

Responsibility for Pharmaceutical Expenses

B) Benefits

Details of Benefits

Healthcare insurance is a system of coverageagainst financial loss, including that resulting from
illness, injury, death and birth, and is provided for the
purpose of treating ailments. The scope of theseinsurance benefits is stipulated to include medical
examinations, medicine and materials used in medical
treatment, medical treatment such as surgery andother procedures, the management of the recuperationof patients at home as well as nursing and other formsof care required for that recuperation, and admittanceto a hospital or clinic as well as nursing and otherforms of care required for recuperation. There is notime limit involved. Employee’s insurance is provided
not only to the employee who has the insurance, butalso to a specified range of nonworking dependents.
Benefits are broadly divided into healthcare
benefits and cash benefits. Healthcare benefits are thehealthcare services provided through healthcare
insurance. In Japan a person with insurance receives
healthcare services at a medical institution designatedby the Ministry of Health, Labor and Welfare as aninsurance medical institution. As a general rule, that
insurant only needs to pay a co-payment, while the112

rest of the healthcare cost is paid by the insurer to the
medical institution as a benefit in kind. When an
insurant cannot receive a benefit in kind – for example,
in a circumstance when he or she has had no choice
but to receive medical treatment overseas – theinsurant pays the entire medical bill and is later
reimbursed for that amount by the insurer. Cashbenefits include cash benefits for sickness andmaternity benefit money as compensation for taking
off from work, transportation expenses as a benefit forcompensation of actual expenses, lump-sum payments
for childbirth and childcare, and funeral costs.
Childbirth expenses are not only paid as healthcare
benefits, but also as cash benefits in lump-sum
payments for childbirth and childcare.

If a patient who regularly goes to a medical
institution receives medication, he or she pays aportion of that cost as a co-payment, based on the typeand quantity of the medication. However, after April
2003 there will be no co-payment.

Meals During Hospitalization

Regarding the cost of meals during hospitalization,
for all forms of coverage the patient pays a standard
amount determined by the cost of food for the average
household (780 yen per day; and for people with low
income 650 yen per day for the first three months of
hospitalization, and 500 yen per day after fourmonths), and the rest is paid through the healthcare
insurance as meal recuperation expenses duringhospitalization.

High Medical and Recuperation Cost Coverage

Furthermore, in order to ease the effect of highhealthcare costs on household finances, all types of
insurance coverage have incorporated a system
whereby if a patient’s co-payment exceeds a certain
amount, he or she is afterwards reimbursed for theexcessive amount through health insurance coverage.
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(healthcare costs – 361,500 yen) x 1%. However, theamount is determined by a person’s income.
Based on the reimbursement afterwards for highmedical and recuperations cost, the effective benefit
rate is 80.2% for union-managed insurance, and 78.8%
for government-managed insurance.

Specific Recuperation Cost
It is prohibited for healthcare service which
exceeds the level provided for by the medical
treatment fee point table to be claimed by being added
to the usual co-payment, or to combine insured
diagnosis and treatment with diagnosis and treatment
outside the realm of insurance coverage and collectfrom the patient the cost of the diagnosis andtreatment outside the realm of insurance coverage(principle of the prohibition of combined diagnosis andtreatment). In other words, for diagnosis andtreatment, or for the administering of medicine, which
are not covered by healthcare insurance benefits – thatis to say, those which are not listed in the medical
treatment fee point table or among the standard prices
of medicine – all of the healthcare treatment regarding
the patient in question shifts from the object of theinsurance claim and becomes outside the realm of
insurance coverage, and the patient is responsible forthe entire amount. However, a system of specified
healthcare coverage has been adopted to address the
emergence of new technology and the diversification ofpatients’ needs, against a backdrop of remarkableadvances in medical technology in recent years. Amongthe costs for lifestyle service and having a pleasantenvironment (amenities) (for example, special costs forprivate rooms, and services including special dental
materials such as gold teeth), and the healthcare costs
accompanying advancements in technology andresearch and development, the costs for normal service
and healthcare are paid for through healthcare
insurance as specific recuperation costs, with othercosts being outside the realm of insurance coverage.
C) Fiscal Resources
Insurance premiums and the national treasury
cover health insurance business costs.

Insurance Premiums

Insurance premiums are calculated by multiplying
the premium rate by the standard monthly salary(determined regularly once every year) paid to an
employee, and are collected monthly. Standard
monthly salaries are classified from Grade 1 (98,000yen) to Grade 39 (980,000), and each insurant falls
under one of those grades depending upon his or her
salary.

Premium Rates for Union-managed Insurance

Premium rates for union-managed insurance aredetermined by the various health insurance unions,
within the range of 3.0% to 9.5%, with the approval of
the Ministry of Health, Labor and Welfare. The
average premium rate for all unions in March 2003
was 8.514%. As a general rule, the responsibility forthe payment premium is split between the employer
and the insurant. However, the maximum percentagethat the insurant can be responsible for is 4.5%, andthe amount that the employer are responsible for may
be increased to more than half of the premium amount.
As of March 2003, the average premium rate for allunions was 4.787% for business owners, and 3.727%
for insurants. The premium amount for which an
insurant is responsible is withheld by the employer
from the insurant’s pay, and the employer are
obligated to make the premium payment. The level ofpremium payment responsibility (fiscal 1998) is
159,000 yen for insurants (364,000 yen when theamount for which business owners are responsible foris included).

Premium Rates for Government-managed Insurance

Premiumrates
forgovernment-managed
insurances range from 6.6% to 9.1%, and can bechanged by the minister of health, labor and welfare
through deliberation of the Social Security Council. In
2001 the rate was 8.5%. The insurance premium issplit between the insurant and the employer. The levelof premium payment responsibility (fiscal 1998) is
152,000 yen for insurants (333,000 yen when theamount for which business owners are responsible foris included).

Special Insurance Premiums

Bonuses are normally paid in Japan. The
proportion of the bonus to total salary varies fromindividual to individual. In order to ensure fairness inpremium payment responsibility, a special insurance
premium is collected from the bonus, which is separate
from the monthly insurance premium. Healthinsurance unions can set the rate of premiums forunion-managed health insurance within the 1.0%
range and collect those premiums accordingly.
However, it is left up to the unions to decide whether tocollect the premiums. The rate for special insurance
premiums of government-managed health insurance is1%, and the responsibility of paying these premiums is
split between the employer and the insurants. The
insurants’ responsibility is exempted by 2/5, and thenational government pays the difference. After April
2003, a total salary system for levying insurance
premiums against bonuses as they are levied against
standard salary will be introduced.

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Responsibility of National Treasury

nursing and recuperation costs, high cost healthcare,lump-sum payments for childbirth and childcare,funeral costs, and transportation costs. In addition
there are arbitrary benefits in the form of cash benefits
for sickness and cash benefits for childbirth which may
be arbitrary according to municipal ordinances orunion regulations. Each of these types of insurance
benefits are similar in content too those of healthinsurance coverage.

For government-managed health insurance, in
addition to clerical expenses the national treasury is
also responsible for paying 13.0% of benefit costs, and16.4% of the health contributions for the elderly (to be
discussed later). The reason that union-managed
health insurance is so generously subsidized at public
expense is because since the insurants are mainly
employees of small and medium-sized business theirsalary level is lower than that of employees of large
corporations. And so the relative burden of paying
their insurance premiums is eased by the nationaltreasury.

The rate of healthcare benefits is 70% (30% is the
responsibilityoftheinsurant).
Withthereimbursement that is received afterwards because ofhigh healthcare costs, the effective benefit rate is
78.4% for National Health Insurance throughmunicipalities.

Since union-managed health insurance is left to theautonomous management of health insurance unions,as a general rule the national treasury is not
responsible for making those payments, with the
exception of a portion of the clerical expenses. However,Blue Cross, which faces a stringent financial situation,
receives assistance for an extremely small fixedamount.

② National Health Insurance CoverageA) Beneficiaries and Insurers
National Health Insurance coverage is acompulsory system of healthcare insurance forindividual proprietors, people engaged in the
agriculture and fishing industries, and retirees who
are not eligible for employee’s insurance. It represents
the last opportunity for universal health insurance.
Even foreigners can receive this insurance as long as
they are registered as an alien and are expected to stayin Japan for a period of one year or longer.
Insurers of National Health Insurance are mainly
cities, towns and villages which are basicmunicipalities, of which there are 3,242 nationwide.
They cover 33.4% of all subscribers. In addition to thisare National Health Insurance unions, which are
made up of health insurance groups of individual
proprietors of the same industry. Currently, the main
professions and industries which have National
Health Insurance unions are physicians, dentists,
pharmacists, the food sales industry, the engineeringand construction industries, cosmetology, the bathing
industry, and lawyers. There are 166 of these unions
nationwide. These do not cover all individual
proprietors; and some of them cover the whole nation,
while others cover individual prefectures. These
unions account for 3.4% of all subscribers.
B) Benefits
There are benefits for recuperation costs. There
are also benefits required by law, including those formeals and recuperation costs during hospitalization,
specific recuperation costs, recuperation costs, at-home
114C) Fiscal Resources

Insurance Premiums

The method and level of insurance premiums
differs from municipality to municipality, and aredetermined by individual ordinances and/or rules.
However, it is common among all municipalities tocollect premiums directly from insurants. There are
two types of systems of insurance premiums: one iscollected as a premium literally as a National Health
Insurance premium; the other is collected as a
National Health Insurance tax as a type of local tax.
Currently, many municipalities use the tax type ofsystem, but aside from the difference in their legal
characteristics, the calculation methods for both arebasically the same.
There are two types of National Health Insurance
premiums. One is the portion that an insurant is
responsible for paying, based on what he or she iscapable of paying (capable percentage), calculated as alevy standard on the amounts of his or her income andassets, which are determined based on the municipal
citizens tax levied by the municipality in which he or
she resides. The other is the portion that an insurant
is responsible for paying, based on the profit that he or
she earns (profit percentage), calculated by a fixedamount for each insurant or for his or her household,which is based on the amount of profit that theinsurant receives. As a general rule the ratio between
the capable percentage and the profit percentage isfifty-fifty.
However,inactuality,inmanymunicipalities the ratio accounted for by capable
percentage is higher. Individual premiums for each
insurant in a household are paid in one lump sum by
the head of that household, adding together thecapable percentage and the profit percentage of each
insurant. The responsibility level for insurance
premiums per household (fiscal 1998) was 154,000 yen
for National Health Insurance through municipalities.

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Since the premium imposed on low-income earners issometimes too burdensome, measures have been taken
to reduce the burden of those premiums. Those eligible
for these measures are households whose income of theprevious year was below the basic exemption
equivalent value, and households who fell below thebasic exemption equivalent value when a fixed amount
was deducted per insurant, excluding the head of thehousehold. In each case, the portion that an insurant is
responsible for paying, based on the profit that he or
she earns, is reduced to 60% and 40%, respectively.

Responsibility of National Treasury
The national treasury is responsible for paying
50% of health insurance contributions for elderly
people. In addition, the national government also pays
one half of the portion of reductions on insurance
premiums of low-income earners carried out bymunicipalities, with the remainder being the
responsibility of prefectures and municipalities.
Generally, many of the people with National Health
Insurance are low-income earners, and many of thosepeople are only capable of paying a small amount inpremiums. Also, since their employer is not
responsible for paying their premium as is the case forpeople with employee’s insurance, a sound means of
insurance financing is made possible throughassistance by the national government for high rates
and large amounts of money. In other words, in order
to assure fairness regarding the benefits andresponsibilities between types of coverage, the lower
the financial capability of the insurance system, thehigher the rate of assistance.
③ Healthcare Coverage for Retirees
Basically speaking, since elderly retirees subscribe
to National Health Insurance after retirement, thelevel of their benefits drops at a time when their needfor healthcare increases, and the burden of paying
those healthcare costs lies mainly with the nationaltreasury and other subscribers to National Health
Insurance. In order to correct this irrationality, asystem of healthcare coverage for retirees wasestablished in 1984.
The entities enforcing this system aremunicipalities, which are the insurers of National
Health Insurance. The beneficiaries are people whohave National Health Insurance (except for elderly
people who receive healthcare), elderly people who
receive pensions based on pensioners laws (for theright to receive a total pension for an elderly, theperson must have subscribed for 20 years or more; orfor people beyond the age of forty, for 10 years) andtheir nonworking dependents.

The fiscal resources needed for this system of
insurance coverage are comprised of the premiums(tax) that retired insurants pay for National Health
Insurance, and recuperation benefit expense grants
covered by donations of insurers of employee’s
insurance. The amount of the recuperation benefit
expense grants is the amount remaining after
deducting the National Health Insurance premiums
for retirees who had employee’s insurance (tax) fromthe amount which is half of the costs required for
healthcare benefits for retirees who had employee’s
insurance and the contributions for the healthcare costfor the elderly who had employee’s insurance, and thisis delivered each year to municipalities from the Social
Insurance Medical Fee Payment Fund. The costs ofpaperwork regarding the healthcare of retirees for therecuperation benefit expense grants and the Social
Insurance Medical Fee Payment Fund are covered inpart by the recuperation benefit expense contributions
collected from insurers of employee’s insurance
through this fund, and by clerical work expense
contributions. For this, the amount that each insurer
must contribute is the amount of the total
contributions divided by the total of the standard
compensation amount paid by each insurer.
The healthcare benefit rate is 80% for retirees who had
employee’s
insurance.
For
their
nonworking
dependents, it is 70% for outpatient care, and 80% for
hospitalization. However, after April 2003, all of thesebenefit rates will be 70%.
④ Health Insurance Coverage for the Elderly
Under the Elderly Health Law, comprehensive
health-related business, including the prevention andtreatment of disease, and function training thereof, iscarried out to ensure sound health maintenance andadequate healthcare for Japanese citizens in their oldage, for the purpose of improving the health ofJapanese citizens and improving the welfare of theelderly. And based on the spirit of self-help and unity
among Japanese citizens, in addition to constantly
endeavoring to maintain and improve their health,with an awareness of the physical and mental changes
which accompany aging, and distributing the burdenof healthcare costs for the elderly fairly, the basic
philosophy of this law is to provide adequate healthservices to the elderly at the place of work, locally andat home, in accordance with one’s age, and mental andphysical condition, in order to maintain people’s healthin old age.
In addition to healthcare benefits, thehealth-related business based on this law includes thedelivery of health notebooks, health education, healthcounseling, health checkups, function training andat-home or on-site instruction, all of which are carriedout by municipalities.

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Municipalities are in charge of healthcare-related
matters for the elderly under the Elderly Health Law.
The beneficiaries of this healthcare for elderly
residents of the municipality in question are those whohave healthcare insurance, and who are 75 years ofage or older, or who are 65 years of age or older but
have been recognized by the mayor of the municipality
in question as being disabled (so-called bedridden) as
prescribed by government ordinance.
The healthcare benefits received are the same as
those received under the healthcare insurance laws,
and the costs charged for this healthcare are based on
medical fees for the elderly.
The responsibility for a portion of elderly patientshas been fixed since the establishment of the Elderly
Health Law in 1988, and the level of that
responsibility differs from the responsibility for a
portion of young patients, with a 20% or 30% portion of
the responsibility being set at fixed rates lower thanthose for young people who require it.
The amount has been raised based on revisions to
the law, and a system has been introduced for revision
based on the rate of fluctuation of consumer prices
since 1995. Currently, while the ability of elderly
people to pay for healthcare costs has increased due tomaturation of pensions, the sense of responsibility forthis payment has increased among young people. An
appropriate relationship of responsibility that takes
root in the unity between generations is a precondition
for maintaining Japanese Social Security in the future.
For this reason, rather than the uniform assumptionthat the elderly are weak, the idea is becoming moreprevalent that elderly people should be responsible forthe portion of their healthcare costs that is suited totheir financial ability.
With the reforms in the healthcare insurance
system in 2000 came the idea that elderly people
should be responsible for a suitable portion of theirhealthcare costs, and revisions were made to change
the fixed 10% rate of responsibility for a portion ofpatients who had thus far been paying a fixed amount.
However, so that the responsibility of elderly people
would not increase to an excessive amount, amaximum monthly amount has been established, withpreferential measures being established for physicians
running their own practices to allow them to choose
the system of fixed amount from the viewpoint of therequired paperwork load.
Furthermore, with the reforms in the healthcare
insurance system in 2002, the age of elderly people
eligible for this healthcare increased from those 70
years of age or older to those who are age 75 or older,
for a gradual increase in the rate of the public expense
116

load from 30% to 50% over a 5-year period. Also, thepercentage for which the patient himself or herself isgenerally responsibility was increased to 10% (20% for
people whose income exceeds a certain amount).
However, starting from the age of 70 patients are
generally responsible for paying the same 10% as
patients who are age 75 or older.
Thirty percent (to gradually increase to 50% overthe 5-year period starting in January 2002) of fiscal
resources for the necessary benefit costs for healthcare
for the elderly are covered at public expense, with thenational government responsible for 2/3, prefectures
for 1/6 and municipalities for 1/6. The remaining 70%
is donated by insurers of government-managed healthinsurance, union-managed health insurance andNational Health Insurance through municipalities. In
addition to the above-mentioned portion paid for at
public expense, the donated funds are theresponsibility of the national treasury, with 16.4% forgovernment-managed health insurance and 50% for
National Health Insurance through municipalities.
This results in tax fiscal resources of about 50% of
benefit costs for healthcare for the elderly, when the
30% which is paid for at public expense is combinedwith the donations from the national treasury.
(2) Healthcare Covered at Public Expense
Healthcare covered at public expense is a system ofcoverage by which the national government or local
authorities compensate patients for the cost of medical
treatment and/or other healthcare expenses, using
taxes as a fiscal resource. In healthcare covered at
public expense, for diseases which require treatment
from the point of view of the national government,
including tuberculosis, mental disease and legal
communicable diseases, patients are compensated forthe cost of medical treatment, while economicallyand/or socially-disadvantaged people, including
low-income earners, the physically disabled, elderly
people, children, people wounded in war, andatom-bomb survivors, are compensated for all or a
portion of their healthcare expenses.
Some healthcare covered at public expense
includes healthcare costs for which the priority of the
responsibility is with the public expense andhealthcare costs for which the priority is withhealthcare insurance. All or a substantial amount ofhealthcare costs for which the priority of the
responsibility is with public expense is covered by thenational government or local authorities, with theremaining portion being applied to insurance. The
remainder of the insurance benefits (the portion forwhich the patient is responsible) or a certain amountof healthcare costs for which the priority is withhealthcare insurance is covered at public expense.

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(3) Nursing Insurance System
In the past there were two different types ofcoverage – welfare for the elderly and healthcare forthe elderly. But there were disproportions in the usage
procedures and the responsibility of users, andproblems occurred in the provision of service based on
government measures for welfare for the elderly. In
addition to restructuring both types of coverage, asystem of nursing insurance was established in April
2000 as a system of social health insurance which
would allow users to use the service that they
themselves chose.
Under the nursing insurance system, the insurers
are municipalities, with the national government,
prefectures, healthcare insurers, and pension insurers
providing important support. The insurants are
divided into two categories: first insurants, who are
age 65 or older, and second insurants, who arehealthcare insurance subscribers between the ages of
40 and 64. The benefit rights and responsibility forpaying premiums differ between the two categories.
Benefits from nursing insurance are provided for a
first insurant if it is determined that he or she requires
nursing or another form of support. Benefits fromnursing insurance are provided for a second insurant if
it is determined that he or she is bedridden with a
specific disease, as stipulated by the Nursing
Insurance Law, or otherwise requires nursing or
another form of support.
To obtain these insurance benefits an elderly
person who is determined to require nursing or amember of his or her family applies with themunicipality for these benefits, and that person mightthen be recognized as requiring these benefits by thenursing recognition examination committee of thatmunicipality. Those committees are made up of people
with academic backgrounds in health insurance,
healthcare or welfare. The committee findings are
based on results from a computer based on an
examination of the physical and mental condition of
the elderly person (first judgment), and a written
report by the physician in charge. Then, after theapplicant is notified by the municipality of the resultsof recognition for the requirement of nursing, if he or
she has any objections to those results, that person
may challenge those results with the prefectural
government or the nursing insurance examinationcommittee.
After being recognized as requiring nursing, if thenursing is to be provided at the patient’s home, thepatient or his or her family member may then submit arequest to a company that provides at-home nursing
care for a care plan to be drawn up, taking into

consideration the recognized degree of nursing
required, the wishes of the patient and the situation of
his or her family. If the nursing care is to be provided
at a nursing facility, the facility will draw up the care
plan.
Service provided to patients who require care athome include home help service and day service. Oneof these types of service are then provided based on thecare plan, with the user responsible for paying 10% of
the cost. It is the same for nursing care provided at anursing facility, with the patient responsible for paying
10% of the cost all services provided, with the
exception of meals. If the user desires special services
which he or she has chosen, these services may beprovided if the user pays the entire cost of the services.
Fifty percent of the cost of the required nursing
benefits is covered by the public expense, with the
exception of that portion which is the responsibility of
the user at the time that the service is rendered. The
breakdown is that national government pays 25% of
the total, with the prefecture or municipality paying
for 12.5%. The 50% of the cost other than the portion
covered at public expense is covered by the insurance
premiums paid by the insurant. The breakdown
between 2000 and 2002 was 17% for first insurants
and 33% for second insurants.
Insurance premiums for first insurants are
determined for each municipality in accordance withincome level. People whose pension exceeds a certain
amount have the premium deducted from theirpension. All others pay the municipality on their own.
Insurance premiums for second insurants are
determined based on the method of calculation of thehealthcare insurance to which they subscribe. The
healthcare insurer collects these premiums in
one-lump payments with the healthcare insurance.
(4) Financial Conditions of Healthcare Insurers
Financial conditions of the systems of healthcare
insurance have shown deficits across the board.
Taking a look at the closing of accounts ofgovernment-managed healthcare insurance, net losses
have appeared continuously since 1995, with losses of
316.3 billion yen in fiscal 1999. If things continue as
they are, it is believed that the 803.9 billion yen
reserve fund from the end of fiscal 1999 will bottom out
in fiscal 2002.
Union-managed healthcare insurance has
also recorded total losses of 203.3 billion yen (forecast
for the end of fiscal 1999), with the total number ofunions showing losses at approximately 70%. With thisincrease in the number of unions showing losses,
insurance premiums of healthcare insurance unions

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are at an average of 8.51%, which is higher than the
8.5% for government-managed healthcare insurance.
There has also been an increase in the number ofunions which have been dissolved.
The difference between revenues and expenditures infiscal 1999 for National Healthcare Insurance throughmunicipalities showed an overall loss of 119 billion yen.
Amid this worsening financial situation, withindividual insurers which are municipalities showing
losses of an approximate 61%, many municipalities arecarrying over their fiscal resources for deficit financing
from general accounting to special accounting for
National Healthcare Insurance.
6. Medical Treatment Fee System(1) Mechanism of Health Insurance Treatment
A distinguishing feature of the Japanese healthinsurance system is that rather than the insurer
concluding a contract directly with the medical
institution, the medical institution is specified by thesecretary-general of the local social insurance based on
an application by the medical institution.
The specified medical institution is obligated toprovide the insurant with recuperation benefits,
including medical treatment, as a health insurance
medical institution, with the medical fees being paidby the insurer to the health insurance medical
institution through an examination payment
organization as the cost of the examination.
When receiving medical treatment, insurants pay
the portion of the cost for which they are responsible atthe payment desk of the health insurance institution.
What’s more, not only the medical institution but thephysician who is actually in charge of the recuperationmust be registered with the secretary-general of thelocal social insurance as a health insurance physician(double specified system of health insurance
treatment). Accordingly, when receiving healthinsurance treatment, insurants must go to thespecified insurance medical institution and receive
this treatment by a registered health insurancephysician.
Presently, this applies to almost all medical
institutions in Japan.
Although all of the medical treatment activities forthe same patient are performed by the same medical
institution, the reason that insurance medical
treatment is specified as double is because all of the
medical treatment is administered to the patient by
the physician, and based on this, that physician must
personally decide what medication, injections ortreatment to administer, and bear the responsibility
thereof.
118(2) Summary of Medical Treatment Fee System
As the cost of recuperation benefits provided byinsurance medical institutions, the specified amountthat must be paid to the healthcare institution is the
medical treatment fee – and the amount remaining
after subtracting (from the total medical treatmentfee) the portion which is the responsibility of thepatient is paid to the healthcare institution. The
medical treatment fee is made up of those diagnostic
fees specified in detail, including those for
examinations,administereddrugs,
injections,
treatment, surgery and tests, as well as the basic fees
for hospitalization. The medical treatment fee isrevised just about every two years. The medical
treatment fee is indicated in points, with 1 point
equaling about 10 yen.
Or the medical treatment fee is determined whenthe minister of health, labor and welfare asks theCentral Social Insurance Medical Council* for its
views.
In the guaranteed healthcare of Japan, as a
general rule healthcare services provided for the
purpose of curing disease are not for the cost ofhealthcare, but rather they are provided as a benefit to
the insurant as healthcare services for direct diagnosis
and treatment, under the principal of benefit in kind.
However, aside for some exceptions, there are twosystems of coverage: the system by which therecuperation costs are paid in cash afterwards, and thesystem of cash benefits.
The Social Insurance Medical Fee Payment Fundand the National Health Insurance Federation, after
received payment consignment, pay medical fees to theinsurance medical institutions for the value of
healthcare treatment provided. The amount iscalculated by the physician’s medical treatment fee
point table for physicians, the dentist’s medical
treatment fee point table for dentists, and thepharmaceutical fee point table for pharmacies. These
point tables are characterized as unit price tables fordiagnoses, used to evaluate diagnoses.
Medical fees are revised as part of the Survey in
Economic Conditions on Health Care which is
conducted once every two years. This revision is madeto ensure sound medical business management overall,heeding the deliberation of the Central Social
Insurance Medical Council, and giving overall
consideration to trends in prices and wages, advancesin medical science and healthcare, and the various
situations surrounding medical treatment, including
the financial situation of insurers.

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* Central Social Insurance Medical Council: This council is made up of people involved in diagnosis andtreatment (8 committee members representing physicians, dentists and pharmacists), people involved in
payment (8 committee members representing insurers of health insurance, seaman’s insurance, and National
Health Insurance, as well as business owners and ship owners), and people representing the public interest (4committee members representing the public interest). Appointment of committee members representing the
public interest must be approved by both Houses of the National Diet.

Sources
1) Trends in National Hygiene (edited by the Health and Welfare Statistics Association, 2003)
2) White Papers on Public Welfare and Labor, 2003 edition (supervised by the Ministry of Health, Labor andWelfare); Gyosei, 2003
3) White Papers on Healthcare, 2003 edition (supervised by the Medical Treatment Economic Research
Organization); planned by the Japan Medical Treatment Project, 2003
4) White Papers on Medical Business (edited by the Editorial Committee of Medical Business); planned by theJapan Medical Treatment Project, 2003
5) Introduction of Social Security 2004 (edited by the Editorial Committee of Introductive Social Security);
Chuohoki Publishers, 2004
6) Problems and Perspectives for Reform of Medicare System (edited by the Office of Reform of Elderly Medicare
System, the Ministry of Health, Labor and Welfare); Gyosei, 2001
7) Introduction of Medical Insurance and National Health Insurance Drug Price System (edited by the ResearchCommittee for NHI Price System, Association of Tokyo Medical Products Manufacturing Industry); Tokyo
Medical Products Manufacturing Company, 2001

An Additional Writing about Kampo Medicine
and Health Insurance

177 types of herbal decoction and 242 individual

Japanese Kampo medicine can be broadly divided

There are additional categories for certain Kampo

into Kampo extracts and herbal decoctions. Kampo

products that are not eligible for NHI coverage when

extracts can be further divided into prescription

taken alone. As a growing number of Kampo

Kampo

formulations have come under NHI coverage, moreformulations,industrially

under

which

are

establishedmanufactured
standards

andproducts listed in the NHI drug price standards.

physicianshave

becomewilling

to

use

these

regulations. These are covered by National Healthformulations in a clinical setting. In recent years, it

Insurance (NHI) when dispensed under a doctor'shas been reported, more than 70% of Japaneseprescription, and over-the-counter formulations thatphysicians are using some form of Kampo medicine inare sold through retail drugstores and can beroutine clinical practice.

purchased without a doctor's prescription.

With the exception of off-label use, the Kampo

In 1960 herbs that made up the raw ingredients offormulations prescribed by physicians after examining

Kampo were placed in the NHI drug price listing. In

the patient are covered by NHI. However, Kampo

1976 Kampo medications were made eligible for NHI

formulations that are prepared directly by a drugstore

coverage. Initially, 43 categories of Kampo formulation

pharmacist are not eligible for NHI coverage.

were listed in the NHI drug price standards and were
eligible for NHI coverage. In 1987, NHI coverage of
Kampo medicine was expanded to 148 categories ofprescription Kampo formulations (147 types of extract
for oral administration and 1 topical ointment), withAcupuncture Therapy and Health Insurance
Health insurance coverage for acupuncture therapy
is handled under a somewhat more complicated systemthan general medical services. The Japanese system of

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

health insurance benefits consists of medical careis reimbursed by the insurer in cash. This form ofbenefits through treatment at authorized insurance

payment of medical expenses is generally termed

medical institutions and"reimbursement." Basically, the medical expenses

to facilities other thansystem focuses on self-payment for medical services.

authorized insurance medical institutions.
When someone who is covered by health insurance

Medical expenses apply to the following types of

becomes ill, and health insurance is accepted by

payments.

ordinary authorized insurance medical institutions● Types of payments covered by the category of medical

insurers such as the national government, municipal

expenses

government, or insurance cooperatives do not pay the・ When treatment was obtained from a medicalmoney for medical care directly to the insured person.

facility other than an authorized insurance medical

Instead, the payment is made to the authorized

institution, and the insurer acknowledges that there isinsurance medical institution(s) that provided thean unavoidable reason that [appropriate medical care]

medical services to treat that illness, covering expenses

could not be obtained through the health insurance

such as hospital care and prescription drugs. Thesesystem.

benefits that are provided to a person who becomes ill

・ When in-home treatment required nursing care by aare generally termed "benefits in kind." The insured

trained nurse

person presents his or her health insurance certificate

・ When insurance notification was delayed and noat the reception desk of the authorized insurance

proof of insurance was available at the time of

medical institution, and receives benefits in kind in thetreatment

form of treatment.

・ When medical care was obtained from an overseas

However, there are some special cases in which, formedical institution while travelingexample, care cannot be obtained from an authorized* Does not apply if the travel was undertaken for the

insurance

purpose of obtaining medical care

medicalinstitution

under

the

healthinsurance system due to unavoidable circumstances,・ When an incident such as a sudden illness occurredand must be covered by the individual. In such cases,

while traveling, and it was unavoidably necessary to

those medical expenses will be reimbursed. Under theobtain treatment through a medical institution that

National Health Insurance system, the category of

was not a participant in the insurance plan

"medical expenses" applies in situations where there is

・ The cost of blood in cases where transfusion (wholenoblood) was ordered by a physician

appropriate

physician-provided

therapeuticmodality and the appropriate medical care is not

・ The cost of therapeutic devices such as corsets, casts,

availableor artificial eyes, when ordered by a physician

from

authorized

insurance

medicalThe cost of massage therapy, acupuncture,

institutions but can only be obtained through facilities

・other than those authorized institutions. This category

moxibustion, or judo therapy, when ordered by ais used for acupuncture therapy treatment and forphysiciantreatment obtained when an insured person becomes

Acupuncture and moxibustion are not accepted as

ill while traveling overseas. In such cases, the insured

forms of medical treatment that can be conducted

person is compensated for medical expenses by theunder National Health Insurance at authorized

insurance provider.

insurance

medicalinstitutions.

Asaresult,Under the medical expenses system, the patientacupuncture and moxibustion are not covered underpays the full amount due for medical treatment to the

medical care benefits available through those ordinary

authorized insurance medical institution, and then theauthorized institutions. Under the present NHI system,

patient applies to the insurer for medical expenses andacupuncture therapy is positioned as treatment

120

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

conducted in facilities other than authorized insurance

receive

medical institutions, and the cost of acupuncture

institution

therapy is handled under a system whereby medical

acupuncturists do not provide acupuncture therapy

expenses are paid directly by the patient. If the insured

under the rubric of "medical expenses," and the most

person is able to claim the cost of acupuncture therapy

common method for payment for such treatment isfrom his/her insurance provider, that reimbursement

self-payment for medical services. The amount thatwill be paid directly to the insured person, in cash. This

will be reimbursed for medical expenses is determined

is considered a "cash reimbursement system."by the MHLW according to an official formula. An

In such cases, the patient receives acupuncture
therapy from an acupuncturist and pays directly forconcomitantfortreatment

that

same

from

a

medicalcondition.

Manyamount equivalent to the traditional insurance co-pay
will not be reimbursed.

that treatment. The Ministry of Health, Labor, and

The insured person pays for treatment expenses at

Welfare (MHLW) has provided a number of restrictions

the clinic where he or she receives treatment, and thenin the form of notifications, which offer guidance on theapplies directly to the insurer for reimbursement.

types of treatment that qualify for reimbursement. If

However, in actual practice it is quite difficult andthe patient suffers from chronic disease for which

time-consuming for the insured person to apply

physicians cannot provide appropriate medical therapy,

individually for these medical expenses. Thus, theand the patient is receiving acupuncture therapy withacupuncturist often applies for these medical expenses

the permission of his or her physician, the patient willon behalf of the insured person. At present, it is mostbe reimbursed for the medical expenses of that therapy.

common for acupuncturists and representatives ofIf the patient is diagnosed by a physician with any ofacupuncture associations to act as the representative

the following conditions that are associated withof the insured person in applying for medical expenses.

chronic pain and that are eligible for coverage of

As of September 2008, the details for provision of

medical expenses, a written permission form or written

acupuncture therapy are as follows.

diagnosis based on this permission form is required.

・ Targeted for payment: Insured persons and their

The permitted duration of treatment is 3 months. If

families

additional extended treatment is required, it is・ Amount of payment: The amounts are calculated bynecessary to again obtained permission for treatment

adding supplementary benefits to the base statutory

from the physician who issued the initial permission

benefits, which are set at 70% of the standard price as

form.

established by the MHLW. These supplementary● Conditions for which medical expenses are covered

benefits amount to 90% of the standard price for・ Neuralgia: sciatic neuralgia, etc.

insured persons 70 years of age or older and their・ Rheumatoid arthritis: acute or chronic, with joint

families (70% for those persons having income above aswelling and pain

specified level), and 80% for families of preschool-age

・ Low back pain: chronic or acute low back pain

children.

・ Frozen shoulder: painful shoulder joint with inability

・ Standard price established by the Ministry of Healthto raise the arm

and Welfare

・ Cervicobrachial syndrome: numbness and tingling(1)

from the neck into the shoulder and arm

moxibustion), ¥1195/treatment (¥2330 for initial

・ Cervical sprain sequelae: Neck injury, whiplash,treatment)

etc.

(2) For 2 procedures (combination of acupuncture andIf a patient receives medical expenses to coveracupuncture therapy, that patient is not eligible toFor1

procedure(either

acupunctureormoxibustion), ¥1495/treatment (¥2680 for initial
treatment)

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

・ Additional fees: Additional fees must be paid if the

When acupuncture therapy is needed by patients whopatient receives treatment for conditions or symptoms

have conditions that are covered under Workers'other than those for which a doctor's permission has

Accident

been obtained.

compensation will apply if the patient goes to a

・ Number of treatments and time frame: There are no

designatedrestrictions on the number of treatments or the time

Compensation Insurance Act). If an acupuncture clinic

frame within which those treatments must be

has contracted with a prefectural government or withadministered. However, 3 months after the date of firstsocialtreatment, the physician's consent for this treatment

acupuncture therapy for those patients under social

must be obtained again.

services.

・ Travel expenses: Where truly necessary (if the

independently

patient has difficulty in walking or must remain at

systems for patients utilizing acupuncture therapy.

Compensation
clinicservices,(underthen

Additionally,

Insurance,thesocialestablished

Workers'

servicessomeworkers
Accident

willmunicipalities
autonomous

cover
have

subsidyrest), travel expenses will be provided for a maximumof 16 km, at a rate of ¥1860 for the first 2 km and ¥800

References

for each additional 2 km. For a one-way trip of more

1. Japan Pharmacopoeia, 15th Edition

than 8 km, an additional flat fee of ¥2400 will apply.

2. Hoken Yaku Jiten (NHI drug price standards, listed

For a one-way trip of more than 16 km, transportation

by drug effects), Jiho, April 2009

costs will not be covered except for reason of absolute

3. Japanese Health Insurance Act, Article 63necessity.

4. Japanese Health Insurance Act, Article 87

Other points regarding acupuncture therapy and5. The Civil Code of Japan, Article 643

health insurance are detailed below. For a patient who

6. Notification from the Director of the Healthwishes to receive treatment for injuries or sequelae of a

Insurance Bureau, MHLW (HIB No. 0526003),

traffic accident, insurance coverage of acupuncture

dated May 26, 2008

therapy will be determined by provisions for accidents

7. Notification from the Director of the Medicalin the patient's contract with his or her insurance

Economics

company for mandatory vehicle liability insurance.

0526002), dated May 26, 2008

122

Division,

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

HIB,

MHLW

(HIB

No.

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Welcome to the Museum of Traditional Medicine!
Morinomiya College of Medical Arts and Sciences

Tatoos in red and black on the white colored face?!
The unusual shaped five-head manikin with roundshoulders(forward

head

posture)exposingthecollarbones and drooping hands is a douningyo or
meridian doll, which attracts popularity as a symbol of
the Museum. Photo 1 shows the manikin that has been
handed down in the Takeda family in Saga prefecture,
Kyushu.
This kind of meridian doll is called tong ren or
douningyo (bronze doll) because it was first made ofbronze in China. Many ancient meridian dolls made of
paper or wood still remain in Japan. The Museum of
Traditional Medicine houses a collection of four othermeridian dolls made of paper and wood.

The photo of Meido-zu (meridian chart) with aunique expression illustrated beautifully with thestyle of the 17th century. This inspired Hidetaro Mori
to begin his collection. Hidetaro Mori collected many of
the historical materials displayed in the Museum.
W he n heen co un teredt hi s M e i do - zu
a bo u t 30 y e a r s
a g o , he w as
i mp re s sed t ha tol d mate rial
r ela ting toa cu pu nc tur e
a nd mox i bu s ti o nr emaine d . The
Muse um of
T r adi tion alMedi ci ne hou se s
ma ny ot her
Meido -zu’s hecolle cted.

Photo 1: Meridian Doll handed down in the Takeda
family (Height 80 cm, Breadth of Shoulder 17cm (circa

Photo 2. Meido Douningyo (Meridian Chart)

1700)

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

123

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Acupuncture and moxibustion originating in China
are said to have been introduced into Japan in the year
562

when

Buddhism

firstarrivedinJapan.

Subsequently, mainstream medicine was Kampo,
acupuncture, or moxibustion until western medicine
was adopted.
Kampo, acupuncture, and moxibustion of Chinese
medicine, however, have not been used literally inJapan. Instead they developed to their present form
with the addition of modifications, theories, andtechniques unique to Japan. Among other things,
advanced metallurgical technology has allowed the
manufacture

of

very

Furthermore,

this

has

fine

acupuncture

enabledneedles.

delicateneedlemanipulations distinctive to Japanese acupuncture,providing subtle stimulation with effectiveness.
Special techniques that are not seen in China havebeen developed, such as the Sugiyama method of“Kanshin-jutsu” inserting a needle using a guide tube
and the Misono method of “Dashin-jutsu” inserting aneedle using a hammer tapping the head of the needle.

Photo 3. Illustration of Meido (Meridians) andManikin with Five Visceral Organs

In the Edo period, many schools of thought emerged
and developed providing techniques that are used tothis day.
On the other hand, moxibustion that uses moxa or
mugwort herb to burn directly on the skin of a patient
was by far the most popular in the Edo period. This
took root in the life of the common people as a means oftreatment or self-care to prevent disease. Books onmoxibustion points and ukiyo-e woodblock prints
depicting a scene where a patient is receiving
moxibustion

provide

us

with

rich

historicalinformation.
We can learn much of the history of acupuncture andmoxibustion from the historical materials including
Meido-zu (meridian chart), douningyo (meridian doll),ukiyo-e, and the book of secrets and tips.
These historical items are on display for the public
at the Museum of Traditional Medicine.
Please visit the Museum and enjoy exploring ourcollections.

124

Photo 4. Old Picture of Workman (acupuncturist),
work in the early Edo period

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

In the right upper part of Photo 4, a scene where apatient receiving tapping acupuncture is depicted. The
tapping technique, which is a needle insertion method
unique to Japanese acupuncture, was widely popularin around 1600.

Photo 8. Scene of Pediatric Moxibustion (A woman
is holding a child using her legs with her left hand
Photo 5. Tapping apparatus of the Mubunryu
Needling Method

taking hold of the right hand of the child to give
moxibustion for her jian (second space on the radial
side

of

the

index

fingerdistal

to

the

2nd

metacarpo-phalangeal joint), san jian (third space on
the radial side of the index finger, proximal to the headof the 2nd metacarpal bone), he gu (union valley in the
middle of the 2nd metacarpal bone on the radial side) of
the large intestine meridian points. (Picture drawn
between 1832 and 1842）

Photo 6. Filiform Needle and Needle Box

Photo 9. Moxibustion Box
Old oil lamp stand type of moxibustion box used by
Photo 7. Ukiyo-e “Atsusou (seems hot)” (1888)

the domain lord of Matsumoto. The box contains all

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

the necessary items for administering moxibustion,such as moxa, incense sticks, charcoal container, andink brush・stone.

Photo 10. Books on Falconry by Nezu Family (1577)
Rolled books handed down in the falconer family,
describing the moxibustion points of a falcon. Horses
and cows received acupuncture or moxibustion therapy
in these days. Old books on meridian points for thetreatment of disease are on display at the Museum.
Introduced above are a part of the collections thatare on display.
References:
Hitoshi NAGANO, et al.: Museum of Traditional
Medicine Vol. 1 Bronze Doll, Meido-zu; Publishing

Opening Times: 13:30 – 18:30 Closed on: Saturdays,
Sundays, National Holidays, and Official School
Holidays Admission fee: Free for all visitors Access: By
Osaka Municipal Subway Chuo Line,
Nearest station: “Midoribashi”, Exit No. 3 (sevenminute walk to the Museum area) By JR Kanjou-sen,
Osaka Municipal Subway Chuo Line/Tsurumi
Ryokuchi-sen, the nearest station: “Morinomiya”(twelve minute walk to the Museum area)
Address: Museum of Traditional Medicine
4-1-8, Nakamoto, Higashi-Nari-ku, Osaka,537-0022 Morinomiya College of Medical Arts
and Sciences, Main building 3F.
TEL 06−6976−6889 FAX 06−6973−3133 URL：
http://www.harikyumuseum.com

Access Map

Department at Morinomiya College of Medical Arts
and Sciences, 2001.
Hidetaro MORI and Hitoshi NAGANO: Museum of
Traditional Medicine Vol. 2 Nihon-no Dentou to Iryou
to Buka-hen; Publishing Department at Morinomiya
College of Medical Arts and Sciences, 2003
Hitoshi NAGANO: Hari-kyu Museum no tanjyo tokongo-no-tenbou,

Acupuncture

andMoxibustion

OSAKA Vol.16-4, p.111-118, 2000
Hidetaro MORI: Shin-setu shita hari-kyu Museum,
THE SHIBUNN No.110, p.69-81,2002

126

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

THINK WITH US

ともに考え、ともに学ぼうCollege of Medical Arts & Sciences
我々の学ぶ技術は、芸術であり、科学であり、職業でもある。
The Skills we are learning . . . are Art . . . and Science . . . and a Profession.
Unsere lernende Fertigkeit somd Kunst, Wissenschaft und auch eine Facharbeit.
L'habilete que nous apprenons, est un Art, une Science, et aussi nue Profession.

Goto Gakuen, in order to build an international medical network of both East and West, has established academic exchange programs with the Beijing University of Traditional Chinese Medicine,
Tienjing College of Traditional Chinese Medicine, California State University at Long Beach, andAmerican post graduate School of Oriental Medicine. The new system of medical knowledge createdfrom this worldwide network of specialists will make a valuable contribution to the future of medicine
and healthcare. Our college is growing together with seekers of knowledge who look to the world forinterdiciplinary exchanges and research crossing over boundaries of convention.

TOKYO EISEI GAKUEN

4-1-1 Omori-kita Ohta-ku, Tokyo 143-0016 Japan TEL (03)3763-6621

KANAGAWA EISEI GAKUEN

2-35-4 Minamikamomiya Odawara 250-0875 Japan TEL (0465)48-3929

ACUPUNCTURE & INTEGRATIVE MEDICINE COLLEGE - BERKELEY
2550 Shattuck Avenue, Berkeley, CA 94704-2724, U.S.A. TEL (510)666-8248
http://www.gto.ac.jp