Volume 4, Number 2 | Summer 2009

Japanese Acupuncture - Current Research
Effect of Acupuncture & Moxibustion Treatment
to Turn Breech Baby

Shuichi Katai, Ph.D., L.Ac., Professor

Department of Acupuncture and Moxibustion
Tshukuba University of Technology, Ibaraki, Japanrisks. Yoshida says “do not forget the attitude
thatvaginaldeliveries

must

be

performed

carefully”6).
In Japan, acupuncture and moxibustion areavailable for the treatment of breech babies.
Ob/gyn Nobuyasu Ishino, who had studied

1. Introduction

Oriental medicine, reported 7) in 1950 that

Breech babies (breech presentations) as wellmoxibustion to the acupuncture point of san yin

as the mothers often have risky conditions

jiao (SP6), generally contraindicated in pregnancy

including a longer time of delivery than in babies

since ancient times, was effective. In 1980s,

born head first and the departments of obstetrics

Kazuo Hayashida reported that the method ofand gynecology need cautious handling.

moxibustion that was usually administered for

For

the

treatment

breechdelivery difficulties had great effecs 8) in thepresentations, there are exercise of the so-called

treatment of a breech presentation, in whichbreechknee-chest

moxibustion was given to the meridian point of

positioning (kcp). However, no RCT reports havezhi yin (BL67) and the “kyutoshin”, warm

been published on the breech pregnancy exercise

needling with moxibustion was also given to theand its effectiveness is not clear 1) 2). And themeridian point of san yin jiao (SP6). Since then,

exercise imposes a heavy physical burden on thethe treatment with acupuncture and moxibustion

mother. On the other hand, although the kcp isfor a breech presentation has become popular inconsidered effective on the ground of certain RCTJapan. Now in other countries, this method is also

results 3), it cannot necessarily be recommended

adopted and RCTs are also being conducted 9),strongly because there may be the risk of10), 11).

pregnancy

to

turn

exerciseandtheaccompanying complications, such as placenta

And so, we searched for postwar literatures on

abruption, compression of the umbilical cord,

the treatment of the breech presentation withplacental

andacupuncture and moxibustion and went throughfeto-maternal transfusion syndrome. Moreover, asthem to study the effect of the treatment. And

the kcp is not a sure method 4), there are quite athen, we further analyzed literatures published,

number of medical professionals who do not

up until 2004, as “EBM in Japan in the treatment

employ this method, thinking of its probable risksof breech presentations with acupuncture andarising from it. To turn breech presentations,moxibustion.”

there are no medicines available that have direct“acupuncture and moxibustion treatment ofeffects.

breech presentations” with illustrations andRecently

hematoma

manyofformation,

theobstetricians

Then we reported the results inandphotos for learning purposes 12). Hereunder isgynecologists in Japan prefer performing an

the results with an addition of literatures after

elective cesarean section in the cases of a single

2004.

breech presentation, partly in response to the2004 report of the Committee of American College

2. Methodof Obstetricians and Gynecologists (ACCG). Even

Literatures reported after the war on breechso, cesarean sections do not always go without

presentation treatment with acupuncture and

2

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

Volume 4, Number 2 | Summer 2009

moxibustion were searched for through the

Of them twelve literatures showed a turn ratio ofjournal of “Ichushi” and on the “websites of

72.2% or above.

Ichushi”.

(3) Treatment method

Searched

were

original

paperspublished during a period of 2004 to July 2011.

In regard to the method of treatment, 15Then individual items in the searched papers

literatures showed the use of moxibustion, andwere analyzed, such as age, primiparity or para,eight literatures reported the use of acupuncture.

the number of weeks of pregnancy when the

Acupuncture alone was reported in one whereas

initial visit was made, the number of weeks whenthea breech baby turned around, turn ratio, use ofmoxibustion was reported in seven literatures.

meridian points, use of tools, method of treatment,

The use of “Kyuto-shin” was reported in fiveother method of treatment, complications, andliteratures.

combination

use

of

acupuncture

with

In reference to the meridian points foradverse events.

moxibustion that were shown in 15 literatures,
3. Results

zhi yin (BL67) was used in 14 literatures, san yin(1) Entirety of published literatures

jiao (SP6) in 9 literatures, and both points in 8

During a period of 61 years after the war fromliteratures. For other points, yongquan (KI1) was1945 to July 2011, 16 literatures were reported inselected in one literature and taichong (KI4) inJapan on case-series studies of correcting the

one literature. With an eye on the kinds ofbreechandmoxibustion for each point that are shown in 14

moxibustion. Of these 16 literatures, eight wereliteratures, direct moxibustion in 6 literatures,

published during six years from 1990 to 1995.

roll moxa in 2, indirect moxibustion in 5, andpresentation

withacupuncture

The total number of the cases reported was

mxibustion plasters in 1 were applied to zhi yin

2,150, including 969 cases in total in the seven(BL67), whereas direct moxibustion in 3, indirectliteratures reporting the number of primiparous

moxibustion in 5, and moxibustion plasters in 1

women and the number of parous women. The

were administered to san yin jiao (SP6). No

ratio of primiparous women (581) against parous

differences existed in the turn ratio depending on

women (388) was 1.5:1. In the 16 literatures,the points due to differences in the kind of

there was no reference to the method ofmoxibustion, except for direct moxibustion in one

randomization. However, there was one literatureliterature.

that made a comparison between the two groups –Relating

to

the

eight

literaturesforthe group (34 cases) of knee-chest positioning andacupuncture points for acupuncture treatment,

the group (34 cases) of knee-chest positioning

San yin jiao (SP6) was selected in all the

combined with moxibustion to zhi yin (BL67).

literatures, except for one that had no clear

Others are of retrospective case series.

mention. Zhi yin (BL67) was selected only in two(2) Turn around ratio

literatures. The use of filiform needles was

In terms of turn ratio, 1,712 (79.6%) cases of
the total 2,150 that were reported in the 16

reported in six, while intradermal needles wereused in one.

cephalic

The diameters of the needles and needlingpresentations with a turn ratio of 11.70% to 91.7%.

depths were reported in one literature. The effectliteratures

turnedaroundtoof the treatment only with acupuncture had no
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 4, Number 2 | Summer 2009

difference from that of acupuncture only or the

4. Discussion

combination treatment of acupuncture with

It was considered all over the world up until

moxibustion of 12 literatures (other than Arai’s

1750s that the fetus was in a breech presentation

literature).

position to the brink of delivery and turns into a(4) Treatment frequency

cepharic presentation before labor starts. In these

The treatment frequency for both acupuncturedays, literatures were published for the first timeand moxibustion was 7 times a week in 7 cases,

reporting that the cepharic presentation wasand 1 (daily) to 3 times a week in 8 cases.

normal after five months of pregnancy 13),14).

At-home moxibustion was conducted in seven

For the reason, until these days, moxibustion hadcases with details of direct moxibustion in 2 cases,

been administered to zhi yin (BL67) at the time ofindirect moxibustion in 4, and moxibustiondifficult labor (delivery).
As mentioned in “Introduction” above, for theplasters in 1.
(5) Excluded

disordersandfactors

causing

non-occurrence of the cepharic presentation.

first time in the world, Ishino 6) performed
moxibustion treatment to expectant mothers in

The diseases excluded from the application ofpregnancy, not at the time of delivery, for theacupuncture and moxibustion were multiple

purpose of turning around the fetuses in a breech

pregnancy (3 cases), severe pregnancy (2 cases),presentation. He reported 80% of the turn ratio.

placenta previa (2 cases), fetal anomaly (2 cases),

Subsequently, in 1988 Hayashida 7) reported

hematologicaluterine

89.9% of the turn ratio in the treatment of 584

deformity (1 case), fibromyoma (1 case), andcases with acupuncture and moxibustion. And inhistory of uterine surgery (1 case). As the factors

1990s literatures relating to the turn ratio withnon attributable to the turn to the head down

acupuncture and moxibustion burgeoned.

disorders(2cases),

position, uterus bicornis, small amounts of

Of the 16 Japanese literatures, only one

amniotic fluid (oligoamnion), uterine myoma, andliterature was about a comparative study withloop of the umbilical cord were pointed.

the control group and most literatures were

(6) Adverse events

reports on case series studies. On the other hand,

Out of the 16 literatures, 10 literatures

there were three 9)-11) overseas RCT literatures,

reported no adverse events. No clear mentions

one of which was a Cardini’s RCT, which has been

were made in two literatures. One literature

criticized for the reason of insufficiency in thereported four cases of nausea. There were blisters

blind trial and placebo 15). However, it is difficultand pigmentation in one literature, and blisters

to conduct blind trials in acupuncture andand reddening in one literature. And in one

moxibustion treatment. Although there wereliterature, there were no adverse events althoughsome trails using placebo needles, perfect tests

the symptoms were claimed during the treatment

like using drugs have not been realized so far, so

period, such as the body becoming heavy andit may be unreasonable to make a valuation only

languid, feeling a fear as the abdomen felt heavily

from this point. Moreover, Cardini conducted

distended, worried as the baby (fetus) moved verysame trial in Italy as the first one he did withactively,unfavorable results. Together with this issue,

metrorrhagia(uterine

bleeding)

appearing, and tendency of threatened premature

conducting

delivery.

moxibustion treatment will be future tasks.

4

RCTs

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

foracupunctureandVolume 4, Number 2 | Summer 2009

The turn ratio in 16 literatures ranged widely

number of stimulation applications and thefrom 11.7% to 91.7%. Out of the 16, 12 literatures

amounts of stimuli, or “stimulation frequency”

showed 72.2% or above, which is not low whenneeds to be studied. This has shed light on one ofcompared with the turn ratio 3) of the external

the subjects to be discussed to ensure successful

cephalic version. As the number of weeks fromacupuncture

the start of treatment differs widely in thesebreech presentations.
Bicornate

literatures from 20 weeks to 37 weeks and manyandmoxibustion

uterusandtreatment

deformity,ofuterinecases of short terms (weeks) were included, amyoma, and loop of the umbilical cord have beenclose look at the 10 literatures having the clear

pointedmention of 32 weeks to 35 weeks revealed 11.7%

considered to exert a negative influence on theto 87.5% of the turn ratio after spontaneousturn ratio, and these are materials for security

turning around was taken into account. And eightand effectiveness studies.

out

as

organic

diseases

that

are

As to side effects, one literature reported

literatures had the turn ratio of 61.4% or above.
In regard to the method of treatment, one

complaints of nausea in four cases and twoliterature showed the use of acupuncture only

literatures reported blisters and pigmentation.

and all other 15 literatures indicated the use of

One literature showed uterine bleeding duringmoxibustion and the selection of zhi yin (BL67) –the treatment period, threatening premature

this may be an application of zhi yin (BL67)

delivery although there were no serious adverse

moxibustion usually performed for difficult labor

events. Except for two literatures that had nosince old days.

descriptions of side effects, 14 literatures reported

By the way, Arai 16) reported the turn ratio of

no serious adverse events. From this, it may be

11.7%, extremely low compared with othersaid that the methods of breech presentation

literatures. There were five literatures, including

treatment with acupuncture and moxibustion

Arai’s, that reported 1-3 times of treatment at

performed so far in Japan are safe.

hospitals,

insteadofeverydayat-homemoxibustion. Of these, two cases used Kampo

5. Conclusion

medicines together with antispasmodic agents for

Sixteen literatures on the breech presentation

uterus and the other one case had intradermal

published after the war were analyzed the results

needles inserted after moxibustion and left them

are reported in this article.

in place for 3-4 days. On the contrary, Arai 16) set
the frequency to “once in a week, or three times a

6. References

week at most.” From what I gather, the quantities

1) TAKEDA Yoshihara, NAKAMURA Masao:of stimuli and the dosage amounts, in other words

Ninshin-chu

the total treatment volume given to patients are

Kyosei-hou, Journal of Sanka to Fujinka

smaller compared to the 15 literatures. On this(Obstetrics andpoint, Arai 16) also states in the part of436-43.

Discussion in his literature that this will be a
problem,moxibustion“increasing
may

have

the
the

2)

no

Kanri

to

Kotsuban-Gynecology) 2005; 72 (4):MARUMO Genzo, et al.: Kotsubani ni taisuru

frequencyof

Shitukyoui Shidou no Yuyousei, Obstetricalpossibilityofand Gynecological Therapy, vol.100 no.1

increasing the correction ratio,” and that the2010 / 1:99-103

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

5

Volume 4, Number 2 | Summer 20093)

4)

Hofmeyr GJ, Kulier R; External cephalic

Breech Version- A Descriptive Review ，version for breech presentationat term. The

ACUPUNCTURE IN MEDICINE 2002; 20(1):Cochrane Library, Issue 2, 2003, Oxford.

26-29

Hotton EK, Hofmeyr GJ, External cephalicversionforbreechterm(Cochranepresentation

Review),

Issue

2,

beforeEffective for Correction of Breech Preseatation?

2006

Acta

Chichester, UK
5)

ACOG

16) Tadashi Arai et al.: Is Acupuncture / moxibustion

Obst

pp1217-1220, 2001

committee,

ObstetGynecol.2001;

98(6): 1189-90
6)

YOSHIDA Koyo: Sanka Shikkan no Shindan,
Chiryou Kanri Kotsubani Bunben, Perinatal
Medicine, 2004; 34(7):1085-8.

7)

ISHINO Nobuyasu: Ijyou-taii ni taisuru
Saninkou Sekyu no Eikyou. Journal of The
Japan

Societyfor

Oriental

Medicine

1(3),7,1952.
8)

HAYASHIDA Kazuo: Toyo Igaku to Kotsuban
Kyousei, Toho Igaku, 1987;34(2)：196-206．

9)

Francesco Cardini, et al. Moxibustion for
CorrectionofBreechPresentation

Randomized Controlled Trial, JAMA 1998;
280: 1580-5.
10) I.Neri, et al., Acupuncture plus moxibustion

to resolve breech presentation: a randomized
controlled

study.

ROMA:

CIC

EdizioniInternazionali, 2003; 58-61
11) Francesco Cardini, A randomized controlled

trial of moxibustion for breech presentation,
BJOG: an International Journal of Obstetics
and Gynaecology. 2005; (112): 783-7
12) KOIDO Yoshihiko, KATAI Shuichi: Kotsubani

ni taisuru Shinkyu-chiryou no Nihon ni okeru
EBM, Irasuto to Shashin de Manabu Sakago
no Shinkyu Chiryou, written and edited by
KATAI Shuichi, Ishiyaku Publishers,Inc 2009
Tokyo: 28-36
13) KAGAWA Genetsu(1700-1777), “Shigenshi

San-ron”(“San-ron”)（1765）
14) KAGAWA Genteki (1739-1779), “ Sanron-yoku” (1775)
15) Ayman Ewies, Karl Olah 、 Moxibustion in
6

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

Jpn

Vol.53,No.8,