Volume 8, Number 4 | Winter 2013

Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (10) – Gynecology

1) Systematic review
Yang H et al.1) reported that among the reviews of

Yoji Shimizu

acupuncture research on primary dysmenorrhea,

Department of Acupuncture and Moxibustion

most of the reported research (32 published reports)

Chuwa Professional Training College of Medical Care

had been ranked at a low level. Relevant research
included 18 studies comparing analgesics andacupuncture.

1. Introduction

Acupuncture

was

found

to

be

Here we introduce studies on the effects ofsignificantly effective. However, it was reported that

acupuncture treatment for gynecological disorders.

9 of these studies did not show significant

The main subjects’ dysmenorrhea, menstrual cycle

effectiveness. These reports focused on traditional

abnormalities, infertility, and menopause are subject

Chinese medicine, pain medication, psychotherapy

mainly. We found that most of the studies fromwith placebo acupuncture used as the control group.

abroad were high level, evidence based research2) Randomized Controlled Trials

based on RCTs (randomized controlled trials), andHelms JM et al reported the results of RCTs. The

however, Japanese studies were primarily casesubjects for these trials included 43 womenstudies with essentially no RCTs presented. One

complaining

similarity between foreign research and that fromrandomly assigned to an acupuncture group, placebo

Japan is that, compared to reports on acupuncture,acupuncture group and a standard control group.

is the relative dearth of research on moxibustion. A

Results following a pre-determined course oflarge number of the studies from abroad are based

treatment were compared between the groups.

on traditional Chinese medicine (traditional Chinese

Improvement rates (that is, reports of reduced pain)

medicine TCM) theory as a standard treatment. In

within the acupuncture group were the highest. It

contrast, the various reports from Japan are based

was also reported that the frequency of analgesic

on the classical theories from Classical Text andtreatment decreased the most within acupuncture

TCM, such as the somatic ─ visceral reflex. Because

group.

ofdysmenorrhea.

Subjects

wererecent Acupuncture research examines therapeutic

Also, Caroline A. et al. investigated 92 women

effects on the endocrine system, it is becoming morewith primary dysmenorrhea. The acupuncture

important worldwide. In the future, I hope thattreatment group and the placebo acupuncture

beyond TCM, clinical research based on classicaltreatment control group were compared. Following

theory and texts contributes to Japan's own research

the treatment series, the acupuncture treatment

development.

group tended to have fewer days of menstrual pain

Now we will proceed with our discussion ofcompared to the control group. Three months after
the treatment series, compared to the placebo

research on Infertility [6.Obstetrics].

acupuncture group, the acupuncture treatment
2. The current state of Clinical Research Abroadgroup had significantly fewer days of menstrual pain.

a) Dysmenorrhea

Additionally, the required amount of additional

Many RCTs on Acupuncture treatment for

analgesics was also significantly reduced among thedysmenorrhea have been performed, these trials

acupuncture treatment subjects. However, it wasoften involve a study of women with primary

reported that6 months following the trials, thedysmenorrhea.

effects of the acupuncture treatments were no longer

Additionally,

there

have

numerous “systematic reviews” published.

2

been

reported by the subjects.

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

Volume 8, Number 4 | Winter 2013c) Menopauseb) Irregular MenstruationareAmong the research on the effects of acupuncture

manifold including but not limited to anovulation

treatment for gynecological diseases, studies on

various disorders associated with the corpus luteum.

menopause have been particularly frequent. There

Clinical studies on menstrual cycle abnormalities

are numerous symptoms associated with Menopause,

are often intricately related to infertility research.

but many of the RCTs are conducted to verify theClinical studies on polycystic ovary syndrome

effect of acupuncture treatment for hot flashes.

(PCOS) have been carried out in efforts to clarify the1) Randomized Controlled Trials

The

causesofirregular

menstruation

Cohen SM et al. used 18 women who complained

causes of irregular menstruation.

of hot flashes. The subjects were randomly divided

1) Systematic Review
Lim CE et al.2) reviewed acupuncture research on

into

two

groups.

The

first

group

received

PCOS. They found that acupuncture treatment for

acupuncture treatments using points appropriate for

PCOS patients led to increased blood flow to themenopausal symptoms and the second groupovaries, reduced in the number of ovarian cysts andreceived

overall size of the ovaries, and, seemed to influence

general strength and vitality. For the acupuncture

blood sugar levels and insulin sensitivity by reducing

treatment trial group, comparing the frequency andcirculating blood insulin levels.

intensity of the hot flashes prior to the treatment

2) Randomized Controlled Trials

series it was reported that, during and following theacupuncture

treatments

designed forStener and Victorin E et al. 3) recruited 20 women

treatments, hot flash frequency and intensity waswith PCOS and divided them into three trial groups:

significantly reduced. Similarly, for the general

the electro-acupuncture stimulation (EA) group, thestrength and vitality trial group, hot flashes were

exercise group and the no treatment group. Many ofsignificantly reduced following the treatments.

the common features of PCOS, such as central

Further, both groups reported significantly improved

obesity, hyper-insulinemia and obstructive sleep

sleep following the treatments.

chronic

Borud EK et al.4) investigated the effects ofthatacupuncture treatment combined with education

sympathetic—excitation may be involved in theabout self-care compared to only education about

pathogenesis of this condition. PCOS patients are

self-care in 267 menopausal women. The trial groups

known to have accelerated sympathetic nerve

were randomly selected and following the treatment

activity within muscle. Stener and Victorin reported

series hot flash frequency and intensity werethat the exercise and EA groups experienced

compared. It was reported that the acupuncture

inhibition of this phenomenon of the muscle

treatment group had significantly reduced hot flash

sympathetic nerve activity.

frequency and intensity. However, at the 6 and 12

3) Comparative Clinical Research比month follow-up sessions, there were no significant

apnea(OSA),

sympathetic

are

over

associatedactivity,withsuggesting

Stener and Victorin E et al. recruited a group ofdifferences between the groups.

24 PCOS women with non-ovulatory menstrual

Also, in recent years there have been numerous ofcycles or oligomenorrhea. Their reported results forreported studies examining the effect of acupuncture

the women who underwent EA, ovulatory cycles

treatment for menopausal symptoms caused by theincreased significantly. EA pretreatment averageside effects of hormone therapy in breast cancer

was 0.15 compared to a treatment and post-

patients in recent years.

treatment average of 0.66.

Walker EM et al. randomly assigned 50 breast
cancer patients with depression to acupuncture

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

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Volume 8, Number 4 | Winter 2013

treatments or venlafaxine (anti-depressant) protocol.

retention method acupuncture treatment. The

Comparing results, both groups reported significant

researchers used a visual analogue scale (VAS) withimprovements in hot flashes, depression and otherboth trial groups and reported that both groups felt

QOL indexes. However, it was reported that thetheiracupuncturegroup`sthat

immediately following the treatments but that there

acupuncture

was

the

were no significant differences between the groups.

reports

more

indicated

effective

than

lower

abdominal

pain

was

relieved

b. Case Studies

pharmaceutical alternative.

Yamashita et al., reported their results from a
3. Currents Status and Prospects for Clinicalcomparativecase

review

of

7

women

with

Research in Japandysmenorrhea. With each passing week of their cycle,a) Dysmenorrhea

these women tended to have lower dysmenorrhea

1) Research on Dysmenorrhea

symptom scores. Significantly lower discomfort

Clinical studies from Japan on Dysmenorrhea

scores were reported prior to the treatments andfocus mainly on painful menstruation and various

during the second and third weeks of their cycles.

pain symptoms experienced during menstruation.

Treatment results for the seven subjects included

There are fewer reports on the cause of the pain and

one remarkably effective case, 3 significantly

other symptom sequela or on classification ofeffective cases. The remaining 3 subjects did not findcommontheprimaryor

secondarysymptoms.

treatments

effective.

Notably,significant

Comparative studies on study design, case series

decreases were observed in lethargy and lower

and case reports make up the majority of publishedabdominal pain. It was reported that, in all 7

literature.

subjects, symptoms that had previously interfereda. Comparative Clinical Researchwith life style enjoyment and daily activities

Yoshimoto et al.5), conducted research on 51
women with dysmenorrhea (painful menstruation).

improved.
c. Case Reports

They established a treatment a treatment free

Taguchi et al., 6) investigated the effects of tackperiod prior to and following the determinedneedles on Sp6 in 2 patients with functional

treatment series. They reported the results of theirdysmenorrhea. After 2 weeks of treatment, subject 1

examination on the effect of embedded needles atreported a Menstrual Disorders Index of 96.5 but

Sp6 on menstrual pain. During the treatment period,

after 6 and 10 weeks of treatment her Menstrual

pain

pain

Disorders index had decreased to 49 and then 40.

improved in about half of the participants. The

VAS scores and amounts of medications decreased

amount of medication taken by the subjects also

until the 6th week but were then found to be

decreased significantly.

increasing again following the 10th week. The second

assessments

showedthesubject`s

Tanaka et al. divided 22 women subjects withsubjects started treatment with a Menstrual

dysmenorrhea into 2 groups. The first group received

Disorders Index of 59. Her score was 49.5 after one

acupuncture that included retention method withmonth of treatment and 21.5 after 5 months. Bothdispersing stimulation. The second group received

her VAS scores and necessary amount of pain

retention method acupuncture without dispersing

relievers also decreased over the course of thestimulation. The treatment protocol began with 2

treatment series.

weeks of treatment, followed by a week without

Among the case reports of acupuncture treatment

treatment. After menstruation had continued fromfor organic dysmenorrhea, Yamashita et al, reported

between 1-3 days, the subjects received a 10 minuteon the results of acupuncture treatment for a 29-

4

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

Volume 8, Number 4 | Winter 2013whose

phases of 4 days. Additionally, after one year of

symptoms resulted from bilateral chocolate ovariantreatment, 5 subjects were confirmed to have high-cysts.

temperature phases as well.

year-old

woman

with

Following

dysmenorrhea

a seriesof 42

acupuncture

treatments, it was reported that her Menstrual

Further, 33 adult women were asked to measure

Disorders Index had decreased from 37 to 23 and she

their basal temperature for 3 months. Six subjects

reported that her menstrual pain was “no longer

were found to have normal basal body temperatureinterfering with her daily activities” and haschanges and regular menstruation, they made up

improved to a level that “no longer bothered her”.

the control group. The trial group was made up of 72) Prospects for Future Research

women who were not found to have normal basal

Among gynecologic clinical studies in Japan, I

body temperature fluctuations throughout theirsuspect the number of reports on dysmenorrhea iscycle. After conducting a 75 g glucose tolerance test,

relatively large. Pain symptoms, such as menstrual

both groups were compared. Blood glucose levels andpains associated with dysmenorrhea, are suitable forblood insulin levels were significantly higher in the

short-term observation and represent the main

abnormal group. Blood glucose was abnormally highreason for the prevalence of such studies. In theat 30, 60, and 120 minute intervals. Abnormally highfuture, reports of studies designed with follow-up

blood insulin levels were confirmed at 120 minutes.

periods and appropriate control groups would add

For the abnormal trial group, ear acupuncture,significantly to the value of this research. Also

needling at Sp6 combined with infra-red light wasstandardized classification of the cause of symptoms,

continued for one year. Blood sugar and insulin

such as primary of secondary would also be desirable.

levels prior to and following the treatment series
were compared and found to be significantly reducedb) Irregular Menstruation

at 30- and 120-minute intervals following the1) Research on Irregular Menstruation

treatment series. It was reported, following theStudies of menstrual cycle abnormalities make up

course of treatment, that the menstrual cycle

the majority of reported cases and comparative

duration (number of days) was reduced and the highstudies. Research often focuses on amenorrhea andtemperature phase was significantly lengthened.

disorders associated with ovulation. Most research

Taguchi et al. investigated 16 women complaining

aims to clarify evaluation methods and observationsof irregular menstruation by comparing a no-

of

the

treatment period followed by electro-acupuncture

menstrual cycle. Specifically, many research reports

group following a pre-determined protocol. Results

include easily obtainable data comparing of the time

showed that 6 subjects improved, 5 had no change

course of basal body temperature and menstrualand 2 became worse following the treatments. Fivecycle dates.

of the subjects became bi-phasic following thea. Comparative Clinical Research

protocol. The author reported that there was no

physicalchangesexperienced

during

Shimizu et al.7, 8), targeting six women who weresignificant change in the cycle duration or basal bodysuspected of anovulatory cycle disease by tracking

temperature (taken at the eardrum).

their basal body temperature. They observed

b. Case Study Reports

changes in basal body temperature following Stick

Shimizu et al. reported on a 23 year old diagnosed

andElectro-with hypothalamic amenorrhea. She had seen no

combined with

infra-redchange following a course of Kaumann Therapy andirradiation. They reported that, after 6 months offertility drugs. These researchers treated her withtreatment, 2 subjects experienced high-temperature

EA (Electro acupuncture). After 45 days her period

Moxa

treatments

acupuncture

at

on

Sp6

the

feet

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

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Volume 8, Number 4 | Winter 2013

started and after 8 menstrual cycles a highreplacement therapy for menopausal symptoms andtemperature phase was confirmed. E2 values werealso complained of retractable shoulder pain. The

taken prior to the treatment series (14th day of her

first group (23 women) received acupuncture

cycle, 57.2pg/ml) and again after 19 weeks oftreatments, the second group (24 women) received atreatment (day 17 of her cycle, 278.9pg/ ml). Samples

muscle relaxant. Results were obtained by interview

were taken while the basal body temperature was inand responses were divided into a 4-tier evaluation

its low temperature phase. The subjects also

scheme. The researchers found that the acupuncturereported that her facial skin was less dry and thegroup reported significantly improved symptoms

edema she had experienced on her lower legs wascompared with the muscle relaxant treatment group.

much improved.

b. Case Study Reviews
Miki et al. attempted to differentiate between

2) Prospects for Future Research
menstrual

psychogenic and autonomic complaints among 150

abnormalities tend to also have or develop infertility.

menopausal women with indefinite complaints. They

Because treatment periods for these types ofused a CMI survey and autonomic function testing

patients tend to be protracted and patients may nottofeel the results of the treatments, it has been difficult

Acupuncture was performed at appropriate neck,to attract new patients to participate in these types

shoulder and/ or upper back, with retention method.

of treatments.

Moxibustion was performed at the low abdomen, low

Clinically,

many

women

with

betterclarifythesedifficultcomplaints.

Studies using the basal body temperature as anback and around the sacrum. Five small cones were

evaluation method are very common. Basal bodyburned on each of the chosen points. The researchers

temperature is a simple and effective objective

found that more than 72% of the patients responded

evaluation method to determine whether or not thepositively

woman`s cycle is bi-phasic, but cannot be relied on toautonomic symptoms had improved.

confirm the presence or absence of ovulation.

c. Case Report

to

the

treatments,

reportingtheir

In the future, studies should be carried out within

Sawada et al. performed two case reports. Thea relatively short period of time and it is necessary

first case involves the case of a 48 year-old post-

to carry out verification using objective evaluation

menopausal woman who received acupuncture

methods, such as ultrasound and blood tests intreatments at a pace of twice in a two week intervalcollaboration with medical institutions.

for 6 months. Her Kupperman index decreased, but
her hot flashes and her blood hormone levels
remained unchanged. Following these results shec) Menopause
Research on menopause in Japan, as well as

started hormone replacement therapy. The second

abroad, can be divided into reporting that focuses oncase focused on a 47 year-old woman who complained

one symptom of menopause and reporting thatof urinary incontinence following a left ovariectomy.

evaluates patients with menopausal symptoms as a

It was recommended that she perform pelvic floor

whole using an index table. Most research designs

exercises at home and receive acupuncture two times

include comparative studies of case reports orevery two weeks. Quantitative urinary incontinence

systematic review of a series of specific cases.

tests were used to evaluate her progress and

1) Research Studies on Menopause

suggested that a great degree of improvement had

a. Comparative Researchoccurred.

Yaegashi et al.9) divided their treatment subjects
into two groups. All subjects were on hormone

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

Volume 8, Number 4 | Winter 2013

2) Prospects for Future Research

References

Compared to research on menopause from abroad,1) Yang H, Liu CZ, Chen X, et al.: Systematic review

the number of Japanese reports are relatively few.

of clinical trials of acupuncture-related therapies

It cannot be said that many symptoms ofmenopause are necessarily specific because they are
often

the

resultofotherhiddenunderlying

for primary dysmenorrhea. Acta Obstet Gynecol
Scand 87 (11): 1114─1122, 2008
2) Lim

CE,

Wong

WS:

Current

evidenceof

conditions such as conditions arising from poor

acupuncture on polycystic ovarian syndrome.

circulation that might include chilliness, aches andGynecol Endocrinol 26 (6): 473─478, 2010

pains etc. And then there are the usual complaints

3) Stener ─ Victorin E, Jedel E, Janson PO, et al.:of hot flashes and stiff shoulders. It is difficult to

Low ─ frequency electroacupuncture and physicalclassify Menopause as a gynecological disorder.

exercise decrease high muscle sympathetic nerve

Since menopause can reduce the QOL of menopausal

activity in polycystic ovary syndrome. Am J

women over a long period of time, it may be

Physiol Regul Integr Comp Physiol 297 (2):beneficial to maintain on-going follow-up and review

R387─395, 2009of treatments and patient changes.

4) Borud EK, Alraek T, White A, et al.: The
Acupuncture on Hot Flushes Among Menopausal
Women (ACUFLASH) study, a randomized
controlled trial. Menopause 16 (3): 484─493, 20095) Professor Yoshimoto, Reina Taguchi, Kenji Imaiet al.: An Investigation of the Effects of PressTack Needle Acupuncture on Menstrual Pain.
Journal of the National Society of Japanese
Acupuncture 59 (4) 406─415, 2009.
6) Rena Taguchi, Professor Yoshimoto, Hiroshi
Kitakoji: Two Case Studies on the Effects of
Acupuncturefor

Functional

Dysmenorrhea.

Adolescence 24 (2): 400─406, 2006
7) Yoji Shimizu: Acupuncture for infertility--mainly
anovulatory cycles ─. Modern Acupuncture andMoxibustion 9 (1): 71─75, 20098) Yoji Shimizu, Kuniaki Niwa Kuniaki, Kazumi
Nakazawa et al.: Effect of Acupuncture on the
Menstrual Cycle and Sugar Metabolism in Women
with Anovulatory Cycles. The Journal of Japanese
Association of Physical Medicine, Balneology andClimatology 73 (3): 202─211, 20109) Minoru

Yaegashi,FujinoTakashi,

Masashi

Nishitani: Acupuncture and Moxibustion for
Menopausal

Disorders.

ObstetricalandGynecological Treatment 76: 802─807, 1998

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

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