Volume 6, Number 2 | Summer 2011

Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (1) – Internal Medicine

consumption combined with medical interventions,

Kenichi Kimura

controlling sympathetic nerve blockers (a β acceptor

Department of Health and Medical Careblocker, an alpha-adrenoreceptor blocker), which act on

Kansai University of Health Sciences

1. The present condition of Clinical Research in
Foreign Countries
In this section, on the topic of circulatory organs, wewill be reporting on the current situation andprospects for domestic Japanese clinical research onAcupuncture and Moxibustion research, especiallywith respect to Hypertension. Hypertension is
known globally as one of several lifestyle relateddiseases, notably in Japan alone has at least 40
million hypertensive patients.

Arteriosclerosis,

which occurs as people age, contributes to theincreased frequency of Hypertension in the elderlypopulation. Currently, hypertension and its related
complications accounts for 30% of medical costs for
Because of the inevitably highpercentage of elderly patients with hypertension, I
often intend to use clinical acupuncture andmoxibustion for these patients. Widely known as thesilent killer, hypertension has relatively mild or
manageable subjective symptoms but if these are left
untreated, the patient may suffer a stroke, ischemia
or renal insufficiency, life threatening complications
caused by this risk factor. For this reason, thepurpose of treatment for hypertension is not simply
to lower high blood pressure, but also to maintainnormal levels to prevent ischemia or stroke.
Classification of hypertension include Essential
Hypertension and Secondary Hypertension, lifestyle
habits such as high intake of sodium or alcohol,
stress, smoking etc., as well as genetics, constitutefactors that clearly contribute to the disease process.
As for treatment, there is the non-medical aspect oftherapy that includes improving daily habits such as
reducing sodium intake and weight loss, moderate
exercise, prohibition of smoking, and limiting alcohol2

therenin-angiotensinsystem.

Reducing

reninsecretion helps to reduce the heart-oxygen demand by

A Circulatory Organs

people over age 65.

including hypotensive agents such as pharmaceuticals

reducing extracellular fluid volume. The side effectsand complications associated with this type ofpharmacological treatment protocol, not to mention
the costs, means many patients cannot adapt to these
medical treatments 2). For many of these patients,
the low cost and elimination of side effects makes thealternative therapies of Acupuncture and Moxibustion
rather appealing 3). Until now there has been a lackof scientific proof for the effectiveness of acupuncture
treatment for hypertension because there have notbeen enough well designed randomized controlled
studies (RTC) or case studies and long term casereviews 4,5).
However, recently, Europe, America and Korea havebeen performing large scale RCTs demonstrating theefficacy of acupuncture treatments for hypertension68). In 2007, Germany conducted an RCT study on 160
low to middle range hypertension patients and reportthat acupuncture treatments effectively lowers highblood pressure. As a result, when compared to thesham acupuncture group, the acupuncture groupexperienced significantly reduced systolic and diastolicblood pressure during the 24 hour period immediatelyfollowing the treatment. This reduction lasted 6 weeks,but, follow-up results, 3 months and 6 months post
treatment, showed the acupuncture group`s bloodpressure had returned to pre-treatment levels 6).
(Figure 1).
Further, Korean researchers performed double-blind
RCTs on 41 patients with High Blood pressure levels
above 120/80mmHg.

Previously, America approved

new guidelines for hypertension, defining systolicblood pressure to be 120-139mmHg and diastolicblood pressure to be 80-89mmHg. The Korean study
showed that 8 weeks of regular acupuncture

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

Volume 6, Number 2 | Summer 2011

treatments significantly contributed to decreases inmoxibustion treatment to two controls, hypertensive

blood pressure when compared to the results of themedications and no treatment, and found asham acupuncture group 7). The group concluded

significant decrease in patient hypertension levels

that regular acupuncture is beneficial as a remedy

when comparing moxibustion treatment with nofor hypertension.

In contrast, an American RCTtreatment. However, because of the low number ofstudy of 192 hypertension patients was conducted 8).

high quality RCTs, differing results between reports;

This study divided the subjects into three random

and with respect to moxibustion treatment RCTs,

groups: standard acupuncture, sham acupuncture

the difficulty of establishing an appropriate control

and no treatment.

intervention, there is insufficient evidence to suggest

All patients received a Chinese

Medical diagnosis where an individualized set ofacupoints

wasdetermined.

Treatments

conducted regularly for 6-8 weeks.

that moxibustion is effective for hypertension.

wereCompared tobasal readings, all three groups showed reductions
in diastolic and systolic blood pressure 10 weeks
following the trials, however the difference between
groups was not significant. Further, 12 months
following the trials, blood pressure levels showed atrend of returning to pre-trial levels, so both theconclusion that acupuncture treatment is effective
for hypertension andnot long lasting for

hypertension were reported.

In recent years, Lee etal. 9), conducted a systematic review of interventions
using acupuncture therapy to treat Hypertension.
They selected 11 RCT reports that satisfied all thestandard criteria and showed references not only tothe slight efficacy of acupuncture treatments toreduce hypertension when compared to the control
intervention, but also to equivalent effectivenesswhen

comparedto

hypertensivemedications.

Unfortunately, because of small sample size, somequalities of the trial designs and some disagreement
between results the researchers could not reach theconclusionthat

acupunctureissufficiently

effective to treat hypertensive patients. Additionally,Figure 1 Effects of Acupuncture Treatment on
Changes in Blood Pressure over a 24 Hour Period

Comparing significant drops in blood pressure levels
between acupuncture and sham acupuncture subject
levels immediately following the treatment: Systolic
Blood Pressure (Upper Level), Diastolic Blood
Pressure (Lower Level)(***p<0.0001). Significant
differences between the two groups were notcompared 3months or 6 months following the trials.

concerning moxibustion treatment as well, Kim et al.,conducted a systematic review of 4 RCTs that met
standard criteria. Of the 4 reports, 2 usedhypertensive medications as the only control groupand did not find a significant difference between to
the control and moxibustion treatment for reducing
hypertension.

Theother2reports

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

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Volume 6, Number 2 | Summer 2011

not elicit significant changes, however, using a crosscomparison between day and night time standard
values, known as a hyperbaric index, the researchersreported a significant decrease in blood pressure forthe hypertensive group. Further, with respect toacupuncture treatment efficacy for hypertension,
until now blood pressure readings were taken at
random times before and after the treatments, but
because acupuncture efficacy was not apparent
using this method, it is now being suggested that 24hours ABPM blood pressure recordings provide thepotential for detailed analysis of blood pressure
readings

thatwereundetectable

using

only

occasional readings.
Concerning the mechanism by which acupuncture
can lead to decreases in blood pressure, basic
Figure 2 Changes in Systolic and Diastolic Blood
Pressure due to Acupuncture treatment

research on intrinsic opioids within the brains ofanesthetized rats activates of the inhibitory systemof the sympathetic nervous system, suggesting theTen weeks following the trials, trends in decreased

involvement of serotonin, nociceptin, GABA etc.

systolic and diastolic blood pressure were confirmed,Further, using an animal as a model with renal

however, significant differences were not confirmed

hypertension, this group treated St 36 (足三里) with

between the three test groups: the individualized

electro-acupuncture causing acceleration of carbon

treatment group, the standardized treatment group

dioxide production, blood vessel dilation and aand the control group. By 12 months following thereported decrease in blood pressure 13)

trials, blood pressure levels had returned to pre-trial

In the future, the themes of clinical researchlevels in all subject groups.

utilizing acupuncture and moxibustion for thetreatment of Hypertension will necessarily need to2. The current situation and outlook of Japanese

focus not only on effectively lowering blood pressure,but also relieving the numerous complaints andClinical Research
On the one hand, in Japan, most research is collected

symptoms that accompany hypertension. Further, as

in clinical case compilations, and fewer documents,

has been pointed out, hypotensive medications haveincluding RCTs and systematic reviews can beside effects、interactions with other drugs and limits

retrieved.

Kou et al., 11) conducted a 2 monthto their applicability so we consider combining

intervention on 15 elderly women (6 with normal

pharmaceuticals with acupuncture and moxibustion

blood pressure and 9 with hypertension). The

in an effort to create a synergistic effect, reducing the

purpose of these trials was to perform whole bodyamount of medicines required for effectiveness to be

acupuncture treatments. The subjects were asked toan important area of investigation.

perform

24hourambulatory

bloodpressure

monitoring (ABPM). According to cosine similarity,
analyzing blood pressure levels during the day may4

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

Volume 6, Number 2 | Summer 201112) Li P, Longhurst JC: Neural mechanism ofReferences
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