Volume 7, Number 3 | Fall 2012

Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (5) – Orthopedic
Disorders B

Hiroshi Yamamoto

Department of Health Sciences
Kansai University of Health Sciences

B Low Back and Legs
1. Concerning Acupuncture and Moxibustion for
Low back and Legs
One particular characteristic of Japanese
Acupuncture and Moxibustion (Traditional OrientalMedicine) is that each patient is treated as anindividual, one by one, based on their uniquecondition, so an appropriate treatment method,
protocol and amount of stimulation is selected,
ensuring

comfortableandeffective

treatment

sessions. Further, practitioners endeavor to develop
a relationship with the patient, the psychologicaleffectsofthisrelationshipgreatly

improvetreatment efficacy. From the initial greeting at theclinic to the medical interview and exceptionally
comfortableacupunctureandmoxibustion

treatment, the high quality of care naturally touches
thepatient.

Japanesetraditional

medicine’s

significant efficacy depends on maximizing thepatient’s natural healing power. To elicit andmaximize the patient’s natural healing potential, thereal goal of acupuncture and moxibustion treatment,
the practitioner’s attitude, word choice, friendliness
and ways of touching the patient cannot beoverestimated. It seems that a combination oftreating a wide variety of patients and conditions
utilizing

theabovementionedfavorable

circumstances, over many years, contributes to thedevelopmentofexcellent

AcupunctureandMoxibustion practitioners.
For the past 30 years, medical research has been
underway, focusing on the objective effects ofphysical stimulation in the fields of health science.
As a result, Evidence-Based Medicine (EBM) has
necessarily

becomethegoldstandardfor

scientifically valid health-related research protocols.

Currently, Randomized Controlled Trials (RTCs)
provide the highest level of reliability for highquality epidemiological studies targeting a specificgroup of people and represents a way to makerecommendations for treatment methods, protocols
and research topics. From the perspective ofAcupunctureandMoxibustion

treatment

thePlacebo Effect must be considered carefully, however,
it is frequently excluded from consideration in RCTs.
Namely, the problem is that the placebo effect isoften considered to be identical in all people andstudies. Included within modern medicine andtreatment effects, the Placebo Effect is often
considered“extra”

orin“error,however,intraditional medicine it is considered an important
treatment effect that should be protected and sought
after. Perhaps, it can be considered that the wide
variety of placebo effects appearing in the research
literature can be accounted for by the variety oftreatment styles and experience level of thepractitioners. The placebo effect is just one healingmechanism, from the human unconscious, not unlike
hormones and the autonomic nervous system, andonce qualitatively and quantitatively clarified, could
help diversify our treatment models.
In any case, for each practitioner, the placebo
effect is different and depending on their technicalskill, medical knowledge and humanity the variation
will be greatly affected. Further, it is essential to becareful here, do not make the mistake of imaginingthat the placebo effect is simply elicited by changing
your words or manner of speech. This is the firstthing practitioners must understand. Nonetheless,considering

current

world-wide

acupuncture

treatment effects using RCTs introduced here,
obtaining objective evaluation of acupuncture andmoxibustion

treatments

continues

toparamountimportance.

However,thebeofcurrent

dispute in many RCT papers focuses on the very
difficult prospect, “Acupuncture works!”. There aremany problems that are usually different in each
RCT

research

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

differing

reactionsto3Volume 7, Number 3 | Fall 2012

descriptions of informed consent and screening

designs, increasing subject numbers (respondents)

methods, stimulation methods and amounts, controland assuring consistent protocol parameters must beselection

points,confirmed before more definite conclusions can betreatment time, duration of treatment, evaluation ofmade regarding treatments for osteoarthritis of thetherapeutic effects (outcome), subjects that are moreknee.

andparameters,

treatmentor less reactive to acupuncture, acupuncturists who

Worldwide trends in RTCs including Japan have

do not distinguish important aspects of theirbeen

research. Therefore, naturally there are many

Acupuncture and Moxibustion. Several excellent

different results, so arriving at an all-inclusive

medicalconclusion will likely take quite a long time. To thatparticularly for osteoarthritis of the knee and low

end, here, we are introducing some reference

back pain using evidence-based acupuncture andmaterials focusing on chronic low back pain andmoxibustion2, 3). Among these, RTCs from Germany

osteoarthritis of the knee obtained from recent

using acupuncture and moxibustion for low backinternationally relevant RCTs. Additionally, we hopepain, these researchers used an acupuncture groups

to convey some of the most common developments inand a sham acupuncture group and calculated theJapanese research in general, as well as insignificant differences between the test groups. TheyAcupuncture

concluded that, compared to results followingandMoxibustion

treatment

inparticular.

introducedbythecommentaries

Japan

have

beenSocietyof

published,modern medical guidelines, better treatment results
were observed using acupuncture4). In addition, a2. Effect of Acupuncture and Moxibustion on
Lumbar area and Lower limbs
In 2009, the National Center for Complimentary

United States based RTC report for Osteoarthritis ofand Alternative Medicine (NCCAM), a researchcombining

center within the National Institute of Health (NIH)in the United States, announced a list of recent RCTs
noted for their high level of validity1). As a summaryof these results, with respect to general treatment
with modern medicine, for example, in cases wheredrugs are ineffective for chronic low back pain,
complementing the protocol with acupuncture andmoxibustion

must

beconsidered.

Further,

acupuncture and moxibustion should be considered as
effective as pharmaceuticals on their own as they
have been shown to increase the efficacy of generaltreatment when used in conjunction with standard
drug protocols. However, it must also mentioned thatongoing research will of course be required to refine
the most effective complimentary methods andtechniques. Similarly, concerning osteoarthritis of theknee, definitive conclusions about effective treatment
cannot yet be made as most treatments only reduce
pain, some life style and functional improvements
have been confirmed but removing flawed research4

the knee, divided the subjects into acupuncture andsham

acupuncture
standardgroups.

Theymedicalfound

thattreatments

andacupuncture with health education significantly
increased clinical effectiveness5).
Unfortunately, there are few RCTs from Japan on
the effects of acupuncture for the Lumbar region andlower limbs. But cited among the current issues arereports on the small number of RCTs and, in contrast,
a great variety of reported acupuncture andmoxibustion techniques6). Just for your information,
the author conducted acupuncture treatment RCTs7)
on 35 subjects with degenerative osteoarthritis of theknee joint and, although the number of subjects was
too small to make a strong conclusion, following
statisticalanalysis comparing pre- and post-treatment symptoms, acupuncture and moxibustion
were found to be significantly effective. However, theplacebo acupuncture control group also reported
improvement following the session, needless to say,
we recommend further research to elicit definitiveresults.

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

Volume 7, Number 3 | Fall 2012

*note As a rule, RCT criteria require emergency
responses to disease, severe conditions often create
ethical problems, the limits of appropriate conditions
can make them difficult to recommend for suchresearch projects. For these reasons, often researchers
select chronic conditions that are not life threatening.
For example, severe low back pain or leg pain
accompanied by numbness, both chronic conditions of
the lumbar region and lower limbs, make more
ethically appropriate candidates for research. Further,acupuncture research for osteoarthritis of the knee
joint is being conducted around the world. The
following criteria for osteoarthritis of the knee provides
a clear and easy-to-understand definition of andguidelines for diagnosis: diagnosis by an X-ray image,
45 years of age or older, chronic persistent andrelatively localized pain and stiffness, and valid
evidence that this pain is negatively influencing thepatient’s quality of life (using a self-administeredassessment method such as the (WOMAC)8).

References
1) “Acupuncture for pain” NCCAM Publication No.
D435, Created May 2009, Updated August 2010
2) National Japan Acupuncture and Moxibustion
Society (Edition), Corporation: Evidence based
research on Acupuncture and Moxibustion for
Osteoarthritis of the Knee Joint, Ishiyaku
Publishers, Tokyo, 2007
3) National Japan Acupuncture and Moxibustion
Society (Edition), Corporation: Evidence based
research on Acupuncture and Moxibustion forLow Back Pain, Ishiyaku Publishers, Tokyo, 2010
4) Haake M, Müller HH, Schade ─ Brittinger C, etal: German Acupuncture Trials (GERAC) for
ChronicLow

Back

Pain:

Randomized,Multicenter, Blinded, Parallel ─ Group Trial With3 Groups. Arch Intern Med 167: 1892─1898, 2007
5) Berman BM, Lao L, Langenberg P, et al:
Effectivenessoftherapy

osteoarthritis

inrandomized,acupuncturecontrolled

asadjunctiveof

theknee:trial.

Ann

InternalaMedicine 141(12): 901─ 910, 2004
6) Yamashita

H,Masuyama

S:

Acupuncture

treatment for low back pain in Japan: A brief
review based on clinical research papers. JAM 2:55─58, 20107) Yamamoto

Hiroshi,Umeda

Yohtaro,Kibi

Yoshihoka, et al.: Acupuncture and Moxibustion
Treatment and Clinical Effects on Osteoarthritisof the Knee 3 ─ randomized controlled trials ─.
Bulletin of the Kansai Medical University 3: 3640, 20098) Bellamy N, Buchanan WW, Goldsmith CH:
Validation study of WOMAC: A health status
instrument for measuring clinically importantpatient relevant outcomes to antirheumatic drug
therapy in patients with osteoarthritis of the hipor knee. J Rheumatol 15: 1833─1840, 1988

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

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