Volume 8, Number 3 | Fall 2013

Clinical Report 1 (Acupuncture)
Rubbing Acupuncture Method: A Case Reportfor Dementia

reassurance to those receiving the treatment as anextremelysafe

method,but

canbeapplied

conveniently, and has high reproducibility.

Haruo Yoshimura

The rubbing acupuncture method has alreadyCare Prevention Committee, Japan Acupuncture &Moxibustion Association
Yoshimura Acupuncture & Moxibustion Clinic

been applied to a total of some 6,400 elderly people

The Ministry of Health, Labour and Welfare
estimates that the number of elderly persons withdementia at a degree of independence level II or
higher totaled 2.2 million as of 2010, and willcontinue to increase hereafter to 4.7 million in 2025.
People of the baby-boom generation will all becomeage 75 or older in 2025. It is a reasonable figure when
considering today’s rate of increase of elderly people
with dementia, and requires urgent measures to betaken hereafter.
Under this situation, focusing on the peripheral
ofover a period of nine years. The following is a reportthat focuses on one of those cases.

1. Introduction

symptoms

with dementia living in group homes in Osaka City,

peoplewithdementia

reveals

symptoms that are thought to occur from emotional
stress, such as anxiety, restlessness and loss ofconfidence, and symptoms that occur from an
imbalance of the autonomic nerve system. This issimilar to autonomic nerve imbalance and stressthat are triggered by a baby crying at night or baby
colic. In simple terms, it was thought that if thecause is the same, the same treatment method might
apply, and thus pediatric acupuncture came to mind.
Pediatric acupuncture involves rubbing the skin asa procedure for treating night-crying and colic inbabies, and has been popularly practiced in Osaka
since ancient times. It was thought that theprocedure could regulate the autonomic nerves andmitigate the peripheral symptoms of dementia.
Based on this thinking, this writer developed an
original rubbing acupuncture tool for adults called
SAKKA (the term ‘sakka’ means rubbing inJapanese), and launched a procedure that uses
SAKKA, Enrishin round-head needles and roller
needles to rub the skin. Because it does not harm thebody in any way, SAKKA not only provides

2. CaseThe subject is an 88-year-old widow who livedalone, as her son and daughter had already gone out
on their own. Two years ago, she lost her balance andslowly collapsed on a bicycle that was parked in theyard in front of her house. She suffered a simple
fracture of the femur. She had an operation to set herbone using a metal plate, but became unable to walk.
Her dementia advanced sharply after the operation,
to the point that she became unable to comprehend
where she is. Her children could not live with her
because of their jobs and families, and the difficulty
ofproviding

at-homenursingcaremadeitimpossible for her to live alone. Upon being
discharged from the hospital, she was admitted to agroup home. Unable to walk on her own, shedepended on a wheelchair to move around. Her
upper limbs were fine, she could eat, wash her face,and get dressed on her own. She required someassistance to defecate and bathe. She was able toturn over in her sleep by herself, but required someassistance to get up and transfer to her wheelchair.
She spent a long time lying down. She used
eyeglasses, but her vision was normal. So were her
senses of hearing and smelling. When she was first
admitted to the nursing home, she was certified as
requiring a nursing care level of 4, and had a degreeof independence level of IIIb. She displayed an
extremely strong desire to go home, and would
repeatedly and with frustration ask the staff to let
her go home, whenever she spotted any staff member.
She had a strong tendency to refuse nursing care,stemming from her helplessness in having thingsThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 8, Number 3 | Fall 2013

her way. She was diagnosed with mixed dementia,

The procedure was completed when thewith characteristics of both Alzheimer’s disease andpatient’s skin became moist and a general

cerebrovascular dementia. She suffered depression,

reddening appeared.

insomnia, anxiety and restlessness. She displayed a* With the progress of treatment, the patientlevel 8 on the face scale, and had a sad expression.

became able to walk, but nighttime pains

She has no past medical history, and took nooccurred from a circulatory deficit in her lower

medicine

limbs, so rubbing was also performed on herfor

herdementia.

She

had

neverexperienced acupuncture and moxibustion, and had
a sense of fear of being pricked by a needle.

lower legs using a roller needle.
* Observations were made of changes in the
degree of peripheral symptoms, changes inexpression according to the face scale (Figure-1) Method of treatment
A KN petit roller, Enrishin needle and SAKKA2), changes in expression according to the(rubbing acupuncture tool) were used to rub the skin.

staff ’s response a question, and changes in

Each procedure consisted of the following routine

care burden, as evaluation criteria.

from (1) to (9) as the basic procedure. (Figure-1)(1) Rub the anterior surface of the forearm along
the meridian flow from the elbow to thefingertips with a KN petit roller(2) Rub the posterior surface of the forearmalong the meridian flow from the fingertips tothe elbow with a KN petit roller(3) Trace the eyebrows from the inner to outerside of the face with a KN petit roller(4) Trace the eyebrows from the inner to outerside of the face with an Enrishin needle(5) Rub the temporal muscles on both sides of thehead in a fan-like manner with an Enrishinneedle, toward the Kakuson acupoint as
though to stretch the muscle(6) Rub from the top of the head to the forehead
with an Enrishin needle(7) Rub from the top of the head to the nape ofthe neck with an Enrishin needle(8) Rub both sides of the dorsal spine diagonally
downward from top to bottom, with a KN
petit roller(9) Rub both sides of the dorsal spine diagonally
downward from top to bottom, with a SAKKA* In all cases, the procedure was applied with2) Result
The procedure was applied once a week 26 times
from June 5 to November 27, 2013.
1st treatment (6/5): The patient had no experience
with acupuncture and moxibustion, so she had aworried expression when she heard the term
acupuncture. The treatment was applied with thepatient sitting in a wheelchair escorted by anursing staff. After the treatment, the patient’sexpression improved from a level 8 to level 3 on
the face scale (Table -1), and a smile appeared onher face, although it was still somewhat stiff. She
voiced that she felt good. Basic treatment.
2nd treatment (6/12): The treatment was appliedwith the patient sitting in a wheelchair. She
remembered the previous treatment, andexpressed her opinion that it had felt good. Her
unhappy feelings disappeared even before thetreatment, and her depression also abated. She
was smiling from before the treatment, without
any stiffness. She said the area where she had
surgery for her right femur fracture hurt, and she
also had lower back pain. She spoke actively.
Expression level 2 on the face scale. Basictreatment.

careful attention to rubbing intensity, inconsideration of the patient’s skin condition,state of perspiration, and reddening of the skin.

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

Volume 8, Number 3 | Fall 2013

NK petit Roller

ENRISHIN

SAKKA(Figure 1)(Figure 2 Face scale)

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Volume 8, Number 3 | Fall 2013

(Table 1)

Changes seen in the face scale
98765

フェイススケールFacescale

4321012 34 5 67 8 910 11 12 13 14 15 16 17 18 19 20 21 22 23(week)

3rd treatment (6/26): The patient voiced her feelingand repeatedly asked to be taken home. She camethat the treatment felt good. However, sheto her treatment with a full smile on her face. She

seemed slightly out of sorts, and her smile washad been refusing to bathe, but with some

somewhat stiff. She talked much about her family,prompting, she took a bath immediately after her

and desired to go home. She had been refusing totreatment. Expression level of 1 on the face scale.

bathe, but with some prompting, she took a bath

Basic treatment.

immediately after the treatment. Expression
level 3 on the face scale. Basic treatment.

8th treatment (7/31): The patient was tired fromgoing to the hospital the previous day, and seemed

4th treatment (7/3): The patient came to theslightly out of sorts. However, she said her bodytreatment room not on a wheelchair, but using afelt lighter, and she felt good. Expression level ofwalker. She said she had been doing walking

1 on the face scale after treatment. Basic

exercises since she came to the nursing home, buttreatment.

she found it difficult to walk. After the treatment,

13th treatment (8/28): She said her surgery site hurt,

she noted that she felt good. Her smile seemedand she found it difficult to sleep at night. Herstiff, perhaps because she was tired due to hersmile seemed to be stiff, perhaps due to lack ofwalking exercise. Expression level 3 on the facesleep. She had been refusing to bathe, but withscale. Basic treatment.
7th treatment (7/24): The patient was using herwalker. Her post-operative progress was good.
She volunteered that she has begun to feel good,
and that she had been looking forward to the day’streatment. She talked about her house and herfamily without any sense of anxiety orrestlessness, and her desire to go home seemed tohave weakened. She no longer called on the staff

some prompting, she took a bath immediately
after the treatment. Expression level of 3 on theface scale. Basic treatment.
17th treatment (9/25): The patient had caught a cold,and coughed up blood in her sputum. She had nofever or chills, but her throat and back of her nose
were swollen. She was administered a coldmedicine. Her smile seemed stiff, perhaps due toher cold. Expression level of 3 on the face scale.
Basic treatment.

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

Volume 8, Number 3 | Fall 2013

18th treatment (10/2): The patient’s cold had abated.

Ten nursing staff members were asked whether

She seemed more energized, and the stiffness had

the patient’s expression changed immediately afterdisappeared from her smile. Expression level of 2treatment,on the face scale. Basic treatment.

significantly,”

19th treatment (10/9): The patient said her body felt

accordingto“Changed5levels:

somewhat,”“Changed“Didnotchange,” “Worsened somewhat,” and “Worsened

heavy, and she felt strong pain in her surgical site.

significantly.”

Her smile was stiff, perhaps due to the pain. She

significantly,” four responded “Changed somewhat,”

did not refuse to bathe, but she asked if sheshould. She took a bath when prompted, andrepeated this thereafter. Expression level of 4 on
the face scale. Basic treatment.
20th treatment (10/16): The patient said her cold
was completely gone, and she was beginning tofeel much better. The pain in her surgical site had
improved, and a smile returned to her face.
Expression level of 1 on the face scale. Basictreatment.
22nd treatment (10/30): The patient began to talk alot, and said she felt much better. She said her
body felt lighter after the treatment, and she felt
good. She came to her treatment with a full smileon her face. Expression level of 1 on the face scale.
Basic treatment.
25th treatment (11/20): The patient experienced areddening of her feet below the ankle in theFive

responded“Changedand one responded “Did not change.”
When combining “Changed significantly” and“Changed somewhat,” 90% of respondents said thepatient’s expression “changed.” No respondents gave
“Worsened somewhat” or “Worsened significantly” astheir answer.
The respondents were also asked to rate thechanges in nursing case burden immediately afterthe treatment, according to the 5 levels of “Decreasedsignificantly,” “Decreased somewhat,” “No change,”“Increased somewhat,” and “Increased significantly.”Two

respondedresponded“Decreased“Decreasedsignificantly,”

somewhat,”

and

five
three

responded “No change.”
When combining “Decreased significantly” and“Decreased somewhat,” 70% of respondents said
nursing care burden “decreased.” No respondents

middle of the night, and woke up in pain agave“Increasedsomewhat”

number of times. The symptom did not appear

significantly” as their answer.

or“Increased

during the daytime, however, and she came to her

Another question asked the respondents to rate

treatment with a full smile on her face.

how the patient’s expression changed from before theExpression level of 1 on the face scale. Basictreatment compared to today, also according to 5

treatment + roller acupuncture of the lower limbs.

levels. Four responded “Changed significantly,” five

26th treatment (11/27): The patient was in good

responded “Changed somewhat,” and one responded

physical condition, and her legs had come to feel

“No change.”light. She began walking using a rollatorWhen combining “Changed significantly” andbeginning from this day. She came to her“Changed somewhat,” 90% of respondents said thetreatment with a full smile on her face.

patient’s expression “changed.” No respondents said

Expression level of 1 on the face scale. Basicher expression “Worsened somewhat” or “Worsenedtreatment + roller acupuncture.

significantly.”
Yet another question asked the respondents toThereafter until today, the patient has beenrate how their nursing care burden changed fromstable, with no recurrence of psychological /before the treatment compared to today, similarly

behavioral disorders, and is showing good progress.

according to 5 levels. One responded “Decreased

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Volume 8, Number 3 | Fall 2013

significantly,” six responded “Decreased somewhat,”

indicating the continuous effect of the treatment. By

and three responded “No change.”

continuing the treatment, the patient’s anxiety,

When combining “Decreased significantly” andrestlessness, and depression coming from these“Decreased somewhat,” 70% of respondents said

feelings disappeared, she became more motivated,nursing care burden “decreased.” No respondents

she stopped refusing nursing care, and became able

said

to communicate better with the nursing staff andtheirburden“Increasedsomewhat”

orother residents. These improvements also helped“Increased significantly.”

decreased the staff ’s nursing burden.
Kurosawa et al.1) reports that non-invasive

3. Observation
The patient’s expression level of 8 on the facemechanical stimulation on the skin promotes

scale before the first treatment improved to level 3

dopamine secretion from the nucleus accumbens.

immediately after the treatment. In a question thatDopamine is said to be a “pleasure” hormone. Whenwas put to the nursing staff, 90% responded that theconsidering the fact that the patient’s expression

patient’s expression “changed” immediately after

rapidly loosened after the treatment and she begantreatment. The patient constantly smiled thereafter,

to smile more often, that her anxiety, restlessness

and the unhappy feelings she had before treatment

and depression disappeared and remained gone, thatdisappeared. Her anxiety and restlessness abated,

she constantly noted that her body felt lighter, andand her sense of depression also disappeared. In athat she remembered her previous treatment andquestion that was put to the nursing staff, 70%

said she had been looking forward to the next

responded that their nursing burden “decreased”

treatment whenever she came in for her treatment,

immediately after treatment. The patient’s desire to

the writer thinks a dopamine activation system wasgo home and her refusal to bathe also dissipated, andinvolved as a reward system.

she began to not only look forward to the treatment,

Depending on the severity of dementia, rubbing

but to also voice her feeling that she had been

acupuncture treatment may have an even greater

looking forward to it. The nursing staff became able

effect by applying it not only once but two to three

to eliminate the time and effort to cajole the patient

times a week.

to doing something she refused to do, and their
nursing burden decreased.

4. Conclusion

The patient had never experienced acupunctureThis case indicates that rubbing acupuncture, bytreatment, and had a sense of fear of being pricked

its method of rubbing the skin without harm to theby a needle, but her first treatment dissipated her

body in any way, may be safely applied within

worries, and the treatment was able to be continued.

around seven minutes, causes no fear of being

In a question put to the nursing staff, 90% responded

pricked by a needle, and has hardly no side effects.

that the patient’s expression “changed” when

It can be applied with the patient sitting or lying

comparing her expression before the treatment anddown, and is thus a simple procedure that anyone

today, and 70% responded that their nursing burden

can receive, including people who are confined to the“decreased” when comparing the burden before

bed or who cannot maintain a sitting position. The

treatment and today. The patient’s expression

side effects of taking multiple drugs have become aimproved significantly and the staff ’s nursing

problem today, but rubbing acupuncture causes

burden decreased immediately after the treatment,

hardly any side effects, as stimulation is applied toand these aspects remained stable thereafter,

the skin by rubbing. Its immediate effect is strong,

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

Volume 8, Number 3 | Fall 2013its effect lasts, and the amount of drugs taken can be
reduced.
The rubbing acupuncture method is thought to bea procedure that is capable of improving such
psychological symptoms as anxiety, restlessness,depression and low motivation, as well as ofdelivering the joy of living, realizing the lifestyle thatis actively desired by the patient, and increasing
QOL.
Reference
1 Maruyama K, Shimoju R, Ohkubo M, Maruyama
H,Kurosawa

M.

Tactileskinstimulation

increases dopamine release in the nucleus
accumbens in rats. J Physiol Sci. 2012; 62(3): 259266.

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