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Report on Disaster Medical Operations with Acupuncture/
Massage Therapy After the Great ast Japan arthquake
Shin Takayama1,*, Tetsuharu Kamiya1,*, Masashi Watanabe1, Atsushi irano1, Ayane Matsuda2,Yasutake Monma2, Takehiro Numata1, iroko Kusuyama1 and Nobuo Yaegashi1
Department of Traditional Asian Medicine, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan.
Graduate Medical ducation Center, Tohoku University ospital, Sendai, Miyagi, Japan. *First author and equalcontribution. Corresponding author email: tatahara1492@gmail.com
12Abstract: The Great East Japan Earthquake inflicted immense damage over a wide area of eastern Japan with the consequent tsunami.
Department of Traditional Asian Medicine, Tohoku University, started providing medical assistance to the disaster-stricken regions
mainly employing traditional Asian therapies.
We visited seven evacuation centers in Miyagi and Fukushima Prefecture and provided acupuncture/massage therapy. While massage
therapy was performed manually, filiform needles and press tack needles were used to administer acupuncture. In total, 553 people weretreated (mean age, 54.0 years; 206 men, 347 women). Assessment by interview showed that the most common complaint was shoulder/back stiffness. The rate of therapy satisfaction was 92.3%. Many people answered that they experienced not only physical but also
psychological relief.
At the time of the disaster, acupuncture/massage therapy, which has both mental and physical soothing effects, may be a therapeutic
approach that can be effectively used in combination with Western medical practices.
Keywords: Great East Japan Earthquake, Traditional Asian Medicine, acupuncture, massage, disasterIntegrative Medicine Insights 2012:7 1–5
doi: 10.4137/IMI.S9541
This article is available from http://www.la-press.com.
© the author(s), publisher and licensee Libertas Academica Ltd.
This is an open access article. Unrestricted non-commercial use is permitted provided the original work is properly cited.
Integrative Medicine Insights 2012:71

Takayama et alIntroduction

At 14:46 on March 11, 2011, a strong earthquakeof magnitude 9.0 struck off the Pacific coast ofTohoku, and the resulting massive tsunami inflicted
immense damage on eastern Japan. After the Great
East Japan Earthquake, Tohoku University Hospital,
located in a disaster-stricken region, immediately
started emergency rescue operations and concurrently received patients from other hospitals in theregion. Furthermore, medical teams were sent to thedisaster-stricken regions to conduct relief operations
at disaster base hospitals and evacuation centers.
As part of the disaster relief operations of Tohoku
University Hospital, the Department of Traditional
Asian Medicine at Tohoku University also conducted
medical operations immediately after the earthquake
disaster, mainly employing traditional Asian medicalpractices, in Onagawa Town and Ishinomaki Cityin Miyagi Prefecture and Aizu-Bange Town inFukushima Prefecture. Because there was a rise inpeople suffering from chronic pain and neck/shoulder
stiffness approximately 1 month after the earthquake,
we provided acupuncture/massage therapy alongwith traditional Asian medical treatments at therequest of physicians. We herein report the detailsof our disaster relief operations with acupuncture/massage therapy.

Methods

During the first three months after the Great EastJapan Earthquake, we participated in the disastermedical operations of the Department of Traditional
Asian Medicine at Tohoku University and provided a
total of 17 sessions of voluntary acupuncture/massage
therapy at seven evacuation centers in Miyagi andFukushima Prefectures. The scenes of the therapy
sessions are shown in Figures 1 and 2. We used thedata from medical records on the therapy performed atfive evacuation centers set up in elementary and juniorhigh schools in Ishinomaki City. The data extraction
period was two months from April through May (totalof five operations). While massage therapy was performed manually, acupuncture therapy was performed
mainly with filiform needles (diameter of 0.16 mm
and length of 30 mm; Seirin Corporation, Shizuoka,Japan) and press tack needles (PYONEX®, diameterof 0.2 mm and length of 0.6 mm; Seirin Corporation,
Shizuoka, Japan). We did not conduct research, such2Figure 1. Scene of massage therapy in the treatment room.

as asking people to fill out questionnaires, in order toavoid burdening the evacuees. Only the data from themedical records are presented in this report. We examined patient background factors, chief complaints atthe time of therapy. Because medical records have
many lack of data of symptoms and affected sites inthe situation of disaster, we used medical records of128 patients that include enough data. The data corrected from medical records were so varied, therefore
we could not perform statistical analysis.

Results

In total, 553 people (206 men and 347 women) weretreated. The mean age was 54.0 years. A dedicatedtreatment room was set up only in one evacuation
center. At the other four centers, evacuees were treatedin their living quarters. Table 1 shows the information

Figure 2. Scene of massage therapy in the living quarters of an evacuation center.

Integrative Medicine Insights 2012:7

132.3

1115
11.7

5
16

153
41.4

2
1
14
5
7
4
14
2242
32.8
2256
6
96
14
3
24
3.1
2
10
7.8
118.6

4

1
122
1

132
2
124
1
1

Integrative Medicine Insights 2012:7

Total

80 # age

60 # age , 80

40 # age , 60

20 # age , 40

ge , 20ale (n = 6)emale (n = 5)
ale (n = 6)emale (n = 13)ale (n = 17)emale (n = 26)
ale (n = 11)emale (n = 34)
ale (n = 5)emale (n = 5)
N = 128
%

232
75
325
5
153
41.4

5
35
1010
17
6
18
3
380
62.5

210
7.8

3
3
3
9
12
20
720
3
282
64.1
2
1

shoulderand back
head
numbness
stiffness

ymptoms

painenderge(year old)

Table 1. Symptoms and affected sites reported by evacuees.

edema

heothers

Affected sites

upperlimb

lumbar lower helimb
othersTraditional Asian Medicine in the Disaster

about age, gender, symptoms, and affected sites of
128 patients who received acupuncture/massage
therapy. The common complaints were pain (total41.4%) and stiffness (total 62.5%), and common sites
were the shoulder and back (total 64.1%) and lumber(total 41.4%) (Table 1).

Discussion

After the Great East Japan Earthquake, the Departmentof Traditional Asian Medicine at Tohoku University
conducted medical operations, mainly providing traditional Asian treatments, in the extensively damaged
coastal regions of Miyagi and Fukushima Prefecture.
Because Western medical treatment was also limited
at the evacuation centers, there were some evacueeswith prolonged symptoms of the common cold, gastroenteritis, allergic reactions, insomnia, etc. Throughthese medical operations, we realised that traditional
Asian treatments can alleviate various symptoms
when given in combination with Western medical
practices even under such difficult circumstances as
those encountered after the disaster.1 Moreover, thecharacteristic symptoms were stiffness and pain thatstarted to increase approximately 1 month after theearthquake. It is said that chronic pain often occurs
based on not only systemic changes but also with a
psychological background.2 In the early period after
the Great East Japan Earthquake, at least 50,000
people were evacuated in Miyagi Prefecture alone.3We speculate that those complaining of pain affecting
various parts of the body increased due to the unaccustomed stay at an evacuation center, as well as lying
down in a space too small to roll over, contents ofmeals, environmental problems, psychological shock,stress, etc. In addition to relief of pain and stiffness,acupuncture/massage therapy can contribute to early
detection of other problems that evacuees might beprone to develop because long therapy sessions allow
practitioners to listen attentively to evacuees. The
therapy satisfaction rate of 92.3% may reflect not only
simple effects of physical treatment but also relaxing
effects derived from the inherent sense of trust andsafety generated by the warmth of manual treatment
and conversation during the therapy sessions.
In early April, when voluntary acupuncture/
massage therapy was started, running water had not
yet been restored at any evacuation center. Under thesanitary conditions at the time, evacuees could not3

Takayama et albathe or even wash their hands properly. During thisperiod, we performed only massage therapy in consideration of infection risks and gave consideration
to performing acupuncture therapy after the evacuees
were again able to bathe. Under such conditions of
inadequate sanitation, the use of contact needles thatnoninvasively stimulate the skin may be an option.
Moreover, the circumstances for setting up a treatment
room varied among the evacuation centers. A dedicated treatment room was set up in only one center.
When acupuncture/massage therapy is performed, adedicated treatment room may be necessary to protect
the safety and privacy of evacuees. We also consider it
to be necessary, if no treatment room is available, thata dedicated space be set up with tents, drapes, etc.,
because acupuncture/massage therapy often requires
exposure of the skin. Acquiring a dedicated space has
the merit of facilitating hygiene and risk managementin addition to protecting privacy. In conversation withtreated evacuees, some told us that being able to lie
down alone, even if only during a therapy session,
was valuable because there is no solitude while staying at an evacuation center. We also considered it tobe necessary to provide time and space to relax for
those experiencing the stress of living in an evacuation center.
Interestingly, history-taking before treatment
revealed many evacuees to be taking oral antiplatelet
or anticoagulant drugs. The incidences of haemorrhage and haematoma formation due to acupuncture
therapy are low but these complications have beenreported.4 In order to predict the occurrence of theseadverse events, it is essential to determine medication usage, blood pressure, pulse, etc., beforehandby sufficiently interviewing evacuees. While questioning patients about the history of infection as
thoroughly as possible, practitioners should ensure
the use of gloves, proper management of disposableneedles, etc., for infection control. Furthermore, possible responses of the body to acupuncture/massage
therapy, such as lassitude, internal haemorrhage anddiscomfort, should be sufficiently explained before
treatment. Especially in volunteer operations that arelikely to provide one-time treatment, considerationmust be given to reducing the amount of stimulation
because evacuees cannot be followed up. Ideally,practitioners should repeatedly visit the same evacuation centers and monitor treatment progress.
4The medical teams of Tohoku University Hospital
accompanied us in our operations, and physicians performed history-taking whenever possible.
Acupuncture/massage therapy at the time of the disaster was widely requested by medical professionals.
There were also rescue medical teams that performed
physiotherapy or musculoskeletal manipulation of
their own accord. In the medical operations of thePrimary Care for All Team of Japan Primary CareAssociation,5 the Association of Medical Doctorsof Asia,6 the Disaster Victim Assistance ProjectTeam,7 etc., practitioners of acupuncture and massage accompanied the medical teams and performed
therapy at their request. In operations conducted at
the time of disaster, collecting various forms of information and making decisions are often left to individual practitioners. However, conducting medical
operations with medical staff assures the adequacy ofhistory-taking, questioning patients about medication
usage, and risk management. Thus, acupuncture/massage therapy can be provided effectively.
At present, there are nearly 90,000 nationally certified acupuncturists, moxacauterists, and masseusesin Japan.8 It is expected that many would want toparticipate in volunteer disaster-relief operations.
However, these practitioners may have to abandon
this desire because no route for participating in suchoperations has yet been established. Thus, we hopethat organisations, such as academic societies, willdevelop strategies and programmes for recruiting
volunteers, possibly via websites and so on, before
the next great need arises.

onclusion

Requests for acupuncture/massage therapy are increasing not only from evacuees but also from medical
professionals. Acupuncture/massage therapy, which
can be performed based on physical findings, may be
among the effective medical treatments offered at thetime of a major disaster. However, there is a possibility that the emotional status of the survivors wereaffected and comforted by the attention and treatment
offered to them at this point in time.

Acknowledgment

We sincerely appreciate all those who participatedin our volunteer operations and who offered generous assistance from all over Japan and the rest ofIntegrative Medicine Insights 2012:7

Traditional Asian Medicine in the Disasterthe world. Moreover, the needles that we used wereprovided for disaster medical operations by Seirin
Corporation. We appreciate its cooperation despite
the difficulties encountered in the distribution ofmaterials.
At last, we express our heartfelt condolences tothe victims of the Great East Japan Earthquake andsincerely pray for the earliest possible recovery andreconstruction.

Authorontributions

Conceived and designed the experiments: All authors.
Analysed the data: TK, ST. Wrote the first draft of themanuscript: ST, TK. Contributed to the writing of themanuscript: MW, HK. Agree with manuscript results
and conclusions: All authors. Jointly developed thestructure and arguments for the paper: All authors.
Made critical revisions and approved final version:All authors. All authors reviewed and approved of the
final manuscript.

Disclosures and thics

As a requirement of publication author(s) have provided to the publisher signed confirmation of compliance with legal and ethical obligations including
but not limited to the following: authorship andcontributorship, conflicts of interest, privacy andIntegrative Medicine Insights 2012:7

confidentiality and (where applicable) protection ofhuman and animal research subjects. The authors
have read and confirmed their agreement with theICMJE authorship and conflict of interest criteria.
The authors have also confirmed that this article isunique and not under consideration or published inany other publication, and that they have permission
from rights holders to reproduce any copyrighted
material. Any disclosures are made in this section.
The external blind peer reviewers report no conflictsof interest.

References

1. Takayama S, Okitus R, Iwasaki K, et al. The Role of Oriental Medicine in theGreat East Japan Earthquake Disaster. Kampo Med. 2011;62(5):621–6.
2. Bulmer D, Heilbronn M. The pain-prone disorder: a clinical and psychologicalprofile. Psychosomatics. 1981;22(5):395–7, 401–2.
3. Miyagi Prefectural Government Web site (http://www.pref.miyagi.jp/
kikitaisaku/higasinihondaisinsai/higaizyoukyou.htm): States of earthquake
damage, evacuation, etc.
4. Yamashita H, Tsukayama H, Hori N, et al. Incidence of Adverse Reactions
Associated with Acupuncture. Journal of Alternative and ComplementaryMedicine. 2000;6(4):345–50.
5. Japan Primary Case Association-Primary Care for All Team Web site (http://www.pcat.or.jp/english/): Activity report.
6. Association of Medical Doctors of Asia Web site (http://www.amdainternational.
com/english/): Feature on the Great East Japan Earthquake. Activity Report.
7. Disaster Victim Assistance Project Team. Oriental Traditional Medical Volunteer Dispatch Base Station Web site (http://saigaisienmiyagi.web.fc2.com/index.html).
8. Ministry of Health, Labour and Welfare Web site (http://www.mhlw.go.jp/toukei/saikin/hw/eisei/10/): Overall results of the Report on Public HealthAdministration and Services (Practicing health professionals) 2010.

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