HOTAL TRADITIONAL ORIENTAL MEDICINE LETTERS, VOLUME 4, NUMBER 1

2017

Acupuncture and Moxibustion Treatment for
Diabetic Neuropathy
Nobuyuki Otsuka
Hotal Ancient Medicine Research Institute (HARI)
3-8-14 Hotarugaike-nakamachi, Toyonaka, Osaka, 560-0033 Japan
E-mail: hari@otsuka.holding.jp
Keywords: diabetes, diabetic neuropathy, numbness, tingling, oriental medicine,
acupuncture and moxibustion

The number of patients with diabetes
is increasing each year. Peripheral neuropathy is the most frequent manifestation of diabetes mellitus. Peripheral neuropathy is a complication that appears
early in the course of the disease and is amajor cause of impaired quality of life
(QOL) of patients. Diabetes mellitus iscaused by insufficient insulin secretion ordecreased insulin sensitivity. Diabetes
mellitus is characterized by impaired insulin action, resulting in elevated blood
glucose levels and metabolic abnormalities. Blood glucose level is elevated, and if
high glucose level is sustained over a long
period of time, can lead to complications
such as retinopathy, neuropathy, andnephropathy [1].
There are two types of diabetes mellitus: type 1 diabetes mellitus, in which insulin replacement is essential, and type 2
diabetes mellitus, in which insulin is notalways essential. They differ not only ininsulin secretion capacity but also in etiology. Type 1 diabetes is caused by a combination of genetic predisposition, viral infections and immune abnormalities. Type2 diabetes is caused by a combination ofgenetic predisposition and environmental
factors such as excessive nutritional intake
and lack of exercise. Type 2 diabetes ismore common in obese people after middle age. In Japan, type 2 diabetes is common, with an estimated 8.9 million people suffering from diabetes and 13.2 million people suffering from pre-diabetes inFY2007.
Symptoms of diabetes mellitus include thirst, polydipsia, polyuria, generalmalaise, and weight loss, as symptoms ofhyperglycemia. Symptoms of diabetic
complications include diabetic retinopathy, vision loss due to cataracts, andnumbness in the extremities due to neuropathy. Neuropathy is the most frequent
complication and appears early in thecourse of the disease. Diabetic neuropathy results from the long-term persistenceof metabolic abnormalities in diabetes
mellitus [2]. They are broadly classified
into three categories. Symmetrical peripheral polyneuropathy, mononeuropathic
neuropathy, and autonomic neuropathy.
In detail, the disease is classified into
seven types [3]. They are polyneuropathy,
diabetic muscle atrophy (proximal neu-Hotal Traditional Oriental Medicine Letters, Vol.4, No.1, pp.1-5, 2017(C) 2017 HARI1

HOTAL TRADITIONAL ORIENTAL MEDICINE LETTERS, VOLUME 4, NUMBER 1ropathy), diabetic radiculopathy, autonomic neuropathy, multiple mononeuropathy, mononeuropathy, and diabetic
ocular muscle palsy.
In Oriental medicine, diabetes mellitus is included in the wasting-thirst.
Wasting-thirst is generated by eating a lotof sweet foods and fatty foods, becoming
terribly fretful, and often angry [4]. In theYellow Emperor's classic of internal
medicine, simple questions, on the chapter of strange disease, the person withthis disease is always obese because he or
she eats a lot of sweets and fatty foods.
Obesity produces heat in the body, andsweetness distends the abdomen. It iswritten that the qi overflows, resulting inwasting-thirst.
In the Yellow Emperor's classic of internal medicine, spiritual pivot, on thechapter of five transformations, for all thefive organs, the weak and tender ones areoften ill and gradually lose weight. The
weak organ is always matched by a strongorgan. The strong organs are often angry,
and the weak organ are easily hurt. A person who is disturbed by alcohol and has
no moderation can also become wastingthirst. In the essential prescriptions worth
a thousand gold for emergencies, all people who drink alcohol get wasting-thirst.
Drinking alcohol and having pleasure time
will finally cause the triple energizer acts
violently and the five organs are dried up.
Diabetic neuropathy is thought to becaused by fire from stomach heat which
generates pain and swelling throughout
the body.
The wasting-thirst is divided into upper, middle, and lower wasting. The upper
wasting belongs to the lungs. The main

2017

symptom is extreme thirst and not being
able to drink enough no matter how
much one drinks. The middle wasting belongs to the spleen and stomach. The patient has a good appetite and feels hungry
immediately after eating. Lower wasting
belongs to the Kidney. The number andquantity of urination is high.
The efficacy of acupuncture in diabetic neuropathy has been shown to havea higher total effective rate with acupuncture than with oral inositol administration[5]. A comparison of acupuncture andsham acupuncture groups reported significant improvements in nerve conduction velocity in the acupuncture group [6].
In diabetic neuropathy, the effects ofacupuncture on numbness and cramp-inthe-calf have also been reported [7].
Acupuncture treatment was performed
once a week for a total of seven sessions.
Acupuncture needles were placed for 15
minutes at the first treatment, and lowfrequency electro-acupuncture were applied from the second treatment. The
acupuncture points were GB34, LV3, SP9,and Kl3. For hand symptoms, LI4 and LI10
were added. Acupuncture needles wereSeirin 40-mm, No. 20 needles. For theevaluation of numbness, the mean valueof visual analogue scale (VAS) of numbness after acupuncture treatment was obtained for 19 cases, using the maximumsubjective symptom as 100 mm. the VAS
decreased significantly from 46 mm at thefirst treatment to 25 mm at the eighth
treatment. Cramp in the calf also oftenoccurs. The incidence of cramps does notdiffer between males and females, and it
is generally occur more often in the elderly [8]. In the mean frequency of thecramp in five patients, a statistically sig-Hotal Traditional Oriental Medicine Letters, Vol.4, No.1, pp.1-5, 2017(C) 2017 HARI2

HOTAL TRADITIONAL ORIENTAL MEDICINE LETTERS, VOLUME 4, NUMBER 1nificant improvement from eight times inthe second examination to three times inthe eighth examination was achieved. 12
out of 13 patients showed a decrease in
the frequency of cramp. There were no
statistical significant changes in the objective findings such as vibration sensation,or the touch test using monofilaments.
In discussion, the acupuncture points
for diabetes described in the classics arecompared with those for diabetic neuropathy to clarify their relationship to effect a radical cure of diabetes. The upper
wasting was treated by draining on BL13,LU11, LU5, Ex-HN12, and Ex-HN13 [4]. The
middle wasting was treated by draining
on BL20, CV12, SP2, ST43, ST28. The
lower wasting was supplemented with
BL23 and CV4, and drained on KI1, KI2,KI7, and LR2. For all three wastings, draining on BL22 and TE4 are added. BL20 andSP2 drain heat of the spleen. CV12 andST43 greatly drain fire of the stomach.
ST28 cools large-intestine and stomach toremove heat and cure excessive heat inthe triple energizer. As wasting-thirst is alesion of the triple energizer, BL22 andTE4 are used to remove heat congestionin the triple energizer. If diabetes wasclassified as an endocrine disease, the following acupuncture points were used:
TE4, CV12, left ST21, KI16, CV6, BL20, BL2,BL23, GV12, GV20, ST36 [9]. When diabetes was considered as an intractabledisease, moxibustion was applied to SP9,
LI11, BL20, and GV6 as specially effective
acupuncture points [10]. CV12, ST19,
BL18, BL20, BL22, GV20, BL10, LI11, ST36,
SP8 or SP5 were also reported[11]. Diabetes mellitus corresponds to the middle
and lower wastings. For the middle wasting, BL20, CV12, SP2, ST43, and ST28 are2017

used. For the lower wasting, BL23, CV4,KI1, KI2, KI7, LR2, BL22, and TE4 are used.
Electrical stimulation of the acupuncture point (ESA) was reported as 15 mm
at SP8 (-) and 5 mm at SP5 (+) if there is aconcomitant increase in appetite [12]. If
the patient is less symptomatic, 15 mmshould be used for ST37 (-). A combination of 5 Hz for 2 s and 100 Hz for 0.5 s ofcoarse-dense current stimulation was performed for 15 min. In the abdomen, ST21(-) and ST25 (+), and in the back, BL20 (-)
and BL22 (+), with 2 Hz of regular current
stimulation for 10 minutes were used. The
patient's pattern of meridian therapy is
considered to be of the kidney deficiency
spleen excess. The acupuncture points fordiabetic neuropathy [7] were energized
between GB34 and LV3 and SP9 and KI3.
These acupuncture points are different
from the acupuncture points for diabetes
treatment. They are used by electroacupuncture to the muscles innervated by
the nerves that are affected by the neuropathy. Therefore, the main purpose is toalleviate the neuropathy, and the therapeutic effect on diabetes itself is not expected to be great.
There were reports that the treatment of diabetes mellitus was mainly dietary and medicinal therapy, withacupuncture and moxibustion as an adjunctive treatment [13]. There were also
reported that severe diabetes mellitus
that causes neuropathy was excluded
from acupuncture and moxibustion treatment [14]. Acupuncture and moxibustion
treatment may not restore blood vessels
and nerves damaged by diabetes, so correct treatment at a medical institution isnecessary. It is important to treat

Hotal Traditional Oriental Medicine Letters, Vol.4, No.1, pp.1-5, 2017(C) 2017 HARI3

HOTAL TRADITIONAL ORIENTAL MEDICINE LETTERS, VOLUME 4, NUMBER 1
acupuncture to improve numbness andsensory abnormalities while treating diabetes at a medical institution.
In summary, the number of diabetic
patients is increasing every year. Amongthem, diabetic peripheral neuropathy is
the most frequent manifestation. Neuropathy is a complication that appears
early in the course of the disease and is amajor cause of impairment of the patient's QOL. In Oriental medicine, diabetic
neuropathy is thought to be caused byfire from stomach heat, which affects thewhole body, resulting in pain andswelling. Acupuncture has been shown tobe effective in patients with diabetic neuropathy, reducing the subjective symptoms of numbness caused by neuropathy.
Cramp in the calf was improved in almost
all patients. There were no statistical significant changes in the objective findingssuch as vibration sensation, or the touch
test using monofilaments. The acupuncture points for diabetic neuropathy aredifferent from those for diabetes mellitus
and are not likely to lead to fundamental
treatment of diabetes mellitus. On theother hand, acupuncture treatment for diabetic patients may be effective in improving QOL by improving numbness associated with neuropathy. Acupuncture
treatment for diabetic neuropathy requires correct treatment at a medical institution because blood vessels andnerves damaged by diabetes may not berecovered. It is important to treat
acupuncture to improve numbness andsensory abnormalities while treating diabetes at a medical institution.

2017[1] Japan College Association of Oriental Medicine edited Clinical
Medicine Detailed Exposition, Second Edition, Japan College
Association of Oriental Medicine, 2015.
[2] Nanzando's Medical Dictionary, 18th edition, Nanzando, 1998.
[3] Encyclopedia of Nursing, 1st edition, Igaku-shoin, 2002.
[4] Lectures on Chinese Acupuncture and Moxibustion, Shanghai Collegeof Traditional Chinese Medicine, Chinese Herbal Medicine, 1984.
[5] Chang Zhang, et.al, Clinical Effects of Acupuncture for Diabetic
Peripheral Neuropathy, Journal of Traditional Chinese Medicine vol.
30, pp. 13-14, 2010.
[6] Yanging Tong, et.al, Fifteen-day Acupuncture Treatment Relieves
Diabetic Peripheral Neuropathy, Journal of Acupuncture andMeridian Studies, vol. 3, pp. 95-103, 2010.
[7] Keita Taguchi et al. The Effect of Acupuncture on Dysesthesias ofLower Extremities in Patients With Diabetic Peripheral Neuropathy,
Journal of the Japan Diabetes Society vol. 60, pp. 489-497, 2017.
[8] Keita Taguchi, Acupuncture for diabetic peripheral neuropathy,
Meiyuukai Workshop of Meiji school of oriental medicine, 2018.
[9]BunshiShirota,AcupunctureandMoxibustion

Therapy

Fundamentals, 7th Edition, Idononippon, 1969.
[10] Kiyoshi Nagano, Acupuncture and Moxibustion Clinical Practice: My
thirty years history, 5th Edition, Idononippon, 1997.
[11] Yoshio Nagahama, New Research on Acupuncture and Moxibustion
Treatment, 2nd Edition, Sogensha, 1977.
[12] Shoichi Sawatsugawa, Pulse Stimulated Electrical Acupuncture
Treatment, Shizensha, 1980.
[13] Yoshio Manaka, Acupuncture and Moxibustion Clinical MedicalDictionary, 14th Edition, Idononippon, 1993.
[14] Hidetaro Mori, Diagnosis and Treatment for Acupuncture andMoxibustion, 7th Edition, Idononippon, 1992.

(Received 1 December 2017)

Hotal Traditional Oriental Medicine Letters, Vol.4, No.1, pp.1-5, 2017(C) 2017 HARI4

HOTAL TRADITIONAL ORIENTAL MEDICINE LETTERS, VOLUME 4, NUMBER 12017

Dr. Nobuyuki Otsuka
He graduated from Tohoku University in 1985 and completed the firsthalf term of doctoral course of Tohoku University graduate school in
1987. He was awarded doctor degree in 1997 from Tohoku University.
He established Hotal Ancient medicine Research Institute (HARI) in
1999. He graduated from Meiji school of oriental medicine in 2017. He isengaged in research on oriental medicine such as traditional Chinese
medicine, acupuncture and moxibustion, qigong etc.

Hotal Traditional Oriental Medicine Letters, Vol.4, No.1, pp.1-5, 2017(C) 2017 HARI5