Volume 3, Number 3 | Fall 2008

Clinical Report 1 (Japan)
Acupuncture Treatment for Vertigo

acupuncture & moxibustion treatment.

Keizo Ebiko, Makoto Kikkawa, Yoko Kimura, Hiroshi Sato
Institute of Oriental Medicine,Tokyo Women’s Medical University, School of Medicine

2. Methods
The study included 70 patients out of a total of 77
patients,

whovisitedtheacupuncture&Vertigo case reports1)

moxibustion outpatient department of this facility,

1. Introduction

presenting with either "vertigo" or "dizziness"

The "Tokyo Women’s Medical University OrientalMedicine Research Active Support System" (below
called TOMRASS), developed by Dr. Fumihiko
Shirota and his group, has been a focus of attention
because the exhaustive and accurate accumulationof clinical facts and analysis of numerous cases
contributes to investigations regarding the efficacy
of both Kampo and acupuncture & moxibustion
treatment modalities as well as the scope theirrespective indications. This system uses a databasebuilt from chief complaints, disease names (namesof prescriptions, sites stimulated using acupuncture& moxibustion and stimulation method), anamnesis,
findings of tongue, abdominal, pulse and similardiagnostic procedures, oriental medical findings likebody type, blood pressure, body temperature andsimilar general findings as well as hematologic andurinalytic data, that is searchable by setting specificconditions. The above mentioned chief complaints
are classified according to the various symptoms,
incidence and severity into 5 levels, which thepatients are requested to identify themselves during(includingpatients

whowereincontinuoustreatment) and in whom the vertigo symptoms wereevaluated using the TOMRASS more than twicefrom the start of operation of TOMRASS in May
2001 until June 2006. "Vertigo" was found in 14
patients with an age of 65±8 years (mean±SD) and"dizziness" in 56 patients with an age of 54±15 years.
The number of treatments for patients with vertigo
was 8 : 3-74 (median：range) and for patients withdizziness 8 : 2-126 sessions. The symptoms ofvertigo were classified into frequency (none: 0 points,
rarely: 1 point, occasionally: 2 points, often: 3 points,
always: 4 points) and severity (none: 0 points,minimal: 1 point, slight: 2 points, marked: 3 points,extreme: 4 points) and the patients requested toevaluate their symptoms themselves using these
five levels respectively.
During the first consultation a questionnaire is used
for this purpose, but from the second visit onwards
it is performed in the form of answering questions
provided on a touch panel before each treatment(picture 1).

consultations. That is, an "evaluation of subjective
symptoms by the patients themselves" allows toidentify sequential fluctuations. The SD method(SemanticDifferentialtechnique)frequently

employed in the field of psychology served as
reference for the preparation of this scale.
Thus, the TOMRASS is characterized in that itallows to perform cohort research into both theKampo as well as acupuncture & moxibustion
modalities. In the present study we used TOMRASS
to conduct a study on outpatients at our oriental
medical department presenting with vertigo as theirchief complaint in order to investigate the effects ofPicture 1 Evaluation of subjective symptoms by thepatients themselves

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

9Volume 3, Number 3 | Fall 2008

Acupuncture & moxibustion treatment intervals

Examination of the frequency + severity score

butbased on the evaluation criteria listed in Table 1

administered basically in 1-week intervals. Mainly

reveals, like shown in Figure 3, that there were 5

and most frequently 40 mm long No. 18 and 50 mm

patients (35.7%) reporting improvement, 5 patients

No. 18 needles were used for inserting and retaining(35.7%) slight improvement and 4 patients (28.6%)

the needles. For the direct moxibustion a set of 3

in whom symptoms remained unchanged, whilehalf-rice

mostaggravation was observed in none of the patientsfrequently. Acupoints in the order of frequency with(this includes among the 4 patients the above

which they were used included in the head and neckmentioned one patient with an initial and final

region Hyakue (GV20; Baihui), Fuchi (GB20;score of 0 points). On the other hand, among theFengchi), Tenchu (BL10; Tianzhu), Shimo Fuchi

patients with "dizziness" 25 patients (44.6%)(*GB20; lower Fengchi), Kami Tenchu (*BL10;

reported improvement, 13 patients (23.2%) slight

upper Tianzhu), in the abdominal region Chukan

improvement, 12 patients (21.4%) no change, 6(CV12; Zhongwan), Kangen (CV4; Guanyuan), onpatients (10.7%) a slight deterioration, while none

the back Kensei (GB21; Jianjing), Kanyu (BL18;(0.0%) reported an aggravation. Three of the 5Ganshu),(BL23;patients with "vertigo" reporting improvement andShenshu), on the upper and lower extremities

14 among the 25 patients with "dizziness" who

Gokoku (LI4; Hegu), Kyokuchi (LI11; Quchi), Soku

reported improvement achieved a final score of 0Sanri (ST36; Zusanli) and Shokai (KI6; Zhaohai).

points. Therefore the improvement ratio composed

variedwidely

grain

Hiyu

amongsizedindividualcones(BL20;werePishu),cases,

used

Jinyu

of the combined ratio of improvement and slight

3. Results

improvement was thus in any case approximately

Examination of the for the 14 patients presenting

70%.

with "vertigo" classified according to the scores forfrequency, severity and frequency + severity shows
for the frequency a score from 3 ： 0-4 points(median：range) to 1：0-3 points, for severity a range
from 2：0-4 points to 1：0-2 points and for thecombination frequency + severity a range from 5：
0-7 points to 2：0-4 points. Thus, for each score asignificant improvement was observed (Figure 1).
For one patient a score of 0 was observed during theFigure 1 Variations in frequency, severity andfirst examination. This patient visited for thefrequency + severity of vertigo (n=14)

purpose of vertigo prevention and so the final score
too was 0 points.
Examination of the 56 patients presenting with"dizziness" classified according to the scores forfrequency, severity and frequency + severity shows
for the frequency a score from 2 ： 1-4 points(median：range) to 2：0-4 points, for severity a range
from 2：1-4 points to 1：0-4 points and for thecombination frequency + severity a range from 4：
2-8 points to 3：0-8 points. Thus, for each score asignificant improvement was observed (Figure 2).
10Figure 1 Variations in frequency, severity andfrequency + severity of dizziness (n=56)

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

Volume 3, Number 3 | Fall 2008

Improv ement
Slight improv ement
No change
Slight deterioration
Aggrav ation

Sample with 0 point score or sample with3 points improv ed score f or f requency +sev erity
Sample with 1 point improv ed scoref or f requency + sev erity
Sample without changed scoref or f requency + sev erity
Sample with 1 point aggrav ated scoref or f requency + sev erity
Sample with 3 points aggrav ated scoref or f requency + sev erity

Table 1 Evaluation criteria

Figure 3 Improvement ratio for vertigo

4. Discussion and conclusion
We examined the effects of acupuncture &moxibustion treatment on vertigo using anevaluation of the subjective symptoms by thepatient themselves as indices and found an
improvement ratio of approximately 70%, indicating
the effectiveness of this treatment modality.
Considering that in particular among acupuncture& moxibustion outpatients in whom thepharmacologic treatment alone may not be very
effective, this was thought to be a fairly highimprovement ratio. The endpoint in thisinvestigation was defined as the resulting score at
the time of the final treatment, but naturally thepathophysiology, number of treatments andtreatment duration also need to be taken into
consideration and examined separately.
“Introduction of our research facility”
The Tokyo Women’s Medical University has
developed out of the Tokyo Women’s Medical School"
established in 1900 as the only medical university
for women in Japan at that time. in 1984 a study
group for Kampo medicine was established within
the university and the 'Institute for Oriental
Medical Research affiliated with Tokyo Women’s
Medical University' established in March 1992
around the founding members of this study group.
Associated with an expansion of the facility it wasmoved in December 2007 to its current location in
front of Tabata station and its name changed toTokyo Women's Medical University, Institute ofOriental Medicine (below called 'this institute'). In
this institute physicians and acupuncturists
performs clinical, research and educationalactivities.
This institute includes the three sections of aclinic, an acupuncture & moxibustion clinicalfacility and a facility for health promotion. In theacupuncture & moxibustion clinical facility mainly 4
acupuncturists are engaged in clinics, research andeducation. The section has 12 beds for acupuncture& moxibustion treatment that are individually
separated from each other through partitions(Pictures 2, 3). The number of patients visiting thefacility per day varies around 40 persons. Moreover,the facility for health promotion provides the"Kampo health care" programme, integrating
Kampo medical and modern medical examination.
Within this framework acupuncturists perform
Ryodo Raku examinations and offer acupointguidance. Regarding research, each individual
acupuncturist pursuits his/her own clinical researchand obtained results are then published via the The
Japan Society for Oriental Medicine.

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

11Volume 3, Number 3 | Fall 2008References

Picture 2

Picture 3

Regarding education this university introduced
courses about oriental medicine and practical

1) Ebiko K: Investigation of the effects of acupuncture& moxibustion on vertigo – using evaluation ofsubjective symptoms by the patients themselves as
an index, Ido no Nihon, 756, 42-46, 2006
2) Ebiko K, Kikkawa M, Fujii A, Kimura Y, Arai M,
Sato H: Attitude survey among medical students
pertaining to acupuncture & moxibustion –comprehension and awareness after completion ofacupuncture & moxibustion classes; Journal of TheJapan Society for Oriental Medicine 56 (4), 591-597,
2005

exercises as obligatory subjects in 1992 and among
these 2 credits are assigned to acupuncture &moxibustion practice. This was the first time, that a
medical university had introduced acupuncture &moxibustion into its curriculum. This attempt has
been realized, because the first professor of thedepartment, Dr. Fumihiko Shirota, had placed greatemphasis on acupuncture & moxibustion related
education similar to the education in Kampo
medicine. A questionnaire performed among thestudents of this medical university following
completion of the course showed, that 97.3%
reportedly recognized the necessity for acupuncture& moxibustion courses and 96.1% of the students
reported, they would recommend acupuncture &moxibustion treatments, thus verifying the highlevel of interest in the subject2). Since 2005 a systemof clinical acupuncture & moxibustion practice has
beenestablishedandefforts

pertainingtopostgraduate studies for acupuncturists are made.

12The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)