Volume 3, Number 4 | Winter 2008

Japanese Acupuncture - Current Research
Practice and Awareness of Acupuncture and Moxibustion
Practitioners engaged in Cancer Treatment– Through Interview Survey and Qualitative Study –Kazuma Ito
Kyoto University

1. Introduction
In order to find out the connection between cancer
treatment and the treatment with acupuncture andmoxibustion, the research status in Japan was
searched through a bibliographic information database.
2. Method
The 1983-2008 editions of ICHUSHI, a web journal,

I. Prolusion

were used for database search. The used key words forCancer is a disease that can make a profound impact

data extraction were “cancer in Japanese hiragana or

on us. Cancer pain and multi-symptoms cause an

kanji,”

enormous psychological and physical burden.

“moxibustion in kanji or hiragana,” and “acupuncture

Cancer has now become something familiar to the“acupuncture

in

kanji

or

hiragana,”

and moxibustion in kanji.” Conference minutes wereJapanese. In 2005, cancer accounted for the largest

excluded.

number of all deathes1 (30.1%) in Japan. The cancer

3. Results and consideration

incidence and cancer deaths are predicted to increase

The extracted number of literatures and articles

in the future 2 , and this disease will become more

was 141. All these sorted by the year of publicationcommon to us.

were as follows: 30 (21.3%) in the years of 1983-1990,

In the treatment of cancer in recent years,
complementary

andalternative

medicine

44 (31.2%) in 1991-2000, and 67 (47.5%) in 2001-2008,

garners

showing an increasing trend. The contents wereattention for improving QOL of cancer patients and it is,classified into one publication (0.7%) of “Incidence

indeed, practiced. The treatment with acupuncture andPrevention/Recurrence Prevention/Physical Condition

moxibustion, which is part of complementary andManagement,” 12 (8.5%) of “Reduction of Side Effects,”

alternative medicine, has a long history in East Asia, and

34 (24.1%) of “Alleviation of Symptoms,” 14 (9.9%) of

it has spread further to Europe and the United States.

“Palliative Care,” and 80 (56.7%) of “Others” relating toDisseminating reliable literatures and articles on cancer

recommendations and enlightenment. As a result, twoand its treatment with acupuncture and moxibustion will

points were clearly indicated.

contribute to research and study developments as well as(1) Interest in cancer treatment with acupuncture andpromote the people’s behavior of receiving acupuncture

moxibustion was increasing.

and moxibustion for the treatment of cancer. And so, I(2) Most of these literatures were case reports, case-have searched the publication status of literatures onseries and interpretations.

cancer and acupuncture and moxibustion treatment inJapan of recent years, and will report the results of aqualitative study on the awareness of acupuncture andIII. Awareness survey ofmoxibustion practitioners

moxibustion practitioners who perform cancer treatment.

1. Introduction

II. Search of literatures on cancer
acupuncture and moxibustion treatment

andacupuncture

andThere were very few qualitative studies conducted
relating to relationships between cancer patients andacupuncture and moxibustion practitioners. Knowingof cancer patients, the practice of acupuncture and

1 Ministry of Health, Labor and Welfare “Table 5 Leading
Causes of Death by Sex (top10 ） the number of otherdeaths/rate distributions”
Hand Book of 2005 Population Survey Report (determinate
number)http://www.mhlw.go.jp/toukei/saikin/hw/jinkou/kakutei05/hyo5.html,

2

October 25, 2006
2
Health, Labor and Welfare Statistics Association.
“Kokuminno Fukushono Doukou” extra edition of Koseino
Shihyou Vol. 48, 12-go (2001) p.24

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

Volume 3, Number 4 | Winter 2008

moxibustion practitioners, and their awareness will

(2) The contents of interviews were documented andprovide an abundance outlook to not only the field ofthen numbers were assigned by context for data

humanities and social sciences but the field of natural

digitization.

sciences.

(3) Characteristic texts concerning the practice andAnd so, a survey was conducted by means of aawarenessofacupunctureandmoxibustion

qualitative study about part of the practice andpractitioners were extracted from the digitized data.

awareness(4) Subcategories of concrete contents were createdofacupunctureandmoxibustion

practitioners engaged in cancer treatment.

from the contents of the extracted texts.

2．Method(5) Common concepts were extracted from theA. Scope and attributes of the individuals being studied

subcategories and then categories were created.

The scope of the individuals being studied waslimitedtotheacupunctureandmoxibustion

practitioners who met all of the following requirements:(1) Those who had the experience treating cancer

2．Survey method
a．Interview method and contents of questions
The technique of the semi-structured interviews
was used for interviewing.

patients for five years or more, and/or those who were

The questionnaire was about the contents of thejudged as having adequate experience to qualify

practice of acupuncture and moxibustion treatment

participation in the study although they did not haveand awareness of the practitioners included in thethe required five years experience treating cancer

studied toward cancer patients and cancer treatment.

patients.

Ethical matters and concerns such as personal(2) Those who had the experience treating 10 or more

information protection were explained to the study

cancer patients.

participants from the ethical perspective.

(3) Those who had the experience of conference

b．Survey period and interview duration

presentation, submission of paper, or writing a book. Or

The survey period was from August 9, 2006 to

those who had a referral from the publisher of an

October 4, 2006. The interview frequency was once per

acupuncture and moxibustion related journal.

person with the length of an interview from 90 to 120

As a result, 13 practitioners were included in the
study.

These

acupuncture

13
andprivate-practicewereclassified

moxibustion

into

hospitalpractitioners

practitioners.

The

minutes.

andhospitalacupuncture and moxibustion practitioners were
further classified by hospital type into “university
hospital,” “cancer center,” “palliative care unit,”“holistic medical center.” (Table 1)
B．Methodology
1．Contents of the qualitative study
Analysis was made referring to the qualitative content
analysis3. The order of analysis is as follows:(1) Question items were created and interviews wereconducted.

An Introduction to Qualitative Research － anmethodology for <Human Science> written by
Professor Flick Uwe, translated by Hiroshi ODA, Norko
YAMAMOTO,Tsune
KASUGA,etal.
Tokyo:
3

ShinjyuSha, 2002 pp． 237-241

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Volume 3, Number 4 | Winter 2008

Table 1Attributes of the study participants4Years ofexperienceof Cancer
Treatment

Contents of medical care4

Sex

Age

Hospital type

Years ofacupuncture& moxibustion
experience

A

Male

30s

University hospital

6 years

5 years

Chinese medicine

B

Female30s

Cancer center

9 years

7 years

Meridian treatment

C

Male

30s

University hospital

9 years

8 years

Chinese medicine

D

Male

30s

University hospital

8 years

5 years

Chinese medicine

E

Male

40s

University hospital

18 years

15 years

Chinese medicine andmodern medicine

F

Male

40s

University hospital

22 years

14 years

Chinese medicine

G

Female60s

Cancer center18 years

15 years

Meridian treatment

H

Male

20s

Palliative care unit

3 years

2 years

Meridian treatment

I

Male

40s

Holistic medical
hospital

11 years

10 years

Chinese medicine

J

Male

50s

Private practice

23 years

18 yearsAncient Chinese medicine

K

Mal

50s

Private practice

30 years

27 years

Traditional Chinese medicine

L

Male

50s

Private practice

36 years

36 years

Meridian treatment

M

Male

60s

Private practice

31 years

15 years or
more

Chinese medicine

3. Results
The focal point in the analysis was placed onpractitioners’ subjective viewpoints or perspectives.
Interviews were classified into “Category” and“Subcateory.”
A. Practice of the acupuncture and moxibustion
practitioners
The practice of these practitioners was defined as the
Explanation of Contents of medical care
Traditional Chinese medicine was systemized in China inaround 1956. This medicine is also called Modern Chinese
medicine because of the period when the systemization took
place and the medical contents.
・ Meridian treatment is the treatment system created inJapan in around 1941.
・ Modern medicine is acupuncture and moxibustion
treatment with the introduction of knowledge of modern
medicine in the treatment.
・Ancient Chinese medicine is the treatment system now
being built with the focus on the medicine before Chinese
basic classics “Plain Conversation” and “Spiritual Pivot” of4

4

Traditional Chinese medicine came in the world.
・ Traditional Chinese medicine, which is based on “Plain
Conversation” and “Spiritual Pivot,” is a treatment systemcomposed of a part of or the whole of traditional medicine ofChina developed from “Plain Conversation” and “Spiritual
Pivot. What makes differences between Chinese medicine
and Traditional Chinese medicine is that Chinese medicine
systemizes the essence of Traditional Chinese medicine tosuit the modern age, whereas Traditional Chinese medicine
encompasses the concepts, theories, and treatment methods
that Chinese medicine failed to incorporate.
As above, there are a variety of treatment forms available inJapan.

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

Volume 3, Number 4 | Winter 2008

disease period that involved the time used for the

In terms of the disease period in which acupuncture

treatment (treatment time) with acupuncture andand moxibustion treatment was performed, themoxibustion and the term during which the treatment

hospitals performed the most number of treatmentswith acupuncture and moxibustion was performed.

during the middle term to the late term whereas

They are referred to, according to their attributes, asprivate practice had the most number in the middle“hospitals” in abbreviated form for those working forterm.

hospitals and “private practices” for those on private

B ． Awareness of acupuncture and moxibustion

practice.

practitioners
Awareness of these practitioners is defined as the

1. Treatment time
The treatment time meant the amount of time used
for examination, treatment and conversation with apatient. The treatment time in the hospital was on anaverage 30-40 minutes, ranging from 5 to 60 minutes,
whereas in the private practices, it was 40-60 minutes
on an average, ranging from 10 to 90 minutes.
2.

Diseaseperiodinwhichacupunctureandmoxibustion treatment was performed.
Cancer disease period was classified into initial

way how they have relationships with patients andtheirunderstanding of patients. So, howtheycommunicate with patients and their understanding ofpatients will be described below:
1. Ways of communication
Understanding patients, which is the basic to
medical practice, needs to have communication withthem. And what patients told in conversations(patients’ conversations) will be described hereunder.

term, middle term, and late term. The initial term wasThen, the types and the contents of what thedefined as the period from surgical treatment to thepractitioners told in conversations (practitioners’

start of chemotherapy or radiation. The middle term

conversations) will be shown below.

was defined as the period in which chemotherapy or

All the study practitioners considered “having goodradiation therapy was being performed aiming at a

communication was essential.” It was also found that

longer survival. The late term was defined as the period

they had both verbal and nonverbal communication.

when it became difficult to have effectiveness from the

The contents of patients’ conversations were “about

treatment aimed at a longer survival. The late term

patients” and “about the contents of treatment.” (Table

was further classified into early stage of the late term

2) The contents of each conversation covered a wide

for a limited life expectancy of six months to several

range of topics. The contents of about patients included

months, the middle stage of the late term for a limited“how they should live with or how to spend what thelife expectancy of several months to several weeks, thetime they had left” and “something that the deep innerlate stage of the late term for a limited life expectancy

surface expressed like spiritual pain.”of a few days, and the stage shortly before death for alimited life expectancy of several hours. (Figure 1)

Surgery

Initial term

Chemotherapy &Limited life

Limited life

Limited life

Limited life

Radiation therapy

expectancy of

expectancy of

expectancy of

expectancy ofTreatment period

6 to several months

several weeks

few days

several hours

Middle term

Early stage of

Middle stage of

Late stage ofStage shortly

late term

late term

late term

before death

Death

Figure 1 Cancer Disease Period (above)
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Volume 3, Number 4 | Winter 2008

Category

Subcategory

Category

Contents
Patients own disease andGeneral conversations
Empathetic

Psychological distressconversations

Some are theSocial distressModern medical

contents

conversations

responding to the

Spiritual pain

patients

Everyday life

themselves

Conversations about

contents ofindications and limits

conversations that

relating to

Past experiences

Verbal/vocal

of acupuncture andthe patients bringpatients

How to live with or how tomessagesmoxibustion, and theout, or the

spend the time left

potentiality

contents being

Personal life

Body reaction

conveyed of what

Everyday life

conversations

the practitioners

Guidance

felt.

Contents ofFamily relationships

patients families

Contents ofContents

modern medicine

medicalContents ofcareacupuncture andmoxibustion

Conversations

Psychological distress

Awareness-raising

Modern medical treatment

conversations

People engaged in medical

Table 3 Verbal communication/Types of conversations

care

relating toof acupuncture and moxibustion practitioners

Acupuncture andmoxibustion treatment

Nurses contact with the bodies of patients for

Acupuncture anddrying off with a towel or massages. However,moxibustion practitioners

acupuncture and moxibustion practitioners contact

Table 2 Contents of Patients’ Conversations
The

verbalcommunication

brought

with
out

by

acupuncture and moxibustion practitioners was madethrough giving verbal/vocal messages. The types of
their conversations were “general conversations,”“sympathetic

conversations,”“modern

medicalconversations,” “conversations about indications andlimits of acupuncture and moxibustion, and thepotentiality,” “body reaction conversations,” “guidance
conversations,” and “awareness-raising conversations.”(Table 3) These conversations were made in response to
the contents of the patients’ conversations or for
conveying to the patient what the practitioners felt.
“Body reaction conversations” were made on the basisof body conditions such as patient’s pains and skinconditions of the patients felt by the study practitioners.

6

Contents

healthContents ofContents

Subcategories

them moredelicately

fortreatment

andpalpation. Body reaction conversations are closely
associated

with

“body

contact”

of“non-verbal

communication.” A simultaneous occurrence of bothverbal and non-verbal communication may be one of
the characteristics of acupuncture and moxibustion
treatment.
“Awareness-raisingconversations”

areusually

initiated in an attempt to change the patients’awareness and are close to “guidance conversations.”“Guidance conversations” in this report, however, aredefined as the contents of knowledge relating todiseases and health that are taught to the patients.
“Awareness-raising conversations” also in this report
are defined as the conversations about patients’ fearof death and spiritual pain. Characteristic remarks
made relating to these are as follows:

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

Volume 3, Number 4 | Winter 2008

received acupuncture and moxibustion treatment.

“Death, you have to accept it as it is one of four
unavoidable human sufferings.” You have to accept

a. What patients want to get from acupuncture andwhatever may happen. (J103) (Moderator: Um)

moxibustion treatment

Say if “there is the next world, true?” “TheThis timing was defined as the time when the patientsmundanity is the place for ascetic training.” (J104)

had the acupuncture and moxibustion treatment for

Non-verbal communication by acupuncture andmoxibustion practitioners was made through conveying“non-verbal/vocal messages” and “non-verbal/non-vocal
messages.” (Table 4) The characteristics were thatthese practitioners attentively listened to “body actions”
and lay their hand on patients of “body contact.” All thepractitioners in this study replied that they were“aware” of “body actions” and “body contact.”

relationship of mutual trust was yet to be established.
What

the

patients

want

were

desires.

The

subcategories were “become cured,” “alleviation ofsymptoms,” and “physical condition management.”b. Changes in the state of mind by acupuncture andmoxibustion treatment
Changes will be described hereunder in the state ofmind of patients who received acupuncture andmoxibustion treatment. The practitioners in the study

Categories

Subcategories

Contents

Non-

Basic metricLoudness of voice,verbal/vocal

factors andpitch of voicemessagesparalanguage

perceived the changes as “desires,” “peace of mind,” and“hope.” “Desires” of the patients are that they desire
to have “conversational partners,” “psychological

Body actions

Attentive listening

support,” “have the practitioner’s hand on the patient,”

Palpation“comfort,” and “healing,” in addition to “become cured,”

Acupuncture andmoxibustion treatment

Body contact
Non-

Palpation, contacts

verbal/non-except for treatment

vocal

Distance from patientsSpacemessagesthe first time. At the first time treatment, aDirection and Position
from patients
Treatment time for
one treatment

Timeand “alleviation of symptoms.”“Comfort” is a pleasant feeling that patients feelcaused by acupuncture and moxibustion treatment.
Acupuncture treatment is interesting, isn’t it?
People come for comfort. Their purpose is.. The
patient’s purpose… (L56)

Number of treatment

Acupuncture and moxibustion treatment brings
Table 4

Types of Non-verbal Communication ofrelaxation to patients and has the effect of bringing a
sense of comfort to the patients. These reactions occur

Acupuncture and Moxibustion Practitioners

whether symptoms improved or not. Since treatment
2.

Acupunctureandmoxibustion

practitioners’

on cancer patients in the middle term causes a physicalburden, and terminal cancer patients who feel pain,

understanding of patients
This chapter deals with the understanding oflassitude, and other physical suffering very seldom feelpatients that the practitioners obtained from the

comfort, so that they want to have a feeling of comfort

followingfrom acupuncture and moxibustion treatment.

twosubjective

perspectives;

from

one

perspective, the practitioners grasped what patients
want

to

get

when

they

received

acupuncture

moxibustion treatment for the first time; from the otherThe subcategories of “peace of mind” were “peace ofmind by conversations” and “peace of mind by
moxibustion and acupuncture treatment.”

perspective, the practitioners discerned that changes

The subcategories of “hope” were “hope for recovery,

occurred in the state of the patients’ mind after theylife prolongation, and alleviation,” “hope for having

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

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Volume 3, Number 4 | Winter 2008

companionship with people,” and “hope for the way of

not essentially occur in all patients who received

living.”acupuncture

According to Kübler-Ross’ Five Stages ofandmoxibustion

treatment.

Itis

Dying, patients held onto some level of hope until theconsidered that such changes occur in the mental state

last moment5. This survey also showed similar results.

only when the patients felt treatment effects or relaxedmentally and physically.
C. Characteristics of acupuncture and moxibustion

4．ConsiderationA.

Practiceofacupunctureandmoxibustion

practitioners and problematic areas (Fig. 2)
Firstlypractitioners

characteristics

ofacupunctureandAcupuncture and moxibustion practitioners spend

moxibustion treatment will be described. In the

more time with patients than with doctors and nurses.

therapy sessions, the practitioners carefully listen to

Concerning the disease period in which acupuncture

what the patients tell them and have conversations.

and moxibustion treatment was performed, theThen, the practitioners have physical contacts with thetreatment was given during a broad period from thepatients including palpation. This process proceeds

middle term to the late term, sometimes to the justtaking relatively a long time in a unique space where

before death. Thus, these practitioners spent a longthe distance between the practitioner and the patient

time for the treatment of patients as well as thegradually decreases. In there, both rich verbal and non-treatment period, which essentially allows the talks ofverbalthe patients to become rich in terms of quality andcommunication, the patient self-disclosure occurs

volume.

together with the practitioner’s questioning. In

B.

Awarenessofacupunctureandmoxibustion

communication

takes

place.

Duringtheresponse to the self-disclosure, the practitioner may
take an action of self-disclosure reciprocity. This is thepractitioners
Acupuncture and moxibustion practitioners value
verbal and non-verbal communication. For this reason,

mutual understanding of the practitioner and thepatient.

have

The acupuncture and moxibustion practitioner

communication on the matters that lie deep inside theprovide treatment to the patients. And, once thepatients, such as patients’ way of living and spiritualpatients recognize symptomatic improvements and apain. The practitioners participated in this study had

sense of relaxation, or once the patients have developed

quite a bit of clinical experience and they cantrust in the techniques, knowledge, and humanconceivably carry a type of conversations to raise

qualities that the practitioners possess, the patientsawareness. And, the physical contact in non-verbal

will have a sense of trust in the practitioners. Then, thecommunication is considered to make it easy for thepatients re-experience treatment effects and the trust

patients to open their heart. However, it can easily be

deepens – then the patients begin to have desires andimagined that unless the practitioners can cause theseek peace of mind, and hope. At this stage, thepatients to have a sense of relaxation or treatment

patients may ask the practitioners about existential

effects, they would not become open-minded.

matters including what caused the cancer, or may

thesepractitioners

arecompelledtoengage in deep self-disclosure. The practitioners may
As a result of acupuncture and moxibustion

take two types of responses. The first is that thetreatment, changes occurred in the state of the patientspractitioners do not tell anything to the patients; andmind; the items of “desires” increased and they began

the second is that the practitioners engage in self-

to have “piece of mind” and “hope.” These changes will

disclosure reciprocity with such as the knowledge,“On Death and Dying” written by Elisabeth Kübler-Ross,
M.D ． and translated by Masayoshi KAWAGUCHI.Tokyo:

Yomiuri Shinbunsha, 1971, pp．171-189．

58The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 3, Number 4 | Winter 2008

thinking, belief, and religion of the practitioners.

mind of practitioners and the patients.

Here some problems arise. One of the reasons why

In order to solve this problem, it is required that thethe practitioners do not tell anything is related to theindustry of acupuncture and moxibustion therapy

relationship between the practitioners and the hospitalprovide certain levels of education together with school

healthcare providers. For instance, even if a patienttraining, and that a safety network be built to cope withreceiving chemotherapy tells the practitioner that he or

the symptoms of burnout.

she wants to refuse the therapeutic method, thepractitioner as a member of the team medicine will notable to openly deny the chemotherapy as it will cause aproblem. However, no-talking to the patient may
possibly leave the patient alone psychologically. The
other reason for no-talking to the patient is that thepractitioner does not know what and how to tell thepatient in response to the patient’s deep self-disclosure.
In short, “the practitioner do not know what to tell” inthe circumstance. Especially the practitioners who do
not have a sufficient amount of experience presumably
tend to fall into such a situation. If a similar situation
continues, the practitioners will become increasingly
stressed, reaching the stage of burnout.
When the practitioners engage in self-disclosure
reciprocity, problems also arise. I consider that there
are two types of reciprocity. The first is the case inwhich the practitioner speaks unilaterally. The second
is the case in which the practitioner and the patient
talk together. In the case of unilateral talk, theappropriateness of the patient’s ways of speaking does
matter. The patient may feel a burden depending on
how the practitioner speaks. What the practitioner tells,such as the practitioner’s knowledge, thinking, belief,
and religion also matter. Before the way of speaking is
discussed, the contents that the practitioner tells to thepatients should be called into question whether they
are good enough to tell to the patient. There is the otherethical issue of confidentiality obligations in a team
medicine. As a thanatoloical matter (death & life
studies), how should the practitioners face spiritual
pains including existential matters. This will emerge asa significant issue, given the state of patient mind.
As such, there are many issues and problems. The
largest problem is that many of the acupuncture andmoxibustion practitioners are unaware of the problems.
The unawareness insidiously increases burdens on the

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

9Volume 3, Number 4 | Winter 2008

Time

Space

Attentive listening
Patient
Practitioner①Self-disclosure

Conversation

Patient

Practitioner
Palpation
Patient

Practitioner②Reciprocity of self-disclosure

Physical contact

Treatment
Practitioner

Patient

In the case that the patient recognized symptomatic improvement or a sense of relaxation, orin the case the patient developed trust in the practitioner (technique, knowledge, and humanly aspects),

Practitioner

Feeling of trust

Patient

Re-experience the treatment effects and increase the feeling of (humanly) trust in the practitioner

What are Required from the practitioner“Desires” “Peace of Mind” “Hope”②Not tell anything

Practitioner

Patient①Deep self-disclosure*Here problems occur.

(such as existential matters)③Some reciprocity of self-disclosure(for instance, knowledge, thinking, belief, and religion)

Figure 2 Characteristics and Issues/Problems of Acupuncture and Moxibustion Treatment

10

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Volume 3, Number 4 | Winter 2008

Problem with the practitioner-patient relationships:
Mostly, being unaware of it.
(Practitioner → Patient）②Not tell anything
A. The relationship between other hospital healthcare
providers and treatment→ the patient was left psychologically unattended.
B. The acupuncture and moxibustion practitioner do
not know how and what to speak to the patients.
→ Mental stress and burnout of acupuncture andmoxibustion practitioner③Some reciprocity of self-disclosure
A. The acupuncture and moxibustion practitioner
speaks unilaterally.
B. Talk to each other/think together→Is the way of speaking appropriate?
→What are the contents of knowledge, thinking,belief, and religion of the acupuncture and moxibustion
practitioner?
→Are they really good to tell to the patient?
Other issues:
・Ethical matter → Confidentiality obligations
・ Thanatological matter→

Relationship withspiritual pain?

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

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