Volume 5, Number 2 | Summer 2010

Japanese Acupuncture - Current Research
Japanese Acupuncture for “Hie” Symptoms(excessive sensitivity to cold)
Shunji Sakaguchi
Research Division of Acupuncture and Moxibustion
Kansai University of Health Sciences

1. Introduction
In Japan excessive sensitivity to cold is a social
1)

common place and definedas "a pathologic

condition where a decrease in environmental

2. Methods
The "Japana Centra Revuo Medicina" (aJapanese searchable database of medicallyrelated documents) served as the data source thatwas searched over the entire period (from 1983 to2010) during which articles pertaining to theacupuncture and moxibustion treatment forexcessive sensitivity to cold had been publishedand as far as possible among these, articles
presenting a high level of evidence credibility wereextracted.

temperature that does not produce any discomfort
to ordinary people elicits an abnormal feeling of

3. Results

cold in regions like the low back, the tips of hands

The extracted articles were summarizedclassified by years to present an outline of theresearch.
1) Fact-finding surveys related to patients withexcessive sensitivity to cold and the effects ofacupuncture and moxibustion treatment Kawana
3-5.
published from 1988 to 1989 three papers

and feet, both legs, or also the entire body, and thisabnormal feeling generally persists for more thana year. In many cases the affected persons
consciously perceive the condition as a disease."
Such a decrease in various physical functions is
considered

to

be

a

generalized

phenotypecharacterized by individual differences in severity

3)

In the first reporthe examined 92 womenand used to be considered a constitutional problem.

(51.1% of whom were in their 40s to 50s) with

However, in recent years fact-finding surveys

excessive sensitivity to cold of the feet regarding

related to this excessive sensitivity to cold

the actual presence of indefinite symptoms, bloodindicated correlations to specific diseases, so thatpressure and the presenting abdominal patterns.

the importance of prevention and treatment of
this condition is beginning to be acknowledged.
Relying on the two pillars of both acupuncture/ moxibustion and Kampo medications Kampo
medicine now uses imbalances related to Qi, Bloodand Water or anomalies in viscera, bowels and

The results showed, that (1) tinnitus, low backpain,

shoulderstiffnessandirregular

menstruations were common complaints and often
appearedtobepartialmanifestationsofgeneralized indefinite complaints. At the root of

meridians as an important indicators for thethe onset of these symptoms existed autonomic

diagnosis of excessive sensitivity to cold and as

dysfunction, (2) blood pressure was in many cases

therapeutic

simultaneously

normal, but tended among the younger patients toattempting to achieve improvements of thebe rather low and conversely in the higher age

associated symptoms.

groups high. (3) Among the abdominal patterns aguidelines,

In this work we discuss Japanese clinicalresearch pertaining to excessive sensitivity to coldand in conjunction with presenting its results
would like to evaluate both the current position
and future tasks.

2

high

incidence

of

Blood

stagnation,

tense

abdominal skin and hard glomus below the heart
were

observed.

For

the

acupunctureandmoxibustion treatment administered to newpatients we used stainless steel needles with a

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

Volume 5, Number 2 | Summer 2010

diameter of 0.2 mm that were usually retained forabout 10 minutes, while for chronic cases thistreatment was combined with low frequency
electro-acupuncture therapy (EAT) and a total of
15 to 20 treatment sessions administered in 1week intervals. Treatment points included thevarious acupoints on the level of the second sacralvertebra along the "S2" line: [Ciliao (BL32),
Pangguangshu (BL28), Baohuang (BL53), Zhongji(CV3)].
For an evaluation of the effects the applicationof a classification using 50% subjective and 50%
objective findings a ratio of symptom alleviation of
more than 80% was defined as highly effective,
more than 60% as effective and more than 40% as
slightly effective. The results showed that thetreatment was highly effective for 4 patients,
effective for 23 patients, slightly effective for 21
patients and thus more than slightly effective fora total of 48 patients (52.1%).
4)
The second report
is a fact-finding
examination related to the correlation between
excessive sensitivity to cold and menstruation,
pelvic circumference and abdominal pattern.
Subjects were 30 women (aged between 19 and 30
years) complaining of constant excessive
sensitivity to cold. The results showed thatpatients with excessive sensitivity to cold had atendency (1) toward low blood pressure, (2) anarrow pelvis and abdominal patterns tended to
be Blood stagnation (70.0%), tense abdominal skin(66.6%) or hard glomus below the heart (63.3%) inthat order. The summary that was also based on
the results of the first report showed, that there
are many common findings between younger
patients with excessive sensitivity to cold andmenopausal patients with excessive sensitivity tocold. Moreover, circulatory disturbances of thepelvic organs apparently have a marked influenceon the excessive sensitivity to cold in women.

5)

The third report is a fact-finding study related
to physical conditions, menstruational status andmental complaints of 105 young women (agedbetween 19 and 30 years). The results showed that
(1) a marked tendency towards presenting aphysical condition classified according to oriental
medicine as Blood deficiency, colic pain fromoverindulgence in cold foods (han shan) or marked
Blood stagnation pattern and the patients would
often be classified according to modern medicine
as asthenic, characterized by a hypersensitive
constitution with a tendency towards low bloodpressure; (2) the menstrual cycle was normal, but
the patients tended to be mentally very tense andbecame easily upset; (3) loneliness, timidity,
impatience and slow reaction to all matters werereported as mental complaints. Basically the same
acupuncture treatment as described for the firstreport was performed and the treatment wasmarkedly effective for 7 patients, effective for 28,
slightly effective for 66 patients, so that it wasmore than slightly effective in 66 patients (62.9%).
2) Effects of the acupuncture and moxibustion
treatment for patients with excessive sensitivity
to cold associated with some underlying disease
6,7)
published two articles in 1998
Nemoto et al.
6)
and 1990. In the first of these reports 21 patients(9 men and 12 women, average age 58.0 years) had
underlying diseases and at the same timecomplained about excessive sensitivity to cold of
the hands and feet. The treatment of the roots aswell as local and symptomatic treatment had the
purpose of activating circulation and inducing
systemically altering effects. Concretely low
frequency electro-acupuncture with a frequency of
1 Hz was applied to PC4 (Ximen), PC6 (Neiguan),
ST36 (Zusanli) and SP6 (Sanyinjiao) for 30
minutes; indirect moxibustion using 2 cones each
was performed on BL23 (Shenshu), ST36 (Zusanli),
KI7 (Fuliu) and KI1 (Yongquan) and thistreatment carried out twice a week for a total of

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

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Volume 5, Number 2 | Summer 2010

10 sessions. The effects were evaluated in thesame manner as described for the Kawana’s report.
The results showed an efficacy ratio of 55.9%
where the associated symptoms were alleviated inconjunction with the improvement of the excessive
sensitivity to cold.
7)
withIn the second report 23 patients
excessive sensitivity to cold and underlying
diseases were grossly divided into 13 patients withhemiplegia (9 men and 4 women, average age 57.2
years) and 10 patients (2 men and 8 women,
average age 55.5 years) with diseases other thancerebral stroke and then the acupuncture andmoxibustion treatment compared. Treatment
method, frequency and evaluation of the results
were the same as described above. The results
showed an efficacy rate of 60.9% where the ratioof improvement classified by diseases was 53.8%
for patients with hemiplegia and 70% for patientswith diseases other than cerebral stroke.
3) Effects of single acupuncture and moxibustion
treatments for excessive sensitivity to cold
8)
Kitamura et al. (1994) administered a single
acupuncture and moxibustion treatment to 7
healthy people (2 men, 5 women, aged 31-52 years)
and 10 people complaining of excessive sensitivity
to cold (3 men, 7 women, aged 29-65 years) andexamined the results using variations in thesubjective findings as well as core and surface
temperature of the sole of the feet. The treatment
used filiform needles that were retained at BL32
(Ciliao), BL23 (Shenshu), BL25 (Dachangshu),
BL52 (Zhishi), KI3 (Taixi), warming needle at SP6(Sanyinjiao) and electro-acupuncture as required.
The results showed therapeutic effects in 70.0% of
the patients with excessive sensitivity to cold.
4) The effects of the acupuncture and moxibustion
treatment when combined with root (general)treatment based on the Akabane method andtreatment targeted at overcoming Blood stagnation

4

9)

As reported in 1995 by the authors , it showedthat the patients presented with subjective
feelings of cold of the feet. Five women (aged 1930 years, average age 23.6 years) responding to
the item "Do you have cold feet even in summer?"in a CMI health check questionnaire covering 37
items received the Akabane style generaladjusting treatment with needles retained at Xuefu, BL32 (Ciliao), BL33 (Zhongliao), irradiation
with far infrared for 15 minutes and additionallyintradermal needles attached to SP6 (Sanyinjiao),
ST36 (Zusanli), CV4 (Guanyuan). A total of 5treatments were administered once a week. The
effects were evaluated after the first and fifth
treatment sessions, using the Terasawa’s Bloodstagnation score and a Visual Analogue Scale(VAS) for evaluating variations among the Bloodstagnation items, associated complaints andsubjective symptoms. The results showed that (1)all of the patients with an excessive sensitivity tocold also had a marked degree of Blood stagnation,(2) the acupuncture and moxibustion treatment
lowered the average Blood stagnation score from71 to 47 points, (3) the acupuncture andmoxibustion
treatment
resultedinanimprovement of the VAS in 3 patients, (4) the
improvement of the VAS induced by theacupunctureandmoxibustion
treatmentsuggested, that among the Blood stagnation items
alleviation of the tenderness and resistance in theileocecal region had contributed to improvementsof the menstrual disorders.
5) Skin temperature distribution over the wholebody as an indicator of the effectiveness ofacupuncture and moxibustion treatment forexcessive sensitivity to cold
10)
(1998) used acupuncture on theMori et al.
abdomen at CV14 (Juque), CV12 (Zhongwan),
ST27 (Daju), CV4 (Guanyuan), CV2 (Qugu), SP12
(Chongmen) and on the back BL20 (Pishu), BL23
(Shenshu), BL25 (Dachangshu), BL32 (Ciliao),

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

Volume 5, Number 2 | Summer 2010

and on the legs SP10 (Xuehai), ST36 (Zusanli) SP6(Sanyinjiao) and KI3 (Taixi) to treat 6 women(aged 20-40, average age 30.2 years) withexcessive sensitivity to cold for a total of 16 times
twice per week. For an evaluation of the effects ofthe treatment the degree of excessive sensitivity
to cold before treatment and 8 weeks later(classified into 4 grades: 3 = very disturbing,cannot be endured; 2 = is bothersome, but can beendured; 1 = somewhat bothersome; 0 = noexcessive sensitivity to cold) and whole body skintemperature distribution were examined. The
results showed that the degree of the excessive
sensitivity to cold improved by more than 2 levels
1 case and by more than 1 level in 5 cases, whilethermography of the legs too showed improvementin 4 cases.
6) Randomized controlled trials regarding theeffects of acupuncture and moxibustion treatment
for excessive sensitivity to cold
11)
(2008) conducted the first
The authors
randomized controlled trials regarding the effectsof acupuncture and moxibustion treatment forexcessive sensitivity to cold in Japan.
The study included 19 female volunteers (aged18-32, average age 20.5 years) with excessive
sensitivity to cold. Following stratification into therelevant numbers based on the questionnaire thesubjects were randomly divided into an"acupuncture and moxibustion treatment group"
and a "control group". In the "acupuncture andmoxibustion treatment group" the subjects weretreated in supine position by needling SP6(Sanyinjiao) and ST36 (Zusanli) on both the left
and right side and then cut pieces of indirectmoxibustion attached to the needle handles andburnt. Moreover, simultaneously with the warm
needling 4 stick-on moxa cylinders attached to alotus-shaped pedestal were placed on CV4(Guanyuan) to perform warming moxibustion.
Later, in prone position far infrared was applied

to the lower back, while applying using the same
lotus-shaped pedestal that was also used on theabdomen, to perform warming moxibustion
centering around BL32 (Ciliao) on both sides. A
comparison showed no significant differences forany of the items observed in both groups prior to
the intervention, with the exception of remnant
lipoprotein cholesterol (RLP-C). Regarding thedegree of suffering before and after theintervention, Blood stagnation score, Ht values,
RLP-C values and 10 RPM values there wasneither any interaction between the two groups
nor any differences.
7) Effects of low frequency electro-acupuncture
applied to the lower extremities for excessive
sensitivity to cold using postural change test
12)
(2010) applied low frequency
The authors
EAT to the lower extremities at SP6 (Sanyinjiao)
for excessive sensitivity to cold and investigatedthe effects.
The effects of low frequency electroacupuncture treatment for excessive sensitivity tocold in young women presenting with posturalchange test induced vasomotor disturbances. The
study included 20 women (aged 18-26 years,
average age 20.6 years), who were aware of theirexcessive sensitivity to cold and in whom the toe
skin temperature increased after lying down
following a 5-minute standing stress or else
showed left-right differences. For the acupuncture
treatment 40 mm long stainless steel needles witha diameter of 0.2 mm were inserted into left andright SP6 to a depth of about 15 mm and then usedas needle electrodes, while on the outside of thetibialtuberosity

on

both

sides

indifferent

electrodes were attached, applying a pulsed
current with a frequency of 1Hz for 20 minutes.
After a total of 5 treatments given once a week thestress test was repeated. Thermograms wereobtained of both lower extremities covering fromthe medial aspect of the foot to the tibial aspect

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

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Volume 5, Number 2 | Summer 2010

with a medical thermography device and then theshowed that ordinary acupuncture treatment andaverage skin temperature was calculated for thelowtoe, metatarsal, ankle and lower extremity areas.

depending on the course and through treatment

A 100 mm wide Visual Analogue Scale (below

along the S2 line improvement of the circulationabbreviated VAS) was used for our originalof the pelvic organs, referring to the intended

evaluation

pursuit of eliminating Blood stagnation, was

of

the

degreeoftheexcessive

sensitivity to cold and the categorical scale of 14
othersymptoms

includingtheexcessive

frequency

EAT

were

used

separately

achieved.
Research

intopatients

withunderlying

sensitivity to cold. A diary was kept starting one

diseases presenting with excessive sensitivity toweek prior to the treatment and continued until

cold receiving both root (general) as well as local

one week after the treatment, noting for all days

(partial) and symptomatic acupuncture treatment

during this period a "chilly score", a total score forpatterns showed, that it is possible to achieve

the 14 symptoms, the VAS values and served

certain effects by using the same indicators ofsubsequently to calculate the average valued.

effects that Kawana used. Moreover, associatedVariations in health related quality of life

with an improvement in the excessive sensitivity

measures due to the acupuncture treatment were

to cold shoulder stiffness, general lassitude,

evaluated using the standard edition of the MOS

constipation and similar associated symptoms

8-Item Short-Form Health Survey(SF-8). The

improved also and notable changes in the

results showed that through the acupuncture

abdominal pattern could be observed. Again, in

treatment the skin temperature of the toes

the second report patients were divided into

following the postural change test did not rise as

hemiplegia and other than cerebral stroke

markedly as it did during adaptation, while 20

patients and a comparative investigation of theminutes after the end of the orthostatic stress test

therapeutic effects reportedly showed, that thethere was a more significant increase in skin

improvement ratio in hemiplegic patients wastemperature on the medial side of the lower

lower. The additional presence of local circulatory

extremity than during adaption. The chilly score,insufficiency due to functional disorders of the

VAS values and the SF-8 heading and summary

central autonomous nervous system was surmised

scores did not show any significant differences

as possible reasons. This conceivably suggested

betweenthat the manifestation of acupuncture treatment

before

and

after

the

acupuncture

treatment, but the total score for the 14 symptoms
decreased significantly.

effects are mediated via central factors.
The research into the effects of single treatments
Kitamura et al. conducted, used retaining filiform

Discussion

needles and warm needling of acupoints in the

A series of articles by Kawana deals with the

lumbar region and on the legs and thereby achieved

pathology of women with excessive sensitivity toa high ratio of improvement. Presumably thecoldfact-finding

mechanism for this improvement involves raising

investigations classified by age indicated incore temperature in the regions affected by themodern medical sense a disorder of autonomic

excessive sensitivity to cold through acupuncture

nervous function and from an oriental medical

and moxibustion treatment of the lumbar region.

point of view a strong correlation to Blood

Moreover, follow-up studies verified that this effectstagnation. Moreover, the accumulation of cases

continued from several hours to several days.

6

and

the

conductionof

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

Volume 5, Number 2 | Summer 2010

For an evaluation of patients with excessive

correlation

to

the

findings

ofhematologic

sensitivity to cold the Cornel Medical Index was

examinations was observed, which suggests thatused and regarding the treatment the authors

the evaluation parameters need to be reconsidered.

conducted research pertaining to the intradermalThe

authors

investigated

among

the

needles originally developed in Japan, that wereaccumulated cases the effects low frequency EAT

used for adjusting the back Shu points within thewith a frequency of 1 Hz applied for 30 minutes had

framework of the Akabane method. A Bloodon toe skin temperature variations induced bystagnation score was used for this evaluation andpostural change tests in persons with excessive

showed, that certain effects had been obtained.

sensitivity to cold. The results showed that AET

Further, there was an apparent correlation to

produced a shift towards normalization of lower

improvements

extremity

in

the

VAS

and

the

Blood

vascular

responsivenessthroughpostural vascular reflexes, so that the excessive

stagnation items.
Mori et al. used thermography as an indicatorsensitivity to cold does not become worse even if theof the effects of acupuncture treatment forambient temperature decreases, suggesting that

excessive sensitivity to cold and found in their

the treatment had improved the general condition.

research using whole body distribution of skin

Stress thermography instead of the so far common

temperature,thesimple thermography as an evaluation index andsubjective symptoms showed a high concordance

the inclusion of an original evaluation chart forwith an increase in the skin temperature of thesubjective symptoms (the chilly diary) can also be
applied to future clinical research.

that

an

improvementoflegs. Regarding the evaluation method the use ofthermography for wide area assessment (wholebody) rather than only the variations in skin andcore temperature of the regions affected by theexcessive

sensitivity

to

cold

is

extremely

Many factors contribute to the onset ofexcessive sensitivity to cold, but among theseautonomic dysfunction from a modern medical

interesting.
In the randomized controlled trial (RCT) the
authors

4. Conclusion

conducted

toinvestigate

excessive

point of view and the pathologic condition of Bloodstagnation from an oriental point of view seem towasbe most deeply involved. Acupuncture andperformed on the sacral region and the lower

moxibustion treatment in the form of warm

abdomen to eliminate Blood stagnation, the effects

needling and intradermal needle, low frequencyof treatment with warm needling applied to the

EAT stimulation etc. applied to acupoints in thelegs was investigated in addition to the common

lumbar, sacral and lower abdominal regions asassessment using subjective symptoms and Blood

well as on the legs to improve autonomic nervous

stagnation score with the new parameter of blood

function and eliminate Blood stagnation is aviscosity. The results showed that acupuncture

treatment form developed in Japan. It causes

and moxibustion treatment led to a reduction ofsubjective variations in the associated symptoms

the suffering and an improvement in the Bloodof excessive sensitivity to cold and additionallystagnation score, but these effects did not exceed

has also been observed using thermography andthose observed among the controls. Although asimilar objective indicators. This verified a clinicalcorrelation between excessive sensitivity to cold

effectiveness among the accumulated cases of as

and Blood stagnation had been verified, no suchhigh as 50-70%. However, there is only little

sensitivity

to

cold,

warm

moxibustion

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

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Volume 5, Number 2 | Summer 2010

research using high evidence level RCTs, so that

7） Nemoto K, Mizukami M, Tanzawa S. A clinicalthese effects have still not sufficiently been

study of acupuncture and moxibustion for thedemonstrated and therefore the conductance ofhypersensitivity to cold (Part 2). Journal of themulti-center clinical studies would be desirable toJapanmake these results publicly known.

Moxibustion. 1990; 40(2): 198-205.

Societyof

Acupunctureand8） Kitamura H. The research on the effect ofReferences:
1） Terasawa K. On the recognition of “Hie-sho”(chillphobia) in the traditional kampoh medicine.
Shoyakugaku Zasshi. 1987; 41(2): 85-96.
2） Hirofumi Kawagoe, Kenji Tahahashi, Akira
Kawashima, Tomoaki Ishikawa: Fact-findings
surveys pertaining excessive sensitivity to cold
– basic data and incidence of excessive
sensitivity to cold classified according todiseases; Diagnostics and Therapy; 2003; 91(12): 139-42 (Japanese only)
3） Kawana R. Acupuncture and moxibustion forthe hypersensitivity to coldness-Studies on thepatients with feeling of leg cold-. Journal of theJapan
Societyof
Acupuncture
andMoxibustion. 1988; 38(3): 249-58.
4） Kawana R. Acupuncture and moxibustion forthe hypersensitivity to coldness (II)-Covelation
with menstruation, pelvic diameters andabdominal symptoms-. Journal of the Japan
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with acupuncture and moxibustion-Chilly
constitution of young female-. Oriental Medicine
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Society of Acupuncture and Moxibustion.
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8acupuncture therapy for cold-feeling patients ona deep skin temperature. The Bulletin ofKanazawa Rehabilitation Center. 1993; 20: 33-9.
9） Sakaguchi S, Tani M, Nishiguchi R, Horikawa
T, Noguchi E, Kawamoto M, Fujikawa O. The
effects of acupuncture therapy on cold hands
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stagnation“Oketsu”-.

Japanese JournalofOriental Medicine. 1995; 45(4): 919-25.
10）Mori H, Nishijo K. Effects of acupuncture on
pain

and

thermographic

indefinite

complaint,

assessment.

with

BIOMEDICALTHERMOLOGY. 1998; 17(2): 133-42.
11）Shunji Sakaguchi, Shigeyuki Kanai, Shizuo
Toda; Randomized controlled trials regarding
the effects of acupuncture and moxibustion
treatment for excessive sensitivity to cold;
Journal of the KANSAI UNIVERSITY OF
HEALTH SCIENCES; 2007; 1: 82-5 (Japanese
only)12）Sakaguchi S, Kuge H, Kojima Y, Takeda T,
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