Volume 13, Number 4 | Winter 2018

Report from WFAS Tokyo/Tsukuba 2016
“Acupuncture for Low Back Pain and Knee Pain in Middle
Age, an Anatomical Point of View”

Acupuncture & Moxibustion and outline its goals. For

1) The Japan Conference of Clinical Acupunctureand Moxibustion2) Department of Acupuncture, Faculty of Health
Sciences, Morinomiya University of Medical Sciences

2. Historical development of the Japan Conference of

this purpose I present one case report of a patient withlow back pain and knee pain.

Tomofumi Ozaki
Clinical Acupuncture & Moxibustion
The society was founded in 1960 under the name of"Japan Acupuncture & Moxibustion Electrical Skin
Resistance Study Group". It had the purpose of building

1. Introduction
The Japan Conference of Clinical Acupuncture &Moxibustion started out when in 1960 Bunshi Shirota
and othermotivated persons attempted toputacupuncture and moxibustion on a scientific foundationand gathered for that purpose under the guidance ofprofessor Tachio Ishikawa at Kanazawa University tofound its predecessor, the "Japan Acupuncture &Moxibustion Electrical Skin Resistance Study Group",
which in 1983 was then given its current name. Basedon the concept of "considering all treatment forms if they
are based on modern medical comprehension ofpathologies"

the

group

strovetoimprovethequalification of clinical acupuncturists. Up to now it has
actively exchanged information pertaining to casereports and clinical studies1) mainly among members.
Improving the qualification of acupuncturists, meaning
enabling

practitioners

toproperlycomprehend

pathologies, acquire appropriate therapeutic skills andpedagogic techniques requires first of all the acquisitionof basic knowledge about modern medical diagnostics,
understanding of pathologies and therapeutics toimplement the aforementioned skills. The reason for thisis the necessity to be able to communicate withphysicians and co-medical staff on the same level. In thiscontext a common medical record form for diseases
designatedasindicationsforacupunctureandmoxibustion like neck-shoulder-arm pain, low back andleg pain, shoulder joint pain, knee joint pain etc. has
been proposed. It has already been listed in text books
and is currently used in the education of acupuncture
therapists2,3).
Here I would like to briefly introduce the historicaldevelopment of the Japan Conference of Clinical2

a scientific foundation for acupuncture and moxibustion
based on the viscerosomatic reflex theory and the use of
the dermometer proposed by doctors Hidetsurumaru
and Tachio Ishikawa.
1983: Based on the concept that improving acupuncture
therapist qualification will also increase the value of the
medical services by these therapists and establish aposition of acupuncture and moxibustion in medical care,
the study group was renamed into "The Japan
Conference of Clinical Acupuncture & Moxibustion".
The conduction of clinical conferences seems to be theshortest way to improve the clinical capabilities ofacupuncture therapists. In other words, the group wastermed Japan Conference of Clinical Acupuncture &Moxibustion, because the understanding of pathologies
based on bedside interviews and examinations, judging
whether a given condition is an indication orcontraindication for acupuncture and moxibustion,
possible referral to medical specialists, assessing the
prognosis and determining the best possible treatment
form can be deducted from free discussions among
acupuncturists based on case studies.

3. Case study: current situation of a patient with low
back pain and knee pain and the acupuncture andmoxibustion treatment
The Comprehensive Survey of Living Conditions
conducted in 2013 reports the ratio of the five leading
symptoms among person reporting to have symptoms
classified by sex (several answers possible).
The leading symptom in men is low back pain, in second
place followed by shoulder stiffness, in third place by
nasal congestion, in fourth place by cough and sputum.

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

Volume 13, Number 4 | Winter 2018

The fifth most frequent symptom was pain of joints ofaccumulation and diarrhea. At times of diarrhea hearms or legs. On the other hand, the leading symptom insuffered from marked pain and tenderness in he left

women was reportedly shoulder stiffness, followed in

BL52 region. An x-ray taken during a visit to an

second place by low back pain, in third place pain oforthopedist showed a mild degree of scoliosis, thejoints of arms or legs4). Pain of joints of arms or legs

formation of bone spurs and the physician also pointed

should be understood as referring to the shoulder andout a mild degree of osteoarthritis of the spine (Figure 1).

knee joint. In other words, low back pain and gonalgia

Therefore the physician diagnosed "fatigue induced low

are considered to be a very common symptom amongback pain". Later, the patient experienced acute low

Japanese people.

back pain attacks once or twice per year. Each time theAmong the symptoms treated in acupuncture clinics

condition improved after acupuncture and moxibustion

many patients complain of low back pain and gonalgia

treatment.

and many of the patients over the age of 40 complainingof low back pain and gonalgia should be considered tosuffer from osteoarthritis of either the spine or the knee
(OA). Being characterized by irreversible elements these
conditionsarechronic

diseasestreatedwith

acupuncture and moxibustion in order to slow down
diseaseprogression,

alleviate

pain

and

improvefunctional disorder5,6).

4. Case report
Patient: dull low back pain and knee pain
Male, 60-years old, acupuncturist, height 173 cm, weight
68 kg, BMI 22.9
Chief complaint: (1) left low back pain, (2) discomfort
and pain of the left knee (ST35), low back pain (left >right)(1) Since the age of 20 the patient experienced chronic
dull low back pain and the muscle of the lumbar region
often tended to be tense. The left leg was the patient's
dominant leg and when he paid attention, he could feelshifting his body weight towards the left side. When
tired, a table tennis ball sized muscle induration
developed in the left lumbar region (BL52) and caused
pain. Pressure was felt as pleasant. Since the age of 40
work related busyness gradually increased, working
hours tended to be irregular and he slept only 4-5 hours,
so that the chronic lack of sleep had already become theabdominal

bloating(2) Since his time in university the patient loved to run
and formerly did jog and commuted 2-3 time per week toand cannot find any time for sports, rendering exercises● Medical history

condition.

(spondylopathy)

a gym for his health management, but now he is too busy

Interest: jogging

normalFigure 1: x-ray findings of the lumbar region

Occasionally
from

he

experienced

gastrointestinalgas

performed once every two weeks largely insufficient. His
weight gradually increased from 60 kg to 68 kg.
Since the age of 30 he participated maybe a dozen times
in full marathons. The gonalgia developed because heoriginally planned to run 100 km per months as training
starting 4 months ago. However, being busy with hiswork kept him from actually implementing the training
schedule and when he actually started training,
discomfort and gonalgia developed after running a
distance of approximately 5 km. An x-ray of the kneetaken during a visit to an orthopedist was normal(Figure 2). From this time onward overuse induced pain
was pointed out. He did not undergo any particulartreatment. He decided to observe the course while being

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

3

Volume 13, Number 4 | Winter 2018

treated with acupuncture and moxibustion. The● General findings

acupuncture and moxibustion treatment provided someBlood pressure 110/70 mmHg, pulse rate 72 bpm,

relief. Later he experienced some mild knee pain after

brachial biceps tendon reflex, triceps tendon reflex,

excessive running. He also experienced some discomfort

brachioradial tendon reflex, patellar tendon reflex,of the left knee while walking and jogging, aggravating

Achilles tendon reflex were all normal, abdominal

after a certain distance and developing into pain duringpercussion showed generalized tympanicity, muscle

exercise. Climbing and descending stairs too resulted intension (left > right) in the lumbar region, loss of lumbar

mild pain. Due to injections into the thigh received

lordosis (Figure 3). A table tennis ball sized induration

during infancy there was a mild degree of quadriceps

and marked tenderness were observed in the vicinity offemoris muscle atrophy. Occasionally shoulder stiffness

the left BL52. Tenderness was also observed at CV12,developed.

ST25, ST26, BL17, BL18, BL25.

Figure 2: x-ray findings of the knee joint
General condition: The patient has appetite andexcessive eating sometimes causes abdominal bloatingor vomiting, sleep duration is short, about 4 hours, bowel
movement frequency varies between once every 1 to 3

Figure 3: Findings of inspection of lumbar region anddays.

knee of a 60-year old man

The annual health check does not show any particular
problems, but he had been advised to take precautions● Findings of physical examinations

against hypertension and pneumonia.

(1) Lumbar mobility (bending forward, backward,● Past history

sideways, rotation) was normal. The finger-floor

Surgery for left paranasal sinusitis, partial resection of

distance was 15 cm and although there was no pain, thebone because of a deviation of the nasal septum (at the

body was stiff. SLR test (-), K-Bonnet test（-）, Kemp's

age of 17), hospitalization for 17 days (at the age of 48)

sign (-), walking on tip toe (possible), plantar and dorsal

becauseorganizing

flexion of the first toe was normal on both left and rightpneumonia, laser photocoagulation (at the age of 50) forside, sensation too was normal on both sides, internal

right retinal tear, atypical pneumonia treated withand external rotation test of the hip joint (-), Newton's

Cravit,oftest (-), normal pulse of A. dorsalis pedis, tibialis

hypertension (at age 58) and is since then treated withposterior, femoralis, no percussion tenderness, FNS test

the antihypertensive agent UNISIA (Camshia) one(-). Tender points: left BL22 (+), BL25 (+), left BL52 (+3),

tablet in the morning.

tension of the erector spinae muscles left > right7).

4ofbronchiolitis

Carbocysteine(atobliterans

age

58),

diagnosis

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

Volume 13, Number 4 | Winter 2018

(2) No rubor, warmth or swelling of the knee joint, nopatient occasionally developed diarrhea, disrupting thevarus deformity, but there is a distance of 4 cm between

regularity of his daily life. His current condition

both knees, no valgus deformity (Figure 3), no flexion

conceivably developed before this background. The low

deformity, atrophy of the left and right thighs. The

back pain and gonalgia were conceivably caused by thesecircumference of the thighs (15 cm above the patella atvarious forms of stress. The low back pain was also

sites of marked indentations) was 47.4 cm on the rightbrought about by an accumulation of muscle fatigue, but

and 47 cm on the left; at a distance of 10 cm above theis basically due to some minor degree of spondylopathy

patella these values were 42 cm on both left and right;

and muscle fatigue. Here I decided to alleviate thecircumference at the level of the patellar base was 37.4

individual symptoms with acupuncture and moxibustion

cm on the right and 37 cm on the left, patellar ballotment

treatment and add some general conditioning.

(-), patella grinding test (-), varus / valgus stress test of(1) Relief of muscle tension in the low back area and overthe knee (-), Steinman test (-), McMurray's test (-),

the back, administering some comfortable needle

anterior drawer test (-), posterior drawer test (-),

sensation at the point of maximal tenderness (BL52). I

Lachman test (-), flexion impairment (-), quadriceps

also added treatment to regulate the gastrointestinal

femoris power (-). Tender points: ST31, GB31, ST34,

function.

SP10, particularly marked at medial Ex218).

(2) Treatment to achieve relief of muscle tension in the● Identifying the pathology

thigh and lower leg to alleviate pain, administering some(1) The x-rays of the lumbar vertebrae showed some

comfortable needle sensation at the point of maximal

minor osteophyte development and based on thetenderness (Ex-LE4).

presence of scoliosis and rotation of the lumbar● Treatment

vertebrae as well as the medical history and the absence

I used 40 mm No. 18 Seirin disposable needles andof positive pathologic findings, the condition was

needled mostly sites of tenderness or indurations10).

considered

age-related

Needling sites were BL10, GB21, SI14, BL43, LI10,

spondylophathy. Constant strain on the left lumbar

ST36, Ex-HN5. Each of these points were needledregion then led through overuse to hypertonic stress ofapplying some thrusting and lifting manipulation to

the erector spinae muscles etc., which then probably

obtain a pleasurable needling sensation. Treatment

resulted in myofascial low back pain.

duration was about 20 minutes.

tobemainlydueto(2) Knee x-rays were normal. Medical history andpathologic examinations allowed to rule out meniscus
damage or lesions of either the anterior crucial ligamentor the collateral ligaments. Injections the patient
received during infancy into the thigh caused a mild

Tenderness/indurations

GB31

degree of quadriceps femoris atrophy, but muscle testing
did not reveal any problems. Exercises like walking andrunning etc. likely strained the patient's knee. A mild
degree of soft tissue inflammation induced by overuse isalso conceivable9).

● Treatment plan
Being very busy with his work, a chronic lack of sleep,
paired with irregular meal times and excessive eating
and drinking caused gastric bloating or nausea. The
gastrointestinal functioning was not really well and the

Figure 4: Left BL52 needling and needling sensation
50 mm disposable needles, No. 24, insertion depth 4 cm
perpendicular to the body surface, with maximal
needling sensation
At GV20 a needle was retained until the end of thetreatment to raise the pain threshold and promote
sleeping. To regulate gastrointestinal function I madesingular insertions at CV12, ST27 and ST36.

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

5

Volume 13, Number 4 | Winter 2018

(1) On the back thrusting and lifting manipulation at

Later acupuncture and moxibustion treatment was

BL17, BL18, BL20, BL22, BL25. Application of acontinued for maintenance at a rate of twice a week.

pleasurable needling sensation at BL5211).

During the treatments the quiet breathing of the(2) Singular insertions on the thigh at ST31, SP10, ST34,

sleeping patient could be heard and after the treatments

Ex-LE4, ST36, GB31; on the posterior side BL37, BL40,

he reportedly felt very refreshed. Even though he

KI10 and BL56. Needles were retained at ST31, ST34,

complained generally about occasional low back pain

Ex-LE4, ST36, GB31 and on the posterior side at BL37,

and stiff shoulders, acupuncture and moxibustion

BL40, KI10 and BL56.

treatment administered early after the onset of those

Needle retention for 7 minutes at ST31, SP10, ST34, Ex-symptoms usually led to an early improvement. He is

LE4, ST36, GB3112).

still very busy with his work and sleeps only about 5hours, but since the acupuncture and moxibustion

ST31

RectusfemorisTensor fasciae latae

Iliotibial tract
Biceps femorissartorius

BL37
GB31

VastusMedialissemimembranosus
SP10 ST34

semitendinosus
Vastus lateralis

Ex-LE4

KI10

BL39

ST35

Figure 5: Basic acupoints for the treatment of gonalgia

treatment has improved his general condition, theSeiichiro Kitamura et al.: Color Atlas of Local Anatomy fortreatment frequency was changed from twice a week to

Acupuncturists and Judo Therapist; Nanzando; 101-111

once a week. Even though the sleep duration has notchanged, he reported to sleep better recently and bothResults

appetite and bowel movements are well regulated. This

The muscle tension in the lumbar and femoral regions

gives the impression of a good health management.

decreased after the acupuncture and moxibustion
treatment and the patient reported a VAS 10 → 1
improvement for the low back pain and a VAS 10 → 5
improvement for the knee pain. The treatment effects
lasted for 2-3 days. After 3 days a similar treatment
resulted in a VAS 5 → 1 improvement for the low backpain and a VAS 5 → 1 improvement for the knee pain.
After the third session the VAS score improvement of 3
→ 0 was achieved for both low back pain and knee pain.

6

5. Discussion
1) Necessity for an accurate assessment of thepathology
BL40

Acupuncture and moxibustion is a treatment form witha long history and has been handed down as an
unbroken tradition. When acupuncturists practice basedon modern medical examination methods and with anunderstanding of pathology, they can accurately assess
the pathology of their patients, assess whether

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

Volume 13, Number 4 | Winter 2018acupuncture and moxibustion treatment is indicated or

acupuncture and moxibustion treatment lies. However,contraindicated, the question of whether the patient

the therapists should inform the patient prior to theshould be referred to a specialist, and holding

acupuncture

discussions with physicians and co-medical staff enables

importance of a regular daily life. Medical care basicallythem to cooperate in medical care. Also, in case thestrives to bring about improvement of symptoms or

conditionahealing, but the essence of acupuncture and moxibustion

contraindication for acupuncture and moxibustion

treatment does not restrict its attention to specific bodytreatment, it is necessary to recommend seeing a

regions or conditions, but rather aims at healthspecialist13).

management (maintenance) and the prevention of2) Tender points and needling points

diseases. Health is sleeping well, eating well and

The needling sensation elicited at the left BL52 induced

pleasantin this patient marked improvement. Acupuncture andmoxibustion treatment can maintain these three healthmoxibustion comprises many different techniques. We

factors10-14).

isconsideredorsuspected

tobeas acupuncture therapists use tender points or
indurations, motor points, trigger points etc. fortherapeutic purposes based on an anatomical point ofview. Treatment point locations often coincide withacupoints, but their selection is not restricted to oriental
medical examinations, but local tender points also
constituteusefulsourcesofinformation

for

an

assessment of the condition at hand and the actual
needling requires a search for the point of maximal
tenderness and identification of its accurate anatomical
location14).

3) Acupuncture and moxibustion treatment for local
and general symptoms
Three years ago this patient had suffered frompneumonia and thus was worried about his health.
While being in general confident about his health, he
was kept very busy and thus had to deal with chronic

and

bowel

moxibustion

movements.

treatmentof

Acupuncture

the

and

5. Conclusions
Above I briefly described The Japan Conference ofClinical Acupuncture & Moxibustion and offered myopinion about the merits of Japanese acupuncture andmoxibustion by presenting a case report. The basis for acorrect understanding of pathologic conditions byacupuncturists

is

the

acquisitionofknowledge

pertaining to modern medical examination techniques,assessment of pathologies and available therapies aswell as the careful observation of tender spots andindurations on the body surface. Acupuncture andmoxibustion treatment is not restricted to local
treatment, but can treat the whole body and thus
presents a holistic medical care allowing to include
health management and maintenance (reconditioning
treatment).

feelings of fatigue. On this occasion an extended period

6. Referencesof acupuncture and moxibustion treatment led to1.

Tomofumi Ozaki: Fifty years development of The

improved sleep and bowel movements, helping to relief

Japan Conference of Clinical Acupuncture andaccumulated fatigue. The treatment also increased theMoxibustion,

patient's awareness pertaining to health management

Acupuncture & Moxibustion, 27-1, 22-23, 2014

and daily efforts related to health maintenance. Clinical

2.

tasks

and

outlook,

Clinical

Sakae Yoneyama: Proposal for the commemorationacupuncture and moxibustion is characterized accordingof the 50th anniversary of the foundation of the The

to Hirohisa Yoneyama10) and Sakae Yoneyama14) not only

Japan Conference of Clinical Acupuncture &by treatment form for diseases, but also as a form of

Moxibustion – Is EBM required for clinicalhealth management, in other words for regularacupuncture and moxibustion? 27-1, 10-21, 2014

maintenance (reconditioning treatment) and the author
too is convinced, that this is where the real value of

3.

Katsuhiro Yamada: The future of clinical acupuncture
and moxibustion in Japan – The past, present and

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

7

Volume 13, Number 4 | Winter 2018

future

of

The

Japan

ConferenceofClinicalAcupuncture & Moxibustion; 27-2, 21-37, 20144.

Yukari Ikeda, Satoshi Yamaguchi, Tomokazu
Kikuchi: The Japanese Journal of Japanese
Acupuncture and Moxibustion Therapies, 78-1,
161-166, 20195.

Hideki Ochi: Clinical research into gonarthrosis;
Osaka

JournalofClinicalAcupuncture&

Moxibustion; 18-4, 33-39, 2002
6.

Tadasu Matsumoto: Acupuncture and moxibustion
treatment for low back pain; Osaka Journal of
Clinical Acupuncture & Moxibustion; 13-4, 47-56,
1997 勅7.

Tatsunori Sakamoto: Low back and lower extremity
pain; Clinical Acupuncture & Moxibustion Pocket
Guide; Artemisia; 77-91, 20108.

Tatsunori

Sakamoto:

Acupuncture&

Gonalgia;

Moxibustion

ClinicalPocketGuide;

Artemisia; 94-107, 20109.

Ken Nakata: Listen to a leading authority in sports
research; Newest insights pertaining to thetreatment and care of the knees; The Japanese
Journal of Japanese Acupuncture and Moxibustion
Therapies; 78-1, 19－27, 201910. Hirohisa

Yoneyama:My

acupunctureandmoxibustion therapeutics; The Japanese Journal ofJapanese Acupuncture and Moxibustion Therapies;
Tokyo 1985
11. Tomofumi Ozaki: Watching the back of my teacher;
The Japanese Journal of Japanese Acupunctureand Moxibustion Therapies; 2005；738. 188-193
12. Toyoji Sakamoto, Seiichiro Kitamura et al.: Color
Atlas of Local Anatomy for Acupuncturists andJudo Therapist; Nanzando; 2016, 106・96; ST31
13. Masami Sato: Case reports about cooperation in
medical care with specialists for the knee joint; The
Japanese Journal of Japanese Acupuncture andMoxibustion Therapies; 78-1, 148-154, 201914. Sakae Yoneyama: Essentials of the treatment ofstiff shoulders - acupuncture and moxibustion
treatment for stiff shoulders -; CLINICIAN, 44-461,
36-44, 1997

8

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