Volume 11, Number 1 | Spring 2016

Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (19) –Geriatric Department
Takashi Sekifamily, residence, and economic status. It has beenreported that people who have undergone CGA
display lower mortality rates, higher survival rates
in the home, improved ADL, and greater cognitive
function compared to people who have notA. The Geriatric Situation and Elderly Medical

undergone CGA2). Before today’s aging society,

Care in Japanemphasis was placed on providing life-prolonging

The population aging rate (percentage of thetreatment to keep patients alive, but in an aging

population over the age of 65) in Japan has beensociety, it is important to provide medical care that

increasing, such that in 2007, the aging rate

not simply allows patients to live longer, but thatexceeded 21% and Japan became a super-aging

allows patients to live in good health by placing

society. By 2055, the aging rate is estimated toimportance on healthy life expectancy and QOL.

reach 40.5%, with one in every 2.5 people a senior

Medical care that is vertically divided by type ofcitizen1).

organ is not suited to treating elderly people.

One of the characteristics of diseases developed

Medical care for the elderly is an area that could

among the elderly is the simultaneous disorder ofbenefit from traditional medicine, which treats

multiple organs, or multiple organ failure. Elderly

patients by examining their entire being. The

people have diminished internal organ functions,concept of CGA is also in a way similar to that ofsuch as the liver and kidney, so even drug doses

traditional medicine. Patient-driven team medicine

that are normally administered to adults take time

based on such comprehensive assessment isto metabolize and discharged, and frequently

indispensable to medical care for the elderly.

produce overly strong effects and side effects. It is

However, in Japan, the medical world still offers

not uncommon for elderly people to be prescribed

only a limited field of activities to acupuncturists. It

many different types of internal medicine from ais thus necessary to create more opportunities

multiplewhere acupuncturists can be active in the same way

numberofclinicaldepartments.

Conditions such as falls, stupor, memory loss,

asphysicians,nurses,

physicaltherapists,incontinence, bedriddenness, malnutrition, andoccupational therapists, nutritionists, pharmacists,

iatrogenic disorder are often observed among theand social workers.

elderly. Called geriatric syndrome, these conditions
simultaneously affect multiple organs, but differs

B. Acupuncture and Moxibustion Therapy forfrom organ diseases that are seen in people who are

Elderly Medical Carenot yet in old age, in that prolonged bed rest in theSymptoms that are commonly seen among thehospital becomes a cause of disuse syndrome. To

elderly could be easily explained as stemming fromprovide medical care for elderly people with suchdecreased kidney function, in many cases. Kidney

characteristics,

Geriatricyang warms the organs and tissues, and deficiency

Assessment (CGA) was developed in England as aof kidney yang produces symptoms of coldness.

multidimensional method of assessing various

Decreased kidney function leads to a decrease infunctions in elderly people. CGA includes anbone marrow, heaviness and unsteadiness of theassessment of the activities of daily living (ADL),

lower back and knees, and eventually gait disorder.

the Mini Mental State Examination (MMSE) andUrination and defecation cannot be controlled, and

the Geriatric Depression Scale (GDS) as measures

hearing is impaired.

theComprehensiveof mental functions, and assessments of patients’8

There was a case in which an 80-year-old woman

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

Volume 11, Number 1 | Spring 2016

was wheelchaired to the hospital. Her family

rehabilitation for patients coping with the after-

requested to purchase a wheelchair, as she has

effects of a cerebrovascular disease. The list can godifficulty walking. The patient was sensitive to theon and on. Some case data are presented below.

cold, and developed coldness particularly in her
lower body. She was bent, had weak legs and a weak

1. Chronic pain

back, and was hard of hearing. She had nocturia andA common complaint among the elderly is chronic

tended to produce loose stool. Mentally, she had apain, mainly in the lower back and knees. Large-feeling of fatigue. Her pulse was sunken and slow,

scale studies have been conducted in Germany

and her tongue was pink. These symptoms all

regarding this.

disappeared with a moxa needle to the bladder

Brinkhausetal.

examined

theeffectsofmeridian and kidney meridian and a salt moxa to theacupuncture therapy in 298 patients with chronic

navel, and the patient recovered to the point where

lower back pain with an average age of 59±9. The

she could go into the mountains alone to pick wild

patients were divided into three groups. One group

edible plants and answer the phone for the first time

was treated by Chinese acupuncture therapy.

in twenty years. The patient had a typical case ofAnotherkidney yang deficiency, and the various symptoms

acupuncture, which involves the shallow insertion ofthat extended into diverse areas, including theacupuncture needles in non-acupuncture points. The

locomotive organs, urinary organs, ear and throat,

third group composed a waiting list, and was notand mental condition, all improved by simple

given acupuncture therapy. Acupuncture therapy

acupuncture

By

and minimal acupuncture were administered twelve

examining clinical patterns called Sho, and applying

times over a period of eight weeks. The degree oftreatment suited to the Sho in question, this caselower back pain was evaluated according to theshowed that the symptoms of even multiple organ

Visual Analog Scale (VAS; 0 – 100mm). The VAS

failure as defined by Western medicine could beshowed an improvement of 28.7±30.3mm for the

improved all at once. The case can also be said toacupuncture therapy group, 23.6±31.0mm for theshow the usefulness of recognizing patterns from aminimal acupuncture group, and 6.9±22.0mm in theperspective that differs from Western medicine.

waiting list group. The difference in improvement

andmoxibustion

therapy.

group

wasadministeredminimalIt is also worthy of mention that while medical

between the acupuncture therapy group andcare by orthodox medicine is invasive in many cases,

minimal acupuncture group was 5.1mm and not a

acupuncture and moxibustion therapy causes little

significant difference, but the difference between thehealth damage. It applies physical stimulation to theacupuncture therapy group and waiting list groupbody surface, and provides treatment without thewas a significant difference of 21.7mm. In the 26thaddition of internal medicine. This is a large

and 52nd weeks, no significant difference in pain

advantage that even Kampo therapy does not offer,

was observed between the acupuncture therapy

although they both fall under the same traditionalgroup and minimal acupuncture group3).

medicine category.

Witt et al. examined the effects of acupuncture

Acupuncture and moxibustion therapy could

therapy in 300 patients of chronic osteoarthritis ofbenefit elderly medical care in many areas. For

the knee of Kellgren grade 2 and lower. 150 patients

example,cancer,were treated by Chinese acupuncture therapy, 76

cerebrovascular diseases, and pneumonia, which arewere administered the abovementioned minimal

the top causes of death. It can also be used to relieve

acupuncture to non-acupuncture points, and thethe pain caused by cancer, or to supplement

remaining 74 composed a waiting list. AcupunctureitcanbeusedagainstThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

9Volume 11, Number 1 | Spring 2016

therapyandminimal

acupuncture

wereon oral drug administration.

administered 12 times over a period of eight weeks.

Seki et al. administered acupuncture treatment to

The WOMAC index adjusted for baseline score was

the stomach meridian and kidney meridian in

used to judge the effects. In the eighth week, thepatients of cerebrovascular diseases who have a past

acupuncture therapy group scored 26.9, the minimal

history of aspiration, and reported an improvement

acupuncture group 35.8, and the waiting list groupin the swallowing reflex and a significant decrease in

49.6, and a significant improvement was observed inaspiration and pharyngeal residue according to

the acupuncture therapy group compared to thevideofluorography7),

other two groups. In the 52nd week, no significant

swallowing reflex was also observed when applying

difference was observed between the acupuncture

electrical stimulus to the same acupuncture points

therapy group and minimal acupuncture group4).

with a skin surface electrode9).

2. Dysphagia and aspiration pneumonia

3. Visual impairment

Pneumonia is the fourth highest cause of death in

Glaucoma

is8).

theAn

improvement

numberonecauseinofJapan, and more than 90% of pneumonia victims areadventitious blindness in Japan. There are anelderly people ages 65 and above. A salient

estimated 4 million patients, but the number ischaracteristic of pneumonia among the elderly isexpected to increase with age. As visual impairment

aspiration pneumonia. Swallowing and coughing

is a cause of falls, it can be said to be a disorder thatreflexes are defense mechanisms we all have, andcannot be overlooked from the perspective ofprotect our lungs from aspiration. A major cause of

preventing falls. Kurusu et al. administered

pneumonia

diminishedacupuncture therapy to glaucoma patients, andswallowing and coughing reflexes caused by areported a lowering of intraocular pressure andcerebrovascular disease of the basal ganglia5). Basal

improved vision10).

among

theelderlyisganglia cerebrovascular diseases reduce the amountof dopamine that is produced in the nigrostriatal

C. Prospects

pathway, and this reduces the amount of substanceMeta-analyses and systematic reviews have been

P (SP) that is released from the sensory branch of themade, but the following issues exist.

vagus nerve to the membranes in the pharynx and1) There are few clinical trials of acupuncture

trachea. As SP is an important trigger for thetherapy

swallowing and coughing reflexes, a decrease in SP

2) There are few trial subjects

causes those reflexes to decline6). In cases of3) Protocols are insufficientdiminished swallowing reflex, aspiration occurs
unawares(silentaspiration),andsaliva

andThe greatest reason why protocols are insufficientis the difficult in establishing a control group.

intraoral bacteria get into the lungs.
In China, acupuncture and moxibustion therapy

Placebo acupuncture therapy is extremely difficult,has long been used for treatment of the after-effects

and so are double blind trials. For this reason, manyof cerebrovascular diseases and dysphagia.

clinical studies cannot be said to accurately assess

In some cases, patients with dysphagia cannot be

acupuncture and moxibustion therapy.

oral

In addition to these issues, there are the following

administration because of their swallowing disorder.

issues in the medical field and education in Japan.

Such patients require a new type of treatment toOne is the small numbers of clinical trials and trial

improve their swallowing reflex without depending

subjects.

given10drug

treatmentthatrequires

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

therearehardlyany

Volume 11, Number 1 | Spring 2016acupuncturists in medical institutions, it is difficult

Reference

to find subjects for clinical trials when they are1)

Statistics Bureau, Ministry of Internal Affairs

needed. Another is that since acupuncture andand Communications. Population of elderly

moxibustion therapy requires manpower, it is notpeople. Available ateasy to increase the number of subjects or to extend

http://www.stat.go.jp/data/topics/topi721.htm.

the follow-up period even when a large-scale clinical

2)

The Aging Society: Current Situation andImplementation Measures, FY2008

study is attempted.
As mentioned earlier, elderly people are weaker

3)

AE, Siu AL, Wieland GD, et al.: Comprehensive

than young people. Therefore, elderly medical caregeriatric assessment: a meta ─ analysis ofrequires due care and attention especially whencontrolled trials. Lancet 342: 1032─1036, 1993

moving patients. However, as it is believed that4)

Brinkhaus B, Witt CM, Jena S, et al.:acupuncture and moxibustion therapy offers vast

Acupuncture in patients with chronic low backpossibilities

pain: a randomized controlled trial. Archives ofinelderly

medicalcare,highInternal Medicine 166: 450─457, 2006

expectations shall be placed on future studies.
5)

Witt C, Brinkhaus B, Jena S, et al.: Acupuncturein patients with osteoarthritis of the knee: arandomised trial. Lancet 366: 136─143, 2005

6)

Nakagawa T, Sekizawa K, Arai H, et al.: Highincidence of pneumonia in elderly patients withbasal ganglia infarction. Archives of Internal
Medicine 157: 321─324, 1997

7)

YamayaM,YanaiM,

OhruiT,etal.:Interventions to prevent pneumonia amongolder adults. Journal of the American Geriatrics
Society 49: 85─90, 2001
8)

Seki T, Kurusu M, Tanji H, et al.: Acupunctureand swallowing reflex in poststroke patients.
Journal of the American Geriatrics Society 51:726─727, 2003

9)

Seki T, Iwasaki K, Arai H, et al.: Acupuncture fordysphagia

inpoststroke

patients:

avideofluoroscopic study. Journal of the American
Geriatrics Society 53: 1083─1084, 2005
10) Akamatsu C, Ebihara T, Ishizuka S, et al.:Improvementofswallowing

reflexafter

electrical stimulation to lower leg acupoints inpatients after stroke. Journal of the American
Geriatrics Society 57: 1959─1960, 200911) Kurusu M, Watanabe K, Nakazawa T, et al.: Acupuncture for patients with glaucoma. Explore(NY) 1: 372─376, 2005

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