Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

insurance. The only exceptions are cases of: ① low

Current Status of Acupuncture in Japan
Tadashi Yano
Health Medicine Department
Meiji University of Oriental Medicine

The history of acupuncture therapy in Japan dates
back to the year 562 CE, when the physician/monk Zhi
Cong brought books on Buddhism and acupuncture
China.

This

was

the

beginningoftheacupuncture tradition in Japan.
Chinese traditional medicine was changed overtime in Japan to adapt to the physical characteristicsof the Japanese people while also incorporating someelements of Western medicine and native Kampo
medicine. It developed gradually into a uniquely
Japanese approach to traditional medicine. However,in the Meiji Era, the government abolished Kampo
medicine and established German medicine as thebasis for Japanese mainstream medical practice.
Acupuncture education continued to be permitted, but
only as employment training for the visually impaired,and acupuncture was positioned well outside themedical mainstream. That positioning and educational
system has continued into the present day.
This article will provide a short overview of thehistory and current status of acupuncture in Japan, in
hopes that the information provided here will lead to
improved understanding of Japanese acupuncture
therapy.

modern medicine provides little hope of relief. Thoseconditions can be covered by national health insurance
if the doctor signs a form certifying that the condition
cannot be cured by orthodox medicine. However, since
only a few Japanese physicians understand theacupuncture system, it can be quite difficult to obtainacupuncture therapy under national health insurance
even for patients who have these approved conditions.
3. The licensing system for acupuncturists andmoxibustionists
A license is required in order toperform

acupuncture or moxibustion therapy. This is because
acupuncturists and moxibustionists have legislated
statusinJapan.

acupuncturists

The

and

professional

moxibustionists

statusisoflegallyprotected, and since their right to independently
operate a business is assured, they are able to open an
acupuncture clinic. However, legislation assures thatno one other than a physician can perform moxibustion
and acupuncture therapy [in such a facility], whichmeans that moxibustion and acupuncture may not be
performed by non-physician health care practitioners.
Thus, licensed acupuncturists and moxibustionists
are free to start a business. However, they are strictly

2. The position of acupuncture therapy
In Japan today, the use of acupuncture within a
medical institution is prohibited. This means that
acupuncture is effectively positioned outside theprimary medical system as "unorthodox" medicine.
Acupuncture is considered to be "free" treatment
meaning that it does not come under the jurisdiction ofnational health insurance, and therefore the services
and fees are not regulated by the government.
Generally, acupuncture must be paid for directly by
the patient, rather than being covered by health76

neuralgia, ④ rheumatoid arthritis, ⑤ cervicobrachial
syndrome, and ⑥ cervical sprain, where mainstream

1. Introduction

fromback pain, ② age-related shoulder pain or stiffness, ③

prohibitedfromperforming

moxibustionor

acupuncture within a medical facility alongsideorthodox mainstream medicine, and their access tonational health insurance coverage for their patients isstrictly limited.
Acupuncturists

andmoxibustionists

arecredentialed by the national government. Thosestudents who qualify for college entrance examinations
must study at a designated school for three years (fouryears for university students) and earn specific credits
in order to qualify for the national examination. Those

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

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

students who pass the national examination andmay include some acupuncturists and moxibustionists

receive a license are permitted to perform acupuncture

who are not currently practicing. According to a survey

and moxibustion therapy. Nearly all examinees apply

by Fujii and colleagues1), approximately 26.5% of thatsimultaneously for both the acupuncturist license andnumber are not actually engaged in the practice oftheacupuncture/moxibustion.

moxibustionist

candidateislicense,designated

and

as

an

the

successful"acupuncturea/

moxibustionist" (or simply "acupuncturist") in Japan.

The register of enrolled (licensed) acupuncturists
and moxibustionists showed 127,018 acupuncturists
and 125,868 moxibustionists in Japan as of September
2005. However, these figures represent the number of
persons in the enrollment register, and do not indicate
the number of acupuncturists and moxibustionists
who are actually working in the industry. The trueofacupuncturists

andmoxibustionists

currently employed in clinical moxibustion andacupuncture is unknown, but a 2004 report on healthand sanitation administrative operations by the
Ministry of Health, Labor, and Welfare showed a totalof 76,643 acupuncturists and 75,100 moxibustionists
at that time (Table 1).

Acupuncture,thenumber of acupuncture clinics providing related formsof alternative medicine showed 14,993 clinics offeringoffering traditional amma massage and shiatsupressure-point massage as well as moxibustion andacupuncture in Japan (2004 report on health andsanitation administrative operations by the Ministryof Health, Labor, and Welfare)2), for a total of 48,594
clinics providing moxibustion and acupuncture.
Based on these findings, we can estimate a total of
approximately

55,000acupuncture/moxibustionists

actively practicing in Japan today.
5. Clients seeking moxibustion and acupuncture
therapy
Table 2 shows the frequency with which people
who had medical complaints ("yusosha") selectedvarious

types

of

1992

1994

1996

1998

2000

2002

2004

treatment options for

12055

12481

13166

13455

14216

14008

14993

their

moxibustion
Amma, shiatsu,

intomoxibustion and acupuncture, and 33,601 clinics

4. Number of acupuncturists and moxibustionists

numberInvestigation

symptoms,

according to a 2001
28624

29451

30850

31434

32024

32722

33601

basic national healthacupuncture,

surveymoxibustion

Forms of treatment
such
and

Japan.

asamma,

Table 1 Annual trends in working acupuncturists andmassage,moxibustionists

accounted for 7.4% of the total. The term ”yusosha”,(2004 report on health and sanitation administrative

meaning people who had subjective symptoms, wasoperations by the Ministry of Health, Labor, andintroduced as an index for health status among the

Welfare)Japanese people. The 2001 survey found 4,0552,000

The totals from the Ministry of Health, Labor, andshiatsu,inacupuncture/moxibustion

yusosha, 322 out of every 1000 individuals. It was

Welfare are for all acupuncturists and moxibustionists

estimated

who registered with their public health center, andpatients

thatapproximately

received

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

300,000

treatment

of

these

at

an
77

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010acupuncture/moxibustion/massage clinic. It was also

did not focus specifically on the situation regarding

reported that approximately 7% of all sick and injured

moxibustion and acupuncture therapy, the author andpersons sought out such alternative clinics for theircolleagues performed an annual interview survey

treatment.

during March in each of the four years from 2003
through 2006. This nationwide survey

Hospital or

Over-the-counter

Amma,

Other

No

mainstream

drugs

acupuncture,therapies

treatment

medicalpoulticesorclinic
49.7%

19.9%

used a random sampling of 2000 men

moxibustion,

and women 20 years of age or older

etc.

(2000 names collected from 157 regions

7.4%

3.7%

across Japan, including 122 cities or

21.8%

municipal wards and 35 towns or villages). This survey
Table 2 Treatment options selected by yusosha

also excluded patients in hospitals and extended-care(2001 survey of health status in Japan)

facilities. The response rate differed somewhat from

These indicators in all cases relate to the situation
for patients receiving treatment. However, since judo
therapy was included in the category of "Amma,
acupuncture, moxibustion, etc.", these figures do notprovideanaccurate

pictureofthestatusofacupuncture/moxibustion therapy.
A nationwide survey of the use of complementary
andalternative

medicine(CAM),

includingmoxibustion and acupuncture, was initiated by
Yamashita

3)in April 2001. For their survey,

Yamashita and colleagues used RDD (Random Digit
Dialing)andayear to year, but was approximately 68%. The primaryreasons for non-response included change of residence,long-term absence, short-term absence, unknown
address, and refusal to respond.
The results of this survey clearly showed that 6%
to 7% of Japanese persons 20 years of age or older
visited an acupuncture/moxibustion clinic during theyear (Table 3). Results for the March 2004 survey
showed a lower level of such clinic visits, but still
within the range of significant error for the March
2003 figures.

telephoneMarchquestionnaire. Their subjects were

2003

March
2004

March
2005

March
2006

persons 20 to 79 years of age who

No. of responses

1,420

1.338

1,337

1,346

were not residing in a hospital or

Consultation rate

6.4%

4.7%

6.4%

6.7%

extended care facility. The survey was

Response rate

71%

66.9%

66.9%

67.3%

continued until 1000 subjects had been contacted.
Even though the response rate was only 23%, thissurvey was notable because it was the first such
survey of CAM to be performed in Japan. The resultsofthesurveyshowednutritional

drinksTable 3 Moxibustion and acupuncture consultation
rates and response rates
Both the findings by Yamashita and colleagues andandthose from our own studies, showed that moxibustion

supplements to be in first place, used by 43% of

and acupuncture therapy accounted for approximately

respondents while moxibustion and acupuncture were

6% to 7% of the annual response to medical

reportedly used by 6.7%.

complaints.

Because the survey by Yamashita and colleagues

If we can determine the mean number oftreatments per patient, then we can also calculate the78

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

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

total number of patient treatments given. Assuming atreatment rate of 6% gives us an estimated 6 million
patients treated. If we also assume an average of 5treatments per patient, then the total number ofpatient treatments would be 6 million × 5 times, or
total of 30 million treatments. A treatment rate of 6.5%
would be 32.5 million treatments, and a treatment rateof 7.0% would indicate 3.5 million treatments.
Acupuncture/moxibustion clinics can provide a
broad spectrum of care, fromhealth maintenanceand wellness care to the treatment of presymptomatic
illness, treatment of disease, and improvement ofquality of life for chronic disease patients. However,
unfortunately acupuncture/moxibustion therapy iscurrently used in only 6% to 7% of cases. If we candetermine why this use rate remains so low, and thenremedy at least some of the reasons for that low use,

Table 4: EQ-5D

Men

Women

Mobility(%)(%)

No problems

81.5

76.4

Some problems

18.5

23.6

No problems

93.0

95.2

Some problems

7.0

4.8

No problems

77.3

77.4

Some problems

22.7

22.6

None

39.9

31.2

Moderate or above

60.1

68.8

None

79.4

73.2

Moderate or above

20.6

26.8

Self-care

Usual activities

Pain/discomfort

Anxiety/depression

acupuncture/moxibustion therapy could experience aEuro-Qol expresses health status as a numericalnew spurt of growth and development in Japan.

value (the functional value or Tariff Score), providing a
6. Health status in those patients who seek out
acupuncture/moxibustion therapy, and their reasonsfor seeking such treatment
In a survey of health status in patients seeking
acupuncture/moxibustion

therapy,

Takanoandcolleagues4) performed a survey based on the Euro-Qol
measure of quality of life (a measure of healthindicators developed in Europe). The survey was
designed as a random sampling of 2210 patients acrosshealth indicator that is used internationally. Healthstatus is assessed on a scale from +1.00 to -0.594, withperfect health scored as 1.0, death as 0.0, and "worse
than death" as -0.594. In addition, since the survey
sheet consists of the 5 separate categories of ①
mobility,②

self-care,

③

usual

activities,④

pain/discomfort, and ⑤ anxiety/depression, patient
responses can give an insight into health status ineach of these different categories.
The surveys by Takano et al.4) and by Ishizaki etJapan, performed through 101 clinics operated byal.5) show that pain and discomfort play a major role ingraduates of Meiji University of Oriental Medicine.

the health status of many patients who seek out

From the 1230 valid responses obtained, the meanacupuncture and/or moxibustion treatment. Thisfunctional value (Tariff Score) was reported to be 0.782

suggests that a primary use of acupuncture and± 0.22 (mean ± SD). Using these materials, Ishizaki

moxibustion in Japan is for relief from pain andanddiscomfort.

colleagues5)

reviewed

theEuro-Qol

EQ-5D

domains (① mobility, ② self-care, ③ usual activities,④ pain/discomfort, and ⑤ anxiety/depression). They
found that "④ pain/discomfort" was a significant factor
for

a

high

percentageofpatients

acupuncture/moxibustion therapy (Table 4).

seekingA

reviewofthepatient's

objectives

inacupuncture/moxibustion

treatment

showedthat

81.6% of complaints involve the musculoskeletal
system. The next most common reasons for seeking
treatment were malaise (6.9%), relaxation/wellness(5.1%), and headache (4.8%). The review by Yamashita

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

79

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

et al. 3) showed musculoskeletal complaints accounting

effects can be expected to provide benefits in diseasefor 79.1% of the total. The review by Takano et al. also

prevention

showedrelaxation.

apreponderanceofmusculoskeletal(healthmaintenance),wellness,andcomplaints, particularly low back pain (59.8%),

However, regardless of these potential benefits, theshoulder stiffness (59.1%), neck stiffness (43.3%), legsituation remains that acupuncture/moxibustion ispain (24.8%), shoulder pain (22.7%), and knee pain

currently used in Japan almost exclusively for the(20.7%).

treatment of chronic musculoskeletal complaints. In

Most

of

the

patients

visiting

contrast,

there

are

countries

overseas

where

acupuncture/moxibustion clinics were seeking relief

acupuncture is being used relatively widely in thefrom musculoskeletal complaints, or improvement intreatment

musculoskeletal symptoms. There were very few visitscomplaints8). In the United States, acupuncture clinics

for other reasons. These findings suggest thatreport that musculoskeletal complaints account forawarenessof

only 33.9% of treatments9). This suggests that the

somewhat

focus primarily on musculoskeletal disorders may be

of

the

potential

acupuncture/moxibustionisbenefits

generally

restricted in Japan. There are a number of factors thatofallergic

rhinitisandpsychiatricspecific to Japan.

may contribute to this situation, including the fact
that

most

of

the

current

acupuncture/moxibustion

patients

specifically

turn

to

7. New developments in acupuncture/moxibustion

for

the

therapycomplaints of low back pain, shoulder stiffness, and

As

noted

above,

in

Japan

the

use

of

arthralgia, and the fact that all of the six conditions for

acupuncture/moxibustion tends to be limited to thewhich acupuncture/moxibustion therapy is covered bytreatment

national health insurance fall under the category ofcharacterized by regressive changes. However, a broad

musculoskeletal disease.

range of recent developments promises to add new life andHowever, this is not all that acupuncture patientsofmusculoskeletal

diseases

that

are

direction to acupuncture/moxibustion therapy (Fig. 1).

hope for when they seek out acupuncture/moxibustion
therapy. According to a report by Yano and colleagues(based on the same materials as the Takano andIshizakireports)6),

thelargestnumberofPreventative
acupuncture
Wellness
acupuncture

acupuncture/moxibustion patients hoped for "relief
from symptoms" (70.4%), followed by "disease cure"Sports acupuncture

Acupuncture
therapy(49.2%), "disease prevention (health maintenance)"

Cosmetic
acupuncture

Acupuncture for
women

Industrial
acupuncture(49.2%), "greater wellness" (32.5%), and "relaxation"(24.5%). These results suggest that, in addition to adesire for symptomatic relief and human from disease,

Fig. １ Areas of Specialization formany acupuncture/moxibustion patients are also

Acupuncture Therapy

interested

in

preventative

medicine(healthmaintenance), wellness, and relaxation.
Goals such as these can be achieved in the processof acupuncture/moxibustion therapy. For example,
there are reports that approximately 80% of patients
"feel

in

a

better

mood"

after

treatment

withacupuncture/moxibustion7).

Thissuggests

that

acupuncture/moxibustion patients experience a rangeof beneficial effects from treatment, and that those80

Acupuncture and moxibustion use a holistic
approach based on patient-centered medicine. The
treatment does not involve drugs, but instead utilizes
healing principles that encourage the body's innate
power to heal itself. We are now approaching a point
where applications based on acupuncture/moxibustion
therapy could produce major developments in a variety of
medical fields. Current areas of activity include sports
acupuncture and acupuncture specifically addressing

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

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

women's health issues. Other areas with strong potential
for development include pediatric acupuncture,industrial acupuncture (health keeper), cosmetic
acupuncture, and acupuncture for presymptomaticconditions.
Sports acupuncture is a specialized field that
focuses on preventing injuries and improving athletic
performance through conditioning. There is currently
a movement underway, in cooperation with regional
health clubs and educational institutions, for Japan toestablish its own "trainer system" to provide healthmanagement for competitive athletes throughacupuncture/moxibustion
therapy.
Also,
recentadvances in gender-specific medicine have brought
into sharp relief the need for treatment methods
designed specifically to match the various stages of awoman's life cycle. This includes child-rearing, and theneed for robust mental and physical development of
the child along with good health for the mother.
Other areas where we expect to see development
are industrial acupuncture (health keeper), cosmetic
acupuncture,andpresymptomatic
medicine
acupuncture. Industrial acupuncture (health keeper),still in the testing stage at present, will be a
specialized field focusing on the maintenance andpromotion of good health and the prevention of disease
in working populations. This is a newly developing
area intended to complement industrial medicine andtraditional mainstream medicine. The specialized areaof cosmetic acupuncture, now being developed incollaboration with esthetic treatment, is based onhealing and health management, in conjunction withthe long-standing interest in the promotion of good
health in this area, and is designed to be incorporated
into a complete program. An area of particular interestis presymptomatic acupuncture. This area, which
focuses on the prevention of lifestyle diseases and themaintenance and promotion of good health, ispotentially the most important of all of the new areas.
There is thus great potential for growth inacupuncture/moxibustion therapy. It is to be hopedthat these developments will occur in specialized fields
and will be securely grounded in evidence-based
medicine (EBM), and that further research to provide
such evidence will be actively pursued.

References
1) Fujii R., Yubita T., Yoshiizumi T., et al.: Employment
trends and issues for the visually impaired in theacupuncture, moxibustion, and massage industries -research into economic self-reliance support for thevisually impaired, National Institute of Vocational
Rehabilitation, Japan Organization for Employment of
the Elderly and Persons with Disabilities (independentadministrative

organization),

ReportofResearch

Review No. 69, 2005.
2) Ministry of Health, Labor, and Welfare: 2004 report on
public health administration and service, number ofworkersinhealth-care-related

occupations,

URL:

www.mhlw.go.jo/toukei/saikin/hw/eisei/04/kekka3.html
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4) Takano M., Fukuda F., Ishizaki N., et al.: Cross-sectional
researchonextentofsatisfaction

withacupuncture/moxibustion treatment among patients ofacupuncture/moxibustion clinics, Japan Society of
Acupuncture and Moxibustion, 55(2); 562-574, 2002.
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ED-5D to assess health status among patients at
acupuncture/moxibustion clinics, Health and Welfare
Statistics, 49(8), 20-25, 2002.
6) Yano T., Takano M., Ishizaki N., et al.: Report of healthsurvey and questionnaire on acupuncture/moxibustion
therapy,

ClinicalResearchon

Wellness-focused

Acupuncture/ moxibustion Therapy, Foundation forTraining and Licensure Examination of Asian Medical
Treatment Methods, 79-92, 2002.
7) Yano T., Mori K., Yukimachi T.: Acupuncture, moxibustion,and stress relief, Japan Society of Acupuncture andMoxibustion, 43(4): 1-11, 1993.
8) White A., Ernst E.: Public usage of Acupuncture in the West.
In; Ernst E. and White A. (ed), Acupuncture, a scientificappraisal, Oxford Butterworth Heinemann, 5-7, 1999
9) Tsuru H., Ishizaki N., Taniguchi K.: Analysis of 2967
patients at Meiji College of Oriental Medicine (US)Clinic (1996-1999), Meiji Shinkyu Igaku (Journal of
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The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)81