Volume 7, Number 1 | Spring 2012

Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (3) – Internal Medicine
Hiroshi Omata
Oriental Medical Center
Saitama Medical University

2.

A

reviewofJapaneseandAmerican

Acupuncture Treatment Reports Concerning
Maintenance Dialysis Patients and Chronic
Renal Failure
The paper (Advances in Chronic Kidney Disease12(3): 282-291, 2005) written by Garcia and et al. at
National Center for Complementary and Alternative

C Maintenance Dialysis (Chronic Renal Failure)1.

Medicine: NCCAM, a subsidiary organization ofIntroduction

As of 2008, there were more than 290,000 people onmaintenance dialysis in Japan, that is 1 in 438.7people. There are more than 280,000 people on
Hemodialysis (HD) and between 9,000 and 10,000
people on continuous ambulatory peritoneal dialysis(CAPD). It is estimated that 1,000 people hadreceived kidney transplants, but a new form of
maintenance dialysis allows about 300 people toremain at home. Among these groups of Dialysis
patients, there has been a recent transition
regarding the underlying disease. Until recently, thepredominantdiseasewasChronic

Glomerulonephritis (CGN) but since 1998 CGN isbeing overshadowed by the prevalence of Diabetic
Nephrology. Generally speaking, people on dialysis
complain of many different symptoms, these are thefactors blocking an improved QOL, however, people
with diabetes have many more disease-related
complications

requiringtreatments.

Perhaps

because of these conditions, following the Japanesepublication of research (2000) about patients who
receive maintenance Dialysis, the authors from thelower branch of the Japan Society of Medical
Dialysis

known

as

“theComplementaryandAlternative

MedicalResearchSociety

MaintenanceDialysis

Patients(RepresentativeSuzuki Hiromichi fromofthe Saitama MedicalUniversity`s Department of Nephrology)”, begancollaborating with other institutions to accelerate
the publication of research papers. Authors from theSaitama Medical University`s Nephrology Center
reported that various Dialysis patients experienced
goodclinicalresults

moxibustion treatments.

withAcupunctureand

National

InstitutesofHealth:

NIH

offerscommentary on the followings under the title of“acupuncture and chronic kidney disease”
1. acupuncture for kidney pain (腎疝痛の鍼)3),2. acupuncture in hypertension (高血圧症の鍼)4),
3. acupuncture in the treatment of uremic pruritus(尿毒症性瘙痒症の鍼治療)5,6),
4. role of acupressure in improving the quality ofsleep quality of life in patients with end─ stage renal
disease (末期腎疾患患者の睡眠の質/生活の質の改善における経穴圧刺激の役割)7,8) and
5. dose acupressure prevent kidney inflammatory
diseases? ( 経 穴 圧 刺 激 は 腎 炎 症 性 疾 患 を 予 防 す るか？)9), and suggests that acupuncture has potential
in this area. Kimura et al.10) searched the literatures
issued between 1979 and 2008 with keywords:
Dialysis, Kidney, Kidney disease, Acupuncture
treatment, and Acupressure in Japanese from theJapan Medical Abstracts Society site, and in Englishfrom the American National Medical Library Searchsite (PubMed), and as a result, 31 Japanesereferences

and20Americanreferences

wereextracted. To summarize, the Japanese Acupuncturereferences included observations on physiologicalresponses within the kidney, complications ofmaintenance dialysis patients, various clinicalreviews of the benefits of acupuncture treatment andfinally, reports of the possible adverse effects ofacupuncture and moxibustion treatments. Amongthe most interesting reports were questionnaire
surveysansweredbydialysis

patients

about

receiving acupuncture treatment. In contrast, theWesternreports

focusedon

theefficacy

ofacupuncture for renal colic and the pruritis (chronicThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

3

Volume 7, Number 1 | Spring 2012

whole body itching) accompanying dialysis, renal

metabolism

sympathetic nerve function, and a recent report fromappropriate points and meridians (Chart 3) toChin et al.,9 on animals with acute Nephritis pre-stimulate the somatic-internal organ reflex. In order

treated with St 36 (Ashi San Li). Of particular noteto provide a thorough method of estimating

was a report from a Taiwan Nurses group reporting

Acupuncture treatment efficacy, we compared pre-on the clinical results of stimulating acupuncture

and post-treatment measurements of local pain

points, they were expecting improved sleep and QOL(lower leg, lower back, shoulder joint, neck stiffness

for dialysis patients. From these accumulatedetc.) and whole body conditions (aches and pains,references,theweariness etc) using a visual analogue scale (VAS);

maintenance dialysis patient was thought to beindicators of biochemical examinations of blood

influencing the autonomic nervous system, causingchanges were statistically processed and used along

a bloodstream change and possibly influencing

side QOL measures such as the frequently usedhomeostasis; and acupuncture`s protective efficacy“Kidney disease quality of life short form“ (KDQOL-of the kidney and renal function were also suggested.

SF) to provide a comprehensive scale of the patient`s

An important research theme for the future included

internal and clinical condition.

the cost-effectiveness of acupuncture in this type ofChart 3 Leg Shou Yin Kidney Channel (K) / Leg Tai Yang

Acupuncture

analgesiaforandelimination,soweselectedpatient.
3.

AcupunctureandMoxibustion

Treatment

outcomes for Maintenance Dialysis Patients at
the Saitama East Asian Medical CenterA)

Evaluation

methodofAcupunctureandMoxibustion treatments, protocols, and evaluations
as they relate to maintenance Dialysis Patients
As was mentioned earlier, we are seeking to evaluate
the situation of acupuncture and moxibustion
treatment and clinical research in maintenanceDialysis patients throughout Japan. We used thetreatment system of our former teacher, Serizawa
Katsusuke,

Professor

Emeritus

fromTsukuba

University on our maintenance Dialysis patients.
While grasping the patient`s disease state thoroughbedside and laboratory findings, we also performeda series of acupuncture treatments 1-2 times a weekusing

Acupuncture

ElectroTherapy(AET)stimulating nerves, muscles and joints with thepurpose of clarifying whether or not Acupuncture`s
analgesic effects could help raise the pain thresholdfor patients with (1) whole body aches, pains,weariness, itchiness etc. (2) Further, from East
Asian Medical Theory we know that Kidney andBladder function are known to influence water4Urinary Bladder Channel (UB)

B) Fourteen maintenance dialysis patients (10 males,4 females, average age 62.5+8.3 years, average timeon dialysis 40.8+38.8 months, (hemodialysis) HD 7,(continuous ambulatory peritoneal dialysis) CAPD7
from the Saitama Medical Hospital of Nephrology
were tracked for local pain, whole body symptoms,
QOL issues and biochemical blood changes, weregiven regular acupuncture treatments for one monthafter which they were investigated. Of these patients,
we confirmed 6 patients reported pain and cramping

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

Volume 7, Number 1 | Spring 2012

in the lower leg, low back pain 4; neck stiffness 19,symptoms (p<0.01), SF-36 scores for [physicalshoulder joint pain, thigh pain and arm pain

function] and [daily life physical functioning] both(average 1.4 complaints per patient); 16 patients

increased (p<0.05, p<0.1). Further, comparing scores

reported whole body complaints including itchingfor [physical and mental wellness] before and afterand weariness (average 1.1 complaints per patient).

the treatments, CAPD subjects reported significant

Given one month of acupuncture treatments, theincreases in levels of physical health (p<0.05). Next,

VAS scores improved (p<0.1, p<0.05) (lower values

scores for KDQOL-SF within the CAPD groupreported) demonstrating a trend toward symptom

increased significantly (p<0.05). Given these results,improvement. Also, after the one month series, using

the CAPD group enjoyed better results compared toa patient QOL measure, MOS Short-Form 36-Item

the HD group, these results are thought to be related

Health Survey (SF-36), with the exception of

to differences in dialysis type and degree of kidney“vitality” as a response, all other responses showed

dysfunction.

increases, raising the subject QOL levels to nearlyD) Results of Long Term Acupuncture Treatments

National Standard levels, however, a statisticalfor Maintenance Dialysis patientsdifference was not confirmed. Comparing responses

Next, we analyzed changes in dialysis patientsto score items, such as degree of physical and mental

following 1 year of continuous regular Acupuncture

health, before and after acupuncture treatments,treatments. Eligibility for this study required more

respondents reported a significant increase in theirthan one year of continuous Acupuncture treatment

reported degree of physical health (p>0.05). Further,(subjects included 4 men and 1 woman, average age,

within the KDQOL-SF, scores for “Work situation”

65.2+_ 8.2 years, HD type 1 subject, CAPD type 4

and “Relationships” showed a downward trend

subjects; underlying disease diabetes Mellitis DM 2,(p<0.1, p<0.1),“personalnon DM 3, average dialysis duration 57.2+37.5

condition” showed a significant increase (p<0.05).

months). Once eligibility was confirmed, we collated

Theseoftheir complaints for local symptoms (total 8

Acupuncture stimulation (that is, the points andcomplaints: 3 lower leg numbness, 1 low back pain,meridians stimulated) travels along the spinal

1 neck and shoulder stiffness, 1 pain and numbness

column or is a spinal nerve transmission, increasingin the hands and fingers, 1 post herpes related

resistance to pain, possibly inducing a whole bodyneuralgia, 1 lower leg chilliness), and whole body

response.

complaints (4 itching and 2 general malaise).

C) An examination of differences between Dialysis

Significant improvement in whole body aches andtype (HD, CAPD) and the relative effects ofpains VAS scores were confirmed following long term

acupuncture treatment on maintenance dialysis

acupuncture treatments, 6 months to one yearpatients.

(p<0.1, p<0.1), the SF-36 life style items such as

We investigated the differences in efficacy between“vitality” improved after one year of treatment

two groups of maintenance Dialysis patients (14(p<0.05), as did the KDQOL-SF item for “Sleep”

subjects, n=7 HD, n=7 CAPD) who received regular(p<0.05). Also, biochemical examination of blood

acupuncture treatments for one month. The results

samples showed significant decreased in BUN

are as follows, within the CAPD group 10 people(Blood Urea Nitrogen) comparing baseline levels,

reported aches and pains, 8 people complained ofwith 1, 3, 6 and 12 month samples (p<0.001, p<0.001,

whole body itchiness and lassitude. Following one

p<0.001,

month of regular acupuncture treatments, the VAS

significant increases with just 3 months of treatment

scores were significantly lower for these whole body

(p<0.1). In addition, we collected a survey of 5results

especiallysuggest

thethatitem,
theinfluencep<0.001),

Hb

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

showed5

Volume 7, Number 1 | Spring 2012

andmeasurements in the dorsal area of the foot and atexperience after receiving long term acupuncture

the medial malleolus following one month of AET

treatments. They reported personal improvements(p<0.05,in actual pain and itchiness, mood, lethargy andsignificantly in all measured areas (p<0.05, p<0.05,quality of sleep. We also collected comments

p<0.05, p<0.01). Also, one month following thereporting improvements in the excretory function oftreatments, the SF-36 item for “Body Function” rose

the kidney and anemia. As a result of long term

significantly (p<0.05). One possible mechanism for

acupuncture treatments, we can suggest that in

Acupuncture

addition

physical, mechanical stimulation by the needle andpatient`snutritional

impressions

toof

their

progressvariousmedicaltherapies

support,continuingandacupuncture

p<0.001),

electricalfurther,treatment

stimulation

SPP

efficacy

increased

could

influences

bedermaltheandtreatments improves the patients QOL by reducing

muscular micro circulation, increasing blood vessel

whole body symptoms and assisting general kidney

reactivity stimulated by the autonomic nervous

function and improving Hemoglobin levels forsystem or vessel dilating peptides.

patients with anemia.

F) The possibility of using Acupuncture TreatmentE) Effectiveness of Acupuncture for Maintenancefor maintenance Dialysis Patients with Pruritis

Dialysis Patients with Peripheral Artery Disease

Itchiness is one representative peripheral symptom(PAD)

that includes atopic dermatitis, contact dermatitis,

Peripheral artery Disease is usually divided intohives,

functional and organic artery disease. Until recently,

dermatological conditions affecting the skin andresearchers have postulated that the efficacy of

mucous membranes, and in particular, there are

Acupuncture for Raynaud`s phenomenon is due to its

many articles presenting supportive evidence for

influence on the autonomic nervous system inAcupuncture

general and the sympathetic nervous system inmodalities for atopic-dermatitis13. In contrast, theparticular, that is, it might encourage the dilation ofitchiness of the maintenance Dialysis patient is

the capillaries of the affected limb nail bed,

thought to be stimulated or suppressed by the

improving local circulation and thereby alleviating

centralnervouspain11. Therefore, we investigated the effects ofactivation

ofacupuncture in maintenance dialysis patients who

Hydrochloride has been attracting attention for its

often experience PAD as a complication. The subjects

abilityin this trial were 9 maintenance Dialysis patients

investigations of acupuncture treatment for thewith Arteriosclerosis Obliterans (ASO) (average age

itchiness associated with maintenance Dialysis

65.1+7.3, 7 males, 2 females, 6 DM, 3 non DM, 2suggest acupuncture at LI11( 曲 池 ) appears to be

Fontaine Classification I, 3 Fontaine Classification

effective5,6. These researchers then used the VAS andII, 3 Class III, 1 Class IV). The acupuncture protocol

KDQOL-SF indexes to investigate the effectivenessincluded electro acupuncture at St 36 and Sp6 on theof acupuncture treatments on the whole bodydiseased lower leg; we tracked skin perfusion

itchiness experienced by dialysis patients. The

pressure (SPP) and transdermal oxygen tension

acupuncture protocol included bi-lateral AET of 1Hz(tcPO2). In addition, following a month of once orfor 10 minutes at LI 4 ( 合 谷 ) and LI11 ( 曲 池 ).

twice weekly acupuncture treatments, we compared

Following one month of Acupuncture treatments,

pre-patients reported a significant increase in theandpost-treatment

tcPO2with

SPP

drug-related

toandskin

Moxibustion

system.
ksuppress

indexevaluations. We found significant increases in SPP

Additionally,following

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

byitchiness.

KDQOL-SF

forasRecently,receptors

measurements and conducted VAS and KDQOL-SF

6

eruptions,year

effective

selective

Nalfurafine
Incontrast,(p<0.05).

“Symptom”
onevariousofregularVolume 7, Number 1 | Spring 2012

treatments, patient VAS scores showed significant

on the efficacy of Acupuncture for Internal

decreases for “itchiness” (p<0.1). These results

Medicine and treatment. Journal of the All-suggest that acupuncture treatments control βJapan Acupuncture and Moxibustion Society 38

endorphin （μreceptors）through the upper central(3): 288-294, 1988.

nervous stimulation, and stimulation of Dinorphin2)

Garcia GE, Ma SX, Feng L: Acupuncture and(k receptors), these mutually balancing actions arekidney disease. Adv Chronic Kidney Dis 12(3):thought282─291, 2005

toimprovewholebodyitchingin3)

maintenance dialysis patients.

Lee YH, Lee WC, Chen MT: Acupuncture in thetreatment of renal colic. J Urol 147: 16─18, 1992

4.

The Future Direction of Acupuncture Treatment

4)

Williams T, Mueller K, Cornwall MW: Effect ofacupuncture points stimulation on diastolicfor Maintenance Dialysis Patients
ofblood pressure in hypertensive subjects: AAcupuncturists, Inc. has sponsored 4 Specialist

preliminary study. Phys Ther 71: 523─529, 1991

Since

2007,

TrainingtheSystemJapanese
Seminars

Associationon“Acupuncture

5)

Shapiro R, Stockard H: Successful treatment ofMoxibustion Medical Care Risk Management”, to beuremic pruritus. The acupuncture approach

implemented in every prefecture throughout Japan.

revisited. Dial Transplant 32: 257─265, 2003

There is now a pressing need not only for dialysis

6)

Che - Yi C, Wen CY, Min - Tsung K, et al.:patients, but also the medical care providers

Acupuncture in haemodialysis patients at the(Dialysis physicians, engineers and nurses) toQuch(i LI11) acupoint for refractory uraemic

stimulate interest in Acupuncture treatment, and atpruritus.

the same time, to insure the importance of risk

1912─1915, 2005

management in this domain while securing the7)Nephrol

Dial

Transplant

28:

Tsay SL, Rong JR, Lin PF: Acupoints massage

safety of Acupuncture treatments. Additionally,in improving the quality of sleep and quality ofcurrent research themes for Acupuncture treatment

life in patients with end ─ stage renal disease. J

include improving patient QOL, but accumulated

Adv Nurs 42(2): 134─142, 2003

data also includes research on the treatment of8)

Tsay SL: Acupressure and fatigue in patients

Fibromyalgia in Dialysis patients, efficacy forwith end ─ stage renal disease ─ a randomized

Kidney function14 and disease in an attempt to delay

controlled trial. Int J Nurs Stud 41: 99─106,

dialysis by preventing disease progression and2004

finally

thecost-effectivenessofacupuncture9)

Chin LH, Pei ST, Tao YW, et al.: Acupuncturetreatment and reducing the high cost of dialysis

stimulation of ST36（Zusanli）attenuates acutepatient health care. Finally, we are coming into arenal

status defining time for Acupuncturists, clearly welipopolysaccharide ─ stimulated rats. Anesth

must take up our role and position within theAnalg 104: 646─654, 2007

medical team attending in the Dialysis Room, it isbutnothepaticinjulyin10) Hirokichi Kimura, Horoshi Omata, Satoshi

one clear way for the next generation of young

Yamaguchi

etal.,

Aliterature

Acupuncturists to make their appearance in theconsidering

Acupuncture

upcoming medical transition.

Dialysis patients and effective points forforsurvey

maintenance

Moxibustion stimulation. Modern Acupunctureand Moxibustion Studies. 8(1): 27-32, 2008.

References1)

Hiroshi Omata, Satoshi Yamaguchi, Katsusuke

11) Hiroshi Omata, Satoshi Yamaguchi, Teruhiko

Serizawa et al., An article for Dialysis PatientsSuzuki et al.,: An Autonomic Nerve Function

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

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Volume 7, Number 1 | Spring 2012

Index used for Acupuncture Treatment Efficacy
in Autoimmune Disorders (Collagen Disease)14(3): 223─227, 1995
12) Suzuki S, Ichioka S, Omata H, et al : Effects ofacupuncture on lower limb ischemia. J Saitama
Medical University 36: 1─10, 200913) Hiroshi Omata: Acupuncture treatment for
atopicdermatitis.

ModernAcupuncture

Moxibustion Studies 3 (1): 99-105, 2003.
14) Kiyoe Tezuka, Kitakouji Hiroshi, Masato Saito:
InfluenceofAcupuncture

Stimulationon

Kidney circulation changes using the Color
Doppler Imaging method Osaka 19(1): 73─76,
2003

8The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)