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

– Correlation between Nocicepetion andAcupuncture and Moxibustion –Yukihito Sugawara
Department of Basic Medical Research
Tokyo Eisei Gakuen College
I. Introduction
Acupuncture and moxibustion therapy is aprimitive stimulation therapy during which either
needles are inserted into the tissue or moxa is burnedon the skin, thereby causing minor damage to thetissue and skin. These stimuli can alleviate pain andelicit various reactions from the autonomous nervous
system, but at the same time the stimuli themselvesalso produce a pain sensation and thus excite
nociceptors. In a manner of speaking, this would be
like "using pain to kill pain", where a basic negative
feedback mechanism can be considered to underlie theinduction of the effects brought about by theacupuncture and moxibustion stimulation1,2,3).
Acupuncture and moxibustion is characterized bystimulation of specific sites called acupoints, but its
applications are extremely varied. Although thistreatment form cannot easily be defined, the stimulus
modalities can be classified as mechanical nociceptive
and thermal nociceptive stimuli. In the end thesestimuli cause some degree of local tissue lesions, therelease of various algesic substances or their relevant
modulator substances, or else the production andrelease of neuropeptides. From this point of view it isnecessary to consider this modality to act as a chemical
stimulus.
Moreover, these stimuli excite nociceptors,
activating endogenous analgesic mechanism4,5,6,7) andlead to the manifestation of various effects on theautonomous nervous and endocrine systems6), or elsethey may also influence the immune system7) and forthis reason acupuncture and moxibustion have beenused since ancient times to cure all kinds of complaints
and symptoms.
On the other hand, in our research department,with Mr. Kazuhiro Goto as the leading figure, we have
employed microneurography for the purpose of
studying the correlation between the activity of humannociceptors and pain in order to directly record humanperipheral nervous activity. Among cutaneous anddeep afferent neuronal activities we recorded theactivity of C-fiber thermomechanical nociceptors(synonymous with C-fiber polymodal nociceptor,
C-fiber mechanical heat nociceptor: CMH) 8,9,10,11) andA-fiber nociceptors 8,12,13) and thereby investigated thecorrelation between pain and acupuncture andmoxibustion stimulation.
In the present paper the correlation between pain
and acupuncture or moxibustion stimulation will be
discussed, while adding some of the insights
pertaining to the activity of human nociceptors
obtained through microneurography.
II. Characteristics and application of microneurography
Peripheral nerve activity in non-sedated humans wasrecorded using microneurography and systematicallyresearched by the Swedish researcher Hagbarth,
Vallbo14) et al. and in Japan by Honno et al.15).
This method employs percutaneous unanethetized
insertion of tungsten microelectrodes that are isolatedwith the exception of a few μm at their tip to directly
record the potential action of nerves. In this way thecorrelation between the activities of human skinmechanoreceptors16), sympathetic nerves of muscles17),
muscle spindles, tendon organs and otherproprioceptors on the one hand; and pyramidal muscle
activity on the other hand18); as well as the nerve
activity of afferent C-fibers from the skin andsympathetic activity19,20,21) etc. were analyzed.

Figure 1
Figure 1 shows a diagram of this method. A
tungsten recording microelectrode with an impedanceof several MΩ to over ten MΩ is used for the recordingof the action potentials, while the indifferent electrode

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

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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010is attached nearby on the skin as a disk-shaped earth
electrode. The signals were amplified using ahigh-impedance type amplifier and a DC amplifier andthen observed on the cathode ray tube of an
oscilloscope. The data were recorded at all times
during the observation.
The electrode was inserted percutaneously above
nerve trunks. To determine a suitable location for theinsertion of the electrode, the course of the nerve canbe confirmed in advance by applying electric stimuli to
it. At this time the motor nerve conduction velocity(MCV) or the sensory nerve conduction velocity (SCV)
at the site for the insertion was determined by using
the evoked wave forms obtained during themeasurement as an index to make the approach of theelectrode to the nerve still more reliable.
The electrode was then advanced by hand towards
the nerve. The occurrence of a transient unusual
sensation confirmed that its tip had reached the nerve
trunk. Simultaneously, the output of the characteristic
nerve activity via a sound monitor was also possible.
When the tip of the electrode had reached a muscularbranch, a deep, diffuse, dull pain ran through the depthof the muscle; or in case of reaching a dermal branch atransient feeling of superficial numbness occurred.
In this way, the derived action potentials of thenerves are in the beginning action potentials of several
units, but through subtle and very carefulmanipulation of the inserted electrode the discharge ofsingle units or cluster discharge with a very good S/Nratio are isolated. During this process, first the activityof afferent nerve fibers of the relevant peripheral
receptive field is probed and then the nerve conduction
velocity measured by applying electrical stimulation tothis receptive field. Or alternatively, by applying
variousstimuli(mechanicalstimuli,musclecontraction of stretch stimuli, heat stimuli andchemical stimuli) the activity of the particular unit isqualitatively identified. Moreover, regarding theactivity of postganglionic sympathetic fibers or similarefferent nervous activities, a variety of load tests of theautonomic nervous systems are performed, or else theorigins of nervous activities related to heart rate,
breathing or sweating etc. are determined.
In this way, recorded nerve activity, in particular20

the activity of primary afferent cutaneous nerve
terminals, can be analyzed in direct comparison with
the intensity of the sensory responses experienced by
the subjects. Through stimulus-response analysis it ispossible to measure the intensity of the direct
subjective sensory responses. Moreover, during
research into acupuncture and moxibustion it is not
only possible to analyze what kind of primary afferent
terminals the acupuncture or moxibustion stimulation
produces analgesic effects and elicits various responsesof the autonomous nervous system, but it is also
considered possible to examine through analysis of theexcitation of peripheral receptors in the skin or
muscles at the site of acupoints, what kind of
peripheral receptors the so-called "de qi phenomenon"
are related. Thus, the application of microelectrodes isa very useful tool for research into human peripheral
nerve activity within the field of studies pertaining toacupuncture and moxibustion. In the present paper wehave focused in particular on acupuncture ormoxibustion stimulation induced activity of primaryafferent terminals in the skin and discuss the results,
adding the insights we have gained.
III. Input system for acupuncture or moxibustion
stimuli (correlation to the nociceptor system)
Assuming that acupuncture and moxibustion
stimulation in itself produces some minor lesions of
the peripheral tissues, in particular in case of needlingstimulation, the insertion or mechanical manipulationof the inserted needle(s) may elicit beside the prickpain a peculiar abnormal sensation called "de qi(tokki)". There are a variety of different patterns
associated with this de qi sensation, but in any case its
characteristics are close to the sensation of pain. Basedon these facts, the likelihood of the possibility
increases, that the peripheral receptors excited by theacupuncture or moxibustion stimuli are rather
nociceptive
receptors
than
non-nociceptive,
proprioceptors. These considerations suggest, andbased on considerations of the input system throughwhich the acupuncture or moxibustion stimulation
acts, that cutaneous and subcutaneous nociceptors are
representative for the polymodal nociceptors playing
the most important role here.

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

1) Polymodal nociceptors(CMH) following electrical, mechanical and thermal

Afferent fibers transmitting nociception include

stimulation8).

C-fibers and A-fibers. On the other hand, polymodal

In case of single discharge recordings from CMH,

nociceptors are widely distributed throughout thethe threshold within the receptive field in response toentire body and serve as the most importantelectrical stimulation is considerably lower than the

nociceptors within the input systems of the bodily

electrical threshold of C-fibers stimulated via nerve

defense22).

trunks, so that pain sensations are negligible. The

One property of polymodal nociceptors is, thatthreshold for mechanical and heat stimulation has amorphologically they are free nerve endings andwide distribution range (Figure 3), so that firing

widely distributed throughout the body, spreading

activity is observed even from comparatively low

antennas that pick up abnormal stimuli applied to thestimulation intensities.

body. Moreover, the modality of the stimuli has a low
specificity, so that they may react to mechanicalstimuli, heat stimuli, or the chemical stimuli provided
by endogenous algesic substances. Thus they arecharacterized by the advantage that they do not
distinguish between the nature of the stimuli as longas it is a nociceptive stimulus. Further, the excitability
in response to stimuli has a wide range from thenon-nociceptive

level

to

the

nociceptive

level,

throughout which these receptors respond strongly
and thus cause the body to sensitively react toabnormalstimuli.

Thismeans,

that

these

characteristics are marked by a high input sensitivityof the body's warning system, so that they also encode
signals caused by abnormal stimuli, even if thosestimuli are not necessarily associated with irreversible
tissue damage.

Figure 3
Again, the average temperature in case of thermal
stimulationwas

41-42°C

andthecategories

corresponding to the subjects subjective sensation of
the intensity of the thermal stimulation were at"warm" or "hot" levels. When CMH are in this way
classified as nociceptive receptors, the ranges for theindividual stimulation types are very wide and one of
their characteristics can be said to be their firing
activity

rangingfrom

non-nociceptive

stimulus

intensities.
The firing of the CMH increases depending on theintensity of the nociceptive stimuli. Tentatively they
encode the intensity of the sensation comparatively
accurate and thus enable central discrimination ofboth localization and intensity23,24,25,26,27).
For example, when the tentative characteristics of
CMH in their response to the stimulus intensity in

Figure 2
Figure 2 shows the evoked firing of humancutaneousC-fiberthermomechanicalnociceptors

case

of

thermalstimulationisexamined,anapproximate dependency of the firing activity on
stimulation intensity is observed (Figure 4).

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

Figure 4
However, in this case the temporal intervals
between repetitions become shorter, so that it isinfluenced by preceding stimuli. In particular, inconnection with strong preceding stimulus a low
correlation to the firing frequency is observed,
characterized by a lower reproducibility of theexcitation than from other cutaneous sensory receptors10)11). Accordingly, the function of CMHs is to transmit
the algesic sensory information, but regarding theintensity of the nociceptive input, the transmission isneither necessarily continuous nor true. The CMH arethus considered to serve mainly the transmission ofearly information pertaining to conditions potentiallyharmful to the body.
Moreover, the changes in the tissue induced by thenociceptive stimulus is transmitted and the conditionof the tissue conversely modifies the receptors
themselves, so that they are considered to fulfill their
original purpose as polymodal receptors within the
biological defense.

On the other hand, needling stimulation easily
excites the CMH (Figure 5). If a series of acupuncture
manipulations have been performed within the CMH
receptive field, simply erecting the needle tube there
after positioning the pressing hand induces firing
activity. Next, the performance of needle tapping toinsert it through the skin results in a transient,dynamic firing, whereas for the needling techniquecalled thrusting and lifting, where the needle is moved
up and down as if in pecking movements, it also
induces dynamic firing activity. With this kind ofthrusting and lifting stimulation, single unit firing
activities show a firing frequency of more than 10
impulses per second, but in most cases the subject does
not experience any tingling prick pain.
In spite of the fact that such a series ofmanipulations induces high frequency CMH firing, it
does not cause the subject any pain. Since theacupuncture stimulus itself is a punctuate mechanicalstimulus, it is difficult to obtain peripheral or central
spatial summation. For example, this indicates thateven if the CMH would be firing, it does notnecessarily mean that this will lead to the perceptionof a "de qi" sensation.
Also, thick fibers are simultaneously excitedthrough the pressing hand or movement of the needle,
which are considered to be related to pain inhibition,
also suggesting a correlation to the manifestation ofeffects of acupuncture stimulation brought about by
retaining the needles, intradermal needles or shallow
needling just piercing the skin.

Figure 6
Figure 5
22

Figure 6 shows the firing activity of CMH when an

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

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010acupuncture stimulation of constant frequency isfiring activity is observed even after 3 repeatedapplied using a thrusting and lifting stimulation

applications. This means that the receptive field at thedevice. Continuous stimulation period was 30 seconds,site of the moxa treatment has not sustained

thrusting and lifting frequency 7.4 Hz and amplitude

destructive lesions by the moxibustion stimulus.

2.4 mm; the upper and lower row show the firing
activity of the same unit.
The firing pattern shown in the upper row shows astrong dynamic activity during the starting phase of
the thrusting and lifting. After that the stimulation
frequency was not followed, but rather a static firing
activity continued. Moreover, the lower row shows only
early phase dynamic firing activity, which is a patternlacking the static firing components observed during
the latter half. With neither of these two patterns did
the subject feel any pain, but reported only a sensationof vibration.
These differences in firing pattern, in spite oforiginating from the same CMH firing activity, areeasily influenced by preceding stimuli and areconsidered to be the manifestation of a fatigue
phenomenon. Also, applying acupuncture stimulation
frequently results in the development of flares orswelling in the vicinity of the needled site. This isconsidered to be the result of neurogenic inflammation
causedbytheexcitation

of

these

polymodal

nociceptors1,2,28).
In this respect, attention has been paid to theaction of polymodal receptors as effectors, where theexcitation of these polymodal receptors serves as
retrograde stimulus; while in the manner of axonreflexes from the free nerve endings in the vicinity
substance P or CGRP (calcitonin gene-related peptide)and similar neuropeptides are released, hypotheticallycausing inflammatory reactions like vasodilatation orplasma exudation29).
On the other hand, moxibustion stimulationinduces a high firing frequency of the CMH. Figure 7
shows the CMH firing activity induced when in thevicinity of a mechanically stimulated receptive fieldwith the relevant sensitivity moxibustion is repeatedly
performed in a different receptive field30).
Direct moxibustion with small cones of moxa with atemperature of 60 - 70°C produced a strong nociceptive
thermal stimulus and cause a local burn, but CMH

Figure 7
During the first
application ofmoxibustion, theskin temperaturereached an averagepeak of 62°C,
whereupon thenumber of CMP
firing impulses andinstantaneous firing
frequency alsoreached aconsiderably highfrequency (average
37 imp and 49.4 Hz)
Figure 8
and the subject felt a strong thermal pain. Yet,following the second application, even though the peaktemperature reached during the moxibustion wasapproximately the same, a CHM firing desensitization
is observed and the thermal pain sensation of subject
is attenuated (Figure 8).
The attenuation of the thermal pain sensation thus
observed after repeated application of moxa treatment
is considered to represent a fatigue phenomenon25).
Moreover, the high CMH firing frequency observed
during the first moxa application may be expected tocause a central inhibition via the DNIC: diffuse
noxious inhibitory control) 31).

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

2) A-fiber nociceptors
Human cutaneous nociceptors also include apartfrom the C-fiber polymodal nociceptor Aδ afferent
nerve fibers8,9,12,32).
Among the records obtained so far from humancutaneous afferent nerve fibers the number of units
with a conduction velocity in the Aδ range are extremely
few. This is also due to the fact that their proportion
among the fibers within nerve trunks is compared to
the CMH units low33). Among these, again, units areclassified as units responding to both mechanical andthermal stimulation (A-fiber mechano-heat nociceptor:
AMH) and receptors with a high threshold responding
to mechanical stimulation only (high thresholdmechanoreceptor: HTM) (Table 1) 34,35).
CMH
C.V.(m/s)

HTM

AMH

0.96±0.17(n=239)

19.2±8.4(n=11)23.5±10.2(n=15)24.1±21.9(n=180)29.1±12.6(n=239)

23.0±14.9(n=15)

MechanicalThreshold (mN)
ThermalThreshold (℃)

41.8±2.7(n=130)

CMH: C Mechano Heat Nociceptor

49.1±1.4(n=12)(mean ±S.D.)

HTM: High Threshold Mechano Nociceptor
AMH: A Mechano Heat Nociceptor

Table 1
The receptive fields of these units show a
distribution of either single or multiple points
sensitively responding to mechanical stimulation
within cutaneous areas of fixed size, where the areas
between the individual points have a high thresholdfor mechanical stimulation, or are not responsive at all.
The terminals of these receptors have several branches
within specified areas and form points responding
sensitively to mechanical stimulation which areconsidered to be distinctly separate from thesurrounding areas.
Morphological studies of high threshold mechanicalreceptors in hairy skin of cats clearly showed, thataxons surrounded by Schwann cells are distributed
among the terminals and the nerve endings are
surrounded by keratinocytes. This increases thethreshold toward stimulation and is considered todefine the localization.
The characteristics of HTM and AMH receptors in

24

response to mechanical stimulation show in any case,slowly-adapting firing patterns, transmitting intensity
or variation components of nociceptive stimulation to
the skin centrally. Both show about the same thresholdfor mechanical stimulation, which are at the sametime of a similar magnitude of the threshold formechanicalstimulationof
CMH.
Originallynociceptors of A-fibers are thought to transmit the
primary pain caused by nociceptive mechanicalstimulation36). The localization of piercing the skin bytapping acupuncture needles is very distinct, so in thatcase it provokes stabbing pain, a high frequency firing
activity of the AMH is induced9).
On the other hand, burning the skin surface withmoxa through direct moxibustion is a stimulation
method definitely causing burns of the skin, in whichcase, the response of the AMH to the thermal stimulus
is very important. Namely, the response of the AMH to
the thermal stimulus is distinctly different from theresponse of the CMH. One of these properties has been
demonstrated in units classified as type 1 AMH in
hairy skin of monkeys and other animals33,37,38), thatare characterized by an extremely high threshold
temperature for nociceptive thermal stimuli (Table 1).
In human AMH, the
units

that

respondtothermal stimulation fromthe very beginning reactat temperatures of 48 52°C. The firing starts
after temperatures havereached this range andthe subjects experience astrongthermalpain

sensation (Figure 9).
Figure 9
Again, depending on the unit, there are also somethat do not show any firing during the initial phase oftrials with repeated thermal stimulation, but after
several preceding thermal stimuli of 50°C, causing thedevelopment of a mild degree of rubescence on the skinsurface, the receptive field becomes sensitized to thethermal stimulation, after which the onset of firing isobserved. Moreover, through repeated thermal

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

stimulation, the relevant excitability is temporarily
obtained so that the units show an obvious increase in
firing in response to the thermal stimulation. In someunits, high frequencies of up to 50 times per second
may be observed (Figure 10) 9,13,33,34).

Figure 10
This degree of sensitization of the AMH in responseto thermal stimulation which may be called dramatic
does not occur in CMH. Here, both firing frequency
and the degree of sensitization can be said to be
distinctly different from that of the CMH10).
Examination of the correlation between the firing
activity of the AMH in response to thermal stimulationand the subjective sensation of heat pain in thesubjects showed only a moderate degree of firing
activity during the initial phase of a stimulation trial
at a time when the excitability just started to develop,
but this did not clearly correspond to a cross-modality
matching induced appearance of subjective thermal
pain sensation. However, with an increasing number ofrepetitions of the stimulation the firing activity of theAMH units gradually increased, while both thesubjective thermal pain sensation and fluctuations in
the firing of the units showed parallel variations thatallowed recognition of a clear correlation between
firing frequency and changes in the expressions used
to describe the thermal pain sensation (Figure 11).
In this way the AMH are sensitized and thethermal pain is localized, allowing accuratetransmission of its intensity. Moreover, this also
indicates a central input of the hypersensitivity
information appearing after the development of burns
in response to the thermal stimulation13,36).

Figure 113) Nociceptors in deep tissues
Needling stimulation does not only excite
nociceptors in the skin, but also nociceptors
distributed in deep tissues like muscles or tendons andthe like. In particular, the excitation of small diameter
afferent fibers from deep tissue is more likely to elicit
responses from the autonomic nervous or endocrine
systems than it did in case of the skin, so that it has
been pointed out, that the deep nociceptors are rather
more likely to feed their information into theautonomic nervous or endocrine systems than thesomatic nervous system1). Moreover, for the
manifestation of acupuncture analgesic effects,
excitation of the deep tissue nociceptors is considered
to be important2).
Units responding to needle stimulation of
nociceptive fibers derived from human deep tissues(muscles) have the following characteristics39).
All of the recorded units had conduction velocity in
the Aδ range and spontaneous firing was not observedin any of these units. Further, areas from which firing
could be evoked by electrical stimulation and theirrespective depths were markedly limited, andcompared with the identification of cutaneous sensory
receptive fields, their positions were not easy todetermine. Also, they did respond only to mechanicalstimulation within a restricted scope while in thepresence of responses from proprioceptors, they did not
respond to mild muscle contraction, stretching, or else
vibrational stimulation. In response to pressure
stimuli the firing increases depending in an intensity
dependent manner. A good correlation is observed withThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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

the intensity of the sensation following pressure
stimulation reported by the subjects. This can beconsidered to represent the transmission of sensory
information pertaining to nociceptive mechanicalstimulation.
Although this pertains only to a portion of the units,
injection of the points most sensitive to mechanicalstimulation with bradykinin (2 ml of a 1μg/ml solution)
also induces firing and the pain induced by thebradykinin and reported by the subjects also increases inparallel with an increase in the firing frequency. The
subsequent gradual decrease indicates a high probability
that these are polymodal receptors (Figure 12A).

Figure 12Upon performance of needling stimulation of thereceptive fields of this type of muscular Aδ units, thatis thrusting and lifting manipulation of muscles, theseunits definitely display a firing activity and inparticular a synchronous high frequency firing wasobserved when the subjects experienced a de qi
sensation. This observation shows the involvement ofthese units in the manifestation of de qi upon needlingstimulation (Figure 12B).
Up to now the activity of C-fiber nociceptors has notbeen recorded from human deep tissue afferent nervesusing microneurography nor found to be mentioned in
the literature. In animal experiments, the activity of
deep tissue C-fiber nociceptors in muscles and joints
has been recorded and numerous relevant research
reports40,41) have been published. This suggests thepossibility that regarding the recording of activities
from human deep tissues there is some form of bias
with the recording method using microneurography.

26

Since deep tissues are much less likely to be
exposed to stimulation than the skin, the spatial
distribution of the receptors themselves is conceivably
narrower. Moreover, another possibility is theexistence of silent nociceptors that under normal
conditions are not sensitive to stimulation, that havebeen detected in muscles, joints, internal organs or the
skin42,43,44）.
These nociceptors are normally present in aconcealed condition. In case of tissue lesions or
inflammation acquiring excitability, after which theyshow excitability even for mechanical stimulation forwhich they had so far not been sensitive, are calledchemo-specific nociceptors, or else noted as sleeping
nociceptors. Through recruitment of the excitation of
this
type
of
nociceptors
hyperalgesiaorhypersensitivity can conceivably develop in thepresence of inflammation45,46,47）.
Accordingly, by creating minor tissue injuries
through needling or moxibustion stimulation, theexcitability of this new type of nociceptors is recruitedand may be considered to carry hidden possibilities of
having various effects on the body's defense system.
IV. Conclusions
The
correlation
betweenacupunctureandmoxibustion stimulation has been described. Any ofthese stimuli probably uses cutaneous or deep tissue
nociceptors as their main input system. Throughexcitation of these nociceptors, a negative feedback
mechanisms exerts various effects on the body's defense
system. Conceivably this can have a variety of effects,
for example, the manifestations of an endogenous
analgesic mechanism, triggering of responses from theautonomic or endocrine systems, or else modulation of
the immune system. Moreover, these stimuli
themselves produce some minor degree of tissue injury,
leading to the release of algesic substances ormodulators and their stimulation then cause retrograde
stimulation of the receptors, subsequently probably
exerting effects on the axon reflexes of terminals in thevicinity.
Furthermore,throughneurogenic
inflammation the excitability of a new type of so farsilent nociceptors is recruited, that then conceivably
leads to both peripheral and central summation effects.

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Through these mechanisms acupuncture andmoxibustion are considered to cause via minor
stimulation of the body surface, various clinical effects.
V. References
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and moxibustion stimulation and peripheral
reception mechanisms; Japanese Journal of
Physiology 51: 303-315, 1989
2) Kawakita K & Goto K: Role of polymodal receptor
in the acupuncture-mediated endogeneous pain
inhibitory systems. Kumazawa T, Kruger L,
Mizumura K (eds). Prog Brain Res 113: 507-523,
1996
3) Takao Kumazawa: Regarding the modes of actionof acupuncture anesthesia, Clinical Physiology 8:
413-419, 1978
4) Sadao Aikawa: Physiology of acupunctureanaesthesia and pain. Keio Medical 50: 463-478,
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5) Sjolund B, Terenius L, et al: Increase CSF levelsof endrophins after electroacupuncture. Acta
Physiol Scand 100: 382-384, 1977.
6) Takao Kumazawa: Pain and polymodal receptors.
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7) Kumazawa T: Opioids and autonomic functions
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8) Kazuhiro Goto, Yutaka Kagoshima: Activity ofhuman cutaneous C-fibers and Aδ fibers.
Collection of abstracts of the 4th Research
Conference on Pain 4, 1982
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Polymodal receptor activity and pain sensation inhuman cutaneous C-fibers; Collection of abstractsof the 5th Research Conference on Pain 5, 1983
11) Kazuhiro
Goto,
Kazuo
Sakurai,others:Fatigability of human cutaneous C-fibers in
response to thermal stimulation. Journal of theJapanese Association for Study of Pain 2:1, 1987

12) Kazuhiro Goto, Kazuo Sakurai, others: Responseof human cutaneous A-fiber nociceptors tothermal stimulation. Journal of the Japanese
Association for Study of Pain 5:3, 1990
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activity
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percutaneously
withsemi-microelectrodes in human peripheral nerves.
Acta Physiol Scand 69: 121-122, 196715) Mano T, Mitarai G, et al: Vibratory sensitivity ofhuman muscle spindle, In: Vibratory stimuli andthe tonic vibration reflex (Watanabe S eds),
Saikon, Tokyo, 1977, 101-110．
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from muscle nerves in human subject. Acta
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from human median nerve fascicles in situ. A
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Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 201024) LaMotte RH, Thalhammer JG, et al: Peripheral

high threshold mechanoreceptors with myelinatedneural mechanisms of cutaneous hyperalgesia

axons by repeated heating. J Physiol(Lond) 265:

following mild injury by heat. J Neurosci 2:549-563, 1977．
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