Volume 10, Number 3 | Fall 2015

Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (17) – Psychiatry
Tetsuya Kondo

extrameridians passing through the area. It may
also be related to the fact that such extrameridiansas the yang link , belt , governor , and yan heel
vessels run through the lower back area. The

1. Present State of Clinical Studies Outside of Japan
With respect to studies in the fields of psychiatry
and psychosomatic medicine outside of Japan, adetailedreviewofpsychosomatic

disordersassociated with fibromyalgia1) has been published in2001, and those of depression2), chronic pain1),
anxiety disorder2), schizophrenia2), drug addiction2),
and gastrointestinal disorders3) have been publishedin 2008.
Depression is among the top ten diseases forwhich patients tend to rely on complementary andalternative medicine due to dissatisfaction with
Western medicine. Many large-scale, randomized
controlled studies thus exist regarding depression4).
Among its symptoms, acupuncture and moxibustion
has been reported to be more effective against
anxiety and somatic symptoms than the tricyclic
antidepressant amitriptyline, and caused fewer sideeffects5). In a comparison with a tetracyclic
antidepressant, acupuncture and moxibustion was
found to have roughly the same effect. However, both
antidepressants used in the comparison are olddrugs, and the only study that provides a comparison
with a new drug, namely serotonin reuptake
inhibitor that is presently the mainstream, simplyreports that a kind of serotonin reuptake inhibitor,
paroxetine had a greater effect when used inaddition to acupuncture and moxibustion than whenused alone6). New studies need to be made, as newdrugs such as mirtazapine have appeared thatprovide the same effectiveness as amitriptyline butgreater tolerability7), and also since different drugs
are effective against different symptoms8).
With regard to chronic pain, many studies
suggest that acupuncture and moxibustion iseffective particularly against lower back pain andhead and neck pains1). This is related to the fact that
meridians are concentrated in the head and neck

American Psychiatric Association classifies chronic
painofimportant

which
role

psychologicalindevelopment,

play

anseverity,

aggravation or sustainability as a type of psychiatricdisease, but hardly any specific study on this exists.
Fibromyalgia is a subject of many high-quality
randomized controlled studies, which report that
real acupuncture is more effective than shamacupuncture in improving scores, mainly by raising
the pain threshold. However, these studies do notentaillong-term

additional

follow-up,

treatment,

so

the

appropriate

effects

ofsimulation

frequencies, the effects of combining drug therapy,
and other such aspects remain unknown.
Anxiety disorders are classified into heart andkidney deficiency, liver excess, non-interaction
between the heart and the kidney, etc., and are a
subject of various studies. There are a number ofreports on randomized controlled studies that haveutilized ear acupuncture to treat generalized anxiety
disorders and anxieties accompanying surgery andcolonoscopy. According to them, ear acupuncture has
contributed to reducing the necessary amount ofanti-anxiety drug before endoscopy and mitigating
discomfort and pain during the exam. However, nostudies exist that have been conducted in Japan. On
the whole, evidence level is low in most papers, sofuture studies need to be made. It should also be
noted that no reports exist regarding other forms ofanxiety disorders such as obsessive-compulsive
disorders and panic disorder9).
Schizophrenia has not been a subject of any
randomized controlled studies. The only controlled
test that exists reports that the metabolite whichincreases when the disorder is exacerbated is further
increased with electroacupuncture. As this goesagainst the effectiveness of acupuncture andmoxibustion, further studies need to be made.

area, with 7 of the 12 main meridians and 7 of the 88

thefactors

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

Volume 10, Number 3 | Fall 2015

Drug addiction is studied mostly outside of Japan,

a dramatic increase in population, with the majority

as a reflection of social situations. A number ofof the people living along the coastal regions, whererandomized controlled studies have been conducted,

humidity is high due to the impact of the monsoon

but they include studies that have both proven orclimate. There is high possibility that Japanese-stylefailed to prove the effectiveness of acupuncture andtreatment could apply to people in those regions.

moxibustion, probably due to differences in severity

In Japan, dialectics is also based on perspectivesof the disorder and the psychotherapy that wasof Qi, blood, and fluid12), which is independent of theapplied in combination.

dialectics of the five viscera. In a large-scale study

With regard to the digestive system, patients withperformedon914

newoutpatients

toaa tendency toward depression are known to develop

psychosomatic department of a university hospital,a disease based on hypersensitivity to pain in hollow

it was found that Qi deficiency and Qi depression areorgans from the esophagus to the intestine. They areinvolved to the same degree in depression among

respectively called irritable esophagus, biliary

women, while Qi deficiency is involved to a far larger

dyskinesia, and irritable bowel syndrome. The

degree than Qi stagnation among men13). Qi

mutual complication of biliary dyskinesia anddeficiency and Qi stagnation were involved in

irritable bowel syndrome is high, as seen in Shimada

depressive state, anxiety state and generalized

et al.’s diagnosis criteria for biliary dyskinesia,

anxiety disorder in addition to Qi flowback inwhich includes the presence of irritable bowel

females and blood deficiency in males13). There are

syndrome among the reference findings10), andalso findings that emphasize fluid retention andsuggests that a common basis exists. Acupuncture

bloodtreatment has proven effective against the abovedepression, rather than (liver) Qi depression

types of conditions, particularly irritable bowel(stagnation) and other Qi abnormalities that aresyndrome, but since sham acupuncture was also

common to traditional Chinese medicine14). There

found to be effective, it likely acted on the pain

have also been findings indicating associationthreshold in the central nervous system that isbetween blood deficiency and somatoform disorder inregulated by opioid.

females, between irritable bowel syndrome and Qi

stagnation

asfactors

associatedwithflowback, and between eating disorders and fluid
retention 13).

2. Present State of Clinical Studies in Japan
Studiesinthefieldsofpsychiatry

andThe Sawada method, which is adopted by many

psychosomatic medicine in Japan include those thatpractitioners of acupuncture in Japan, focuses on thetake into consideration the Japanese climate.

triple energizer meridians, and particularly the left

Ascendant hyperactivity of liver yang caused by yin

TE4. Kondo et al. also revealed a model that

deficiency, which is a problem in China’s dry inlandsuggests involvement of excess heat from the triple

climate, and warm dryness that is an effect ofenergizers,

dryness in the hot season, are rarely seen in Japan.

oligohydruria, in a study on outpatients of mental

However, humidity, which becomes a problem on theand psychosomatic disorders, which is consistentcontinent only during the long summer, is a year-with Sawada’s theory15).

round problem in Japan, and treatment needs toIt

isnamely

known

that

scybala,patients

nausea,withandclassic

take cold humidity into consideration in the winter11).

psychosomatic disorders, diabetes, or hypertension

In fact, there have been cases where treatment thathave little self-awareness of their bodies, and tend tosimultaneously addresses the cold and humidity has

develop the disorder due to poor communication

been applied to depression, when stress far exceeded

between mind and body. Kansai University ofthe patient’s physical strength. Asia is experiencing

Health Sciences and other such institutions are

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

9Volume 10, Number 3 | Fall 2015

conducting studies of evaluation methods foris specific to psychological stress20), and amylase,autonomicfinger

which is said to increase in response to unpleasant

plethysmography that can record measurements instimuli21). With regard to the neuroendocrinea non-invasive, simplified manner, based on the ideasystem, an increase in 17-KS-S/17-OHCS ratio hasthat harmony of mind and body could be achieved bybeen reported the day after acupuncture therapy,

presenting objective indicators in response to one’sindicating an increase in latent stress tolerance22).

nervousfunctionsusing

physical conditions. Oriental medicine places focus
on curing diseases in their pre-symptomatic state.
The deficiency or excess of one’s predisposition is a
type of pre-symptomatic disease. As measures thatspecifically detect subtle changes in a living body,the indicator that is calculated from the Lyapunov
exponent, which is a non-periodic component offinger plethysmography and expresses the vagariesof the trajectories of the pulse wave, and theindicator that is calculated from entropy as anindicator of complexity, are reported to be high in theexcess pattern and low in the deficiency pattern16). It
has also been observed that these indicators recoverin the healthy direction after exposure to thearomatics of moxibustion therapy17). The healthy
directionreferstoastatein

which

subtleadjustments are made per pulse and bring anabundant change. Additionally, it has been reported
that these indicators drop below normal levels at thepreliminary stage before developing depression,
which

is

alsoa

pre-symptomatic

disease18).

Psychosomatic

medicine

inJapanwidelyintroduces transactional analysis, and a uniqueegogram has been developed as a method ofquantifying the intensity of five ego states of anindividual, which is an important factor intransactional analysis. There is a theory thatassociates these five ego states with the fiveviscera23). In psychosomatic disorders, in which thesame symptoms appear sustainably in a certain
organ, the ego of the “adapted child” is so strongthat over-adaptation becomes the cause of thedisorder in many cases. In fact, when examining themedium pattern between egogram and ryodoraku,
it was found that electric current in the spleen andliver decreased among patients whose “adaptedchild” was predominant over their “free child,” andcontrarily increased in the liver among patients
whose “free child” was predominant over their“adapted child”24). A decrease in electric current in
the spleen and liver is a ryodoraku pattern that is

Furthermore, the closer F Constant, an index of how

deeplymany pulses equal a cycle, is to 4.69, the better

fatigability, insomnia, taste disorder, depressive

homeostasis is maintained in a living body. Whenmood, and hypobulia, and may reflect depression

this is obtained through finger plethysmography,

causedhomeostasis is reported to be highest in the medium

melancholicus. Such tendency for excess adaptation

pattern that determines the degree of deficiency in

is at the foundation of disease conditions such as

response to questions about fatigue, chills, anddefinite chronic pancreatitis25) and gastroduodenal

pernoctation burden19). If a state of tension isulcer. Thus, there is strong possibility that mind

considered a psychological excess, and sleepinessand body therapy that takes into considerationand fatigue are considered a psychological deficiency,

ryodoraku

homeostasis is reported to drop below the medium

contribute to the treatment of psychosomaticpattern16) in both cases.

disorders.
References

Acupuncture and moxibustion have the effect ofmitigatingstress. Their effects

are reported

particularly against saliva chromogranin A, which

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