Volume 6, Number 4 | Winter 2011

Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (2) – Internal Medicine

become the subject of research. In response theTomomi Narushima1), Eitaro Noguchi2)

announced in Rome 2000, the resulting large supply

1) East-West Integrative Medical Centerof public funds for acupuncture research for treating

Tsukuba University of Technology

IBS led to a sudden increase in research reports. As2) Graduate School of Technical Sciencesa result, Takahashi (2006) 8 as well as Yin et al.

Tsukuba University of Technology

B Influences on Digenstive Tract Function due to
Acupuncture

started a long history of scientifically researching
the effects of acupuncture and moxibustion on thedigestive system.
In 1912, Jujiro Kashida et al., studied the effects ofmoxibustionondomesticatedrabbits

intestinalusing

peristalsisainmanometer.

Stimulating ST36（足三里）as well as abdominal
points with moxibustion they reported a transient
acceleration that gradually became a resistance
response to the stimulation1. Further, in 1914,
Michio Goto observed an acceleratory response tomoxibustion stimulation in the intestinal movementof rabbits2. Additionally, in 1929, Shuji Fujii et al.,reported a resistance response to moxibustion in thesmall intestinal movement of rabbits3. Later, in the
1970's, Sato et al., and Noguchi, who played aleading role as Japanese researchers performed
basic research, gradually clarified the mechanism bywhich acupuncture and moxibustion treatment
somato-autonomic

nerve

reflex

thereby influencing the digestive system4,5.
Concerning clinical research, in 1992, Li et al.,presented Chinese acupuncture and moxibustion
research on the subject of the digestive tract. In 1999,
at a Symposium sponsored by the Japanese Societyof Acupuncture and Moxibustion, a comprehensive
review of basic and clinical research outcomes waspresented7.
Recently in foreign countries, due to increased publicneed, Irritable Bowel Syndrome (IBS) has frequently
2reported

acupunctureaandcomprehensive
moxibustion

reviewoftreatment

fordigestive disorders. The crux of the matter will beof the reviews introduces research on salivary

Compared to other countries, at an early date Japanthe(2010)9

introduced below, where a relatively high proportion

1. General Overview of Research

influences

introduction of clear standards for IBS diagnosis,

secretion, gastric acid secretion and gastrointestinal
disorders, especially IBS.
2. Acupuncture and Salivary Secretion
Research on Acupuncture and salivary secretions
precedes the conditions of clinical research, Blom etal. (1992)10 reported, when compared to the placebo
control group, patients with dry mouth associatedwith Sjogren’s syndrome experienced significant
increases in salivary secretions following needle
retention acupuncture. Additionally, Dawidson et al.,reportedly confirmed the mechanism for increased
salivary

secretions

following

acupuncturewasthought to be due to an increase in blood vessel
dilatory factors such as CGRP11 and VIP12 leading to
improved circulation to salivary glands. O’Sullivan etal.13 emphasized the importance of extremely
accurate acupuncture RCTs to assure clinicaleffectiveness and patient safety. This groups clinicallyevaluated 3RCTs demonstrating that acupuncture
effectively mitigated the dry mouth that often results
as a side effect of radiation therapy for head and neckcancer patients. Omata et al., conducted clinicalresearch and reported in Japan that high frequency
electro-acupunctureonsalivary

andsecretions

facialpointsmitigated

increased

dry

mouth

symptoms associated with Sjogren’s syndrome14.
Further, Omata et al. reported in 2007 that at the
time

of

stimulationhighfrequency

(1Hz

and

30Hz)

electro-acupuncture
measurable

VIP

emissions caused blood vessel dilation that led to

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

Volume 6, Number 4 | Winter 2011

significant increases in secretions such as tears, theamount of salivary secretions and facial skintemperature changes. Tears and salivary secretions
were confirmed to increase with 30 Hz electroacupuncture stimulation15.
As reported above, acupuncture treatment has beenclinically shown to increase salivary secretions,however, the functional mechanism of that process
has yet to be convincingly clarified. It has beensuggested that increased blood flow to an area as aresult of increased blood vessel dilation factors in thearea would accelerate secretions, however further
research is thought to be necessary (Table 1).
Table 1 Salivary Secretion
AuthorBlom M.

Year of

Subject,Object

Number of

Publicationof study

Cases

1992

Xerosis21

Method of stimulation

Conclusion

Journal

Needle Retention

Salivary Gland Secretion increase

Oral Surg Oral

Technique vs. Shamdue to shallow needling

Med Oral Patho

needling(Shallow needl ing)
Blom M.

1996

HNC

38

Sham Acupuncture (1 cm

Salivary secretion increase due to

Eur J Cancer, B.

far from acupoint &acupuncture,shallow acupuncture andOral 0ncol

shallow needling) vs.

no significant difference Manual

Manual Acupuncture

acupuncture stimulation

stimulation
Dawidson

1998

Xerosis patient

65

I.
Dawidson

1999

Xerosis patient

65

I.
Omata H.

2000

Manual Acupuncture with

Increased Salivary secretion, increased

Qi arrival

VIP concentration within the saliva

Manual Acupuncture with

Increased Salivary secretion, increased

Qi arrival

CGRP concentration within the saliva

Neuropeptides

Neuropeptides

In both

Healthy

Electro-acupuncture in the

Effectiveness of facial electro-

The Japan

Sjogren’s

subjects

cervical (neck) area/ Facial

acupuncture (20Hz), Dray Score

Society of

syndrome and=10

area electro-acupuncture

improvement

Balneology,

healthy subjects

Subjects

Climatorogy andwithPhsical Med

Xerosis =10
Omata H.

Cho JH.

Pfister DG.

2007

2008

2010

In both

Healthy

Facial electro-acupuncture

Increased tears volume following 30Hz

The Autonomic

Sjogren’s

subjects

1Hz vs. 30Hz

electro-acupuncture, 1 and 30Hz

Nervous System

syndrome and=10electro-acupuncture causes increased

healthy subjects

Subjects

saliva volume, facial epidermis

withtemperature increase with 1 Hz electro-

Xerosis =11

acupuncture

HNC

NHC

12

58

Needle Retention

Acupuncture and shallow acupuncture

J Altern

Technique vs. Shamcauses an increase in salivary gland

Complement

needling

secretion, subjective symptoms

Med(Shallow needl ing)

significantly improved

Manual acupuncture

XI Score significantly decreased withstimulation vs. standard

acupuncture

J Clin Oncol

acupuncture treatment

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

3

Volume 6, Number 4 | Winter 2011

3. Acupuncture and Gastric Acid Secretion

Also, Jin et al., observed that acupuncture stimulation

It is thought that Sodipo et al.16, were among thewas capable of inhibiting amino acid induced gastricfirst European and American researchers to reportacid secretion in under conscious dogs. Because thison the effects of Acupuncture therapy on gastric acidreaction was eliminated by naloxone, it was thoughtsecretions. These researchers used a 6 week protocolthat endogenous opioids must be related to the painofelectro-relief mechanism of acupuncture related pain relief 18.

acupuncture on patients with duodenal ulcers andOn the other hand, Noguchi et al., observed

non-ulcerative indigestion. The patients reported

accelerated gastric acid secretion in anesthetizedelimination of stomach pain and, within therats treated with electro-acupuncture at ST36.

duodenal ulcer group, because there was a reduction

Because this reaction was eliminated by severing thein maximum-stimulation gastric acid secretion the

Sciatic and/or Vagus nerves, it was reported that the

researchers concluded that acupuncture inhibits

accelerated gastric secretions must involve thegastric acid secretion in these patients.

somato-autonomic nerve reflex19.

Within the field of basic research, Zhou et al. (1984),

Currently, there are numerous reports concerning

treated and unanesthetized dog with a gastric fistula

gastric

using electro-acupuncture on ST36(足三里), PC 6(内stimulation,

unfortunately

関 ), and UB 21( 脾 兪 ) for 2 hours and observed

hypothesizedmechanisms

remaininhibition of gastric acid secretion, this response wasFurthermore,

given

developments

reported as inhibition of gastric acid secretion by thepharmaceutical treatments and elucidation of thesomato-autonomic nerve reflex because the reaction

mechanisms involved in ulcer occurrence, thedisappeared with the administration of the Vagal

importancenerve blocker Atropine and/or local anesthesia,

acupuncture’s role in controlling gastric acid has

procaine17.

been diminished (Table 2).

acupuncture,

moxibustion

andsecretionofresultingfromacupuncture

theresults

recentclarifying

and

and

unclear.

reportinginonTable 2 Gastric Acid Seretion
AuthorSodipo J

Year of

Subject,Object

Number of

Publicationof study

Cases

1979

Gastric Ulcer

10

patient

Zhou L1984

Conscious

5

dogs

Jin H

1996

Conscious

5

dogs

Method of stimulation

Conclusion

JournalRetention method of Acup.,

Reducing gastric ulcer pain is related to

Am J Chin Medelectro-Acupuncture, Moxa

reducing the amount of gastric acidon sliced ginger

secretion

Electro Acup. vs. Manual

Sham Acup. <Manual Acup.<Electro-

Acup.

acup. reduces gastric acid secretion

No stimulation vs. Shallow

Acupuncture shown to suppress gastricAcup. vs. Electro-Acup.

acid secretion following amino acid

Life Sci

Am J Physiol

ingestion

Noguchi E

1996

Anesthetized
rats

4

56

Electro Acup. on St 36 (足三Electro-Acup. at ST36 accelerated里) vs. LI 10 (手三里)Gastric acid secretion

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

Volume 6, Number 4 | Winter 2011

4. Acupuncture and Gastrointestinal Dysfunction

effectiveness of acupuncture, sham acupuncture

Li et al.(1992) , reviewed 25 reports, published(shallow acupuncture) or another intervention for

between 1979-87, on the role of acupuncture in

IBS.

gastrointestinal function and disorders. A majority

In 2007, Schneider et al., investigated all the clinicalof the reviewed papers (17) used basic research

papers related to acupuncture used to treat

papers, whereas only 8 reports used human subjects

gastrointestinal disorders on MEDLINE (submitted

for functional and clinical research 6.

until 2006) (Table 3).

Since 1997, the National Institutes of Health, NIH

Their results included 18 extracted reports, fromhave announced a general consensus with respect tothese they selected 4 RCTs that met the standard

acupuncture and have generously made funds

criteria and used these for their systematic review.

available for further research. As a result, numerous

The subject of two of these papers was Irritable

reports on the usefulness of acupuncture for stomach

Bowel Syndrome (IBS) and Chrohn’s Disease (CD),and intestinal function have been published by

one paper discussed Ulcerative colitis and one

American Medical Universities 20. Takahashi (2006)8

discussed

reportedon

Discussion within these papers related to thegastrointestinal

usefulness of acupuncture and sham acupuncture

on

the

acupuncture

andfunctional

disorders.

thefollowing

In

above

results,

focusing(IBD).

(shallow acupuncture) for these conditions as well assummarize the Yin et al., report on gastrointestinal

whether or not the patient’s quality of life (QOL)

motility disorders (2010) 9.

significantly improved. Acupuncture treatment was

Recent studies on acupuncture treatment forfound to be significantly more effective for patients

gastrointestinal disorders reflects a growing social

with Chrohn’s Disease and Colitis than shamneed, so IBS research has been conducted quite

acupuncture(shallow acupuncture) regarding theenergetically. For these reasons the following two

activity of the disorders (CAI score). From thesereports (2006, 2007) were selected for this systematic

results, it has been thought that the effectreview. Lim et al.(2006), used online databases

acupuncture may have on QOL for IBS patients is

PubMed,ofnon-specific, but because the possibilities areControlled Trials (CENTRAL) on The Cochranedetectable, there is a clear imperative for further

Library,

research 22.

Cochrane

EMBASE,

CentraltheChineseweBowel Disease

will

the

sectionInflammatory

Register

Biomedical

Database, the Cumulative Index to Nursing andIn this way, it has been suggested that acupuncture

Alliedhas the potential to be effective for IBS, Chrohn’s

Health(CINAHL),

and

the

AlliedandComplementaryMedicineDatabase (AMED) to

Disease,analyze and extract 6 relevant clinical studies (Table

gastrointestinal

3).

conclusion has not been fully verified.

The

resultsdid

notconfirm

statistically

Ulcerative

colitis,functionetc.,

disorders,

and

other

but

this

significant differences in studies where sham

However, according to MacPherson et al.(2010), they

acupuncture was set up as a group to be compared tocurrently have 233 IBS patients whose results are

standard acupunctures, but did report that whenbeing analyzed and they anticipate publishing a newacupuncture was set as the control group symptoms

systematic review 23(Table 3).

often improved 21. However, a large portion of the

So while these two systematic reviews at once give

reviewed clinical papers were of low quality andthe impression that the possibility of effective

although meta-analysis was attempted, only 2acupuncture exists, there is also the impression thatreports were worth analyzing. For these reasons, itboth acupuncture and sham acupuncture provideisdifficult

to

make

a

judgment

about

the

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

5

Volume 6, Number 4 | Winter 2011little more effect than a Placebo. The origin of these
conclusions are strongly reflected in the current
research model that equates “sham acupuncture”
with a “non-invasive control”, when this assumption
has not been universally approved. When using
sham acupuncture as a control (non-invasive, nonstimulation=

placebo)differing“doses”

ofstimulation have been confirmed. That is to say, thestimulation from sham or non-invasive stimulation(as a control or a placebo) is thought to be sufficient

As for Japan, conducting acupuncture andmoxibustion RCTs has been relatively difficult, infact, in recent years Japan has contributed almost no
meaningful clinical research RCTs. However, in lightof some outstanding recent report using acupuncture
to treat IBS that utilizes an inversion method, it is
now being thought that methods besides RCTs thatare still evidence based medicine (EBM) arecertainly possible 24. Moving onward from this point,
it is now necessary to confirm acupuncture andmoxibustion research methodologies in Japan.

to provide a therapeutic effect.
Table 3 Lim’s Systematic Review, The Cochrane Library, 2005
No

Author.

Year ofCategory

Publication

Subject,

NumberObject ofof Cases

Method of stimulation

Conclusion

JournalLI4(合谷) stimulation vs.

Comparing Acup. with Sham Acup.

Digestion

Sham acup. (UB60:崑崙)

treatment, Abdominal pain as well as

study
1

Fireman

2001

RCT

Z

Israeli

25

Patient
with IBS

over all complaints were improved,
there was no significant difference inimprovement between the 2 groups.

2

Forbes A

2005

RCT

English IBS

59

out patient

Chinese Acup. vs. ShamAcupuncture seems to be superior toWorld J

acup. using non-meridian

Sham treatments, but there is no

Gastroenterol

pointssignificant difference.

Accordingly,

Acupuncture has relatively little effecton IBS
3

Liao YC

2000

RCT

Chinese IBS

97

Patient

Chinese Acup. withAcupuncture with PsychologicalClin Acup &Psychological CounselingCounseling is more effective thanMox

vs. Chinese Herbal

Chinese Herbal Medicine with

Medicine with

Psychological Counseling

Psychological Counseling
4

Liu M

1995

RCT

Chinese IBS

37

Patient

Chinese acup., Ear acup.,

Ear acup. is more effective thanShanghai J

Western ｄrugWestern drug treatment

Acup & Mox

Chinese Acup. vs.

Compared to using Acup. alone,

Chin Acup &Chinese Acup. with

Combining Acup. with some

Mox

Psychological Counselingcounseling is more effective

Chinese Acupuncture vs.

Acupuncture is not especially effective

Gastroenterol

Sham Acupuncture by

for IBSogy

treatment
5

Liu GZ

1997

RCT

Chinese IBS

50

Patient

6

Lowe C

2000

RCT

Canadian
Patient

28

blunt needles

6

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

Volume 6, Number 4 | Winter 2011

Table 3 Schnelder’s Systematic Review, World J Gastroenterol, 2007
No

Author.

Year ofCategory

Publication

Subject,

NumberObject ofof Cases

Method of stimulation

Conclusion

JournalChinese Acup.vs. ShamAcupuncture is superior to ShamWorld J

Acup. (Non-meridian

Acupuncture but there is no

Gastroenterol

points)significant difference. Further,

study
1

Forbers A

2005

RCT

IBS Patient

59

Acupuncture is not especiallyeffective for IBS
2

Joos S

2004

RCT

Patient with51

Chinese Acup. and Mox.

In line with CAI, acupuncture is

Chrohn’s

vs. Sham Acup. (shallow

considered more effective than

Diseasestimulation on meridian

Sham acupuncture.It appears thatpoints)Acupuncture is moderately effectivefor

3

Joos S

2006

RCT

29

Digestion

Chrohn’s Disease

Chinese Acup. and Mox.

In line with the Colitis Activity

ScanJ

vs. Sham Acup. (shallow

Index (CAI), Acupuncture is

Gastroenterol

stimulation on meridian

considered more effective thanpoints)Sham acupuncture, but considering
QOL there is no difference between
the two. It appears that
Acupuncture is moderately effective
for ulcerative colitis (UC).

4

Scheider

2006

RCT

IBS Patient

43

A

Chinese Acup. vs. Sham

Both Acup. and Sham Acup.

(Streitberger) acup.

contribute to an improved QOL for

Gut

the patient. Acupuncture`s effect ismostly attributed to the Placebo
effect.
5

Liu GZ

1997

RCT

Chinese IBS

50

Patient

6

Lowe C

2000

RCT

Canadian

28

Patient

Chinese Acup. vs.

Compared to using Acup. alone,

Chinese Acup. with

Combining Acup. with some

Psychological Counselingcounseling is more effective

Chinese Acupuncture vs.

Acupuncture is not especially

Sham Acupuncture byeffective for IBS

Chin Acup & Mox

Gastroenterology

blunt needles

References

4.

General view of research
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JujiroKashida,somatosensory input on autonomic functions.
Kazuo

Harada:About

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Etaro Noguchi, Kenji Imai, Eiji Sumiya, et al.:on Facial Autonomic Nerve Function. The

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