Volume 9, Number 1 | Spring 2014

Japanese Acupuncture – Current Research
Japanese Traditional Medicine Text (11) –Orthopedic Medicine

point Shiatsu. Additionally, a wide variety of sample
sizes, control group criteria and sham treatment

Masahiro Iwa

group criteria contributes to a wide range of effects

Associate Professor
Faculty of Acupuncture and Moxibustion
Meiji University of Integrative Medicine

and conclusions. P6 tends be used most frequently asA. Postoperative nausea and vomiting, postoperative
intestinal paralysis
Various symptoms and complications occur aftersurgery, for example postoperative nausea andvomiting (PONV) and postoperative ileus (POI).
These seem to be especially adaptable acupuncture
and moxibustion therapy. Of course these are due tovarious factors but anesthetics and analgesic drugs
used after surgery are certainly big factors. Thesenot only reduce patient quality of life, but alsodelayedacupuncture electrical stimulators, acupuncture

recoveryoperatively, there has been a recent trend to use
percutaneous electrical stimulation as opposed toelectro-acupuncture.
To begin with a review of the RCT literature,
Cochranepublishedthelatest

report9).

The

antiemetic effects (POVN) of P6 were verified bycomparing actual needling with sham needling.

Itwas found that patients treated with P6 requested
fewer anti-emetic drugs. It was further foundbecause that there was no difference in effectbetween the acupuncture and the antiemetic,

prolong

recentevidencemeans for preventing PONV. Shiao10) et al, used asuggesting acupuncture treatment is useful formeta-analysis and found that both acupuncture andcoping with side effects of drugs such as PONV andanti-emetic medications were equally effective forPOI.

reducing PONV. Notably, it was reported that forWesurgery

be used pre-operatively, intra-operatively and post-andhospitalization.

aftera treatment area. Because treatment methods may

examinedpatients treated with acupuncture, there were fewer

1. Clinical Studies from Abroad
Studies on the effects of acupuncture point
stimulationfor

postoperativecomplaints

overwhelmingly focus on PONV. A PubMed searchusing

keywords[acupuncture][postoperative

produced150

nausea]relevantandarticles.

Approximately 30 references were found for clinicalresearch using RCTs in the past 10 years (since2000).
After reviewing more than 25 references, weextracted 8 reports for examination here.

effects of acupuncture point stimulation for PONV(18). Every year, a number of papers are presented fromcountries.

Targeted

techniques

oracupuncture point stimulation covers a wide range
oftreatment

options:

acupuncture,requests for emergency anti-Emetic which is usefulfor POVN patients. Further, the systematic review
by Sun1) et al., they investigated the side effects ofopioids in post-operative PONV patients. It wasreported that the acupuncture group, compared tothe control, had a reduced occurrence of nausea but
there was not significant difference concerning theincidence of vomiting. Dune12) et al, reported in theirsystematic review on pediatric POVN the effects ofacupoint stimulation. Acupuncture and acupuncture
point

Table 7 shows the RCT literature examined

Westernacupuncture stimulation might be reasonable as aelectricalacupuncture, Transcutaneous and percutaneouselectrical stimulation (TENS), laser stimulation,

Shiatsupostoperative

ledtovomiting

significantlyinchildren.

decreased
Notably,acupuncture and acupuncture point Shiatsu were
found to be more effective than electro acupuncture
for these subjects.zAllen13) et al. conducted a meta-analysis on theeffects of stimulus at P6 for PONV following
Cesarean surgery under spinal anesthesia. Requests
for Inter-operative, post-operative nausea andThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 9, Number 1 | Spring 2014

vomiting and emergency anti-emetic medications

What remains unclear is, to what extent are thesewere reduced however, several inconsistencies in theprotocols being used successfully clinically? On theprotocol may diminish the strength of the analysis

other hand, regarding post-operative ileus (POI), aand conclusions. Also, the Gynecology Physicians

PubMedAssociation of Canada`s Executive Council has[postoperative ileus] and [acupuncture], 1 RCT

published management guidelines14) recommendingreference was extracted15). Post-operative Colonelectrical stimulation of acupoints as prophylaxis

cancer patients were given electro-acupuncture atand as useful for PONV. Acupoint stimulation

GB34 and SJ6 for 6 days following their surgery.

received a high evaluation and was strongly

However, it was reported that electro-acupuncture

recommended based on evidence based evaluation

was ineffective for preventing POI in these patients.

grades II-1 (I, II-1 through II-3, III of 5 levels).

It

Until recently, most fundamental RCTs on the effects

received a grade A on the A-L 6 level recommendedof acupuncture stimulation for gastrointestinal

degree classification. As the above research suggests

motility have focused in irritable bowel syndrome

acupuncture has been used successfully as a(IBS) and very little research has been done on thesepreventive therapy for PONV.

effects in POI patients.

wordsearch

wasconductedusing

Table 7 Major Research Paper on Acupuncture Point Stimulation for Post-Operative Nausea and Vomiting
Researcher

Name of surgery

Teatment area

Treatment method

ShamTENS
ReliefBand (electroacupuncturestimulation device)
ReliefBand (electroacupuncturestimulation device)
Auricularacupuncture

Non-acupoint areas
Not operating theReliefBand

TENSTENS used on/ along
the Ulnar nerve
Stimulate the dorsal
aspect of the wristwith a ReliefBand
Not operating theReliefBand(year)

4

Wang1) (2010)
Frey2) (2009)

Cranial Surgery
Laparoscopiccholecystectomy

Nei Guan (PC6)Nei Guan (PC6)

Frey2) (2009)

Hysterectomy

Nei Guan (PC6)

Sahmeddini4)(2008)

Laparoscopiccholecystectomy

Arnberger5)(2007)
Habib6) (2006)

Laparoscopiccholecystectomy
Caesarean Section

Points on the Sympathetic nervous
system, stomach points, Shen Men(UB23), Occipital point
Nei Guan (PC6) (Median nervedomain)
Nei Guan (PC6)White7) (2005)

Orthopedic Surgery

Nei Guan (PC6)

Gan8) (2004)

Mastectomy, Surgery
for Breast CancerNei Guan (PC6)

ReliefBand (electroacupuncturestimulation device)
ReliefBand (electroacupuncturestimulation device)TENS

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

Not operating
ReliefBand

theAffixed with tape

Electrode only affixedVolume 9, Number 1 | Spring 2014

2. Current Clinical Studies and Prospects for theparticularly the United States since1999, within theFuture of Japanese Research

NIH, The National Center for Complementary andA web search of online journals for the keywords[postoperativenausea][postoperativeandintestinal[acupuncture]paralysis]orandAlternativeMedicine(NCCAM)

has

been

established. Every year, millions of dollars are
donatedbyNationalResearchFoundations,references

Harvard, Johns Hopkins, UCLA, Maryland, Dukehowever, many of these were from minutes atand many other University and medical institutions

meetings, discussions and case study reviews, none

conducting clinical trials on the effects andof which were RCTs. One pilot study for PONV,

usefulness of acupuncture. Additionally, numerous

reported on 11 cases of Gynecologic Surgery whose

medical institutions have incorporated various

subjects were given tack needles at St36, P6, ShencomplimentaryMen (auricular point).

Integrated[acupuncture]

producednumerous

Results suggested that

medicalMedicine

modalities

into

theirDepartments.

One

prime

PONV was reduced for these subjects16).

example might be the acupuncture done at Memorial

On the other hand, regarding POI, 12 relevant

Sloan Kettering Cancer Center, one of the world's

reports17,18) were extracted, however these are quite

leading cancer centers. Also, in the United Kingdom

dated. All of these reports set control groups butinthese did not use sham acupuncture and the sample

acupuncture treatment (published in the British

sizes we between 12 and 15 subjects which was tooMedicalsmall. The acupuncture protocol included either

acupuncture research is being conducted. In contrast,

St36 and LI11 (20 minutes, once a day, 3 days

it must be said that compared the great amount offollowing surgery) or SP13 and SP6 with retention

clinical research from the West, Japan is clearly a(Post-surgery 16 hours).

Positive results were

step or two behind. Not until 2010 did theobtained as the period of post-operative flatulence

Democratic Party Healthcare policy adopt anwas significantly reduced. Further, although notintegrated

primary research, we also conducted acupuncture on“Establishment of integrated health care” andpatients following gastro-intestinal surgery. Tackinauguration of an integrated health project team.

needles were placed at LI4 and ST36. Compared toHowever, as of March, 2010, the “Japan Medical

thereported

Association for integrative medicine report released

significantly less post-operative flatulence19). There

their opinion” suggesting that the current flow of theis an especially strong trend for patients following

Japanese Medical Association runs counter to thegastro-intestinal surgery to suffer from extended

trends of integrative medicine.

controlgroups,thetestgroupperiods of flatulence, so in this case acupuncture was2000,

BritishJournal),

medicalmedicalandmodel

doctorsbegan

approved
conducting

promotingtheThese different attitudes to alternative medicine(acupuncture) expressed by the established medicaleffective.
ofcommunities in the West and in Japan, reflectacupuncture and moxibustion therapy in surgery, we

differences regarding the fundamental awareness ofattempted to review appropriate RCTs on the effects

and purpose behind alternative medicine. From theof acupuncture administered post-operatively forbackground to the citations we reviewed here,

PONV and POI, however, compared to Western

Western considers acupuncture a useful modality forcountries, far fewer papers have been published incounteracting the side effect of pharmaceuticals.

Japan. The differences between Western andCertainly, the cost effectiveness of acupuncture

Japanese acupuncture and moxibustion research iscannot be overlooked and we may even begin to see

the most important factor. In Western countries,

more evidence based RCTs as a result. However, asHere,onthesubjectclinicalresearch

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

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Volume 9, Number 1 | Spring 2014

is often the case in Japan, the specialists,

prevention of nausea and vomiting during andinstitutions and facilities focused on acupuncture

after cesarean delivery under spinal anesthesia.

research tend to be pursuing evidence based

Anesth Analg 102(2): 581─ 584, 2006

research with the primary purpose of proving the7) White PF, Hamza MA, Recart A, et al.: Optimal

efficacy of acupuncture and moxibustion.

timingofacustimulation

forantiemeticIn the future, it is considered important that, beyond

prophylaxis as an adjunct to ondansetron in

the narrow scope of orthopedics, high level RCTs onpatients undergoing plastic surgery. Anesth

acupuncture and moxibustion from Japan be

Analg 100(2): 367─ 372, 2005

established8) Gan TJ, Jiao KR, Zenn M, et al.: A randomizedorganizations, medical facilities, doctors and othercontrolled comparison of electro ─ acupoint

researchers, all of which have the financial resources

stimulation or ondansetron versus placebo forto design and carry out specialized research on its

the prevention of postoperative nausea andmany uses and conveniently economical procedures.

vomiting. Anesth Analg 99(4): 1070─ 1075, 2004

organizedandconductedby9) Lee A, Fan LT: Stimulation of the wrist
References

acupuncture1) Wang XQ, Yu JL, Du ZY, et al.: Electroacupoint

postoperative nausea and vomiting. Cochranestimulation

forpostoperativenauseaandvomiting in patients undergoing supratentorial

P6forpreventing

Database Syst Rev 2: CD003281, 200910) Shiao

SY,DuneLS:

Metaanalysesofcraniotomy. J Neurosurg Anesthesiol 22(2): 128─acustimulations: effects on nausea and vomiting

131, 2010

in postoperative adult patients. Explore (NY)2) Frey UH, Funk M, Lohlein C, et al.: Effect of P6

2(3): 202─ 215, 2006

acustimulation on post ─ operative nausea and11) Sun Y, Gan TJ, Dubose JW, et al : Acupuncture

vomiting in patients undergoing a laparoscopic

and related techniques for postoperative pain: acholecystectomy.

systematic review of randomized controlled

Acta

Anaesthesiol

Scandtrials. Brit J Anaesth 101: 151─ 160, 2008

53(10): 1341 ─ 1347, 2009
3) Frey UH, Scharmann P, Lohlein C, et al.: P612) DuneLS,

Shiao

SY:

Metaanalysisofdecreases

acustimulation effects on postoperative nausea

postoperative nausea and vomiting in high ─and vomiting in children. Explore (NY) 2(4):risk patients. Br J Anaesth 102(5): 620─ 625,314─ 320, 2006

acustimulation

effectively200913) Allen TK, Habib AS: P6 stimulation for the4) Sahmeddini MA, Fazelzadeh A: Does auricularprevention of nausea and vomiting associatedacupuncture reduce postoperative vomiting afterwithcholecystectomy? J Altern Complement Medanesthesia: a systematic review of randomized

14(10): 1275─1279, 2008

controlled trials. Anesth Analg 107(4): 1308─

5) Arnberger M, Stadelmann K, Alischer P, et al.:cesareandeliveryunderneuraxial

1312, 2008

Monitoring of neuromuscular blockade at the P614) McCracken G, Houston P, Lefebvre G: Guideline

acupuncture point reduces the incidence offor the management of post-operative nausea

postoperativeand vomiting. J Obstet Gynaecol Can 30(7):nauseaandvomiting.

Anesthesiology 107(6): 903─ 908, 2007

600─607, 608─616, 2008

6) Habib AS, Itchon ─ Ramos N, Phillips ─ Bute BG,etal.:

Transcutaneous

stimulation

6pointwith

theacupoint
ReliefBandelectricalfor15) Meng ZQ, Garcia MK, Chiang JS, et al.: Electro─

acupuncture

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

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Volume 9, Number 1 | Spring 2014

postoperative ileus: a randomized clinical trial.
World J Gastroenterol 16(1): 104─ 111, 201016) Yukie Fukushima, Mahiko Nagase, Michio Tani:
AppliedOriental

postoperative

medicalnausea

andmethods

onvomitingwith

droperidol epidural infusion. Eastern Medicine
17 (3): 31─ 34, 200117) Koji

Matsumoto,Atsuro

Shimizu,

Satoshi

ShimizuTrial of electro acupuncture stimulation
for post abdominal surgery flatulence and pain
relief. Kyoto Minami Hospital Medical Journal
10: 71─ 74, 1991
18) Shin Mastumoto, Takao Sano, Shiji Kokui:
Effects of acupuncture treatment on PostOperative surgical pain relief and stimulation ofperistalsis. Journal of the World of Obstetrical
Medicine 34 (10): 1099─ 1102, 1982
19) Hirofumi Nakanishi, Takashi Tamura Masakazu
Sakutaetal.

InfluenceofTackneedle

acupuncture effects on post-operative intestinal
function. Journal of the National Japan Societyof Acupuncture and Moxibustion 53 (3): 352,
2003

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