It is said that the key to effective acupuncture is to perform appropriate stimulation of the best combinations of meridian points which directly or indirectly affect the disease.
In order to determine the difference in the efficacy between combinations of clinically important meridian points, this study examined the effect of two-point acupuncture stimulation on the exteroceptive vibration-induced finger flexion reflex (Eklund et al., 1978).
METHOD
Subjects were six healthy adults of both sexes between 20 and 35 years of age. Two-point combinations were made of IC₄ Hegu (standard point) with each of the following points: IC₆ Pianli, P₇ Lieque, C₃ Shaohai, TM₂₀ Baihui, VU₁₃ Feishu, VU₂₅ Dachangshu, G₃₆ Zusanli. Perception threshold electrical stimulation of each combination was performed at 45Hz for 5min. using subcutaneous needles. The finger flexion reflex was induced by a tapping vibrator applied to the palm and recorded through a pressure transducer.
RESULTS
1) The combination of adjacent points on the hand: Stimulation of Hegu together with Pianli, both of which are on the Large Intestine meridian, caused a strong inhibition of the reflex. The inhibition lasted about twice as long as that caused by stimulation of Hegu alone. However, neither Hegu and Lieque not Hegu and Shaohai stimulation caused prolongation of the inhibition.
2) The combination of the hand and the back: Neither Hegu and Feishu nor Hegu and Dachangshu stimulation caused any prolongation of the inhibition.
3) The combination of the hand and the leg: Hegu and Zusanli stimulation caused marked inhibition, which lasted about four times as long as that caused by Hegu-alone stimulation.
4) The combination of the hand and the head: Hegu and Baihui stimulation caused no or much less inhibition that caused by Hegu-alone stimulation.
5) Examination of difference among stimulating methods: Electrical stimulation through surface electrodes (A), Retained subcutaneous needles (B), Electrical stimulation between a subcutaneous needle and the indifferent electrode. (C), Electrical stimulation between subcutaneous needles (D). The intensity of the inhibition effect of these methods can be expressed as follows:
D>C>B>A
DISCUSSION and CONCLUSION
The reflex inhibition caused by the standard point stimulation was strengthened or weakened by simultaneous stimulation of an additional point. Based on our examination of the characteristics of the inhibition, it was thought that not only mutual interference of impulses at the spinal level but also humoral factors and some polysynaptic reflex mechanism in the higher center level participate in this effect.

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The two-point fused sensory area (fused area) was calculated from two-point fused distance. The fused area was enlarged by acupuncture stimulation. This enlargement of the fused area by acupuncture was explained on the point of the central nervous mechanisms.
Applying the two points of touch and pressure stimuli to the skin, the threshold separation required for the two stimuli to be noticed as one rather than two points was determined. On the same region of the body, three longitudinally combined points and one transversally combined point were measured and the area which was surrounded by them was calculated.
The fused area was more enlarged through the touch stimuli than through the pressure ones. On the upper limbs, the shape of the fused area was like an oblong and the area was smaller at the peripheral part than the central part. Acupuncture stimulation enlarged the fused area. This was concerned that the lateral inhibition could not be worked in the tract by impulses which were generated by acupuncture.

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[in Japanese]

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The purpose of this study is to determine the efficacy of acupuncture in treatment of neurosurgical diseases, especially intractable head ache or post cerebral apoplexy symptoms (i. e. paresthesia, stiffness, pain, etc.)
METHOD
230 outpatients of the neurosurgical section, whose headache or symptoms of cerebrovascular disease or injury had not been controlled with any analgesics, were divided into two groups. Electrical acupuncture was applied to Group I for 7 minutes once a week, and to Group II for 20 minutes twice a week. Moxa needle therapy was also undertaken for Group II. In order to determine the effect of acupuncture, the degree of relief in their symptoms was rated on a percentage basis (severity of pretreatment symptoms was rated as 100%). The duration of the effect and the influences of drugs were also examined.
RESULT
Migraine was relieved by about 50% in Group I, and by about 70% in Group II. The duration of the effect was longer in Group II. Headache from cerebrovascular disease was relieved by about 60% in both groups, without any difference between the groups or between underlying diseases. Paresthesia in the extremities, pain in the shoulder or extremities and stiffness was relieved by 30-50% in both groups.
DISCUSSION
Acupuncture is effective in relieving headache, especially of non-cerebrovascular origin. It seems that other migraine or paresthesia can be well relieved with longer and more frequent sessions of electro-acupuncture. It is noteworthy that paresthesia, peculiar to post cerebral apoplexy symptoms, can be ameliorated with the combined use of acupuncture and drugs.

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In the 31st conference of this society, experience of acupunctural treatment of 15 cases of pain-related diseases in our orthopaedic section was already reported. In the present paper, some clinical observations on acupunctural treatment of ruptured lumbar disc, which is a representative orthopaedic disease, were reported.
METHOD
Treatment and observation were carried out on 47 ruptured lumbar disc patients (29 males and 18 females between 19 and 61 years of age, average age: 34.2 years) who were diagnosed in our clinic on the basis of findings in physical examination, myelograms, electromyograms, etc. in the two years since 1981. Using Chinese needles and an electro-anesthesia device (G 6805, made in China), several acupuncture techniques were performed: in situ technique, electrical stimulation, moxa needle, combination of electrical stimulation and moxa needle and so on. The patients were divided into two groups. Acupuncture-only group (29 cases) were treated with acupuncture alone. 21 cases of them showed good results, whereas the remaining 8 cases showed no excellent results and subsequently underwent other conservative treatment or operation. Combined-treatment group (18 cases) were treated with both acupucnture and other conservative treatment from the beginning.
RESULT
The effectiveness of the treatment was noted in 21 cases (72.4%) of Acupuncture-only group and in 15 cases (83.3%) of Combined-treatment group. In terms of age, the under forties showed better results than the over forties in both groups: the aging factors, which provoke lumbago or sciatica, were supposed. As to the period between the onset of the symptoms and the institution of treatment, fresh cases (the period is shorter) mostly showed better results than old cases (that is longer). The old cases in Combined-treatment group showed better results than those in Acupuncture-only group. The improvement rate of “tension sign” was fairlry high in both Acupuncture-only (70.9%) and Combined-treatment (81.2%) group, whereas that rate of “abnormal tendon reflex” or “sensory disorder” was not high. Nine of 11 cases without avail (8 cases in Acupuncture-only group and 3 cases in Combined-treatment group) underwent discectomy. A prolapsed disc was seen in 3 of the 9 cases, and severe compression and adhesion of the nerve root were observed in all of them. Their postoperative course was uneventful.
DISCUSSION
Using existing conservative treatment, most of ruptured lumbar disc patients can be ameliorated. Excellent results have been also obtained with acupuncture therapy in the present study. However, in consideration of social adaptation, there are operation-unavoidable cases among the ruptured disc patients who are undergoing acupuncture or other conservative treatment.

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[in Japanese]

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INTRODUCTION
In our research of acupoint tension we performed acupuncture on the dorsal entry acupoints (yu-ketsu) and measured the skin resistance to the needles. We called this measured value “keiketsuryoku” or acupoint tension. Since we found many examples of a recovery from distortion in the acupoint tension of dorsal entry points, we concluded that moxibustion of five element acupoints is indeed effective in causing just such a recovery. Besides this there was also the question of whether acupuncture of the dorsal entry points alone was effective or not.
The aims of this research were 1) In order to measure the acupoint tension we performed acupuncture of the dorsal entry points to see if there was a recovery from distortion in the acupoint tension or not, 2) We compared the results of this with the effect of moxibustion on five element acupoints.
METHODOLOGY
A device called a “tanomi meter” was used to measure the acupoint tension. The acupoints used for this study were, HAI YU (Bl. 13), KETSU IN YU (Bl. 14), SHIN YU (Bl. 15), KAN YU (Bl. 18), HI YU (Bl. 20) and JIN YU (Bl. 23). These six bilateral acupoints thus totalled twelve in all. Deciding the distortion of acupoint tension. A decrease in the standard deviation value was deemed “effective” (σn SYGMA) and an increase as “reverse effect”.
Measurement of acupoint tension: The ten subjects in group “A” were measured three times. The twenty subjects of groups “B” and “C” had moxibustion administered at acupoint “KOUKAN” (Lv. 2) and were measured each time before and after treatment. Using the five element theory, KOUKAN (Lv. 2) was found to be the most suitable acupoint for “B” group, diagnosed as having hyper liver and kidney. However in “C” group which had a different diagnosis, eight examples were found of the unsuitability of acupoint KOUKAN.
RESULTS
There were four examples of efficacy in “A” group (40%). Using moxibustion at acupoint KOUKAN in “B” group we had ten examples of effective results (83%). The same treatment resulted in three examples of efficacy in “C” group (38%).
Average σn value: In “A” group 3% decrease. In “B” group 33% decrease and in “C” group 2% increase.
CONCLUSION
In group “B” which was suited to using moxibustion at acupoint KOUKAN, there were many effective results. The decrease of the σn value was obvious, whereas in group “C” which was not correlated to this acupoint there were many examples of non-efficacy, and from the 2% increase of the σn value we can see the importance of classifying five element acupoints in their applicability, or non applicability (to meridian imbalances).
“A” group. Even with simple insertion only, to measure acupoint tension, there were some effective examples, but the σn value decrease was a mere 3%, showing rather poor clinical results. However, it can be assumed that the reverse effect found in “C” group, with a fixed σn value increase of 2%, points to the suppression of efficacy at the “YU” entry points. Here then, after careful consideration, we concluded that the efficacy of acupuncture of entry points held no influence over treatment results obtained using the five element acupoints.

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Since the greater part of the patients who undergo acupuncture therapy show little objective symptoms, it is difficult to determine the efficacy of acupuncture on an objective basis. An attempt was made in this paper to employ the measurement of finger skin temperature, which is supposed to express the relaxed condition, in acupuncture therapy for various cases so-called neurosis, pain of simple locomotrial diseases and so on.
In each treatment session, “self-control” was undertaken prior to acupuncture: The patients were made to listen to the “Self-Control; 1st stage” tape by Ikemi through a headphone to relax themselves physically and mentally with the aid of a biofeedback device developed for self-control training. The finger skin temperature or galvanic skin response was successively recorded during each treatment session (i. e. self-control and acupuncture) in order to determine how far the patients are relaxed. The intensity of acupuncture stimulation was instantaneously adjusted according to the fluctuation in the finger skin temperature. The data obtained from patients resting in the supine position at a constant room temperature was referred to.
Each case showed a peculiar response pattern, which was almost similar in every treatment session. In some cases, there were large differences between the data obtained during “self-control” and those during acupuncture.
The patients who were in a well relaxed condition during the treatment session showed marked result: ameliorated subjective symptoms, enlarged range of joint movement and so on.
It was thought that the magnitude of acupuncture stimulation should be controled in order to make the patient relaxed.

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Joint mobilization (i. e. intracapsular passive exercise) is now attracting clinicians' attention as manipulative therapy for pain of intervertebral joint disorder.
In the present paper, introducing a part of a mobilization technique for the lumbar and sacroiliac joint and our mobilization evaluating method, we report a comparative study on the efficacy of acupuncture and mobilization therapy using our “lumbago evaluation chart”.
METHOD
Fifteen lumbago outpatients (6 males and 9 females with average age of 41.6±16.28 years) of our physiotherapy department, who showed no remarkable radiographic changes, were divided into three groups: Acupucnture alone, mobilization alone, and both acupuncture and mobilization were, performed for A, B, and C group respectively. Their responses were compared on the evaluation chart.
The patients were asked to rate the severity of pain and disability on a four grade basis. Five movements were chosen from A. D. L. and the results were rated as “easy”, “difficult” and “impossible”. The following were measured for lumbar flexibility: the distance between the finger-tip and the floor; the maximum backward bending of the upper body; S. L. R.; the distance between the S₁ and an upper point on the skin (10cm in an erect posture) at the maximal flexion the distance between the top of the iliac crest and an upper point (10cm in an erect posture) at the maximal lateral flexion.
Tenderness was measured with an algesiometer (maximum 10kg). CHILLS were rated on a three-grade basis. All the measured values were rated so that the maximum number of the total points in the evaluation chart was 100. Another chart (a mobilization test chart) was made, in which the severity of STIFFNESS and PAIN was rated on the following basis: None=0, Minimal=1, Severe=2, and the maximum total was 50.
RESULT
1) As for the score of “TENDERNESS and CHILLS”, C group was significantly different from both A and B group at 10% level by t-test. As for the total score, C group was significatly different from A and B group at the 0.5% level.
2) C group showed high rated improvement in the score of “PAIN”, “TENDERNESS”, and “STIFFNESS” after treatment.
3) Tenderness was often detected at VU₅₂ Zhishi and VU₄₀ Weizhong, and lumbar vertebrae stiffness was often seen in the lower part.
CONCLUSION
1) An evaluation chart for lumbago was developed to rate the symptoms.
2) Lumbago pationts without remarkable x-ray findings underwent acupuncture alone, mobilization alone, or both acupuncture and mobilization. The score of the evaluation chart has shown that combined use of acupuncture and mobilization is more effective than solitary use of each therapy in relieving pain.

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Introduction
We have seen no description of obvious cases of acute myocardial infarction in any authentic literature on acupuncture. However, it can be gathered from some literatures that blood letting therapy might be effective against heart diseases to some extent.
This case of anteroseptal myocardial infarction is reported because an acupuncturist participated in the treatment as a member of the medical team and obtained a good result.
Case Report
The patient was a 62 year old woman, an insurance canvasser, with a history of hypertension, obesity, hyperlipemia, and cardiac insufficiency. On the day of hospitalization (Sep. 17, 1982), shortly after having luncheon about noon, she felt a pain from the shoulder to the neck, followed by vomiting, diarrhea, diaphoresis, cyanosis in the lips, and unconsciousness.
On the first hospital day, the electrocarbiogram showed elevated ST segments in Leads V_1-5, and depressed ST segments in Leads II, III, aV_F, and V₆. GOT 14, LDH 286. The ECG on the second day showed clear coronary T waves. On and after the third day, an frequent ventricular extrasystole was present. Tachycardia was not improved, and the blood pressure fell. GOT 120, LDH 1200. On the fifth day, the patient fell into a severe condition from about 8:50p.m.: ST segments were elevated. Administration of xyiocain etc. was not effective. The doctor intuitively decided to apply blood letting therapy to the patient. At 10:07p.m., blood letting was undertaken by the acupuncturist firstly at the left IT₁ shaoze, then at the right IT₁ shaoze. Shortly after the therapy, the ECG showed changes. The blood pressure, heart rate, and other symptoms were dramatically improved. On and after the sixth day, acupuncture therapy was successively undertaken three times a day for forty-eight days.
Conclusion
In this case report, we put emphasis on the blood letting therapy which was undertaken on the fifth hospital day. In addition, we discussed the efficacy of blood letting therapy and acupuncturist's duties as a member of a medical team which treats severe cases such as acute myocardial infarction.

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[in Japanese]

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INTRODUCTION
The basic concept of oriental medicine is that of the dual phenomenon of Nature and living beings, a concept which has been rendered relative via philosophy. In particular, the fundamental idea, viewed dualistically, is that for ane one phenomenon there are two relative aspects, that of YIN and YANG.
METHODS
This time we used anatomical positions: left is yang and right is yin, upper is yang and lower is yin. We took the view that there is an analogy between the above and what Kentaro Takagi proved, namely pressure vis a vis the semi lateral sweating reflex. Between June 1976 and September 1979, using the six fixed position type pulse diagnosis we examined 1400 patients coming to the research lab (male, 744. female, 655). We also used the Motoyama type machine for meridian/organ function measurement, from which we obtained the electrical resistance value of well points (sei ketsu). Then we quadridemarcated the body into left and right together with hands and feet.
RESULTS
By comparing the 1400 cases and separating male/female for each diagnostic group, we classified these into quadridemarcation charts and observed the patterns. We came up with;
1) It was proved that a quadridemarcarcation pattern exists.
2) A left/right resistance and a lower/upper resistance was proved.
3) No difference was noted in any difference between male and female as cited in the classics.
4) Changes in the pulse vis a vis diagnosed patterns were noted.
5) The difference of each diagnosed group as well as the correspondence between pulse diagnosis and quadridemarcation of the body was proved. From the above results we would like to report that the basic yin yang concept of oriental medicine is of great importance as noted in the classics.

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“Moxa” has not been studied sufficiently. Something seems to remain still unknown in its history, its process, and its raw material. The purpose of this study is to clarify these points.
Method
The author visited the major producing districts of moxa to investigate the process of preparation, and examined the raw material “Yomogi” botanically.
The latest process of making moxa is outlined as follows: gathering Yomogi→drying→pulverizing with a rotating stone mill→premoving impurities through sieves→refining with an equipment called “tômi”.
A botanical study : In Niigata-, Toyama-, and Ishikawa-prefecture, the raw materials were identified mostly as common Yomogi (Artemisia princeps Pamp.), and partly as Ooyomogi (=Yamayomogi, A. montana Pamp.). All the materials used in Shiga-prefecture was supposed to be Yomogi (A. princeps Pamp.).

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