This symposium was held as the second in a three part series at Kagawa Conference (June 6-8, 2003). During the Tsukuba conference (2002), distal area treatment was the topic of focus. The criteria and evidence for the effectiveness of distal area treatments were presented. Three symposists and one minor speaker reported on the effectiveness of distal area treatments from clinical and basic viewpoints. However, another symposist showed the superiority of local area treatments and denied the effectiveness of distal area treatments. There fore, we decided that a succinct and definitive discussion on distal area treatments (etc) should be presented during the second symposium. To this end, long time members of JSAM were given a questionnaire survey prior to the conference. Respondents were asked to define their own use of local and distal treatment, to hypothesize on the curing mechanism involved and to state which practice methods they use most.
Mr. Ogawa reported that, as a result of analyzing the questionnaire survey no distinct differences were found in the definitions stated by respondents from several different schools. The standard images of “the local area” were the area where pains were felt when pressure is applied, the areas which transmit special sensitivity or the area where a disorder is found. Also, the images of “the distal area” were the areas which have some relationship to the local area, such as meridians and collaterals, nerves, reflex points, tender points, or related points which induce a clearly recognizable physical reaction.
Mr.Shinohara showed the superiority of distal area treatments according to the muscle meridian theory by utilizing the 3 arm crossover examination. Furthermore, he established the delayed myalgia as a model of the illness on a specific muscle meridian region. He investigated the effect of intradermal needling. He observed that after a weight bearing exercise on the biceps brachii, the threshold of tenderness on the Lung meridian decreases. He proposed the possibility of using the points in extremities which had selectively responded by manifesting of the delayed myalgia.
Mr. Moriyama, one of the minor speakes, explained, using the theory of biomechanics, the possibility of in-fluences of distal area disharmony on the local area. He introduced the Meridian Test as one clinically useful method for finding disharmony which is typically difficult to discern and may contribute to the disorder. He proposed that a microscopic “eye” to be used to see the local area and the macroscopic “eye” b used to see the whole body in medical examination and treatment. Using the “eyes” in synthesis and not separately, he concluded, must be the basic state for treatment.
Another minor speaker, Mr.Shiraishi reported on analyzed results of the experiments on lumbago patients. Applying Yuandaoci (distant needling) reduced a response on points of the trunk (BL 23, Shenshu, Jinyu) in stimulating points, i.e, BL 40 (Weizhong, Ichu), BL 57 (Chengshan, Shozan) BL 58 (Feiyang, Hiyo) BL 60 (Kunlun, Konron) GB 34 (Yanglingquan, Yoryosen) varying in many ways and confirming the peculiarity of each point, meridian and collateral. Based on these findings he supports the effectiveness of distal meridian area treatments.
Mr. Ozaki, also, another minor speaker proposed, from the outcome of animal experiments. Stimulation by acupuncture at either adjacent or distal areas can affect motor reflex. So from this point of view, insertion at adjacent and distal area has some recordable effect. He added that stimulation given either at adjacent or distal areas would converge to the same neuron and the same modification would occur. From this point of view, the difference in processing information at the neuron level would control the manifestation of the effect and thus investigations on these treatments should be discussed as a synthesis, including, not

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We used a questionnaire survey to assess the JSAM (the Japan Society of Acupuncture and Moxibustion) members' use of local therapy and distal therapy. We wanted to apply the results of the discussion titled “the definition of local therapy and distal therapy” in the symposium during the 52nd Annual JSAM meeting (2002, Kagawa). Questionnaires were distributed to 500 of the 1250 JSAM members registered in 1991. The subjects who received questionnaires were selected at random. Of the 500 questionnaires sent out 145 replies were received. Each respondent was asked to submit their definition of local and distal therapy.
Also, eight examples of local and distal therapies were given and respondents were asked to reply as to whether they treat with local or distal therapies and the.reasons for these choices.
The results were analyzed by simple and cross tabulation. We were able to define local therapy as 1) insertion to the injured area by acupuncture, 2) treatment on the area traveling along a nerve, and 3) treatment on the area where the patient feels some sensation. And we also defined treatment with a spectrum of tender points as local treatment, according to relationships with nervous reflexes such as an axon reflex, similarly to needling on muscles and along the path of the nerve. The use of distal therapy was usually carried out at points with relationships to fundamental treatment, tender points, meridians, autonomic nervous system and mechanisms through nerve centers. It was found that most practitioners consider distal points that are defined with some theory. Distal points were not selected randomly without the above consideration.

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Review of the effects of acupuncture and moxibustion on brain function and cerebral disorders in human and animals was presented. Firstly, in basic research on experimental animals, the change of cerebral blood flow induced by acupuncture and its mechanisms had been reviewed. Nextly, the effect of acupuncture and moxibustion on human brain function that measured from fMRI, PET, magnetoencephalography (MEG), EEG (including event related potential) have documented in the review of basic research on humans. Finally, effectiveness of acupuncture and moxibustion on stroke was reviewed, and its possibility of QOL-improvement of the patients was discussed.

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We updated safety information on acupuncture and moxibustion, focusing on adverse events. Case reports published between 1998 and 2002 were searched, using “Ichushi Web” (Web version of Japana Centra Medio Medicina) and “PubMed”. Thirtysix cases of acupunctureassociated adverse events (13 infections, 11 dermatological problems, 6 organ injuries or foreign bodies, 5 nerve injuries etc.) and nine cases of moxibustionassociated adverse events (6 dermatological problems etc.) were located. Most cases were published in academic journals in the field of modern Western medicine, which clinical acupuncturists usually do not read. Therefore, our committee should play a role of collecting safety information and performing the feedback for the acupuncturists.
We also summarize the contents of the Workshop held by our committee on June 6, 2003. The most controversial issue was determining an appropriate method of needle insertion in terms of infection control. More evidence is needed for establishing a good manual for safety acupuncture.

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Nobody studies economic evaluation of acupuncture and moxibustion in Japan. To establish a method of economic evaluation of acupuncture and moxibustion, we introduced case study of economic evaluation of acupuncture and moxibustion at work. In addition, we examined a course of study that annex economic evaluation to a study of acupuncture and moxibustion. This manuscript introduces two case studies of economic evaluation and essential points of economic evaluation.

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To identify indications for acupuncture treatment, we examined certain evidence-based medicine (EBM) practices by acupuncture/moxibustion clinicians who are novices in this field and identified problems and solutions from the perspective of an acupuncture/moxibustion clinician.
We collected cases of lumbago, shoulder disorders and strokes from the literature, and critically assessed these reports. We also investigated Cochrane Library's acupuncture/moxibustion reviews and evaluated the quality of domestic studies using randomized controlled trials and controlled clinical trials (RCT/CCT). Simultaneously, one of the authors evaluated her own clinical reports in light of EBM.
As a result, acupuncture/moxibustion treatments showed promise for treating lumbago and shoulder disorders, but the higher the quality of studies, the lower the effect of treatment after stroke. According to research by the Cochrane Library (as of issue 1, 2003), the effects of acupuncture/moxibustion was measured only for cases of idiopathic headache but those for other disorders were measured more severely. In Japan, RCT started as early as the 1960 s, but the studies were sluggish and high quality studies were not produced until the late 1990 s.
We presented problems of RCT assessment score, the gap between RCT designs and actual clinical scenes, and the difficulty of masking at the bed-side. To contribute to the accumulation of more evidence-based data, it would be desirable for clinicians to acquire EBM methods, consider clinical problems and collaborate positively with investigators in the field.

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We examined whether wiping acupuncture needles with cotton could remove Hepatitis C viruses (HCV) adhering to the needles. The needles were incubated in the serum from patients infected with HCV, then the needles were wiped with dry cotton or cotton soaked in 80% ethanol. RNA was extracted from these needles and the HCV genome was amplified by reverse transcription-polymerase chain reaction (RT-PCR). The results indicated that the HCV genome was not detected when the needles were wiped with dry cotton. However, in one of two experiments, the HCV genome was detected after wiping the needles with cotton soaked in ethanol. We also examined the HCV contamination on the needles extracted from patients infected with HCV. The HCV genome was detected on extracted needles that were not wiped with cotton, but the genome was not found on needles wiped with cotton at the time of extraction. Therefore, wiping acupuncture needles with cotton might effectively remove HCV on the contaminated needles, but the viruses could not always be re-moved by simply wiping the needles with cotton.

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[Purpose] The characteristic of electrical activities recorded at the clinical trigger point was examined.
[Materials] A 26-year-old woman complained of chronic shoulder pain. She had a trigger point near GB 21 (Jianjing, Kensei). The electrical activities were recorded at the trigger point and a non- tender point.
[Results] Electrical activities were detected only when the electrode was located on the trigger point andthere was a subjective dull pain sensation. The amplitudes of electrical activities did not change during psychological stress. [ Conclusion ] These results suggest that the electrical activities were the result of nociceptive reflex.

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A recent survey of licensed acupuncturists in the United States conducted by the National Certification Commission of Acupuncture and Oriental Medicine (NCCAOM) revealed the breadth and variety of methods used by acupuncturists in their clinical practice. Many of these are techniques that are not taught in schools of Oriental Medicine and do not originate in east Asia, but are considered by the practitioners to be significant to their practice of oriental medicine. The survey affords an opportunity to observe how the nature of oriental medicine is changing and evolving as it is assimilated into a new cultural environment.

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