The definition of Pain, “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (International Association for the Study of Pain : IASP, 1994), which is often used to explain its subjectivity. It is necessary to evaluate the pain objectively for diagnosis and effectiveness of therapy.
As an evaluation method of chronic pain, Visual Analog Scale (VAS) and Numerical Rating Scale (NRS) are used. Recent years, face visual analog scale and Current Perception Threshold (CPT) testing are also used commonly. Drug challenge test draws attention as it combines an evaluation method and an effective therapy. Meanwhile as a therapy of chronic pain, the reports of epiduroscopy and phototherapy are increasing. The epiduroscopy is an endoscopic operation for patients with the chronic low back pain. In Japan the therapy is performed increasingly for patients with the low back pain of spinal canal stenosis, failed back syndrome and lumbar disc herniation. Regarding the phototherapy, the reports which show the effectiveness of linear polarized infrared raytherapy and xenon phototherapy are mainly observed. Though the nerve block is still the dominant therapy in pain clinics, acupuncture therapy and phototherapy are prospected to increase their demands in future.

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Acupuncture is one of the most popular complementary therapies in the world. Pneumothorax due to perforation of the lungs by needle insertion is one of the most common and serious complications of acupuncture treatment. Although there have been several case studies of pneumothorax induced by acupuncture, as far as we know there have been no reports on the pathological findings of autopsy cases.
In this report, we describe the pathological findings of an autopsy case of bilateral tension pneumothorax after acupuncture. The patient suffered dyspnea and chest pain soon the completionof an acupuncture treatment, and died 90 min later. Several ecchymoses were macroscopically observed on the parietal pleura in the left and right thoracic cavity, suggesting that needles were inserted into the thoracic cavity and that the lungs were perforated. The many black spots we observed on the parietal pleura along the vertebral column microscopically consisted of a number of dust-like black pigments and macrophages containing these pigments. These spots seemed to have appeared because of the previous insertion of needles.

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We reviewed case reports of bilateral pneumothorax after acupuncture treatment from the point of view of clinical acupuncture. A paper showing pathological findings based on autopsy suggests that, in more cases than we had expected, acupuncture needles penetrate the lung or the pleura. We speculate a portion of these cases develop into pneumothorax and a few of these become serious. By means of literature search, we have found that 23 cases of bilateral pneumothorax after acupuncture have been published in Japan and other countries. We must learn from these case reports. Further, we should reassess the contents of clinical acupuncture education and introduce the concept of failsafe treatment.

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[Objective] The aim of this study was to investigate the effects of Joksamni (ST 36) combination on NADPH-diaphorase, neuronal nitric oxide synthase (nNOS), neuropeptide Y (NPY) and vasoactive intestinal peptide (VIP) in the cerebral cortex of spontaneously hypertensive rat.
[Methods] The experimental groups were divided into four groups : Normal, Joksamni (ST 36), Joksamni (ST 36) + Eumneungcheon (SP 9), and Joksamni (ST 36) + Gokji (LI 11). Needles were inserted into acupoints at the depth of 0.5 cm with basic insertion method. Electroacupuncture was done under the condition of 2 HZ electrical biphasic pulses with continuous rectangular wave lasting for 0.2 ms until the muscles produced visible contractions. Such stimulation was applied continuously for 10 minutes, 1 time every 2 days for 10 sessions of treatments. Thereafter we evaluated changes in NADPH-d positive neurons histochemically and changes in nNOS, NPY and VIP positive neurons immunohistochemically.
[Results] The optical densities of NADPH-d positive neurons of the Joksamni (ST 36) + Eumneungcheon (SP 9) group in all areas of cerebral cortex and Joksamni (ST 36) + Gokji (LI 11) group in primary somatosensory cortex, visual cortex, auditory cortex, perirhinal cortex were significantly increased as compared to the Joksamni (ST 36) group.
The optical densities of NADPH-d positive neurons of the Joksamni (ST 36) + Gokji (LI 11) group were sig-nificantly decreased as compared to the Joksamni (ST 36) + Eumneungcheon (SP 9) group with the exception of primary somatosensory cortex.
The optical densities of nNOS positive neurons of the Joksamni (ST 36) + Eumneungcheon (SP 9) group in all areas of cerebral cortex and Joksamni (ST 36) + Gokji (LI 11) group in auditory cortex, perirhinal cortex, insular cortex were significantly increased as compared to the Joksamni (ST 36) group. The optical densities of nNOS positive neurons of the Joksamni (ST 36) + Gokji (LI 11) group were significantly decreased in all areas of cerebral cortex as compared to the Joksamni (ST 36) + Eumneungcheon (SP 9) group.
The optical densities of NPY positive neurons of the Joksamni (ST 36) + Gokji (LI 11) group were signifi-cantly decreased in primary motor cortex, primary somatosensory cortex, cingulate cortex as compared to the Joksamni (ST 36) and Joksamni (ST 36) + Eumneungcheon (SP 9) groups.
The optical densities of VIP positive neurons of the Joksamni (ST 36) + Eumneungcheon (SP 9) group were significantly increased in all areas of cerebral cortex except f or cingulate cortex as compared to the Joksamni (ST 36) group. The optical densities of VIP positive neurons of the Joksamni (ST 36) + Gokji (LI 11) group were significantly decreased in auditory cortex, cingulate cortex, perirhinal cortex as compared to the Joksamni (ST 36) + Gokji (LIII) group were significantly decreased in all areas of cerebral cortex as compared to the Joksamni (ST 36) + Eumneungcheon (SP 9) group.
[Conclusions] The result demonstrated that electroacupuncture on Joksamni (ST 36) and its combination change the activities of the NO system and peptidergic system in the cerebral cortex of SHR and that acupoint combination is one of the important parameters for the effects.

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[Objective] The effects of acupuncture on muscular blood flow, muscular weight, and muscular dynamics were investigated in the rat hindlimb with induced hypoemia. In addition, the optimal conditions for acupuncture in the model were investigated.
[Methods] In male SD rats, the right femoral artery was cut, and a No. 20 40-mm stainless needle was inserted about 3-5 mm into the anterior tibial muscle of the ischemic hindlimb for acupuncture. During acupuncture, the needle was indwelled or electric current was passed, and various stimulations (5h/day, 1 h × 5 times/day, 15 min × 5 times/day, 1 h/day, and 15 min/day) were applied for 5 consecutive days. Seven days after cutting the artery, blood flow was measured by the radioactive microsphere method, and the degree of muscular atrophy was investigated by the weight ratio of the ischemic hindlimb to the contralateral healthy limb, and findings in the intact, hypoemia, hypoemia + indwelled needle, and hypoemia + various current groups were compared. In addition, the anterior tibial muscle was stained to observe the condition of muscular fibers.
[Results and Discussion] In the ischemic group, muscular blood flow was decreased. In the hypoemia+current groups, blood flow was increased. In the groups that received electric current for a prolonged period, 5 h/day and 1 h ×5 times/day, the blood flow was increased but the muscular weight ratio was decreased. However, in the group that received stimulation for 15min×5 times/day, the muscular blood flow was markedly higher that those in the other groups, and the muscular weight ratio was not changed, showing that muscular atrophy did not occur. On staining, capillary neovascularization and VEGF production were greater than those in the hypoemia group, suggesting that these factors were closely involved in the increase in blood flow.

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Dietary habits in Japan have become more westernized in recent years. An increasing number of people are developing colorectal cancer, which may be considered a lifestyle disease. Moreover, many people develop post-operative problems following surgery for colorectal cancer. We present a patient who complained of excessive bowel movements and various nonspecific complaints after surgery for colorectal cancer. We performed acupuncture treatments, and in order to objectively examine changes in symptoms as well as to document the usefulness of acupuncture treatment, we used a health chart produced by the Nonspecific Symptoms Team, Research Department of the Japan Society of Acupuncture and Moxibustion. We performed tanshijutsu (treatment in which the practitioner continues holding the needle from insertion until removal), which included zuishou (therapy based on the symptoms), taikyoku (basic meridian points for total body adjustment according to the Kurono style), and topical therapies using 30mm 18-gauge needles. In total, 14 treatments were administered. The results objectively demonstrated the usefulness of acupuncture in treating the patient's postsurgical nonspecific complaints. Moreover, the acupuncture treatments were also effective in improving the patient's bowel problems. These findings suggest that acupuncture may be a useful method of postoperative care.

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After the one-and-a-half years of combined efforts that started in June 2002, the Memorandum of Understanding (MOU) among three society related in acupuncture in Japan and the Republic of Korea-Japan Society of Acupuncture and Moxibustion (JSAM), the Korean Acupuncture and Moxibustion Society (KAMS), the Korean Oriental Medical Society (KOMS) -was finally signed on 14 February 2004 at the Westin Chosun Hotel, Seoul, Republic of Korea. This article presents a history of the development of the MOU and the proceedings at the celebration ceremony, as well as current and future activities on the basis of the MOU.

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