Acupuncture and moxibustion are traditional medical treatments with a long history which have been practiced since ancient times in the East and are promising therapeutic methods for many diseases and symptoms. In recent years, a large number of basic and clinical studies in the field of acupuncture and moxibustion have been reported also from Europe and United States, and expectations for establishment of acupuncture and moxibustion as integrated medicine have grown. The establishment of the Department of Oriental Medicine at Saitama Medical University goes back to the year 1984, and since then, it has been involved in the treatment, research and education for about 25 years.
As to the treatment, close coordination with other departments has been developed;now, the number of patients seeking acupuncture and moxibustion treatment exceeds half of the total patient population, and some of the patients receive inpatient treatment. Acupuncture and moxibustion are given to patients with intractable pain, paralysis, or a series of unidentified complaints, for which the treatments have been found to be highly effective. It has been suggested that acupuncture and moxibustion are likely to play an important role in the setting of a medical university hospital.
As to the research, basic and clinical studies on acupuncture and moxibustion have been promoted, and effects and mechanism of action of acupuncture and moxibustion were investigated in the treatment of primary headache, stroke, facial palsy, rheumatoid arthritis, Sjogren's syndrome, nonspecific low back pain, etc. Studies using autonomic nerve function and immunity as indices of characteristics of the traditional medicine were conducted for their scientific elucidation.
In future, it is essential to enhance further coordination with specialists of other treatment departments, demonstrate efficacy and usefulness of acupuncture and moxibustion treatment, and promote evidence-based research work. It is my desire to give Japanese traditional medicine of acupuncture and moxibustion a clear position within medical university, have them established as integral medicine, and to offer to the world Japanese acupuncture and moxibustion treatment.

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Kampo medicine and acupuncture have traditionally been compared to "two wheels of one cart". Both Kampo medicine and acupuncture have the main aim of eliciting the healing ability of human nature and treat the disease state grasped as "physical/mental distortion"to correct the distortion. Kampo medicine and acupuncture have a lot in common. For example, both respect the subjective symptoms, place an emphasis on removal of complaints and are based on individual care. By utilizing such common points and common direction of care, the combination therapy with Kampo medicine and acupuncture can contribute to alleviation of complaints and QOL (Quality of Life) improvement more effectively than each monotherapy alone. Furthermore, Kampo medicine and acupuncture increase the therapeutic effect of each other and a synergistic effect rather than the additive effect can be expected.
On the other hand, Kampo medicine is basically taken by oral ingestion and treats the body from inside, whereas acupuncture is based on stimulation of acupuncture points of the body surface and treats the body from outside. Based on such difference, Kampo medicine and acupuncture have actually different favorite fields and different favorite disease states. It is therefore possible to realize a complementary therapy by utilizing the characteristics of each other.
At the outpatient office of oriental medicine of Saitama Medical University, various combinations of Kampo medicine and acupuncture have been tried and it is often experienced that such combinations are useful to improve patient's QOL. Furthermore, in not a few patients, it is combination therapy that can show a high effect or combination therapy is essential.
In this lecture, among the cases where combination therapies were effective, those for which the combination effect can be explained easily were presented and discussed. Some cases of chronic urticaria, fibromyalgia syndrome, low back pain (lumbar spondylosis), tension headache and patulous eustachian tube were raised. Kampo medicine added with acupuncture or acupuncture added with Kampo medicine could achieve further QOL improvement such as shortening of the duration of treatment until cure, improvement of complaints not resolved by each monotherapy and alleviation of accompanying symptoms.

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[Objective]To motivate acupuncture school teachers to introduce higher-quality methodology in clinical acupuncture research.
[Methods]Twenty-eight teachers from 18 acupuncture schools participated in the simulated randomized, subject and evaluator-blinded, and sham-controlled trial of acupuncture for low back pain. Twenty of them played a role as subjects, four of them were raters, and another four were therapists. Before and after conducting the trial, all the participants were asked several questions using the Visual Analogue Scale (VAS) regarding necessity of Evidence-Based Medicine (EBM) in acupuncture and their level of understanding of several terms related to a Randomized Controlled Trial (RCT),
[Results]After the simulated RCT, the understanding level of all terms related to RCT increased significantly ("RCT":from 58.0 ± 27.2 to 75.5 ± 25.7, "informed consent":from 88.1 ± 15.4 to 99.2 ± 10, "recruitment":from 43.0 ± 41.0 to 74.8 ± 31.3, "random allocation":from 55.5 ± 35.0 to 78.7 ± 25.8, "masking":from 54.7 ± 35.0 to 79.0 ± 26.0) (mean ±SD). Nineteen teachers answered that they would try to conduct RCT and introduce it to their education program.
[Conclusion]The results suggest that the practice of simulated RCT is effective in understanding RCT and motivating acupuncture teachers to introduce it to their education program.

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[Objective]Esthesia and algesthia quantitative analyzers (PainVision®) are instruments that enables us to objectively assess the pain intensity. By applying an electrical current we can measure the intensity of pre-existing pain (pain equivalent current) and the minimum electrical stimulation that can be sensed by the patient (minimum perceptible current). In this study, we used PainVision®to evaluate the effectiveness of acupuncture treatment in patients with chronic pain and compared pain-related parameters with the Visual analogue scale (VAS).
[Methods]Twenty-three patients (4 males, 19 females;median age of 68) with chronic pain were studied. Pain degree was evaluated by the following equation;
Pain degree = 100 x (pain equivalent current -minimum perceptible current)/minimum perceptible current.
Pain degree was compared with VAS at pre-and post-acupuncture treatment.
[Results]VAS, pain degree and pain equivalent current by PainVision®decreased significantly after acupuncture treatment (p < 0.0001, p < 0.0001 and p < 0.01, respectively). Minimum perceptible current did not change significantly (p > 0.05). Pain degree and VAS had relatively high correlation coefficients at pre-and post-treatment (r = 0.52, p < 0.05 and 0.47, p < 0.05;respectively). Changes in VAS and pain degree agreed in 87%of the cases.
[Conclusions]PainVision®is a useful tool to assess pain intensity objectively, and parameters derived from it correlated well with VAS. In patients with chronic pain, acupuncture treatment can be evaluated by PainVision®.

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[Objective]More accurate data of the relationship between the composition and distribution of the pelvic plexus and hachiryoketsu is discussed to get an effective acupuncture method.
[Methods]Detailed dissections were performed under a stereomicroscope in five cadavers belonging to the Unit of Clinical Anatomy, Graduate School, Tokyo Medical and Dental University.
[Results]1. The pelvic plexus is composed of the sympathetic hypogastric nerve and sacral splanchnic nerve, and the parasympathetic pelvic splanchnic nerve.
(1) The hypogastric nerve arises from the superior hypogastric plexus contributing constantly to the second and third lumbar splanchnic nerves, and enters the postero-superior horn of the pelvic plexus. The sacral splanchnic nerves arise from the third and fourth lumbar gangalia and enter the postero-inferior horn of the pelvic plexus.
(2) The pelvic splanchnic nerves mainly arise from the most ventral layer of the ventral primary of the third and fourth sacral nerves, and enter the postero-inferior horn of the pelvic plexus. These nerves tend to compose the common trunk with the pudendal nerve and the nerve to the levator ani.
2. The visceral branches of the pelvic plexus do not originate and distribute equally, but tend to divide into I-IV groups. Especially, group III is considered important clinically as these nerves are related to sexual and voiding functions.
[Conclusion] 1. BL33(Zhongliao, Churyo) and BL34 (Xialiao, Geryo) are suggested to have an effect on the function of the intrapelvic organs as these acupuncture points can stimulate the pelvic splanchnic nerves directly rather than BL31 (Shangliao, Joryo) and BL32 (Ciliao, Jiryo).
2. The point of the needle into the hachiryoketsu reaches the side of the rectum, so treating with a needle to the median direction should be avoided or paid attention to.

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[Objective]For the possibility of the spread of acupuncture treatment in the future, we did a questionnaire survey for the dialysis facilities in Mie Prefecture, and clarified dialyzed patient's complaints, the problems existing in the background, and the problem related to it.
[Method]We sent questionnaire forms to representatives in the dialysis facilities (50 facilities as of February 2007) of Mie Prefecture. The survey contents were the situation of dialysis patients and acupuncture treatment for them.
[Results]In 6.0%of the dialysis facilities in Mie Prefecture, acupuncture treatment had been introduced. No facility answered that acupuncture treatment is not recommended for patients, and some facilities were interested in acupuncture treatment (15.4%). Most patients were suffering from itching and pain, which would be a target of acupuncture treatment. The problem in the spread was treatment effect and safety.
[Conclusion]Itching and pain, which are embarrassing symptoms, would be the target of acupuncture treatment. There are no facilities where acupuncture treatment had been introduced in Mie Prefecture. The possibility that acupuncture treatment introduction may not be low because there are no facilities where acupuncture treatment is not recommended and it had interest. For the spread of acupuncture in dialysis facilities, it is necessary to solve the problem of "Safety"and lack of the interface, and to construct an information network.

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[Objective]This case evaluates the effects of acupuncture for a Parkinson's Disease patient with frozen gait.
[Case]Patient:a 58-year-old male. Chief complaints were frozen gait and fatigue of legs. The gait disturbance was realized about three years ago, and has been gradually worsening. The Hoehn &Yahr stage is III. Treatment:The patient received medication and acupuncture treatment once a week or two for 18 months. Electric acupuncture treatment was adopted on arms and lower legs, and lone needles on the back and legs. Measurements:Outcome measures were timed in a 10 m walk and turn for frozen gait and Visual Analogue Scale (VAS) for fatigue of legs.
[Results]From a long term point of view, there were no significant changes for the outcomes measured. However just after the treatment VAS was statistically improved, and the patient reported a comfortable feeling.
[Conclusion]The effect of acupuncture for frozen gait was not seen, but the improvement in fatigue of legs was noted, and the patient felt comfortable after the treatment.

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Objective:We successfully treated a patient suffering from pain and numbness in the waist and lower limbs with phobia. Sedative acupuncture treatment was performed in addition to somatic treatment.
Case:A 64-year-old woman complained mainly of pain and numbness in the right waist and the lower limbs and had a sense of fear. Following the postoperative pain of lumbar disk herniation (L4-L5) in X-14 year, dorsal positioning without grasping anything frequently triggered a sense of fear with a scary feeling that her body was suspended in midair, which could not be alleviated by medication. As the symptoms in the waist and lower limbs recurred due to a fall in January of X year, she consulted an orthopedist in April. She was given a diagnosis of lumbar disk hernia (L5-S1) and hospitalized. Since the symptoms sustained, she consulted the department of acupuncture attached to the Kansai University of Health Sciences Clinic in November. The sense of fear triggered by dorsal position in the acupuncture treatment interfered with the treatment. When she was referred to the department of psychosomatic medicine, the diagnosis of "Other types"of the DSM-IV "300.29 specific phobia"was given. While low-frequency acupuncture electrotherapy on the same side and the same level as the hernia was provided, we applied sedative acupuncture treatment once a week 30 times using the following acupuncture points:GV23;PC6;CV17;and CV6. Before and after every acupuncture treatment after the 10th, the symptoms were evaluated with Finger Floor Distance (FFD), Visual Analogue Scale (VAS) of pain and mood (feelings) and State-Trait Anxiety Inventory (STAI).
Results:The sense of fear during the acupuncture treatment slowly decreased after the 14th treatment. Decreases in FFD, VAS for pain and mood (feelings), and state anxiety score of STAI were observed. The pain and the numbness in the waist and the lower limbs decreased in parallel with the sense of fear. Furthermore, the dosage of hypnotic agent decreased gradually as sleep improved.
Conclusion:Pain and numbness in the waist and the lower limbs with phobia were relieved by sedative acupuncture treatment.

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(Object) We, in collaboration with Wacoal Corp., assessed the effects of human hemoglobin dynamics associated with pressure stimulus applied by half-ovoid protrusions lined on brassiere straps, which were developed with an intended use by females to safely alleviate shoulder stiffness and associated pain in a convenient manner, and compared them to those of conventional flat and round magnets (5 mm in diameter, 800 Gauss).
(Method) Six healthy females volunteered for each of the four experiments. The participants'thoracic circumference or band size was 70 cm (B70) for experiments one and two, and 80 cm (B80) for three and four. For experiments one and three, we obtained the control hemoglobin (Hb) values, by near-infrared spectroscopy, 20 minutes after participants had worn brassieres with the newly developed straps turned inside out;and were compared to the values obtained after the straps were worn with protrusions pressing down on the skin (Protrusion-lined Strap Group, PST). For experiments two and four, the control Hb values were obtained after the participants had worn generic brassiere straps, and were compared to Hb values obtained after the magnet-lined straps were worn (Magnet-lined Strap Group, MSG).
(Result) In the PSG (B70 &B80), both Oxy-Hb and Total-Hb values increased by stimulation with a 5%significant difference;however, no significant increase was observed in the MSG (B70 &B80). There was no significant difference depending on the band size.

(Discussion) In the present study, the post-stimulation increase of Hb values showed significant differences in PSG as a result of stimulation by protrusions. Stimulation by flat magnets demonstrated no such significance on Hb values, presumably due to the lower pressure to the skin. Stimulation by magnets showed no significant changes in total Hb values despite prior reports of it accelerating the blood flow. The shape with which pressure is applied against the skin may have relevance to the effect of stimulation.
Protrusions left post-stimulation depression marks and flare on the skin surface, suggesting the possible involvement of mechanothermal polymodal receptors.
(Conclusion) Stimulation with the protrusions we developed increased Hb values, showing a regional concentration of hemoglobin. This suggests that it is effective in alleviating shoulder stiffness and associated pain, and lining brassiere straps with the protrusions provides a means for females to self-apply such stimulation safely and conveniently.

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Zen Nippon Shinkyu Gakkai Zasshi (Journal of the Japan Society of Acupuncture and Moxibustion:JJSAM).
2010; 60(2): 244-251. Received 19 Mar, 2009 Accepted 27 Mar, 2010

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The WFAS University Cooperation Working Committee and WFAS Standard Working Committee were held during 2009 WFAS World Acupuncture Congress at European Parliament in Strasbourg, France on 6 November 2009. Publishing an International Textbook of Acupuncture and Moxibustion was proposed in the WFAS University Cooperation Working Committee. Also establishing Making WFAS standards on acupuncture needles, nomenclature and location of auricular points, manipulation of moxibustion, and manipulation of scalp acupuncture were discussed and proposed in the WFAS Standard Working Committee.

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