In oriental medicine, the state in which blood is stagnant is called "oketsu, (Yu xie)"meaning preceding state or symptomatic of sickness. However, the pathological detail and mechanism of "oketsu"is not clear. Therefore we attempt to clarify the meaning of "oketsu"with Western medical knowledge and methods. The relationship between "oketsu"and blood fluidity (BF) was studied in human studies and the influence of several kinds of stress, "anti-oketsu"herbal medicine, electro-acupuncture stimulation (ACU), adrenoceptor agonist and antagonist on BF, platelet aggregation (PA), plasma ATP level, reactive oxygen metabolites level (d-ROM) and biological anti-oxidant potential level (BAP) were studied in animal studies using male Wistar rats. BF and PA were examined using a Micro Channel Array Flow Analyzer (MC-FAN) and a laser scattering platelet aggregometer (PA-20), respectively. D-ROM and BAP levels were studied using a Free Radical Elective Evaluator. In ACU study, 1Hz, 3-5 V stimulation was applied to the acupoints for 15 or 60 minutes. Stimulated acupoints were as follows:ZuSanli (ST-36), Sanyinjiao (SP-6), Hegu (L-I4), Neiguan (P-6) and Shenshu (BL-23). A significant decrease of BF was observed in "oketsu"patients compared to the "non-oketsu"patients in human studies. In the animal study, restrained and electrical shock stress applied to rats results in a quick decrease of BF, increase of PA, increase of plasma ATP level, increase of d-ROM level and decrease of BAP level. ACU applied to ST-36, SP-6 and L-14 revealed significant increases in BF, while PA activity decreased. The effect was observed even with 15 min stimulation. However, no significant changes were observed when ACU was applied to P-6 and BL-23. Furthermore, ACU applied to ST-36 represented a significant reduction to the stress induced blood changes such as BF, PA, plasma ATP level, d-ROM, and BAP level. These data suggest the close relation of BF with the "Oketsu"and that sympathetic nervous system activity and plasma ATP level have important roles in the changes of blood fluidity. Acupoints may have some role in the result that ACU affects BF depending on the stimulation loci. ACU has an immediate effect on BF since 15 min stimulation shows a significant effect. PA decrease by ACU suggests that an increase of BF is mainly associated with PA ability. The result that ACU reduced the stress induced BF and other changes of blood properties may imply that ACU has anti-stress activity.

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"chi mi-byo (premorbidity) or zhi-weibing is defined as "preventive treatment of disease" in the "Annual Report on Health and Welfare 1997". In China, in the 2006 five-year plan for the "zhi-weibing" policy and in the 2008 "zhi-weibing" project, the policy has been changed in quality to emphasize prevention, "yo-jo or yangsheng (care of life)", and health for the purpose of improving lifestyle-related diseases and reducing the medical costs.
The word "zhi-weibing" is used in "Suwen" and "Ling Shu" in reference the following: prevention, "yangsheng", and the initial/early treatment at the onset of disease. Additionally in "Nanjing" and "Jingui Yaolue", "zhi-weibing" means predicting the change of disease and preventing the progress of disease. Furthermore in Kampo Ikkando Medicine in Japan, it means improvement of constitution.
In this symposium, I touched on the following:
Volunteer activity reports at disaster areas
Macroscopic viewpoint of current medical state (health issue in modern times)
The relationship of health, disease, and the power to cure oneself
"zhi-weibing or chi mi-byo"
The world of Tao (way, path) and Mei (life)
The "zhi-weibing" policy in China
Symposiasts spoke on topics as follows:
1) Ascertaining the history of "zhi-weibing or chi mi-byo" and terminological issues like "chi mi-byo" or "mi-byo chi" in Japan
2) As a clinical practice of "chi mi-byo", an approach to a part of various methods of "yangsheng or yo-jo" based on the power to cure oneself and holistic healing method, the initial treatment, preventing the progress of disease, and the improvement of constitution
3)Achievement of the initial treatment of "Jingei-Kiko pulse diagnosis" and checking "the pulsation type and clinical condition"
Whenever thinking about the future of the field of acupuncture and moxibustion, life quality of each and every human being, health, happiness, and medical economy, I would be much obliged if the contents of this "chi mi-byo" symposium are helpful to inspire medical care and the Society of Medicine, all healthcare professionals, and all patients.

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[Objective]Traumatic pneumothorax in acupuncture treatment should be avoided. This study was designed to detect the safe depth of the thoracic area with acupuncture and was compared with other studies in the past.
[Methods]The Subjects were 187 cases, male: 90, female: 97, mean age: 67.8 (min-max: 23-91) and classified into 3groups (thin, normal, fatty) from BMI. MultiCT images were filmed in 3anatomical levels (the tracheal point (TP), scapular point (SP), shortest point (MsP) of the thoracic area and the distance between the skin and lung tissue on the display was measured (Osirixver3. statistics:ANOVA).
[Results]The distance between the skin and lung tissue were, average ±SD, TP 3.01 ± 0.79, SP 2.34 ± 0.65, MsP 2.14 ± 0.61 cm. The longest distance was 5.5 cm (TP), and the shortest was 0.9 cm (MsP). The differences between the body depths and TP and SP, and MsP were statistically significant (TP >SP >MsP). There was a positive correlation between BMI and body depth, and a negative correlation between age and body depth. From an anatomical point of view, TP seemed to coincide with BL38, SP seemed to coincide with BL40, and MsP seemed to coincide with BL41 or BL42.
[Conclusions]MultiCT was very useful for a measurement of the distance between skin and lung tissue scientifically. The results of this study were almost in agreement with other studies in the past. The results are informative in showing that the risk of traumatic pneumothorax might be reduced clinically. But it is too difficult to confirm what is a safe depth, and it is recommended to measure the body depth under the conditions that include clinical problems, for example, the positioning in the treatment of acupuncture. The concept of safe depth should be changed to a dangerous depth with acupuncture treatment.

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[Introduction]The patulous eustachian tube is an intractable disorder for rational symptoms such as a blocked ear, hearing breath sounds and autophony. Most of the causes are unclear. Therefore, we report a rare case of acupuncture on the patulous eustachian tube.
[Case]K. X., 43years old, male, Occupation:staff of an association.
Chief Complaint:Auto phony. Self breath sound listening.
Clinical history:In Oct 20xx, he was aware of suddenly hearing breath sounds and autophony.
The same year Oct, the "Y"Otolaryngology Clinic diagnosed it as normal hearing ability and patulous eustachian tube. It was not improved by pharmacotherapy.
In the same month, an otoscope examination was taken at the "Z"Medical College of Otolaryngology and it was diagnosed as a patulous eustachian tube again. Acupuncture treatment was started from Dec. of the same year.
Present illness:Weber test (-), hearing ability (normal), hypertonus of splenius capitis muscle
[Acupuncture treatment]Selection of acupoints was considered where the patient said "symptoms decreased with mandibular exercise". Therefore, the trigeminal nerve regional acupoints that influence the masseter and posterior region of the neck were chosen.
[Progress]In total, 25 acupuncture treatments were performed once a week from the onset.
The patulous eustachian tube symptoms were evaluated by Numerical Rating Scale (NRS) from the first treatment.
Barometric change and psychological stress exacerbated symptoms repeatedly, but the NRS of symptoms was relieved to about 50%by acupuncture at the first hospital visit.
[Discussion and conclusions]It was suggested that the symptoms of patulous eustachian tube were relieved by stimulation of acupoints on the splenius capitis muscle and trigeminal nerve region.

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[Objective]This report is a case where Chinetsu moxibustion treatment (feeling heat but non-scarring moxibustion) improved atopic dermatitis symptoms;despite the internal application of antihistamines and external application of topical steroids. Prolonged damp erythema and scars were caused by scratching during sleep.
[Method]The patient received Chinetsu moxibustion to the affected area (left popliteal fossa and both hands) once every 2 weeks over an 11 month period, totaling 25 treatment sessions.
[Results]The scars by scratching during sleep were reduced from the day after the first moxibustion. After one month of treatment, the symptom level of the patient's left popliteal fossa changed from "moderate"to "slight". For her hands, the symptom level improved from "moderate"to "slight"after 9 months. As a result, her doctor halved the amount of internal medicine and switched topical steroids to moisturizer only for external treatment. The patient's skin condition continued to be good after 11 months, so treatments by moxibustion and internal medication were terminated.
[Conclusion]It is suggested that Chinetsu moxibustion treatment may be effective for preventing scratching behavior during sleep, and therefore may complement dermatologic treatment for atopic dermatitis.

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In order to address conflicting accounts of the Huiyin-vessel and CV1 (Huiyin) in the Wang Bing version of "Huang-di nei-jing Su Wen", we analyzed the origins of the Huiyin-vessel based on its relationship to hemorrhoids in ancient sources on the topic. Furthermore, by considering the curing methods used by health scholars during the Warring States period in China and hemorrhoid treatments until the Song dynasty, we demonstrated the specificity of the posterior yin (anus) and identified the reason behind moving the location of the Huiyin-vessel. We also clarified the way of determining the location of CV1 (Huiyin) and factors that have until now caused confusion related to CV1 (Huiyin).

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I observed the ICMART (International Council of Medical Acupuncture and Related Techniques) World Congress on Medical Acupuncture held on May 13-15, 2011 in Den Haag (Netherlands). The ICMART is an association of western medical societies mainly interested in scientific evidence for acupuncture and other oriental medical techniques. Naturally, the number of presentations dealing with scientific evidence in relation to oriental medicine outnumbered those dealing with clinical aspects or traditional characteristics. The presented results showed, however, that while one set of evidence proves one thing, for example whether acupoints are really points or rather extended areas, another set proves the exact opposite and thus renders either the scientific questionable and the applied methods and/or the obtained results at least questionable. On the other hand, presentations dealing with traditional characteristics or techniques sometimes presented no evidence at all, or did not explain the rational behind the shown results.
Extensive discussion about the integration of alternative medicine into mainstream medicine showed that this subject is much more related to political and financial questions than patient interests, but there seemed also to be some progress and hope for future development.

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I participated in the TCM (Traditional Chinese Medicine) Kongress hosted by the AGTCM(Arbeitsgemeinschaft fur klassische Akupunktur und traditionelle chinesische Medizin e.V.) that is held every year (this year: 5/30-6/5, 2011) in the same location, namely the small town of Rothenburg in Germany. While a substantial portion of the attendees are also physicians, this congress is mainly for non-physician practitioners using mainly acupuncture and Chinese herbal therapy. As the name already indicates, the focus here is more on the traditional aspects of oriental medicine that were dealt with during both theoretically and practically oriented presentations. The presentations, or rather study groups, were designed mostly for small groups of about 20-30 people and lasted 3hours each. This allowed extensive discussions that sometimes even took the entire presentation into an unforeseen direction. Although there were a number of presentations dealing with Japanese or Korean acupuncture, etc., naturally the majority discussed the Chinese style and characteristics of theory and practice. This practice seemed to rely, in most cases, mainly on theoretical considerations that could give the attendee the impression that examination of the unique characteristics of each patient (using palpation, etc.) so common in Japan is of rather secondary importance.
Political aspects of alternative medicine and questions pertaining to standardization, etc. played an important role and I found it very interesting that one of the leading executives mentioned that although acupuncture may have developed in China, its future (further development) will probably lie in the West.

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