[Aim] We compared the effects of acupuncture and press tuck needle (PTN) acupuncture in office workers with physical and psychological fatigue. [Design] A randomized, open-label, parallel-group, comparison study. [Setting] An acupuncture room in the A Clinic within the Kanto Metropolitan Area. [Patients] Clinic workers. The inclusion criteria were 20-45 years of age and awareness of physical and psychological fatigue. The exclusion criteria were fatigue-related diseases and symptoms, medical abnormalities, and history. [Intervention] The subjects were randomly allocated to either the acupuncture treatment group (ACP group) or PTN acupuncture treatment group (PTN group). The interventions were based on acupoints for fatigue symptoms as per previous reports and individualized treatment for physical symptoms, including neck and lower back pain, among others, and were performed twice a week for one month. [Evaluation methods] The visual analog scale (VAS) scores were the primary method for evaluating for physical and psychological fatigue at four weeks post-treatment. Other forms of measurement used were the VAS scores within groups immediately after treatment and to evaluate physical health, the Health Perceptions Questionnaire, General Health Questionnaire-12, and Short Form-36 responses; and salivary amylase levels were used. [Results] Thirteen of 14 subjects in the ACP group and 13 of 15 in the PTN group were included in the analysis. There was no significant difference between the groups for VAS scores. Evaluation, immediately before and after the intervention showed a significant decrease in VAS scores for physical fatigue in both groups. The ACP group showed a greater immediate change than the PTN group. In a comparison within each group, the VAS of psychological fatigue in the PTN group showed significant decrease after the eighth treatment. [Conclusions] Acupuncture may immediately improve physical fatigue in office workers. Moreover, the frequency of using PTN acupuncture may eventually decrease physical fatigue. Therefore, acupuncture and PTN acupuncture can help office workers' health.

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[Objective] The purpose of this cross-sectional questionnaire-based study is to investigate the challenges of adverse events during treatment by acupuncture and moxibustion to an athlete. [Methods] In total, 1,804 subjects, including athletes who participated in marathons and university athletes were enrolled in this study. The survey was conducted by distributing the questionnaire or via online questionnaire to the athletes who fit the criteria for the study. The questionnaires were collected after consent was received from the participants; online questionnaires were also collected. The questionnaire was examined for age, sex, and type of competition, purpose of the acupuncture treatment and the actual effects, and treated area, content of adverse event, number of times the subjects received acupuncture, and informed consent, and free description of adverse events. [Results] In total, 1,525 (84.5%) valid responses to the questionnaires were received. The survey analyzed 841 subjects (55.1%) who experienced acupuncture and moxibustion. The following responses about adverse events of acupuncture were obtained: "pain at time of needle insertion"; 17.0%, "subcutaneous-bleeding"; 10.1% and "pain and feeling of heaviness due to the needle": 10.0%, among others. For moxibustion, responses included "burns"; 5.9% and "malaise"; 5.8%, among others. In the free description, there were 17 descriptions of discomfort due to excessive stimulation and difficulty in movement during exercise. Of the questions regarding whether or not they received informed consent, 215 were received orally (25.6%), 34 were received in written form (4.0%), 99 were received both orally and in written form (11.8%). [Discussion and Conclusion] Acupuncture for athletes causes a certain rate of adverse events. It was suggested that guidelines for athletes to receive acupuncture safely and training and education for practitioners are important.

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[Objectives] In this study, we examined the effects of acupuncture stimulation on short latency reflexes (SLR) and long latency reflexes (LLR) to determine the site of acupuncture stimulation in modulating motor reflexes. Further, we investigated the relationship between changes in LLR and changes in the N20 somatosensory evoked potential (SEP) component induced by acupuncture stimulation and examined changes in central motor conduction time (CMCT). [Subjects and Methods] Sixteen healthy and right-handed adults (11 males and 5 females; 28.9 ± 6.6 years old; upper limb length 54.9 ± 3.2 cm) participated in this study. The experiments were performed under three conditions: (1) control (no acupuncture stimulation), (2) acupuncture stimulation of right-sided Hegu (LI4), and (3) acupuncture stimulation of left-sided LI4. An acupuncture needle (0.18 mm in diameter) was inserted up to a depth of 10 mm at the right- or left-sided LI4. Electrical stimulation was delivered to the median nerve in the right hand joint at a 120% intensity compared with the threshold to produce an M-wave. SLR and LLR were recorded from the opponens pollicis muscle of the right hand. The frequency and amplitude ratio of SLR (latency, approximately 20-30 ms) and LLR (latency, approximately 40-70 ms) were analyzed. SEP was produced by electrical stimulation delivered to the median nerve. The amplitude from baseline and mean latency of N20 waves were measured. F-wave in the evoked electromyography was evoked by electrical stimulation of the median nerve of the right hand at supramaximal intensity to elicit an M-wave and recorded from the opponens pollicis muscle of the same hand. We analyzed the mean latency and calculated the CMCT using the mean latencies of LLR, N20, F-wave, and M-wave. [Results] The frequency and amplitude ratio of SLR were reduced by acupuncture stimulation of left- and right-sided LI4, respectively. LLR frequency and amplitude ratio were reduced by acupuncture stimulations on either side. A correlation was observed between changes in the LLR amplitude ratio and changes in the N20 SEP amplitude ratio induced by acupuncture stimulation. No effect of acupuncture stimulation was observed on CMCT. [Discussion and Conclusion] SLR is the reflex potential of the spinal cord, and LLR is the motor reflex of the central nervous system via supraspinal pathways. These findings suggest that acupuncture stimulation inhibits motor nerve reflexes via both spinal and supraspinal modulation systems.

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[Introduction] Heating of the skin by moxa needle depends on the amount of radiated-light absorbed during combustion. In this paper, the absorption characteristics of radiated-light were revealed in each skin layer. [Method] A moxa ball (1 g, 10 mm-radius) was attached to a needle (50 mm-long, 0.25 mm-diameter), and K-type thermocouples were used to measure the temperatures (top, center, bottom, side) inside the moxa ball and temperature-increase on the cypress board directly below the moxa ball (board-temperature). The smoke-loss time taken for the moxa to stop smoking was also measured. The distances between the moxa ball and the cypress board were 30, 40, and 50 mm. Four types of ignition positions (upper, lower, upper & lower, and left & right) of the moxa ball were employed. Measurement was carried out for five trials. The significance level was 5%. [Results] The maximum values of the board-temperature equivalent to the skin temperature were not significantly different with respect to the ignition positions. The correlation coefficient of 0.82 was the highest for each time when the board-temperature and bottom-temperature were the highest. The amount of radiation calculated from the bottom-temperature was the highest in right & left-ignition, but there was no significant difference in ignition positions. Thirty seconds after smoke-loss, the cumulative radiation-amount was as high as 77% of total radiation-amount in lower-ignition, therefore, the time for smoke-loss became a guide for when to finish the treatment. By the absorption characteristics of water based on human skin, the absorption-amount of radiated-light was calculated. When bottom-temperature increased from 500°C to 700°C, the absorption-amount increased 1.3 times in the dermis and 4.1 times in the subcutaneous tissue. In the deepest part of the skin, it was expected that the higher the bottom-temperature, the higher the heating effect would be. Due to the existence of temperature sensitive nerves in the epidermis, lower thermal sensation was expected in lower-ignition and strong thermal sensation was expected in right & left-ignition based on the absorption characteristics of the skin. The highest thermal-effectiveness was expected in both types of ignition. [Conclusion] Board-temperature had an excellent correlation with bottom-temperature. In the deepest part of the skin, a higher heating effect was expected at higher bottom-temperatures. In lower-ignition, the smoke-loss became a guide to when to finish the treatment, and the thermal sensation was lower, but the highest thermal-effectiveness was expected.

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[Objective] We report a successfully treated case by a combined therapy of acupuncture and Kampo medicine for a patient with lower limb pain associated with Guillain-Barre syndrome (GBS). [Case] The patient was a 74-year-old man whose chief complaints were severe lower limb pain, gait difficulty, and hyposthenia. Clinical history: In late September in X year, the patient had a cold infection. On October 14, he became aware of weakness in his lower limbs on both sides, difficulty in walking, and severe pain in his lower limbs. He visited our hospital's general internal medicine department and was diagnosed with GBS. The patient was hospitalized and started to receive intravenous immunoglobulin therapy for GBS. Since pain in the lower limbs continued after treatment, he received analgesics, which was not effective. Therefore, acupuncture treatment was started on October 30 aiming to alleviate lower limb pain. Evaluation: Pain and burning sensation were evaluated using a numerical rating scale (NRS), and Hughes' function grade scale (FG) as an objective evaluation. [Acupuncture treatment] The acupuncture treatment was based on Chinese medicine. The basic combination of meridian points for treatment of the case were LR3 (Taichong), LI4 (Hegu), KI6 (Zhaohai), KI3 (Taixi), ST36 (Zusanli), PC6 (Neiguan), and SI8 (Xiaohai). The patient received acupuncture treatments once a day for 12 weeks. [Progress] The first evaluation of the patient's pain in his lower limbs on both sides was 10 points in NRS and 4 units in FG. Pain was alleviated immediately after acupuncture treatment was started, and a significant improvement in pain was observed by the seventh acupuncture treatment. However, the　patient started to complain of burning sensation on his soles. Therefore, the combined use of Kampo medicine (Choutousan, Rokumijiougan) were introduced in addition to the acupuncture treatment, and his burning sensation disappeared. Since then, rehabilitation was enhanced, and after three months from the start of acupuncture treatment, he was discharged since the FG was improved to 2 units. [Discussion] Lower limb pain and burning sensation in this case were considered to be neuropathic pain associated with GBS, and conventional analgesics were only temporarily effective. In contrast, the combined use of acupuncture and Kampo medicine alleviated the pain and burning sensation, and ADL was improved. Acupuncture and Kampo medicine were effective for lower limb pain and burning sensation from GBS.

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[Purpose] This study is a case report of an acupuncturist's new evaluation index for acupuncture treatment aimed at reducing or eliminating cardiac rehabilitation inhibitory factors in home medical care due to exacerbation of heart failure. [Method] Acupuncture was evaluated by heart rate variability, respiratory sinus arrhythmia, and saturation pulse O2. [Results] In severe heart failure in the evaluation index used in this study, there was no significant change in the autonomic function of the heart before and after acupuncture stimulation. [Discussion] In order for acupuncture to be accepted as a member of team medical care in the future, acupuncturists need to share objective information for multi-professional collaboration.

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A vertebral compression fracture is a red flag for low back pain. The closed-fist percussion sign is a useful physical examination, but there is a possibility of misdiagnosis. A 58-year-old woman complaining of low back pain with suddenly developed pain at rest. Physical examination using x-rays and closed-fist percussion sign were negative, but auscultatory percussion was positive. As a result, vertebral compression fracture was diagnosed by magnetic resonance imaging (MRI). Auscultatory percussion is a method that can determine a vertebral compression fracture without causing pain, and is necessary to improve accuracy in the future.

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The WFAS Annual Conference 2019 was held between November 14th and 17th at Kaya Palazzo Hotel, Antalya, Turkey. The WFAS executive committee was convened on the 14th. In the EC (Executive Committee) meeting, the JSAM proposed inclusion of the Declaration of Helsinki (DoH) in the WFAS Code of Ethics. Other issues discussed in the EC meeting included approval of the special consultative status by the the United Nations ECOSOC (Economic and Social Council) and preparation of the next WFAS symposium in the Netherlands in 2020. Individual presentations and other exhibitions in the symposium are also introduced in the present report. In addition, recent large-scale RCTs of acupuncture conducted in China were reviewed.

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