Public status and prevalence of acupuncture in Japan.

Acupuncture originated in China and is widespread throughout Asia. It is expected that a higher utilization of this remedy exists in these countries compared to Western countries. We conducted annual nationwide surveys from 2003 through 2006 on the utilization of acupuncture in Japan. Face-to-face interviews were conducted with 2000 individuals randomly chosen from the resident database. Annual utilization percentages, based on the number of respondents, from 2003 to 2006 were 6.5%, 4.8%, 6.4%, and 6.7%, respectively, while lifetime experiences determined in each surveys were estimated as 26.7, 19.4, 24.4 and 25.4, respectively. Respondents who had utilized acupuncture and/or moxibustion tended to be older than those who had no experience. Acupuncture was mainly used for musculoskeletal symptoms, and a detailed breakdown of the musculoskeletal symptoms identified in the 2005 survey showed 50.9% for low back pain, 35.9% for shoulder stiffness and 12.0% for knee pain. Reasons given for continuing therapy included the effective amelioration of symptoms, comfort of the procedure and low number of side-effects, while those who decided against continuing cited no improvement of symptoms, cost and lack of time for treatment. In conclusion, annual utilization of acupuncture and/or moxibustion was estimated at more than 6%, and the percentage of those with a lifetime experience was ∼25%, thus demonstrating the relatively higher utilization of the remedy in Japan over utilization in western countries. Application of the treatment for musculoskeletal problems and utilization by the older population were specific standouts of the use of acupuncture and/or moxibustion in Japan.

Effects of manual acupuncture with sparrow pecking on muscle blood flow of normal and denervated hindlimb in rats.

INTRODUCTION: In clinical practice, it has been thought that acupuncture might serve to wash out pain-generating metabolic end-products by improving blood circulation in muscles. We investigated the effects of manual acupuncture (MA) on muscle blood flow (MBF) of normal and denervated hindlimbs in rats. METHOD: Sprague-Dawley rats (n=100) anaesthetised with urethane (1.2g/kg ip) were used. Manual acupuncture with sparrow pecking (SP) at different doses (1, 10 or 30 pecks) was given to the right ventral hindlimb muscles (tibial anterior and extensor digitorum longus muscles) or the right dorsal hindlimb muscles (gastrocnemius, plantaris and soleus muscles). MBF with or without MA was measured using the radiolabelled microsphere technique. The blood pressure was recorded through the right common carotid artery until MBF measurement started. Denervation of hindlimb was conducted by cutting the sciatic and femoral nerves. RESULTS: In normal rats, significantly increased MBF after MA were observed only in muscles which were penetrated by an acupuncture needle. The size of the increase depended on the number of times of pecking and seemed to be sustained at least until 60 minutes after MA. However, the increase was observed after both acute and chronic denervation. On the other hand, the mean arterial blood pressure (MAP) did not change significantly before, during or after MA. CONCLUSION: These results suggest that MA could increase muscle blood flow locally in a dose-dependent manner and that this increase may be caused by local vasodilators, as well as the axon reflex. A further study is needed to elucidate the mechanism.

Relief of low back pain immediately after acupuncture treatment--a randomised, placebo controlled trial.

BACKGROUND: The purpose of this study was to examine the immediate effect of single acupuncture stimulation to the most painful point in patients with low back pain. METHOD: A randomised, evaluator-blinded, sham controlled clinical trial was conducted in which 31 patients with low back pain were randomly allocated to either an acupuncture group (n = 15) or a sham acupuncture group (n = 16). Both acupuncture and sham acupuncture were performed at the most painful point on the lower back of the subjects. For the acupuncture group, a stainless steel needle was inserted to a depth of 20 mm and manually stimulated (sparrow pecking method) for 20 seconds, while for the sham treatment a guide tube without a needle was placed at the point and tapped on the skin. Changes in low back pain were evaluated with a visual analogue scale (VAS) and the Schober test. Participants were also asked if they felt the needling sensation or not. The therapy and the evaluation were independently performed by two different acupuncturists. RESULTS: VAS score and the Schober test score showed significant improvement after treatment as compared with the sham group (P = 0.02, 0.001, respectively). There were no significant differences in the needling sensation between the acupuncture and sham group. CONCLUSION: These results suggest that acupuncture at the most painful point gives immediate relief of low back pain.

Effects of lumbar acupuncture stimulation on blood flow to the sciatic nerve trunk--an exploratory study.

INTRODUCTION: Acupuncture may have a role in the treatment of intermittent claudication of the cauda equina due to lumbar spinal canal stenosis. The aim of this study was to explore the possible physiological mechanisms. METHODS: In a laboratory experiment, manual acupuncture was performed at a point adjacent to the sixth lumbar vertebra of 13 animals and its effect on sciatic nerve blood flow was measured using a laser Doppler flowmetry. Simultaneously, changes in blood pressure and cardiac rate were observed. Each animal was stimulated four to eight times, making a total of 58 experiments. RESULTS: Acupuncture stimulation did not produce consistent changes in sciatic nerve blood flow, with increased and decreased blood flow as well as no change in blood flow observed. Among the 58 individual experiments, sciatic nerve blood flow was increased in 33, reduced in 12, and unchanged in 13. Approximately half of the stimulations showed a correlation between blood flow and blood pressure change. CONCLUSION: Our results indicate that lumbar acupuncture stimulation can have an influence on sciatic nerve blood flow. The effect is dependent not only on blood pressure but also other factors, for example vasodilator and vasoconstrictor nerve activity. This mechanism may contribute to a clinical effect on intermittent claudication of the cauda equina.

Electroacupuncture direct to spinal nerves as an alternative to selective spinal nerve block in patients with radicular sciatica--a cohort study.

We applied electroacupuncture to the spinal nerve root by inserting needles under x ray imaging in three cases with radicular sciatica, as a non-pharmacological substitute for lumbar spinal nerve block. In all three cases, symptoms were markedly reduced immediately after electroacupuncture to the spinal nerve root. The sustained effect was noticeably longer than that of spinal nerve blocks previously performed, in two out of the three cases. We suggest that descending inhibitory control, inhibitory control at the spinal level, inhibition of potential activity by hyperpolarisation of nerve endings, or changes in nerve blood flow may be involved in the mechanism of the effect of electroacupuncture to the spinal nerve root. These results suggest that electroacupuncture to the spinal nerve root may be superior to lumbar spinal nerve block when it is applied appropriately in certain cases of radicular sciatica, taking into consideration patient age, severity of symptoms and duration of the disorder.

Preventive and curative effects of acupuncture on the common cold: a multicentre randomized controlled trial in Japan.

OBJECTIVE: To determine the preventive and curative effects of manual acupuncture on the symptoms of the common cold. METHOD: Students and staff in five Japanese acupuncture schools (n=326) were randomly allocated to acupuncture and no-treatment control groups. A specific needling point (Y point) on the neck was used bilaterally. Fine acupuncture needles were gently manipulated for 15 s, evoking de qi sensation. Acupuncture treatments were performed four times during the 2-week experimental period with a 2-week follow-up period. A common cold diary was scored daily for 4 weeks, and a common cold questionnaire was scored before each acupuncture treatment and twice at weekly intervals. A reliability test for the questionnaire was performed on the last day of recording. RESULTS: Five of the 326 subjects who were recruited dropped out. The diary score in the acupuncture group tended to decrease after treatment, but the difference between groups was not significant (Kaplan-Meier survival analysis, log rank test P=0.53, Cox regression analysis, P>0.05). Statistically significantly fewer symptoms were reported in the questionnaire by the acupuncture group than control group (P=0.024, general linear model, repeated measure). Significant inter-centre (P<0.001, general linear model) and sex (P=0.027, general linear model) differences were also detected. Reliability tests indicated that the questionnaire with 15 items was sufficiently reliable. No severe adverse event was reported. CONCLUSION: This is the first report of a multi-centre randomized controlled trial of acupuncture for symptoms of the common cold. A significantly positive effect of acupuncture was demonstrated in the summed questionnaire data, although a highly significant inter-centre difference was observed. Needling on the neck using the Japanese fine needle manipulating technique was shown to be effective and safe. The use of acupuncture for symptoms of the common cold symptoms should be considered, although further evidence from placebo controlled RCTs is required.

The effects of electroacupuncture on peripheral nerve regeneration in rats.

This study was designed to examine the effects of electroacupuncture with direct current (DC) on peripheral nerve regeneration. The left sciatic nerve of 55 7-month-old rats was crushed at the thigh. They were ramdomly allocated to four groups: distal cathode DC group (n = 15), distal anode DC group (n = 14), sham operated group (n = 13), and control group (n = 13). In the distal cathode DC group, a cathode electrode was connected to an insulated acupuncture needle inserted at 1 cm distal to the injured site, while an anode electrode was connected to a needle inserted at 1 cm proximal to the lesion. In the distal anode DC group, the anode and the cathode electrode were connected to the needle at 1 cm distal and proximal to the lesion respectively. In the sham operated group, no electrical stimulation was given to the insulated needle inserted at the same site, and in the control group, no treatment was given. Regeneration of the sciatic nerve was evaluated by the number of evoked EMGs recorded at 12 sites in the plantar region, by their latency, and by the weight ratio of the tibialis anterior at four weeks after the crush injury. Regeneration of the peripheral nerve was faster and more accelerated in the distal cathode DC group than in the other groups, while in the distal anode DC group the regeneration was delayed. This result suggested electroacupuncture with cathode distal orientation might be a useful treatment having the advantage of enabling deeper insertion with minimal tissue damage.

Improvement in glucose tolerance as a result of enhanced insulin sensitivity during electroacupuncture in spontaneously diabetic Goto-Kakizaki rats.

We studied whether electroacupuncture (EA) applied on the abdomen improved glucose tolerance in the Goto-Kakizaki (GK) rat, a genetic model of type 2 diabetes mellitus. Male GK rats and nondiabetic Wistar rats were studied under pentobarbital anesthesia. Blood samples were drawn from the ventral tail artery during the fasting stage and after a glucose load (0.5 g/kg). Electroacupuncture (15 Hz, 10 mA) was performed for 90 minutes during both the fasting and intravenous glucose tolerance test (IVGTT) periods. A hyperinsulinemic euglycemic clamp was also carried out to assess glucose uptake during EA. A significant decrease in fasting blood glucose and an increase in plasma insulin levels were observed during the fasting period in GK rats treated with EA. Blood glucose levels after glucose load were also significantly lower in GK rats treated with EA compared with controls. The homeostasis model assessment index during IVGTT indicated an improvement in insulin sensitivity in GK rats treated with EA, whereas glucose infusion rate during hyperinsulinemic clamp was increased significantly during EA. The present study demonstrated that EA improved hyperglycemia in the fasting stage with a marked increase in plasma insulin levels. Electroacupuncture also restored impaired glucose tolerance during an IVGTT in GK rats by enhancing insulin sensitivity.

The effect of acupuncture in the treatment of chronic obstructive pulmonary disease.

OBJECTIVE: Many claims have been made regarding the therapeutic efficacy of acupuncture. However, most controlled clinical studies have been limited to treatment of pain-related disorders and do not provide objective, quantifiable data for analysis. Traditional acupuncture has been applied to chronic obstructive pulmonary disease (COPD). However, only a few studies have been performed to determine the efficacy of this treatment. This study was conducted to determine whether a combination of traditional acupuncture treatment and conservative treatment for COPD improves dyspnea on exercise. METHODS: This was a prospective trial with matched-pair parallel groups of patients from the departments of respiratory internal medicine of Gifu University of Medicine, Meiji University of Oriental Medicine, and Gifu Red Cross Hospital, Japan. Thirty patients were divided into the acupuncture group (n = 15) and the control group (n = 15). The control group received conservative treatment with medication only. The acupuncture group received acupuncture treatments once a week for 10 weeks, in addition to conservative treatment with medication. The main outcome measure was the Modified Borg dyspnea scale after the 6-minute walk test. RESULTS: The acupuncture group had significantly better results on the Borg scale than the control group after 10 weeks (2.2 +/- 2.7 versus 6.4 +/- 3.4, p = 0.0001, 95% confidence interval, -5.10 to -2.35, paired t-test). The 6-minute walk distance and oxygen saturation at the minimum rate improved significantly in the acupuncture group compared with the control group. CONCLUSIONS: This study demonstrated that acupuncture contributed to the reduction of COPD-related dyspnea on exercise in 15 matched-pair parallel subjects.

Acupuncture Treatment for Low Back Pain and Lower Limb Symptoms-The Relation between Acupuncture or Electroacupuncture Stimulation and Sciatic Nerve Blood Flow.

To investigate the clinical efficacy of acupuncture treatment for lumbar spinal canal stenosis and herniated lumbar disc and to clarify the mechanisms in an animal experiment that evaluated acupuncture on sciatic nerve blood flow. In the clinical trial, patients with lumbar spinal canal stenosis or herniated lumbar disc were divided into three treatment groups; (i) Ex-B2 (at the disordered level), (ii) electrical acupuncture (EA) on the pudendal nerve and (iii) EA at the nerve root. Primary outcome measurements were pain and dysesthesia [evaluated with a visual analogue scale (VAS)] and continuous walking distance. In the animal study, sciatic nerve blood flow was measured with laser-Doppler flowmetry at, before and during three kinds of stimulation (manual acupuncture on lumber muscle, electrical stimulation on the pudendal nerve and electrical stimulation on the sciatic nerve) in anesthetized rats. For the clinical trial, approximately half of the patients who received Ex-B2 revealed amelioration of the symptoms. EA on the pudendal nerve was effective for the symptoms which had not improved by Ex-B2. Considerable immediate and sustained relief was observed in patients who received EA at the nerve root. For the animal study, increase in sciatic nerve blood flow was observed in 56.9% of the trial with lumber muscle acupuncture, 100% with pudendal nerve stimulation and 100% with sciatic nerve stimulation. Sciatic nerve stimulation sustained the increase longer than pudendal nerve stimulation. One mechanism of action of acupuncture and electrical acupuncture stimulation could be that, in addition to its influence on the pain inhibitory system, it participates in causing a transient change in sciatic nerve blood blow, including circulation to the cauda equine and nerve root.

Do Japanese style acupuncture and moxibustion reduce symptoms of the common cold?

We summarize the results from a series of investigations of Japanese style acupuncture and moxibustion therapies on symptoms of the common cold that have been conducted (FTLE 1999-03, supported by the Foundation for Training and Licensure Examination in Anma- Massage- Acupressure, Acupuncture and Moxibustion). We also discuss the various interventions and concerns that we faced during these investigations. The subjects were students and teachers. The pilot study (FTLE1999) of a two arm (real and non-treatment control) RCT at a Japanese acupuncture school showed that manual acupuncture to a specific needling point at the throat clearly reduced symptoms of the common cold. The first multi-center (five centers) RCT (FTLE 2000) revealed a significant reduction in cold symptoms, by general linear model analysis (between groups, P = 0.024). To reduce the technical variation, we employed indirect moxibustion to the neck points as a uniform intervention in the next project (FTLE 2001) without statistically significant results. Then we elongated the periods of treatment from 2 to a maximum of 12 weeks (FTLE 2002) with different interventions accompanied by 4 weeks follow-up. The results were still not statistically significant. As the final project, we tried to develop a new experimental design for individualized intervention by conducting n-of-1 trials using elderly subjects in a health care center but without detecting a clear effect. In conclusion, the safety of Japanese acupuncture or moxibustion was sufficiently demonstrated; however, a series of clinical trials could not offer convincing evidence to recommend the use of Japanese style acupuncture or moxibustion for preventing the common cold. Further studies are required as the present trials had several limitations.

Relationship of serum brain-derived neurotrophic factor level with other markers of disease severity in patients with atopic dermatitis.

Elevated serum levels of neurotrophins such as nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) have been reported in allergic and autoimmune diseases. The aim of this study was to assess serum levels of BDNF in patients with atopic dermatitis (AD) and to investigate the relationship of the BDNF level with other markers of disease severity. Serum BDNF concentration was significantly higher in patients with AD (n=62) compared to control subjects (n=20) (P<0.01). Stepwise multiple regression analysis showed a significant influence of the peripheral blood eosinophil counts (F=6.90) and the percentage of CD4(+)IL-4(+) (Th2) cells (F=6.61). Moreover, after remission of AD patients with conventionally treated AD patients (n=14), serum levels of BDNF, eosinophil counts and percentage of Th2 cells were decreased significantly. These results suggest that serum BDNF may be a useful marker of disease activity in AD and that both eosinophils and Th2 cells are major cellular sources of serum BDNF.

How do acupuncture and moxibustion act? - Focusing on the progress in Japanese acupuncture research -.

The mechanisms of action of acupuncture and moxibustion as reported by Japanese researchers are reviewed. The endogenous opioid-mediated mechanisms of electroacupuncture (EA) as used in China are well understood, but these are only one component of all mechanisms of acupuncture. These studies emphasize the similarity of the analgesic action of EA to various sensory inputs to the pain inhibition mechanisms. In Japanese acupuncture therapy, careful detection of the acupuncture points and fine needling technique with comfortable subjective sensation are considered important. The role of polymodal receptors (PMR) has been stressed based on the facts that PMRs are responsive to both acupuncture and moxibustion stimuli, thermal sensitivity is essential in moxibustion therapy, and the characteristics of acupuncture points and trigger points are similar to those of sensitized PMRs. Acupuncture and moxibustion are also known to affect neurons in the brain reward systems and blood flow in skin, muscle, and nerve. Axon reflexes mediated by PMRs might be a possible mechanism for the immediate action of acupuncture and moxibustion. Reports on the curative effects of acupuncture on various digestive and urological disorders are also reviewed briefly.

Acupuncture stimulates the release of serotonin, but not dopamine, in the rat nucleus accumbens.

Acupuncture has been introduced as one of the available therapies widely used in alternative medicine, but it has not achieved widespread acceptance with scientific evidence. Furthermore there are still many unanswered questions about the basic mechanisms of acupuncture. To investigate the neuropharmacological mechanisms of oriental acupuncture, we studied the acupuncture-induced changes of in vivo monoamine release in the rat brain. A microdialysis guide cannula was implanted into the nucleus accumbens (ACC), which plays an important role in the brain reward system. Acupuncture treatment at the unilateral or bilateral Shenshu (bladder urinary channel 23) acupoints, located on the both sides of the spinous processes on the lower back, was carried out for 60 min in freely moving rats, and the dopamine (DA) and serotonin (5-HT) contents of the microdialysates in the ACC were measured simultaneously. In rats subjected to acupuncture at bilateral Shenshu acupoints, increases of 5-HT release in the ACC were observed at 20 min of acupuncture treatment and continued until 40 min after acupuncture was ended. Acupuncture at a unilateral Shenshu acupoint increased the release of 5-HT at 20 min compared with that in the sham-control group. Five-HT release returned to the baseline level at 120 min. The effects of acupuncture at bilateral Shenshu acupoints on the release of 5-HT in the ACC were greater than that of unilateral acupuncture treatment. In contrast, DA release in the ACC was not changed following acupuncture treatment. Effective acupuncture increased and prolonged the activity of serotonergic neurons in the reward system pathway of the brain. This suggests that oriental acupuncture therapy may be effective for the treatment of emotional disorders, drug abuse and alcoholism.

Effect of moxibustion on dopaminergic and serotonergic systems of rat nucleus accumbens.

Acupuncture and moxibustion are traditional medical treatments that have come to play important roles in complementary and alternative medicines. Moxibustion also has a long history as a folk remedy in Japan, particularly due to the technical simplicity and selective efficacy on certain types of disease and distress. This study examined the effects of moxibustion focusing on the brain reward system, particularly in the nucleus accumbens. The effects of moxibustion stimulation at various sites and frequencies on monoamine levels of adult male Sprague-Dawley rats were examined using high-preformance liquid chromatography of dissected nucleus accumbens tissues. The rats weighing 290-310 g were divided into 3 groups according to the moxibustion point used: hindlimb, lumbar or parietal points. Each group was further divided into 3 subgroups, with stimulation for 10 consecutive days, for 1 day, or sham treatment (control). On each day of stimulation, 5 moxibustion cones with a peak temperature of 200 degrees C were applied consecutively. Stimulation of any point on 1 day only did not change dopamine or serotonin levels, but lumbar stimulation significantly increased the metabolic turnover of dopamine. Conversely, stimulation for 10 consecutive days resulted in significantly decreased serotonin levels for hindlimb and parietal stimulations, and significantly increased 5-hydroxyindolacetic acid/serotonin ratio for hindlimb stimulation. These results suggest that the metabolic turnover of serotonin release may be accentuated by moxibustion in a reward-related brain area. Moxibustion over consecutive days, especially that to peripheral regions, appears most efficient to influence on monoamine levels in the nucleus accumbens.

Alterations in the function of cerebral dopaminergic and serotonergic systems following electroacupuncture and moxibustion applications: possible correlates with their antistress and psychosomatic actions.

Alterations in cerebral monoamines following application of electroacupuncture were investigated using conscious rats with and without application of restraining stress. The dopamine and serotonin levels were significantly decreased in the nucleus accumbens, caudate putamen, and lateral hypothalamus and increased in the dorsal raphe nucleus by restraining stress. On the other hand, application of electroacupuncture on the lumbar and hindlimb segments eliminated the above changes in dopamine, while the changes in serotonin were attenuated by lumbar and hindlimb electroacupuncture. However, the effects of hindlimb electroacupuncture were greater than those of lumbar electroacupuncture. These results clearly indicate that lumbar and hindlimb electroacupuncture stimulations have differential effects on brain monoaminergic neurons in rats exposed to restraining stress. Moxa burning stimulation was applied to the lumbar and hindlimb segments of rats without restraining stress. The dopamine level was significantly increased in the midbrain substantia nigra-ventrotegmental area by hindlimb moxibusion. On the other hand, the serotonin levels were significantly increased in the nucleus amygdala by lumber moxibusion and decreased in the nucleus accumbens by hindlimb moxibusion. The present results indicate that electroacupuncture applied to the lumbar and hindlimb segments has an antistress effect, while the application of moxibustion to the lumbar and hindlimb segments was likely to stimulate the functions of mesocortical and mesolimbic dopaminergic and serotonergic neurons. We suggest that functional alterations in cerebral dopaminergic and serotonergic neurons are involved in the clinical efficacy of electroacupuncture and moxibustion, especially because of their antistress and psychosomatic actions.

Increase of rat alcohol drinking behavior depends on the age of drinking onset.

BACKGROUND: Although alcohol drinking onset in younger people is associated with an increased risk of alcohol-related injuries, other factors, such as habituation and susceptibility to alcohol, in the process of aging have not been adequately examined in animal models. In the present study, we determined whether age of drinking onset affected alcohol drinking behavior and led to alcohol tolerance in experimental animals, and extrapolated some of the findings to human alcohol drinking patterns. METHODS: In the first experiment, 18 rats that were naive to alcohol were tested at the age of 1, 4, and 10 months with 4 hr of access to 10% (v/v) alcohol. After the time access tests, these animals (1, 4, and 10 months of age) were housed individually and given free access to 10% alcohol solution and tap water. At 3 and 6 months later, all rats that had experienced alcohol drinking were studied for the voluntary consumption of the alcohol solution, alcohol preference, under the two-bottle method in a second experiment. RESULTS: In the 4-hr alcohol-access test, alcohol intake (g/kg/hr) was significantly increased at 0.5 and 1 hr in 1- and 4-month-old naive rats compared with 10-month-old naive rats. The daily alcohol intake (g/kg/day) of rats with drinking onset at 1 month of age was significantly increased at 3 and 6 months after the voluntary alcohol consumption. The daily alcohol intake in the rats with drinking onset at 4 months of age was significantly increased at 6 months only. However, the daily alcohol intake did not change in the rats with drinking onset at 10 months of age through the alcohol preference test. CONCLUSIONS: Alcohol drinking behavior in experimental animals depends on the age of alcohol drinking onset.