This is the third symposium on 'cancer and acupuncture and moxibustion'. Many physicians and intellectuals are skeptical of the use of Western medicine for cancer patients, which often lead to serious adverse events. Acupuncture and moxibustion, which is capable of improving quality of life (QOL) and activating immunity with minimal side effects is also expected to have beneficial effects on various stages of cancer patients, such as prevention of development or recurrence of cancer and palliative care. In fact, evidence has recently accumulated in the field. Dr. Fukuda, Associate Professor of Meiji University of Integrative Medicine, who reported the usefulness of acupuncture and moxibustion in palliative care in the first symposium and bibliographical information in the second has reported this time on the topic of safety and effectiveness of acupuncture on chemotherapy-induced peripheral neuropathy. Dr. Kurokawa from the National Defense Medical College reported the effectiveness of acupuncture on physical and psychological symptoms, QOL, prevention of adverse events, and pre-and post-operative disorders in cancer patients. Dr. Kouchi from Saitama Medical School reported on the usefulness of acupuncture in the university hospital and factors which influence the effect. Dr. Nakamura from Morinomiya University presented a case with chemotherapy-related symptoms who had been cared for with a long-term application of moxibustion. In contrast to these reports on the efficacy of the acupuncture for chemotherapy-and radiotherapy-induced side effects, Dr. Magara from Somon Hachipuji Clinic, who had consistently reported a preventive effect of autonomic immune therapy that involves acupuncture without Western clinical treatment from the first symposium, this time presented topics regarding improvement in the immunity by increasing various cytokines, the possibility of reduction of a tumor even in a case of advanced cancer that cannot be treated with a surgical approach, reduction of the recurrence rate among cases who were treated with his approach as compared with those under conventional approaches. He insisted we should concentrate our efforts on research on preventing the recurrence of cancer with approaches that activates the natural healing process of human beings.
We concluded that clinical trials with a larger sample are needed to clearly identify the usefulness of acupuncture and moxibustion for cancer patients.

[Objective] This report describes a patient with bilateral peripheral facial paralysis who was strongly suspected to have neurosarcoidosis and whose facial paralysis improved after acupuncture treatment.[Case] A 73-year-old man developed right facial nerve paralysis on July 24, X followed by left facial nerve paralysis three days later. The patient visited our Department of Neurology on August 2 and was hospitalized the next day. Upon examination, neurosarcoidosis was strongly suspected, and steroid pulse therapy was performed until he was discharged from the hospital on August 26. On September 13, still experiencing bilateral facial paralysis, the patient was referred to our department for acupuncture treatment. The patient's height was 159 cm and weight was 48.6 kg. Valley signs and pathologic reflexes were negative, and deep tendon reflexes and sensory tests of the upper and lower extremities were normal. MMT was fair only for the dorsiflexion movement of the left ankle. The Yanagihara score was 26 on the right and 10 on the left. Facial muscle contraction response to electrical acupuncture stimulation targeting the facial nerve showed contraction at 0.04 mA on the right side and no contraction at 0.30 mA on the left side. According to these examinations, the right side was considered to be mildly paralyzed and the left side was considered to be severely paralyzed, and acupuncture was performed to improve the symptoms of paralysis and prevent sequelae.[Treatment] Acupuncture was applied to GB2 and ST7 on the right side of the face. On the left side, acupuncture needles were placed on the frontalis muscle, orbicularis oculi muscle, elevator muscle of upper lip and wing of nose, nasalis muscle, zygomaticus major and minor muscle, orbicularis oris muscle, depressor angle oris muscle, and platysma muscle. From the 106th day of illness, asynchronous electroacupuncture was applied to the left side only. Acupuncture was performed once or twice a week for 10 minutes per session. The degree of paralysis was assessed by the Yanagihara score.[Progress] Acupuncture was combined with corticosteroids prescribed by the Department of Neurology. As a result, the right side had a score of 38 points after 170 days after start of illness and the left side had a score of 38 points after 204 days.[Discussion and Conclusion] The combined treatment of medication and acupuncture was effective and showed excellent results for this patient taking into account the degree of facial nerve damage. Acupuncture may be considered as an effective treatment option for bilateral peripheral facial paralysis.

[Introduction] Psychosocial factors are associated with chronic low back pain (CLBP), but there are no known reports of screening for psychosocial factors and combined acupuncture and Kampo treatment for this. We present the case of a patient with CLBP with neuralgia of the posterior right thigh whose quality of life (QOL) improved after evaluation of psychological factors and treatment with acupuncture and saibokuto.[Case presentation] A 38-year-old woman developed low back pain with neuralgia in the posterior right thigh in August of the X year. She visited a nearby orthopedic clinic and was diagnosed with a lumbar disc herniation. In November she visited a nearby psychiatric clinic because she noticed dizziness, was diagnosed with an adjustment disorder and was prescribed bromazepam. Six months later, she was diagnosed with sciatica by an orthopedic surgeon at our hospital. In the following month, she visited the psychiatrist at our hospital and was diagnosed with depression in April. In April, she also visited our department, hoping for improvement of her low back pain and neuralgia in the posterior right thigh. Neurological and orthopedic manual examinations showed normal results, but pain in the lumbar region when flexing the trunk and baikakuki and kyo-kyo-kuman were noted. The Keele STarT Back Screening Tool classified her under medium risk, and the Roland-Morris Disability Questionnaire (RDQ) showed a score of 16 with a deviation score of 1.22. We administered acupuncture and saibokuto to improve her symptoms. The acupuncture treatment was performed on the right L2/L3 lateral sacral border, piriformis equivalent area, BL37, and BL40. As a result, after the third acupuncture treatment, her RDQ score improved to 2 points and the deviation score to 50.14 points.[Discussion] Our results suggest that acupuncture and saibokuto may improve the QOL of CLBP patients with neuralgia in the lower limbs who have psychological factors.

[Objective] Postherpetic neuralgia (PHN) is commonly associated with allodynia in around 90% of patients, which is related to both physical and psychosocial distress. In this report, we report two cases in which surrounding needling with electroacupuncture (EA) at 2Hz was performed for allodynia in the thorax and upper limb, resulting in a reduction of the allodynic area. [Case 1] A 67-year-old male with right-sided anterior thoracic pain. He experienced the initial symptoms in December of a certain year and was diagnosed with herpes zoster the following day. Despite receiving antiviral medication, the pain persisted, leading to a referral to our Saitama Medical University in June of the following year. [Case 2] An 80-year-old female complained of left upper limb pain because of herpes zoster following chemotherapy for multiple myeloma in February of a certain year. In September of the same year, she was referred to our department due to persistent pain and allodynia, despite receiving analgesic medication for PHN since June. [Evaluation] The allodynic areas were calculated as the ratio of the allodynic area to the total area of the anterior thorax and upper limb using Image J. Pain intensity was assessed using the Visual Analogue Scale (VAS). [Treatment] We applied surrounding needling with electro-acupuncture for two cases. Acupuncture needles in the specification of 0.18 × 50 mm (Seirin Co., Ltd, Japan) were inserted transversely as like surrounding the allodynic region and connected to the EA apparatus (Zeniryou Co., Ltd, Japan). EA parameter was selected as dilatational wave. [Time course 1] The ratio of allodynic area was 20.0% at the first session, with a VAS of 28mm. After 8 months, the ratio decreased to 1.7%, and the VAS reduced to 18mm. The analgesics that were being taken at the first session were discontinued by the end of the session. [Time course 2] The ratio of allodynic area was 66.1%, with a VAS of 82mm at the first session. After 6 months, the ratio decreased to 24.1%, and the VAS reduced to 48mm. The analgesics were unchanged, while there was a reduction in the rescue medication. [Discussion] In two cases of intractable PHN with allodynia, EA reduced pain intensity and improved quality of life, with Image J serving as a useful assessment tool. [Conclusion] Surrounding needling with EA at 2Hz may be effective for two cases of PHN with allodynia.

[Objective] The aim of this study was to investigate the therapeutic effects of acupuncture in patients with chronic primary musculoskeletal pain. First, factors influencing treatment outcomes were identified using multiple regression analysis. Second, factors related to treatment selection were identified using logistic regression analysis. Third, the effects of non-electroacupuncture and electroacupuncture were compared using propensity score matching. [Subjects and Methods] This study utilized a retrospective observational design, enrolling participants based on the International Classification of Diseases, 11th Revision. In the multiple regression analysis, the dependent variable was the change in Visual Analogue Scale score before and after treatment, and in the logistic regression analysis, the dependent variable was the presence or absence of electroacupuncture. To compare the therapeutic effects of the non-electroacupuncture group and the electroacupuncture group, propensity scores were calculated based on factors related to treatment selection, and matching was performed to adjust the background characteristics of the two groups. The change in pain intensity was compared between the two groups using a two-sample t-test. [Results] First, in the multiple regression analysis, the initial Visual Analogue Scale score, Body Mass Index, and Undergoing electroacupuncture treatment were significantly associated with the change in pain before and after treatment. Second, the logistic regression analysis indicated that previous acupuncture experience and gender were related to treatment selection. Third, the comparison between the two groups revealed that the change in pain intensity was significantly greater in the electroacupuncture group (p = 0.03). [Discussion] The influence of initial Visual Analogue Scale score and Body Mass Index on treatment outcomes was consistent with previous studies. Regarding treatment selection, it was suggested that there is a tendency to avoid high-intensity treatments such as electroacupuncture for patients without prior acupuncture experience. The comparison between the non-electroacupuncture and electroacupuncture groups showed that both treatments resulted in a reduction in pain exceeding the minimum clinically important difference, indicating that both methods may be effective for pain management. [Conclusion] In patients with chronic primary musculoskeletal pain, electroacupuncture may be more effective than non-electroacupuncture, suggesting a greater therapeutic effect.

[Introduction] The effects of combining acupuncture and kampo medicine on in vitro fertilization (IVF) outcomes is unclear. Therefore, we aimed to investigate their combined effects on promoting conception in patients with multiple IVF attempts.[Methods] Participants with at least two IVF attempts who gave informed consent were included in this study. Administering acupuncture and kampo medicine, the study was conducted across three facilities from 2013 to 2017 using a case series design． Case 1: A 40-year-old woman presented after 13 months of infertility, having experienced a natural conception and subsequent miscarriage 10 months prior, which led to IVF. After a second embryo transfer, she miscarried again 3 months before visiting. She began kampo medicine and acupuncture for support in our department. Case 2: A 46-year-old woman with a 36-month infertility history did not achieve pregnancy after three IVF cycles． Case 3: A 37-year-old woman with a 20-month infertility history failed to conceive after two IVF attempts． Case 4: A 26-year-old woman, new to infertility treatment, received acupuncture for fertility preservation, experiencing headache, shoulder stiffness, and widespread pain. Case 5: A 38-year-old woman with a 108-month infertility history suffered from shoulder stiffness due to prolonged IVF therapy. The main outcome measured was pregnancy. Standard acupuncture points utilized included L14 (Hegu), CV12 (Zhongwan), CV7 (Yinjiao), ST27 (Daju), ST29 (Guilai), BL18 (Ganshu), BL20 (Pishu), BL23 (Shenshu), BL33 (Zhongliao), SP10 (Xuehai), ST36 (Zusanli), and SP6 (Sanyinjiao)． [Results] Four out of five participants achieved pregnancy． [Discussion] Our findings reveal a positive effect of combining acupuncture and kampo medicine on enhancing pregnancy rates in patients undergoing multiple IVF treatments, suggesting clinical effectiveness in fostering an appropriate environment for conception．