Purpose:
We previously reported that using D-phenylalanine (D-PA) as a pre-medication increasingly enhanced acupuncture aneshesia effects occur. In order to investigate this effect clinically, we performed tooth extractions under acupuncture anesthesia using D-PA as a premed.
Method:
We divided the patients in the oral surgery department of our hospital for whom acupuncture-moxibustion was determined indicated, into 2 groups, a test group (9cases) to which D-PA (4.0g) was administered 30minutes prior to acupuncture anestesia, and an acupuncture anesthesia only group (about 31cases), and comparitively examined results.
The points used were: LI-4 on both sides in all cases, and indicated local points selected from among JOKAN, ST-7, GV-26, ST-2, LI-20, CV-24, ST-6, SI-18 and ST-5. Needles were inserted (in some cases a point surface electrode was used) and the acupuncture sensation aroused, following which low frequency current at 3-15Hz was administered.
The tooth extractions were begun about 30minutes later. The standard for determining results was a score of 1=absolutely no pain, 2=slight pain, 3=very painful, 4=a small amount of local anesthesia administered, as supplement, 5=attempt to use acupuncture anesthesia abandoned.
Results:
In the control group effective results (score 1 or 2) were obtained in about 30% of the cases while in the test group there was almost no need for supplementary local anesthesia and generally effective results were obtained in most cases.
Summary:
The results were more excellent in the group in which D-PA was used as a pre-med for tooth extractions with acupuncture anesthesia than in the group in which it was not used.

We have been studying the effect of preadministration of D-phenylalanin (DPA) on acupuncture analgesia for various types of pain. DPA is thought to suppress the activity of carboxypeptidase, which discomposes endorphins. In this double-blind placebo-controled study, clinical effectiveness of acupuncture with DPA preadministration in relieving chronic low back pain was examined.
DPA (4g) or placebo (lactose: 4g) was orally administered to thirty out patients with chronic low back or lower extremity pain 30 minutes before acupuncture treatment. A half of the patients were given placebo in the first session and DPA in the second one, and the other half were given DPA firstly and placebo secondly.
The patients were asked to rate their pain after treatment in comparison with pre-treatment condition. Successful pain relief was obtained in 60% of the patients given DPA prior to acupuncture and in 33.4% of those given placebo. Although it is said that there is a great individual variation in response to acupuncture therapy, this result demonstrates that preadministration of D-phenylalanin enhances analgesic effect of acupuncture therapy.

Introduction
It is said that D-phenylalanine improves the pain relief effect of acupuncture on pain disease. We applied it to different kinds of pain disease as preadministration and studies the clinical effectiveness.
Method
Subjects were 24 patients suffering from such comparatively chronic pain diseases as prosopalgia (2), a pain in the posterior region of neck (5), frozen shoulder (4), coxalgia with melosalgia (10) and gonalgia (3).
A. The low frequency electrical acupuncture (3Hz, sub-successive wave, 20 minutes) was applied to them on the most frequently used points by the JSA Committee of Acupoints.
B. 0.5g of DPA was administered to each patient as preadministration and acupuncture was given.
C. Lactose was administered to all of the same patients as a placebo and acupuncture was given.
D. The therapy was repeated two times.
E. We evaluated the just after effect of the therapy on both groups with the double blind experiment.
Effect
The preadministration of DPA improved the effectiveness of acupuncture against such pain disease. From our study, it was clarified that the effectiveness of DPA rose by 30% in comparison with the placebo.

Introduction:
There are two types of phenylalanine, one of the essential amino acids, D-Type and L-type. Phenylalanine in itself has shown no clear analgesic effect in human beings, however, as we reported previously, D-type phenylalanine (DPA) when administered prior to acupuncture analgesia in human beings lengthens the analgesic effects of acupuncture. At this time then, using volunteers in whom acupuncture analgesia failed to raise the pain threshold (PT) we experimentally studied whether or not DPA has any influence.
Methods:
Subjects were divided into an acupuncture anesthesia effective group (a rise in PT was observed due to acupuncture) and an acpuncture anesthesia ineffective group (no rise in PT). 4.0g. DPA was administered orally in both groups 30 minutes prior to acupuncture anesthesia. For acupuncture anesthesia right and left LI-4 and right and left ST-36 were used with low frequency electric current administered for 50 minutes. For the determination of PT a radiant heat pain meter was used. The PT was measured when DPA was administered, during acupuncture anesthesia and at every 30 minutes for 3 hours after the needles were withdrawn.
Results:
In the acupuncture anesthesia effective group, a rise in the PT was observed in 4 of the 5 cases and, the rise was much faster than when acupuncture anesthesia was used alone. In the acupuncture anethesia ineffective group, there were cases in which a remarkable rise in PT was observed or in which no rise in the PT occured during acupuncture stimulation but occured after the discontinuation of the acupuncture and some cases in which no rise occured during or after anesthesia.
Discussion:
1. In the acupuncture anesthesia effective group due to DPA pre-medication, the rate of PT rise quickened.
2. After operations the PT rise was lengthened.
3. The individuality of the acupuncture effectiveness in human beings was partially eliminated.

In previous papers, we experimentally demonstrated the enhancing effect of D-phenylalanine (DPA) administration on the analgesic effect of acupuncture by the increase of pain threshold. In the present study, we examined the effect of administration manners in the patients with chronic lumbago who visited our anaesthesiological department. We conducted a double-blind study with two different administration manners: “previous-day” and “just-before”.
METHODS
Fifty-six patients suffering from chronic low back pain for more than three months were devided into two groups. DPA or placebo was orally administered intwo different manners prior to low-frequency electro-acupuncture treatment. Group I patients (26 cases), took 0.5g three times (i. e. a total of 1.5g): after the evening meal and before go to bed on the day before, and after the beakfast on the day of acupuncture (“previous-day” administration). Group II patients (30 cases), took 4.5g 30 minutes before acupuncture treatment “just-before” administration. The treatment was undertaken twice with DPA administration and twice with placebo administration for each group. “Direct effect” was determined by the number scale method and a comparison between the two groups was made. In the additional experiment, three volunteers were orally given 4.0g or 1.5g DPA, and blood phenylalanine level was determined two hours, four hours and one month later.
RESULTS
In the group I (previous-day administration), “DPA+acupuncture” produced the following result: excellent 7.8%, good 69.2%, moderate 19.2%, (significantly different from placebo administration). In the group II (just-before administration), “DPA+acupuncture” produced the following result: excellent 23%, good 37%, moderate 20%, and no-effect 20% (significantly different from placebo administration). Comparing group I with group II, the percentage of the “excellent” or “good” cases in the former was larger than that of the latter (+17%). Blood phenylalanine level showed its high value 2-4 hours after administration of 4g DPA, whereas 2 hours after that of 1.5g DPA.
Conducting a clinical investigation into the effectual administration (timing and doses) of DPA, we found that previous-day administration is more effective than “just-before” administration in enhancing effect of acupuncture analgesia. Although there is room for further studies with a larger number of cases, considering that DPA has a “slow onset long acting” effect (Ehrenpreis), we can conclude that the series administration of DPA on the day before acupuncture treatment is advisable.