[Objective]Mie University Hospital Department of Anesthesiology established an integrated acupuncture care clinic in April 2010. A total of 8 incidents and accidents occurred during a period of eight months from commencement in April through November of 2010.
Re-examination of the issues from the incident and accident reports, led to the creation of a clinical manual for the acupuncture clinic as a means to improve the safety of the acupuncture clinic.
[Methods]Based on the contents of the reported incidents, which were collected from electronic medical records up to November 1st 2010, a safety manual was created for the prevention of recurring incidents and accidents. Following a request for approval to the Safety Division of Mie University Hospital, the safety manual underwent screening and inspection and was eventually approved.
After the introduction of the manual, the occurrence of incidents and accidents, was tracked using electronic medical records for a period of four months from December 2010 to March 2011.
[Results]The incidents and accidents that occurred before the creation of the manual were all related to acupuncture (dropped acupuncture needles: 5, needles taken home: 1, and leaving needles inserted: 2). Incidents and accidents have not been reported since the introduction of the manual, that is, for a period of four months from December 2010 to March 2011.
[Conclusion]Clinical practice based on the manual suggests the possibility of preventing incidents and accidents, as none have been reported since the introduction of the manual. The safety manual is still incomplete, as it emphasizes mainly the management of acupuncture and not its entire context. If any further negative incidents or accidents occur, a review and improvement of the present manual will be required. In order to deal with any new negative incidents or accidents, organizing a team will be indispensable.
Since Mie University Hospital has an established Safety Division, soliciting the cooperation of the infectious disease control and medical safety experts to ensure safe clinical practices in the acupuncture core clinic should also be arranged.
The results suggest that the creation of a safety manual can be a means of preventing the occurrence of incidents and accidents.

A 72-year-old man with proton pump inhibitor (PPI)-resistant gastroesophageal reflux disease (GERD) had been complaining of ructus, sore throat, and mid-back pain during the night despite the administration of the standard dose of PPI. As his symptoms improved rapidly after taking bukuryoin, he discontinued PPI on his own judgment. However, his nocturnal symptoms relapsed. Adding hangeshashinto before bedtime was so effective that he could cease using PPI. However, upper endoscopy revealed poor mucosal findings such as Grade D in the Los Angeles classification of GERD ; we increased the dose of hangeshashinto to 3 times a day and added orengedokuto before going to bed. His subjective symptoms completely disappeared, however, we could not operate endoscopy again during our intervention. It seems that not only rikkunshito which is recommended in the guideline for GERD but also other Kampo formulas were possibly effective to PPI-resistant GERD. Although endoscopic findings are not always correlative to their subjective complaints, we need further discussion on the endpoint of Kampo therapy to prevent complications.

A 70-year-old woman was diagnosed with peripheral T-cell lymphoma and received chemotherapy. She developed chemotherapy-induced peripheral neuropathy (CIPN), and her chief complaint was numbness of her fingertips and toes. However, the symptoms did not change even 9 months after the chemotherapy was completed. Our Kampo diagnosis was dual deficiency of qi (ki) and blood. Hence, we applied pedestal moxibustions to the following acupuncture points : SP 6 (Sanyinjiao), Ex-LE 10 (Bafeng), Ex-UE 9 (Baxie), CV 4 (Guanyuan). Her symptoms improved rapidly after moxibustion treatment. There were neither adverse events nor relapse of the numbness. Moxibustion treatment might reduce symptoms of CIPN.

There is a well-­known “kuketsu : traditional oral instruction for using Kampo formula”, for yokukansan and yokukansankachimpihange (yokukansan group) which mentioned about the importance of existence of “an­ger”. It says that responders to yokukansan group are likely to be irascible. However, no statistically analyzed report about the accuracy of this “kuketsu” is published to date. Therefore, we retrospectively analyzed the charts of patients at one institution who had been treated with yokukansan group by multivariate analysis. We selected amelioration of their chief complaints as dependent variable ; ten items from inquiry as independent variables. The number of patients was 32 (male 12, female 20), mean age was 47.3. “Gender” and “irascible” were statistically significant in logistic regression analysis. The adjusted odds ratio of male versus female was 21.7, while being “irascible” versus not being “irascible” was 8.2. Yokukansan group seemed to be more ef­fective if patients were male or irascible in this study.