[Purpose] To evaluate the state of moxibustion therapy education.
[Methods] Investigation with a questionnaire at 66 vocational colleges of acupuncture and moxibustion in Japan based on the list issued by the Foundation for the Training and Licensure Examination in Anma-Massage-Shiatsu, Acupuncture and Moxibustion in April 2004.
[Results] The rate of valid responses was 62.1% (41/66). Basic practical moxibustion skills are taught in the first year of the three year program. For this class, 36.6% (15/66) of colleges gave students two credits. Most colleges devote more class time to direct moxibustion compared to indirect moxibustion. Students must learn to prepare a small, perfect shape, smaller than a grain of rice. The direct moxa cones are typically burned only 70∼80% to reduce the chance of burns.
More than 80% of colleges responded that moxibustion therapy was very available. The biggest problem is afflicting burns. Although more than 90% of colleges teach direct moxibustion with one's fellow students, the problem of burns remains. Colleges in eastern Japan tend to teach lower temperature moxa stimulation than western ones.
[Conclusion] The state of Japanese moxibustion education in vocational colleges of acupuncture and moxibustion is clear. In the future it is important that we consider new methods of moxibustion therapy based on safety and patient comfort, while maintaining traditional Japanese methods. Further it is necessary to investigate the state of Japanese moxibustion therapy at the clinical bed side.

We report on a case of acute, sport-related back pain treated with pressing moxibustion and acupuncture therapy. A 15-year-old high school freshman fell on his back while shooting a basketball during a game. He felt acute back pain on the second day following his injury. We suspected a fracture and advised him to visit an orthopaedic surgeon, where he was diagnosed with a contusion. Upon return to us, we began acupuncture therapy of his inferior limb acupoints and pressing moxibustion of his contused muscle, while evaluating his pain using a numerical rating scale. He experienced pain relief after the second pressing moxibustion treatment. His numerical pain score changed for the better, and his treatment was ended after the third visit. In cases of pressing moxibustion, moxa sticks are directly pressed onto acupoints protected with non-flammable cloth. In Japan, however, the term moxibustion therapy generally indicates direct moxibustion. Therefore Japanese moxibustion therapists rarely choose the pressing moxibustion therapy option. This case suggests that pressing moxibustion for acute contused wounds or lower back pain is also effective.
Acute ; Back Pain ; Therapeutic procedure ; Pain ; therapeutic aspects

We treated a 38-year-old woman with Traumatic Cervical Syndrome (TCS) due to a traffic accident, with orthopaedic therapy plus acupuncture. She was driving a light vehicle and was rear-ended. She reported finger numbness, and shoulder and back pain on the day following the accident. We treated her with acupoints of the superior and inferior limb and evaluated her pain using a Numerical Rating Scale (NRS). She felt an immediate effect after the treatment, and NRS changed for the better following her progress. Her most severe symptoms gradually improved with a course of 49 treatments over 7 months. These results suggest the effects of acupuncture appear useful in TCS. Patients with intractable TCS are troubled by long-term treatments. Therefore it is necessary to establish more evidence for acupuncture therapy in TCS cases.
Therapeutic procedure ; symptoms <1> ; Traumatic ; Cervical ; Syndrome

[objective] Using a questionnaire survey, we investigated the state of clinical training for Anma-Massage-Shiatsu, Acupuncture and Moxibustion at Japanese acupuncture school training centers (included were schools for the blind and colleges for the non visually impaired)
[DesignandMethods] We sent a 5 point questionnaire consisting of 49 questions concerning the state of clinicaltraining to 121 acupuncture schools in Japan. All these schools are listed in the 2002' List of Colleges published by the Foundation for Training and Licensure Examination in Anma-Massage-Shiatsu, Acupuncture and Moxibustion.
[Results] The response rate was 82.6% (100/121). Ninety-two schools have Acupuncture clinics open to the publicand 7 schools have Western Medical Clinics. Twenty-four percent of the schools in the survey have not registered their acupuncture clinics with the Governor of the Prefecture. Of the schools that responded 93.1% used disposable acupuncture needles, although 85.2% of the schools did not use needles only once, as recommended. While 49.4% (42/85) of the schools reported some adverse events at their clinics, 49.0% of the schools hold a liability insurance. Many acupuncture clinics at schools for the blind were established before the 1930's. During their clinical training, students at these schools are responsible for the majority (93.8%) of the patients' treatments. Clinical fees at these acupuncture clinics were under 525 yen. On the other hand, most of these clinics at acupuncture colleges for the non visually impaired were established in the 1990's after an amendment in the Law. Therapists at these colleges are largely responsible (82.1 %) for clinical treatments during the students' clinical training. Fees at these clinics were between 1576 yen and 2100 yen.
[Conclusion] The state of clinical training for Japanese Anma-Massage-Shiatsu, Acupuncture and Moxibustion education was only elucidated to a small extent. Clinics must improve safety precautions and reassess risk management strategies. Another survey is necessary to define global standards of clinical acupuncture and moxibustion styles. In order to suggest standard policies for clinical management further study is necessary.

[Objective] We analyzed the transition and state of Japanese 141 colleges, schools and training centers for anma-massage-shiatsu, acupuncture and moxibustion therapists in 2004.
[Methods] We collected a basic data from Japanese 141 colleges, schools and training centers and several sources : a list published by the foundation for the Training and Licensure Examination in Anma-Massage-Shiatsu, Acupuncture and Moxibustion, an investigation of the state of Japanese schools for the visually impaired students, the 10th Anniversary report of Oriental Medicine Colleges Association and school guides of each school. We considered and analysed this basic data.
[Result] Data was collected from 141 different sources : 5 universities and colleges, 61 schools for the visually impaired students, 66 vocational colleges and 9 training centers for the visually impaired students. Most of the schools and training centers for the visually impaired students are public. All colleges for the non-visually impaired students are private. We analysed and verified 3 periods in the history of these institutions of 141 colleges, schools and a training centers. The 1 st period concerns the establishment of schools for the visually impaired students the early 1900's. The 2nd period is concerns the establishment of older vocational colleges after World War II in the 50's. And the 3 rd period is a sudden increase of new vocational colleges following the 1998 Fukuoka district court judgement.
[Conclusion] We analyzed the changes and the situations regarding 141 Japanese colleges, schools and training centers for anma-massage-shiatsu, acupuncture, moxibustion therapists from their foundation to the present. The rapid increase of vocational colleges for acupuncture and moxibustion represents a phenomenon we have never experienced. With this condition, acupuncture and moxibustion markets must expand. In the future Japanese anma-massage-shiatsu, acupuncture and moxibustion education should be researched and hopefully we will benefit from this new situation.

Background: In terminally ill patients with cancer, sleep disturbance makes worse their quality of life. Midazolam has not ever been used for the treatment of sleep disturbance in general wards of our hospital, used in palliative care unit of other hospital, however. Method: This is a retrospective study based on chart review. Twenty-eight patients who were treated with midazolam for sleep disturbance included in this study. We designed evaluation methods to strictly follow the actual chart descriptions. Efficacy was rated as good, fair, or poor. Safety was defined by the presence or absence of respiratory depression and hypotension. Results: The median administration periods and initial doses were 6 days (range, 1-151) and 5.0 mg/night (1.8-20.0), respectively. Fourteen patients showed good sleep a night after midazolam infusion, four and nine patients showed fair and poor sleep, respectively. No patient demonstrated a respiratory rate of less than 8/min and systolic blood pressure of <60 mmHg at any point during and after midazolam infusion. Conclusion: Intravenous midazolam appeared to be safe for sleep disturbance of terminally ill patients with cancer in general wards. A future improvement administration methods are necessary to treat for sleep disturbance more effectively as well as PCU.

Continued from the previous year's theme of our workshop, we collected various information and ideas for safer acupuncture practice. Subjects and presentations of the present workshop were as follows:
1. Literature review of papers on adverse events published between 2003and 2006
1) Papers in domestic journals (by Ishizaki and Egawa)
2) Papers in foreign journals (by Yamashita and Umeda)
2. Debate on wearing sterilized fingerstall or glove
1) Present status of the use of fingerstall in acupuncture practice (by Katai and Minowa)
2) Practical side of clinical education of acupuncture using fingerstall (by Hatakeyama and Furuya)
3) Problem of using individual fingerstalls in acupuncture practice (by Handa and Miyamoto)
We will continue to provide information and discuss solutions in order to reach a common understanding and specific methods for safer acupuncture practice.