The concept of "patient's satisfaction"has become increasingly important among healthcare providers during the past decade. Acupuncture and moxibustion therapists have relatively longer contact time with patients, and a certain proportion of users of these remedies seek care for conditions that had not been satisfactorily managed with conventional care. Also, the comfortable process of the treatment is one of its beneficial characteristics. However, the characteristics and opinions of the users of acupuncture and moxibustion in Japan have long remained unclear. We have conducted a series of nation-wide surveys between 2003-2007 with grants from the Foundation for Training and Licensure Examination in Anma-Massage-Acupressure, Acupuncture and Moxibustion. The questions in these surveys included utilization rates, patient satisfaction, reasons for discontinuation, opinions on costs, and so on. The results of these surveys are provided along with some discussion in this article.

As a preparatory study for treating diabetic neuropathy by acupuncture, we investigated the effect of electroacupuncture on the sciatic blood flow in rats. Nerve blood flow was measured with a laser doppler flowmeter. Different treatments were applied to three groups of rats as follows:
1) those stimulated with low-frequency (1Hz, 5Hz) electroacupuncture,
2) those stimulated with high-frequency (20Hz, 100Hz) electroacupuncture and
3) those stimulated by pinching in the tails.
In the electroacupuncture groups, stimulation was applied to the plantae. While little change was observed in the rats stimulated with low-frequency electroacupuncture, temporary increases in both blood flow and blood pressure were observed in the rats stimulated with high-frequency electroacupuncture and in the rats subjected to pinch stimulation.
These reactions were all inhibited by the administration of phentolamine (α receptor blocker).
These results suggest that the increase in sciatic blood flow induced by high-frequency electroacupuncture and pinch simulation are dependent on the blood pressure.

Background
Although there are several reports that electroacupuncture (EA) in the abdomen reduces fasting blood glucose and improves insulin sensitivity, the effects under a glucose load or hyperinsulinemic conditions have not yet been studied. In this study, we investigated the effect of EA at Zhongwan (CV12) under the conditions of an intravenous glucose tolerance test (IVGTT) and a hyperinsulinemic euglycemic clamp in normal Sprague-Dawlay (SD) rats.
Methods
Male SD rats were anesthetized with pentobarbital (40mg/kg i. p.) and then maintained by continuous infusion through a tail vein. Blood samples were drawn from the ventral tail artery during the fasting stage (baseline and 30min after), and at 2, 5, 10, 20, 30, 45, 60min after a glucose load (0.5g/kg). EA was performed for 30min (EA30, n=8) during the fasting stage and for 90min (EA90, n=8) during both the fasting and IVGTT periods. In the hyperinsulinemic euglycemic clamp experiments, insulin (2mU/kg/min) was infused through the tail vein, followed by infusion of 20% glucose at variable rates to maintain fasting blood glucose levels. EA was performed for 40min after a steady-state was achieved.
Results
Significant decreases in fasting blood glucose and increase in plasma insulin concentration were observed during the fasting period in rats in both the EA30 and EA90 groups, whereas rats in the control group (n=8) which did not receive any EA stimulation showed no such changes. Total glucose levels during the IVGTT were lower in the EA30 and EA90 groups compared to controls, with a significantly higher level of relative insulin secretion. During the hyperinsulinemic euglycemic clamp, glucose consumption was increased significantly by EA stimulation with a marked increase in both insulin concentration and sensitivity.
Conclusion
EA at CV12 accelerates glucose consumption during IVGTT and hyperinsulinemic conditions probably as a consequence of increased insulin sensitivity and/or increased plasma insulin concentration.

To investigate the effect of electro-acupuncture stimulation (EAS) on insulin sensitivity in rats, we performed several stimulations on Otsuka Long Evans Tokushima Fatty (OLETF) rats, during euglycemic clamp. We divided OLETF rats into five groups according to the kind of the stimulation: EAS at vagal innervated region of the auricle (AVA), EAS at non-vagal innervated region of the auricle (ANVA), EAS on the back of the body (AB), pinching on the back of the body (PB), and no stimulation on the body (NS). These procedures were also applied on Long Evans Tokushima Otsuka (LETO) rats as a control study.
Furthermore, we performed long-term stimulation (from six to 24 weeks of age) on OLETF rats to assess the preventive effect of those stimulations on the formation of the insulin resistance. EAS of pulse duration 300ms, 1.5V, 1Hz was applied for 10 or 15minutes. As a result, the glucose infusion rate (GIR) showed significantly higher levels during stimulation of PB group in LETO rats. On the other hand, the GIR of AVA group in LETO rats and PB group in OLETF rats were decreased by stimulation. The GIR in AVA group and AB group after long-term stimulation were significantly higher than those of NS group in OLETF rats. These results suggested that EAS at the auricle and the back is useful for the prevention of the formation of insulin resistance when it's applied before onset of the symptoms in OLETF rats.

Recently, the importance of patient satisfaction emerged in the context of providing high-quality health care. However, the level of patient satisfaction with acupuncture treatment and the factors that influence satisfaction have not been investigated. We conducted a cross-sectional survey on the satisfaction of patients who consult acupuncture clinics and investigated factors that have a certain influence on the level of satisfaction using multivariate analysis.
Subjects in the present study consisted of 2210 patients who consulted acupuncture clinics that were randomly selected from the alumni association of Meiji University of Oriental Medicine. The survey was conducted between July 10 through July 23, 2000 using our original questionnaire which consists of questions about health state and basic information about the patient, environment of the clinic, assessment of the practitioner by the patient and overall patient satisfaction with the clinic. Sampling of the subject was made using stratified random sampling method and the questionnaires were returned directly from the patient by mail.
Of 2210 patients given the questionnaire, 1, 319 (59.7%) responded. Mean (SD) level of the total satisfaction with the clinic evaluated using 100 mm visual analogue scale (VAS) was 81.4 (13.8). Simple linear regression analysis showed that the degree of explanation given by the practitioner was significantly related to patient satisfaction, while multiple regression analysis showed that the effect of treatment, treatment skill of the practitioner, patient's reliance on the practitioner, clean environment of the consultation room, depth of the practitioner's understanding of the patient and willingness of the practitioner to answer questions were factors significantly related with the patient's satisfaction.
In the present study, there was high overall satisfaction among patients consulting acupuncture clinics and the factors influencing satisfaction could be classified into three kinds : factors relating to the quality of treatment, communication factors between the patient and practitioner, and environmental factors related to the clinic.

[Objective] It is necessary to administer anti-cholinergic agents or glucagon during gastroscopy for inhibition of gastric peristalsis. However, application of these drugs are limited in patients with glaucoma, hypertension, benign prostate hyperplasia, heart disease, or diabetes mellitus because of possible adverse events.
Based on the report that acupuncture stimulation at CV 12 (Zhonguan, Chukan) inhibited gastric activity, we studied whether the acupuncture at CV 12 could be applicable as an alternative to these drugs.
[Method] Subjects in the present study were 60 patients who underwent gastroscopy at Meiji University of Oriental Medicine Hospital. They were allocated into two groups; acupuncture group (mean [SD] age, 66 [10]) and drug group (mean [SD] age, 64 [13])
Patients in the acupuncture group were given manual stimulation at CV 12 with an acupuncture needle for 10 minutes before examination and during gastroscopy.
After examination, a gastroscopist evaluated the magnitude of the peristalsis and disturbance during the examination using the visual analogue scale (VAS) and a 4-grade categorical scale.
Patients in the drug group were pre-administered anti-cholinergic drug or glucagon, and evaluated with the same scale.
[Results and Discussion] Inhibition score in the acupuncture group was lower but not statistically significant, as compared with the drug group, and the effect of acupuncture stimulation was acceptable to allow examination of the patients without severe disturbance.
Acupuncture may be a useful non-pharmacologic alternative to anti-cholinergic drugs and glucagon to inhibit gastric movement during gastroscopy, when these drugs could not be administered.

[Background/aim] Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders, affecting more than 15 % of Western populations. It is characterized by a wide variety of persistent symptoms (abdominal pain or discomfort, bloating, transit disorders) without any clear organic causes. Because medical treatments are sometimes ineffective, some patients with IBS seek alternative therapies to manage the condition. The aim of the present study was to investigate the clinical effect of acupuncture treatment in patients with IBS.
[Method] Four patients with IBS were treated with acupuncture according to the way of Traditional Chinese Medicine. We employed reversal single-case study design in which an acupuncture treatment period (“period B”) was alternated with no treatment period (“period A”). Ten or twenty times acupuncture therapies were performed during the “period B” and the length of the “period A” was comparable with the “period B” GSRS, frequency of defecation, softness of the stool, intensity of abdominal pain or abdominal fullness, and POMS were recorded over the periods.
[Results] During the “period B”, three patients showed a remarkable improvement in lower abdominal pain, abdominal fullness and QOL evaluated with GSRS, while the psychological condition evaluated with POMS showed inconsistent changes without a remarkable improvement.
[Conclusion] The result of our study indicated that acupuncture might be useful for the management of IBS.

[Background] Elderly people often have disturbances of bowel habits, including irritable bowel syndrome (IBS). IBS is one of the most common gastrointestinal disorders, affecting more than 15% of the general population. It is characterized by a wide variety of persistent symptoms (abdominal pain or discomfort, bloating, transit disorders) without any clear organic causes. Because medical treatments are sometimes ineffective, some patients with IBS seek alternative therapies to manage the condition. There is very little research examining IBS in the elderly. We report two elderly patients with IBS successfully treated with acupuncture.
[Cases and Methods] A 72-year-old woman and an 88-year-old man with IBS were treated with acupuncture according to theory of traditional Chinese medicine. Gastrointestinal Symptoms Rating Scale (GSRS), frequency of defecation, softness of the stool, intensity of abdominal pain or abdominal fullness were recorded over the periods.
During the treatment period, both patients showed a remarkable improvement in lower abdominal pain, bloating and quality of life evaluated with GSRS.
[Result and Discussion] In both cases, acupuncture treatment was effective for alleviating abdominal symptoms with IBS. The result of these cases indicated that acupuncture might be useful for the management of the condition with elderly IBS.