In Japan, acupuncturists generally use Oshide (Japanese style handling of the needle) to insert needles. It means that Japanese acupuncturists frequently handle the needle shaft during insertion and treatment (albeit with sterilized fingers). This everyday practice of Oshide used by almost all Japanese Practitioners differs significantly from the global Safety Standards for medical and acupuncture sterilization procedures. Furthers, practitioners in other countries may report such practices of needle handling as malpractice.
The author introduces the history and status of Oshide in Japan and other countries and hopes that Japanese practitioners will discuss it.

The birth of Oriental Medicine, including Acupuncture and Moxibustion, is attributed to Chinese civilization and is thought to have occurred in the Yellow River valley 2000 years ago. The contributing factors establishing Oriental medicine included the development of city-states designed to unite the country under a single authority. The governors of these city-states wisely designed policies to make the health of the people a top priority.
In the middle of the 6th century Acupuncture and Moxibustion spread into Japan. From the enactment of the "Taiho Code"(701 AD) until the promulgation of the "Modern Medical System"(1878) these modalities were recognized as the National Medicine of Japan.
During the Nara and Heian period (8-12 c), Japanese practitioners mainly accepted and learned the Chinese style of acupuncture and moxibustion. After the Kamakura period (13-14 c), during the Muromachi and Azuchi Momoyama periods (15-16 c), and into the Edo period (17-19 c), the original character of Japanese-style acupuncture and moxibustion began to develop unique characteristics.
Here, I have to specifically mention that a Portuguese ship arrived at Tanegashima Island in 1543, after which the cultures of Spain and the Netherlands influenced Japanese culture. Of course these foreign influences spread to the field of Acupuncture and Moxibustion.
During the Edo period, Japan closed its borders to foreign influences. During this time Japan traded only with China, Korea and the Netherlands. These trade routes, the merchandise, and exchange of information did not directly or immediately influence Japan, but they did play an important role in future cultural trends. Especially in the medical field, through trade with China, and Korea, Japan continued to accept information about Oriental Medicine. Likewise, through trade with the Netherlands, Western medical innovation gradually became popular.
In this way, Japan received the latest medical information from the forerunners of the world's medicine of that period. Naturally, the use of both traditional and modern modalities increases. As a result, Japanese Acupuncture and Moxibustion practitioners deepened their knowledge of classic texts, and made good use of the information from China and Korea. Significant innovations of this period include the concept of inserting acupuncture needles through a guide tube, more thorough abdominal diagnoses according to Chinese theories, and increasing acceptance of Western medicine theories. During the Edo period, developments in Japanese Acupuncture and Moxibustion would sustain the progress of these medical fields up to and into the Meiji era.
These developments included changes in the medical system, education, and research of Japanese acupuncture and moxibustion.

Direct moxibustion has been a common used moxibustion method in Japan, has required moxa floss of high-quality, and has promoted the development of a moxa floss manufacturing method unique to Japan. At the same time in China, because indirect moxibustion and the stick moxibustion method has been commonplace, low moxa floss of a purified standard has been produced with a simple manufacturing method. However well-refined moxa has become available in China recently, and it is now more similar to that in Japan.
In this study, we investigated the difference between highly-refined moxa made in Japan and China based on reports from Japanese clinicians on the usability of moxa in firsthand practice. We performed a questionnaire survey with the country of manufacture blinded in 265 moxibustion clinicians. The number of valid responses was 164 (61.9%).
To the question asking what the difference between the two types of moxa was, 54.9% of clinicians responded there was “a little difference,” and more than half responded with “better usability” and “favorability” for the Japanese moxa. Of 119 clinicians who performed moxibustion, 85 (71.4%) selected “comfort” for the Japanese moxa.
We therefore conclude that Japanese clinicians recognize moxa refined with the Japanese manufacturing method as more suitable for direct moxibustion treatment.

[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.

An International Symposium for Developing an Acupuncture Standard of WFAS was held at the WFAS Office Building in Beijing on 18 May 2010. The aim of this meeting was to make the WFAS Industry Standard and to further develop the International Standard of Acupuncture and Moxibustion.
JSAM dispatched two representatives to the meeting as informal observers. The reason why JSAM did not send representatives formally is that there was a serious discrepancy regarding the resolution of the EC meeting between WFAS and JSAM. However, after the several discussions with WFAS, JSAM eventually decided to send informal representatives who have a right to speak. JSAM presented the necessary information about Japanese moxibustion as well as its techniques.

We reviewed case reports of bilateral pneumothorax after acupuncture treatment from the point of view of clinical acupuncture. A paper showing pathological findings based on autopsy suggests that, in more cases than we had expected, acupuncture needles penetrate the lung or the pleura. We speculate a portion of these cases develop into pneumothorax and a few of these become serious. By means of literature search, we have found that 23 cases of bilateral pneumothorax after acupuncture have been published in Japan and other countries. We must learn from these case reports. Further, we should reassess the contents of clinical acupuncture education and introduce the concept of failsafe treatment.

[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.