We used a questionnaire survey to assess the JSAM (the Japan Society of Acupuncture and Moxibustion) members' use of local therapy and distal therapy. We wanted to apply the results of the discussion titled “the definition of local therapy and distal therapy” in the symposium during the 52nd Annual JSAM meeting (2002, Kagawa). Questionnaires were distributed to 500 of the 1250 JSAM members registered in 1991. The subjects who received questionnaires were selected at random. Of the 500 questionnaires sent out 145 replies were received. Each respondent was asked to submit their definition of local and distal therapy.
Also, eight examples of local and distal therapies were given and respondents were asked to reply as to whether they treat with local or distal therapies and the.reasons for these choices.
The results were analyzed by simple and cross tabulation. We were able to define local therapy as 1) insertion to the injured area by acupuncture, 2) treatment on the area traveling along a nerve, and 3) treatment on the area where the patient feels some sensation. And we also defined treatment with a spectrum of tender points as local treatment, according to relationships with nervous reflexes such as an axon reflex, similarly to needling on muscles and along the path of the nerve. The use of distal therapy was usually carried out at points with relationships to fundamental treatment, tender points, meridians, autonomic nervous system and mechanisms through nerve centers. It was found that most practitioners consider distal points that are defined with some theory. Distal points were not selected randomly without the above consideration.

This symposium was held as the second in a three part series at Kagawa Conference (June 6-8, 2003). During the Tsukuba conference (2002), distal area treatment was the topic of focus. The criteria and evidence for the effectiveness of distal area treatments were presented. Three symposists and one minor speaker reported on the effectiveness of distal area treatments from clinical and basic viewpoints. However, another symposist showed the superiority of local area treatments and denied the effectiveness of distal area treatments. There fore, we decided that a succinct and definitive discussion on distal area treatments (etc) should be presented during the second symposium. To this end, long time members of JSAM were given a questionnaire survey prior to the conference. Respondents were asked to define their own use of local and distal treatment, to hypothesize on the curing mechanism involved and to state which practice methods they use most.
Mr. Ogawa reported that, as a result of analyzing the questionnaire survey no distinct differences were found in the definitions stated by respondents from several different schools. The standard images of “the local area” were the area where pains were felt when pressure is applied, the areas which transmit special sensitivity or the area where a disorder is found. Also, the images of “the distal area” were the areas which have some relationship to the local area, such as meridians and collaterals, nerves, reflex points, tender points, or related points which induce a clearly recognizable physical reaction.
Mr.Shinohara showed the superiority of distal area treatments according to the muscle meridian theory by utilizing the 3 arm crossover examination. Furthermore, he established the delayed myalgia as a model of the illness on a specific muscle meridian region. He investigated the effect of intradermal needling. He observed that after a weight bearing exercise on the biceps brachii, the threshold of tenderness on the Lung meridian decreases. He proposed the possibility of using the points in extremities which had selectively responded by manifesting of the delayed myalgia.
Mr. Moriyama, one of the minor speakes, explained, using the theory of biomechanics, the possibility of in-fluences of distal area disharmony on the local area. He introduced the Meridian Test as one clinically useful method for finding disharmony which is typically difficult to discern and may contribute to the disorder. He proposed that a microscopic “eye” to be used to see the local area and the macroscopic “eye” b used to see the whole body in medical examination and treatment. Using the “eyes” in synthesis and not separately, he concluded, must be the basic state for treatment.
Another minor speaker, Mr.Shiraishi reported on analyzed results of the experiments on lumbago patients. Applying Yuandaoci (distant needling) reduced a response on points of the trunk (BL 23, Shenshu, Jinyu) in stimulating points, i.e, BL 40 (Weizhong, Ichu), BL 57 (Chengshan, Shozan) BL 58 (Feiyang, Hiyo) BL 60 (Kunlun, Konron) GB 34 (Yanglingquan, Yoryosen) varying in many ways and confirming the peculiarity of each point, meridian and collateral. Based on these findings he supports the effectiveness of distal meridian area treatments.
Mr. Ozaki, also, another minor speaker proposed, from the outcome of animal experiments. Stimulation by acupuncture at either adjacent or distal areas can affect motor reflex. So from this point of view, insertion at adjacent and distal area has some recordable effect. He added that stimulation given either at adjacent or distal areas would converge to the same neuron and the same modification would occur. From this point of view, the difference in processing information at the neuron level would control the manifestation of the effect and thus investigations on these treatments should be discussed as a synthesis, including, not