[Objective]Asperger's disorder, one of autism, is characterized by a limited radius of interest and activities and also difficulty in mutual social relationships. We treated a girl who developed school refusal due to general fatigue by directing our attention to the background of forming a symbiotic relationship with her mother, who had symptoms of depression. The symptoms of the both patients were improved by acupuncture treatment.
[Case]A 12-year-old girl complained of general fatigue. Since May X (year), the patient had complained of general fatigue and had started refusing to attend school. In August, she consulted the psychiatry department and was diagnosed with Asperger's disorder. While receiving educational counseling by the city, she started undergoing acupuncture treatment from May X+1 (year). Prior to that treatment, her mother, who had complaints of joint pain due to pustulosis palmaris and depression, had started acupuncture treatment in September X (year). We applied acupuncture treatment once in 1-2 weeks with the aim of tonifying the heart and spleen, and unblocking yang, the governor vessel. We conducted fact-finding on the spot in minute detail for both patients. We asked them to use a categorical scale and provide scores for symptoms, particularly body (general) fatigue, feeling of sound sleep, glow of hands and feet, headache and dejection.
[Result]We performed acupuncture treatment 28 times over 11 months and symptoms were a 30-50%improvement. The girl became able to go to classes for school-refusing children, which is managed autonomously, and also attended school events. Her mother's symptoms also scored similarly and stabilized.
[Conclusion]The symptoms of the patient were related to the condition of her mother and also physical and mental imbalances due to adolescence. We concluded that acupuncture treatment for both the mother and girl improved the symbiotic relationship between mother and child, providing success in both acupuncture effects and countenancing acceptance.

Background: High-altitude headache (HAH) is defined by the International Headache Society (IHS) as the headache that occurs within 24 hours after ascending to 2,500 m or above and subsides within 8 hours after descending. The Japanese and Chinese women climbers performed a joint expedition on Mt Qomolangma (Everest 8844m) in 2005. During the expedition, we investigated whether there was a difference in clinical manifestations of HAH between the native inhabitants of highland (Lhasa) and those of lower heights. Method: The expedition team consisted of 39 members (26 males and 13 females), in which 26 individuals were Lhasa inhabitants and 13 individuals lived at lower altitude. Vasodilative reaction was assessed by digital volume plethysmography at Lhasa (3,780m), Base Camp (BC, 5,200m) and Attack Base Camp (ABC, 6,500m). Results: Development of headache was associated with younger age, gender (female) and a history of HAH. As for lower inhabitants, 15.3% experienced headache at Lhasa (3,780m), and the incidence of headache increased up to 46.2% at BC and 61.5% at ABC. In contrast, none of the Lhasa inhabitants developed headache at Lhasa, and only 7.7% presented with headache at BC. However, the incidence of headache increased to 65.4% at ABC, which was as high as that observed in inhabitants of lower heights. We have previously demonstrated that vasodilative reaction at high altitude is primarily mediated through hypoxia, since vasodilation was completely abrogated by administration of oxygen. During the current expedition, vasodilative reaction was also observed in Lhasa inhabitants as they climbed to higher altitude. Conclusion: Exposure to more pronounced hypoxic/hypobaric conditions was associated with vasodilation of peripheral vascular system and with the development of headache even in individuals of high-land inhabitants. Therefore, it is considered that high-altitude headache is also common in high-altutde inhabitants.

We evaluated the efficacy, usefulness and safety of acupuncture and moxibustion treatment in rheumatoid arthritis, by the randomized, parallel-group, multi-center study with the drug-treated outpatient group as the control. The endpoints, important in the clinical assessment of acupuncture treatment, included the improvement criteria in ACR core set variables and the Japanese version of the Arthritis Impact Measurement Scales Version 2 (AIMS-2), a system of evaluation of the QOL of patients with RA.
Regarding intervention (therapy), a therapy chart for each stage of disease was drawn up to give local and systemic treatment in consideration of the patient's activity and disability in each stage of rheumatoid arthritis, so that generally consistent therapy adapted to the patient's condition would be provided. Result 1. Patients eligible for analysis were 80 patients of A-group (drug therapy group) (80 females, 2 males, 2dropped) and 90 patients of B-group (drug plus acupuncture and moxibustion group), total 170 patients. 2. Patients who satisfied the improvement criteria in ACR core set variables (improved patients) were 8 of 80 patients in A-group and 20 of 90 patients in B-group. The improvement rate was significantly higher for B-group treated by drug plus acupuncture and moxibustion versus A-group, with P=0.04 in 2×2 table chi square test. 3. In QOL change investigated by AIMS-2 questionnaire, the improvement occurred significantly more frequently in the drug plus acupuncture and moxibustion group, with difference between groups at 12 months after the initiation of clinical study at P=0.001. 4. Changes in the subjects included in AIMS-2 questionnaire: Improvement was significantly more frequent in the drug plus acupuncture and moxibustion group versus drug therapy group in respect to the ability to walk, finger function, housework, sociableness, pain, mood, and the degree of subjective improvement. In the present randomized, parallel-group, multicenter study, a significant improvement was detected in the drug plus acupuncture and moxibustion group versus the drug therapy group in the aforesaid respect, which suggested that the use of acupuncture and moxibustion combined with the conventional therapy would prevent deterioration of physical functions, improve blood circulation, stabilize mental status, and thereby contribute to the improvement of QOL in patients with rheumatoid arthritis.

Background/Purpose: Previous studies have suggested that environmental factors, such as weather, atmospheric temperature, humidity and seasonal change, may affect the disease activity of rheumatoid arthritis (RA). In the present study, we aimed to determine whether RA disease activity, including patient’s global assessment (PtGA), is influenced by seasonal variation, using a nationwide Japanese cohort database, NinJa (National Database of Rheumatic Diseases by iR-net in Japan). Methods: RA patients, who were registered in NinJa, are evaluated at any point during the indicated year. We analyzed data from RA patients (n=8,726), whose PtGA, pain visual analog scale (VAS) and physician’s global assessment (PhGA) data were available in NinJa 2012. In the present study, spring was defined as from March to May, summer as from June to November, Fall as from September to November and winter as from December to February. Age, sex, disease duration, number of tender joints, swollen joints, pain VAS, PtGA, PhGA, ESR, CRP, stage, class and mHAQ were also included as explanatory variables. Results: Univariable analysis using NinJa 2012 database revealed that PtGA, pain VAS and disease activity score (DAS)-28 were lowest during the fall months with statistical significance, which was reproducible in NinJa 2011 database analysis. On the other hand, multivariate analysis revealed that pain VAS, mHAQ and the number of swollen joints were the main determinants of PtGA, and seasonal variation was not identified as a statistically significant factor. Conclusion: We have clearly demonstrated that PtGA was lowest in fall. Seasonal changes can thus affect RA, although to a lesser degree than pain and activity of daily living, which should be taken into account when examining RA patients to better understand their symptoms.