We have been utilized acupuncture and moxibustion in our department of internal medicine at Meiji University of Integrative Medicine since its investment in 1987. In the department, various kinds of symptoms in the field of internal medicine have been managed with acupuncture and moxibustion. In this article, I would like to introduce our activities regarding acupuncture treatment in the department of internal medicine and some remarkable results of our clinical studies which evaluated effects of acupuncture and moxibustion as well as relationship between acupuncture therapists and the staff of our department. In the field of respiratory disorders such as COPD or bronchial asthma, usefulness of acupuncture have been proved through a controlled clinical trial which involved COPD patients who had not been able to control with standard care. Also, acupuncture was found to be useful in the management of bronchial asthma in a case series study in which acupuncture treatment was repeatedly applied with intervals without acupuncture. We have also demonstrated that acupuncture was useful for gastrointestinal disorders such as irritable bowel syndrome (IBS). Results of a case series with n-of-1 study design showed significant reduction in the symptoms during acupuncture treatment, while those in the period without acupuncture had been aggravated. Data from studies on diabetic complications such as peripheral neuropathy or gastropathy also showed usefulness of acupuncture. We considered that it is valuable to explore unknown usefulness of acupuncture in the field of internal medicine and prove effectiveness of acupuncture with appropriate scientific manner.

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.

INTRODUCTION:Acupuncture has been reported to be useful for both physical and psychological symptoms. Here we report a case who complained of various physical symptoms due to advanced hepatocellular carcinoma effectively cared for with acupuncture.
Case:A 64-year-old female complained of general fatigue, constipation, and pain in the lower back and leg during her hospitalization for leg edema due to advanced hepatocellular carcinoma. Although the leg edema was improved by the administration of albumin, physical symptoms such as pain in the lower back and leg, constipation, or general fatigue remained.
We applied acupuncture with aiming at relaxing muscles (erector spinae, rectus femoris, right adductor) by a local needling approach, and to improve incomplete defecation by applying moxibustion at the acupoint on the abdomen.
METHOD:Faces Scale was used to evaluate general condition. Evaluation of the pain in the lower back and lower extremities were made with a Numerical Scale where 10 indicates the most painful, while 0 indicates no pain.
RESULT:Both general fatigue and pain in the lower extremities wererelieved after acupuncture treatments (FS for general condition improved from 3to 1, NS for pain decreased from 7 to 4). Also, the feeling of incomplete defecation disappeared.

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.

Chronic obstructive pulmonary disease (COPD) causes severe respiratory dysfunction and severely limits patients' daily activities. We report a case of the patient with COPD whose respiratory symptoms were successfully improved by acupuncture. A 70-year-old man visited Meiji University of Oriental Medicine Hospital complaining of dyspnea during exercise on _??_. Despite strictly controlled medication and a regimen of home oxygen therapy (HOT), his general condition continued to worsen. Then a series of acupuncture treatment was started on _??_. The severity of dyspnea of the patient before acupuncture treatment was determined as level V according to Hugh-Jones classification, and spirometry showed severely disturbed respiratory functions (%VC: 63.5%, FEV₁%: 29.4%, PEFR: 84.8 1/min in the morning and 93.5 1/min at night). The basic combination of meridian points for the treatment of the case was LU1 (Zhongfu), CV12 (Zhongwan), CV4 (Guanyuan), LU5 (Chize), and BL13 (Feishu). The acupuncture needles were retained for ten minutes in each session. The single-subject research design (A-B-A method) was applied to detect the specific effect of the acupuncture treatment on the respiratory functions or the symptoms of the subject. “A” and “B” mean “treatment period” and “no treatment period” respectively. After 60 acupuncture treatments during a 14-month period, both the respiratory symptoms and the VAS for dyspnea showed improvement, which were specifically observed during the intervention period. Improvement was also reflected in the level of the Hugh-Jones classification and respiratory function test. It was suggested that acupuncture treatment might be effective for advanced cases of COPD.

[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.

[Objective]The present study investigated the relationship between subjective symptoms of katakori (shoulder stiffness) and shoulder hardness which was examined both with clinical palpation and a mechanical device, as well as the correlation between these two measurements.
[Methods]Subjects were enrolled to the study if they had a stiff shoulder on the day of the visit (katakori group, n = 60) or if they had no experience of katakori in their lifetime (non-katakori group, n = 10). The intensity of the katakori was evaluated with a visual analogue scale (VAS). Shoulder hardness was evaluated at acupoint Jianjing (GB21) and at the point where the subject felt the most intensive symptom by both palpation of experienced acupuncturists who were unaware of the allocation and a hardness meter. The method of acupuncture treatment was decided by acupuncturists who were not an evaluator of the hardness.
[Results and Discussion]There was no significant relationship in the hardness measured with the device and palpation between the katakori group and non-katakori group. Also, the intensity of katakori (VAS) and the changes after treatment showed no significant correlation with the hardness and its changes. These results support the validity of our clinical experience that patients who complain of severe shoulder stiffness do not always have a hard shoulder.

Pneumonia is one of major causes of cough, which sometimes resists medication and remarkably deteriorates QOL of the patient. We report a case of pneumonia in a person suffering from severe cough and pain in the general body accompanied by cough for which conventional medication did not work but was improved by acupuncture treatment.
A 47-year-old woman was diagnosed by her physician with pneumonia on August 2, 200X. Although antibiotics were administered, her symptoms were not improved. She visited Meiji University of Integrative Medicine Hospital and was hospitalized on the same day. Despite strict medication with antibiotics, antitussive agent and expectorant during hospitalization, her severe cough and body pain remained unchanged.
Acupuncture treatment was then started on August 7. The basic meridian points used were LU1 (Zhongfu), LU5 (Chize), BL13(Feishu), LU7 (Leique), LI4 (Hegu), GB20 (Fengchi), GB14 (Danzhui), ST12 (Quepen), ST11 (Qishe), and CV22 (Tiantu). The acupuncture needles were retained for ten minutes at these points in each session. After ten acupuncture treatments for over seven days, the VAS for body pain accompanied by cough showed a remarkable improvement. Also, significant relief in cough was observed every time immediately after treatment.
We suggested that acupuncture treatment might be useful for cough and/or pain in the body accompanied by cough in a patient with pneumonia.