[Objective]We report on a hemophilia A patient who was treated at the department of internal medicine of our hospital receiving acupuncture treatment at an acupuncture treatment clinic. It began with iliopsoas muscle hematoma, and remarkably hindered daily life with severe pain.
[Case]The case was a male hemophilia A patient in his twenties. He continuously took clotting factor replacement therapy by self-injection. He received acupuncture treatment in the lower back, and increasingly came to have more pain in the lower back and extremities. He was admitted to our hospital with a fusiform blood tumor in the iliopsoas muscle with MRI.
[Conclusion]In a congenital bleeding disease, it is necessary to check the condition and the severity of symptoms by collecting information through medical examination by interview, visual examination, examination by touch, and manual muscle testing for acupuncture treatment.

One of the complications in patients on long-term hemodialysis is spondyloarthropathy resulting from amyloidosis due to abnormal accumulation of β2-microglobulin. With deposition of β2-microglobulin in soft tissues, such as ligaments and joints, destruction of bones and cartilages begins at the site of ligament attachment and proceeds with the accompanying inflammatory reaction, fibrosis and ligament thickening. The soft tissue proliferative lesion and destruction of bones and cartilages produce spinal canal stenosis and, ultimately, compression of the spinal cord and cauda equina, to give rise to various clinical symptoms.
We tried acupuncture treatment on two patients with lumbar spinal canal stenosis due to hemodialysis-related spondyloarthropathy who presented with neurogenic intermittent claudication, and evaluated its effects. Acupuncture treatment involved placement of acupuncture needles chiefly in the stenotic region, once weekly, for about three months. Marked improvement was obtained regarding claudication distance and JOA score in patient number one, who had radicular type intermittent claudication. Slight improvement of claudication distance and improvement of JOA score (particularly relief of pain) were obtained in patient number two, who had mixed type intermittent claudication. These results suggest that acupuncture treatment might be effective for dialysis patients with lumbar spinal canal stenosis associated with hemodialysis-induced spondyloarthropathy.

This paper introduces the 2023 guidelines for the treatment of facial nerve palsy, which have been revised for the first time in 12 years, mainly related to acupuncture. The purpose of this study is to assist medical professionals in selecting appropriate evaluation and treatment for paralyzed patients. In this revision, the two clinical questions on acupuncture and moxibustion are recommended: (1) Is acupuncture effective for early recovery from paralysis (acute phase)? Both have been reorganized from "not recommended" to "weakly recommended". Regarding these results, several systematic reviews have been published in which acupuncture intervention can be expected to be more effective than conventional treatment (control) in recovering from paralysis in the acute phase and reducing sequelae such as contracture and stiffness in the chronic phase. Among them, it is suggested that prevention and reduction of aftereffects in particular contribute to the improvement of quality of life. Acupuncture and moxibustion treatment and guidance on self-care are also considered to be the role of the acupuncturist.

We executed an acupuncture therapy to 62 lumbar spinal canal stenosis cases who were diagnosed by CT, MRI photo state and clinical symptom and examined the result.
The 36 men and 26 women in this study had a mean age of 67.3 years.
An acupuncture was executed by aiming to give an effect to the soft tissues and a blood circulation around the area where the stenosis was recognized then pierced facet joint closely and deeply and gave an electric acupuncture stimulus.
14 cases were very good and 17 cases had good results according to the JOA score. No cases worsened.
We concluded an acupuncture treatment was effective for treating lumbar spinal canal stenosis.

The effect of acupuncture treatment on ending peripheral facial nerve paralysis was examined using standard set by the Japan Society of Facial Nerve Treatment. A comparison was made of how recovery was affected by acupuncture treatment alone, drug treatment alone, and a combination of drugs (steroids) and acupuncture.
As a result we found that 1) in groups having an ENoG of 41% or more, the acupuncture-only group showed less recovery than did the group that received oral steroids. 2) Among the groups having an ENoG of 21% or more, there was no significant difference between the group given oral steroids and the group given both steroids and acupuncture treatment. 3) For groups having an ENoG of 1%-20%, there was no difference in recovery between the group given large doses of injected steroids and the group given large doses of injected steroids concommitant with acupuncture. But the group that was given both oral steroids and acupuncture did not recover as well as the other groups. 4) A comparison of the groups receiving only medication and receiving medication with acupuncture showed there was no special hastening of recovery seen with the administration of acupuncture; in fact, the acupuncture may have even delayed recovery.
The above results indicate that the administration of steroids is more important than the use acupuncture in the treatment of peripheral facial nerve paralysis, and that a suitable treatment should commence within 7 days after the occurrence of symptoms.

[Introduction] We evaluated the efficacy of treatment and clinical characteristics of a patient with incomplete rotator cuff tear with a clinical presentation similar to that of frozen shoulder. It seems difficult to differentiate incomplete rotator cuff tear from frozen shoulder on physical findings alone since the former lacks the specific characteristics of rotator cuff tear. However, many patients with incomplete rotator cuff tears show a poor response to treatment due to mechanical disorders; thus, differentiation of incomplete rotator cuff tear from frozen shoulder may be demonstrated during the patient's clinical course.
[Patient] In this patient, the joint range of motion improved in all directions, and the pain score also improved from 10 to 5, showing reduction of pain. However, the symptoms did not resolve smoothly; frequent remis-sions and exacerbations of symptoms were observed.
[Discussion] We frequently encounter disorders diagnosed as periarthritis scapulohumeralis in daily clinical practice, and patients with such disorders usually respond well to treatment. However, we should realize that a variety of clinical conditions are involved in the disorders, and the clinical courses of patients should be followed closely during treatment.

We examined the effects of acupuncture therapy on 41 patients with various levels of periarthritis scapulohumeralis. These patients were classified into two groups: one consisting of 20 patients having no contracture, those of freezing type (age 61.0±9.0; suffering period 3.0±5.1 months) and the other consisting of 21 patients having contracture, those of frozen type (age 53.8±7.3; suffering period 5.8±7.8 months).
As a result, we found that acupuncture therapy relieved pain more effectively in patients having no spontaneous pain than in those having spontaneous pain regardless of the presence or absence of contracture. We next investigated the effects of this therapy by the patient types. In the group of 20 freezing-type patients, which includes only six patients having spontaneous pain, pain relief was relatively easily obtained as indicated by the pain score after the therapy of 3.6±1.8. In the group of 21 frozen-type patients, which includes 13 patients having spontaneous pain, however, it was difficult to obtain sufficient pain relief as indicated by the pain score of 5.7±2.8. There was a statistically significant difference (P<0.002) between these scores. This shows that acupuncture therapy is more effective on freezing-type patients than on frozen-type patients.
Therapy also improved the range of motion. In many freezing-type patients, the range of motion was expanded due to pain relief. The abduction ROM expanded from 151.8±39.0° before therapy to 163.8±25.0° after acupuncture therapy. In frozen-type patients, however, the range of motion did not expanded significantly (87.6±24.1° before to 94.8±21.1° after therapy). The above results suggest that acupuncture therapy is effective for relieving the pain of periarthritis scapulohumeralis and that this therapy is particularly effective when applied to those patients having no spontaneous pain before they enter into the frozen phase.

The skin has a special significance in acupuncture. In acupuncture, the skin is both a site of both examination and treatment while providing an interface for information exchange with the external world. Various findings that appear on the body surface should not simply be understood as dermatologic findings, but considered as a reflection of the internal condition of the body, the external world and the mental condition. From this perspective, although acupuncture treatment use only simple stimuli, such as needles, and stimulate only specific sites on the body surface, they can produce therapeutic effects and regulate physical and mental functions
In this symposium, we reviewed the relationship between skin and acupuncture by examining acupuncture and moxibustion treatments for specific dermatologic diseases and their clinical effects. As a result, we were able to reaffirm the above relationship from the perspective of an acupuncturist.
The methods and clinical effects of acupuncture and moxibustion treatment were introduced for atopic dermatitis (by Egawa), tinea unguium (by Dr. Menjou), and the dermatologic symptoms of connective tissue diseases (by Dr. Kasuya). Moreover, Dr. Kagawa presented his research results related to the effects of acupunctural stimulation on the condition of the skin. Based on these research results, the possible effects of acupuncture treatment were discussed based on extensive application in fields such as dermatology, cosmetics, and anti-ageing. Regarding the significance of the skin (body surface) within the practice of acupuncture, it was reconfirmed that the skin reflects the condition of the organs and the mind, and examination of the skin may elucidate both mental and physical health. In addition, we also discussed the body surface as a site of both examination and treatment, and investigated the efficacy, potential for further development, and significance of acupuncture, which connect the skin with systemic functions.

The goal of this panel discussion
The understanding of lumbago has been changing in recent years.
It has moved from "Trouble of the spine"to recognizing the importance of catching the concept of "Living thing, psychology, and social pain syndrome".
It is a way of thinking that is going to grasp the clinical condition of lumbago along with the invisible dysfunction and provide better viewpoint in order to understand the aberration which we call a disorder of conventional intervertebral disc clinical condition of lumbago.
This view point supports the appropriate technical use of acupuncture and moxibustion.
It is important for the medical man not to begin treatment until the complete condition is understood.
In keeping with this viewpoint, the panel of four will be joined by an orthopedist and a physical therapist, and this panel discussion 1 planned "primary care for lumbago".
Each panelist described how to catch condition of a patient, a way of the correspondence, the advantages and disadvantages of acupuncture and moxibustion, therapeutic method and evaluation method in this method of treating lumbago.