In the present paper, the author reviews acupuncture clinical practice and the research scene in Western countries, and discusses problems in Japanese acupuncture.
The use of acupuncture is increasing in the West, but many more people have received this treatment in Japan. Although regulations on acupuncture depend on the country, many EU countries limit acupuncture practice to medical doctors. Regarding the style and theory of acupuncture, Traditional Chinese Medicine is overwhelmingly dominant in the world.
In recent years, the worldwide prevalence of the concept of evidence-based medicine (EBM) has facilitated randomized controlled trials on acupuncture in the West. However, there is a bigproblem in setting a sham acupuncture group. Pragmatic clinical trials should be considered more in the future.
If the researchers of “Japanese acupuncture” pursue only reductionistic research methodology, they might lose something important that traditional medicine has brought for many years. Although we should employ the concept of EBM, we, at the same time, should discuss what Japanese acupuncture is and how we evaluate the aspect of the “art” of acupuncture medicine more intensely.

In the previous report of case studies, it was concluded that traditional techniques of oriental medicine could be utilized toward promotion of the level of health.
Among many sorts of traditional techniques of oriental medicine, moxibustion is thought to be one of the most practical methods of self-care. In this report, we wish to mention some of the roles and problems of the care system of oriental medicine utilizing moxibustion for patients with chronic health problems in present-day medicine.
The clinical records of the patients which consist of 149 males and 246 females over 40 years old were investigated. Of these patients, during the first course (for about 40 to 90 days), 67% (263) had been under both of our care and other hospitals' treatment, and 81% (321) had practiced moxibustion in the limbs or the back at home at least 3 times a week and 56% (139) of female patients had practiced in the back.
The patient of the demonstrated case, who was a 72 year old female, complained of a decrease in left vision, asthenopia, tinnitus and other chronic health problems involved in several life events. After she pacticed moxibustion with us, she was finally relieved of her health problems. We believe that she consistently accepted the oculist's treatment and our care, because the oculist treated her from a viewpoint of specialty while we cared for her holisticly.
From the above results and case, the following can be concluded;
1. The care system of oriental medicine utilizing moxibustion can play a complemental role in present-day medicine from a holistic, inclusive point of view.
2. As a social factor which interfares with practical uses of moxibustion, there is a difficulty in securing manpower that practices moxibustion in the back, particularly for middle or advanced aged females.

We have been promoting moxibustion practice as a means of self-care, because it is thought to be useful from the viewpoint of life as well as body.
We guided 49 rural inhabitants in moxibustion at home and investigated their practical situation for a year in order to clarify problems in promoting “moxibustion as a means of self-care”.
From the above investigation, the following were clarified.
1. Insufficient manpower for family care
2. Time restriction due to cauterizaion
3. Intolerance of moxa heat
4. Dermal disorders from moxibustion scar
5. The limits of moxibustion
6. Social restraint against moxibustion
These problems are thought to have solutions and some of them are being experimented on in our institute now.

With the purpose of clarifying the influence of density and height of moxa cones on the quantity and quality of direct moxibustion stimulation, temperature changes at the bottom of moxa cones the size of a “rice grain” were measured with a thermocouple on an asbestos board.
As a result, the mean peak temperature of each density group (height of 5mm, bottom diameter of 3mm) was between 140°C and 160°C. There was a significant linear regression between density (mg/11.8mm³) and heating temperature duration above 45°C (seconds) (y=1.9+3.2x, r=0.92, p<0.0001). There was no significant difference in the velocity of temperature increase (32-45°C) between two groups of cones of different height and the same density, meaning there is no evidence to indicate that tall moxa cones make patients feel mild heat.
From the results obtained in this experiment, the density of the moxa cone was found to be one of the most important factors affecting direct moxibustion treatment.

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.

Acupuncture, which was originated and developed in the East Asian countries, has been globalized today. In Japan, acupuncture is more popular than the West, but lagging behind in terms of medical policy, research funding and evidence-based clinical research. Evidence-based approach such as randomized controlled trial has brought new developments in acupuncture research scene. On the other hand, clinical implication of acupuncture “system” seems to have been underestimated in evidence-based clinical research until recently.

Unresolved problems remain in the clinical research methodology of acupuncture. In particular, the creation of placebo group in randomized controlled trial (RCT) is controversial: sham and / or minimal acupuncture may appear more powerful than placebo treatments in trials. Hence, in the future more emphasis should be placed on pragmatic RCTs, which compare typical treatment vs typical treatment plus acupuncture.
In order to more effectively integrate acupuncture therapy into modern Western medicine, evidence of efficacy, safety and cost-effectiveness should be clearly shown from both rational and clinical points of view. At the same time, we should reassess whether or not the present research methodology appropriately evaluates the essence of acupuncture therapy.