[Objective]To analyze and understand cases of adverse effects of acupuncture and moxibustion published in medical journals between 2007 and 2011.
[Methodology]We searched relevant articles with the Web of Japan Medical Abstracts Society and PubMed. We used keywords for acupuncture, moxibustion and related adverse events.
[Results]We located 39 papers reporting 39 cases that occurred in Japan:infection (7 cases), organ injury (11), foreign body or needle breakage (8), neurological damage (6), cutaneous disease (1), adverse effects of moxibustion (4), and others (2). As for cases published in foreign countries, we located 60 relevant papers:infection (19 cases including 2 outbreaks), organ injury (13), foreign body or needle breakage (5), neurological damage (9), cutaneous disease (5), adverse effects of moxibustion (2), and others (7).
[Conclusion]Although causal relationship has not been established in some cases, occurrences of infection, organ injury, and needle breakage/foreign body are still as high as they were before. This suggests that continual feedback to acupuncturists of information on safety is necessary.

We have detected Hepatitis B viral DNA on the surface of needles after removing acupuncture needles. Using a polymerase chain reaction we confirmed a band specific for Hepatitis B virus in one out of two patients who are known carriers. Our study indicates that acupuncture needles represent one possible sources of viral infection.

We examined whether wiping acupuncture needles with cotton could remove Hepatitis C viruses (HCV) adhering to the needles. The needles were incubated in the serum from patients infected with HCV, then the needles were wiped with dry cotton or cotton soaked in 80% ethanol. RNA was extracted from these needles and the HCV genome was amplified by reverse transcription-polymerase chain reaction (RT-PCR). The results indicated that the HCV genome was not detected when the needles were wiped with dry cotton. However, in one of two experiments, the HCV genome was detected after wiping the needles with cotton soaked in ethanol. We also examined the HCV contamination on the needles extracted from patients infected with HCV. The HCV genome was detected on extracted needles that were not wiped with cotton, but the genome was not found on needles wiped with cotton at the time of extraction. Therefore, wiping acupuncture needles with cotton might effectively remove HCV on the contaminated needles, but the viruses could not always be re-moved by simply wiping the needles with cotton.

We have been collecting various ideas on safer acupuncture practice from participants in our workshop as well as members of the committee. Subjects and presentations of the present workshop were as follows:
1. Forgotten needles
  1) Ideas of prevention based on a questionnaire survey (Egawa and Ishizaki)
  2) Effect of incident reporting system (Yamashita)
2. Cleaner method of needle insertion and Oshide (needle-supporting fingers)
  1) Merits and demerits of sterilized fingerstall and glove (Miyamoto)
  2) History of the clean needle development (Umeda)
  3) A novel clean acupuncture needle device (Imai and Ishizaki)
Although there was not enough time for discussion, we collected some useful ideas from the participants. A novel clean needle invented by Imai gave a strong impression to the audience. We should continue to discuss a diverse impact when such new devices and concepts become widespread in traditional acupuncture practices. We welcome more ideas and opinions from relevant facilities, clinics and fields in order to further improve safety of acupuncture.

We updated safety information on acupuncture and moxibustion, focusing on adverse events. Case reports published between 1998 and 2002 were searched, using “Ichushi Web” (Web version of Japana Centra Medio Medicina) and “PubMed”. Thirtysix cases of acupunctureassociated adverse events (13 infections, 11 dermatological problems, 6 organ injuries or foreign bodies, 5 nerve injuries etc.) and nine cases of moxibustionassociated adverse events (6 dermatological problems etc.) were located. Most cases were published in academic journals in the field of modern Western medicine, which clinical acupuncturists usually do not read. Therefore, our committee should play a role of collecting safety information and performing the feedback for the acupuncturists.
We also summarize the contents of the Workshop held by our committee on June 6, 2003. The most controversial issue was determining an appropriate method of needle insertion in terms of infection control. More evidence is needed for establishing a good manual for safety acupuncture.

Knowledge and procedures regarding safe acupuncture practices often include conjecture and anecdotes lack-ing scientific evidence. In order to improve the safety standards of acupuncture, we should collect, scrutinize, and apply evidence on the safe management of acupuncture. We, the Committee for Safe Acupuncture, have commenced collecting and reviewing relevant evidence published. Subjects in 2004 were as follows :
1. The present situation of safety education and damages (by Katai)
2. Hand washing and finger disinfection (by Ishizaki)
3. Disinfection of the needle insertion area (by Umeda)
4. Procedures of needle insertion and removal (by Miyamoto)
5. Safe insertion depth (by Yamashita)
6. Environmental sanitation (by Egawa)
We hope that the knowledge and questions which come to light through the present work will influence school education, clinical practice, manual editing and research activities.

We continued reviewing published evidence and information regarding the safety of acupuncture. Subjects in 2005 were as follows :
1. Safety during acupuncture stimulation
2. Quality and strength of acupuncture needle
3. Sterilization and storage of equipments
4. Hygienic handling of equipments
5. Relevant notices from the Government
6. Standards of notification regarding hygienic practice and contaminated wastes
We hope that the information here will influence the future school education, clinical practice, manual editing and research activities.

The purpose of this study was to investigate the effect of weight reduction on the anti-mutagenicity of human saliva. Subjects were 16 male college judo players. The anti-mutagenicity of the saliva was measured using the umu test. There was an inhibiting effect of the saliva on the mutagenicity of AF-2. However, a modifying effect of the saliva on Trp-P-1 was not observed. On the day before a competition and 7 days after the competition, the inhibiting capacity of the saliva for the mutagenicity of AF-2 decreased and increased in two non-weight reduction and two weight reduction groups, respectively. However, on the day before the competition, the changed body weights (r=−0.77, p<0.01) and BMI (r=−0.77, p<0.01) were significantly correlated with that of the inhibiting capacity of the saliva for the mutagenicity of AF-2. In addition, the BMI at 20 days before the competition was not significantly but markedly correlated with it (r=0.50, p=0.057). At 7 days after the competition, however, these correlations were not found. These findings suggest a unique correlation between the anti-mutagenicity of human saliva and body weight or BMI.
Saliva ; competition ; Human ; Body Weight ; g <3>

The purpose of this study was to investigate the effect of weight reduction prior to a competition on the salivary cortisol level for first-rate judo players. Subjects were divided into three groups by the weight reduction rate. On the day before the competition, the cortisol levels of the low- and high-weight reduction group showed a tendency to decrease and were significantly lower than that of the non-weight reduction group (p<0.05). However, with regard to the change in the stress indices, there was a difference between the high- and low-weight reduction groups. In the high-weight reduction group alone, there was a significant increase in the stress indices on the day before the competition (p<0.05). These findings suggest that the HPA axis is affected during the relatively early stage of weight reduction and mental stress is increased at the higher weight reduction rate.
Reduction (chemical) ; Weight ; competition ; Salivary ; Levels