At the Tokyo Proclamation Symposium, I was responsible for the study of Characteristics of Japanese Acupuncture and Moxibustion from the clinical viewpoint. The subject was based on an analysis of the discussion of the drafting committee and the results of a survey concerning the acupuncture-moxibustion business conducted by Ido-No-Nihon magazine.
The characteristics of Japanese acupuncture-moxibustion differing from those of general medicine are:
1 st In both diagnosis and treatment "touch"is extremely important
2 nd The development of treatment and diagnostic implements based on Western medical concepts
3rd The development of weak stimulation treatment using insertion tubes and various fine minute needles
4 th Therapy based on a blending of Western medical concepts and classical teachings
5 th The popularity of moxibustion therapy
6 th The importance placed on preventative therapy
7 th Individualized treatment not limited to the main complaint
There is a great diversity of characteristics in Japanese acupuncture-moxibustion but this should not be taken advantage of or lead to complacency.
As individualization is not adaptable to Cartesian science, Western medicine aims for standardization. Also in spite of the fact that the patient's condition is grasped in terms of causes, therapy begins and ends with what is known as allopathic or symptomatic therapy, as analysis of the functions of the whole body systemically and dynamically is impossible. As allopathy applies opposition therapy, when the body temperature is elevated, regardless of the cause, the aim of treatment is to reduce the temperature. Likewise in cases of high blood pressure or glucose count. With Eastern medicine, in order to increase immune power and restrict the activity of bacteria and viruses, treatment is administered to increase the body temperature. Which type of treatment is more substantial is obvious.
With the decreasing birthrate and the aging population one would expect that hereafter the demand for economical acupuncture-moxibustion therapy which safely promotes the natural healing powers of the body and is useful in the prevention of disease should increase. However the reality is, the demand is declining, not only among the general population but also at medical facilities which proves our neglect to analyze the customers'(population and medical facilities) needs and our failure to revolutionize. To rectify this situation, educational reform before and after graduation is a necessity

We used a questionnaire survey to assess the JSAM (the Japan Society of Acupuncture and Moxibustion) members' use of local therapy and distal therapy. We wanted to apply the results of the discussion titled “the definition of local therapy and distal therapy” in the symposium during the 52nd Annual JSAM meeting (2002, Kagawa). Questionnaires were distributed to 500 of the 1250 JSAM members registered in 1991. The subjects who received questionnaires were selected at random. Of the 500 questionnaires sent out 145 replies were received. Each respondent was asked to submit their definition of local and distal therapy.
Also, eight examples of local and distal therapies were given and respondents were asked to reply as to whether they treat with local or distal therapies and the.reasons for these choices.
The results were analyzed by simple and cross tabulation. We were able to define local therapy as 1) insertion to the injured area by acupuncture, 2) treatment on the area traveling along a nerve, and 3) treatment on the area where the patient feels some sensation. And we also defined treatment with a spectrum of tender points as local treatment, according to relationships with nervous reflexes such as an axon reflex, similarly to needling on muscles and along the path of the nerve. The use of distal therapy was usually carried out at points with relationships to fundamental treatment, tender points, meridians, autonomic nervous system and mechanisms through nerve centers. It was found that most practitioners consider distal points that are defined with some theory. Distal points were not selected randomly without the above consideration.

We carried out a 2 nd questionnaire survey to complement the results of the initial questionnaire survey in 2003. The results of the symposium, “Acupuncture treatment on the local area versus the distal area” from the 53rd JSAM (Japan Society of Acupuncture and Moxibustion) 2003 annual meeting and the first questionnaire helped us refer our continuing discussion. In the last survey we had selected subjects at random from members of JSAM who had been since more than 12 years ago. But in this survey we selected subjects whom we expected as leaders of schools or groups. All answers had to be described. We sent questionnaires to 87 members, and 41 sent back replies.
Items of investigation were the method of treatment (at modern acupuncture and moxibustion schools, traditional acupuncture and moxibustion schools, traditional Chinese medicine schools, etc), the conditions under which local treatment and/or distal treatment are effective or ineffective, and syndromes for which local treatment and distal treatment are effective, and under those circumstances the theory of acupoint selection, the depth of insertion and resulting sensation. Eventually, opinions about both treatments were requested. The results were analyzed by simple and cross tabulation.
The subjects were leaders of schools or groups. This questionnaire was based on the results of the past two symposiums and the initial questionnaire. As a result this survey of opinions and ideas were collecting articulated and approached the achievement of our purpose.

[Introduction]This symposium was organized for the adoption of the Tokyo Declaration for Japanese Acupuncture and Moxibustion at the final meeting of the congress and was composed of three subjects that were supposed to become a framework for the declaration draft.
[Subjects] 1. History of acupuncture in Japan 2. Analysis of the present circumstances 3. Tasks for the future
The first subject was an explanation of important matters in acupuncture development in Japan, based on the key note lecture given prior to this symposium. The second subject was analysis from both aspects of research studies and clinical situations. The third subject was to be suggestions for further development of acupuncture after revealing present problems.
There are more or less many issues in the acupuncture field;clinical practice, education, research and clinical training, but these issues may not have been approached either systematically or generally before. Whereas, in the light of opinions gathered from many others, many future issues came apparent through the three subjects of this symposium. In conclusion, the goal was to find a strategy that would make Japanese acupuncture become a prevailing therapy in the future more than what it is today.

This symposium was held as the second in a three part series at Kagawa Conference (June 6-8, 2003). During the Tsukuba conference (2002), distal area treatment was the topic of focus. The criteria and evidence for the effectiveness of distal area treatments were presented. Three symposists and one minor speaker reported on the effectiveness of distal area treatments from clinical and basic viewpoints. However, another symposist showed the superiority of local area treatments and denied the effectiveness of distal area treatments. There fore, we decided that a succinct and definitive discussion on distal area treatments (etc) should be presented during the second symposium. To this end, long time members of JSAM were given a questionnaire survey prior to the conference. Respondents were asked to define their own use of local and distal treatment, to hypothesize on the curing mechanism involved and to state which practice methods they use most.
Mr. Ogawa reported that, as a result of analyzing the questionnaire survey no distinct differences were found in the definitions stated by respondents from several different schools. The standard images of “the local area” were the area where pains were felt when pressure is applied, the areas which transmit special sensitivity or the area where a disorder is found. Also, the images of “the distal area” were the areas which have some relationship to the local area, such as meridians and collaterals, nerves, reflex points, tender points, or related points which induce a clearly recognizable physical reaction.
Mr.Shinohara showed the superiority of distal area treatments according to the muscle meridian theory by utilizing the 3 arm crossover examination. Furthermore, he established the delayed myalgia as a model of the illness on a specific muscle meridian region. He investigated the effect of intradermal needling. He observed that after a weight bearing exercise on the biceps brachii, the threshold of tenderness on the Lung meridian decreases. He proposed the possibility of using the points in extremities which had selectively responded by manifesting of the delayed myalgia.
Mr. Moriyama, one of the minor speakes, explained, using the theory of biomechanics, the possibility of in-fluences of distal area disharmony on the local area. He introduced the Meridian Test as one clinically useful method for finding disharmony which is typically difficult to discern and may contribute to the disorder. He proposed that a microscopic “eye” to be used to see the local area and the macroscopic “eye” b used to see the whole body in medical examination and treatment. Using the “eyes” in synthesis and not separately, he concluded, must be the basic state for treatment.
Another minor speaker, Mr.Shiraishi reported on analyzed results of the experiments on lumbago patients. Applying Yuandaoci (distant needling) reduced a response on points of the trunk (BL 23, Shenshu, Jinyu) in stimulating points, i.e, BL 40 (Weizhong, Ichu), BL 57 (Chengshan, Shozan) BL 58 (Feiyang, Hiyo) BL 60 (Kunlun, Konron) GB 34 (Yanglingquan, Yoryosen) varying in many ways and confirming the peculiarity of each point, meridian and collateral. Based on these findings he supports the effectiveness of distal meridian area treatments.
Mr. Ozaki, also, another minor speaker proposed, from the outcome of animal experiments. Stimulation by acupuncture at either adjacent or distal areas can affect motor reflex. So from this point of view, insertion at adjacent and distal area has some recordable effect. He added that stimulation given either at adjacent or distal areas would converge to the same neuron and the same modification would occur. From this point of view, the difference in processing information at the neuron level would control the manifestation of the effect and thus investigations on these treatments should be discussed as a synthesis, including, not