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.

The purpose of this symposium was to clarify clinical significance of the pulse diagnosis at the wrist used for detecting the function of various organs. Base of the literature survey and his personal experiences, the importance of reliability (reproducibility) test of the pulse diagnosis in blinded manner and necessity of clinical trials with “_??_”-specific intervention was proposed by Ogawa. A unique training program of the pulse diagnosis was introduced by Kido, and he also demonstrated a significant positive result of “_??_”-specific intervention determined by the pulse diagnosis procedure in his program and suggested the clinical significance of the pulse diagnosis. Detection of various changes in pulse waveforms at the wrist using pressure transducer was demonstrated by Maruyama, and he also suggested a possible progress of objectivity in pulse diagnosis by various sensors and biomedical devices in future. From circulatory physiological point of view, factors which may affect the pressure pulse wave at the wrist were explained with several examples of pathologic conditions by Chihara. He also suggested a possibility of reflection of general condition in the pressure pulse at the wrist although it might be partial one, and stressed the necessity of other information for the accurate diagnosis. In general discussion, it was pointed out that evidence of the pulse diagnosis was still limited, and further experimental approaches of the pulse diagnosis will be required.

The very first session of the symposium on ‘cancer and acupuncture’ was held at the 53^rd Annual Conference of the Japan Society of Acupuncture and Moxibustion (JSAM). It suggested the efficacy and potential of acupuncture and moxibustion not only for cancer but also for cancer patients. This is the second session for further discussion. In recent years, acupuncture and moxibustion treatment for cancer patients has come to the world's attention, and many reports about its expediency and beneficial effect have been conducted in Japan and in the world. However, the adaptation range of acupuncture and moxibustion treatment for cancer is still limited because there is not enough evidence, so compilations of more sufficient case reports or research for presentation and effects in preventing relapse of cancer are required to prove its reliability. Acupuncture and moxibustion are used as one of the medical treatments directed at relieving symptoms and life-sustaining treatment in hospitals today. Earlier, frequent acupuncture treatment led to significant efficacy for cancer patients, and it is also reported that the number of lymphocytes increases in sequential acupuncture treatment but the number tends to return in a short time after cessation of treatment. Sequential autonomic immune therapy over a long term revealed several significant effects as follows; lymphocyte activation while the lymphocyte count remained, increase of cytokine (IL 12, IFNγ, TNFα, etc.) production and Th 1, Th 1/Th 2, immunostimulatory activity effect, reduction of tumor markers down to or close to normal, reduction or resolve of malignant neoplasm and recurrence prevention for unoperated cancer patients, QOL improvement with symptoms relief and life prolongation. In this seminar, it suggested that acupuncture and moxibustion are potential and appropriate treatments for cancer and further research in this field is required.

This is the third symposium on 'cancer and acupuncture and moxibustion'. Many physicians and intellectuals are skeptical of the use of Western medicine for cancer patients, which often lead to serious adverse events. Acupuncture and moxibustion, which is capable of improving quality of life (QOL) and activating immunity with minimal side effects is also expected to have beneficial effects on various stages of cancer patients, such as prevention of development or recurrence of cancer and palliative care. In fact, evidence has recently accumulated in the field. Dr. Fukuda, Associate Professor of Meiji University of Integrative Medicine, who reported the usefulness of acupuncture and moxibustion in palliative care in the first symposium and bibliographical information in the second has reported this time on the topic of safety and effectiveness of acupuncture on chemotherapy-induced peripheral neuropathy. Dr. Kurokawa from the National Defense Medical College reported the effectiveness of acupuncture on physical and psychological symptoms, QOL, prevention of adverse events, and pre-and post-operative disorders in cancer patients. Dr. Kouchi from Saitama Medical School reported on the usefulness of acupuncture in the university hospital and factors which influence the effect. Dr. Nakamura from Morinomiya University presented a case with chemotherapy-related symptoms who had been cared for with a long-term application of moxibustion. In contrast to these reports on the efficacy of the acupuncture for chemotherapy-and radiotherapy-induced side effects, Dr. Magara from Somon Hachipuji Clinic, who had consistently reported a preventive effect of autonomic immune therapy that involves acupuncture without Western clinical treatment from the first symposium, this time presented topics regarding improvement in the immunity by increasing various cytokines, the possibility of reduction of a tumor even in a case of advanced cancer that cannot be treated with a surgical approach, reduction of the recurrence rate among cases who were treated with his approach as compared with those under conventional approaches. He insisted we should concentrate our efforts on research on preventing the recurrence of cancer with approaches that activates the natural healing process of human beings.
We concluded that clinical trials with a larger sample are needed to clearly identify the usefulness of acupuncture and moxibustion for cancer patients.