Moxibution therapy, along with acupuncture and herb therapies, has long been one of major traditional therapies in East Asia. It has history of over two thousand years. Since ancient days Artemisia, the material of moxa was gathered up in early May and used for the purpose of protection against outer evil materials.Some of the medical texts excavated from Mawangtui tomb _??__??__??__??__??_ in 1973 suggest that around 2 B.C.fumed moxa was used for disinfection of the operated parts in body. We can also find in the Mawangtui medical texts the first description on moxibution therapy based on meridian theory. But it is not until the publication of Zhenjiu Jiaouyijing _??__??__??__??__??_ that detailed correspondence between diseases and treating points (acupoints) was made clear.
Qianjinyaofang _??__??__??__??_ and Waitaimiyaofang _??__??__??__??__??_, both published in Tang period, left a strong in-fluence over the practice of moxibution therapy in later period. Qianjinyaofang has a lot of articles indicating superiority of moxibution to acupuncture therapy. It also gave moxibution therapy a new concept, ’Yangsheng (prophylaxis) _??__??_’.Wangtao_??__??_, the author of Waitaimiyao, depended much on Qianjinyaofang for hiswriting, and recorded only moxibution therapy. Ishinpo _??__??__??_, the first comprehensive medical text in Japancompiled by Tanba Yasuyori (_??__??__??__??_) in the late 10th century, is wealthy of excerpts from these twobooks. In medieval Japan, moxibution therapy achieved dominant position in the cure of disease while acu-puncture was applied mostly for surgical operation.
The influx of medical books from Ming China since the 16th century enabled Japanese physicians to domore detail and careful analysis of moxibution therapy. Leijingtuyi _??__??__??__??_ and Huangdimingtangjiujing_??__??__??__??__??__??_ were the main objects of their research. It is also notable that in Edo Japan, the therapy waspracticed not only by physicians, but practiced also among the commonality for the purpose of their health care. Actually, in many parts of Japan moxibution therapy has been practiced among families as an annual event in community.
The discovery of the New Continent in the late 15th century brought many Westerners to East Asia. The knowledge of moxibution therapy was transmitted to Europe by the Jesuit priest and physicians who were in-terested in the natural history of Japan. In Nippojisho _??__??__??__??_, a Japanese-Portuguese dictionary printed in1603 at Nagasaki, we can find some words regarding moxibution. Engelbert Kaempfer, a German physician who did botanical research in Japan in 1690-92, published in 1712 Amoenitatum Exoticarum in which he in-troduced moxibution therapy. In this best selling book, he made very interesting comparison between Japanese moxibution and the similar therapies practiced in Arabic world. He also inserted a chart of moxibution points, reprinted from a kind of pamphlet on moxibution, Kyushokagami _??__??__??_.
Erwin von Baeltz, a German physician who stayed in Japan for more than thirty years in the second half of the 19th century and contributed much to the foundation of western medicine in Japan, left a photo of a male patient with Hansen’s disease with many burning dots of moxibution on his body. Though it was already reported in the 17th century by Willem ten Rhijne that moxibution was applied to Hansen’s disease in Japan, Baeltz’s photo is quite rare proof of the practice.

Standardization in the field of acupuncture and moxibustion by an international organization first started in the 1980's, when the Western Pacific Regional Office (WPRO) of the World Health Organization (WHO) developed standards for basic nomenclature in acupuncture medicine. After his 2002 inauguration as WPRO's regional officer in charge of traditional medicine, Choi Seung-hoon launched several projects including development of standard terminology and acupuncture point locations for standardization of traditional medicine. Those projects were planned and carried out for the purpose of increasing the exchange of more information in the field of traditional medicine
In 2009, the Standardization Administration of China (SAC) applied to the International Standards Organization (ISO) for the establishment of a new technical committee for TCM, resulting in the creation of TC249 'TCM (Provisional)'in September of year. The scope of proposals in the application documents submitted to ISO included comprehensive standardization including licensing, education, terminology, manipulation and medical devices.
In order to promote Japan`s own standpoint and cope with international trends for developing standards, four academic societies in Japan and two WHO collaboration centers for traditional medicine formed a liaison (the Japan Liaison for Oriental Medicine:JLOM).
So far, TC249 plenary meetings have been held in 2010 and in 2011, and two working groups have been created to contend with medical devices used in traditional medicine (acupuncture and moxibustion). Such recent movements for standardization in ISO and WHO also brought to light the problems with Japan's domestic standards regarding clinical practice, education and research in acupuncture and moxibustion. We should understand that what we face as international problems are closely related to domestic ones, and we are required to be accountable for both.

WHO Congress on Traditional Medicine was held in Beijing, China from 7 to10 November 2008. Dr. Margaret Chan, Secretary General of WHO addressed a speech at the opening ceremony, emphasizing the role of traditional medicine (TM) /complementary and alternative medicine (CAM) in primary health care and preventive medicine. During the congress, the Beijing Declaration was adopted. The Declaration affirms the importance of government action to promote the integration of TM /CAM into their health care system.
In addition, there were four satellite symposia, including the symposium of the World Federation of Acupuncture and Moxibustion Societies (WFAS). In line with the principle of the congress, a session regarding the present status of legislation, education and research in each member country was presented. In the executive committee meeting of WFAS, revision of the constitution and other issues were discussed. The university cooperation working committee of WFAS proposed a project editing an international textbook on acupuncture and moxibustion.

Currently, the international environment surrounding traditional medicine, including acupuncture and moxibustion, is changing faster than we can imagine. In recent years there are some Far East Asian countries that have registered the classical medical books of traditional medicine and a part of traditional medicines in their own countries to the Memory of the World and the Intangible Cultural Heritage in UNESCO. In addition, preparations to include traditional medicine in ICD-11 have been carried out with revision of ICD-10 in WHO. Furthermore, the working of international standardization of traditional medicine of Far East Asia is underway in ISO. Also WFAS is working on the international standardization of acupuncture and moxibustion in an official relationship with WHO. Furthermore, genetic resources and traditional knowledge related to traditional medicine have been discussed in CBD. The matters concerning traditional medicine have been discussed separately elsewhere in a wide variety of international organizations such as WIPO, WTO/TRIPS and FAO.
In this panel discussion, firstly, we outlined the main points about the protection of traditional knowledge by CBD and the Nagoya Protocol, clarified the current status of discussions in WIPO about traditional medicine and registration of traditional knowledge under the Intangible Cultural Heritage in UNESCO, and examined future protection of traditional knowledge of acupuncture and moxibustion. Secondly, we summarized the current status and progress of the international standardization of acupuncture and moxibustion driven by WFAS as commissioned by WHO, clarified the viewpoint of JSAM about problems with the efforts of WFAS for the international standardization of acupuncture and moxibustion, and discussed the relationship of the international standardization of acupuncture and moxibustion in WFAS and ISO. Finally, we summarized the progress of the international standardization of acupuncture and moxibustion from the 1980s when international standardization of acupuncture and moxibustion was first initiated by WHO up until the present when international standardization of acupuncture and moxibustion is included in ISO/TC249, surveyed the present situation of the international standardization of traditional medicine in the countries that are leading the international standardization of acupuncture and moxibustion, and discussed about the aspects of the struggle for supremacy lurking behind the international standardization of traditional medicine and the issues associated with the future of the international standardization of traditional medicine.

An 80-year-old man was admitted to our hospital with a diagnosis of distal aortic arch aneurysm. A preoperative chest CT demonstrated a 54 mm in diameter distal aortic arch and coronary angiography revealed stenosis of LAD and the diagonal branch. We planned a thoracic endovascular repair after total arch replacement with a coronary artery bypass graft. A ZTEG-2P-30-200-JP was deployed at the proximal side of the elephant trunk, and a ZTEG-2P-34-152-JP was deployed. About 10 months later, a chest CT demonstrated a 90 mm in diameter distal native aortic arch, and anemia had increased to Hb 7.7 g/dl. A CT and angiography revealed a type II endoleak and so we tried to close the endoleak through a left thoracotomy approach. Twenty-eight months after the TEVAR, the patient had esophageal perforation and stent graft infection. At first, we resected the esophagus and reconstructed it with a gastric tube. Secondly, a descending thoracic aorta replacement was performed. The patient suffered from a cerebral infarction. However, infection was controlled successfully and he was transferred to another hospital for rehabilitation 69 days after the descending aorta replacement.

It has been five years since TC 249 was established as a new Technical Committee (TC) at the International Organization for Standardization (ISO), specializing in the field of Chinese traditional medicine. In the second Plenary Meeting held in Den Haag (2011), five working groups (WGs) were established within the TC, two of which specialize in standard development of acupuncture needles (WG3) and other medical devices used in traditional medicine (WG4). Japanese delegates have participated in the discussion within these WGs, paying close attention so as to keep the proposals under discussion consistent with existing Japanese standards and certification standards regulated by the Ministry of Health, Labour and Welfare. However, since most of the participants in TC 249 are clinicians or researchers engaged in medical practices, and not experts on domestic/international standards, discussions on harmonization of the submitted projects often become complicated. In this manuscript, four experts (two from academia and two from companies that manufacture acupuncture needles and moxibustion devices) who attended the fourth plenary meeting held in Durban, South Africa, in May 2013, report on the stage of progress of standardization development in WG3and WG4.

According to the World Health Organization (WHO), mortality by age, sex, and cause of death is the foun­dation of public health both globally and domestically. Comparable mortality statistics over time and investi­gations of mortality were used to develop the International Statistical Classification of Diseases and Related Health Problems (ICD). In the ICD, the WHO states that morbidity statistics are also an essential foundation of public health, but they are much less widely applied. The 10th revision of the ICD (ICD-10) is now in use, but further revisions must be made in the development of the 11th revision (ICD-11) to capture advances in health science and medical practice, to make better use of the digital revolution, and to evaluate traditional medicine (TM). Revision of ICD-10 began in 2007, and an ICD-11 version for preparing implementation was released on July 18, 2018. ICD-11 features a new TM chapter on Japanese traditional medicine, known as Kampo medicine, traditional Chinese medicine, and Korean medicine. ICD-11 will be approved at the next World Health Assembly in May 2019 and will come into effect. This means that the WHO does not currently recognize the effects of TM, but that we as well as the WHO will have hard time to prepare and study the effects of TM on morbidity statistics. It is very important to the study of Kampo medicine that we will be able to properly evaluate the terms and classifications contained in ICD-11.