The Safety Committee, Clinical Information Department, Japan Society of Acupuncture and Moxibustion (JSAM) held a workshop at its 73rd Annual Meeting in Miyagi titled "Literature Review on Adverse Events and Introduction of the Practical Manual for Safety Management of Acupuncture and Moxibustion Therapy." The following topics were presented, followed by a question-and-answer session: 1. Literature Review on Adverse Events Associated with Moxibustion 2. Literature Review on Adverse Events Associated with Acupuncture 3. Introduction of the "Practical Manual for Safety Management of Acupuncture and Moxibustion Therapy" The manual was published in July 2024, and members are encouraged to read it and use it as a safety reference for daily practice settings.

Five years have passed since the release of the Safety Guidelines for Japanese Acupuncture and Moxibustion Practice 2020. The original plan was to amend the guidelines every five years.The devising of a revision plan (draft plan) began in 2024. This revision organized a working group in the committee for safe acupuncture, and this revision was pushed forward.In the working group, we investigated domestic and foreign adverse event reports added newly in the last five years and reviewed the additions or the contents that needed revisions. In April 2025, we took a plan that was drafted since March 2025 and displayed it on the Society's homepage to encourage public comments. We completed the Safety Guidelines for Japanese Acupuncture and Moxibustion Practice 2025 after referring to the public comments. Three main revisions were incorporated in the new guidelines.First, under "Ⅱ. General Requirements and Precautions for Safety," we arranged problems about a moxa cautery surgery to the facial region. In addition, we omitted a mention of direct moxibustion (scarring moxibustion) cautery and changed the notation.Second, under "Ⅳ. Preventing Adverse Events," we mentioned pneumothorax (including hemopneumothorax) as an item independent of an organ and nerve injury and subsequent care. In addition, in an item related to the difficulty in removing the needle due to a side effect (adverse response), we added that we must not perform prickle acupuncture as an instruction related to the prevention of acupuncture in such cases.Third, under "Ⅴ. Safety in Related Therapies," we performed a full-scale review of an item of electro-acupuncture therapy. We revised the definition of low-frequency acupuncture electricity treatment that was previously unclear in the Guidelines for Japanese Acupuncture and Moxibustion Practice 2020. We proposed the new definition after vetting the attached documents of a medical instrument in a surgery we performed following this definition.We discussed the main revisions in the Guidelines for Japanese Acupuncture and Moxibustion Practice 2025 while referring to the public comments sent for the draft plan.

A 15-year-old girl who had undergone a tracheostomy 4 years earlier because of holoprosencephaly and severe mental and physical disabilities had tracheo-innominate artery fistula with sudden-onset bleeding after endotracheal suctioning. Due to respiratory and circulatory instability, VIABAHN® was implanted in the brachiocephalic artery, and the patient was discharged on postoperative day 33. Three months later, rebleeding from the tracheostomy site was observed, and the patient was transported to our hospital. Although the bleeding stopped spontaneously on arrival, the patient experienced multiple bleeding episodes after admission. Therefore, transection of brachiocephalic artery was performed, after which the patient was discharged on postoperative day 20. Tracheo-innominate artery fistula is a rare complication that occurs after tracheostomy, but it is associated with a poor prognosis, and has a mortality rate of 100% if left untreated. Our case suggests that endovascular treatment using VIABAHN® for tracheo-innominate artery fistula is useful for temporary hemostasis.

The Safety Committee, Clinical Information Department, Japan Society of Acupuncture and Moxibustion (JSAM) held a workshop at their 72nd Annual Meeting in Kobe titled "Forgotten Needles: Present Conditions and Measures."In the workshop, the following information was offered by the three committees, and a question and answer session was conducted with the audience afterward. 1. Patient's affection for forgotten needles: analysis of a contribution to Twitter 2. The present conditions and measure plans of forgotten needles: based on the present conditions of Kansai University of Health Sciences 3. Forgotten needles at the Suzuka University of Medical Science: the real condition of prevention of outbreak We performed a thorough cross- and/or double-check to prevent forgotten needles. The reports suggested various ideas as check methods, and the results of the study helped the practice from the next day.

The safety committee has been undertaking activities, such as conducting regular workshops at the annual congresses, managing the "Safety Measures Website for Acupuncture and Moxibustion," researching the literature, conducting multicenter prospective studies on acupuncture and moxibustion-related adverse events, collecting information about medical accidents involving acupuncture and moxibustion in Japan, addressing the media pertaining to false information regarding the safety of acupuncture and moxibustion, and formulating the Safety Guidelines for Japanese Acupuncture and Moxibustion Practice. At the 71st annual Tokyo congress workshop, activities conducted over the past decade were summarized.　Regarding the studies on acupuncture and moxibustion-related adverse events, a literature review of reports concerning acupuncture- and moxibustion-associated adverse events published globally from 2004 to 2019 was introduced. Furthermore, the results of a multicenter prospective study conducted by the safety committee were also introduced. Additionally, the Safety Guidelines for Japanese Acupuncture and Moxibustion Practice were introduced, and the results of a questionnaire survey determining the degree of recognition of these guidelines were simultaneously reported. Moreover, regarding future developments, plans to create and publish a safety manual for acupuncture and moxibustion (provisional name) were reported.　In the second half of the workshop, reports on the past cases of needle breakage and retained needles were introduced under the topic "precautions and preventive measures regarding needle breakage and retained needles." Furthermore, the number of needle breakage claims filed under the liability insurance of acupuncture and moxibustion practitioners was reported. These details demonstrate that despite the common use of single-use acupuncture needles, accidents involving needle breakage still exist. Lastly, measures for reducing the difficulty in needle removal and preventing needle breakage were summarized, and opinions on the same were exchanged with the participants.