[Objective] This study aimed to collect, analyse, and examine the literature on adverse events in acupuncture and moxibustionin order to improve safety.[Subjects and Methods] A literature search was conducted using Ichushi Web and PubMed to identify reports of adverse eventsrelated to acupuncture and moxibustion published in domestic and international medical journals from 2020 to 2023. The searchkeywords included 'acupuncture', 'moxibustion', and various terms related to adverse events associated with them.[Results] We identified 33 papers describing acupuncture-related adverse events in Japan. The reported adverse events includedinfections (9 papers), organ injuries (11), neurological injuries (2), dermatological problems (2), and needle breakage, retainedneedles, or foreign bodies (9). We also identified 56 papers reporting adverse events that occurred abroad, including infections(17); organ injuries (23); neurological injuries (1); dermatological problems (6); needle breakage, retained needles or foreignbodies (3); others (4); and moxibustion-related adverse events (2).[Conclusion] Consistent with previous surveys, various adverse events related to acupuncture and moxibustion occurred bothdomestically and internationally. These findings highlight the importance of learning from the reported cases and implementingsafety education on acupuncture and moxibustion.Zen Nihon Shinkyu Gakkai Zasshi (Journal of the Japan Society of Acupuncture and Moxibustion: JJSAM).2025; 75(4): 442-462. Received 29 Jun, 2025 Accepted 13 Jul, 2025

The textbooks edited by the 'Japan College Association of Oriental Medicine' are utilized by numerous vocational schools and universities specializing in acupuncture, moxibustion, anma, massage, and shiatsu. The committee responsible for preparing teaching materials within the association reviews the contents' outlines and produces these textbooks. In recent years, the restructuring of three textbooks - 'Acupuncture Theory,' 'Clinical Theory of Oriental Medicine,' and 'Anatomy and Physiology' - has been undertaken. However, the background detailing how each textbook was created, restructured or revised, including its purpose and method, hasn't been adequately communicated to the individuals using these resources. During this symposium, the three individuals involved in the reorganization and revision of the textbooks presented the purpose, process, and key points to consider regarding three recently revised textbooks across four subjects.

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.

In The 63rd Annual Congress of JSAM (Ehime 2014), the Committee for Safe Acupuncture of Research Department in the Japan Society of Acupuncture and Moxibustion (JSAM) conducted a workshop entitled "The Regional Anatomy Q&A for safety needling"which provided information on organ damage and neurological injuries that may occur after acupuncture treatments. This workshop stated the need for improvements in safe practices of acupuncture.
This workshop was divided into three parts:(1) results of questionnaire surveys conducted in Japan for acupuncturists on their clinical experience of adverse events and for orthopaedic doctors on their clinical experience of patients who suffered adverse events after acupuncture treatment;(2) a literature search of severe adverse events e.g., pneumothorax and neurological injuries, associated with acupuncture treatment in Japan;(3) the regional anatomy of the upper part of the body, which is based on several anatomical studies on acupoints.
The incidence of severe adverse events is considered to be very low during all acupuncture treatments;however, the real incidence is estimated to be higher than the number of case reports in the literature. In order to prevent severe adverse events, regional anatomical knowledge of needling points is very important, and furthermore, safe needling techniques are required.
We hope that this workshop can aid in enhancing the knowledge and techniques and contribute to safe practices of acupuncture.

[Objective]The purpose of this study was to gain a clear understanding of adverse events associated with acupuncture (Acp) and moxibustion (Mox) therapies. Thus, we administered questionnaires to orthopedists in order to understand the clinical experience of patients who suffered adverse events.
[Materials and Methods]For this study, 6,000 orthopedic hospitals and clinics were randomly selected from 13,225 hospitals and clinics listed in the telephone directory iTown Page (http://itp.ne.jp). In October 2011 and July 2012, 3,500 and 2,500 questionnaires, respectively, were sent by mail. The questions addressed the following:(1) the respondent's profile (e.g., years of experience as a licensed orthopedist);(2) adverse events associated with Acp, including electroacupuncture;(3) adverse events associated with Mox;(4) use of Acp and Mox therapies in the orthopedist's hospital or clinic;(5) comments on the safety of Acp and Mox therapies. The identity of respondents remained secret.
[Results]The questionnaire response rate was 10.7%. The respondents were licensed orthopedists for 30 ± 11 years (mean ±standard deviation). Adverse events associated with Acp included retained needles and needle breakage (n ≥148), hemorrhages (n ≥ 64), infections (n ≥ 40), organ injuries (n = 28), and so on. Retained needles (≥ 145 out of 148), subcutaneous hemorrhages (63out of 64), arthritis (17 out of 40), and pneumothorax injuries (27 out of 28) occurred most frequently. The adverse events associated with Mox were burn injuries (n ≥ 121), infections (n ≥ 16), and other adverse events (n = 2). Second-degree burn injuries (n ≥ 48 out of 121) and suppuration infections (11 out of 16) occurred most frequently. These were the most common adverse events associated with Acp and Mox. The usage rate of Acp and Mox therapies in the orthopaedist's hospital or clinic was 18.6%. There were many comments on infection control by acupuncturists (n = 27), education and technical levels of Acp and Mox (n = 13), and retained needles and needle breakages (n = 13).
[Conclusion]These survey results reveal that the occurrence of severe adverse events associated with Acp and Mox was higher than our expectation. In order to improve the safety of Acp and Mox therapies, various educational activities to disseminate information about existing safety measures to acupuncturists are needed. Further studies on new preventive measures, continuous surveys, and feedback to acupuncturists are also required.