[Introduction] Moxibustion on ST36 (Zusanli) has been traditionally practiced and is expected to improve endurance capacity. Therefore, this study investigated the effects of moxibustion stimulation on ST36 before exercise on respiratory metabolism during incremental exercise.[Subjects and Methods] The study included 14 healthy adult males who provided informed consent. A randomized crossover design was employed, with a Moxa period and a Cont (control) period. During the Moxa period, three sessions of moxibustion stimulation (Takashima, Senefa Co.) were applied to bilateral ST36 daily for three consecutive days before the exercise. Incremental exercise loading was performed using a bicycle ergometer. Respiratory metabolism was evaluated at ventilatory threshold (VT), respiratory compensation point (RC), and peak exercise (Peak). Oxidative stress markers, including the degree of oxidative stress (d-ROMs) and antioxidant potential (BAP), were also measured.[Results] During the Moxa period, significant increases (P < 0.05) were observed in Peak exercise parameters compared to the Cont period, including time to exhaustion (Time), ventilation (V・E), workload (Watt), oxygen uptake (V・O2), carbon dioxide production (V・CO2), and oxygen uptake per body weight (V・O2/W). No significant differences in oxidative stress markers (d-ROMs and BAP) were observed between the two periods. However, within the Cont period, a significant increase (P <0.05) in d-ROMs was observed between pre- and post-exercise measurements.[Discussion] At peak, the Time during the Moxa period was prolonged by 5.8% compared to the Cont period, and V・O2/W increased by 4.7%. These results suggest that moxibustion stimulation enhanced aerobic energy metabolism, improved exercise tolerance, and increased overall endurance capacity. Enhancing antioxidant activity before exercise appears to be beneficial. Based on the oxidative stress dynamics observed within each period, it is suggested that moxibustion stimulation may have suppressed significant increases in oxidative stress before and after exercise, potentially contributing to improved endurance.

[Introduction] Work-life balance has become increasingly important in modern society, leading to efforts to promote flexible working arrangements. Acupuncturists have various career options, including self-employment, employment, and freelance work. However, how these work styles impact job satisfaction and work-life balance remains underexplored. Previous surveys have classified acupuncturists' work styles into broad categories such as "self-employment" and "employment." However, recent trends show expanding career opportunities, including roles in sports, education, and beauty industries, as well as multiple job combinations. Additionally, not all licensed acupuncturists work in traditional clinical settings, suggesting diverse career paths. Despite these developments, research on the relationship between work styles, job satisfaction, and quality of life among acupuncturists remains limited. This study explores these factors, aiming to provide insights into how diverse career options influence satisfaction and work-life balance, contributing to discussions on acupuncture career development.[Methods] A cross-sectional study was conducted among currently working acupuncturists. An online questionnaire was distributed with the cooperation of the Japan Society of Acupuncture and Moxibustion, the Japan Acupuncture and Moxibustion Association, the All Japan Acupuncture and Massage Association, and a specific SNS group. The survey included items on gender, years of licensure, work style, working hours, marital status, sense of ease (time, economic, mental, and overall life), and satisfaction (work, life, and work-life balance). Descriptive statistics, chi-square tests, Wilcoxon rank-sum tests, and logistic regression analyses were used to assess factors influencing satisfaction.[Results] A total of 500 responses were analyzed. Work styles were distributed as follows: self-employment (65.6%), employment (25.6%), freelance (5.8%), and other occupations (3.0%). The proportion of participants reporting a positive sense of ease ranged from 58.6% to 76.2%, and those with positive satisfaction ranged from 68.2% to 79.4%. Logistic regression analysis revealed no significant association between work style or years of licensure and satisfaction. However, longer working hours were associated with lower satisfaction in both private life and work-life balance.[Discussion] This study indicates that acupuncturists have diverse work styles, and their satisfaction levels were not significantly affected by work style or years of licensure. The presence of multiple work options allows individuals to choose a work style that suits their circumstances and values, potentially contributing to higher satisfaction and quality of life. Additionally, working hours and financial stability were key factors influencing satisfaction. These findings contribute to discussions on career paths and work styles among acupuncturists.

【Introduction】Thumbtack needles for skin stimulation are used in the field of sports medicine. Their primary therapeutic mechanism is believed to be the increase in regional blood flow mediated by the axon reflex. However, it is not clear at this time whether a medical device (acupuncture device) for skin stimulation significantly increases regional blood flow at the stimulation site. Furthermore, sterile acupuncture needles in which the acupuncture needle body is inserted into the skin with multiple needles (hereafter referred to as Multi-core thumbtack needle) have not been manufactured to date, and their usefulness and potential application for blinding is unknown.【Materials and Methods】A single-blind randomized crossover trial was conducted in 16 healthy adult males. A multi-core thumbtack needle (needle length 0.55 mm, needle base diameter 0.3 mm, number of needles 37, pitch 1.0 mm, made of biosafe resin) was placed in the center of the palmar side of the forearm for 30 seconds, and then one week later they were randomly assigned in a 1:1 ratio to one group to receive stimulation in the same way with a sham needle (a flat disk made of the same material), or one group to receive stimulation in the opposite order. The primary endpoints were the change in regional blood flow (5 min post-stimulation vs. pre-stimulation) and the rate of change at the stimulation site, which were measured using a laser perfusion meter. The secondary endpoint was heart rate. A linear mixed model was used as the statistical method, with a significance level of 5%.【Results】Regarding the amount of change in regional blood flow, sham needles showed a mean of -0.09 (95% confidence interval [CI]: -0.39 to 0.21) mL/min/100g, whereas multi-core thumbtack needles showed a mean of 8.83 (95% CI: 5.86 to 11.79) mL/min/100g, indicating a significant intervention effect (P < 0.001), with no significant period effect (P = 0.474) or carryover effect (P = 0.441). There was no intervention effect on heart rate (P = 0.95).【Conclusion】A significant increase in local blood flow was observed with the use of the multi-core thumbtack needle employed in this study. As this response was not accompanied by a significant increase in heart rate, it is speculated that the effect is primarily mediated by the axonal reflex and the involvement of nitric oxide, as well as somatic-autonomic reflex mechanisms.

Red flags are clinical signs and symptoms that may indicate serious underlying conditions with potentially poor prognosis if missed. Originally established in orthopedic and emergency medicine guidelines, the concept is highly relevant to acupuncture practice, where practitioners often encounter patients without prior medical evaluation. This review summarizes the key red flags discussed in an educational lecture at the 74th Annual Meeting of the Japan Society of Acupuncture and Moxibustion. Common warning patterns include cold sweats, sudden onset of symptoms, and acute events described as obstruction, rupture, dissection, or torsion. Vital signs-such as consciousness level, blood pressure, pulse, respiratory rate, body temperature, and oxygen saturation-are emphasized as essential non-invasive tools for rapid assessment. Symptom-specific red flags are outlined for headache (SNOOP criteria), shoulder pain (cardiac, hepatobiliary, pulmonary causes), low back pain (TUNAFISH criteria), and pregnancy (fetal movement decrease, rupture of membranes, vaginal bleeding). Based on the Acupuncture Safety Guidelines in Japan, immediate cessation of treatment and referral to appropriate medical facilities are recommended when red flags are present. Early identification and appropriate triage by acupuncturists can significantly contribute to patient safety and improve outcomes through timely medical intervention and interprofessional collaboration.

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.

[Introduction] Electrical stimulation is widely used in the field of rehabilitation for purposes such as promoting muscle contraction, enhancing muscle strength, and alleviating pain. In particular, electroacupuncture (EA), a therapy that delivers low-frequency electrical stimulation through acupuncture needles, is commonly used in the acupuncture field and is considered effective for providing direct stimulation to deep tissues. However, detailed evaluations of muscle contraction dynamics induced by EA remain insufficient. The purpose of this study was to quantitatively assess the lateral displacement of muscle and adipose tissues during EA using ultrasound imaging and motion tracking techniques, and to clarify the differences in dynamic behavior among anatomical regions.[Subjects and Methods] Seven healthy young males participated in this study. EA was applied to the medial head of the right gastrocnemius muscle. Longitudinal ultrasound images were obtained, and three 20-second video recordings were collected. Using motion tracking software, lateral displacement was calculated for four regions: fat, gastrocnemius (shallow and deep layers), and soleus. Additionally, gliding distances were defined between fat and the shallow layer (DF), and between the deep layer and soleus (DIF), and their gliding characteristics were compared.[Results] Significant differences were found among the four regions. In particular, the gastrocnemius (both shallow and deep layers) and the soleus showed significantly greater lateral displacement compared to the fat layer. Moreover, a significant difference was observed in gliding distance between DF and DIF, suggesting that EA markedly influences the lateral dynamics of muscle and fascial tissues.[Discussion] This study represents the first objective visualization of muscle contraction dynamics induced by EA. These findings may contribute to the establishment of appropriate application methods and treatment strategies for EA. Future studies involving different muscle groups and stimulation parameters are expected to further expand its clinical applications.

[Background] Recent studies have shown that thermal stimulation involves transient receptor potential (TRP) channels. Moxibustion-like stimulation affects brain function and muscle blood flow, whereas pedestal-based indirect moxibustion (Daizakyu) affects the autonomic nervous system responses. The distribution of thermal stimuli has been better understood thanks to these studies, but it is still unclear what mechanisms underline the sensory reception and related physiological processes.[Objective] This study examines the effects of Daizakyu removal timing on skin surface temperature and thermal perception, with implications for self-care.[Methods] Thirty-eight adult women without cold-related conditions were enrolled in the study. A cold-water immersion test was used one week before the intervention to separate the participants into healthy and impaired peripheral circulation groups. Four smokeless indirect moxibustion cones (Chosei-kyu Non-Smoke; Yamasho, Shiga, Japan) were placed on the EX-UE9 (Baxie) points of the non-dominant hand. Based on prior temperature measurements using plywood, cones were removed at either an estimated skin temperature of 43 °C or the maximum temperature. Thermography was used to monitor skin temperature for 10 min post-ignition, and the average temperature of the five fingers on both the treated and untreated sides was calculated. A 7-point scale was used to quantify thermal sensation immediately following treatment. Comparisons between groups and conditions were also performed.[Results] There were no significant differences in the temporal changes in thermal sensation or skin temperature between the two removal times. However, in both situations, the skin temperature briefly decreased immediately after moxibustion on both the treated and untreated sides when compared to post-adaptation levels. At the 43 °C removal point, both the healthy and peripheral circulatory impairment groups experienced a significant decrease immediately after moxibustion. At the peak temperature removal point, only the healthy group showed a significant decrease, whereas no significant changes were found in the peripheral circulatory impairment group.[Discussion and Conclusion] There were no discernible impacts on skin temperature or thermal perception because of the timing of the platform moxibustion device removal. However, regardless of when removal occurs, the transient decrease in skin temperature immediately after moxibustion points to the central thermoregulatory system being involved. Furthermore, the absence of significant thermal responses in participants with peripheral circulatory impairment suggests that moxibustion-induced responses may be influenced by individual peripheral circulatory functioning.

[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

At the 74th Annual Congress of the Japan Society of Acupuncture and Moxibustion (JSAM), held in Nagoya from May 30 to June 1, 2025, three major international events took place: the Japan-Korea-Taiwan Symposium, an international session on electronic medical records (EMR), and the signing of an academic cooperation agreement between JSAM and the Chinese Medical Association of Acupuncture (CMAA), Taiwan. The tri-national symposium, themed “Acupuncture and Moxibustion for Women's Health through Femcare,” highlighted clinical applications, evidence-based guidelines, and case studies from Japan, Korea, and Taiwan, emphasizing the role of acupuncture in supporting women's health. In the EMR session, experts from Japan and Korea presented on the current status, challenges, and prospects of digitizing oriental medical records, underlining the importance of standardization and interoperability. The academic agreement with CMAA is expected to promote collaborative research, academic exchange, and development in acupuncture and moxibustion education and clinical safety. This report summarizes the key content and outcomes of these initiatives.

From September 27th (Friday) to 29th (Sunday), 2024, the 37th International Council of Medical Acupuncture and Related Techniques (ICMART) World Congress on Medical Acupuncture was held on Jeju Island, South Korea. The congress showcased groundbreaking research in a wide array of foundational and clinical fields related to medical practices centered on acupuncture, with vibrant discussions taking place. Additionally, academic exchanges between Japan and South Korea were conducted, including a joint session organized by the Korean Acupuncture and Moxibustion Medicine Society and the Japan Society of Acupuncture and Moxibustion, which featured a symposium on "Facial Nerve Paralysis". The variety of research presentations from around the world was particularly stimulating. Notably, the follow-up report on a study published in "Nature" concerning electroacupuncture at the ST36 point and its anti-inflammatory effects, as well as a neuroimaging study evaluating changes in neural metabolites in the anterior cingulate cortex of patients with anxiety disorders following electroacupuncture stimulation, were especially impressive. This article reports on the memorable presentations and key topics from the 37th ICMART World Congress on Medical Acupuncture.