[Objective]We report herein the use of acupuncture to counteract gait disturbance in a patient with Parkinson's disease (PD). A portable gait rhythmogram was used to objectively demonstrate gait improvements.
[Case]Case:A 72-year-old woman, who a 64 experienced a tremor of the right hand and was diagnosed with PD. Symptoms improved with anti-PD medication, but at 71 years old, she experienced heaviness of the neck and shoulders and stiffness of the anterior thighs, and her step length decreased. Acupuncture therapy was initiated to relieve these symptoms.
Present illness:On examination, she presented a wobbly gait, cold feet, and reported frequent falling. Heaviness in the neck and shoulders extended from the neck to the suprascapular region, and increasing heaviness resulted in a forward-flexed posture and decreased step length. Muscle hypertonia of the quadriceps muscles was bilaterally observed, explaining the perceived stiffness in the thighs. She was at stage III on the Hoehn and Yahr Scale.
Acupuncture therapy:Acupuncture therapy was performed weekly for 12 weeks to alleviate the muscle hypertonia associated with muscular rigidity. Acupuncture points comprised the points in the muscle hypertonia where tenderness was observed, including BL 10, DU 16, ST 32, SP 10 and ST 34.
Evaluation:A portable gait rhythmogram was used to measure the ground reaction force (GRF), velocity and step length. Dynamic balance functions and PD symptoms, were respectively evaluated using the Timed Up and Go Test (TUGT) and Unified Parkinson's Disease Rating Scale (UPDRS). Evaluations were conducted on initial examination and after the 12th therapy session.
[Results]After the fourth session, perceived stiffness in the neck, shoulder region and thighs decreased. all frequency decreased from 5 times/day to 3times/day (4th session) and then once/day (7th session). There were no falls after the 8th session. Reduction in gait disturbance was objectively observed as follows:Increases were observed in GRF (0.15 to 0.17 m/s 2), gait velocity (49 to 53m/min), and step length (47 to 49 cm), while TUGT time decreased (11.8 to 9.5 s). Improvements in PD symptoms were also observed with decreased UPDRS score (41 to 28 points).
[Discussion and Conclusion]The use of acupuncture therapy achieved improvements in Parkinson-related gait disturbance (objectively demonstrated using a portable gait rhythmogram). Acupuncture improved not only gait disorder but also other PD symptoms.

[Objective]To analyze and understand cases of adverse effects of acupuncture and moxibustion published in medical journals between 2007 and 2011.
[Methodology]We searched relevant articles with the Web of Japan Medical Abstracts Society and PubMed. We used keywords for acupuncture, moxibustion and related adverse events.
[Results]We located 39 papers reporting 39 cases that occurred in Japan:infection (7 cases), organ injury (11), foreign body or needle breakage (8), neurological damage (6), cutaneous disease (1), adverse effects of moxibustion (4), and others (2). As for cases published in foreign countries, we located 60 relevant papers:infection (19 cases including 2 outbreaks), organ injury (13), foreign body or needle breakage (5), neurological damage (9), cutaneous disease (5), adverse effects of moxibustion (2), and others (7).
[Conclusion]Although causal relationship has not been established in some cases, occurrences of infection, organ injury, and needle breakage/foreign body are still as high as they were before. This suggests that continual feedback to acupuncturists of information on safety is necessary.

[Objective]To aleviate incidents and prevent medical accidents in acupuncture and moxibustion therapy, we constructed an incident report (IR) system at the Center of Acupuncture Science, Meiji University of Integrative Medicine.
[Methods]The IR system was operated with the center staff as reporters. The staff reported incidents when encountered or found. The cases of incidents were added up per item, and the contents of incidents fed back per month to staff and students. The feedback was given orally at a morning assembly, and a feedback poster was put up.
[Results]There were 146 cases from July 2004 to September 2005. The contents of incidents were 96 cases concerning the environment of treatment, 0for incidents before treatment and 50 during or after treatment. The largest number of incidents in the environment of treatment was 66 cases for inappropriate disposal of instruments. The largest number of incidents during or after treatment was 12 cases in nearly forgetting to remove acupuncture needles from the body.
[Discussion]Ten mean cases per month occurred as incidents. However, it was clear that the incidents in most cases could have been prevented if the acupuncturist had been noticed and took measures to deal with the situation. To prevent medical accidents, we consider a need to continuously feed back the contents of incidents to instructors and students and call them to their attention.

The skin has a special significance in acupuncture. In acupuncture, the skin is both a site of both examination and treatment while providing an interface for information exchange with the external world. Various findings that appear on the body surface should not simply be understood as dermatologic findings, but considered as a reflection of the internal condition of the body, the external world and the mental condition. From this perspective, although acupuncture treatment use only simple stimuli, such as needles, and stimulate only specific sites on the body surface, they can produce therapeutic effects and regulate physical and mental functions
In this symposium, we reviewed the relationship between skin and acupuncture by examining acupuncture and moxibustion treatments for specific dermatologic diseases and their clinical effects. As a result, we were able to reaffirm the above relationship from the perspective of an acupuncturist.
The methods and clinical effects of acupuncture and moxibustion treatment were introduced for atopic dermatitis (by Egawa), tinea unguium (by Dr. Menjou), and the dermatologic symptoms of connective tissue diseases (by Dr. Kasuya). Moreover, Dr. Kagawa presented his research results related to the effects of acupunctural stimulation on the condition of the skin. Based on these research results, the possible effects of acupuncture treatment were discussed based on extensive application in fields such as dermatology, cosmetics, and anti-ageing. Regarding the significance of the skin (body surface) within the practice of acupuncture, it was reconfirmed that the skin reflects the condition of the organs and the mind, and examination of the skin may elucidate both mental and physical health. In addition, we also discussed the body surface as a site of both examination and treatment, and investigated the efficacy, potential for further development, and significance of acupuncture, which connect the skin with systemic functions.

Continued from the previous year's theme of our workshop, we collected various information and ideas for safer acupuncture practice. Subjects and presentations of the present workshop were as follows:
1. Literature review of papers on adverse events published between 2003and 2006
1) Papers in domestic journals (by Ishizaki and Egawa)
2) Papers in foreign journals (by Yamashita and Umeda)
2. Debate on wearing sterilized fingerstall or glove
1) Present status of the use of fingerstall in acupuncture practice (by Katai and Minowa)
2) Practical side of clinical education of acupuncture using fingerstall (by Hatakeyama and Furuya)
3) Problem of using individual fingerstalls in acupuncture practice (by Handa and Miyamoto)
We will continue to provide information and discuss solutions in order to reach a common understanding and specific methods for safer acupuncture practice.

We have been collecting various ideas on safer acupuncture practice from participants in our workshop as well as members of the committee. Subjects and presentations of the present workshop were as follows:
1. Forgotten needles
  1) Ideas of prevention based on a questionnaire survey (Egawa and Ishizaki)
  2) Effect of incident reporting system (Yamashita)
2. Cleaner method of needle insertion and Oshide (needle-supporting fingers)
  1) Merits and demerits of sterilized fingerstall and glove (Miyamoto)
  2) History of the clean needle development (Umeda)
  3) A novel clean acupuncture needle device (Imai and Ishizaki)
Although there was not enough time for discussion, we collected some useful ideas from the participants. A novel clean needle invented by Imai gave a strong impression to the audience. We should continue to discuss a diverse impact when such new devices and concepts become widespread in traditional acupuncture practices. We welcome more ideas and opinions from relevant facilities, clinics and fields in order to further improve safety of acupuncture.

[Aim] Diffuse pan-bronchiolitis (DPB) causes severe respiratory dysfunction and severely limits a patient's daily activities. Case: This paper reports a case of a DPB patient whose respiratory symptoms were successfully improved by acupuncture. In a case report in January 2002, a 62-year-old male visited the Department of Respiratory Internal Medicine at Gifu University Hospital, complaining of cough, pumlent sputum and dyspnea on exercise. His general condition had worsened despite ordinary medical treatment. Thus acupuncture was added to the treatment in August, 2001. Intervention: The patient received acupuncture treatments once a week for 50 weeks. The acupuncture treatment was based on the Chinese medicine theory. Measurements: Outcome measures were respiratory symptoms using the Fletcher-Hugh-Jones (F-H-J) classification, 6-minute walking distance (6 MWD), blood test, arterial blood gas and pulmonary function tests. Computed tomography (CT) was assessed. Each evaluation was done after 15 weeks and 50 weeks later.
[Results] After 15 weeks of acupuncture treatment, cough, pumlent sputum, walking distance, the Borg scale and respiratory function were significantly improved compared with the baseline. Moreover, the effect of the acupuncture treatment continued for 50 weeks.
[Conclusion] This suggests that acupuncture treatment was effective in treating the advanced case of DPB.

We continued reviewing published evidence and information regarding the safety of acupuncture. Subjects in 2005 were as follows :
1. Safety during acupuncture stimulation
2. Quality and strength of acupuncture needle
3. Sterilization and storage of equipments
4. Hygienic handling of equipments
5. Relevant notices from the Government
6. Standards of notification regarding hygienic practice and contaminated wastes
We hope that the information here will influence the future school education, clinical practice, manual editing and research activities.

[Aim] Acupuncture has traditionally been used in Japan in the treatment of bronchial asthma and is being increasingly applied. However, although there are many published studies on acupuncture and asthma, few meet the scientific criteria necessary to prove the effectiveness of acupuncture. Therefore, this study presents the clinical results of acupuncture treatment for adult bronchial asthma.
[Design] Single-subject research design (N-of-1 method).
[Setting] Department of Internal Medicine, Acupuncture and Moxibustion Center, Meiji University of Oriental Medicine, Japan.
[Participants] Six patients of both genders (mean age, 49.0 years old) with moderate-to-severe persistent bronchial asthma.
[Intervention] Six patients received 10 sessions of acupuncture treatment (once per week) for 10 weeks. The basic combination of meridian points for the treatment of the patients were LU 1 (Zhongfu), LU 5 (Chize), LU 9 (Taiyan), CV4 (Guanyuan), CV 12 (Zhongwan), BL 13 (Feishu), BL20 (Pishu) and BL23 (Shenshu).
[Measurements] Primary outcome was the symptom of asthma at the end of the 10 treatment sessions. Secondary outcomes were the Dyspnea Visual Analogue Scale (DVAS), respiratory function, Peak Expiratory Flow Rate (PEFR), blood, the use of asthma drugs. The effect of the intervention on eosinophils in blood was assessed.
[Main results] Late effects of asthma patients showed significantly better results compared with the base line on outcome measures after the 10 weeks. In this study, symptoms of asthma and dyspnea VAS in patients with asthma were significantly improved by acupuncture.
[Conclusion] This study indicated that acupuncture was effective in asthma symptoms and respiratory functions.