Acupuncture and Moxibustion are useful traditional medicine that are widely applicable for various kinds of health care services including health maintenance, health promotion or palliative care. Conventional medicine has been developed focusing mainly on curing diseases. However, recent changes in the medical structure that is characterized by an increase in the elderly and chronic diseases emphasize the importance of preventive or amenity medicine or medicine that focuses more on welfare services. Since a unitary system of modern medicine was not suitable to respond to these demands, the necessity of medicine that cares for patients with the view point of welfare has emerged. Also, from the viewpoint of holistic medicine, traditional therapies as complementary and alternative medicine (CAM) have been attracting public attention and extending its field of application. These changes suggest the importance of an integrated approach from the viewpoint of patient oriented, holistic, and welfare medicine. We herein discuss the 'Role of Acupuncture and Moxibustion in Welfare'. In order to understand the situation, we need a common point of view to mediate between welfare and medicine with the knowledge of the relationship between these systems. We should discuss how acupuncture and moxibustion medicine can bear the role as well as its possibilities. Outlines of the presentations by invited specialists are as following;Dr. Tadakazu Kumatani will present the relationship between medicine and welfare. He will introduce social workers who support care-at-home or rehabilitation by assisting the patients and their families to solve or regulate economic, psychological and social problems in the health care system as well as their histories. Dr. Ippei Watanabe will state the idea and viewpoint that is common between welfare and acupuncture and moxibustion, and Dr. Tadasu Matsumoto will introduce practical applications of acupuncture and moxibustion in welfare and will state the usefulness and possibilities of acupuncture and moxibustion in the field.
When we view society in the future, medicine is expected to be developed in cooperation with welfare systems. It is necessary for specialists in each field to cooperate. Also, it is necessary to develop a welfare-medical system to provide sufficient services in compliance with demands of each patient, which is based on a firm idea. We would like to suggest role of acupuncture in welfare systems as well as its future and ideas.

[Objective] There are two types of image the students have towards elderly people, positive and negative, and it is thought to be difficult for students to interact with elderly people when negative images are the most powerful. Changes in the students' feelings towards elderly people during their time in a nursing home are of importance when assessing the project's educational effectiveness. Given this factor, we have researched the changes in the students' impression towards elderly people before and after the project.
[Method] We carried out a research questionnaire before and after the project.
[Results] Number of valid response was 106 before the project (response rate 89.8%), and 56 after the project (response rate 47.5%). Over half (56%) of the students said that their image of elderly people changed after the project. Negative image comes from realising elderly people's physical disability and difficulty in having conversations with them, and positive image comes from understanding elderly people more by interacting with them.
[Conclusions] Although there was a growing awareness of elderly people and some of the students changed their feeling towards them, there are still students who have a negative image. We think that it is important to provide methods of approaches before and during the project to minimise these negative images.

[Purpose] We report a case treated by acupuncture in a health care facility for the elderly to evaluate the effect of acupuncture on severe pulmonary emphysema.
[Case and methods] A 88 year-old man visited Meiji University of Oriental Medicine Hospital with dyspnea in March 2000 and was diagnosed with pulmonary emphysema. He was hospitalized in October 2002 because his chronic respiratory failure was worsening : oxygen therapy was started. After discharge from hospital, he entered a health care facility for the elderly and acupuncture treatment for lumbago was initiated. Thereafter, acupuncture treatment for dyspnea and stiff shoulder started. He was determined to be grade V according to Fletcher-Hugh-Jones classification of dyspnea. Spirometry of the patient before acupuncture for dyspnea showed 88.0 % in %VC, 38.2 % in FEV 1 %, and 30 % in %FEV 1, and the patient was diagnosed with chronic obstructive pulmonary disease of serious grade. Acupuncture treatment was performed once or twice a week, and acupuncture treatment for dyspnea was performed 21 times (total of 33 treatments).
[Results] Subjective symptoms of lumbago, stagger of the legs, and shoulder stiffness were evaluated with Numerical Scale or Pain Scale. The state of dyspnea was evaluated with Numerical Scale and Borg Scale, and exercise tolerance was evaluated with 6 min of walking. After 33 acupuncture treatments, dyspnea on exertion, exercise tolerance, and the findings of spirometry were not improved. But dyspnea on rest had disappeared with improvement in lumbago, stagger of the legs, and shoulder stiffness. These results indicate that acupuncture as a general treatment is effective for the improvement of dyspnea, especially in elderly patients whose general state of health is not good because of restriction in their ability to exercise in the course of daily life due to dyspnea of exercise such as lumbago, stagger of the legs, and shoulder stiffness.

[Objective] The effect of indirect moxibustion on cold symptoms was examined in elderly subjects living in a nursing home.
[Design] A single-case experimental design that enables clinical trials in small a number of subjects was used in this study.
[Methods] Two elderly subjects living in a nursing house participated for 16 weeks. The experimental periods were allocated at random as treatment periods and control periods of eight weeks each. During the treatment periods, subjects were treated with indirect moxibustion GV 14 and BL 12 (both sides) 3 units each, 3 times a week. Rating scores with 4 and/or 5 grades were used to evaluate common cold symptoms.
[Results] Concerning the presence of common cold, there were no significant differences between the treatment and control periods. Moreover, concerning common cold symptoms, there were no significant differences between treatment and control periods.
[Conclusion] Effects of an indirect moxibustion on the common cold symptoms were not detected in this study. We speculated that the living environment of these subjects and the intensity of stimulation were factors. Furthermore, we suspected that a single-case experimental design was unsuitable for common cold research.

Objective : To investigate the utilization of Acupuncture and Moxibustion therapy (AMT) in nursing homes (NH), we gathered information through questionaires.
Method; We sent questionaires to 1, 237 NH that were in 6 prefectures in the Kinki area and 5 prefectures in the Kanto area.
Results : We obtained replies from 321 NH (26%). Sixteen NH (14%) were already utilizing AMT, 9 NH were planning to utilize AMT soon and 79 NH were considering utilizing AMT sometime in future. The results suggest that AMT utilization will increase in 46 NH which are already utilizing it, 22 NH (48%) employed acupuncturist and other nursing homes relied on volunteers or visit. About 1/3 of NH had privaterooms for AMT while the other NH had a rehabilitation room which also serves as an AMT. The cost of AMT was borne directly by patients in 8 NH (7%) while it was free in 29 NH (52%) and paid by public funding or medical insurance in 14 NH (30%). One reason for non-utilization of AMT is the costs for treatment and or personnel. Another reason is that questions remain about the necessity of AMT and its effects on disease. The most apparent of AMT in nursing homes were improvements in activity of daily living (ADL), feeling and expression. On the other hand, the problems of AMT in NH were time limits for treatment, indistinct effects, AMT and cost.
Conclusion : Given these results, we concluded that to promote the utilization AMT in NH, it is necessary to instruct elderly residents as well as medical doctor, nurses and workers in NH, about AMT.

To clarify the effect of acupuncture on the skeletal muscle blood flow, measurements of muscle blood flow by hydrogen gas clealance method were taken on the left anterior tibial muscles of thirty rabbits (weighing about 2.5 to 3.3 kg) anesthetized with pentobarbital sodium (35mg/kg, i.v.). Arterial blood pressure in the common carotid artery and body temperature were also measured.
Blood flow was measured 6 times every 10 min. In the stimulation group, acupuncture needles were inserted into the center of the anterior tibial muscle before the third measurement and “sparrow pecking” was performed, then the needles were removed. In the denervation group, the sciatic nerve was cut to observe the influence of denervation on the effect of acupuncture.
In the stimulation group (n=12), a significant increase in blood flow to the muscles occurred after acupuncture stimulation, compared with the control group (n=12). The increase in blood flow in the stimulation group was maintained until the final measurement. Arterial blood pressure and body temperature did not change.
The blood flow values in the second and third measurements were 18.1 ± 2.2, and 17.6 ± 2.4, respectively, in the control group, and 17.8 ± 1.8 and 25.9 ± 2.2 ml/min/ 100g (mean ± S.E.) in the stimulation group. The changes in blood flow values from the second to the third measurement were -0.5 ± 0.3 ml/min/100g in the control group, and +8.2 ± 2.0 ml/min/100g in the stimulation group. An increase in blood flow after acupuncture stimulation also occurred in the denervation group (n=3).
Despite there being no change in arterial blood pressure. blood flow was increased after acupuncture stimulation, and the increment of blood flow after acupuncture stimulus was also observed in the denervation group. Therefore, the increment of blood flow seems to have been caused by vasodilation of the blood vessels induced by axon reflex.

Health conditions were surveyed among elderly persons (over sixty five years old) living in two towns in Kyoto prefecture in 1994. In this study, a second survey of symptoms was conducted among elderly persons in one town, and ADL (activity of daily living) disorders were simultaneously surveyed. Questionnaires were distributed and collected by mail. Nine hundred and thirty five elderly persons completed and returned the questionnaires.
Upon investigation it was found that the elderly living in this town had many symptoms and ADL disorders. The incidense of these symptoms was over two times greater than the mean value in the general elderly population nation wide. Symptoms noted included low back pain (43%), shoulder stiffness (34%), low back and lower limb pain (25%), knee joint pain (24%), heavy sensations in the lower limbs (24%), numbness (22%), heavy sensations in the low back (18%), shoulder pain (18%), foot pain (16%), lower thigh pain (13%), thigh pain (11%) and arm pain (11%) in descending order of frequency. Concerning ADL disorders, pain while going up or down stairs (34%), slight pain while walking (28%), difficulty while walking without stopping to rest (19%), impossibility in walking due to pain (5%) were also reported by many elderly people.

[Purpose] It is generally known that the acupuncture treatment to the low back is useful for lumbagoand lower limb pain. It is considered that improvement of blood flow to the muscle, connective tissue and/or nerve is associated with the effect of acpuncture. However, the effect of acupuncture on blood flow to the nerve has not clarified. So, this study was performed to clarify the effect of acupuncture on microcirculation in the sciatic nerve trunk.
[Method] Twenty-nine rabbits (weighing 2.1 to 3.5kg) were used. The rabbits were anesthetized withpentobarbital sodium (30mg/kg, i.v.). Then, the sciatic nerve was exposed and an electrode for blood flow measurement was inserted in the interfascicular space. An catheter was inserted into the common carotid artery to measure blood pressure, and thermister thermometer was placed in the anus to monitor body temperature. Blood flow was measured 6 times every 15 min. by the H2 gas clearance method. In the stimulation groups, acupuncture needles were inserted 1 cm from interspinous process (between the vertebra lumbalis 3 and 4. : A group, and between the vertebra lumbalis 7 and vertebra sacralis 1. : B group). Acupuncture stimulation by the “sparrow pecking” was performed immediately before the third measurement and by the “retaining needle” for 15 min., then the needles were removed just before the fourth measurement.
[Result] S In the stimulation groups (A and B groups), a significant increase in blood flow occurred afteracupuncture stimulation, compared to that in the control group. The increase in blood flow to the sciatic nerve in the stimulation groups was maintained until the final measurement. Arterial blood pressure and body temperature did not change. The changes in blood flow values from the second to the third measurement were -1.5 ± 0.4 (mean ± S.E, ) in the control group (n=10), +2.4 ± 1.2 in A group (n=11), and +4.0 ± 2.0 ml/min/100g in B group (n=8).
[Discussion] Blood flow increased after acupuncture stimulation, although there was no change inarterial blood pressure. Therefore, the increment in blood flow seems to have been caused by vasodilation of the blood vessel in the sciatic nerve trunk due to a parasympathetic nerve response. However, because the interfascicular blood flow in the present study was measured, change in the intrafascicular blood flow is not clear. It is necessary to measure the intrafascicular blood flow in future.
[Conclusion] As a result of this study, it was demonstrated that acupuncture stimulation near the vertebra lumbalis induced increased interfascicular blood flow to the sciatic nerve trunk. It was suggested that the increase in blood flow to the nerve is also associated with the effect of acupuncture treatment for lumbago and lower limb pain.

Acupuncture has been recognized as an useful treatment for muscle pain, muscle fatigue and muscle hypertonus in sports medicine. This study developed an experimental model to investigate the effect of acupuncture on muscular disorders.
Twenty-seven rabbits, anesthetized with pentobarbital (i. v.) were used. The anterior tibial muscle was exposed, and the distal end of the tendon was cut then attached to the push-pull gauge and tension during the isometric contraction induced by electrical stimulation of the muscle was recorded.
The tension was measured immediately before and 15, 30, 45 and 60min after the electrical stimulation. The frequencies of 1, 10, 20, 30, and 50Hz were used as the conditioning stimulation (1ms in duration, 60s).
Tension was decreased after the conditioning electrical stimulation of muscle. High frequency of stimuli tended to induce a marked decrease in tension.
Acupuncture stimulation (leaving the needle in place for 10min) reduced the decrement of the evoked tension by 30Hz tetanic stimulus significantly (p<0.05), and enhanced the recovery. Occlusion of the blood vessel supplying the muscle potentiated the decrement of evoked tension, and acupuncture stimulation still reduced the initial decrement of the evoked tension, suggesting that acupuncture acted on the blood flow in the muscle. After transection of the nerve innervating the muscle, acupuncture stimulation still demonstreted the same effect.
These results suggest that the acupuncture stimulation induces vasodilatation by axon reflex and the subsequent increase in blood flow to the muscle induces the recovery of reduced tension by tetanic contraction.