Acupuncture and moxibustion therapy in Japan has a long history, and it has developed differently from the Chinese or Korean procedures. The use of a guide tube for the insertion of a fine acupuncture needle without pain, shallow needling and use of intradermal needle without “de-qi” are known as Japanese acupuncture techniques. Our previous study clearly demonstrated variations of the point selection and methods of procedures among the Japan, Korea and Chinese traditional acupuncture therapy on the same subjects. The results obtained by three kinds of traditional acupuncture therapies were also different.   The majority of basic research and clinical trials of acupuncture have used Chinese acupuncture procedure using thick needles with “de-qi” sensation. Participation of the endogenous opioids in relatively intense electro-acupuncture induced analgesia has been well established, but similar analgesia is also induced by stressful stimuli such as electrical foot shock, so opioid-mediated analgesia is not the specific phenomena induced by acupuncture therapy.   Recent literature survey of the Ma Wang Dui（馬王堆）tomb clearly demonstrated the moxibustion (cauterization) was the primitive therapeutic procedure and the meridian concept was established by moxibustion not by acupuncture therapy. On the peripheral mechanisms, various sensory receptors could be activated by acupuncture but receptors responsive to moxibustion are limited. The polymodal receptors (PMRs), which responsive to mechanical, thermal and chemical stimuli, are activated by both acupuncture and moxibustion. They are also responsive to gentle skin scratching and pressure application with blunt acupuncture needle which used as sham acupuncture in recent clinical trials. Sensitization of the PMRs might be a possible cause of acupuncture point formation. These several lines of evidence suggest the PMRs are the key candidates of the action mechanisms of acupuncture and moxibustion. Figure 1 shows schematic illustration of the polymodal receptor hypothesis of action mechanisms of acupuncture and moxibustion.

[Objective]Capsaicin induces flare reaction in the human skin, and repetitive capsaicin applications induce capsaicin desensitization. To investigate the receptors related to flare reaction by acupuncture and moxibustion, we measured pain thresholds and flare reaction in two areas.
[Methods]Thirteen healthy volunteers with informed consent participated in this study. Capsaicin (0.1%) was applied repetitively (6 h/3days) to the forearm skin to desensitize the area. Then, mechanical and heat pain thresholds, flare reactions that induced by acupuncture and moxibustion were measured.
[Results]In the desensitized area, the heat pain threshold was significantly increased but the mechanical pain threshold did not change. Moxibustion induced flare reaction and it was significantly diminished under capsaicin desensitization. On the other hand, acupuncture induced flare reaction and it disappeared completely under capsaicin desensitization.
[Discussion and Conclusion]These results revealed that the flare reaction induced by acupuncture and moxibustion requires TRPV1 activation. For the moxibustion, flare reaction was significantly diminished under capsaicin desensitization but remained significant. Therefore we suggest that TRPV1 mainly mediates the flare reaction but other heat sensitive receptors might be involved in flare reaction. While the mechanical pain threshold was not changed under capsaicin desensitization, flare reaction induced by acupuncture disappeared completely. This suggests that flare reaction is not induced by the mechanical stimuli of acupuncture itself, but other factors such as inflammatory mediators released from damaged cell causing flare reaction by acupuncture.

On this coming June 12, 2009, the 2nd JSAM International Symposium on Evidence-based Acupuncture on "Evidence of the Effectiveness of Acupuncture for Low Back Pain"is to be held in Saitama. We briefly outline the background and expected controversial points in this symposium.
There are three sessions including 1) Present status of RCT research on low back pain, 2) Treatment method for low back pain in China, Korea and Japan based on the database research, and 3) Sham acupuncture. When we assess the effectiveness of acupuncture for low back pain within the realm of Evidence-Based Medicine, the following discussions may be expected:
1) Therapeutic effect of sham needling -are we able to distinguish placebo effect?
2) Masking using sham needle -are we able to conduct double-blind trials on acupuncture?
3) Specific treatment technique -which factors contribute to "more effective acupuncture technique"?
Most of invited speakers are specialists who published their papers on RCT or sham needle in top medical journals in the world. We hope that issues, such as working together with other medical professionals and reflecting evidence to medical policies, to be tackled in the future for the development of acupuncture will become clearer in this symposium.

The purpose of this symposium was to clarify clinical significance of the pulse diagnosis at the wrist used for detecting the function of various organs. Base of the literature survey and his personal experiences, the importance of reliability (reproducibility) test of the pulse diagnosis in blinded manner and necessity of clinical trials with “_??_”-specific intervention was proposed by Ogawa. A unique training program of the pulse diagnosis was introduced by Kido, and he also demonstrated a significant positive result of “_??_”-specific intervention determined by the pulse diagnosis procedure in his program and suggested the clinical significance of the pulse diagnosis. Detection of various changes in pulse waveforms at the wrist using pressure transducer was demonstrated by Maruyama, and he also suggested a possible progress of objectivity in pulse diagnosis by various sensors and biomedical devices in future. From circulatory physiological point of view, factors which may affect the pressure pulse wave at the wrist were explained with several examples of pathologic conditions by Chihara. He also suggested a possibility of reflection of general condition in the pressure pulse at the wrist although it might be partial one, and stressed the necessity of other information for the accurate diagnosis. In general discussion, it was pointed out that evidence of the pulse diagnosis was still limited, and further experimental approaches of the pulse diagnosis will be required.

Effects of acupuncture and moxibustion on chronic pain in human and animals were reviewed. Firstly, the role of sensitization of pheripheral and/or central nervous systems on the mechanisms of chronic pain was introduced based on the basic researches in experimental animals. Secondly, the effects of acupuncture on neuropathic pain and postoperative pain patients were reviewed and its possiblemechanisms were discussed. Finally, effectiveness of acupuncture and moxibustion on several kinds of chronic nociceptive pain (low back pain, neck pain, headache) was systematically reviewed based on the online database