[Objective]The purpose of this study was to investigate the effects of manual acupuncture stimulation (MA) on motor evoked potential (MEP) induced by transcranial magnetic stimulation (TMS).
[Methods]The subjects were 10 healthy volunteers who gave oral and written informed consent. Experiment 1. MEPs were induced from the right abductor digiti minimi muscle (rADM) by TMS with a circular coil to the left cortex motor area and were measured before and after MA to the right LI4 (right Hoku point), left LI4 (left Hoku point), right LR3(right Taichong point) or left LR3(left Taichong point). A sparrow pecking technique (1 Hz for 1 minute) with a stainless steel needle (40 mm long, 0.18 mm in diameter, Seirin co., Inc, Shizuoka) was used for MA. The subjects received the same experiments four times with MA to different acupoints on a different day. Experiment 2. MEPs were measured during imaging of rADM and lADM contraction and immediately after noxious pinch stimulation to the skin on the right LI4 and left LI4 and right LR3and left LR3respectively. Repeated measure two-way ANOVA was used for statistical analysis to compare between all groups. Repeated measure one-way ANOVA and multiple comparison (Dunnett's test) were applied to time point data in each group.
[Results]MA to the left LI4 or right LR3was significantly decreased MEP (P < 0.01, respectively). In the right LI4, there was a tendency to decrease of MEP, but not significantly (P = 0.26). Most subjects answered feeling severe or strong acupuncture needle sensation. MEPs were significantly increased by imaging of contraction and noxious stimulation (P < 0.001 and P < 0.01, respectively).
[Conclusion]These results suggested a possibility that distant acupuncture stimulation would suppress motor activity via several roots and that an acupuncture inhibited effect was compensated by facilitation arising from the concentration to the stimulated hand.

[Objective]To survey the current situation of infection control in clinical practice of acupuncture and to discuss the problems and strategy.
[Methods]The subjects were 1,000 acupuncture clinics enrolled in iTownPage in the Chubu region. The questionnaire was sent to them by mail in November 2008. The questions were the following; 1) Profile of respondent, 2) Hand hygiene, 3) Preparation of needling sites, 4) Sterilization and storage of needles and equipment and disposable products, 5) Disposable needle, 6) Hand-pressing (Oshi-de), 7) Infectious waste, 8) Awareness, efforts and self-evaluation of practitioner for infection control, and 9) Comments of this survey.
[Results]The collection rate was 22.2%. Washing time for less than 30 sec was 31.1%, Usage rate of a cloth towel was 67.7%, Hand antisepsis by the basin method was 18.9%, Usage rate of 50 %isopropyl alcohol was 19.8%, etc. 26.6%of all respondents answered that the possibility of infection in acupuncture and moxibustion therapy was very low and 50.9%of those responded that it was low. However, only 27.0%of the responders answered that infection control in their own clinics was appropriate. In addition, 72.5%of the responders belonged to the Japan Acupuncture and Moxibustion Association (JAMA) or the Japan Society of Acupuncture and Moxibustion (JSAM).
[Conclusion]Although some infection controls have been improved, many problems became clear. These problems are suggested to be caused by poor acknowledge, previous experience and wishful thinking of practitioners. It is necessary to continue activities to raise practitioner's awareness for infection control.

We have been utilized acupuncture and moxibustion in our department of internal medicine at Meiji University of Integrative Medicine since its investment in 1987. In the department, various kinds of symptoms in the field of internal medicine have been managed with acupuncture and moxibustion. In this article, I would like to introduce our activities regarding acupuncture treatment in the department of internal medicine and some remarkable results of our clinical studies which evaluated effects of acupuncture and moxibustion as well as relationship between acupuncture therapists and the staff of our department. In the field of respiratory disorders such as COPD or bronchial asthma, usefulness of acupuncture have been proved through a controlled clinical trial which involved COPD patients who had not been able to control with standard care. Also, acupuncture was found to be useful in the management of bronchial asthma in a case series study in which acupuncture treatment was repeatedly applied with intervals without acupuncture. We have also demonstrated that acupuncture was useful for gastrointestinal disorders such as irritable bowel syndrome (IBS). Results of a case series with n-of-1 study design showed significant reduction in the symptoms during acupuncture treatment, while those in the period without acupuncture had been aggravated. Data from studies on diabetic complications such as peripheral neuropathy or gastropathy also showed usefulness of acupuncture. We considered that it is valuable to explore unknown usefulness of acupuncture in the field of internal medicine and prove effectiveness of acupuncture with appropriate scientific manner.

An educational video describing the acupunctural stimulation of the pudendal nerve for treatment of urinary disturbances was produced. Treatment points on the meridian were selected within the limits of the top 1/2 to 3/5 of the line that connects the superior posterior iliac spine and the inner lower edge of the ischiatic tuberosity. Since the pudendal nerve is situated between the sacrospinous ligament in this region, it could be readily stimulated from the body surface. A 90mm (#24) acupuncture needle was used for the treatments. When the needle was inserted to a depth of 50-80mm from the body surface, the pudendal nerve was reached. Echo sensation in the penis indicated that the acupuncture needle had contacted the pudendal nerve.
Either the sparrow-pecking, needle-twisting, or the low frequency acupunctural techniques were used to delver stimulation to the pudendal nerve. In conclusion, acupunctural stimulation of the pudendal nerve was clinically useful for treatment of urinary disturbances, such as uncoordination of the detrusor muscles in neurogenic bladder and urinary incontinence.

Temporomandibular arthrosis, whose major symptoms are trismus, pain of the temporomandibular joint and articular noise, has recently been increasing, primarily in younger people. This condition is often accompanied by unexplained complaints (e. g., headache and stiffness of the neck and/or shoulder) which are indications for the application of acupuncture therapy. To deepen the recognition of temporomandibular arthrosis by clinicians, we recently prepared a video tape showing detailed procedures of acupuncture therapy for this disease. The first half of this video tape consists of an explanation of the anatomical features of the temporomandibular joint, the pathophysiology and classification of temporomandibular arthrosis, and magnetic resonance images of the temporomandibular joint. The latter half consists of the diagnostic and therapeutic procedures for this disease, including the acupoints often stimulated for its treatment and the techniques of acupuncture therapy.

Acupuncture anesthesia is not often used in dental practices because its efficacy depends on various conditions. However, pain-relieving methods, which use no medication, are necessary for those rare patients who are hypersensitive to local anesthetics or for whom local anesthetics are difficult to use because of diseases of the internal organs of the nervous system. In a patient hypersensitive to local anesthetics, we recently attempted to relieve the pain during extraction of an impacted lower third molar by applying acupuncture anesthesia, after relaxing the patient both physically and mentally with acupoint stimulation. By these methods, pain control for this patient was successful during and after surgery, without medication.

A new therapy was recently developed by combining low frequency in situ needle acupuncture with Body Sonic Pad therapy. With this therapy, the patient lies on a bed fitted with Body Sonic Pads which vibrate slightly, in synchrony with the low-pitched sounds of the music which is played during the therapy. The patient listens to music and can feel the music-synchronized vibration of the pads while receiving in situ needle acupuncture. We recently assessed the effectiveness of this combined therapy.
The subjects were 30 patients with chronic shoulder stiffness who visited our department of anesthesiology. These patients received each of the following 5 treatments at different times in random order: (1) Method M (listening to music without any other therapy), (2) Method B (Body Sonic Pad therapy without listening to music), (3) Method MB (Body Sonic Pad therapy while listening to music), (4) Method L (conventional continuous low-frequency (3Hz) in situ needle acupuncture), and (5) Method MBL (continuous low-frequency (3Hz) in situ needle acupuncture combined with Body Sonic Pad therapy while listening to music). The direct therapeutic effect and the degree of comfort during treatment were compared among these five methods. The acupuncture therapy for shoulder stiffness consisted of stimulating the standard points in the shoulder and neck region with 30mm acupuncture needles (No. 20). The electrical stimulation lasted for 20 minutes. The music used for Body Sonic Pad therapy was primarily classical music selected according to the desire of the patients. The effectiveness was rated by the patients on a 4-point scale (markedly effective, effective, slightly effective and ineffective). Effective or markedly effective cases were regarded as responding to the therapy. The level of comfort during treatment was rated on an 11-point scale.
The number of patients who responded to the therapy was 7 (23%) for Method M, 6 (20%) for Method B, 10 (34%) for Method MB, 18 (60%) for Method L and 23 (77%) in Method MBL. The response rate was significantly higher for Method MBL when compared to Method M or MB. The mean level of comfort during treatment (rated on a visual analog scale; 0=most uncomfortable; 10=most comfortable) was 6.3±2.1 for Method M, 6.0±2.1 for Method B, 7.0±1.6 for Method MB, 7.2±1.9 for Method L and 8.3±1.6 for Method MBL. Thus, low frequency in situ needle acupuncture combined with Body sonic Pad therapy was slightly superior to the other therapies.

During the 23 years since this pain clinic was founded, 29, 458 patients have been treated here (about 385, 000 patient visits in total). In the earlier days, patients with whiplash injury (posttraumatic neck syndrome) were predominant. More males than females visited our clinic in those earlier days. Several years after this clinic opened, the percentage of female patients became higher (55% or more) than the percentage of male patients. Reflecting the social trend of an increase in the percentage of elderly people in the total population, the percentage of patients between 60 and 80 years of age has been increasing. Patients who visit this clinic live primarily in Osaka Prefecture. However, it is not uncommon that patients living in other prefectures of the Kinki district visit this clinic. Although patients visit our clinic because of various complaints, they often suffer from chronic, intractable complaints, such as low back pain, combined pain of the lower back and legs, and postherapuetic neuralgia. They often visit our clinic as a last resort for healing, after having consulted many other institutions. The duration of sickness among patients who visit our clinic is long (often over 5 years). Although the methods of treatment and the patients' responses vary, depending on their diseases, the combination of nerve block with acupuncture seems to be more effective on pain. We have utilized various techniques of acupuncture, including the in situ needle acupuncture, low-frequency therapy, SSP therapy, laser therapy and hyperthermia.