The Japan Society of Acupuncture and Moxibustion (jsam)

Japanese Acupuncture

HOME > Japanese Acupuncture

2011 Tokyo Declaration on Japanese Acupuncture

2011TokyoDeclaration on Japanese Acupuncture

¾ TowardBetter Healthcare in Japanand the World in the 21st Century ¾


June 19, 2011

I. Preface 

The TokyoDeclaration on Japanese Acupuncture was adopted after due deliberation in the60th Annual Congress of the Japan Society of Acupuncture and Moxibustion andthe 39th Annual Congress of the Japan Traditional Acupuncture and MoxibustionSociety, both held on June 19, 2011, under the theme °»Wisdom of JapaneseAcupuncture and Moxibustion Concerning the Mind and Body.°… The Congresses weresponsored by the Ministry of Health, Labor, and Welfare; the Japan MedicalAssociation; the Foundation for Training and Licensure Examination inAnma-Massage-Acupressure, Acupuncture, and Moxibustion; the Japan Acupuncture andMoxibustion Association; Zen Nihon Shinkyu Massage Shikai; the Japan CollegeAssociation of Oriental Medicine; the Japan Society for Oriental Medicine; The National Society of the Principals of the School for the Blind; JapanAssociation of Massage & Acupuncture Teachers; All Nippon Hospital PhysicalTherapy Association; the Japanese Society of Oriental Physiotherapy; theJapanese Society of Ryodoraku Medicine, and the Japan Conference of ClinicalAcupuncture Moxibustion.


TheDeclaration was prepared by the Drafting Committee of the Tokyo Declaration onJapanese Acupuncture composed of twenty Japanese scientists in related fields.The committee's deliberations began in early 2010 and the first draft waspublished on the website of the Japan Society of Acupuncture and Moxibustion inMay 2011 for collecting public comments. The second draft prepared by theDrafting Committee was presented at the above-mentioned Congresses.


TheDeclaration was addressed to national governments of the world, relatedassociations and academic societies, and the general public, and presents the currentdistinctive characteristics of Japanese acupuncture and moxibustion based on theirhistorical background. It aims to promote the further advancement ofacupuncture and moxibustion as a component of medicine (or healthcare) in theworld.



II. Background


Acupuncture andmoxibustion began almost 2000 years ago when the first comprehensive ancientChinese medical text °»Huangdi Neijing(YellowEmperor's Classic of Internal Medicine°… was written. Thetheoretical system of °»Huangdi Neijing°…is followed by the basic theories underlying current Japanese acupuncture andmoxibustion practices: yin-yang theory, five phase theory, viscera and bowels, meridians,pathogenesis, and the principle of treatment. The system of medicine practicedby the Han people who lived in the YellowRiver basin in China has been pervasive incultures using Chinese characters and has long played an important role in healthmaintenance and treatment of diseases in East Asian countries.


Although acupunctureand moxibustion were formally introduced into Japanin the 6th century, Chinese medicine probably came to Japan via the KoreanPeninsula earlier, since people in Japan and the Peninsulahad been interacting with each other prior to the 6th century. Acupuncture andmoxibustion as a branch of Chinese medicine was officially adopted in Japanbefore the Nara Period (AD 710 – 784) as evidenced by the presence of the medicalsystem Ishitsuryo in the Taiho Ritsuryo (Taiho Code), which wasenacted in AD 701. The Ishitsuryo atthat time stipulated a 7-year period of training to qualify as an Acupuncturistor doctor of Acupuncture.


SubsequentlyJapanese acupuncture and moxibustion were repeatedly devised, improved andadapted to the Japanese climate and culture as well as characteristics andthought of the Japanese people, thereby evolving into the classic form ofmedicine in Japan known as Kampomedicine by the Edo era (AD 1603 – 1868). Moreover,it persisted to the present time as part of the cultural heritage of Japan.In the Meiji era (AD 1868 – 1912), inspired by the slogan fukoku kyohei (rich country, strong army), various measures andpolicies were implemented in all sectors of society. In the medical care sector,with the advent of Western medicine, there was a decline in the esteem withwhich Japanese acupuncture and moxibustion medicine was held as the classic formof medicine. However, Japanhas preserved its unique form of acupuncture and moxibustion medicine by eclecticallyassimilating the principles of Oriental medicine and Western medicine andsystematically organizing the both. In recent years, Japanese acupuncture andmoxibustion medicine has developed further into a comprehensive form ofmedicine by incorporating new findings in modern Chinese and Korean medicine aswell as modern Western medicine (Footnote 1).


Diversity is adistinctive characteristic of Japanese acupuncture and moxibustion medicine, owingto the willingness of Japanese practitioners to provide healthcare that utilizesvarious theories according to the complex structure of the human body.Currently in clinical settings, acupuncture and moxibustion are available asmedical care that aims to enhance the natural healing ability of the human bodyas well as takes advantage of examination techniques used in both Oriental andWestern medicine for individualizing treatment.


Because ofthese diverse characteristics, acupuncture and moxibustion medicine has beenattracting the attention of medical institutions in Japan, and then opportunities tocooperate with Western medicine are increasing. Underlying this trend could bethe recognition and acceptance of acupuncture and moxibustion treatment by practitionersof Western medicine.


Kampomedicine and acupuncture and moxibustion, which had played a pivotal role inJapanese medicine until the end of the Edo Period, were supplanted by Westernmedicine during the Meiji Period. Consequently acupuncture and moxibustion wereplaced outside the national healthcare system and laws applying to them weredeveloped separately. In the late Meiji Period, a license system foracupuncture and moxibustion practice was instituted. After World War II, theJapanese government ordered a ban on acupuncture and moxibustion in accordancewith recommendations of the General Headquarters of the Allied Forces (GHQ).However, the order was withdrawn in the wake of intensive opposition byscholars and practitioners of acupuncture and moxibustion, resulting inenactment of the law which led to the present Act for Practitioners of Massage,Finger Pressure, Acupuncture and Moxacauterization, etc. Since 1988, acupuncturistsand moxibustionists have been licensed by the Minister of Health, Labor, andWelfare (Footnote 2).


Acupunctureand moxibustion education was based on an apprenticeship system before theMeiji era and an institutionalized school system during and after the Meiji era.Specifically since 1947, the laws have undergone multiple changes. Todayacupuncture and moxibustion training is provided at vocational colleges and4-year colleges to those who graduate from senior high schools. Licenses aregranted to those who finish the required college course and pass the nationalexaminations for acupuncturists and moxibustionists (Footnote 3).


The currentcurriculum for acupuncture and moxibustion in Japan is based on a Westernmedicine model and includes specialized subjects such as acupuncture and moxibustion.Thus, the mentality and thought of the Japanese people are combined with thoseof Western medicine to serve as a basis not only for the diversification ofmedical practice which is characteristic of Japanese acupuncture andmoxibustion, but also for the promotion of complementary medicine andintegrated medicine.


A number ofbasic studies on acupuncture and moxibustion medicine have been published in Japan.These elucidate the mechanism of action as well as provide a certain amount ofevidence of efficacy. These findings should be disseminated throughinternational academic exchanges, thereby contributing to the advancement ofbasic research on acupuncture and moxibustion on a global scale. In clinicalresearch, rather than randomized controlled trials to assess the efficacy ofacupuncture and moxibustion are performed. Moreover it is recommended that clinicalstudies be designed in accordance with the innate characteristics ofacupuncture and moxibustion to explore the unique clinical efficacy ofacupuncture and moxibustion, and their results should be published.



III. Current Status


The medicalcare system in Japanis modeled solely on Western medicine. Although acupuncture and moxibustion andmedicine are separate systems, acupuncturists and moxibustionists have the sameright to practice as physicians and dentists. Hence acupuncturists andmoxibustionists may privately practice acupuncture and moxibustion for purposesof health maintenance and promotion and the treatment of disease, and play a distinctiverole in the healthcare system of the Japanese people.


Even thoughthe Western medicine-based healthcare system is well established in Japan,acupuncture and moxibustion have a unique role because they are practiced fromboth an Oriental and Western medicine perspective. Thus, Japanese acupunctureand moxibustion are widely used to treat a range of diseases and symptoms1–10)(Footnote 4).


Because therapeuticmeasures do not require sophisticated equipment, acupuncture and moxibustioncan be performed in rural areas with inadequate medical facilities as well as insituations where medical facilities have become nonoperational. For instance,after the devastating Great East Japan Earthquake on March 11, 2011, acupuncture andmoxibustion treatment was offered to victims to maintain and improve theirhealth.


Even in asociety where highly sophisticated medical technologies are widely available,medical care that is familiar and readily available to people is still necessary.In this regard, acupuncture and moxibustion can perfectly fulfill this need,provided that their usefulness is well supported by mounting academic evidence.


Today in Japan,acupuncture and moxibustion are actively studied and the number and quality of researchpapers is increasing.11–15) Areas of research have also beenexpanded to include medical education, classical diseases, gynecologicaldiseases, geriatric diseases, and cancers. Acupuncture and moxibustion researchin Japanhas thus been advancing; however, research findings have not been adequately disseminated.Hence international exchanges of information will be needed to advance thepractice of acupuncture and moxibustion medicine as well as promote research.In addition, improved systems of education, training, and the like should beimplemented to improve practical techniques and the quality of acupuncture andmoxibustion medicine available to the people of Japan.


In clinicalpractice in Japan,many acupuncturists are using minimal invasive methods involving soft andtender stimulation such as thin needles, shallow insertion, and stimulation to skinwithout needle insertion, which have been well received by patients. Suchacupuncture techniques have been appreciated globally.


Diagnostically,palpation is valued; most acupuncturists touch the skin and select acupuncturepoints and treatment sites on the basis of the responses of patients. Consequentlyacupuncture and moxibustion are increasingly thought of as individualizedtreatments.


On the otherhand, in Europe and the U.S., large-scale clinical studies that are not clarifyindividualized treatment have been conducted in recent years.16, 17)Although the efficacy of individualized treatment has been demonstrated in someJapanese studies,18, 19) the evidence remains inadequate. UnlikeWestern medicine which has an emphasis on etiology, acupuncture and moxibustiontreatment takes various entangled factors into account. Hence it is not easy tofind specific efficacy in current clinical research settings.


Consequently,a methodology of clinical research which focuses on characteristics ofacupuncture and moxibustion is needed. Specifically for Japanese acupunctureand moxibustion which use soft and tender stimulation, it is critical todevelop study designs as well as new technical methods to evaluate the efficacyof interventions involving individualized treatment as a main component. Suchefforts should academically contribute to modern medicine focus onindividualized medicine. Thus, there is an urgent need to publish highlydetailed results of clinical research on acupuncture and moxibustion.



IV. Future Issues andProposals


1.Future Issues


Japaneseacupuncture and moxibustion date back more than 1000 years when the acupunctureand moxibustion therapy of ancient Chinamigrated to Japan via the Korean Peninsula.Devising unique techniques to suit the Japanese climate and the individualneeds of the Japanese people and even integrating Japanese acupuncture andmoxibustion with the newly introduced methods of modern Western medicine have resultedin distinctive practices. With globalization of acupuncture and moxibustion,all professionals responsible for Japanese acupuncture and moxibustion shoulddeepen their knowledge of Japanese acupuncture and moxibustion as well as sharetheir knowledge and experience globally.


In clinicalsettings, commonalities of diversity should be clearly identified. To this end,focus should be placed not only on techniques of diagnosis and treatment butalso on body view, philosophy, professionalism, mission and sense of ethicswhich underlie acupuncture and moxibustion, so as to establish a consensus viewof the entity of Japanese acupuncture and moxibustion.


As a matterof course, acupuncture and moxibustion should contribute to prevention andtreatment of disease. In addition, if death is the consequence of life,Japanese acupuncture and moxibustion should address not only the quality ofhealth, but also the quality of processes leading to death (i.e., quality oflife) in an aging society. Data must be gathered on demerits of medical carewithout acupuncture and moxibustion and merits of medical care with acupunctureand moxibustion.


With regardto research, approaches that not only focus on some local responses toacupuncture and moxibustion stimuli, but also evaluate holistic responses occurringin mind and body should be promoted. Besides, efforts should be made to improvethe quality of evidence (i.e., by conducting randomized controlled studies),and research using epidemiological techniques should also be conducted todemonstrate that acupuncture and moxibustion contribute to the treatment of mibyo (the presymptomatic state).


Meanwhile, withrespect to research methodologies including control group selection,interindividual differences, and difficulties arising out of the clinical trialenvironment should be actively discussed. In the past, a press report onacupuncture anesthesia triggered intensive research on pain, resulting in aquantum leap forward in that area. Likewise, it is expected that there will bemore discussion about reactions to weak Japanese acupuncture and moxibustionstimuli and the placebo effect. The Japan Society of Acupuncture andMoxibustion along with individual researchers are obliged to disseminate thesenew findings and concepts.


In the areaof education, a core curriculum should be drawn up for human resourcedevelopment. However, not only knowledge and technique, but also following thephilosophy of Japanese acupuncture and moxibustion needs to be clarified. Andthe quality of instructors needs to be enhanced to ensure the quality ofeducation. To this end, postgraduate and continuous education for instructorsand clinicians should be more actively carried out.

Finally,a database which offers the general public and healthcare professionals easyaccess to basic knowledge and clinical evidence of Japanese acupuncture andmoxibustion should also be maintained. Such a database should help promote theunderstanding that acupuncture and moxibustion are a very promising part of notonly primary healthcare but also other areas of care including rehabilitationand palliative care.




Thehistorical background and current social status of Japanese acupuncture andmoxibustion were analyzed prior to preparing this Declaration. The greatsignificance of this Declaration will be recognized by promoting anunderstanding of the characteristics and future issues of Japanese acupunctureand moxibustion among professionals in acupuncture and moxibustion medicine,and in healthcare and healthcare administration. We hope that such anunderstanding would influence the development of acupuncture and moxibustionthroughout the world in the future.


Wehereby declare the following:


1.   We shall extensively publish new findings inacupuncture and moxibustion to the medical community and the general public forfurther comprehension and appraisal of acupuncture and moxibustion.

2.   We shall establish a study design capable ofdemonstrating the clinical significance of acupuncture and moxibustion in orderto contribute to the advancement of research worldwide on the clinical efficacyand safety of acupuncture and moxibustion.

3.   We shall secure the appropriate position ofacupuncture and moxibustion in the Japanese healthcare system.

4.   We shall promote understanding of acupunctureand moxibustion as part of Japan°«sprecious cultural heritage and familiarize the public with the therapy.

5.   We shall facilitate exchanges among theacupuncture and moxibustion communities of Japan and other countries, regardfor their characteristics and make deeper understandings of acupuncture andmoxibustion one another, and endeavor to maintain and inherit the diversity ofacupuncture and moxibustion practices globally.

6.   We shall take a holistic approach in offeringacupuncture and moxibustion therapy, thereby further contributing tomaintenance and improvement of health as well as prevention and treatment ofdisease.


Contents ofthe Tokyo Declaration shall be subject to change over time as acupuncture andmoxibustion develop and evolve in the future.



Description of theDeclaration


Items 1 and2: Further expanded use of acupuncture and moxibustion treatment ascomplementary care for chronic pain diseases and age-related locomotivediseases and disorders ¾ that do notrespond adequately to modern Western medical treatment ¾ will improvequality of medical care and bring great benefits to patients. The specific of acupunctureand moxibustion treatment can also be adequately utilized in primary healthcareand primary care settings because of its diagnostic and treatment methods. Moreovercontributing to improvement of quality of life (QOL) will be necessary bydemonstrating the value of these methods in diverse areas including palliativecare of cancer patients,. To this end, high quality evidence showing theclinical value of acupuncture and moxibustion in Japan and other countries needs tobe collected and presented to healthcare professionals and the general publicin order to promote the use of acupuncture and moxibustion. A number of papersreporting results of basic medical research on acupuncture and moxibustion in Japanhave been published. These elucidate the mechanism of action as well as providesome evidence of efficacy. These findings should be disseminated throughinternational academic exchanges, thereby contributing to the advancement ofbasic research in acupuncture and moxibustion. Meanwhile in clinical research,randomized controlled trials to evaluate efficacy of acupuncture andmoxibustion should be performed as well. It is recommended that clinicalstudies be designed in accordance with innate characteristics of acupunctureand moxibustion to explore their unique clinical efficacy, and that the resultsbe published. It is also necessary to promote the understanding thatacupuncture and moxibustion treatment is reliable and safe which is theaccepted fact.20–22) Particularly use of disposable needles andclean needle technique should be actively promoted. Accumulation of evidence iscontinued for the safety of equipment used in treatment and development ofsafer equipment is also continued; thereby Japan is playing a leading role inthe world in improving equipment safety.


Items 3 and4: Acupuncture and moxibustion are branches of traditional Japanese medicine.At the same time they are part of the precious cultural heritage of Japan and have been identified with Japan.These facts should be publicized to facilitate advancement of Japaneseacupuncture and moxibustion. In Chinaand Korea,acupuncture and moxibustion medicine has been duly regarded as traditionalforms of medical practice. Likewise acupuncture and moxibustion should beappropriately incorporated into the Japanese healthcare system.


Item 5: Owingto globalization, acupuncture and moxibustion are no longer traditional medicalpractices limited to East Asia. Under thecircumstances, there is a push for international standards of acupuncture andmoxibustion. However, countries where acupuncture and moxibustion have beenpracticed as traditional medicine have established their own standards ofacupuncture and moxibustion in the course of history. Therefore it is criticalto promote exchanges with other countries including Chinaand Koreaand to respect the standards of each country. As acupuncture and moxibustionmedicine progresses in each country, the diversity of practice will be bothmaintained and developed throughout the world.





Footnote 1


In the Edo era, the Gosei school continued to play a leadingrole, although the Koho school came to the forefront in and after the middle ofthis era. Throughout the Edo era, Western medicine was brought to Japan from the Netherlands,which influenced Kampo medicine as well as gave rise to the Sechu school whichblended traditions of Kampo medicine and Dutch medicine in the later Edo era. It was after the Meiji Restoration in 1868 thatWestern medicine became mainstream.


In thedevelopment of acupuncture between the Azuchi Momoyama era (AD 1568 – 1600) andthe early Edo era, kanshinho (amethod of needling using a guide tube) was devised, which brought about a distinctshift to soft and tender stimulation methods involving the use of fine needlesand guide tubes. Meanwhile, highly refined moxa was produced by using stonemills and winnowers. This development facilitated utilization of moxibustionbecause stimulation could now be carried out with less heat.


During theEdo era, Japanwas closed off from the outside world to avoid pressure from Western Europeancountries. However, Japanvoluntarily adopted customs not only from Chinaand Korea but also the Netherlands.Conversely Japanese acupuncture and moxibustion techniques including kanshin-ho (needling with tube method)and dashin-ho (needling-tappingmethod) were introduced to Europe via the Netherlands.23) As aresult, Japan was able to develop its unique culture and civilization withoutbeing totally isolated from the world and even achieved landmark success inmedicine and developed innovative treatment methods. These circumstancesbrought about qualitative changes in Japanese acupuncture and moxibustion (i.e.,adaptation to the culture and climate of Japan). Such qualitative changesmay have led to the modernization of Japanese acupuncture and moxibustion basedon the Huangdi Neijing system afterthe Meiji era.


Today thereare many acupuncture and moxibustion practices in Japan: classic acupunctureand moxibustion following the HuangdiNeijing system which is based on the yin-yang and five element theories,modern Chinese medical acupuncture and moxibustion influenced by modern Chinesemedicine, modern medical acupuncture and moxibustion based on modern medicine,treatment on the basis of tenderness and response, and specialized acupunctureand moxibustion including sports and cosmetic acupuncture and moxibustion.Although current Japanese acupuncture and moxibustion practices vary widely,they also seem to reflect past practices and are assumed to play similar rolesin treatment.


Footnote 2


The first lawgoverning acupuncture and moxibustion was stated in Article 53 of the Isei (medical system) which was promulgatedin 1874. Although Article 53 stipulated that acupuncture and moxibustion shouldbe put under the control of Western medicine, the Article was never executed.However, the ethos of the law has been incorporated into subsequent laws and ispresently still apparent. With the adoption of HarijyutsuKyujyutsu Eigyo Sashiyurushikata (an act controlling acupuncture andmoxibustion practice) in 1885, the practices of acupuncture and moxibustionwere formally accepted. In 1911, a license system was introduced upon adoptionof the regulation of Acupuncture and Moxibustion Practice.


A majorturning point was 1945 when the Department of Health and Welfare of theOccupation Forces, the GHQ recommended a total ban on medical practice otherthan that by qualified medical doctors. An active nationwide campaign forcontinuing the practice of acupuncture and moxibustion was carried out and ledto adoption of the Practice of Anma-Massage-Acupressure, Acupuncture,Moxibustion, Judo Therapy, etc. Act in 1947 and introduction of thepractitioner licensing system. However, acupuncture and moxibustion were notincorporated into the healthcare system. The law has undergone multiple changesand the Act for Practitioners of Massage, Finger Pressure, Acupuncture andMoxacauterization, etc. was enacted in 1970. In 1988 a major revision of thelaw was carried out and administrative authority for licensing was transferredfrom the prefectural governor to the Minister of Health and Welfare (presentlythe Minister of Health, Labor, and Welfare).




Footnote 3


Modernacupuncture and moxibustion education was started early after the MeijiRestoration. In 1903, the Tokyovocational training school for the Visually and Hearing Impaired wasestablished to initiate a training program for teachers of acupuncture,moxibustion, and massage at schools for the visually impaired. This training isnow conducted at the Acupuncture and PhysicalTherapy TeacherTraining School, University of Tsukuba(authorized by the Ministry of Education, Culture, Sports, Science, andTechnology). On passage of the Regulation for Control of Acupuncture andMoxibustion Practice in 1911, licenses to practice were granted to those whograduated from elementary school and completed a 4-year training program at adesignated school. Thus, a parallel apprenticeship system to meet the trainingneeds of student acupuncturists was started. Subsequently, enactment of the Practiceof Anma-Massage-Acupressure, Acupuncture, Moxibustion, Judo Therapy, etc. Actin 1947 brought about a major change; training of all acupuncturists andmoxibustionists was transferred to specialized schools, special-needs schools,etc. The Act underwent minor and major revisions in 1970 and 1988,respectively, and the latter revision introduced a credit system andmatriculation for 3 years (earning of 86 or more credits [basic courses, 14credits; pre-requisite field-specific courses, 27 credits; field-specificcourses, 45 credits]) for senior high school graduates. Higher education beganwith the establishment of the Meiji College ofAcupuncture and Moxibustion in 1978, which subsequently became a universitywith a graduate school of acupuncture and moxibustion (offering masters anddoctoral degree courses). Meanwhile Tsukuba Collegeof Technology, Tsukuba University of Technology, and Tsukuba University ofTechnology Graduate School of Health Sciences (offering masters degree programsin Acupuncture and Moxibustion) were established in 1987, 2005, and 2009,respectively. Thus acupuncture and moxibustion training in higher educationfacilities is now available to people with or without visual impairment.


Footnote 4


Japaneseacupuncture and moxibustion are characterized by six distinctive features. Thefirst is that °»touch°… is the most important concept. Diagnostically, palpationis valued; especially pulse diagnosis has been emphasized. The typical exampleis °»meridian treatment°… that resulted from the development of a pulse diagnosisof six-position pulse diagnosis based on a unique interpretation of pulsediagnosis. Besides, a variety of palpatory techniques including abdominaldiagnosis beyond the Chinese classic medical book °»Nanjing(Classic of Difficult Issues)°…, Chapter 16 have been newly developed and haveevolved gradually. In clinical settings, emphasis has been placed on touchingthe skin and selecting acupuncture points on the basis of responses of thepoints as well as practicing treatments frequently on the sites of cutaneousand subcutaneous indications such as tenderness and induration.


The second isthat the development of acupuncture and moxibustion treatment along withdiagnostic devices is advanced from the Western medicine perspective. Actually,tools for objective diagnoses ¾ such asmeridian patterns of Ryodo-raku (Ryodomeridian therapy, Ryodoraku Medicine), electro-dermal points, and sadenten (potential difference point) ¾ and acupuncture point detector have been developed inparallel to the development of therapies. Particularly to the diagnosis oflocomotive disorders, manual test (physical examination) has been applied,suggesting the emphasis of objectivity. In addition, scientific clinical andbasic researches have progressed into practical utilization in Japan.Given these facts and a very large number of patients with locomotivedisorders, which are more likely to be treated with acupuncture and moxibustion(rather originated from Western medicine), valuable needle insertion method forlocal regions have evolved.


Third,promoted development of acupuncture and moxibustion treatment using lessburdened and soft and tender stimulation has resulted in realization of kanshin-ho (needling method using aguide tube), thin and shallow tender needling, contact needling, infant needle,intradermal needle, thumbtack needle, laser acupuncture and electro-moxibustion.


Fourth,acupuncture and moxibustion practitioners in Japan are most commonly taking amiddle course between Western medicine and classical medicine (based on theChinese classic books °» Suwen [Plain Questions]°… and °» Lingshu [Miraculous Pivot]°…) in diagnosis, therapy, technique, andphilosophy. The reason may be the flexibility of Japanese people. In fact,tool-assisted treatment such as hyperthermia and electrotherapy, massage,chiropractic, judo therapy, and combination therapy with Western medicine arevery popular.


Fifth,moxibustion treatment is highly thriving. Particularly the practice of tonetsu-kyu (diathermic moxibustion) isquite unique technique in the world. This may be attributed to excellent moxawith low burning temperature that has been developed with delicate technologycapability.


Finally, thetreatment of the presymptomatic state referred to as °∆mibyo°« follows. At any acupuncture and moxibustion clinic,practitioners treat not only affected patients but also a considerableproportion of healthy or apparently healthy people with mibyo for health control and promotion, as is known by yojo no kyu (moxibustion for lifenurturing) and sanri no kyu(moxibustion to legs, ST 36).





1) Tanzawa S, Yano T andKawakita K: Clinical researches of acupuncture and moxibustion treatment as mibyochi(treatment in presymptomatic state). Annual Report of the Foundation forTraining and Licensure Examination in Anma-Massage-Acupressure, Acupuncture andMoxibustion. 2001.

2) Tanzawa S, Ishizaki N, Iwa A, Ono N, Yano T, Kawakita Kand Nishimura S: Cross-sectional survey of utilization of acupuncture andmoxibustion therapy in Japan. Annual Report of the Foundation for Training andLicensure Examination in Anma-Massage-Acupressure, Acupuncture and Moxibustion.2002.

3) Tanzawa S, Ishizaki N, Iwa A, Ono Nand Yano T: Survey on the acupuncture and moxibustion therapy-focused on thefactors related to patients°« behavior. Annual Report of the Foundation forTraining and Licensure Examination in Anma-Massage-Acupressure, Acupuncture andMoxibustion. 2003.

4) Tanzawa S, Ishizaki N, Iwa A, Ono Nand Yano T: Survey on the acupuncture and moxibustion therapy-focused on thepatients°« attitudes to acupuncture and moxibustion therapy. Annual Report ofthe Foundation for Training and Licensure Examination inAnma-Massage-Acupressure, Acupuncture and Moxibustion. 2004.

5) Yano T,Ishizaki N, and Kawakita K: Survey on the acupuncture and moxibustion therapy-focusedon the patients°« behavior. Annual Report of the Foundation for Training andLicensure Examination in Anma-Massage-Acupressure, Acupuncture and Moxibustion.2005.

6) Yano T,Ishizaki N, and Kawakita K: Survey on the acupuncture and moxibustion therapy-focusedon the patients°« behavior and promotion of acupuncture and moxibustion therapy.Annual Report of the Foundation for Training and Licensure Examination in Anma-Massage-Acupressure, Acupuncture and Moxibustion. 2006.

7) Yano T,Kawakita K and Ishizaki N: Survey on the acupuncture and moxibustiontherapy-focused on the factors related to facilitation of the patients°«behavior. Annual Report of the Foundation for Training and LicensureExamination in Anma-Massage-Acupressure, Acupuncture andMoxibustion. 2007.

8) TakanoM, Fukuda F, Ishizaki N and Yano T: A Cross-sectional Survey of PatientSatisfaction after Acupuncture Treatment in Japan. Journal JSAM. 2002; 52 ( 5): 562-574 .

9) Yamashita H, Tsukayama H, Sugishita C°ßPopularity of complementary and alternative medicine inJapan: a telephone survey. Complement Ther Med. 2002; 10: 84-93.

10) Yamashita H and TsukayamaH: Prevalence of complementary and alternative medicine in Japan. Jpn J Acupunct Manual Ther(Ido no Nippon). 2003; 710: 151-157.

11) Ozaki A, Imai k, Ito K, Mukaino Y, Shiraishi T, Ishizaka N and TakedaT: Reviewof the Auricular Acupuncture Effects. Journal JSAM. 2006; 56 ( 5 ): 779-792.

12) Kashiba H, Ishimaru K, Itoh K, Imai K, Watanabe I and Kawakita K: Reviewof the Effects of Acupuncture and Moxibustion on Chronic Pain. Journal JSAM.2006; 56( 2 ): 108-126.

13) Ozaki A, WakayamaI, Tanaka H, Suzuki T and Shinbara H: Effects of Acupuncture and Moxibustionon Muscle Diseases and Muscular Functions/Metabolism and the Status of TheseTechniques. Journal JSAM. 2004; 54( 5 ): 698-716.

14) Yano T, Sato Y, Uchida S, Tokutake T, Sakai T, Sakaguchi S andHiro M. Effectof Acupuncture and Moxibustion on Peripheral Circulation. Journal JSAM. 2003;53( 1 ): 28-29.

15) Kawakita K, Sumiya E, Noguchi E: Effects of acupuncture andmoxibustion on visceral pain, digestive functions and digestive disorders.Journal JSAM. 2000; 50( 4 ): 638-640.

16) LathiaAT, Jung SM, Chen LX. Efficacy of acupuncture as a treatment for chronicshoulder pain. J Altern Complement Med. 2009; 15: 613-618.

17) CherkinDC, Sherman KJ, Avins AL, Erro JH, IchikawaL, Barlow WE, et al. A randomized trial comparing acupuncture, simulatedacupuncture, and usual care for chronic low back pain. Arch Intern Med. 2009;169: 858-866.

18) Itoh S, Itoh K andKatsumi Y. Effect oftrigger point acupuncture treatment in older patients with chronic low backpain: randomized controlled trial. Journal JSAM. 2009; 59( 1 ): 13-21.

19) Watanabe K andShinohara S. Clinicaleffectiveness of acupuncture applied to strongly reactive points: randomizedcontrolled trial regarding clinical efficacy. Journal JSAM. 2010; 60( 1 ): 74-83.

20) Yamashita H, Tsukayama H,Tanno Y and Nishijo K. Adverse events related to acupuncture. JAMA. 1998; 280:1563-1564.

21)MacPherson H, Thomas K, Walters S, Fitter M. The York acupuncture safety study: prospectivesurvey of 34000 treatments by traditional acupuncturists. BMJ. 2001; 323:486-487.

22)Melchart D, Weidenhammer W, Streng A, Reitmayr S, Hoppe A, Ernst E,etal. Prospective investigation of adverse effects of acupuncture in 97733patients. Arch Intern Med. 2004; 164: 104-105.

23) Wolfgang Michel. Japanese acupuncture and moxibustion in16-18th-century Europe.Journal JSAM. 2010; 60 ( 1 ): 74-83.



The Drafting Committee of Tokyo Declaration Member


ShujiGoto*£Ī,Ph.D., Chairman, Goto College of Medical Arts and Sciences


ShuichiKatai*£≤,Professor, Course of Acupuncture and Moxibustion, Department of Health, Facultyof Health Sciences, National University Corporation Tsukuba University ofTechnology


AyumiSakamoto*£≥,M.D., Ph.D., Chairman, Kuretake College of Medical Arts and Sciences


KatsumiIshihara, Director, ToumeidouIshihara Acupuncture and Moxibustion Clinic


KazunoriItoh, Associate Professor, Department of Clinical Acupuncture and Moxibustion, Meiji Universityof Integrative Medicine


TakayoshiOgawa, Lecturer, School of Teaching Certificate Program for L.Ac, Tokyo Eisei Gakuen College


Kenji Kawakita, Professor, Department ofPhysiology, Meiji University of IntegrativeMedicine


Hiroshi Kitakoji, Professor, Department ofClinical Acupuncture and Moxibustion, Meiji Universityof Integrative Medicine


Hideto Komatsu, Director, Jyujido Acupuncture andMoxibustion Clinic


Shoji Shinohara, Professor, Department of Traditional Acupuncture andMoxibustion, Meiji University of IntegrativeMedicine


Masami Senoh,Director, Acupuncture and Moxibustion Clinic of Hakko Ryoin


DaikiTakahashi, Faculty, Tokyo Eisei Gakuen College


ToshihiroTogo, Ph.D., Associate Professor, Department of Acupuncture and Moxibustion, Facultyof Health and Medical Sciences, Tokyo Ariake University of Medical and HealthSciences


MasaoTogasaki, Director, Hou Treatment Center


FumihikoFukuda, Associate Professor, Department ofClinical Acupuncture and Moxibustion, Meiji Universityof Integrative Medicine


Takahiro Funamizu, Faculty, Kuretake School of Integrative Medicine


TetsujiMurakami, Faculty, TokyoTherapeutic Institute


TadashiYano, Professor, Department of HealthPromoting and Preventive Acupuncture and Moxibustion, Meiji Universityof Integrative Medicine


SatoruYamaguchi, Lecturer, The Center for Oriental and Integrated Medicine, Saitama Medical University


HitoshiYamashita, Professor, Morinomiya University of MedicalSciences



* 1 President, The JapanSociety of Acupuncture and Moxibustion

* 2 President, The Japanese Traditional Acupuncture and Moxibustion

* 3 Chairperson, TheDrafting Committee of TokyoDeclaration

Page top

The Japan Society of Acupuncture and Moxibustion (JSAM) 3-44-14, Minami-otsuka, Toshima-ku, Tokyo 170-0005, Japan tel: +81-3-3985-6188, fax: +81-3-3985-6135