Hitoshi Yamashita

The Japan Society of Acupuncture and Moxibustion (JSAM) and experts on the safety of acupuncture and moxibustion (AM) in Japan have focused on safety improvement among acupuncturists, moxibustionists (AMists), and AM-practicing physicians. This article provides an overview of the activities conducted by academic experts in AM safety, primarily from the JSAM, to improve AM safety. The JSAM formed the Safety Committee in 1998 to collect data regarding AM-related adverse events, provide relevant information to members, and conduct educational activities to prevent malpractice. Early literature reviews on AM-related adverse events in Japan published by the committee significantly shifted the paradigm regarding the awareness of AM safety among Japanese AMists and AM-practicing physicians. The committee has been holding educational workshops on safe clinical AM practices at the annual conferences of the JSAM, managing a website on AM safety strategies, conducting various surveys on AM safety, and performing periodic literature reviews of AM-related adverse events. In recent years, the committee has focused on publishing guidelines and manual books. This article briefly describes the guidelines published in 2020, as well as a practical manual based on these guidelines that was published in 2024. Despite extensive efforts in this area, further enhancement of safety management education in Japan is essential. The information provided herein is expected to stimulate the exchange of ideas, discussions, and innovations for improving AM safety worldwide.

Japanese acupuncture and moxibustion (AM) originated in ancient China; however, it gradually became unique to Japan. Regarding the education of acupuncturists/moxibustionists (AMists), ancient Chinese classical theory is reverenced; however, the content being taught largely incorporates modern Western medicine. In this study, we focused on the current school curriculum, national examinations, postgraduate education, and certification systems for physicians and nonphysician AMists. In Japan, only physicians, dentists, or AMists are licensed to practice AM; however, AM has recently been mostly practiced by nonphysician AMists. Medical students are only slightly exposed to AM in their undergraduate curricula; therefore, only a few physicians practice AM. Notably, some universities or public hospitals offer postgraduate education on AM; however, the system has been insufficiently available to both physicians and AMists. Each society has a certification system for physicians and AMists to be recognized as Kampo (Japanese traditional medicine that is primarily a herbal medicine-based treatment) specialists and certified AMists, respectively; however, there is no AM certification system for physicians. Therefore, enhancing undergraduate and postgraduate education for medical AM practitioners is a future challenge.

The relationship between health literacy of Japanese people, their attitudes toward acupuncture, and their behavior in choosing this therapy is currently unclear. Therefore, for this study, we conducted a web-based survey to address this unknown relationship. A questionnaire comprising four categories (health status, health literacy, previous acupuncture experience, and attitudes toward acupuncture) was administered to 1,600 Japanese participants. For this study, we performed cross-tabulation and path analysis to examine the relationship between each questionnaire item. The mean score of participants’ health literacy was 3.41 (SD = 0.74), and older, educated, female participants tended to have higher health literacy. The respondents perceived acupuncture to be effective for chronic low back pain, tension-type headache, and knee pain due to osteoarthritis (40.0%, 38.7%, and 21.8%, respectively). Contrastingly, acupuncture was perceived as far less effective for postoperative nausea/vomiting and prostatitis symptoms (8.3% and 8.7%, respectively). Of the total study respondents, 34.4% reported that they would try acupuncture only if recommended by clinical practice guidelines, and 35.6% agreed that acupuncture is safe. The path analysis showed that attitudes toward acupuncture were significantly influenced by the participants’ health literacy, number of information sources, and previous acupuncture experience. However, it was also found that experience with acupuncture was not directly associated with health literacy. Although the Japanese population with higher health literacy is more likely to perceive acupuncture positively, they do not necessarily have sufficient relevant knowledge of the clinical evidence. Therefore, their decision to receive acupuncture may be more dependent on personal narratives rather than clinical evidence. Thus, future challenges lie in individual education of the population on how to choose a reliable health information source, and organizational efforts to provide more reliable health information.

Background: More new randomized controlled trials (RCTs) on acupuncture have been published in Japan since our last updated systematic review (2010). This systematic review aimed to evaluate the quality of RCTs on acupuncture conducted in Japan and understand the decade-wise changes in the methodological characteristics of the relevant RCTs. Methods: The literature search was performed using Ichushi Web, the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed and our team’s compilation of relevant papers. We included full-length papers reporting RCTs that examined the clinical effects of acupuncture on patients in Japan published in or before 2019. We assessed the risk of bias (RoB), sample size, control setting, negative trial reporting, informed consent, ethics approval, trial registration, and adverse event reporting. Results: A total of 99 articles reporting 108 eligible RCTs were identified. The number of RCTs published in each decade was 1, 6, 9, 5, 40, and 47 in the 1960s, 1970s, 1980s, 1990s, 2000s, and 2010s, respectively. Quality assessment using the Cochrane RoB tool revealed that “sequence generation” improved in and after 1990 (73%–80% of RCTs were rated as “low”) and “blinding of outcome assessors” slightly improved in and after the 2000s (40%–50% judged as “low”). However, “high” or “unclear” remained the dominant grades in other domains. Clinical trial registration and adverse events were reported only in 9% and 28% of the included RCTs even in the 2010s, respectively. A different acupuncture method or different point selection (e.g., deep vs. shallow insertion) was the most dominant control setting before 1990, while sham (or “placebo”) needling and/or sham acupoints became the most dominant in the 2000s. The proportion of RCTs with positive results was 80% in the 2000s and 69% in the 2010s. Conclusions: The quality of RCTs on acupuncture conducted in Japan did not appear to have improved over the decades except for “sequence generation.” While the culture of submitting negative trial reports was prevalent in the Japanese acupuncture research milieu as late as the 1990s, the overall quality of the relevant trials needs to be further improved.

Gestational diabetes mellitus (GDM) results from an interaction between susceptibility genes and the diabetogenic effects of pregnancy. During pregnancy, mice heterozygous for the lepin receptor (db/+) gain more weight, are glucose intolerant, and produce macrosomic fetuses compared with wild-type (+/+) mothers, suggesting that an alteration in leptin action may play a role in GDM and fetal overgrowth. To investigate whether leptin administration or pair-feeding can reduce adiposity and thereby prevent GDM and neonatal overgrowth, we examined energy balance, glucose and insulin tolerance, and fetal growth in pregnant db/+ and +/+ mice treated with recombinant human leptin-IgG during late pregnancy. Leptin reduced food intake and adiposity in pregnant db/+ mice to levels similar to pregnant +/+ mice and significantly reduced maternal weight gain. Maternal glucose levels were markedly lower during glucose and insulin challenge tests in leptin-treated db/+ mice relative to db/+ and pair-fed controls. Despite reduced energy intake and improved glucose tolerance, leptin administration did not reduce fetal overgrowth in offspring from db/+ mothers. Fetal and placental leptin levels were 1.3- to 1.5-fold higher in offspring from db/+ mothers and remained unchanged with leptin administration, whereas leptin treatment in +/+ mothers or pair-feeding decreased placental leptin concentration and reduced fetal birth weight. Our results provide evidence that leptin administration during late gestation can reduce adiposity and improve glucose tolerance in the db/+ mouse model of spontaneous GDM. However, fetal and placenta leptin levels are higher in db/+ mothers and are subject to reduced negative feedback in response to leptin treatment. These data suggest that alterations in placenta leptin may contribute to the regulation of fetal growth independently of maternal glucose levels.