public status and prevalence of acupuncture in japan

Advance Access Publication 19 June 2008 eCAM 20107(4)493ndash500doi101093ecamnen037

Original Article

Public Status and Prevalence of Acupuncture in Japan

Naoto Ishizaki1 Tadashi Yano2 and Kenji Kawakita3

1Division of Acupuncture for Visceral Functions Department of Clinical Acupuncture and Moxibustion2Department of Preventive and Health Promotive Acupuncture and Moxibustion and 3Department of PhysiologyMeiji University of Integrative Medicine Kyoto Japan

Acupuncture originated in China and is widespread throughout Asia It is expected that ahigher utilization of this remedy exists in these countries compared to Western countries Weconducted annual nationwide surveys from 2003 through 2006 on the utilization of acupuncturein Japan Face-to-face interviews were conducted with 2000 individuals randomly chosen fromthe resident database Annual utilization percentages based on the number of respondentsfrom 2003 to 2006 were 65 48 64 and 67 respectively while lifetime experiencesdetermined in each surveys were estimated as 267 194 244 and 254 respectivelyRespondents who had utilized acupuncture andor moxibustion tended to be older thanthose who had no experience Acupuncture was mainly used for musculoskeletal symptoms anda detailed breakdown of the musculoskeletal symptoms identified in the 2005 survey showed509 for low back pain 359 for shoulder stiffness and 120 for knee pain Reasons givenfor continuing therapy included the effective amelioration of symptoms comfort of theprocedure and low number of side-effects while those who decided against continuing cited noimprovement of symptoms cost and lack of time for treatment In conclusion annualutilization of acupuncture andor moxibustion was estimated at more than 6 and thepercentage of those with a lifetime experience was 25 thus demonstrating the relativelyhigher utilization of the remedy in Japan over utilization in western countries Application ofthe treatment for musculoskeletal problems and utilization by the older population were specificstandouts of the use of acupuncture andor moxibustion in Japan

Keywords acupuncture ndash aim ndash Japan ndash prevalence ndash reason

Introduction

Backgrounds

Acupuncture is Positioned Out of the Mainstream of theHealth Care Systems in Japan

The dawning of acupuncture and moxibustion medicine in

Japan dates away back to the year 562 when a literature of

acupuncture medicine had been brought with the Buddhistliterature by a Chinese monk Chiso The traditionalChinese medicine brought to Japan had been modified tosuit with physiological constitution of Japanese and devel-oped under the influence of European medicine HoweverduringMeiji Era (1868ndash1912) as GermanMedicine becameofficial medicine in Japan the traditional medicine haddeclined After that acupuncture and moxibustion therapywas separated fromChinese herbal medicine and positionedas occupation mainly for the people with disabled visualacuity being placed outside of the mainstream of the healthcare system in Japan The status of acupuncture andmoxibustion therapy had not been improved after thatwhile Kampo the Chinese herbal medicine had later beenincluded in the medical system in Japan

For reprints and all correspondence Naoto Ishizaki Division ofAcupuncture for Visceral Functions Department of ClinicalAcupuncture and Moxibustion Meiji University of IntegrativeMedicine (former name Meiji University of Oriental Medicine)Hiyoshi-cho Nantan-shi Kyoto 629-0392 Japan Tel +81-771-72-1181Fax +81-771-0394 E-mail n_ishizakimeiji-uacjp

2008 The Author(s)This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (httpcreativecommonsorglicensesby-nc20uk) which permits unrestricted non-commercial use distribution and reproduction in any medium provided the original work isproperly cited

Acupuncture Practice in Medical Facilities is Limitedin Japan

Acupuncture practice in medical facilities in Japan islimited which is reflecting relatively lower status of theremedy as non-official medicine in this countryGenerally acupuncture treatment is not covered bypublic health insurance system except for particularkind of medical conditions (i) low back pain (ii) frozenshoulder (iii) neuralgia (iv) rheumatoid arthritis (RA)(v) cervicondashbrachial syndrome (vi) neck sprain onlywhen the patients could get consent document by theirphysicians However not many physicians are favorableto recommend acupuncture to the patients and conse-quently it is difficult to get acupuncture treatment withsupport of public health insurance

License of Acupuncture and Moxibustion in Japan

Japanese national license for acupuncture and for moxi-bustion are separately issued The status of acupuncturistsand moxibustionists is guaranteed and they are allowed tohave their own clinics while the other health care providerssuch as physiotherapists or occupational therapists are notallowed to practice by themselves Because right to practiceacupuncture and moxibustion is under the protection of thelaw any other health care providers except medical doctorsare not allowed to practice acupuncture and moxibustionwhile physiotherapy or occupational therapy which ismainly provided by physiotherapists or occupational the-rapists can also be provided by nurses or massage the-rapists Although acupuncturists and moxibustionists haveright to practice by themselves their practical activity in themedical facilities of which health care services are coveredby public insurance are strictly limited License for acupun-cture and moxibustion are national qualification and com-pletion of 3-year program in the accredited vocationalschool or 4-year program in accredited university arerequired to be qualified for licensing exam Althoughlicense for acupuncture and for moxibustion are separatelyissued most of the schools have programs for both acup-uncture and moxibustion Therefore those who completedthe program usually are licensed for both of them and arecalled lsquoAcupuncture and Moxibustion therapistsrsquo

Number of Acupuncturists and Moxibustion Therapistsin Japan

The total number of those who are listed as acupuncturistsand moxibustionists as of September 2005 in Japan are127 018 and 125 868 respectively (a statistics by ToyoRyoho Kensyu Shiken Zaidan (Foundation for Trainingand Licensure Examination in AmmandashMassagendashAcupressure Acupuncture and Moxibustion) (1)Although actual number of the active practitioners is notprecisely investigated a statistics by Ministry of HealthLabour and Welfare (2) estimated that approximately

76 643 acupuncturists and 75 100 moxibustionists wereactive as of the year 2004 Since the statistics provided bythe Ministry of Health Labour and Welfare are based onthe number of acupuncturists or moxibustionists who areregistered at regional public health center it probablyincludes the practitioners who have already retiredAccording to a report by Fujii et al (3) 265 of theregistered practitioners is not actively practicing Thenumber of facilities that provides acupuncture andormoxibustion are 14 993 and those that provides acupunc-ture and moxibustion andor amma massage shiatsu are33 601 in 2004 (2) (Table 1) According to these statisticsthe number of the facilities that provides acupuncture andor moxibustion estimated in the report by Fujii et al was48 594 and likewise the number of active practitioners foracupuncture and moxibustion was estimated to be 55 000 asof the year 2004

Use of Acupuncture andor Moxibustion Therapy and

Characteristics of the Patients in Recent Years in Japan

Despite long history and knowledge of the medicine inthe country little is known about the popularity and thecharacteristics of the patients who use acupuncture andor moxibustion in Japan The most reliable informationabout popularity of acupuncture in Japan was presentedin 2002 by Yamashita et al (4) which summarized theresults from a nationwide telephone survey conducted in2000 The result of the report indicates that 67 of thepopulation had used acupuncture and moxibustion in thepast 12 month

Purpose of the Present Study

Although the statistics presented by Yamashita et alprovides important information on utilization of acupunc-ture in Japan there were some limitations in the study as theauthor described Furthermore because their study wasconducted focusing not specially on acupuncture users buton all CAM therapy users specific information onacupuncture users are limited Therefore more reliableand specific information on acupuncture users whorepresent the population of the country is desired In thepresent study we report results from nationwide popula-tion-based survey on utilization of acupuncture andor

Table 1 The number of facilities that provides acupuncture andormoxibustion

Kind of license Year

1992 1994 1996 1998 2000 2002 2004

Acupuncture andmoxibustion

12 055 12 481 13 166 13 455 14 216 14 008 14 993

Amma massageshiatsu andacupunctureand moxibustion

28 624 29 451 30 850 31 434 32 024 32 722 33 601

494 Utilization of acupuncture in Japan

moxibustion and characteristics of users which wereconducted annually between 2003 and 2006

Methods

Subjects Sampling Methods

The data in the present study were collected as part ofomnibus surveys which were conducted by a researchcompany (Central Research Cervices Inc Tokyo Japan)every March between 2003 and 2006 with the support ofFoundation for Training and Licensure Examination inAmmandashMassagendashAcupressure Acupuncture and Moxi-bustion (Toyo Ryoho Kenshu Siken Zaidan) The subjectsof the study were individuals whose age was 20 yearsand who were randomly selected from Japanese popula-tion The data were collected as a part of omnibusquestionnaire that was brought to the individuals byinterviewers The subjects were then asked to answerclosed-ended questions of which the maximum number ofoptions was 10 Subjects were allowed to ask questions tothe interviewer whenever they wanted The sample size ofthe survey was fixed as 2000 which enable the researchto obtain approximately 1400 (70) random samplesSampling method of the survey was as following Allmunicipalities in Japan were divided geographically into12 blocks which was further stratified into 30 areasaccording to the city scale (major cities cities andtowns or villages) From the 30 areas stratified approxi-mately 160 local points are selected in the randommanner according to the population size to obtain 10ndash14samples from a local point which will be a total of 2000samples

Questions Analyzed

Common questions in all four surveys included utilizationof acupuncture andor moxibustion within the past12 month lifetime experience and basic characteristics

of the respondents such as age gender education leveland occupation Other questions regarding the mainsymptoms for which acupuncture was applied reasons orexpectations for the use of acupuncture treatment therespondentsrsquo inclination to utilize the remedy in thefuture satisfaction with conventional medicine and use ofother CAMs were also included in various years

Statistical Methods

Percentages were indicated with the 95 confidenceintervals Fisherrsquos exact test or chi-square test were per-formed to detect significant differences between propor-tions Differences were considered statistically significantwhen type I error (a) was lt5 under null hypothesisAll the computation was performed with commerciallyavailable PC software SYSTAT 11(SYSTAT IncSan Jose CA USA)

Results

Of the 2000 subjects visited 1420(710) 1338(669)1337(669) and 1346(673) were eligible to fill thequestionnaire of the survey in 2003 2004 2005 and 2006respectively Table 2 shows the percentage of the subjectswho saw acupuncture practitioner(s) in the past 12 monthswhich is further stratified by age group and sex Totalpercentage of the subjects who saw practitioner(s) were 6548 64 and 67 at the survey in 2003 2004 2005 and 2006respectively As shown in the table female subjects aremorelikely to visit acupuncturists in most survey years indicatingstatistically significant in the 2003 survey Table 3 showspercentage of the subjects who had answered to haveexperience of acupuncture andor moxibustion in theirlifetime The percentage of the subjects who experiencedacupuncture at sometime prior to the survey periods were267 194 244 254 at the survey in 2003 2004 2005and 2006 respectively which indicated statistically sig-nificant differences between males and females in 2003

Table 2 Percentage of the subjects who saw acupuncture practitioner in the past 12 months by age and sex

Age group(years)

Survey year

2003 2004 2005 2006

Percentage(95 CI)

MF Percentage(95 CI)



MF

20ndash39 34 (16ndash59) 3136 28 (12ndash53) 4120 41 (21ndash69) 4240 39 (19ndash68) 4831


60 95 (64ndash129) 43136a 85 (56ndash122) 65103 93 (64ndash128) 69118 86 (58ndash119) 9180

P-valueb 0001 ndash lt0001 ndash 0006 ndash 0027 ndash

Overall 65 (51ndash82) 4483a 48 (35ndash63) 4450 64 (50ndash80) 5770 67 (52ndash83) 7460

Total number of the respondents (denominator) except who answered to the question as lsquoDo not Knowrsquo were 1405 1316 1330 and 1335 in thesurvey year 2003 2004 2005 and 2006 respectively aPlt001 (Differences in the proportion between male and female subjects according to theFisherrsquos exact test) bProbabilities of difference between age groups according to chi-square test with 1 df

eCAM 20107(4) 495

(overall subjects and those who were 60 years M lt F)

and in 2006 (those whose age was between 30 and 49 years

FltM) Table 4 shows percentage of the subjects who

visited acupuncture clinic within the past 12 month by city

scale which is stratified by age group Although significant

differences between city scale was found in the survey in

2003 which indicates the relatively higher utilization in

major city and townvillage no significant differences

were found between city scale in further surveys Table 5

indicates differences in the percentage of the utilization of

acupuncture in the past 12 month between groups divided

by education level Overall tendency shows that the higherthe education level the lower utilization of acupuncturewas found which resulted in significant differences in thesurvey years 2003 and 2004 The reason for utilization ofacupuncture which was answered by 375 respondents whohave had prior experience of acupuncture in the surveyof 2003 is shown in Table 6 The most common reasonfor utilization was recommendation of family or friends(587) No significant differences in the percentagebetween male and female respondents or those who utilizedwithin the past 12 months and those utilized earlier except

Table 5 Percentage of the utilization of acupuncture in the past 12months by age and education level

Age group Education

Junior high High College orhigher

Pa Overall

2003

20ndash39 00 25 43 0544 34

40ndash59 135 67 45 0076 66

60 95 94 104 0903 95

Total 101 63 51 0037 65

2004

20ndash39 00 30 28 0923 28

40ndash59 29 36 32 0968 34

60 107 86 33 0216 86

Total 90 47 30 0006 48

2005

20ndash39 00 50 36 0589 41

40ndash59 00 58 60 0357 55

60 90 84 133 0502 93

Total 70 64 59 0859 64

2006

20ndash39 00 43 37 0710 39

40ndash59 63 81 53 0508 69

60 71 95 90 0709 86

Total 64 76 53 0322 67

aDifferences in the proportion between different education levelsaccording to the chi-square test

Table 4 Percentage of the subjects who visited acupuncture clinicwithin the past 12 months by age and city scale

Age group Scale

Major city City Townvillage Pa Overall

2003

20ndash39 67 14 36 0036 34

40ndash59 71 43 120 0014 66

60 179 85 57 0007 95

Total 97 49 76 0010 65

2004

20ndash39 29 31 16 0816 28

40ndash59 45 30 34 0746 34

60 71 81 105 0690 85

Total 44 46 56 0763 48

2005

20ndash39 57 36 30 0597 41

40ndash59 69 58 39 0632 57

60 108 81 107 0649 93

Total 76 59 63 0571 64

2006

20ndash39 42 45 16 0591 39

40ndash59 74 46 145 0007 69

60 102 80 83 0787 86

Total 74 58 88 0257 67

aProbabilities according to the chi-square test between different cityscales

Table 3 Percentage of the subjects who had answered to have lifetime experience of acupuncture andor moxibustion by age and sex

Age group Survey year

2003 2004 2005 2006

Percentage(95 CI)




MF


40ndash59 290 (247ndash335) 281297 170 (135ndash210) 185160 255 (211ndash301) 254255 240 (198ndash285) 283206a



Total number of the respondents (denominator) except who answered to the question as lsquoDo not Knowrsquo were 1405 1316 1330 and 1335 in thesurvey year 2003 3004 2005 and 2006 respectively aPlt005 (Differences in the proportion between male and female subjects according to theFisherrsquos exact test)


for the primary reason when compared by utilizationperiod and for the reason of that the condition was notserious when compared by sex Table 7 shows the medicalconditions for which acupuncture was used More than

80 of the respondents have had answered that theysought acupuncture because of musculoskeletal problemThe other symptomspurposes for which acupuncturewas utilized includes general fatigue health promotion

Table 8 Breakdown of the musculoskeletal problem for which acupuncture was used (survey of 2005)

Kind of the problem Overall Users By sex By utilization period

Percentagea (95 CI) Male Female Pb lt12 months gt12 months Pc

Low back pain 509 445ndash571 603 429 0002 525 502 0719

Shoulder stiffness 359 299ndash420 285 423 0011 384 348 0533

Knee pain 120 82ndash165 99 137 0310 202 84 0005

Shoulder pain 52 28ndash86 60 46 0624 61 48 0601

Neuralgia 43 21ndash75 46 40 0791 51 40 0767

Sports injury 34 15ndash63 46 23 0357 51 26 0319

Numbness in hands 34 15ndash63 33 34 gt099 30 35 gt099

Numbness in foots 34 15ndash63 40 29 0760 61 22 0096

Other joint paina 25 09ndash51 20 29 0729 30 22 0703

Other 141 100ndash189 99 177 0055 121 150 0604

Total number of the subjects=326 aSummation of the percentage will not be 100 because of multiplied answers bDifference between males andfemales (based on Fisherrsquos exact test probabilities) cDifference between utilization periods (Fisherrsquos exact test probabilities)

Table 7 Medical conditionpurposes for which acupuncture was used (results from survey of 2003)

Conditon Overall users Sex Period of utilization

Percentagea (95 CI) Male Female Pb12 Months gt12 Months Pc

Musculoskeletal problems 816 (766ndash858) 849 794 0222 785 828 0376

Fatigue 69 (42ndash104) 66 72 gt099 121 49 0022

Health promotion 51 (28ndash82) 33 63 0236 112 26 0001

Headache 48 (26ndash78) 46 49 gt099 75 37 0178

Eyestrain 32 (15ndash58) 20 40 0374 47 26 0335

Digestive symptoms 29 (13ndash55) 20 36 0536 38 26 0517

TinnitusHearing loss 19 (06ndash41) 13 22 0706 19 19 gt099

Paralysis 13 (03ndash33) 07 18 0652 19 11 0626

Urination problems 03 (00ndash16) 00 04 gt099 0 04 gt099

Others 115 (80ndash156) 105 121 0742 75 131 0152

Total number of the respondents=375 aSummation of each percentage will not be 100 because of multiple answers bDifference between males andfemales (Fisherrsquos exact test probabilities) cDifference between utilization periods (Fisherrsquos exact test probabilities)

Table 6 Reason to utilize acupuncture andor moxibustion (results from survey of 2003)

Reason Overall users By sex By period of utilization

Percentagea 95 CI Male Female Pb Past 12Months

More than1 year ago

Pc

Recommendation of family or friends 587 527ndash643 605 574 0594 505 619 0048

Not satisfied with conventional medicine 128 91ndash171 151 112 0274 168 112 0170

Do not want to use drugs 125 89ndash168 92 148 0115 178 104 0059

Not serious condition 117 82ndash159 72 148 0033 159 104 0154

Recommendation of MDs 88 126ndash58 79 94 0712 93 86 0841

Saw the clinic facilities 56 32ndash88 66 49 0502 56 56 gt099

Saw advertisement (TV Radio Internet) 16 05ndash37 00 27 0085 09 19 0679

Others 48 26ndash78 66 36 0221 47 49 gt099


eCAM 20107(4) 497

headache eyestrain digestive symptoms hearing prob-lems paralysis or urination problem Further breakdownof the musculoskeletal symptoms which was questionedlater in the survey in 2005 is shown in Table 8 The mostcommon musculoskeletal symptom for which acupunc-ture was utilized was low back pain (509) which wasfollowed by shoulder stiffness (359) and knee pain(120) Significant differences between male and femalerespondents were found in the percentage with low backpain (603 in males and 429 in females) and shoul-der stiffness (285 in males and 423 in females) Alsoa significant difference between respondents who experi-enced acupuncture within 12 months and those whoexperienced more than 12 months ago prior to the surveywas found with the knee pain (202 of those whoexperienced within 12 months and 84 of those whoexperienced more than 12 months ago) Table 9 showsthe percentage of the respondents who have answeredto or not to continuereuse acupuncture and its reasonApproximately half (504) of those who have experi-enced acupuncture answered to continuereuse acu-puncture while 371 answered not to The mostcommon reason to continuereuse was because theyexperienced amelioration of the symptom (762)The following reason includes comfortable treatmentlow number of side-effects convenient easy to visitand so on In contrast the reason for not to continuereuse includes no amelioration of the symptom highcost lack of time uncomfortable treatment and so on

Discussion

Utilization of Acupuncture andor Moxibustion in Japan

Utilization of acupuncture andor moxibustion in Japanwas relatively higher than those reported in Westerncountries (5ndash9) Although there are many reports aboutCAM use and characteristics of the users in Westerncountries (10ndash12) such kind of information among Asiancountries so far is rather limited (13ndash15) Since acupunctureis originated in China and brought to Japan more than athousand year ago and distributed as one of the conven-tional folk medicine (16) utilization of the remedy in thepopulation is considered to be higher than those in theWestern countries However no reliable information onusage of acupuncture and moxibustion in Japan had beenavailable until 2002 when the first nationwide telephonesurvey regarding popularity of CAM by Yamashita et al(4) had been reported The study reported a surprisingresult that 76 of the respondents had used at least oneCAM therapy in the past 12 months and average annualout-of-pocket expenditure of the respondents for CAMwas half as much as those for orthodox Western medicineThe kind of CAM reported in the study includes nutritionaland tonic drink dietary supplements health-relatedappliances and herbs Percentage of the respondents whoused acupuncture and moxibustion in the past 12 monthswas reported as 67 Their study is valuable as the firstnationwide survey of CAM in the far-east countriesHowever as the author stated there are some limitationsin the study because the eligible call rate was relatively low(23) Furthermore most results were not specialized foracupuncture use We therefore conducted surveys topresent more reliable data and to further clarify the char-acteristics of the subjects their aim or reason for utilizingacupuncture andor moxibustion Results of our annualsurveys showed that the utilization of acupuncture andormoxibustion in Japan between 2003 and 2006 were almoststable at around 65 of the population and their lifetimeexperience of the remedies was 25 These proportionsare considered to be relatively higher than those in theWestern countries (5ndash8) A relatively lower proportion ofutilization was found in the survey in 2004 This may be dueto systematic bias of sampling procedure because bothannual and lifetime utilization was lower than those in theother surveys It was clear that elder people were morelikely to use acupuncture than younger This result wasdifferent from the results of the overall CAM usersreported in the previous reports that relatively youngerpopulation had used acupuncture (57)

Characteristics of Users of Acupuncture andor

Moxibustion in Japan

Utilization by female respondents was higher than thoseby male respondents in the survey in 2003 (both annual

Table 9 Percentage of respondents who have showed their intention tocontinue acupuncture and its reason (survey of 2003)

Reason Percentage

Continue 504(189375)

Amelioration of the Symptom 762

Comfortable 376

Low number of side-effects 217

Convenient 159

Easy to visit 95

Favor with the practitioner 58

Inexpensive 42

Favor with the facilities 21

Other 21

Not to continue 371 (139375)

No amelioration of the symptom 424

Expensive 209

Lack of time 137

Uncomfortable 108

Not easy to visit 86

Had adverse effects 36

Not in favor with the practitioner 14

Not in favor with the facilities 07

Other 194


utilization and lifetime experience among respondentswhose age was 60 years or older) and lower in part in thesurvey in 2006 (lifetime experience among respondentswhose age was 40ndash59 years) Although many researchersreported that females were more likely to use CAM(56141517) the tendency was not clear in the presentstudy The results may reflect difference between overallCAM users and acupuncture users or difference betweenJapanese users and those in the other countries Therewere tendency that proportion of users was higher in themajor city or town or village than those in the middle-scale city The possible reason for this is that there maybe larger number of facilities which provides acupunctureandor moxibustion in the major city although it is notproven because reliable statistics that indicate number ofsuch facilities per person in each city is not availableUsers of acupuncture andor moxibustion had relativelylower education level This tendency was same as thatreported in the previous survey in Japan but differentfrom tendency of CAM users reported in Westerncountries that indicated that the education level of theusers are relatively high (57) Although present data werestratified by age group it is still presumable thatdifference in age is contributing the results becauseeducation level in the elderly is generally lower thanyounger population Multivariate analysis such as logisticregression of which independent variable includes ageand sex may be necessary in further studies to clarifythese tendencies

Reason to Utilize Acupuncture andor Moxibustion

in Japan

The most common reason for utilization of acupunctureandor moxibustion in the present survey was lsquorecom-mendation of family or friendsrsquo although it is signifi-cantly decreased when it was compared between userswithin the past 12 months and those who used more thana year ago (505 versus 619 P=0048) Patients seemedto seek reliable information as much as possible becausemost of them did not have much information about theremedies and might have concerns to get treatment Thesecond or third reason reflects dissatisfaction or distrustwith the conventional medicine Because there are severalreports that indicates no significant association betweenCAM use and dissatisfaction with conventional medicineand most of the users also receive standard care notrelying primarily on CAM (1819) it is important tofurther investigate in a newly designed survey whetherthese respondents use acupuncture as an lsquoalternative(substitute for)rsquo or lsquocomplementary (add on)rsquo to theconventional medicine The fourth common reason lsquonotserious conditionrsquo was more likely to be chosen byfemale respondents (148 versus 72 P=0033)Although detail of the symptom is unclear in the present

study the fourth reason includes some kind of conditionsthat are specifically occurs in female subjects

Medical Conditions for which Acupuncture and

Moxibustion was utilized by Japanese Population

Musculoskeletal problem is the most common conditionfor which acupuncture andor moxibustion was appliedThe proportion of the subject (816) was comparablewith those in the previous telephone survey that was alsoconducted among Japanese population (4) and muchhigher than those surveyed in the United States (2021)Of the musculoskeletal problems low back pain was themost common condition for which the respondentssought acupuncture andor moxibustion followed byshoulder stiffness and knee pain indicating significantdifferences in the proportion between female and malerespondents in low back pain (MgtF) and in shoulderstiffness (FgtM) These figures represents the commonsymptoms of the general population that the mostcommon symptom in male population was low backpain while those in female population was shoulderstiffness which is presented by statistics of the Ministryof Health Labor and Welfare as of 2004 (22)

Respondentrsquos Intention to ReuseContinue Acupuncture

andor Moxibustion

Approximately half (504) of the respondents werefavorable to reuse or continue acupuncture andormoxibustion in the future while 371 answered notto The most common reason for the favorable answerwas that the respondents experienced amelioration oftheir symptom Improvement of their symptom seems tobe the most important because the most common reasonfor discontinue was that the respondents did not feelamelioration of the symptom It is notable that morethan one-third of the respondents who were favorable tocontinue had chosen the reason lsquocomfortablersquo whichindicates one of the favorable features of these remediesAlthough some of the respondents who had answered notto continue had chosen the reason lsquouncomfortablersquo(painful or too hot) most of these sensations may beavoidable by improvement of the practitionerrsquos skill Thereason lsquoexpensiversquo may be one of the major obstacles tocontinue acupuncture andor moxibustion because lessthan half of the patients are benefited from reimburse-ment (17) while most of the conventional medicines arecovered with the public insurance system The coveragerate of health insurance may have considerable influenceto visit acupuncture clinics as previously reported inCAM users (23) This hypothesis is supported by ourrecent statistics that 42 of the respondents who had noexperience of acupuncture andor moxibustion and 69of those who had experience answered that they would

eCAM 20107(4) 499

like to receive these treatments if it was covered by publichealth insurance (24)

Conclusion

Utilization of acupuncture andor moxibustion in Japanwas relatively higher than those in the Western countriesand the prevalence rate seemed to be stable in recentyears The characteristic of the users appeared to berelatively older generation though the difference betweenmales and females are inconclusive from the presentsurveys Many users paid much regard to recommenda-tion by their families or friends for decision of visitingacupuncture clinics Musculoskeletal problems includinglow back pain shoulder stiffness and knee pain was themost common condition for which acupuncture andormoxibutsion was applied indicating considerably higherthan those reported in US Approximately 50 of theusers were favorable to use these remedies in the futurewhile 37 were not The problem claimed by therespondents for the treatment included lack of effectrelatively higher cost or uncomfortable treatment It wassuggested that improvement of the practitionerrsquos skill aswell as improvement of coverage with public healthinsurance is the important factor to these remedies togain a larger market share in Japan

Acknowledgements

All surveys included in this study were funded everyfinancial year between 2002ndash2005 by Foundation forTraining and Licensure Examination in AmmandashMassagendashAcupressure Acupuncture and Moxibustion (ToyoRyoho Kenshu Siken Zaidan) Tokyo Japan (httpwww15ocnnejpahakiindexhtml)

References1 Foundation for Training and Licensure Examination in Amma-

Massage- Acupressure Acupuncture and Moxibustion Official WebSite httpwww15ocnnejpahakienrollment html

2 Ministry of Health Labor and Welfare Official Web Site Availableat httpwwwmhlwgojptoukeisaikinhweisei04indexhtml

3 Fujii R Yamashita H Iwamoto M Survey on the Number ofAmma Acupuncture Moxibustion Clinics and PractitionersVerification of the table 63 and 64 in Biennial Report on PublicHealth Administration and Services 2002 J Japan Soc AcupunctMoxibust 200555566ndash73

4 Yamashita H Tsukayama H Sugishita C Popularity of comple-mentary and alternative medicine in Japan a telephone surveyComplement Ther Med 20021084ndash93

5 MacLennan AH Wilson DH Taylor AW Prevalence and cost ofalternative medicine in Australia Lancet 1996347569ndash73

6 Fisher P Ward A Medicine in Europe complementary medicine inEurope Br Med J 1994309107ndash11

7 Eisenberg DM Davis RB Ettner SL Appel S Wilkey SRompay MV et al Trends in alternative medicine use in theUnited States 1990ndash1997 J Am Med Assoc 19982801569ndash75

8 Thomas KJ Coleman P Use of complementary or alternativemedicine in a general population in Great Britain Results from theNational Omnibus survey J Public Health 200426152ndash7

9 Menniti-Ippolito F Gargiulo L Bologna E Forcella ERaschetti R Use of unconventional medicine in Italy a nation-wide survey Eur J Clin Pharmacol 20025861ndash4

10 Adams J Sibbritt DW Easthope G Young A The profile ofwomen who consult alternative health practitioners in AustrariaMed J Australia 2003179297ndash300

11 Goldstein MS Brown ER Ballard-Barbash R Morgenstern HBastani R Lee J et al The use of complementary and alternativemedicine among California adults with and without cancer EvidBased Complement Alternat Med 20052557ndash65

12 Shmuel A Shuval J Satisfaction with family physicians andspecialists and the use of complementary and alternative medicinein Israel Evid Based Complement Alternat Med 20063273ndash8

13 Lee SL Khang YH Lee MS Kang W Knowledge of attitudestoward and experience of complementary and alternative medicinein western medicinemdashand oriental medicinemdashtrained physicians inKorea Am J Public Health 2002921994ndash2000

14 Napadow V Kaptcuk T Patient characteristics for outpatientacupuncture in Beijing China J Altern Complement Med200410565ndash72

15 Chen FP Chen TJ Kung YY Chen YC Chow LF Chen FJ et alUse frequency of traditional Chinese medicine in Taiwan BMCHealth Services Res 2007726

16 Kobayashi A Uefuji M Yasumo W History and progress ofJapanese acupuncture Evid Based Complement Alternat Med 2008Feb 4 [Epub ahead of print] doi101093ecamnem155

17 Yamashita H Tsukayama H Characteristics of acupuncturepatients in Japan - data from nationwide survey on complementaryand alternative medicine Japan Acupunct Moxibust 2005143ndash8

18 Astin JA Why patients use alternative medicine Results of anational survey J Am Med Assoc 19982791548ndash53

19 Druss BG Rosenheck RA Association between use of unconven-tional therapies and conventional medical services J Am Med Assoc1999282651ndash6

20 Sherman KJ Cherkin DC Eisenberg DM Erro J Hrbek ADeyo RA The practice of acupuncture who are the providers andwhat do they do Ann Fam Med 20053151ndash8

21 Tsuru H Ishizaki N Taniguchi K Actual condition survey of3000 patients in affiliated acupuncture clinic of Meiji College ofOriental Medicine in the USA Japan Acupunct Moxibust 2005127ndash35

22 Ministry of Health Labor and Welfare Official Web Site Availableat httpwwwmhlwgojptoukeisaikinhwk-tyosak-tyosa043-1html

23 Wolsko PM Eisenberg DM Davis RB Ettner SL Phillips RSInsurance coverage medical conditions and visits to alternativemedicine providers results of a national survey Arch Intern Med2002162281ndash7

24 Ishizaki N Yano T Kawakita K Survey research on use ofacupuncture andor moxibusion in Japanmdashresults from a survey inMarch 2006 The Program of the 56th Annual Meeting of the JapanSociety of Acupuncture and Moxibustion June 8ndash10 2007Okayama (proceeding written in Japanese)

Received December 28 2007 accepted April 28 2008


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Acupuncture Practice in Medical Facilities is Limitedin Japan

Acupuncture practice in medical facilities in Japan islimited which is reflecting relatively lower status of theremedy as non-official medicine in this countryGenerally acupuncture treatment is not covered bypublic health insurance system except for particularkind of medical conditions (i) low back pain (ii) frozenshoulder (iii) neuralgia (iv) rheumatoid arthritis (RA)(v) cervicondashbrachial syndrome (vi) neck sprain onlywhen the patients could get consent document by theirphysicians However not many physicians are favorableto recommend acupuncture to the patients and conse-quently it is difficult to get acupuncture treatment withsupport of public health insurance

License of Acupuncture and Moxibustion in Japan

Japanese national license for acupuncture and for moxi-bustion are separately issued The status of acupuncturistsand moxibustionists is guaranteed and they are allowed tohave their own clinics while the other health care providerssuch as physiotherapists or occupational therapists are notallowed to practice by themselves Because right to practiceacupuncture and moxibustion is under the protection of thelaw any other health care providers except medical doctorsare not allowed to practice acupuncture and moxibustionwhile physiotherapy or occupational therapy which ismainly provided by physiotherapists or occupational the-rapists can also be provided by nurses or massage the-rapists Although acupuncturists and moxibustionists haveright to practice by themselves their practical activity in themedical facilities of which health care services are coveredby public insurance are strictly limited License for acupun-cture and moxibustion are national qualification and com-pletion of 3-year program in the accredited vocationalschool or 4-year program in accredited university arerequired to be qualified for licensing exam Althoughlicense for acupuncture and for moxibustion are separatelyissued most of the schools have programs for both acup-uncture and moxibustion Therefore those who completedthe program usually are licensed for both of them and arecalled lsquoAcupuncture and Moxibustion therapistsrsquo

Number of Acupuncturists and Moxibustion Therapistsin Japan

The total number of those who are listed as acupuncturistsand moxibustionists as of September 2005 in Japan are127 018 and 125 868 respectively (a statistics by ToyoRyoho Kensyu Shiken Zaidan (Foundation for Trainingand Licensure Examination in AmmandashMassagendashAcupressure Acupuncture and Moxibustion) (1)Although actual number of the active practitioners is notprecisely investigated a statistics by Ministry of HealthLabour and Welfare (2) estimated that approximately

76 643 acupuncturists and 75 100 moxibustionists wereactive as of the year 2004 Since the statistics provided bythe Ministry of Health Labour and Welfare are based onthe number of acupuncturists or moxibustionists who areregistered at regional public health center it probablyincludes the practitioners who have already retiredAccording to a report by Fujii et al (3) 265 of theregistered practitioners is not actively practicing Thenumber of facilities that provides acupuncture andormoxibustion are 14 993 and those that provides acupunc-ture and moxibustion andor amma massage shiatsu are33 601 in 2004 (2) (Table 1) According to these statisticsthe number of the facilities that provides acupuncture andor moxibustion estimated in the report by Fujii et al was48 594 and likewise the number of active practitioners foracupuncture and moxibustion was estimated to be 55 000 asof the year 2004

Use of Acupuncture andor Moxibustion Therapy and

Characteristics of the Patients in Recent Years in Japan

Despite long history and knowledge of the medicine inthe country little is known about the popularity and thecharacteristics of the patients who use acupuncture andor moxibustion in Japan The most reliable informationabout popularity of acupuncture in Japan was presentedin 2002 by Yamashita et al (4) which summarized theresults from a nationwide telephone survey conducted in2000 The result of the report indicates that 67 of thepopulation had used acupuncture and moxibustion in thepast 12 month

Purpose of the Present Study

Although the statistics presented by Yamashita et alprovides important information on utilization of acupunc-ture in Japan there were some limitations in the study as theauthor described Furthermore because their study wasconducted focusing not specially on acupuncture users buton all CAM therapy users specific information onacupuncture users are limited Therefore more reliableand specific information on acupuncture users whorepresent the population of the country is desired In thepresent study we report results from nationwide popula-tion-based survey on utilization of acupuncture andor

Table 1 The number of facilities that provides acupuncture andormoxibustion

Kind of license Year

1992 1994 1996 1998 2000 2002 2004

Acupuncture andmoxibustion

12 055 12 481 13 166 13 455 14 216 14 008 14 993

Amma massageshiatsu andacupunctureand moxibustion

28 624 29 451 30 850 31 434 32 024 32 722 33 601



Methods



Questions Analyzed



Statistical Methods


Results



Age group(years)

Survey year

2003 2004 2005 2006

Percentage(95 CI)




MF







eCAM 20107(4) 495














Age group Education


Pa Overall

2003

20ndash39 00 25 43 0544 34

40ndash59 135 67 45 0076 66

60 95 94 104 0903 95

Total 101 63 51 0037 65

2004

20ndash39 00 30 28 0923 28

40ndash59 29 36 32 0968 34

60 107 86 33 0216 86

Total 90 47 30 0006 48

2005

20ndash39 00 50 36 0589 41

40ndash59 00 58 60 0357 55

60 90 84 133 0502 93

Total 70 64 59 0859 64

2006

20ndash39 00 43 37 0710 39

40ndash59 63 81 53 0508 69

60 71 95 90 0709 86

Total 64 76 53 0322 67



Age group Scale


2003

20ndash39 67 14 36 0036 34

40ndash59 71 43 120 0014 66

60 179 85 57 0007 95

Total 97 49 76 0010 65

2004

20ndash39 29 31 16 0816 28

40ndash59 45 30 34 0746 34

60 71 81 105 0690 85

Total 44 46 56 0763 48

2005

20ndash39 57 36 30 0597 41

40ndash59 69 58 39 0632 57

60 108 81 107 0649 93

Total 76 59 63 0571 64

2006

20ndash39 42 45 16 0591 39

40ndash59 74 46 145 0007 69

60 102 80 83 0787 86

Total 74 58 88 0257 67




2003 2004 2005 2006

Percentage(95 CI)




MF














Knee pain 120 82ndash165 99 137 0310 202 84 0005


Neuralgia 43 21ndash75 46 40 0791 51 40 0767





Other 141 100ndash189 99 177 0055 121 150 0604






Fatigue 69 (42ndash104) 66 72 gt099 121 49 0022



Eyestrain 32 (15ndash58) 20 40 0374 47 26 0335



Paralysis 13 (03ndash33) 07 18 0652 19 11 0626


Others 115 (80ndash156) 105 121 0742 75 131 0152





More than1 year ago

Pc








Others 48 26ndash78 66 36 0221 47 49 gt099


eCAM 20107(4) 497


Discussion







Reason Percentage



Comfortable 376


Convenient 159

Easy to visit 95


Inexpensive 42


Other 21



Expensive 209

Lack of time 137

Uncomfortable 108





Other 194




in Japan







andor Moxibustion


eCAM 20107(4) 499


Conclusion


Acknowledgements


































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of

















Methods



Questions Analyzed



Statistical Methods


Results



Age group(years)

Survey year

2003 2004 2005 2006

Percentage(95 CI)




MF







eCAM 20107(4) 495














Age group Education


Pa Overall

2003

20ndash39 00 25 43 0544 34

40ndash59 135 67 45 0076 66

60 95 94 104 0903 95

Total 101 63 51 0037 65

2004

20ndash39 00 30 28 0923 28

40ndash59 29 36 32 0968 34

60 107 86 33 0216 86

Total 90 47 30 0006 48

2005

20ndash39 00 50 36 0589 41

40ndash59 00 58 60 0357 55

60 90 84 133 0502 93

Total 70 64 59 0859 64

2006

20ndash39 00 43 37 0710 39

40ndash59 63 81 53 0508 69

60 71 95 90 0709 86

Total 64 76 53 0322 67



Age group Scale


2003

20ndash39 67 14 36 0036 34

40ndash59 71 43 120 0014 66

60 179 85 57 0007 95

Total 97 49 76 0010 65

2004

20ndash39 29 31 16 0816 28

40ndash59 45 30 34 0746 34

60 71 81 105 0690 85

Total 44 46 56 0763 48

2005

20ndash39 57 36 30 0597 41

40ndash59 69 58 39 0632 57

60 108 81 107 0649 93

Total 76 59 63 0571 64

2006

20ndash39 42 45 16 0591 39

40ndash59 74 46 145 0007 69

60 102 80 83 0787 86

Total 74 58 88 0257 67




2003 2004 2005 2006

Percentage(95 CI)




MF














Knee pain 120 82ndash165 99 137 0310 202 84 0005


Neuralgia 43 21ndash75 46 40 0791 51 40 0767





Other 141 100ndash189 99 177 0055 121 150 0604






Fatigue 69 (42ndash104) 66 72 gt099 121 49 0022



Eyestrain 32 (15ndash58) 20 40 0374 47 26 0335



Paralysis 13 (03ndash33) 07 18 0652 19 11 0626


Others 115 (80ndash156) 105 121 0742 75 131 0152





More than1 year ago

Pc








Others 48 26ndash78 66 36 0221 47 49 gt099


eCAM 20107(4) 497


Discussion







Reason Percentage



Comfortable 376


Convenient 159

Easy to visit 95


Inexpensive 42


Other 21



Expensive 209

Lack of time 137

Uncomfortable 108





Other 194




in Japan







andor Moxibustion


eCAM 20107(4) 499


Conclusion


Acknowledgements


































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of





























Age group Education


Pa Overall

2003

20ndash39 00 25 43 0544 34

40ndash59 135 67 45 0076 66

60 95 94 104 0903 95

Total 101 63 51 0037 65

2004

20ndash39 00 30 28 0923 28

40ndash59 29 36 32 0968 34

60 107 86 33 0216 86

Total 90 47 30 0006 48

2005

20ndash39 00 50 36 0589 41

40ndash59 00 58 60 0357 55

60 90 84 133 0502 93

Total 70 64 59 0859 64

2006

20ndash39 00 43 37 0710 39

40ndash59 63 81 53 0508 69

60 71 95 90 0709 86

Total 64 76 53 0322 67



Age group Scale


2003

20ndash39 67 14 36 0036 34

40ndash59 71 43 120 0014 66

60 179 85 57 0007 95

Total 97 49 76 0010 65

2004

20ndash39 29 31 16 0816 28

40ndash59 45 30 34 0746 34

60 71 81 105 0690 85

Total 44 46 56 0763 48

2005

20ndash39 57 36 30 0597 41

40ndash59 69 58 39 0632 57

60 108 81 107 0649 93

Total 76 59 63 0571 64

2006

20ndash39 42 45 16 0591 39

40ndash59 74 46 145 0007 69

60 102 80 83 0787 86

Total 74 58 88 0257 67




2003 2004 2005 2006

Percentage(95 CI)




MF














Knee pain 120 82ndash165 99 137 0310 202 84 0005


Neuralgia 43 21ndash75 46 40 0791 51 40 0767





Other 141 100ndash189 99 177 0055 121 150 0604






Fatigue 69 (42ndash104) 66 72 gt099 121 49 0022



Eyestrain 32 (15ndash58) 20 40 0374 47 26 0335



Paralysis 13 (03ndash33) 07 18 0652 19 11 0626


Others 115 (80ndash156) 105 121 0742 75 131 0152





More than1 year ago

Pc








Others 48 26ndash78 66 36 0221 47 49 gt099


eCAM 20107(4) 497


Discussion







Reason Percentage



Comfortable 376


Convenient 159

Easy to visit 95


Inexpensive 42


Other 21



Expensive 209

Lack of time 137

Uncomfortable 108





Other 194




in Japan







andor Moxibustion


eCAM 20107(4) 499


Conclusion


Acknowledgements


































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of























Knee pain 120 82ndash165 99 137 0310 202 84 0005


Neuralgia 43 21ndash75 46 40 0791 51 40 0767





Other 141 100ndash189 99 177 0055 121 150 0604






Fatigue 69 (42ndash104) 66 72 gt099 121 49 0022



Eyestrain 32 (15ndash58) 20 40 0374 47 26 0335



Paralysis 13 (03ndash33) 07 18 0652 19 11 0626


Others 115 (80ndash156) 105 121 0742 75 131 0152





More than1 year ago

Pc








Others 48 26ndash78 66 36 0221 47 49 gt099


eCAM 20107(4) 497


Discussion







Reason Percentage



Comfortable 376


Convenient 159

Easy to visit 95


Inexpensive 42


Other 21



Expensive 209

Lack of time 137

Uncomfortable 108





Other 194




in Japan







andor Moxibustion


eCAM 20107(4) 499


Conclusion


Acknowledgements


































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of

















Discussion







Reason Percentage



Comfortable 376


Convenient 159

Easy to visit 95


Inexpensive 42


Other 21



Expensive 209

Lack of time 137

Uncomfortable 108





Other 194




in Japan







andor Moxibustion


eCAM 20107(4) 499


Conclusion


Acknowledgements


































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of


















in Japan







andor Moxibustion


eCAM 20107(4) 499


Conclusion


Acknowledgements


































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of

















Conclusion


Acknowledgements


































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of





















of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of
















public status and prevalence of acupuncture in japan

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