The Acupuncturist System and Acupuncture Education in Japan

Ruixia Wang

Abstract: According to laws and regulations of Japan, the profession of acupuncturist is a nationally recognized qualification. To become an acupuncturist, individuals are required to complete a three-year education at an acupuncture school. After graduation, you must pass the National Qualification Examination for Acupuncture Practitioners, and then one can obtain a license to practice acupuncture.

Historically the development of Japanese acupuncture to the present, just like the use of herbal medicines deriving from Chinese traditional medicine (Kampo), acupuncture has experienced periods of flourishing and decline which correspond with the historical changes in Japan, and has even been, at times, in danger of being eliminated.

The author is engaged in acupuncture education in Japan, and this article will be an introduction to the acupuncture system and current state of acupuncture education in Japan.

1. Historical changes in the acupuncturist system in Japan

The current law in Japan regarding acupuncturists and their practice of medicine is the “Laws Relating to Massage, Acupuncturists, and Moxibustion Practitioners.”In other words, according to Japanese law, the title acupuncturist is not one qualification, but two qualifications: acupuncturist and moxibustionist.

Typically, after passing the national qualification examination for acupuncturists, two licenses for acupuncture and moxibustion will be issued in the name of the Japanese Minister of Health and Welfare (equivalent to the Minister of Health in China). Every year when students who graduate from Japanese acupuncture schools take the national qualification examination, if they only pass the acupuncture examination, they will only get an acupuncture license and can only perform acupuncture treatment, and ff they only pass the moxibustion examination, they will only get a moxibustion license and are able to perform moxibustion treatment. If they pass both, they have both an acupuncture and moxibustion license and can perform acupuncture and moxibustion treatment.

Before the current acupuncturist system was formed, the Japanese acupuncture community, like other traditional medicines, had experienced political and policy changes in various eras. The history of Japanese acupuncture and moxibustion from a developmental and regulatory context, can be roughly divided into four periods: the early stage、the Meiji Restoration period to the early Showa period、the middle Showa period and the late Showa period to the present.

The initial stage of the transmission of Chinese medicine to Japan occurred in the 5th to 6th centuries. During the early Meiji period (around 1870), both practitioners of traditional Chinese medicine and acupuncturists had equal status and were considered mainstream medical professionals. Acupuncturists even had titles such as “Needle Doctor,” “Acupuncturist,” and “Apprentice Acupuncturist.” Tanba Yasuyori, the author of the well-known Kampo medicine classic “Yishinbo”, which is now designated as a national treasure of Japan, holds the title of doctor of acupuncture during the Heian period (784-1185).

The period from the Meiji Restoration to the early Showa era marked the comprehensive decline of traditional Japanese medicine. During this time, the Japanese government, under the policies of “enrich the country, strengthen the military” and industrial revitalization, established a modern healthcare system in 1874 that imitated Western medical systems. This system mandated that only those who had studied Western medicine could receive a medical license, and acupuncture as a medical practice had to be conducted under the supervision of Western medical doctors. However, because acupuncture was very popular among the people this edict was resisted by the acupuncture community, and this system was not implemented.

In view of this actual situation, the relevant departments issued the “Acupuncture and Moxibustion Business regulation Law” in the 18th year of Meiji (1885), allowing the business practice of acupuncture treatment, that is, the acupuncture business licensing system. Then, in 1911, during the 44th year of the Meiji era, the “Acupuncture and Moxibustion Business Regulations” were issued, which allowed not only the traditional master-apprentice method of learning acupuncture and moxibustion, but also formal education at schools to train acupuncture practitioners. This meant that practitioners could be trained in two ways: through apprenticeships under experienced masters or through formal education at schools.

After the end of World War II in Showa 20 (1945), Japan once again ushered in a major reform of the medical system. Acupuncture treatment was branded as “unscientific”, and some advised the government to completely ban medical practices other than Western medicine. However, after strong opposition campaigns from celebrities, scholars and groups in both Western and Kampo medicinal communities, and after passing the defense of the Medical System Review Committee of the Ministry of Health and Welfare, the Massage, Acupuncture, Moxibustion, and Judo Rehabilitation Business Act was established in 1947 (“Judo rehabilitation” refers to those who are trained in martial arts and traditional bone setting for injuries). This act was revised in Showa 26 (1951), and the business law was changed to regulate the massage, acupunctuet, moxibustion, and judo osteopathypractitioners. After this reform, the regulation of acupuncture and moxibustion transitioned from a business license system to individual medical licenses.

The mid-Showa period can be considered a phase of improvement in the acupuncture and moxibustion healthcare system in Japan. In 1970, during the 45th year of the Showa era, the Judo Manipulator Act was separated from the existing law and established as the Judo Manipulator Act. The relevant lawsconcerning acupuncturists and moxibustion therapists were officially categorized under the “Massage Therapist, Acupuncturist, Moxibustion Therapist Act.”

However, at this time, the legal authority to grant licenses to acupuncturists and moxibustion therapists was held by the governors of the prefectures in Japan (equivalent to mayors or provincial governors in China). The licensing examinations for acupuncturists and moxibustion therapists were conducted at the prefectural level, with no nationwide standardized examination.

In 1988, during the 53rd year of the Showa era, another legal amendment was implemented. The authority to issue licenses was transferred from the prefectural governors to the Minister of Health and Welfare (equivalent to the Minister of Health in China). This change meant that acupuncture, and moxibustion therapist licenses became national qualifications, and the licensing examinations were standardized nationwide.

2.Japan’s current acupuncture education system

Acupuncture schools in Japan are also called “acupuncture training facilities.” In addition to training acupuncturists and moxibustion practitioners, some schools also offer massage, acupressure and other majors. There are currently about 90 three-year acupuncture schools and 11 four-year acupuncture universities. A master’s degree program in acupuncture was established in 1991, and a doctoral degree program in acupuncture was established in 1994.

Since the main institutions responsible for acupuncture and moxibustion education in Japan are the three-year specialized schools, this article provides an overview of the education system in these specialized schools.

Acupuncture and moxibustion specialized schools admit students who have completed at least a high school education or its equivalent. The student body in these schools is typically diverse and may include recent high school graduates, individuals with general work experience, as well as those who have worked in medical-related fields such as nursing, pharmacy, physical therapy, and even homemakers. The age of the students ranges from 20 years old to around 70 years old.

During the three-year period of enrollment in these specialized schools, students are required to complete the curriculum prescribed by the school. The curriculum typically consists of 86 credits, which are divided into the following categories:

Basic Courses: 14 credits

Basic Professional Courses: 27 credits

Specialized Courses: 45 credits.

Upon successfully completing these required credits and passing the graduation examination, students become eligible to participate in the national examination for acupuncturists and moxibustion therapists. It’s important to note that Japan does not recognize Chinese medicine qualifications obtained outside of Japan. Even if someone has graduated from a Chinese medicine university in their home country, they must, like Japanese students, study in these specialized schools for three years, complete the prescribed courses and credits, pass the graduation examination, and then become eligible to take the national examination for acupuncturists and moxibustion therapists.

It’s worth mentioning that the curriculum in specialized Japanese acupuncture and moxibustion schools has been consistently based on Western medical courses since the Meiji Restoration. These schools offer a broader range of subjects in Western medicine, spanning from basic medical sciences to various clinical disciplines, compared to traditional medicine. This can be clearly observed from the content of the Japanese national examination for acupuncturists and moxibustion therapists, as it emphasizes a strong foundation in Western medical knowledge.

Here is a table outlining the subjects covered in the Japanese national examination for acupuncturists and moxibustion therapists, which includes topics from both traditional Eastern medicine and Western medicine。

From the table, it’s evident that the number of subjects related to Western medicine is greater than those in the Eastern medicine category. Additionally, the subjects listed in the Eastern medicine category, namely Acupuncture Theory and Moxibustion Theory, essentially encompass content related to Western medical physiology and pathology. In other words, the content related to Eastern medicine on the Japanese national examination for acupuncturists and moxibustion therapists is limited to Oriental Medicine Overview (equivalent to the fundamental theories of traditional Chinese medicine taught in Chinese medicine schools), Oriental Clinical Medicine (which includes concise versions of clinical specialties like internal medicine, external medicine, gynecology, etc, as taught in Chinese medicine schools), and Meridians and Acupoints.

Another distinctive aspect of Japan’s acupuncture and moxibustion education system is the presence of specialized schools for the blind that teach acupuncture and moxibustion.

Japanese acupuncture education facilities for the blind were first established in the Edo period. Sugiyama Kazuichi, a famous blind acupuncturist at that time, won the favor of Edo shogunate Tokugawa Tsunayoshi because of his superb medical skills. Relying on this relationship, he established the “Sugiyama Acupuncture Guidance Training Center”, the first acupuncture education institution for blind people. The emergence of this educational facility laid the foundation for blind people to learn and engage in acupuncture work at that time and in the future. It was also the origin of the long-term active participation of blind people in the Japanese acupuncture community.

During the Meiji era, the Blind Medical Association was established, and in 1902, the “Blind Acupuncture and Massage Training School” was officially opened, eventually evolving into specialized schools for blind individuals in the field of acupuncture, moxibustion, and massage.Currently, Japan has two forms of schools for blind individuals in the field of acupuncture and moxibustion. One type is under the jurisdiction of the Japanese Ministry of Education, Culture, Sports, Science, and Technology (equivalent to the Ministry of Education in China). These schools typically admit students with junior high school qualifications and have a 5-year curriculum. The other type falls under the jurisdiction of the Ministry of Health, Labour, and Welfare and accepts students with high school qualifications, offering a 3-year curriculum. Like students in other acupuncture and moxibustion schools, blind individuals studying at these schools, upon completing the prescribed courses and credits and passing the graduation examination, are eligible to participate in the national qualification examination. The difference is that the examination rooms for people with normal eyes and those with visual impairments are separate during the examination.

The establishment of specialized acupuncture and moxibustion education facilities for blind individuals has made a significant contribution to their employment, livelihood, and active participation in societal activities.

This has been a brief introduction to acupuncture medical regulation in Japan and the current Japanese acupuncture education system.

Reference List:

1. Kitagoshikoji, H. (2021). Changes in the Acupuncture and Moxibustion Healthcare System, Education, and Research during the Meiji Era. Journal of the Japan Acupuncture and Moxibustion Society, 62(1), 29-37.

2. Shinohara, S. (n.d.). Characteristics of Acupuncture and Moxibustion in Japan: Post-War History, Education, and System. Meiji International Medical University, Traditional Acupuncture and Moxibustion Research Office.

3. Terada, K., & Wada, T. (2018). Visual Impairment and Acupuncture & Massage. Proceedings of the Human Rights Research Laboratory at Tenri University, 21, 19-27.

4. Wakayama, I. (2022). Comprehensive Traditional Chinese Medicine. Seifusha, 275-276.

About the Author:

Wang Ruixia, a graduate of the Traditional Chinese Medicine Department at Shandong University of Traditional Chinese Medicine, holds a master’s degree from Beijing University of Chinese Medicine and a doctoral degree from the Medical Faculty of a Japanese university. She serves as a lecturer at Japan Medical Judo Orthopedics and Acupuncture school.

日本的針灸師制度及針灸教育現狀

王瑞霞

摘要：依日本現有相關法律規定,日本的針灸師屬於國家資格,必須通過3年的針灸學校學習,畢業後參加針灸師國家資格考試，考試通過後才能拿到執照並進行針灸醫療行為。

而日本針灸發展到現在,和用漢方藥（即中國的中藥）進行醫療的漢方醫師一樣,伴隨著日本的歷史變遷經歷過興旺盛衰,甚至有過被消取消的危機。

因作者在日本從事針灸教育，本文就日本的針灸師制度及現行針灸教育做一介紹。

1.日本針灸師制度的歷史變遷

日本現行的針灸師及針灸師行醫的法律是「按摩指壓、針師、灸師相關法律」。 也就是說，針灸師這個稱呼依日本法律規定的話不是一個資格，而是分針師和灸師二資格。

通常針灸師國家資格考試通過後，會以日本厚生大臣(相當於中國的衛生部長)的名義發放針師、灸師二個執照。 每年日本針灸學校畢業的學生參加國家資格考試時,如果僅通過了針師考試就只拿到針師執照，只能進行針灸治療,如果只通過了灸師考試就只拿到灸師執照，只 能進行灸治療,二個都通過則既有針師也有灸師執照,可以進行針和灸的治療。

在形成現有的針灸師制度之前,日本針灸界和其他傳統醫學一樣,經歷了各個時代、時期的政治、政策變化等的洗禮,針灸師制度也不例外。從日本針灸史的演變、演化及盛衰過程來分,可以將其大體分成初期、明治維新期至昭和初期、昭和中期、昭和末期至今的4個時期。

初期即自5～６世紀由中國傳到日本至日本明治是時代初期(1870年)這個階段。這個階段用漢方藥行醫的漢方醫師和用針灸行醫的針灸具有同等的地位,屬於主流醫學。

針灸也曾設置過針博士、針師、針生的職務職稱。 現被指定為日本國寶又廣為周知的漢方醫學古典《醫心方》的著者丹波康賴即具有平安時代的針博士職稱。

明治維新期至昭和時代初期是日本傳統醫學全面衰退期。 當時的日本政府在“富國強兵、振興產業”政策之下,於明治7年（1874年）制定了模仿西洋諸國醫療制度的近代醫療衛生製度,規定只對學習過西醫的人頒發醫師執照。針灸 這一醫療行為必須在西醫醫師管理之下才能進行.但因為針灸在民間備受歡迎，也遭到針灸界的抵制，此制度並沒有付諸實施。「也鑑於這一實際情況，明治18年( 1885年)相關部門發布針術、灸術營業取締法」（編者注：日文的取締,是管理之意），允許針灸治療這一營業行為,即針灸營業許可製度。其後的明治44年（1911年）又發布了「針術、灸術 營業取締規則」,允許除了既往師傅帶徒弟形式學習針灸以外,還可以以學校教育形式培養針師,也即培養針灸師的形式醫師一是以師帶徒,二是學校教育。

昭和20年（1945年）第二次世界大戰結束後,日本再次迎來醫療制度大改革。 針灸治療一度被打上非科學療法的烙印,並有一部分人勸告政府全面禁止西醫以外的醫療行為。 但經過西醫及漢方醫各界名士、學者及各相關團體的強烈反對運動,並透過厚生省醫療制度審議會答辯,於昭和22年（1947年）成立了按摩、針、灸、柔道整復營業法 ,昭和26（1951年）年修改前法，將營業法改為按摩師、針師、灸師、柔道整骨師(柔道整骨簡稱柔整)法。 自此以後,針灸從營業許可製度變成個人式行醫執照制度。

昭和中期可謂是針灸醫療制度完善期。 昭和45年(1970年)柔道整復師法單獨分離為柔道整復師法,有關針灸師的法律正式成為「按摩師、指壓師、針師、灸師法」。

但此時法律規定授予針師、灸師執照權的是日本都道府縣知事（相當於中國的直轄市長、省長等）,針灸師執照考試也由各都道府縣實施，沒有全國統一考試。

昭和53年（1988年）再次實施法律修改，由上述都道府縣知事授權修改為厚生大臣（相當於中國的衛生部長），也即針灸師執照成為國家資格，針灸師執照考試變為全國統一 考試。

2.日本現行針灸教育制度

日本的針灸學校又被稱為“針灸養成設施”，除了培養針師、灸師以外，有些學校還並設有按摩、指壓等專業。 現有三年制針灸專門學校約90所，四年制針灸大學11所，並於1991設立針灸碩士學位制，1994年設立針灸博士學位制。

因擔負針灸教育的主要是三年制專門學校，本文就專門學校的針灸教育制度做一介紹。

針灸專門學校招生對像是具有高中畢業以上學歷的人，各個學校學生構成一般為高中應屆畢業生、有過一般工作經驗的社會人及從事過護士、藥劑師、物理治療師等醫藥相關的社會人、 家庭主婦等。 學生年齡在20歲前後至70歲前後。

在校三年期間必須履修完學校規定課程，具體為基礎課14學分,專業基礎課27學分,專業課45學共86學分。修完這些規定學分,畢業考試通過後方有參加針灸師國家考試的資格。 另外，日本不承認本國以外的中醫學歷，即使畢業於本科中醫大學的人要想拿針師、灸師執照必須和日本學生一樣在校學習三年，修完規定課程及學分，通過畢業考試後 才能參加國家考試。

值得一提的是:日本針灸專門學校的課程設置自明治維新以後一貫西醫課程為基盤,西醫基礎醫學到臨床各科的科目都多於傳統醫學。這一點,從下面的日本針灸師國家考試科目就能一目了然。

下表列出了日本全国针灸师和艾灸治疗师考试所涵盖的科目，其中包括东方医学和西医的主题。

表：日本針灸師全國考試科目

由上表可看出；西醫科科目數多於東洋系，且列在東洋系的針論及灸理論的實質是有關西醫師理學、病理學內容。

也就是說，日本針灸師國家考試的東洋醫學系內容僅是東洋醫學概論（相當於中國醫院院校的中醫基礎理論）、東洋醫學臨床論（相當於中醫院校包括中醫內科、外科、婦科等在內的臨床各科簡要版）及經絡經穴這三科。

另外，日本針灸教育制度最值得一提或最具日本針灸教育特色的是日本有盲人專門的針灸學校。

日本盲人針灸教育設施最早建立在江戶時代。 當時有名的盲人針師杉山和一因醫技高超，深得江戶幕府將軍德川綱吉的寵愛。 依靠這層關係他設立了最初的盲人針灸教育機關「杉山流針治導引講習所」。 這項教育設施的出現為當時及以後盲人學習、從事針灸工作奠定了基礎，也是長期以來盲人活躍在日本針灸界的淵源。

明治時代成立盲人醫學協會，並於1902年正式開設“盲人針灸按摩講習所”，以後演變成盲人針灸按摩學校。

現在日本的盲人針灸學校有二種形式，一種是屬於日本文科省(相當於中國的教育科學部）管轄的盲人針灸學校，一般接受初中學歷的學生入學，學制為5年。 一種是厚生省管轄的針灸專門學校，接受高中學歷入學的學生，學制為3年。 盲人針灸學校的學生和其他針灸學校同樣，修完規定課程及學分,畢業考試通過後參加國家資格考試。 不同的是考試時眼睛正常者和眼睛障礙者考場是分開的。

盲人專門的針灸教育設施建立後對盲人的就業謀生、積極參與社會活動做了很大貢獻。

以上，就日本針灸醫療及現行針灸教育制度做了簡單介紹，讀者如果透過此文對日本界有所了解，實屬萬幸。

參考文獻

1.北小路博司,明治時代的針灸醫療制度·教育及研究變遷.全日本針灸學會雜誌2021年第62卷第1號:29-37。

2.篠原昭二,日本針灸的特質(戰後的歷史與教育、制度),明治國際醫療大學傳統針灸學教研室。

3.寺田和史,和田恆彥,視覺障礙與針灸·按摩。天理大學人權問題研究室紀要第21號:19-27.2018。

4.若山育郎, 漢方醫學大全,275-276.靜風社2022。

作者介紹：

王瑞霞,山東中醫藥大學中醫系畢業,北京中醫藥大學碩士學位,日本大學醫學部博士學位,日本醫學柔整針灸專門學校 (註:柔整是柔道整骨的簡寫)