Volume 6, Number 4 | Winter 2011

Kampo Medicine - Current Research
Investigation of Clinical Indications of Goreisan inPatients with Epigastralgia in the Summer Season－From the “Goreisan Symposium 2010”－[Introduction]

Goreisan is based on ancient Chinese medical
books “Shanghanlun” (Treatise on Cold Damage
Diseases)

and“Jinguiyaolue”(SynopsisofYoko Kimura

Prescriptions of the Golden Chamber), and is a

Institute of Oriental Medicine,

representative prescription used for all types ofTokyo Women’s Medical University,“Water toxin”, such as edema, vertigo, headaches,

School of Medicine

and diarrhea. In clinical practice, it is applied forvomiting,[Abstract]waterydiarrhea

and

other

such

gastrointestinal colds, as well as for cyclic vomiting,

Teian Azai classically described that summer

migraineheadaches,heat was caused by humidity in addition to hot

hangovers,

vertigo,weather. It may occur after getting chilled whilesyndromei). Signs for using goreisan include dry

asleep, enjoying the evening cool and taking cold

mouth, low urine output, water-counterflow-likefoods and drinks. Humidity and high temperature

vomiting, and splashing sound in the epigastricprevent qi circulation in the stomach. Therefore, heregion1).

trigeminal

nephritis,neuralgia,andnephrotic

insisted that goreisan, a formula improving water

Recently, I saw patients who developed epigastriccirculation, could be applied for diverse symptoms

pain triggered by consuming cold foods during thecaused by summer heat. We present two cases ofsummer, and improved after taking goreisan. Therepatients with epigastralgia caused by cold foods andhave been no case reports published that describeddrinks in air-conditioned environments, whoseepigastric pain improved by goreisan. Thus, asymptoms were improved by goreisan. In priorretrospective comparison study was performed,treatment, anchusan in case 1, and rikkunshito incomparing effective cases using goreisan withcase 2 were not effective for their epigastralgia.

ineffective cases. The study aimed to clarify what

Nineteen cases of epigastralgia after taking cold

types of epigastric pain goreisan is effective against.

foods and drinks in summer, including these twocases, revealed that goreisan was efficacious againstA) Cases of improvement of epigastric pain by

the summer epigastralgia with white fur on thegoreisan

tongue and a stuck feeling in the pit of the stomach.

[Case 1] 47-year-old female care manager

Abdominal fluid congestion is a major abdominal

Chief complaint: Epigastric pain

sign for an indication of goreisan, but a stuck feeling

Past medical history: None in particularin the pit of the stomach appeared in some effective

History of present illness: From around 2 years ago,cases of goreisan. We concluded that epigastralgia

the patient’s symptoms of cold sensitivity andcaused by cold foods and drinks with white fur on themenstrual

tongue and a stuck feeling in the pit of the stomach

tokishakuyakusan
tokishigyakukagoshuyushokyoto

could be a target for the application of goreisan.

pain

had

lightenedafter

takingandthat

wasprescribed by the hospital. From mid-July, the[Keywords]

humid heat of summer prompted her to frequently

goreisan, epigastralgia, summer heat, cold drinks

consume ice cream and cold beverages in an air-and foods

conditioned

environment,andshebegantoexperience piercing pains near her stomach. She
thus sought medical attention.

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

9Volume 6, Number 4 | Winter 2011

Subjective symptoms: The patient complained of

Subjective symptoms: The patient complained of coldthirst, excessive consumption of liquids, epigastricsensation (feet), general malaise, dry mouth,pain, loose stool, and edema in her legs. She

excessive consumption of liquids, loss of appetite,

experienced no excessive sweating or low urine

heavy stomach feeling, epigastric pain and nausea.

output.

She had regular bowel movement, and experienced

Physical observations: 155cm, 50kg (BMI 20.8),

no excessive sweating or edema.

blood pressure 108/68 mmHg, pulse 68/min.

Physical observations: 161cm, 54kg (BMI 20.8),

Normal facial complexion. No vacuous nor forceful

blood pressure 118/64 mmHg, pulse 68/min.

pulse. Pale red tongue with a white fur. Medium

Normal facial complexion. No vacuous nor forcefulabdominal muscle strength, and signs of epigastricpulse. Pale red and enlarged tongue with a white anddiscomfort and resistance.

greasy fur. Weak abdominal strength, and signs ofProgress: The epigastric pain was thought to be

epigastric discomfort and resistance and splashingcaused by consuming cold foods and beverages. The

soundpatient was treated by 7.5g/day of anchusan for two

extremities was also observed.

weeks containing crude drugs such as Corydalis

Progress: Because rikkunshito did not completely

Tuber, Alpiniae Officinari Rhizoma, Amomi Semen,
Foeniculi Furctus and Cinnamomi Cortex that warm

improve the patient’s symptoms, her epigastric pain

the body and act against stomach pains. However,cold foods and beverages. A splashing sound in theher symptoms did not ameliorated, and 7.5g/day ofepigastric region indicated 7.5g/day of goreisan. Twogoreisan was prescribed, focusing on the symptoms

weeks later, her epigastric pain improved, but she

caused by “Water toxin”, characteristics of which

continued to take goreisan, as she claimed that she

includes loose stool and edema in the legs. As afelt better when she took goreisan.

intheepigastricregion.

Coldnessofand nausea were thought to be caused by consuming

result, the patient’s epigastric pain had improved by
the time she visited the hospital two weeks later. AsB) Study of effective and ineffective cases of goreisan

her symptoms resolved, the goreisan prescription

Goreisan was administered to 19 patients whowas terminated, but the epigastric pain relapsed thecomplainedofepigastricpain

triggeredbyfollowing day, and she was prescribed a continued

consuming cold foods and beverages, and thedose of 5 to 7.5g/day of goreisan, and her symptoms

effective cases (16 cases) and ineffective cases (3have been improving.

cases) were summarized in the Table. In all cases,
epigastric pain occurred after consuming cold foods[Case 2] 57-year-old housewife

and beverages when the weather became hot. The

Chief complaint: Epigastric pain, nausea

epigastric pain was mostly described as a “heavyHistory of present illness: She had been takingpain,” “piercing pain” or “tingling pain.” Among the

rikkunshito for upset stomach due to chronic

effective cases, the epigastric pain improved withgastritis, and her symptoms had been contained.
However, around July, when the summer heat begangoreisan, after switching from anchusan (cases 1, 7,8, 10), rikkunshito (cases 2, 3, 5) and heiisan (caseto set in, she started to consume cold foods such as13),

ice cream and watermelon, and came to experience

formulae. Among the ineffective cases, epigastricepigastric pain and nausea. Her symptoms would

pain and canker sores improved with orento andlighten somewhat after taking rikkunshito, but she

hangeshashinto.

sought medical attention, as the epigastric pain andnausea continued.

10whichindicatedineffectivenessoftheseNo clear different characteristics were seen
between patients in the effective and ineffective

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 6, Number 4 | Winter 2011groups with regard to such symptoms as thirst, low

the summerheat-heat but also by the yin pathogen

urine output, diarrhea and edema; however, aor unhealthy qi. One gets chilled while asleep andsignificant difference was observed with respect toenjoying the cool of the evening, and one is affectedtongue fur. Among cases in which goreisan wasby the yin-qi of the night. In addition, one takes raw

effective against epigastric pain, the patients’foods and cold drinks because of hotness, andtongues had a white fur or a white and greasy fur.

exterior side receives a yin-cold qi and interior side

Among the ineffective cases, the patients’ tongues

is harmed by cold foods and drinks. This is seen in

had a yellow fur. Additionally, regarding abdominal

70% to 80% of cases of summerheat-strokes.” 3) It

findings, patients in the effective group had

explains that heat strokes are caused not only by

epigastric discomfort and resistance (15 out of 16

heat but also by humidity, and that seven to eightcases) more than they did a splashing sound in thetimes out of ten, it is caused by cooling the body, such

epigastric region (5 out of 15 cases). Furthermore,as by sleeping with chills, sitting out in the cool

theirbreeze, or consuming cold foods and beverages.

epigastricdiscomfortandresistanceameliorated as their epigastric pain improved.

It also notes, “If the heat enters the exterior,behind which it includes dampness and yin-qi, and[Observations]water-dampness

accumulates

inside,itis

Two cases were presented in which goreisan wasrecommended to administrate medicine for theeffective against epigastric pain accompanying thesummer-heat stroke. For this reason, when treating

consumption of cold foods and beverages during thesummer-heat, formulae like byakkoto will be

hot summer, and 19 cases were examined toprescribed for internal and external heat; formulae

determine the types of epigastric pain goreisan islike goreisan for the exterior summerheat andeffective against. Among patients who complained ofinterior dampness; formulae like seishoekkito for theepigastric pain that was triggered by cold foods andexhaustion of source qi and yang-qi. These three

beverages, goreisan tended to be effective in thosemethods should be differentiated and combined towho had a white coating on their tongue andtreat summerheat” 3) It explains that goreisan

displayed epigastric discomfort and resistance in anshould be used when there are signs of exterior

abdominal examination.

summerheat and interior dampness.

The “Byomeiikai” (Collected Explanations ofWith regard to summer health, “Shiki Choushin

Disease Names) by Keishu Ashikawa describesTairon” (Si Qi Tiao Shen Da Lun, On Presenting

damp stroke as a disease caused by summerheat.

Health in Accordance with the Four Seasons) ofDamp stroke is divided into “external damp” and“Huang-di Nei-jing, Su Wen” Chapter 2 contains the“internal damp”. The former occurs when the patientphrases“Don’t detest the sun” and “Let qi leak, likeis rained upon in a marshy place or goes into theloving place is outside.”4) Shibasaki5) explains themwater, while the latter occurs when the patient

as meaning that in the summer, one must bask inconsumes an excessive amount of foods that are cold

the sun without disliking the sun, and take care notraw foods, fruits or noodles, and drinks a large

to be preoccupied with seeking shades, pursuingamount of liquor or tea.” 2

coolness and avoiding the heat. Furthermore, one

The summer heat section of “Hoikuketsu” (Themust allow the qi inside the body to flow out of theClinical pearls of Prescription Collection) by Teian

body at all times, and prevent it from being pent up

Asai writes, “Summerheat stroke is a common

inside the body.

manifestation; however, it occurs often not only by

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 6, Number 4 | Winter 2011

Goreisan is composed of Alisma Tuber, Polyporus
Sclerotium, Poria Sclerotium, Atractylodis Rhizoma
and Cinnamomi Cortex. The early yang stage section

the way of the water. Thirst, oliguria, and stoolof “Shang-Han-Lun” contains the passages, “Whenis disturbed by dampness, and this is the target ofin greater yang disease, after sweating is promoted
stomach, vexation and agitation with insomnia, andgoreisan. Understanding its main indication, youcan apply goreisan to various situations.”3) Thismeans that goreisan may be widely used for heata desire to drink water, giving a small amount ofstrokes in general to remove fluids that accompany

water will harmonize the stomach qi so that recovery“dampness” when it is hot and hinders the[will ensue]. If the pulse is floating and [there is]circulation of qi inside the stomach.

and great sweat issues, [if there is] dryness in thedysregulation are signs of poor water circulation.
The circulation of yang-qi in the Spleen and Stomach

inhibited urination, slight heat and dispersion―

Additionally, since anchusan, rikkunshito andthirst, goreisan governs it.” And “When sweating has

heiisan were ineffective in half of all effective cases

already been promoted, the pulse is floating and(8/16 cases), it was thought that dissipating

rapid, and [there is] vexation and thirst, goreisan“dampness” with goreisan is also important togoverns it.” 6) (This translation is quoted from "Shang

alleviating epigastric pain occurring from consuming

Han Lun: On Cold Damage" written by Craig

cold foods and beverages.

Mitchell et.al, 1999). This means goreisan should be
used in the early yang stage when consuming fluids

In this study, no certain trend was seen withmitigates the symptoms of irritability and dry mouth

regard to dry mouth, low urine output and edema,

following sweating, but the patient has a floating

which were considered signs for utilizing goreisan,pulse, abnormal urination, low-grade fever and dry

but in cases where goreisan was effective against

mouth. It also states that goreisan is the chief

epigastric pain, white tongue coating was observed

treatment for patients who have yet to sweat

and epigastric discomfort and resistance wassufficiently, whose exterior pattern remains, andobserved in an abdominal examination. In the 16

who have a sunken pulse and extreme thirst.

effectivecases

thatwerestudied,epigastricdiscomfort and resistance was more predominant
Due to the spreading of air conditioners today, wethan a splashing sound in the epigastric region, as atend closely to “seek shades, pursue coolness andresult of abdominal examination. The passage, “Ifavoid the heat,” as mentioned above, and do notthere is the palpitations below the heart, give

sweat or give vent to our qi enough. At such times

shashinto. If it does not heal, goreisan governs it”7)when we do not sweat sufficiently when it is hot and(This translation is quoted from "Shang Han Lun:allow “dampness” to accumulate in our body,

On Cold Damage" written by Craig Mitchell et.al,

goreisan or other such medicine that dissipates1999) in the Greater yang disease stage section offluids becomes necessary.

“Shang-Han-Lun” states that goreisan should be
used for epigastric discomfort that cannot be

The summer heat section of “Hoikuketsu” bymitigated with shashinto preparations. This implies

Teian Asai contains the following passage aboutthat epigastric discomfort may occur due to fluid

goreisan,alldisturbance. As a case report on treating abdominal

summerheat stroke. …When it is hot, the closed

pain with goreisan, it is written in “Kohobinran”, “Aatmosphere contains dampness. It contains the qi ofpatient presented with thirst, epigastric palpitations

yin-dampness. Therefore, to eliminate summerheatand severe abdominal pain to the level that he could

evil to treat heat stroke, eliminate the heat utilizing

not sit down. Dr. Todo Yoshimasu examined this12“Thisprescription

isusedfor

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 6, Number 4 | Winter 2011

patient and said ‘This is an indication of goreisanReferencespattern,’” referring to cases in which Todo Yoshimasu

1) Ishino, Shogo: Goreisan. Shinpan Kampo Igaku

successfully treated abdominal pain with goreisan8).

2nd Edition: 257-259, Institute of Kampo

Additionally, Furuya et al. reports on a case in which

Medicine, Tokyo, 1999.

epigastric pain of unknown cause was alleviated2) Ashikawa,Keishu:Chushitsu.

Byomeiikaiwith goreisan9). In this case, the patient had a(Commentary of the Name of Diseases) vol. 2,

gripping pain in the epigastric region, and anKinsei Kampo Igakusho Shusei 64: 182, Meicho

abdominal examination found epigastric discomfort

Shuppan, Tokyo, 1982.

and resistance in the same way as other cases in thisstudy, in addition to bilateral rectus abdominis.
As discussed above, the comorbidity of epigastricpain due to consumption of cold foods and beverages,

3) Asai, Teian: Chushomon. Hoikuketsu (TheClinical pearl of Prescription Collection), vol. 3,
Kinsei Kampo Igaskuho Shusei 77: 283-311,
Meicho Shuppan, Tokyo, 1981.

white coating on tongue, and epigastric discomfort4) Koteidaikeisomon, Kojutoku-bon (Huang di Neiand resistance may be signs for the administration

jing Su Wen, Gù Cóng-dé version)” Chapter 2of goreisan.

“Shiki Choushin Tairon, Si Qi Tiao Shen Da Lun,On Preserving Health in Accordance with theFour Seasons”. Jukohochu Koteidaikeisomon No.

[Conclusion]Heat strokes are caused not only by heat by also

1: 8-10 (1-11a – 1-14b), in the “Sì kù shànběnby “dampness” that hinders the circulation of qicóngshū”, Nippon Keiraku Gakkai, Tokyo, 1992.

inside the Stomach and intestine. For this reason, it5) Shibasaki, Yasuzo: “Shiki Choushin Tairon

is important to eliminate the “dampness,” andHen“PartII.

Shinkyu

Igakutaikei

1goreisan, which is effective for heat strokes inKoteidaikeisomon Josetsu – Main part No. 1 – 4:

general, was applied to cases in which epigastric259-270, Yukonsha, Kyoto City, 1979.

pain occurred on occasion of consuming cold foods6) Cho, Chukei (Zhang Zhong-jing): Shokanron (Shang-and beverages in an air-conditioned environment. InHan-Lun, Zhào kāiměi version) vol. 3: 134-135 (3-cases of epigastric pain for which goreisan was

17b–3-18a), Ryogen Shoten, Tokyo, 1988.

effective, white tongue coating and epigastric

7) Cho, Chukei (Zhang Zhong-jing): Shokanron

discomfort and resistance were observed. Since it is(Shang-Han-Lun, Zhào kāiměi version )necessary to eliminate the “dampness” to alleviate

166 (4-3b), Ryogen Shoten, Tokyo, 1988.

vol. 4:epigastric pain that is triggered by the consumption8) Rokkaku, Shigeto: Kohobinran, Nihon Kampo

of cold foods and beverages, goreisan is thought to beMeii Shoho Kaisetsu vol.1 Kohokei1: 430-431,an effective prescription.

Orient Shuppansha, Tokyo, 1989.
9) Furuya, Yoichi; Nogami, Tatsuya; Watanabe,

Supplementary note: Hachimigan from Uchida

Tetsuro; Shimada, Yutaka: A case in which

Wakanyaku Ltd. was used in case 18, but all othergoreisan was effective against epigastric pain of

medical Kampo extract preparations were fromunknown cause. Journal of Kampo Medicine

Tsumura & Co.

53(10), 2006.
(This report has been prepared by partiallyrevising “Kimura et al.: Kampo Medicine 61(5):722-726, 2020”.)(This report has been prepared by partially revising “Kimura et al.:Kampo Medicine 61(5): 722-726, 2020”.)The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 6, Number 4 | Winter 2011

Table：Breakdown of the 19 cases in which goreisan was used for epigastric pain
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The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)