･

KAIM
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Accuuppuunnccttuurree aanndd IInntteeggrraattiivvee M
Meeddiicciinnee
INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 2, Number 3 ･ Fall 2007

Foreword

Japanese Knack and the Cultural Background
Noboru Mitsuhata

Japanese Acupuncture - Current Research
Effects of Press Tack Needle in the Sports Field
Toshikazu Miyamoto

Kampo Medicine - Current Research

Effects of Saikokeishito on Pediatric Diseases
Hiromichi Yasui

Clinical Report 1 (Japan)

Acupuncture and Moxibustion Treatment as Health Management
Tomofumi Ozaki

Clinical Report 2 (Japan)
Headache
Mihoh Koga

Clinical Report 3 (Japan)

Treatment of Insomnia based on Benshou-ronchi (Holistic Diagnosis for Disease Pattern Identification)
Naoki Hirama

Introduction of Japanese Acupuncture
Considering the Therapist’s Hand (7)Shuichi Katai

Medical History in Japan

Todo Yoshimasu and His Medicine (1)Hiromichi Yasui

ISSN:1559-033X

Volume 1, Number 1 | Spring 2006

A good motive creates a selfless devotion.
“I just want my customers to feel better, body and soul. Just to see
their faces light up with hope and happiness, I’d do anything,”
remarks Masao Tsuji, President of Ominedo Pharmaceutical Industry
Company. He visits various sites where raw herbs and substances foruse in their Kampo products are picked. And he believes this is the
tradition Ominedo had maintained for over a century now since thecompany was founded in 1900.
The same philosophy is applied in handling the numerous
high-quality formulas created at their labs where highly advanced
scientific and pharmacological researches are conducted. The
company’s state-of-the-art facilities that comply with GMP standards
turn out various extracts to be incorporated into their pride products.
“Every merchandise is the by-product of our sincere devotion todelivering a lineup of products that not only work for the customers’
body, but also bringing peace of mind as well,” Tsuji concludes,“delivering the right product to customers who appreciate ourknowledge and devotion is our ultimate goal.”

Ominedo Pharmaceutical Industry Co., Ltd.
574, Nenarigaki, Yamatotakada-City, Nara 635-0051, Japan
URL: www.ominedo.co.jp
Contact: info@ominedo.co.jp
FAX (81) 745-23-2540

The Journal of
Kampo, Acupuncture andIntegrative Medicine(KAIM)

T
Thhee JJoouurrnnaall ooff
K
Meeddiicciinnee
Kaammppoo,, A
Accuuppuunnccttuurree aanndd IInntteeggrraattiivvee M

Research on Theory, Practice and Integration

EXECUTIVE EDITOR

Shuji Goto
Chairman, GOTO College ofMedical Arts & Sciences
Tokyo, JapanEDITOR-IN-CHIEF

Donald Lauda, Ph.D.
Dean Emeritus, College of Health &Human Services
California State University-Long Beach
CA, U.S.A.

Volume 2, Number 3 ･ Fall 2007

TA B L E O F C O N T E N T S
1 Foreword
Japanese Knack and the Cultural Background
Noboru Mitsuhata

2 Japanese Acupuncture - Current Research
Effects of Press Tack Needle in the Sports Field
Toshikazu Miyamoto

ASSOCIATE EDITORS
Shuichi Katai
Ibaraki-ken, Japan

Hiromichi Yasui
Tokyo, Japan

8 Kampo Medicine - Current Research
Effects of Saikokeishito on Pediatric Diseases
Hiromichi Yasui

EDITORIAL STAFF

Akira Shimaoka
Hiroshi Tsukayama
Hitoshi Yamashita
Naoya Ono
Noboru Mitsuhata
Yoshiro Sahashi

EDITORIAL BOARD
Denmei Shuto
Hajime Haimoto
Hideaki Yamaguchi
Hidemi Takahashi
Katsutoshi Terasawa
Kazushi Nishijo
Keigo Nakata
Keishi Yoshikawa
Koji Ebe
Shohachi Tanzawa
Tadashi Yano
Takahisa Ushiroyama
Tomomasa Moriyama
Toshihiko Hanawa
Yoichiro Ebe
Yoshiharu Motoo
Yoshiro Yase

12 Clinical Report 1 (Japan)
Acupuncture and Moxibustion Treatment as Health Management
Tomofumi Ozaki

15 Clinical Report 2 (Japan)
Headache

Mihoh Koga

24 Clinical Report 3 (Japan)
Treatment of Insomnia based on Benshou-ronchi (Holistic Diagnosis for Disease Pattern
Identification)
Naoki Hirama
28 Introduction of Japanese Acupuncture
Considering the Therapist’s Hand (7)30 Medical History in Japan
Todo Yoshimasu and His Medicine (1)Shuichi Katai

Hiromichi Yasui

PUBLISHER

Shuji Goto
International Institute of Health andHuman Services, Berkeley
2550 Shattuck Avenue, Berkeley
California 94704-2724, U.S.A.

MISSIONTo disseminate peer-reviewed information on the use of acupuncture and herbs, and integration with western
medicine, based on research from an international perspective; thereby stimulating further research, applicationof documented therapeutic measures; and facilitating dialogue among health care practitioners worldwide.

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

Volume 1, Number 2 | Summer 2006

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

Volume 2, Number 3 | Fall 2007

Foreword
Japanese Knack and the Cultural Background
Japan's forests cover approximately 70% of the Japanese landmass, an unusually high ratio among
the developed nations. Perhaps because forests have been so much a part of the social and historicalenvironment, animism is deeply rooted in the Japanese consciousness. We see this expressed in the
traditional Japanese religion of Shintoism. According to Shinto beliefs, there are a myriad of "kami"(deities, spirits, and other supernatural creatures) that inhabit the world. Those kami are said to live
within large trees, rocks, and mountains, so that nature itself becomes the focus of religious faith. Because
Shinto is polytheistic, the arrival of Buddhism in the sixth century led to the syncretism of Buddhism andShinto, with both belief structures coexisting, and over time the distinctions between the two graduallybecame more blurred.
Buddhism originated in India, and arrived in Japan via China and the Korean peninsula, but nodifferentiation was made in Japan among the deities from these different cultures. Today some people saythat the Seven Gods of Fortune (often called the Seven Lucky Gods in English) are Japanese Kami.
However, the only one that is truly Japanese is Ebisu, the god of fishers and merchants. Most Japanese do
not know that the other six are actually Chinese deities. Perhaps this is yet another example of theJapanese knack for being influenced by other countries and converting the effects of that influence into
something unique to Japan.
If we look at the development of Kampo and acupuncture therapy in Japan, we see the same knackat work. Both Kampo and acupuncture came to Japan from China by way of the Korean peninsula atabout the same time as Buddhism. However, these therapeutic methodologies did not really begin todevelop independently in Japan until the Edo period (from the 17th to the 19th centuries). After WorldWar II, the General Headquarters (GHQ) of the occupying forces tried to prohibit acupuncture. Partly
because the current of the times was pushing Japanese society toward westernization, traditional Japanese
medicine met with some hard times at that point. However, the Japanese knack showed up again,
advocating for harmony between modern Western medicine and traditional medical therapy.
It will still take quite some time before Kampo and acupuncture are thoroughly rooted in modern
Japanese society. However, encouraged by the support of organizations like this journal and your readers,we will continue to move forward.

Noboru Mitsuhata
Clinical Education Dept., Tokyo Eisei Gakuen College
GOTO College of Medical Arts & Sciences

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Volume 2, Number 3 | Fall 2007

Japanese Acupuncture - Current Research
Effects of Press Tack Needle in the Sports Field
Toshikazu Miyamoto
Doctoral Program in Sports Medicine,no pricking sensation. This paper will present
studies on PTN in the field of sports as well as
double blind randomized, controlled studies on
which the author would make comments.

Graduate School of Comprehensive Human Science,
University of Tsukuba

Introduction
In recent years, treatment with acupuncture for
sports injuries is drawing increasing attention. The
majority of sports injuries such as tennis elbow orbaseball shoulder are caused by repeatedmovements of a portion of the body during sports
activities. In these sports injuries caused by therepetition, acupuncture, moxibustion and massage
are applied in Japan. The first systematic literatureon acupuncture treatments in the field of sports was
published in 1949 by Honma in the journal of“Ido-no Nihon”, which carried six articles in series.
The literature describes that acupuncture was
extensively applied, beyond the general notion ofacupuncture practice, to even enhancing athletic
performance and recovering from muscle fatigue, in
addition to the treatments of sports injuries. Since
the publication of the report, only case reports on
acupuncture treatments in the field of sports havebeen reported sporadically. It is only after 1980 thatstudies in this field have begun to be actively
undertaken.
Meanwhile, the press tack needle (PTN), often
called the thumbtack-type needle (empishin), which
was devised in Japan in around 1980, is like a small
0.5 – 1mm long thumbtack. The press tack needle isan acupuncture technique that the needle is stuckin the skin and attached to the site with a piece ofadhesive tape. The PTM is employed in the field ofsports since it does not cause pain while in use,making it possible for athletes to continue sports
activities with the needle in place. Since around1990 basic studies on PTN involving humansubjects have been carried out with the muscle
fatigue models to examine its effects on fatigue
dissipation. PTN has been used for double blind
clinical trials since around 2000 as it gives virtually2

Studies on PTN in the field of sports
Most studies on PTN in the field of sports focus
on the process of acute muscle fatigue recovery. The
experimental protocols were with indwelling PTN(1) to investigate muscle output by voluntarily
applying isometric exercise stress with the
maximum muscle strength mainly to biceps muscle
of arm1-4), quadriceps muscle7), hamstrings5,6), andtriceps muscle of calf8,9); (2) to investigate the index
for the number of movements for the knees andelbows to be able to carry out isotonic exercise until
all-out muscular failure14,15); and (3) to observe an
decrease in the total work and the maximum muscle
strength by applying isokinetic exercise stressloading11,12,13).
The results of these studies are summarized asfollows:
1) The PTN showed the ability of suppressing the
reducing process of muscle output compared to
non-treated.
2) In comparison between non-treated and placebo,some cases showed differences in the maximum
muscle output but some cases did not.
3) PTN was effective when it was used 1cm lateral
to the spinous process of the vertebra where thecutaneous branches of the posterior branches ofthe spinal nerves that control muscles are
distributed, whereas almost no effects wereobserved when it was used on any otherdermatome areas.
4) A correlation between the levels of lactic acid andmuscle output were suggested. However, thePTN did not affect the level of lactic acid.
5) In regard to isokinetic exercise of knee joints,
PTN suppressed the declining rate of the total
work in extension movements, whereas no
suppression was observed in flexion movements
in many cases.
6) Buffering the blood lactic acid was accelerated
under low stress and high rotation.

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

Volume 2, Number 3 | Fall 2007

7) No influences on hemoglobin dynamics wereobserved.
These results showed that PTN was effective forsuppressing transient decreases in muscle strengthand muscle fatigue. The mechanisms, however, arenot known. Many of these studies have several
issues that (1) bias factors of the study subjects
might have caused influences on developing themodels of muscle fatigue, (2) the relationshipbetween subjective fatigue perceptions and themuscle strength was not examined, (3) theconnection with matters of biochemistry was not
examined, and (4) comparisons with otherinterventions than PTN were not made. Now theseissues have progressively been improved, leading to
the enhanced quality of studies.

practitioners who manipulate needles; and (2) theskin and muscles of the subjects are stimulated,which also makes it difficult to blind them.
Thus, double blind studies on acupuncture
treatments have focused on the effects of needlingdifferent points – meridian points and non-meridian
points and on the effects of shallow needling anddeep needling. These are comparisons of needlingpoints or needling depths and are not double blindin the strict sense. There are studies in which thesubjects were blinded under general anesthesia in
operation and also randomized studies in whichsham needles were used. However, practitioners inthe study system were not blind. In short, no clinicalstudies were conducted under the condition of which
both subjects and practitioners were unaware.

There are few studies in which comparisons weremade between PTN and other interventions. Izumi
et al.16) reported that for muscle fatigue of boxing
players, comparisons were made based on the
M-Test (meridian test) between the results of PTN
and those of self-stretching performed with a ballfor stretching. The results indicate that PTN
improved the number of positive movements
assessed by the M-Test.

PTN is the acupuncture needle most suitable fordouble blind trials because (1) its needling does notgive pain, which allows blind testing of the subjects;and (2) practitioners are able to needle without
checking the presence of the needle tip and afterneedling, a plaster is affixed so that the needle
inserted cannot be viewed.

Randomized, clinical trial in the field of sports
Documents of such placebo, sham-controlled
studies as pointed out by “Acupuncture-NIH
Consensus Statement” in the sports field have been
published by Brattgerg et al.17) for tennis elbow, by
Julia Kleinhenz et al.18) for rotator cuff tendinitis,and by Vrehota et al.19) for plantar fasciitis. Thesestudies did not satisfy the criteria for double blind
and were invalid as double blind tests since bothtest subjects and practitioners were not “blind.”

In order to make double blind trails in the true
sense, Miyamaoto20) has developed placebo
acupuncture needles that have no needle tip, packed
in the package liked ones (Fig. 1). And he has
conducted
arandomized,
doubleblind,
placebo-controlled study to examine whether or not“acupuncture treatments have positive effects on
conditioning of long-distance athletes of track andfield” and reported investigation results. (The study
was subsidized by the scientific research fund of the
Ministry of Education, Science, Sports, andCulture.)Randomized, double blind method is used as aclinical study of the highest level of evidence.
Double blind is the technique to conduct a clinicaltest under the condition in which biases of thesubjects and practitioners are eliminated. Applying
the double blind method for acupuncture treatments
is difficult due to the reasons that (1) unlike
medication therapy, it is unfeasible to blind

Papers of randomized, clinical trials with thesubjects of athletes
Introduced hereunder are two representative
clinical studies on PTN in the field of sports inwhich placebo needles were used.
Miyamoto21) has conducted a randomized, double
blind study using placebo needles to investigate theeffects of PTN on muscle soreness and muscle

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

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Volume 2, Number 3 | Fall 2007

stiffness that resulted from running a marathon
race.
The subjects were 15 university students who
were to experience a marathon for the first time.
They were randomly divided into two groups: thePTN group of 8 persons (6 male, 2 female) who were
not involved in the acupuncture practice,
examination, and data analysis; and the placebogroup of 7 people (6 male, 1 female) who wereassigned to placebo having no needle that was
uniquely developed with the same package
appearance as the one for the PTN (Fig 1). Before
the marathon run either PTN or placebo was affixedaccording to the assignment list to the 8 acupointsof Zusanli (ST36), Sanyinjiao (SP6), Xuehai (SP10),
and Liangqiu (ST34) on both legs. Needles were
removed after 5 days. Measuring items were Visual
Analogue Scale（VAS）for muscle soreness, serum
CK activity, LDH isozyme, forward flexion from astanding position, and muscle hardness, andmeasurements were evaluated three times-before
the start of the run after the finish and 5 days after
the marathon run. The results showed following.
Press needle

1. The PTN reduced muscle soreness caused after
the marathon run (p<0.01) (Fig. 2). 2. Although thelevels of CK activity and LDH 4-5 isozyme increased
after reaching the goal line (p<0.01), no effects of
the PTN were observed. 3. No differences in a
forward flexion from a standing position wereobserved in both groups. 4. The level of muscle
hardness increased in the vastus lateralis muscle
and vastus medialis muscle (p<0.05). However, noeffects of the PTN were observed. 5. The marathon
time of the PTN group was shorter. 6. The subjects
were not aware of the difference between the PTN
and placebo needle. It was reported from theseresults that the PTN was effective for relievingmuscle soreness after a marathon race.
Miyamoto et al. confirmed that their study wasvalid as a double blind study by means of directly
asking the practitioners and the subjects whether
they recognized that needles used for the subjects
had a tip or not and found that they did notunderstand the difference between the PTN andplacebo needle. Although there is an issue about the
study that the number of the subjects is limited, thisPlacebo needle

is the first research to which the indexes were added
needleneedleplasterplaster

about muscles including muscle soreness, muscle
stiffness, muscle flexibility and CK activity.
Kaneko22) has investigated the effects of the PTN

plaster 12mm

plaster 12mm

on muscle soreness after a triathlon race in aplacebo-controlled study.

needle tip (length 0.7mm)

needle tip (length 0mm)

Ｆｉｇ. 1. Press needle and placebo needle

The subjects were 149 of males and females who
participated in a triathlon event. They wererandomly divided into two groups: a group of 79 (67male, 12 female) who were assigned to PTN and agroup of 70 (56 male, 14 female) who were assigned
to placebo. The placebo needle used in the study was
the same as the one used by Miyamoto. Stimulus
sites for both groups were Shenshu (BL23), Qihashu(BL24), Dachangshu (BL25), and Ciliao (BL32) ofright and left sides with leaving the needles
indwelled only during the race. Measuring item was
VAS (visual analog scale) values for muscle soreness

4

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Volume 2, Number 3 | Fall 2007

in 6 regions of the lower extremity (anterior thigh,The study by Kaneko et al. is an excellent study

posterior thigh, anterior lower legs, posterior lower

that was properly designed as a randomized, double

legs, lower back, and buttocks), and measurements

blind study with an adequate number of subjects

were made before the race (PRE) and immediately

involved. Although variations with time for each

after the race (POST1) and on the following day

group(POST2). The results showed the following (Table 1).

between the two groups were not made. Moreover,

Each VAS score was increased on POST1

muscle soreness was reviewed as DOMS (delayedcompared to that on PRE (p<0.01) for both groups.

onset muscle soreness). It is, however, not clear if

With PTM treatment, VAS score were decreased on

the soreness was the type of DOMS or not since it

POST2 compared to those on POST1 on except for

was more intense immediately after the race thanGluteus (p<0.01, p<0.05), and had recovered to theon the following day (next day) and the intensity

condition before the race. In the P group, VAS score of

was not measured continually on the days following

the hamstrings was decreased on POST2 compared

the next day after the race.

werestatisticallytreated,comparisons

to that on POST1, while VAS score were significantly
higher than those on PRE for Quad, Hamstrings, andFrom the studies by Miyamoto and Kaneko,

Calves. It was reported that these results suggested

it is becoming clear that a placebo-controlled

suppression of delayed onset muscle soreness by thestudy using a needle without a tip packed in theuse of the PTN during the race.

same package as the one for PTN is suitable for

Table.1

a double blind study since both subjects andChanges of muscle pain(VAS）

practitioners are unaware of which needle ispress needle （N=79)

assigned to and that the PTN is able to relieve
muscle soreness caused by marathon run,

before start

after finish

af.1dayQuads

32.1±24.2

48.4±22.0 **36.0±24.9 ＃＃Hamstrings

32.2±23.6

47.0±20.6 **30.9±22.5 ＃＃Calves

25.8±18.940.4±23.5 **30.5±22.4 ＃＃Tibialis

32.7±23.1

49.0±24.2 **35.1±24.6 ＃＃Glutes

37.8±24.5

46.8±24.1 **37.5±24.2 ＃＃40.3±22.4 **＃＃lower back

31.4±22.6

32.8±22.4

triathlon

race,

or

long

distance

running.

Sedative mechanism of the PTN, which has notbeen investigated, is a subject for futurestudies.
References1)

placebo (N=70)

Takahashi

M,

et

al.:

The

Influenceof

Acupuncture and Moxibustion Stimulation on

before start

after finish

af.1day

the Experimental Acute Muscle Fatigue Model -Quads

30.2±23.0

41.9±24.2 **38.1±22.8 **The Effects of Press Tack Needle on the Flexor

Hamstrings

25.6±19.7

41.6±25.1 **33.0±21.3 *＃Muscle Group in the Upper Arm. The Journal of

Calves

25.5±21.7

35.4±23.3 **28.9±20.6 **Oriental Medicine College Association 14: 60-64,

Tibialis

30.0±23.0

43.3±26.4 **36.7±25.6 **1990

Glutes30.3±22.6

37.8±23.0 **33.2±21.8 **lower back28.0±21.1

35.9±23.0 **34.4±21.0 ****：vs. before start (p,0.01) *： vs. before start (p,0.05)＃＃：vs. after finish (p,0.01) ＃： vs. after finish (p,0.05)

2)

Anzai T, et al.: The Influence of Acupuncture andMoxibustion Stimulation on the Experimental
Acute Muscle Fatigue Model, Report No. II - The
Effects of the Press Tack Needle used on Distant
Points. The Journal of Oriental Medicine College
Association 15: 40-45, 1991

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

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Volume 2, Number 3 | Fall 2007

3)

Sugiyama T, Tone K, Takahashi M, et al.: The

JournalEffects

Association 22: 64-68, 1998

ofAcupuncture

andMoxibustion

Stimulation on the Experimental Acute Muscle

4)

from Muscle Fatigue. Journal of Japan College

Medicine College Association 23: 53-57, 2000

Association of Oriental Medicine 16: 32-37, 1992

10) Kaneko Y, Ito H, Iida M, et al.: The Effect ofTone K, Sugiyama T, Otake S, et al.: The

Press

Tack

NeedleInfluence of Acupuncture and Moxibustion

Time-dependent

ChangeStimulation on the Experimental Acute Muscle

Values when Maximal Exercise Stress is applied.

Fatigue Model, Report No. IV - The Relationship

The Journal of Oriental Medicine College

between Fatigue Recovery and the Amount of

Association 25: 85-93, 2002

Treatmenton

Various

Index

in11) Sugiyama N, Miura Y, Sato R, et al.: Effects ofCollege Association 17: 21-26, 1993

Press Tack Needle on Lowering Muscle Output

Inoki H, Furuya E, et al.: The Influence ofAccompaniedwith

Acupuncture and Moxibustion Stimulation on

Flexion/Extension–

the Experimental Acute Muscle Fatigue Model,

Exercise. The Journal of Oriental Medicine

Report No. V - Study on Hamstring Muscles.

College Association 27: 33-39, 2003

Knee

Joint

on

Isokinetic

Study12) Takahashi N, Komuro S, Aoyama T, et al.:

Association 18: 48-52, 1994

Effects of Press Tack Needle on Lowering

Ueno M, Ishibashi Y, Watanabe K, et al.: The

Muscle Output Accompanied with Knee Joint

Influence of Acupuncture and Moxibustion

Flexion/Extension (Report No. II) – Study on

Stimulation on the Experimental Acute Muscle

Isokinetic Exercise under Heavy Load and Slow

Fatigue Model, Report VI - The Influence ofrotation. The Journal of Oriental Medicine

Muscle Output depending on the Timing ofCollege Association 28: 103-107, 2004
13) Aoyama T, Gowa N, Tsukahara Y, et al.: Effects

College Association 19: 102-108, 1995

of Press Tack Needle on Lowering Muscle

Adachi J, Nagao M, Murakami T, et al.: The

OutputInfluence of Acupuncture and Moxibustion on

Flexion/Extension (Report No. III) - Study on

the Experimental Acute Muscle Fatigue Model,

Isokinetic Exercise under Light Load and Rapid

Report No. VII - The Effects of Press Tack

Rotation. The Journal of

Needle on Quadriceps Muscle Fatigue. The

College Association 29: 73-76, 2005

of

Oriental

MedicineCollege

Accompanied

with

Knee

Joint

Oriental Medicine

14) Egashira I, Goto M, Kobashi M, et al.: Effects of

Association 20: 27-33, 1996

Press

Aritake H, Kogure M, Kumade T, et al.: EffectAccompaniedofon

Flexion/Extension – Study on Isotonic Exercise.

Experimental Muscular Fatigue Models. Effect

The Journal of Oriental Medicine College

of Press Tack Needle on Muscular Output of

Association 30: 66-70, 2007

Acupuncture

andMoxibustion

Lower Leg Triceps, Report No. VIII - The

6

Kurita H, Ozono I, Hattori N, et al.: The Effects
the Lower Extremities. The Journal of Oriental

Journal8)College

Effects of the Press-Tack Needle on Recovering

Acupuncture. The Journal of Oriental Medicine
7)

Medicineof the Press Tack Needle on Muscle Training of

The Journal of Oriental Medicine College
6)

Oriental

Fatigue Model, Report No. III - The Enduring

Stimulation - The Journal of Oriental Medicine
5)

9)

of

Tack

NeedleonwithMuscleFatigue

Knee

Joint

15) Imokawa Y, Kitano Y, Nakamura Y, et al.: Effects

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

Volume 2, Number 3 | Fall 2007of Press Tack Needle on Muscle Fatigue
Accompanied

K.

WindelerJ,

Pilot Study on Different

Randomized clinical trial comparing the effects ofCollege Association 31: 82-86, 200816) Izumi S, Miyamoto T, Hiura M, et al.: The effectsof acupuncture and stretching in muscle fatigue
of Boxers were compared. – The Meridian Test is
used for evaluation-. Oriental Medicine and The
Pain Clinic 37(3, 4):61-69, 2007

in rotator cuff tendinitis. PAIN, 83: 235-241, 1999.
20) Miyamoto T: Does Acupuncture Treatment have
Positive

Effects

Long-Distance

Track

on

Conditioning

Athletes?

Reportsofof

Research Results that21) Miyamoto T, Hamada J, Wada T, et al.: Effect ofPain and Stiffness after Marathon Race Double
Blind – Randomized Control Trial. Kampo

elbow. Pain, 16: 285-288, 1983
18) Vrchota K D, Belgrade M J, Johnson R J, et al.:True Acupuncture vs. Sham Acupuncture andConventional Sports Medicine Therapy forPain:acupuncture and a newly designed placebo needle

Acupuncture using Press Needle on Muscle

17) Brattber G: Acupuncture Therapy for tennis

Fasciitis

Streitberger

Güssbacher, A, Mavridis, G, Martin, E, et al.:Knee

Acupoints. The Journal of Oriental Medicine

Plantar

J,

Joint

with

Flexion/Extension –19) Kleinhenz

A

Controlled,

Double-blind Study, International Journal of
Clinical Acupuncture. 2, (3): 247-253, 1991.

Medicine 54(5):939-944, 2003
22) Kaneko Y, Furuya E, Sakamoto W: The Effectsof Press Tack Needle Treatment on Muscle
Sorenessafter

Triathlon

Race–

Placebo-controlled Study. Journal of the Japan
Societyof

Acupuncture

andMoxibustion

56(2):158-165, 2006

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Volume 2, Number 3 | Fall 2007

Kampo Medicine - Current Research
Effects of Saikokeishito on Pediatric Diseases

observed, saikokeishito had been effective in 34 of
the cases. The age distribution here too ranged from

Hiromichi Yasui
Japan Institute of TCM Research

1 to 12 years and classified by sex the patients
included 17 boys and 17 girls. Regarding diseases
these patients included 19 cases of common cold

Introduction

syndrome, 9 cases of common cold induced gastritis,

The source text for the prescription saikokeishito

3 cases of acute otitis media, 2 cases of pollinosis(Chai-hu-gui-zhi-tang) is the "Shang Han Lun" andand one case of urticaria. The treatment period

this formula is used extremely frequently in Japan.

varied from one day to six weeks. Combination

The reason lies in the fact, that Japanese physicians

therapy with other Kampo prescriptions washave traditionally attached great importance to theadministered in 3 cases of common cold syndrome, 1"Shangthiscase of acute otitis media and 2 cases of pollinosis.

prescription very frequently. This resulted in the

The other patients were treated with saikokeishito

accumulation of a wealth of experience pertaining toalone.

its use and the achievement of good results obtained

combination therapy with western medications only

by

therapeutic

2 out of the 34 patients with acute otitis media

developments in this field in recent years treatingreceived a combination therapy with antibiotics.

Han

pediatric

Lun"

and

physicians

therefore

due

to

used

various diseases. Miyazaki and Mori have focusedon this aspect and examined pediatric patients inwhom treatment with saikokeishito had beeneffective in the past and studied the kind of diseases
for which this prescription is effective. The results
published in "Journal of Kampo Medicine", Vol. 53
No.2 under the title "Study of pediatric diseases
treated effectively with saikokeishito". Below I will
discuss the application of this prescription while
presenting some of the contents of that treatise.

Among

the

patients

who

received

aThere were 37 cases that saikokeishito was effective
against chronic pediatric diseases.
The age distribution ranged from 2 to 12 years
and the patients included 20 boys and 17 girls.
Classified by diseases there were 10 patients withatopic dermatitis (7 moderately severe and 3 mildcases), 7 cases with bronchial asthma (6 cases ofmoderate severity and 1 mild case), 5 cases of
exudative otitis media, 4 patients with a highsusceptibility to catching cold and 3 patients withchronic gastroenteritis. The administration period
for saikokeishito varied from 2 months to 2 years

Research by Miyazaki and Mori
Miyazaki and Mori examined 71 cases (37 boys,

and2months.

The

20

cases

had

recieved

34 girls; age distribution from 1 to 12 years, average

combination therapies with other Kampo medicines.

age being 7.3±3.6 years) among the pediatricPatients receiving western medical combination

patients in their two clinics treated successfully

therapies included 8 cases of atopic dermatitis and 7with Tsumura's saikokeishito between January andcases of bronchial asthma.

June 2005. These patients were then classified byacute and chronic conditions and the Kampo
findings (excess-deficiency, pulse pattern, tongue
pattern,

abdominal

subsequently

thepattern)diseases,summarized
treatment

andperiods,

combination therapies with Kampo prescriptions or
combination therapies with western medications
studied.
Among the acute pediatric diseases these authors
8

Miyazaki

and

Mori

made

Kampo

medicaldiagnoses of all these patients. They were as follows.
Regarding excess and deficiency 35 of the patients
presented with a pattern intermediate between
excess and deficiency, 29 patients with mild
deficiency pattern and 7 patients with clear
deficiency patterns. Regarding the pulse patterns
intermediate between floating and deep, clearly

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

Volume 2, Number 3 | Fall 2007

floating or deep, slightly floating and wiry as well as

fluctuating and did not yet bring about a cure. In

wiry and somewhat deficient were found in this

this situation the administration of saikokeishito

order. The tongue showed patterns of moist +led to improvements in moderately severe and mild

minimal white fur, slightly dry + minimal white fur,cases of acute otitis media. Regarding the twomoist + white fur as well as moist + no fur in thispatients

order.
patients

saikokeishito
and
other
Kampo
medicine(shokenchuto) allowed to achieve a skillful control.

intermediate, somewhat soft in 36 patients andIn these patients the pollinosis was triggered byclearly soft in 5 patients. The incidence of the"common cold", so that it can be considered to be a

individual abdominal patterns was in 59.2% of theform of cold and thus the Kampo medicines werecases tension, 52.1% presented with fullness,

administered

tenderness or discomfort of the hypochondrium,

manifestations, while the use of the medication

28.2% with increased resistance and tenderness ofduringthe epigastric region and 25.4% with a hard glomus

unnecessary, so that this treatment plan allowed to

below the heart epigastrium in that order.

obtain sufficient therapeutic results by treating only

Abdominal

strength

was

in

30

with

pollinosisaaccording

asymptomatic

combination

to

the

periods

wasofrelevant
considered

the acute symptoms.
Research results

Below follows a breakdown of chronic diseases for

Below follows a breakdown of acute diseases forwhich saikokeishito had been effective.

which saikokeishito had been effective.
The authors classified many atopic dermatoses

This prescription is used in many cases ofaccording to either treatment of the root or local andcommon cold syndrome when a few days after thesymptomatic treatment, where treatment of the root

onset of the condition in addition to a lack ofappetite, bitter taste in the mouth and similar
symptoms of a half exterior half interior pattern
headache, chills and similar symptoms of an

representsacausaltherapy

and

local

and

symptomatic treatment a conservative therapy.

saikokeishito has a harmonizing action on theexterior pattern are still remaining. Yet, two cases

nutrient

have also be reported, in which the administration

conditioning for the constitution, so that it is used

for early symptoms like headache, chills andas a prescription for the treatment of the root.

generalized malaise brought about a cure in just one

Ephedra preparations for example eppikajutsuto etc.

day. This indicates the efficacy of saikokeishito forcan be used for local and symptomatic treatment,

acute pediatric diseases from an early stage on. The
authors have in the past already recommended theearlyadministration

of

Kampo

medicineforcommon cold and now would like to emphasize, thatanddefensesystems

and

works

Scutellaria and Coptis prescriptions for example

orengedokuto etc. or byakkokaninjinto etc. are usedasprescriptions

for

local

and

symptomaticthe prescription saikokeishito should be added totreatment. The 7 patients with bronchial asthma

the selection of applicable formulas.

were classified as moderately severe or mild cases

Reportedly administration of this prescription tothe9patients

withcommoncold

during the chronic stage. Since 6 out of the 7

inducedpatients simultaneously presented with patterns

gastroenteritis produced quick improvements. The

representing indications of other Kampo medicines,

three patients with acute otitis media were alreadyunder treatment by otolaryngologists using mainly
antibiotics, but the therapeutic progress was

saikokeishito was used in conjunction with thoseother prescriptions (mainly Ephedra prescriptions,enriching and moistening prescriptions as well as Qi

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

9Volume 2, Number 3 | Fall 2007

Regulating prescriptions. This decision has its

sweating,

foundation in the dragover disease theory of theirdiscomfort of the hypochondrium (Kyokyo kuman),teacher Fujihira. In particular a combination of thestuck feeling in pit of stomach, excessive strain ofhere discussed prescription and the qi normalizing

abdominal muscles, so that with a treatment usingprescription

hangekobokuto

often

producesfavorable therapeutic results.
Regarding pediatric exudative otitis media mostcases represent a transitional condition from a notyet fully healed acute otitis media in a state, where
there is an accumulation of exudate in the middle
ear. Those authors considered this disease to belocated in the lesser yang region, because the lesion
is at the side of the head. Moreover, based on theaccumulation of the exudate, they considered it to
be a form of water stagnation. Again, by becoming
chronic the condition is considered to deteriorate
into a deficiency pattern, so that mainly Bupleurum
preparations, diuretic prescriptions or kenchuto areused. The reported five cases presented with anindication for Bupleurum preparations and a mildly
deficient pattern, which was associated withspontaneous

sweating

anddizziness,

so

that

saikokeishito was used. Three out of these patients
presented with a spleen and stomach deficiency (qideficiency), so that they reportedly combined theformerprescription

withshokenchuto.

A

combination with shokenchuto is often used in casesof refractory chronic pediatric diseases, probably
based on the experiences of those authors.
A high susceptibility to catching cold and chronicdizziness,fullness,

tendernessormainly saikokeishito good results were reportedly
achieved.
There was one patient with pseudomyopia. This
was a 7-year old boy. Visual acuity upon firstexamination was 0.4 on the right and 0.5 on the left.
Miyazaki and Mori observed a mild deficiency
pattern, bitter taste in the mouth, glomus below theheart, mild degree of fullness, tenderness or
discomfort of the hypochondrium on the right side
and excessive strain of abdominal muscles. Basedon these findings they administered saikokeishito.
Seven months later visual acuity had improved on
both sides to 0.8 and after 1 year of treatment visualacuity had improved on the right to 1.0 and on theleft to 0.9.
Habitual headache, orthostatic dysregulation,
bed wetting etc. are interpreted as a form ofpediatric autonomic dystonia and these authors
reported, that saikokeishito provides an effective
treatment. Saburo Aimi published in his work
"Application of saikokeishito to the treatment ofautonomic dysregulation syndromes" numerous
cases of effective treatment2). Those authors too had
success with the application of this prescription
based on this concept.

Conclusion

gastroenteritis represent what is generally regarded

Miyazaki and Mori investigated cases in which

as a pediatric weak constitution. There are asaikokeishito had been effective and their report

number of reports describing the effectiveness ofshows that this prescription is indicated for a wide

saikokeishito in treating these children. Bupleurum

range of pediatric diseases, both acute and chronic,

preparations are in general frequently used to treat

and has been found to be an effective formula.

mainly chronic nose diseases like allergic rhinitis,

Actually, in the field of pediatrics in Japan thischronic rhinitis, chronic parasinusitis and similarprescription is one of the most frequently usedconditions that are associated with heat syndrome

formulas. For example, when used for children

or water stagnation. The 4 cases described here

suffering from repeated upper respiratory tract

presented with mild deficiency pattern, spontaneous

infections the frequency of infections gradually
decreases and through long-term treatment the10

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

Volume 2, Number 3 | Fall 2007

children have reportedly slowly become healthy3,4).

saikokeishito

Otherwise Saburo Aimi reported the application ofJapanese Journal of Pediatrics, 45 (9), 1964,

this prescription for the treatment of epilepsy5),

1992

Hiroseits

headache6)

application

in

cases

and

et

al.

Mori

of

for

for

orthostatic

dysregulation:

habitualorthostatic

dysregulation7), which shows, that there is a
substantial amount of study regarding the use of
thisprescription

in children.

The reportbyMiyazaki and Mori verify the results of past reports
and at the same time newly proposed its use during
the early stage of common cold. Reading this reportmakes it clear, that the skillful use of saikokeishito
in pediatric care is very important.

References
1) Miyazaki M, Mori K: Examination of pediatricdiseases effectively treated with saikokeishito,
Journal of Kampo Medicine Vol. 53, No.2,
265-277, 2006
2) Aimi S: Application of saikokeishito to thetreatment of autonomic dysregulation syndromes,
Japanese Journal of Oriental Medicine, 160,
41-46, 1965
3) Akiba

T,

Araki

Y,

Nakajima

A,

et

al.:

Improvement of easy susceptibility to infections
through long-term treatment with saikokeishito,
Japanese Journal of Oriental Medicine 41:
149-155, 1991
4) MineM:

Experiences

with

the

use

of

saikokeishito in nursery school children withfrequently repeated infections, Third General
Conference of Japan Ambulant Pediatrics, 1993
5) Aimi S: Treatment of epilepsy with saikokeishito,
Results and discussion as well as the influenceon encephalographic findings, Japanese Journalof Oriental Medicine 27, 99-116, 1977
6) Hirose S: Pediatric habitual headache andsaikokeishito,

Journalof

Traditional

Sino-Japanese Medicine (extra edition), Modern
Kampo Medical Case Report Collection No. 3,
150-151, 1987
7) Mori

M,

et

al.:

Clinicalapplicationof

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

11

Volume 2, Number 3 | Fall 2007

Clinical Report 1 (Japan)
Acupuncture and Moxibustion Treatment as
Health Management
Tomofumi Ozaki
Morinomiya University of Medical Sciences

1.

Introduction
Acupuncture and moxibustion treatment is inJapan not only used to treat diseases, but also as aform of health management and to prevent diseases.
In particular in the modern social environment
expectations are placed rather on healthmanagement than on the treatment of diseases.
Health means, plainly spoken, sleeping well, eating
well and having regular, comfortable bowel
movements. Through acupuncture and moxibustion
treatment these three essential elements of healthcan be maintained, which means the treatment has
significance as health management1).
Here I will report a case observed over a
prolonged time, in which developing disorder of thedaily life led to insomnia and chronic fatigue.
2. Case
Age: 51 years, male, acupuncturist, first visit on
Nov.11, 2007
Height: 173 cm, weight: 68 kg, standard body typeaccording to BMI (22.7)
Chief complaint: chronic low back pain, healthmanagement (maintenance)
History: onset of chronic low back pain from his
twenties, occasional occurrence of shoulder stiffness.
From the age of 40 gradually increasing workload, lecturing from forenoon until late at night andirregular working hours led to a gradual delay in
bedtime to 2 or 3 o'clock in the morning, while thepatient still woke up in the morning around 7
o'clock, leaving him with only 4 to 5 hours of sleep.
This chronic lack of sleep resulted consequently in afrequent occurrence of drowsiness during meetings
in the daytime.
Formerly he used to jog as a means of healthmanagement and visited a gym 2-3 times a week,
but since he started to hold two positions in 2008 as
a lecturer at a vocational school and an acupuncture
university, his schedule became highly irregular.

12

Further, because of explanatory meetings at boththe vocational school and the acupuncture
university as well as entrance examinations often
held on Saturdays or Sundays and his attendance atconferences and research meetings, he had even on
holidays almost no time to rest any longer. Since thepatient did not find for this reason any free time, hesuffered a lack of exercise, working out only once
every two weeks. Body weight gradually increased
and had reached 68 kg.
There was chronic low back pain (in particular on
the left side) with a markedly increased muscle
tonus in the low back region (left > right), in thevicinity of left Shishitsu (BL52) a ping-pong ball
sized myogelosis was observed, which produced
upon pressure a mixture of pain and comfort.
X-ray images of the lumbar vertebra revealed amild degree of scoliosis. The patient complained ofoccasionallydeveloping
flatulencecausingdistention and diarrhea. Times of diarrhea wereassociated with distinct pain tenderness of the left
BL52.
General condition: The patient had a good appetiteand sometimes developed abdominal distention andvomiting after eating too much. Tended to sleep only ashort time, thus suffered from a lack of sleep and had
only one bowel movement every one to three days.
Annual health check did not show any anomalies.
Past history: 35 years ago surgery for deviation of thenasal septum and left maxillary sinusitis; 3 years ago
20-day hospitalization because of atypical pneumonia.
General findings: blood pressure 118/88 mmHg,
pulse 84 bpm, reflexes of biceps brachii, triceps
brachii, brachiradial muscle, patellar and Achilles
tendon reflexes were normal. ROM of the low backand other examinations for low back pain, like theLasègue test, were also normal. Percussion of theabdomen showed a generalized tympanicity, amarkedly increased muscle tonus in the low backregion (left > right), in the vicinity of left Shishitsu(BL52) a ping-pong ball sized myogelosis andtenderness at Chukan (CV12), Tensu (ST25), Daiko(ST27) and left Shishitsu (BL52).
Treatment plan:Due to the high work load the patient suffered

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

Volume 2, Number 3 | Fall 2007

from a chronic lack of sleep. Irregular meal times
contributed to frequent excessive eating anddrinking, resulting in distention of the gastricregion and nausea; gastrointestinal functions were
not good either, resulting in occasional occurrence of
diarrhea, so that the disruption of the daily life
rhythm was considered to be the basis for his
condition.
Symptoms like low back pain etc. were also
considered to have developed from stress. The lowback pain was considered to be caused by anaccumulation of muscle fatigue, therefore generally
suggesting the presence of degenerative lumbago. In
this context acupuncture and moxibustion
treatment targeted both the individual symptoms
and attempted to achieve a generalized
conditioning.
Needling method:
Disposable No.18, 40 mm Seirin needles wereused to needle the entire body, but with special
emphasis on tender and indurated spots.
2) Needled points: Tenchu (BL10), Fuchi (GB20),
Kankotsu (GB12), Kensei (GB21), Kengaiyu (SI14),
Koko (BL43), Kakuyu (BL17), Kanyu (BL18), Hiyu
(BL20), Shishitsu (BL52), Daichoyu (BL25), Chukan(CV12), Tensu (ST25), Te Sanri (LI10), Soku Sanri(ST36), Taiyo (EX-HN5). Each point was needled ina manner, so that a mild de qi sensation was
obtainedthroughthrustingandlifting
manipulation. Treatment duration was about 20
minutes.
Results:
The patient received acupuncture treatments
twice a week and during the treatment shifted into
a comfortable breathing pattern of a sleeping person,
feeling refreshed after the treatment. In general,
although he sometimes developed some degree oflow back pain or shoulder stiffness, early
acupuncture treatment usually brought a quick
relief about. He is still working on a very tightschedule and gets only 5 hours of sleep, but after
one year of acupuncture treatment his condition has
much improved and the treatment interval
accordingly reduced to once a week. From April
2008, although the amount of sleep did not vary, hereported a better sleep as well as good appetite andbowl movements. This gives the impression, that an
adequate health management has been achieved.

3.

Discussion
The patient described in this case report sufferedfrom a lack of sleep due to an irregular life style andthree years ago from pneumonia. Based on theseexperiences he was worried about his health andfelt that excessive confidence in his own health has
led to this misfortune. Yet, he continued his hard
work and the resulting lack of rest consequently led
to a state of chronic fatigue. However, on thisoccasion the prolonged acupuncture treatment
improved his sleep condition, normalized his bowel
movements and thus could be considered to havesucceeded as a form of health management(maintenance).
Hirohisa and Sakae Yoneyama3) postulated that
one clinical characteristic of acupuncture treatment
is, that it not only treats diseases, but also
contributes to health management, in other words
health maintenance (reconditioning treatment). The
author believes, that this is precisely the essence ofacupuncture treatment. Yet, the therapist should
convince and motivate the patient prior to theacupuncture and moxibustion therapy to adopt a
regular life style. That is, an appropriate patient
education is considered to be essential.
4.

Conclusion
A clinical characteristic of acupuncture
treatment is that it not only treats diseases but also
contributes to a health management, in other words,
health maintenance (reconditioning treatment). A
sufficient patient education is essential to achieve
this goal.
5. References
1) Yoneyama H: My acupuncture treatment
concept; Ido no Nippon, Tokyo, 1985
2) Ozaki T: Watching my honored teacher's back;Ido no Nippon, 2005; 738. 188-193
3) Yoneyama S: Essentials of the treatment of stiffshoulders, ―acupuncture treatment of shoulder
stiffness― CLINICIAN, 44-461, 36-44, 1997

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

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Volume 2, Number 3 | Fall 2007

Introduction to the Morinomiya University of
Medical Sciences

western medical analytic explanation of pathologic
conditions, search for scientific evidence and theintroduction of advanced technologies. In this way

The Morinomiya University of Medical Sciences

the institution turns out practitioners offering

is located in the Cosmosquare District close to the

medical services that integrate both forms ofocean in Osaka and has opened in April 2009. The

medicine and is therefore also called "integrative

old school, Morinomiya College of Medical Arts andmedicine".

Sciences, originated from the vocational Osaka

Considering that the school has been established

Professional School of Acupuncture that opened inthrough funding by practicing acupuncturists, it

1973 and is therefore even in Japan considered anemphasizes

acupuncture school with a long history. This school

development of clinical skills. For that reason

maintains not only its pedagogic department, but isnumerous

also known to be a publisher and for its Museum of

reputation are working as part-time instructors

Traditional Medicine.

alongside with the academic staff and hold classes

in

its

practicing

educational

efforts

acupuncturists

of

the
good

The Morinomiya University of Medical Sciences

dealing with clinical practice. Regarding research

is a small university with a Department of

the school has an abundant collection of material

Acupuncture and a Department of Physical Therapy.

pertaining to medical history in its museum, library

The instructions take into account on the one handand publishing department, so that the school isconsiderations pertaining to holistic care within

expected to facilitate in the future not only

the framework of traditional medicine, inheritancedevelopments in the medical field, but also promoteof traditional techniques and lifestyles as well as

research in the humanities.

14

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

Volume 2, Number 3 | Fall 2007

Clinical Report 2

Headache
Mihoh Koga

will be discussed focusing on the qi-blood-water
aspects, trying to keep the terminology as simple aspossible.

Division of General Medicine,
Division of Clinical Pharmacology & Therapeutics
Jikei University School of Medicine

Introduction
Headache is a symptom frequently encounteredin an outpatient office specialized on Kampo.
Generally, this condition is classified into primaryheadache, which in turn is classified into 1)
migraine, 2) tension headache, 3) cluster headache,
4) headache associated with prolonged drug abuse,and secondary headache occurring in the presenceof an underlying disease. Even though remarkableprogress has been achieve regarding thepharmacotherapy of headache, the number ofpatients suffering from headache still remains high.
The migraine guidelines of the American Headache
Society® (AHS) recommend that "treatment of acuteconditions should be individualized". Moreover,egarding the ideal pharmacotherapy for theprevention of attacks: there are currently nosuitable drugs.
The relationship between diagnoses according to
the above described classification and specific"patterns" has not yet been clarified. Yet, throughintegration of TCM diagnostic methods a usefulconcept pertaining to the "individualized therapy"
can possibly be provided.
Practicing Kampo therapy and looking back at
cases with chronic headache, it appears that often
several patterns are involved. So far there has beena tendency of patterns like cold, blood deficiency,
blood stasis and phlegm being rather frequent, but I
believe the heat excess patterns are also on the rise.
Moreover, in cases of headache associated withrefractory diseases or prolonged drug abuse, I haveoften experienced that the use of blood stasis
expelling drugs led to an early alleviation of thesymptoms.
In the present paper I would like to briefly
discuss a few cases of tension head and migraine I
have seen in our outpatient department. Each case

Cases
<Tension headache; prolonged cold, phlegm-rheum>
Case (1): 46 years, female, housewife, clinic visit inJanuary YYYY
Chief complaint: right shoulder pain, headache,dizziness (floating feeling), pollinosis
Anamnesis:
At age 35: enucleatic myomectomy
At age 45: total hysterectomy because of myoma
induced anemia
At this time there were adhesions of the small
intestines, requiring reoperation, during which a
portion of the small intestines was removed.
At age 45: pollinosis
Present illness:
Development of a chronic sense of fatigue
following the total hysterectomy, at rest discomfort
that felt like the right were about to solidify andpain of the right shoulder joint was so severe, that it
prevented sleep; chilling around the waist and thethighs and a generalized feeling of edema over theentire body. Considering the presence of pain as if
from pinching the right upper arm and stagnation ofliver qi as well as blood deficiency into account, theformula nijutsuto, kamishoyosan plus Coicis
Seemen was prescribed. After 4 months oftreatment the shoulder pain had been alleviatedalmost completely and the pollinosis considerably.
By the sixth months of the treatment the headacheand sense of floating grew worse and symptoms
were highly sensitive to low atmospheric pressure.
The headache was reportedly associated with aslightly depressive heaviness. Recurrence of thetemporarily relieved edema of the legs. The patientoriginally has a tendency towards indigestion. The
husband is currently living alone abroad because of
his work.
Findings:
Moderate build, skin slightly brown. Good
appetite, bowl movements and micturition normal,
but has a tendency towards constipation when

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

15

Volume 2, Number 3 | Fall 2007

nervous. During bathing the patient felt on thecontrary cold. She was the type of person that does
not sweat. Her physical condition used todeteriorate in spring. Pulse was deep, slippery andwiry / weak right cun pulse, the tongue was pale red
but had a thick white fur coating its entire surface
and dental impressions, sublingual veins were
somewhat engorged. Mild degree of fullness,tenderness or discomfort of the hypochondrium.
Pattern: Spleen – stomach deficiency ->phlegm-rheum, upward harassment of wind phlegm
Prescription: hangebyakujutsutemmato
Following the third day of taking the prescription
the perceived fog in the head cleared and left thepatient feeling reportedly invigorated. The
heavyheadedness too improved. She experienced
regular bowl movements, became able to sweat
when bathing and thus felt fine. Temporarily
switching the prescription to ryokeijutsukanto
resulted in recurrences of the headache, regularadministration of hangebyakujutsutemmato twice
daily and an additional dose when symptomaticallowed controlling the symptoms and the patient iscurrently continuing this schedule. The patientreported that taking the medication helps to brace
her physically and makes her feel lighter both
physically and mentally.
<Tension headache; spleen deficiency, countercurrentof phlegm-rheum>
Case (2): age 47, female, dental assistantChief complaint: headache, stomach disharmony,
amyloidosis of the skinAnamnesis:
After the death of her husband she became
nervous and anxious. At that time she wasdiagnosed with amyloidosis of the skin and Sjörgren
syndrome. Headache often developed in case of
fatigue or when she had been under stress;
endurance of the symptom generally led to a
gradual increase in the pain, so that she had to takeanalgesics and lie down. The stomach responded
sensitively to the mental status and she complained
about heartburn, stomach disorder and a sense of
distention.

16

Findings upon first visit:
Fair-skinned and leptosomatic habit, sloping
shoulders. Visible amyloid depositions on theabdomen and lumbar regions. Easily sweats on thepalms. Poor sleep. Occasionally soft stools. Thin andweak pulse, the tongue being pale red with a thick,greasy white fur, stickiness within the mouth.
Engorgement of sublingual veins. Abdominal
palpation reveals clapotage and tension of theabdominal wall.
Pattern:
spleendeficiency,qi
depression,countercurrent of phlegm-rheum
Prescription: bukuryoingohangekobokuto
Course:She started to enjoy her meals, the severity of theheadaches decreased and often she even forgot
about them. No use of analgesics. Use of single
doses of goreisan produced marked relief in case she
had a headache. Later, targeting the easy
fatigability, xerophthalmia, poor sleep and the skin
symptoms her condition improved using a combinedprescription with ninjin’yoeito, she could sleep
soundly and the headaches disappeared.
Four years later, after she finally came to terms
regarding the death of her husband and herstomach maintained a good functional condition,
treatment with bukuryoingohangekobokuto was
discontinued. The nature of her work facilitated thedevelopment of high tension and easily led to thedevelopment of posture induced shoulder stiffness,
which resulted in headaches (dull pain), but since
the condition of her stomach had improved, theeffects of goreisan had weakened, while
shakuyakukanzoto now had become markedly
effective. It turned out to be a medication, which insingle doses provided refreshing relief and bestowed
upon her a feeling, as if the neck were straightening
and sometimes even extended to the head.
<Tension headache; spleen deficiency, cold phlegm,
blood deficiency>
Case (3): age 40 years, female. Assistant in former
family business (restaurant)
Chief complaint: headache, anxiety
Anamnesis:
At the age of 20 iron deficiency anemia (sheThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 2, Number 3 | Fall 2007

sometimes takes iron drugs)
At the age of 37 hypertension (initiation ofantihypertensive pharmacotherapy)
Present illness:
From the age of 38 her nervousness increased, asense of her body floating and palpitations
appeared;sheusedbenzodiazepine
type
tranquilizers 2 to 3 times a day; from the age of 39
she took ryokeijutsukanto for about one year after
which the symptoms had almost be alleviated. The
use of western medications was reduced to about
once per month for preventive purposes and she
started to work as a kindergarten assistant. Yet, sheused to complain about headaches lasting 2-3 weeks.
The headaches were located on the forehead like aheadband, producing a pain as if this headband
were tightened, so that she used to press down on
the painful areas while taking deep breaths andreported that warmth provided some relief of thesymptoms. Severity of the symptoms increased in
the evening with increasing fatigue. On thisoccasion the symptoms had appeared 5 days ago on
the last day of her menstruation.
Findings:
Fair-skinned obese, normal appetite, sleep andexcretion. Becomes easily nauseated. Her condition
used to vary with the menstrual cycle. The tongue
was enlarged, pale white, had dental impressions,sublingual veins had disappeared, the pulse wasdeep and thin, the abdomen showed a generalized
hardness and was mildly tender, there was fullness,tenderness or discomfort of the hypochondrium andchilliness of the lower abdomen.
Pattern: blood deficiency, phlegm rheum
Prescription: ryokeijutsukanto plus tokishakuyaku-sanHeadaches tended to become worse during thelatter half of the menstrual cycle and the lingual
findings too suggested the necessity to take blood
deficiency into account, but since the so farprescribed ryokeijutsukanto could not be expected
to have any blood supplementing effects,
tokishakuyakusan was added. After the ingestion
marked improvements were observed and four days
later the symptoms had disappeared. Later, while

the dose was adjusted according to the findings,
after continued treatment using the combined
formulation with tokishakuyakusan the headaches
did not occur any longer.
And yet, severe headaches occurred on days
typhoons hit the country and on these occasions thepatient complained, that she would on the contrary
like to cool her head. The body felt hot and she
became restless and nervous. Originally she did not
like the summer. senkyuchachosan was prescribedand had marked effects, leaving her feelingrefreshed and comfortable.
After
that
the
administrationoftokishakuyakusan from autumn through spring anda combined formulation with senkyuchachosan fromthe rainy season through summer prevented
aggravation of the headaches and stabilized thepatient both physically and mentally.
<Tension headache; spleen and stomach cold
deficiency, deficiency of heart and spleen>
Case (4): age 49, female, visited our clinic in
February YYYY.
Chief complaint: headache, anxiety, discomfort in
the gastric region, arthralgia of multiple joints
Present illness:
At the age of 27, triggered by a pregnancy, thepatient started to suffer from frequent headaches.
She is regularly using commercial analgesics, butsince half a year ago their effects were declining.
The headaches were a sort of pinching pain from theback of the head down the back of the neck and at
the same time associated with ocular pain,
repeating cycles of alleviation and aggravation
almost daily. The anxiety influenced the gastricdiscomfort, so that she could eat, but felt nauseatedon an empty stomach and therefore constantly ate
little portions. She had no sense of satiety. Anotherdoctor diagnosed reflux esophagitis and prescribed a
protective agent for the gastric mucosa, but its effectwas obscure. Moreover, about 1 year earlier thepatient had been diagnosed with chronicrheumatoid arthritis and is currently under
treatment. Three months ago development of frozen
shoulder. Three years ago she had to worry about

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

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Volume 2, Number 3 | Fall 2007

family matters and this problem now got worse
about
half
a
year
ago,
so
that
saikokaryukotsuboreito was recommended in a
pharmacy, which she is currently using.
Findings upon first visit:
The facial complexion was yellowish-white andthe patient had a leptosomatic habit, she was
occupied by worries about her symptoms anddescribed the circumstances of their developmentwith dissatisfaction. She repeatedly asked: "Whatshould I do?" This gave the impression that she had
started to panic because of what was going on withher both mentally and physically. There was a mild
degree of chilliness of both hands and feet, recently
her visual acuity deteriorated and she noticed
nocturnal urine and dryness of the mouth during
the night. One bowl movement every three days. No
feeling of exhaustion. The pulse was thin andslippery, the tongue had a thick white fur and she
had a bitter taste in the mouth. The abdomen
showed chilliness and increased resistance of theepigastric region and a mild degree of fullness,tenderness or discomfort of the hypochondrium,
softness of the lower abdomen, tenderness of both
inguinal regions, marked palpitation above theumbilicus were observed.
Pattern: deficiency of both heart and spleen,
deficiency cold (stagnation of liver qi)
Prescription: kamikihito, keishininjinto
Course: The patient expressed strong anxiety
regarding
discontinuationofthesaikokaryukotsuboreito she was using so far, so thattheprescription
was
first
changedtokeishikaryukotsuboreito, taking her feelings into
account. This helped to overcome her anxiety andsettle down, but still left the symptoms incompletely
controlled, with no changes in the incidence ofheadaches and gastric discomfort. After persuading
the patient to use a prescription with added
keishininjinto the incidence of the headaches
decreased to once per week. Later, using kamikihito
as the main formula and reducing the dose ofkeishikaryukotsuboreito to 1/3 both headaches andgastric discomfort improved and after three weeks
were almost completely alleviated. The arthralgia

18

and anxiety also improved and the patient now
presents with a calm expression.
<Tension headache; liver qi stagnation, transverse
invasion of the stomach>
Case (5): age 41, female, employee
Chiefcomplaint:
headache,gastrointestinal
weakness
Present illness:
From the time she became employed the patient
repeatedly experienced stomach disorders, belching,abdominal distention, a bitter taste in the mouth
and reduced appetite, occasionally gastric pain.
After examination she was diagnosed with neurotic
gastritis and was prescribed western medicine, butlater visited our clinic, because the symptoms did
not improve. The headaches developed at the sametime and were characterized by a slowly progressive
and continuous dull pain.
Findings upon first visit:
Intermediate build, the skin appeared slightly
yellowish brown and there was some edema. She
had difficulties waking up in the morning and felt
exhausted and headheavy from morning; usually
did not have any appetite in the morning. Although
she had one bowl movement a day, there was always
a sense of incomplete evacuation. The menstruation
was regular, but prior to the onset of themenstruation the headaches grew worse. She
complained about shoulder stiffness. The pulse wasthin and wiry, the tongue was faintly dark red andhad a thick white fur and dental impressions, theabdomen showed a marked degree of fullness,tenderness or discomfort of the hypochondrium.
Pattern: liver qi stagnation, transverse invasion of
the stomach
Prescription: saikokeishito
Course:After about 2 months of treatment, the ease withwhich she could wake up in the morning improvedand both the sense of exhaustion and headheavinessdecreased. Her stomach felt comfortable too, but she
was easily susceptible to influence from stress atwork. Improvement of the shoulder stiffness. Since
after about one year of treatment almost all

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

Volume 2, Number 3 | Fall 2007

symptoms had healed, the dose was tapered, butsince complete interruption of the treatment
resulted in a deterioration of her physical condition,
she currently continues on a low dose schedule.
<Migraine; tension headache; blood stasis>
Case (6): age 24 years, female, employee
Chief complaint: headacheAnamnesis: At the age of 21 onset of a collagendisease, that was treated over a period of one yearwith steroids and the therapy then terminated.
Present illness:
Onset of repeatedly occurring headaches after thepatient started to work in an office at the age of 23.
Her work requires that she uses a computer. The
headaches were characterized by throbbing,pulsating pain (1) in the occipital region and (2) the
temporal regions and occasionally she also felt likeshe had be hit or (3) a pain as if a heavy stone wereplaced in the center of her head. The incidence
fluctuated but was higher on hot days with fairweather so that summers were difficult for her. A
neurosurgeon diagnosed migraine and tension
headache. The use of acetaminophen during periodsof pain became increasingly frequent. Currently, sheuses analgesics on average 5 times per week.
Findings upon first visit:
Obese physique, muscular, face was flushed red,
there was acne on the mandible, she disliked heatand there was no sense of coldness. She had a good
appetite, but since about one and a half years ago
she experienced almost daily heartburn and gastricdiscomfort. She had a dry mouth and preferred cooldrinking water. There was a tendency toward easy
development of edema of the face and extremities.
She had difficulties falling asleep and experienced
night sweats all over her body. She had 1 to 2 bowl
movements per day (in the morning). Her eyestended to tire easily and she was also easily
irritated. Her menstrual cycle ranged between 30 to
35 days, lasted for 3 days, she had little menstrual
flow and the menstrual blood was dark red. Latestage. The pulse was slippery and wiry, the tongue
pale and the sublingual veins thin, there wasdistention of the lower abdomen and tenderness on

the right side next to the naval.
Pattern: exterior-interior evil repletion
Prescription: bofutsushosan
Course:Two weeks later she experienced comfortablebowl movements and lost about 1 kg in body weight.
Both frequency and intensity of the headaches
decreased. Pulse was wiry and thin, tongue slightly
red. Six weeks later improvement of the sense ofbody heat. Headaches and dizziness occurring
during the forenoon sometimes were alleviatedwhen she had diarrhea. There was a strong sense offullness, tenderness or discomfort of the
hypochondrium, the entire lower abdomen was
tender and even stroking it hurt. Drugs for
expelling blood stasis and rectifying qi wereconsidered necessary and thus a modified formula of
bofutsushosan used. Ten weeks later the usage ofanalgesics had decreased to 1-2 times per week andwithout her really realizing since when, she noticed
that the gastric symptoms did not longer bother her.
She continues to take the medicine.
<Migraine / tension headache; blood stasis>
Case (7): age 62 years, female, housewife
Chiefcomplaint:
headache,dyshidrosis,
constipation
Present illness:
Since 10 years, following her climacteric age, thepatient experienced hot flashes and abnormal
sweating, constipation and was prescribed atanother clinic unseiin plus tokakujokito and similar
formulas, which improved these symptoms. Recently,
the same symptoms recurred and the patient visited
our clinic, also because of the headaches she hadsince her youth.
The headaches started at the age of 20, hereyesight deteriorated and she experienced
throbbing pain 2-3 times a month. On theseoccasions she used commercial analgesics andrested for 2-3 days, but sometimes these symptoms
were also accompanied by nausea and vomiting.
Also, from her climacteric age onward she
experienced in the morning upon getting up a senseof headheavyness and felt as if she wore a hat.

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Volume 2, Number 3 | Fall 2007

Formerly,shereported that the use of
kamishoyousan reduced the frequency of analgesic
use. She also had been constipated since her teensand could not have bowl movements without the useof cathartics. She used a cathartic from a Kampo
pharmacy (content unknown) and had one bowl
movement every 3 to 5 days. There was also cervicalspondylosis (C7).
Findings upon first visit:
Fair-skinned large-built person, obese, lightbrown complexion of the face with many freckles. In
her daily life she is working industriously. She has a
big appetite, gets up twice for nocturnal urine,
dreams a lot, is under stress relating to family
matters, her legs are prone to easy development of
edema, her face flushes and she sweats abnormallyon her head and back, dislikes summers, does notcomplain of chilliness. The pulse was deep and wiry,
the tongue deep red with a white fur and dental
impressions, engorged sublingual veins, theabdomen showed a mild degree of fullness,tenderness or discomfort of the hypochondrium andthere was a marked degree of tenderness on bothsides of the naval.
Pattern: blood stasis, qi stagnation
Prescription:tsudosan
Course:
The administration of tsudosan led to a quick
alleviation of the headache and 2 months later theuse of analgesics had decreased to half its former
frequency. The frequency of the use of commerciallyavailable cathartic did not change, but upon
combination with daiobotampitpo, she experienced
from the following month onwards comfortable bowl
movements and in association with this the use ofanalgesics decreased to the range between one andtwo tenth. Since the alleviation of the symptoms
was also associated with improvements in the bloodstasis findings of the tongue and abdomen, she
continued to take this formula and gradually
improved. She stabilized mentally too.
<Migraine, chronic continuous dysentery, yangdeficiency, blood deficiency, blood stasis, liver
depression and qi stagnation>

20

Case (8): age 35 years, female, pharmacist, visitedin March YYYY
Chief complaint: headache, sense of coldness of thelower half of the body, constipation, insomnia, easy
susceptibility common cold, menorrhalgia
Present illness:
Since her high-school days she developed every
afternoon a headache that radiated to the left
temporal region and required in severe cases theuse of commercial analgesics. Recently she has been
under the impression that the effectiveness of theanalgesics

hasdecreased.

Severeheadaches

occurring once or twice a month require that she
takes to bed, but they seem not to be related to her
menstrual cycle. Although she has sufficient energy,
she lacks physical strength. When tired, themuscles of the right upper arm produce a dragging
pain, after which she reports the development ofpharyngeal

pain

and

fever.

She

has

been

constipated

since

her

youth

with

one

bowl

movement every 10 days, or 1-2 bowl movements
per week, if she took 1.5 times the normal amount of
senna. Serious of character. Previously the use of

tokakujokito for constipation caused the onset ofsevere dizziness and headaches.
Findings upon first visit:
Average height and weight with a normal bodytemperature of 36.3℃, little facial expression andspeech as if suppressing her voice. Menstrual cycleof approximately 30 days, containing blood clots,
menorrhalgia. The pulse was thin and wiry, thetongue dark red and moist with a white fur,engorged sublingual veins, presence of fullness,tenderness or discomfort of the hypochondrium,
chilling of the epigastric region and tenderness on
the left side of the naval.
Pattern: yang deficiency, blood deficiency, bloodstasis, liver depression and qi stagnation
First prescription: tokishigyakukagoshuyushokyoto
Course:The prolonged use of senna had led to chronic
continuous dysentery and thereby induced blood

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

Volume 2, Number 3 | Fall 2007

stasis, while the liver depression and qi stagnation

their flow preventing their even distribution pain

was considered to prevent recovery. First, in order towill result." This may be caused by influence of thereliefdysenteryexternal world (six excesses) or emotions (seventokishigyakukagoshuyushokyoto was chosen, theemotions), exhaustion, unwholesome dietary habits

use of senna for the constipation discontinued andand similar factors, variations in the body's internal

instead Mashiningan once daily prescribed. This

environment or disorders causes by exogenous

also improved the effects of analgesics used for thepathogenic factors.

thechronic

continuous

treatment of the headache, the severity of which

The clinical aspects of headache too have to be

gradually decreased, but since their frequency did

considered depending on the pathologic condition.

not

In other words, there are three different views of thechange,

they

still

causedanxiety.

Bowl

condition, including the questions A) Is there a

movements improved to once every three days.
Taking the medication over a period of half a year

stagnation of qi, blood or water?; B) Is there be a

improved the sense of coldness of hands and feet,deficiency of qi and blood or yin essence or else

but the sense of exhaustion did not even improve

nutrients (nourishment)?; and C) Are there any

with sleep and increasingly strong stress at work

mental factors leading to aggravation of the pain?

influenced also the pulse and abdominal findings, so

These different aspects A, B and C do influence each

that

other

the

prescriptionwasswitched

tomutually

and

are

often

observedyokukansankachimpihange. Although the coagulasimultaneously. It is important to ascertain the realin the menstrual blood disappeared and thenature of the pathologic condition, but depending on

menorrhalgia improved, the patient suffered fromthe symptoms this may often prove to be difficult.

severe headaches during the latter half of theYet, among these aspects the one mentioned undmenstrual cycle. Prescription after half a year:b) "presence of deficiency" (insufficiency) causes

yokukansankachimpihange and tokishakuyakusan

pain and is therefore called "deficiency pain". Qi and(each 2/3 of the dose).

blood mutually generate each other and supplement

After one month of treatment improvements ofshortages, so that states of deficiency continuing

both the frequency and severity of the headaches

over extended periods of time will eventually result

were observed and after half a year the use of

in deficiencies of both qi and blood. For this reasons

analgesics had become unnecessary and headaches

pain that has become chronic, will also becomeweresingledoses

ofrefractory to treatment and the deterioration of thethepatient

hadbodily environment and the ensuing insufficiency in

comfortable bowl movements even without the use

pharmacokinetics may then possibly result in aof mashiningan once every 1-2 days.

decrease of the efficacy of analgesics.

alleviatedtokishakuyakusan.

with
By

then

Also,

Discussion"chronic

diseasesinevitably

areaccompanied by blood stasis" and it is said, that "in

1. “Pain”
In Kampo medicine pain is considered to havethe following causes. "For the activities of mind andbody qi, blood, and water (bodily fluids) must
circulate without excess or deficiency. However,when there are deficiencies in the functions of qi,
blood, and water (bodily fluids) or a stagnation of

the presence of blood stasis, treat this first".
Therefore, in cases of chronic headache it isimportant to take blood stagnation = blood stasis
also into consideration.
2. Types of headache and pathologic condition
Here I would like to discuss, adding a few

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Volume 2, Number 3 | Fall 2007

comments about the individual cases, the types ofCase No. 5 is an example of qi stagnation caused

headache and their correlation to the patterns.

by the stress after employment.

1) Tension headache2) Migraine

Tension headache is characterized by a sense ofMigraine is characterized by a throbbing paintightening of the head with a heavy, dull kind of

occurring several times a month in form of attacks,

pain that continues typically on a daily basis andassociated with nausea, hypersensitivity towards

which is usually triggered by increased muscle

light and sound and similar symptoms. Generally,

tension or stress.

compared to tension headache, the pain is severe.

The heavy, dull pain is characteristic for astagnation of water. It also resembles this conditionin that it is alleviated by massage etc. The
generation of moisture due to spleen deficiency is
considered to be one of the distal factors andillustrated in the cases (1), (2) and (3). Improvementof all symptoms after administering Bukuryouin topatients visiting our clinic with headache andchronic gastritis is something we experience on arather regular basis in our outpatient department.
Again, a state of muscle tension can be considered torepresent a state of malnutrition for the muscles
themselves and considering that the spleen is
supposed to nourish the skin and underlying flesh,relaxation of the muscles is an essential aspect of
the treatment and suggests that there is somecorrelation between the state of the health of spleenand stomach on the one hand and tension headacheon the other hand. Among these patients in

Regarding severe pain there is a marked
correlation with excess patterns. In cases of excessof the blood this manifests as blood stasis, while qi
excess gives rise to qi stagnation or qi reversal. On
the other hand, water in these cases often occupies
the third space and causes quietly concealed
infiltration. Therefore, it is considered that even incases of excess there is no sudden rise in local
internal pressure and thus severe pain. Naturally, ifwater were to be enclosed within cerebral ventricles
or the capsule of surrounding tumors, it may cometo excess condition in these restricted spaces
producing severe pain. Also, the hyperesthesia'sthat often occur in conjunction with the migraine
are a pathological condition in which the evil of anexcess pattern is present and may easily imaginable
trigger either locally or systemically an state of hightension, suggesting a correlation with the excess
pattern.
Blood stasis is often responsible for locally fixed,

particular case (2) was interesting, considering thestabbing

fact that the effective prescription for single use

stagnation often produces wandering pain that feels

variedlike stretching or swelling. In case No. 6 the "paindepending

on

with

the

presenceofgastrointestinal symptoms.

or

else

lancinating

pain,

while

qi

like being hit" is a form of lancinating pain often

Moreover, in cases of blood deficiency theobserved with blood stasis. The "pain as if a heavy

reactivity towards the pain decreased and thesestone lies inside" improved with treatment topatients characteristically presented often with aregulate qi and thus is possibly related to qi

mild, but nagging and continuous pain.

stagnation. In this patient the treatment shouldThis resembles the pain of tension headache.
When like in case No. 3 the condition was based on

probably have aimed from the beginning at
expelling stasis and regulating qi.

anemia, or in case No. 4 where the condition was

In case No. 7 too blood stasis and qi stagnation

triggered by a pregnancy, a post partum or

induced symptoms were prominent and tsudosan

post-menstrual headache should be considered.

proved to be markedly effective. The persistent

22

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

Volume 2, Number 3 | Fall 2007

constipation required combination therapy with

daiobotampitpo, indicating that the nature of theheadaches and constipation as well as the mental
condition are important criteria for the treatment.
Otherwise, I often experienced that during thetherapeutic course following treatment of malignant
tumors or treatment of collagen diseases and thelike conditions migraine may develop and treatment
were found to be markedly effective in cases
complicated by agitation and constipation.
The cold deficiency of spleen and stomach
induced by prolonged use of senna in case No. 8 led
to the development of a yang deficiency. Since"Bloodcirculates

by

being

warmed"coldness

obstructs the circulation of blood. For chilling of thehands and feet in the presence of chronic continuous
dysentery

and

blood

stasisinthepelvistokishigyakukagoshuyushokyoto is very effective.
Moreover, circulation of the blood also requires theflow of qi. The stress at work impeded recovery fromthe blood stasis further and thus I focused on
regulating qi once the coldness had been alleviated,but the treatment still required the use of

tokishakuyakusan with its blood stasis expelling
action to supplement the blood.

Conclusion
Among the forms of chronic headache tension
headache and migraine are frequently observed in
the Kampo outpatient practice. I presented a few
cases and discussed them briefly. I also offered one
opinion pertaining to the characteristics of bothconditions and their pathological conditions in the
Kampo medical sense.
Combination of western medical diagnosis with
TCM theory appears to be useful for providing the"individualized

therapy"mentionedatthebeginning recommended by the AHA. Integration of
TCM theory into the therapy is considered tocontribute also to the development of western
medical care.

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Volume 2, Number 3 | Fall 2007

Clinical Report 3

returning home from work, she felt exhausted and was

Treatment of Insomnia based on Benshou-ronchi(Holistic Diagnosis for Disease Pattern
Identification)
Naoki Hirama
Tokyo Research Society of Chinese Clinical Medicine

The medicine of China in the Age of the Ming
Dynasty, the medicine of Japan in the early Edo Era(which is later called the “Goseiha School” – Schoolof Later Development in Medicine), and the
medicine of Dongui bogam (The Precious Mirror of
Oriental Medicine) of Korea in the Age of the Lee
Dynasty evolved in the same period and are nearlyof the same nature. Mutually understanding thedevelopments made in the later days of eachcountry based on these ancient medicines as astandard will facilitate the cultural exchanges
between three countries with the least discomfort.
Dosan Manase, the author of “Keitekishu”, which isa clinical reference book for the medicine of theGoseiha School, called this book “Sasshou-benchi”,
which is the same diagnostic treatment system as
the one for “Benshou-ronchi (to give treatment[ronchi] based on holistic diagnosis to identify
pathogenic

pattern)”intheModernChinese

Medicine. Learning the medicine of the Goseiha
School will help practitioners acquire tips how to
direct treatments.
This paper presents two cases of insomnia forwhich treatment was conducted on the basis of the
Benshou-ronchi with the use of prescriptions thatare popular in Japan.

first daughter. With persistent tiredness, she does not feel
her spirit emerge. The patient had difficulty falling asleep
even when going to bed, feeling tired. The patient also
complained of being unable to feel slept well, hard to get
up in the morning and not being confident in her physicalstrength so that the patient covered insufficient physicalstrength by mental toughness, a weak stomach and ofloss of appetite in recent days.
Worries in daily life: The patient felt helpless as her
husband was transferred not accompanied by family andhad a worry about her first son’s finding employment.
She had handled various types of office work but
recently she got to become anxious by small things andfelt palpitations. She lied awake and had difficulty
sleeping in peace due to brooding over her physicalcondition, office work, and family affairs.
Findings of tongue and pulse: Pulse was deep, thready,and weak, and the tongue body was pale with a whiteand white coating.
Case analysis
Insomnia, one of the chief complaints, is considered tobe caused by disordered functions of the liver and theheart, which house the spirit that is substances to control
the activities of spiritual (inner) consciousness. Therefore,
consideration was given to look for the cause of disease
and pathogenic mechanisms of how the heart functions
became disturbed. In the process, consideration was also
given to find out any association with disturbed functions,
if any, of other visceral and bowel organs.
First the nature of the disease was determined by theCase 1: 46 years old, female, company employee
Chief complaint: Difficulty sleeping and fatigability
History of Present illness: Two months ago in the
middle of December, the patient caught a cold, feelinglassitude with cough and phlegm production. Having a
low-graded body temperature, the patient forced herself
to go to work (accounting). Although a low-graded fever
dissipated after a week and the cough and phlegm
subsided after a while, the tiredness lingered. When24

barely able to manage the domestic cares with help of her

Eight Principle Pattern Identification whether it fits into
interior or exterior, deficiency or excess, and cold or heat.
Although the disease originally developed from anexternal contraction, exterior symptoms were not alreadyapparent and had progressed to interior syndrome. Pulse
was deep, thready and weak which indicated evil hadgone away. The symptoms and signs did not show thecharacteristics of excessive yin-qi but showed deficiency
syndrome. Although the pathological pattern was not

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

Volume 2, Number 3 | Fall 2007

clear whether it was cold or heat, heat-syndrome

nature of disease, the dynamics (momentum) of deficiency

symptoms and signs were at least not observed. Hence, it

and excess, and the locations of disease in the patient that

could be said that the nature of the disease was interior

the patient had the deficiency in the heart blood plus

deficiency without heat-syndrome.

deficiency in spleen qi, i.e., deficiency syndromes in both

Next, in observing the dynamics of healthy-qi andthe heart and the spleen.

evil-qi, it could be determined from the foregoing findingsthat the condition was deficiency of healthy-qi, having
evil-qi receded. So, the treatment was to be made mainly

Treatment
Treatment was to be carried according to theconclusion of the Benshou to increase the heart blood andby supplementing tonics.
Then, what deficiencies were occurring in what organs

spleen qi, i.e., supplementation of blood to nourish theor parts of the body – i.e., identification of the diseased

heart and increase spleen qi making the spleen healthy.

location? Many mental symptoms were manifested, such

kihito might be the prescription best suited for theas difficulty falling asleep, feelings of anxiety, strain oftreatment of the above conditions. Since the symptoms

worries, and palpitations. Moreover, spleen symptoms

surfaced were insomnia and anxieties that were

were observed, such as the physical constitution of weakassociated with the heart (mind), kihito was formulated

stomach and intestines and shortage of physical strength,with adjustments according to each symptom with theand loss of appetite. From these, the disease locations

focus on nourishing the heart (mind) of the patient.

were the heart and the spleen. Then what were deficient?
It could be judged from the history of disease thatexhaustion after having a cold and mental stresses
including anxieties over her family and personal matter,and her physical condition induced deficiencies. When
qi-deficient syndrome such as lassitude, do not feel likedoing anything, and weak pulsation; and the findings of
the unstable spirit such as having trouble getting to sleep
and do not feel slept soundly were all taken into account,
together with the state of thready pulse, it was
hypothesized that the spirit was unable to be nourishedand sustained with insufficient heart blood.
Weak pulse appears when yang-qi is deficient.
However, a cold sensation in the patient was not marked.
The patient was constitutionally short of the spleen qi,
which was presumably further exhausted. Although thepulse usually becomes thready when either blood or
yin-qi is deficient, an imbalance between yin and yang,like deficiency syndrome with heat, was not observed in
the patient. Thus, it was concluded that deficient was
blood-qi.
When the locations of disease were taken into accounttogether with the above consideration, it was judged thatboth spleen qi and heart blood were deficient. The
Benshou diagnosis concluded from the analysis of theGinseng 6, Astragalus root 9, Atractylodes Vvatae
Rhizoma 6, Rhizoma 9, Japanese Angelica Root 6, White
Peony Root 6, Longan Aril (fruit) 6, Roasted Zizyphus
Seed 12, Thinleaf Milkwort Root 6, Salvia Miltiorrhiza
Bge 9, Jujube (Chinese Date) 6, Dried Ginger 3,
Honey-roasted Licorice Root 3. (unit: gram)
As the patient was in the exhausted state of the heart
spirit and blood qi, the author comforted her by saying
not to worry too much about her physical condition andtry to think positively about family matters. The author
also gave psychological guidance to ease the sense ofanxiety.
CourseAfter a week of the administration, the patient began
to have the stomach and intestines in good conditions andalso to have an appetite. Difficulty falling asleep was
improved slightly. However, as she still dreamed a lot,
she could not feel that she slept soundly. After two weeks,
she was able to sleep soundly on some days and easily getout of bed. She became able to handle her work at theoffice as previously. Her expression became lively. After
four weeks, her sleep became stable and an appetite andstamina were back. She had a healthy color. Her pulse

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Volume 2, Number 3 | Fall 2007

became vibrant. Back to the Spleen Decoction wassmooth flow of qi? From fire・heat of the tongue findings,

replaced with the Extract of kihito and after thewiry pulse, irritation, anger, sighing, and feeling ofcontinuous administration for a while, she felt completely

swollen in the temporal regions, it might be reasonable towell and the treatment was discontinued.

think qi was stuck.
Putting the results of the above analysis together led

Case 2: 28 years old, female, company employee

to the Benshou diagnostic conclusion that the disease

History of Present illness: With some kind of trouble

pattern was identified as liver qi stagnation andthat started about six months ago, the patient was unable

up-flaming of liver fire. Hyperactivity of liver fireto sleep soundly, having a hard time falling asleep.

provoked heart fire, inducing insomnia, tightness in the

During the month, the patient woke up in two hours after

chest and palpitations. In the inquiry during the clinicalfalling asleep and was unable to sleep again. The chest

examination at a later time it was revealed that she wasfelt tight with palpitations. With stiff shoulders, a swollen

worrying about a lost love. Anger and lingering affection

discomfort was felt in the regions of the temples toward

seemed to have caused liver qi stagnation and liver fire.

the internal regions of the ears. A headache occurred
sometimes. The patient easily got irritated and angry.

Treatment

Although having no appetite, she was able to eat when

The treatment for the identified disease pattern was

she tried to eat. Further complaints were slight

to be performed by means of soothing the liver to relieve

constipation, dry mouth, and frequent urination.

constraint for resolving depression and clearing the liver

Findings of tongue and pulse: Pulse was wiry, and theby draining fire. As the heart (mind) syndrome had been

tongue was red with a greasy whitish yellow coating.

manifested, medications for dispelling heat evil to calm
the heart were supplemented. The prescription was based

Case analysis

on ryutanshakanto.

The analysis based on the Eight Principles indicatedScutellaria Root 6,

Cape

there were no findings of deficiencies unlike Case 1. From

Gentian Root 3

Jasmine Fruit 6, Dried Rehmannia Root 9,

White

the wiry pulse and the greasy tongue coating, excess wasPeony Root 9, Bupleurum Root 6, Arisma Rhizoma 9,

dominant. In terms of cold or heat, the red tongue body

Roasted Zizyphus Seed 9, Uncaria Hook 6,

and a yellow tongue coating were the indication of heat

12,

Pearl Layer

Fresh Licorice Root 3. (unit: gram)

predilection. In short, the state could be judged as excessinterior heat. In regard to the dynamics of yin-qi andyang-qi, healthy-qi was exuberant and evil-qi was excess.
Then consideration was given to the locations ofdisease: Although the chief complaint was insomnia,
which is a symptom of the heart, the liver functions
responsible for regulating and maintaining the smooth
flow of qi were markedly disturbed from such symptoms
as being irritable, easily get angered and sighing a lot.
The excess evil-qi in the liver channel was observed fromCourseAfter a week of the administration, headaches andfeeling of swollen in the head were alleviated. Frequenturination was improved and the tongue coating also
improved to yellow and thin.
After three weeks, continuous five hours sleep could beachieved and irritability disappeared. Appetite was back.
The tongue body was slightly red with a white and thincoating. The pulse was moderate. The medication to

the symptoms of stiff shoulders and feeling of swollen insooth the liver was reduced and heart-nourishing

the temporal regions. Thus, it was judged that the liver

tranquillizer was added. That is, Scutellaria Root was

was the main location of the disease, rather than the

excluded and Japanese Angelica Root 6g and Ginseng 6g

heart.

were added.

Then, what evil did disturb the liver functions for the26

After five weeks, sleep was greatly improved and her

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

Volume 2, Number 3 | Fall 2007

mood became stable. She spoke about the lost love andIn regard to the location of disease, two cases differed:other matters with a touch of self-mocking. The tongue

The heart and the spleen were involved in Case 1, whilst

coating was white and thin. The treatment was directed

the liver was mainly involved with the heart in Case 2. It

to sooth the liver for resolving depression and to clear theliver by draining fire. So, the prescription was changed
to kamishoyosan plus Wild Jujube seed Decoction.
The treatment was discontinued after the continuous
administration for a while.
Comparison between Case 1 and Case 2

is important to find out accompanying signs andsymptoms of the chief complaint.
Pulse findings and tongue findings were consistent
with the nature of disease and the dynamics of excess anddeficiency in both Case 1 and Case 2. In such case, aconclusion can be drawn with confidence.
Once analyses have been made in the above

The chief complaint of the two cases was insomnia.

procedures and disease patterns have been identified,

The causes of disease and disease mechanisms differed intreatment appropriate for the identified pattern may be

the two cases: Case 1 had deficiency syndrome caused

carried out. In case the original Benshou (disease patternby exhaustion of blood qi induced by after-illness, worries,

identification) has hit the target with effects, the disease

and anxieties, whereas Case 2 had excess syndrome

developments should be followed to judge the nature andcaused by qi depression and liver fire provoked by the

momentum (dynamics) of disease and to establish an

feeling of anger about a lost love.

appropriate treatment over time. This is the shortest way
to healing. The author recognizes that the treatment
based on Benshou is the method to practice the orthodox
treatment with Traditional Ancient Chinese Medicine.

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

27

Volume 2, Number 3 | Fall 2007

Introduction of Japanese Acupuncturewith the hands, it is definitely not done solely with

Considering the Therapist’s Hand (7)the fingers or the wrists alone. The entire body

Shuichi Katai, Ph.D., L.Ac., Professor

should concentrate on the palpation and that its

Dept. of Acupuncture and Moxibustion

complete

Tsukuba University of Technology, Ibaraki, Japanpalpation.

involvementiscrucialtoeffective

Table 7 Basic training of the hands II

V. Basic training of the hands- Placement of the hand -2. Palpation posture
Next I will describe the way the hands should be1) Place first the wrists and then the fingertips
2) Form an arch with the palms and fit them toplaced and the posture (Table 7).
Detailed findings of the body surface are felt

the body form

with the fingertips, but trying to perform the2) Don't spread shoulders or elbows

palpation solely with the fingertips renders the3) Keep wrists and fingertips parallel to the bed

patient most uncomfortable. It would be advisable
to place the entire palm in close contact with theregion to be palpated, or else form the hands into ashape similar to that of the examined body region
from a little distance and then bring the fingertips
into contact with the body. Also, conscious efforts
should be made not to use the fingertips per se forthis task, but rather perform the palpation fromthe wrist, using the entire palm.
Shoulders and elbows should not be spread out

surface (or the surface to be palpated)
3. Acquaintanceship / Familiarity / Putting thepatient at ease
During palpation the things listed in Table 8
should be taken to heart. It is important to avoid
making the patient uncomfortable by trying toobtain the necessary information quickly andabruptly. These two items may appear to becontradictory, but both are necessary to obtainpalpatory information. Therefore, although underand both wrists and fingertips kept parallel to theparticular circumstances there may be a certain

target area during the palpation. When sitting on adegree of inconsiderations pertaining to pain,

chair, the upper half of the body should rest on the

discomfort or shame of the patient (occasionallyhips, the back positioned directly above the pelvis,

even disregard), if at all possible, attempts shouldarms extending effortless from their base at thebe made to perform the palpation from the point ofshoulder and palms positioned at the end of them.

view of patient. Moreover, attempt to acquire theIn other words, hips, back, shoulders, elbows,

skills to aptly obtain the necessary information.

systematicallyAlso, it is important to take care not to expose

together. It is important to realize this. Naturally,

the patient's skin more than necessary. The skillfulonce this posture becomes comfortable, it will nouse of bath towels to cover the patient and arrange

longer be necessary to concentrate this flow ofthings for this purpose assures that only the area

movements and the practitioner can concentrate

to be palpated is exposed. Prepare two bath towels

completely on the area being palpated. Also, whento cover the patient, covering the upper and lower

standing, both legs form the foundation of thehalves of the body separately. Skillful use of thesewrists,fingertips

arelinkedposture, the hips are placed on top of the legs andtwo towels allows elegant exposure of only thethe remaining upper half of the body again

necessary areas.

assumes the same posture above the hips as when

4. Evaluation of the palpation and therapeutic

sitting. In short, although palpation is performed28

effects

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

Volume 2, Number 3 | Fall 2007

This is related to the following section on

be examined. First, muscle tension and stiffness

practice methods, but the question as to whether

shouldbeunderstood

distinctfromtension,the information obtained through palpation isswelling and tone of the skin and connective

really appropriate or not, requires that thetissues. This is a skill that is comparatively easy topractitioner constantly and repeatedly questionacquire, because the practical training duringhim/herself. Until intuition upon touch produces

regular schooling usually focuses on the acquisition

the correct results, repeated self-questioning isof information pertaining to tension, stiffness andvery important.

similar 'excess' information. By graduation, theDuring palpitation confirmation of the sensation

skills of palpation for excess conditions andobtained from the fingertips through touch is areactions are often fairly well developed. Actually

recollection of the past. It is a comparison withtension and similar signs of excess are rather easy

memories of what one has felt through touch in theto comprehend.

past to verify the current sensation. However,Once you have learned to assess excess, you

many people have little experience of touchingshould try and practice to obtain information aboutother people and the available memories from the“deficiency”. One example of a practice method

past are not very clear either. It is therefore

would be to practice and palpate the round shape ofnecessary to establish one's own set of sensory

subcutaneous veins or foveations in the skinmemories. This process requires some time andwithout applying too much pressure. This form of

will be associated with a strong feeling of fatigue.

palpation should be done by gently sliding yourYet, once this stage has been passed, it becomes

hands over the skin without applying too much

possible to comprehend reactions without muchpressure.

conscious effort based on the thus established

Always confirm with your teacher (master),whether your sensation is correct or not. Also, it ismemories.
Table 8 Basic training of the hands III- Help the patient relax 1) Warm your hands
2) Don't use unnecessary pressure3) Don't let the patient feel any pain4) Always scrutinize your own sensation
5. Practice methods
Now I would like to describe some practicalmethods for improving palpation skills (Table 9).
During practice it would be good to blindfold
yourself or use other means to block vision, so thatyou can concentrate on touch without being
distracted by visual information. As I havedescribed in this paper on the training of the hands
under (- Object -), it is important to clearly
distinguish during practice between the tissues toadvisable to practice in a way that inspires thepatients to ultimately tell you, that your "hands
are warm, soft, pleasant and comforting".
Table 9 Palpation targets* Skin (surface) -> The feel of the skin, degree oftension, irregularities, temperature, degree ofmoisture, alterations etc.
* Skin (deep) -> Tone of connective tissues,
hardness, arteries and veins, indurations,edema etc.
* Muscles -> Tone of muscles and tendons,
tension, swelling, lack of power, indurationsetc.
* Organs -> In acupuncture and moxibustion
therapy organs are not the subject of
palpation, but you must be aware of theirrespective positions* Bones -> Bones are important as anatomical
landmarks and for acupoint location.

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

29

Volume 2, Number 3 | Fall 2007

Medical History in Japan
Todo Yoshimasu and His Medicine (1)yin-yang five phase metaphysics, and in his 30s he

Hiromichi Yasui
Japan Institute of TCM Research

In KAIM Vol. 2 No. 2, we looked at the medicineof Dosan Manase (1507-1594), and I described someclinical cases. Dosan took the latest available
medical technology from Ming China and arranged
it in ways suited to Japanese life and society, in theprocess creating a structure that closely resembles
modern-day Traditional Chinese Medicine (TCM).
In the mid-18th century Todo Yoshimasu advocateda very different and unique medical system, andDosan's system fell from favor. The differences
betweenJapanese

Kampo

medicine

andthetraditional forms of medicine in China and Korea
are primarily due to the changes that were
implemented at that time by Todo Yoshimasu, who
effectively constructed the basis for modern Kampo
medicine in Japan. I would like to introduce his
medical perspective in two parts.

the Shang Han Lun (On Cold Damage) and the Jin

Gui Yao Lue (Synopsis of Prescriptions of theGolden Chamber). In 1738 at the relatively young
age of 38, he expressed the aspiration of "curing thephysicians of the world" (in other words, to bring his
own system to other physicians so that they could
cure their patients more effectively). To do this, he
set off for Kyoto, which was then the cultural capitalof Japan. At first, things did not go according to his
expectations, and he was hard-pressed to survive.
He made dolls, fired clay pots, and in general led a
hand-to-mouth existence. Presently, however, hebegan to be recommended by the Emperor's head
physician, Toyo Yamawaki, and the name of Todo
Yoshimasu began to be widely known. His medical
work flourished, and he attracted a large number ofstudents.
In 1759, one of his students published acollection of Todo Yoshimasu's medical treatises
under the title "Idan" (roughly translated as"medical diagnostics"), and this publication became

1. Biography
Todo Yoshimasu was born the son of a physician
in the city of Hiroshima, which in later years would
become famous as Ground Zero for an atomic bombat the end of World War II. He descended from aprestigious samurai family. However, in the 17th
Century after a long and devastating civil war, theJapanese nation entered into the generally peaceful
Tokugawa period. Since there was less demand for
warriors at that point, his family followed the adviceof the old Japanese proverb, "If you cannot be a goodruler, then be a good doctor." Todo himself began the
study of medicine at the age of 19. The Yoshimasu
family traditionally practiced surgery, but Todo
Yoshimasu involved himself in the study of internal
medicine.
He questioned the medical theories based on

30

put together a unique system of medicine based onquite influential. Todo also collected each of theformulations described in the chapters on the 220
formulations in the Shang Han Lun and Jin Gui Yao

Lue, added his own opinions, and published theresulting manuscript under the title Ruijuho topresent the standards for "Koho" or traditional
methods of treating patients. In addition, hecollected information on the indications for various
herbaldrug

formulations

andpublishedamanuscript called Yakucho, in which he describedanalogous pharmacologic effects for the individual
drug substances contained in those prescriptions.
At the end of his life, Todo was happily
surrounded by his children and grandchildren. He
died of a stroke on September 25, 1773, at 72 yearsof age. His medical writings, in addition to thethree-volume set of Ruijuho, Hokyoku, and Yakucho,

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

Volume 2, Number 3 | Fall 2007

also included titles such as Hoki, Ijiwakumon

Yoshimasu refused to include the traditionally(medical questions and answers), Kenjuoku, andaccepted concept of original vital energy15) into his

Koshoigen (a collection of medical expressions fromconcept of diseases. He believed that the original

the ancient texts).

vital energy was given by the heaven, and although
it waxed and waned according to time's flow, Qi16)

2. Medical Views

itself did not suffer disease.

Todo Yoshimasu's biography, his medical views,

Yoshimasu also criticized the theories of Yin andand the process by which he formulated those views

Yang and the five phases, the basic principles of thehave been widely discussed [1, 2, 3, 4, 5, 6, 7, 8, 9, 10,

Manase School. His point was that, as Yin and Yang

11, 12]. We can see the main points of his medical

was the Qi of heaven and earth, it was wrong totheory in “Idan 医 断 ”, compiled by his disciple,

apply the concept of yin and yang to a human body.

Tsuruta and in his “Iji Wakumon 医事或問”, written

As a clinical physician, he did not accept thein question and answer style. Here I am going totheories of Zhu Danxi 朱丹溪, and Zhang Jing-yue 張

summarize some important points, which can be

景岳, And he ignored the theory of five phases, as

found in these books.

well as the concept of the Rotating Qi. He also did
not accept the concept of viscera and channels.

(1) The theory that all diseases are caused by one
poison, and Kampo sho relativity(3) Etiology and pathogenesis

Todo's medical theory was based on two points:

As we have seen above, his medical principle was"All disease comes from a single poison," and "Never“relating symptoms to medication,” based on a

speak of what you cannot see with your eyes." [13]complete

Because he was unable to see with his own eyesprescription.

what occurred within the body, he refused to say

the causes of diseases. The important thing for him

anything about that. Since he could not analyze thewas to know in which part of the body there wasmechanisms of etiologic pathogenesis, he refused topoison, and not to research the cause of disease. He

accept the theories of traditional medicine.

thought that this type of research could not help in

He also held that disease was caused by toxins

understanding

of

the

indicationof

For that reason, he did not question

clinical treatment.

developing within the body, and that those toxins

Todo Yoshimasu did not rule out the existence ofcame from food, drink, and other external sources.

pathogenic mechanisms, but instead held that

He considered the important question to be not how

theories

the toxins were formed, but rather how to heal the

hypotheses, and that they were unnecessary for

person by removing the toxins from the body.

treatment. According to his position, the mostThe location of the toxin is confirmed by"fukushin" (abdominal diagnosis), and the patient is

about

these

mechanisms

were

only

central tenets of Chinese traditional medicine wereactually unnecessary.

treated with a prescription that accurately targets
the patient's symptoms. This method is called(4) Diagnostics

For Todo, the purpose of diagnosis was to"Kampo shou relativity."

determine the location where the poison was(2) Criticism of yin-yang five phase metaphysics

present, and the method upon which he placed hisand "zofu riron" (literally "entrails theory")

greatest emphasis for such diagnosis was fukushin.

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

31

Volume 2, Number 3 | Fall 2007

He attached importance to the abdominal diagnosis,
based on his idea that the “Abdomen is the origin of(6) Dosimetry

Todo made extensive use of formulations fromthe Shang Han Lun (On Cold Damage). In thelife and also of all diseases.”reports, the reader realizes the extreme importanceRuijuho, he compiled lists of the individual
prescriptions in the Shang Han Lun and the Jin Gui
Yao Lue (Synopsis of Prescriptions of the Golden
Chamber), and he used those prescriptions in ways

he attached to abdominal shou.

that were unrelated to their context within the

Fukushin was not at all theoretical, but had a
specific rationale for clinically based confident
diagnosis. Looking through his numerous caseHe did not think much of the pu1se diagnosis. He

Shang Han Lun.

thought that pulses differed from one person to

Yoashimasu's frequent use of Zhang Zhong-jinganother. If he could know the usual pulse condition

張仲景 prescriptions was based on his belief thatof a patient, he could then know how it differed wasthey were used and effective in the old times. He

when a patient was ill. But it was very rare, 10-20%

used not only the prescriptions of Zhang Zhong-jing,

possibility in general, that certain qualities of the

but also other prescriptions, if they were effective.

４)

pulse, such as floating or deep , slow or rapid ,His attitude toward “Shang Han Lun” was veryslippery or uneven , could be diagnosed. Yoshimasu

different from others of the Koho School. Yoshimasu

also thought little of Qi of the five parenchymatous

put his emphasis on grasping the indication ofviscera.

prescription, and tried to ignore the contexts which(5) Drugs (herbal medications)were related to “Shang Han Lun”. Concerning the３)５)

As for medications, he had ideas far different
from

the

contemporary

theories.

Concerning

descriptions in “Shen-Nung Ben-Zao-Jing”19) andchose ideas which agreed with the principle oftheory of six pairs of channels27), he said he used it
only as a way of classification, that the more
important thing was Sho (a symptom-complex).
His

attitudes

were

also

expressedin

hisZhang Zhong-jing 張仲景 20) With his concept ofcompilation, “Ruiju Ho 類聚方”. In the book, for each

medicine as poison, and with his principle ofprescription he described extracts from the texts oftreatment, in which poison could be eliminated only

“Shang Han Lun”, “Jin Gui Yao Lue”, and theby poison, he did not accept the idea of moderating

indication of each prescription in a style that closely

the efficacy of medicine.

related symptoms to medications. Some phrases,

He wrote the book, “Yakucho 薬徴” about theput in square brackets, meant that he had not

efficacy of medicines. A prototype of the bookinvestigated them himself, and perhaps, he thought

seemed to exist in 1740. In 1771 it was completed.

of those as being in the category of “should not”. For

Throughout

hiswritings,

Todo

criticized

Yoshimasu, concepts such as Yin and Yang,conventional pharmacology based on the Shen Nong

Tai-Yang-Bing30),

Ben Cao Jing, a Chinese book on agriculture andmedicinal plants, and insisted that the Shang Han
Lun (On Cold Damage) should be used instead.

necessary.

In the book, he said that ginseng cured stuffiness

His

Yang-Ming-Bing

were

not

(7) Treatment

treatments

were

made

of

variousand rigidity of the epigastric region22), and did not

combinations of prescriptions from “Shang Han

replenish the original vital energy. For that purpose,

Lun”, and strong laxatives such as croton seed23),

ginseng produced in China was not effective, only

kansui root24）, rhubarb25) etc pills which contained

the Japanese one should be used.

mercury, as well as. The basic idea behind his

32

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

Volume 2, Number 3 | Fall 2007

treatment was the elimination of poison.
Yoshimasu

had4

therapeutic

was their fate. However, others said that they did

methodsof

not understand Todo's protocols.

treatment: diaphoresis, emesis, purgation andmediation１) which he used according to the region
which was poisoned. And he thought that in the

3. Medical Theories and TCM
Accordingtotraditional

Chinesemedicine,

medical arts, only a method of attack existed, adiagnosis clarifies the condition's etiology andmethodHepathogenesis, and this is an inseparable part ofemphasized that attacking poison meant everything.

treatment. In contrast, Kampo medicine in Japanofreplenishment

did

not

exist.

It was Ming-Xuan 瞑眩, a medical reaction which
one felt when attacked by medicine.
Concerning the concept of deficiency and excess
he also had a unique idea. Citing “the excess(symptom-complex) results when the invading
pathogens is exuberant, exhaustion of vital essence
brings on insufficiency (symptom-complex from
“Huan-Di Nei-Jing” he said that what attacked
excess was poisonous medicine, and what nourisheddeficiency were foods such as rice or meat. He
maintained his theory that diseases were caused bypoison, so treatment should be geared toward
driving poison away from in the body by medicine
which was itself poison.

He said that as a physician he always tried his best
to cure diseases, but that had nothing to do with thepatient's life and death. Only destiny could decide
he

meant

was

that

when

he

administered his treatments based on his methods,
he could nothing but await the judgment of destiny.
This issue elicited strong reactions within theJapanese

medicalestablishment

in

the

18th

Century, and became a major area of controversy at
the time. In his Ijiwakumon, Todo spent many pages
explaining

his

position,"black box" that they did not try to explain. Todo
Yoshimasu started the tradition that the mostimportant tenets of traditional Chinese medicine
were the very points that should be deemphasized.
The new Meiji government, which took control ofJapan in 1868, adopted a German medical model,
and

Kampo

medicineceased

to

be

in

the

mainstream of Japanese medical practice. However,Kampo continued to be popular among the common
people, and even experienced a certain level ofrevival. Since that process of revival was based onJapan closely resembles his teachings. However,

Yoshimasu had a unique concept of life and death.

Whatand doctors put etiology and pathogenesis into a

Yoshimasu's theories, modern Kampo medicine in(8) Views on life and deaththat.

provided treatment in direct response to symptoms,

which

was

that histreatment was based on a kind of protocol. Today wemight consider it "textbook-standard treatment." He
believed that if people were treated according to theappropriate protocol, and they were not healed, that

there are some differences. For example, althoughthe "black-boxing" of etiology and pathogenesis
remains unchanged, modern methods differ from
Yoshimasu's in that they utilize a number of
etiologicalcategories.

However,modernpractitioners continue to avoid analyzing etiology
and pathogenesis during the diagnostic process, justas Yoshimasu taught.
By any measure, Todo Yoshimasu exercised
tremendous influence on Japanese Kampo medicine.
Yoshimasu's denial of the central tenet of Chinese
TCM, a position that has been continued inJapanese Kampo medicine, makes it difficult for thetwo traditions to have a conversation about
theoretical points that they hold in common. Clearly
Yoshimasu's tradition continues to live on in Japan
today.

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

33

Volume 2, Number 3 | Fall 2007

References
1) Yoshimasu N. Todo Sensei Gyojoki (Conduct

8) Huang Huang, 徐 霊 胎 (Joreitai) and Todo

Report on Dr. Todo), Collected works of Todo,

Yoshimasu, Journal of the Japan Society of

551-558 Shibunkaku Co., Ltd., 1918

Medical History No. 2, Vol. 47, 229-260, 2001

2) Kure S. Dr. Todo Yoshimasu, Collected Works of9) Wada M. Todo Yoshimasu, a revolutionary,Todo, 1-138, Shibunkaku Co., Ltd., 1918
3) Oka S. Biography of Todo Yoshimasu,

extraordinary physician, Journal of Kampo

Medicine, special issue commemorating 100th
edition, **-** 1963

Joranshawa, Vol. 354) Otsuka K. Todo Yoshimasu, Kinsei Kampo

10) Yamamoto I. Todo Yoshimasu and his medical

Igakusho Shusei (Collection of Modern Kampo
Medical Texts) 10, 7-38, Meicho Shuppan, 1979

methods, Toui Zatsuroku (1), 19-33 Ryogen,5) Yasui H. Todo Yoshimasu and his medical art,

Kinsei Kampo Chiken Senshu 6, Meicho

198311) Yamamoto I. Speaking of Todo Yoshimasu, Toui

Zatsuroku (3), 1-57, Ryogen, 1983
12) Yamamoto I. On Japanese Kampo and the Koho

Shuppan, 1985
6) Tateno M, Oyama M. Todo Yoshimasu and Taoist

School, Toui Zatsuroku (2), 1-104, Ryogen, 1981

Philosophy, Journal of the Japan Society of13) Otsuka K. Medicine in the First Half of Modern

Medical History, No. 4, Vol. 47 P 855-857, 2001
7) Tateno M. A study of “Kosho Igen” by Todo
Yoshimasu, Kyuko Shoin, 2004

Times, Modern Scientific Thought (2nd volume),

34

Nihon Shiso Taikei (A Compendium ofJapanese Thought) 535, Iwanami Shoten, 1979

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

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