Volume 7, Number 2 | Summer 2012

Kampo Medicine - Current Research
Essentials of Pediatric Kampo Medicines (2)Hideaki Yamaguchi

or episodic apnea and so is yokukansan for diaphragmatictics.
In recent years the importance of developmental
disorders in general practice has increased, in

2. Kampo medicines with emotionally stabilizing
functionsAmong various crude drugs, even though there
are certain differences in the strength of the effects,
many drugs have emotionally stabilizing functions
and if Kampo formulas contain several such crude
drugs, they may correspondingly be expected tomanifest such emotionally stabilizing actions. It is
well-known that mind and body can only hardly beseparated in children and any mental problem has ahigh tendency toward somatization. The relevant
Kampo medicines act simultaneously on stabilizing
the emotional state and improve the physicalcondition (for example, improve the gastrointestinal
function) and are precisely for this reason well suitedfor children. Characteristics of these formulas
include them being mild, not inducing drowsiness,
dry mouth or gastrointestinal dysfunction or similarside effects. Therefore they are not suited for therelief of severe symptoms, but they can be consideredto act by transforming both mind and body of thechildren little by little (providing relief). The use ofpsych mimetic drugs in pediatrics is currently moredifficult than in adults. Kampo medicines therefore
can probably considered to be easily applicable drugs
for emotional and psychological problems.

Yokukansan, kanbakutaisoto, saikokaryukotsuboreito
can be listed as representative tranquilizers that canbe used in children.

Yokukansan (or yokukansankahangechinpi) is aformula that has been devised in ancient times forpediatric convulsive diseases and because of its
sedative actions it is therefore indicated for
conditions associated with irritability and easy
excitation. Kanbakutaisoto and saikokaryukotsuboreito
are thought to have mainly anti-anxiety action, but thismay not always be taken literally. Based on experience isparticular for pervasive developmental disorders or
attention deficit hyperactivity disorder and theabove mentioned three preparations are useful andreportedly have been found to be effective even inpatients

non-responsive

Apart

from

the

methylphenidate11).

mentioned

preparations

orengedokuto, kamikihito etc. can also be used.
* Kanbakutaisoto: anti-anxiety activity, improving
gastrointestinal function* Saikokaryukotsuboreito: sedative, anti-anxiety
activity, anti-inflammatory

activity* Yokukansan:

strongly

sedative,

gastrointestinal

function,

improving

circulation,

original

text

the

improvingblood

recommends

simultaneous application to mother and child.
3. Kampo medicines with gastrointestinal function
improving actions
In Kampo medicine gastrointestinal function are
expressed as "spleen/stomach = digestive system".
The meaning of this term is thought not to be
restricted simply to the gastrointestinal function,
but includes the more comprehensive concept ofmaintaining the functioning of the entire body.
Naturally, both aspects are closely related, but forthe sake of convenience I would like to discuss here
the following 2 separately.
1) Treatment of diseases of the gastrointestinal tract
in a general sense
Basically, gastrointestinal symptoms representing
problems in pediatric clinical practice include
vomiting, diarrhea, constipation and abdominal pain.
These may be caused by a variety of pathologic
conditions

andwhile,

differential

diagnosis

needlessandtotreatment

say,

their

is

very

important, Kampo medicines may prove to be helpful
in cases difficult to treat with Western medications.

kanbakutaisoto the drug of first choice for pavor nocturnus

6to

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

Volume 7, Number 2 | Summer 2012

It has long been known that oral administration*A formula particularly for warming the intestinalof Goreisan is markedly effective during the earlytract and improving blood flow to increase

phase of acute viral gastroenteritis presenting

peristalsis: daikenchuto.

mainly as vomiting. Yet, in recent years the use of(4) For abdominal pain

dissolved*Formula

extract

preparationsasenemasorforwarming

the

body

and

suppositories has also been reported. Regarding

simultaneously relieving smooth muscle tone:

these application forms Yoshida12) and others haveshokenchuto, keishikashakuyakuto

published many reports, each of which indicates, aUsed for example for recurrent umbilical colics,

quick inhibition of the vomiting and improvement of

irritable bowel syndrome.

the general condition had been achieved.
Like in adults too daikenchuto is effective forchronic constipation13).

Although it is not acathartic, it promotes peristalsis by improving blood2) Treatment of digestive organs and not directly
related symptoms and diseases using the "Kampo
medical concept of digestive function"
Maintaining the function of the body depends

flow in the intestinal tract14).

Shokenchuto warms the body and relaxes smoothaccording to Kampo medical concepts on respiratory

muscle tone and therefore is used to treat recurrent

function (lung), digestive function (spleen andumbilical colics, while rikkunshito is used forstomach) and the genetic life force (kidney). In

gastroesophageal reflux and thus has been variously

developing children the digestive function is viewed

studied in the field of pediatrics15-16).

as particularly important among these. In this casedigestive function refers not simply to the functions(1) For Vomitingof the digestive organs in the Western medical sense,*Vomiting in the early phase of acute gastroenteritis:

but is presumed to mean the energy production

Goreisansystem related to food ingestion in general. In*Gastroesophageal reflux (GER): rikkunshito

Kampo medicine impairment of digestive functions

Slightly increasing peristalsis of the stomach

for any reasons is thought to easily cause secondary

results in an alleviation of the vomiting.

generalized dysfunction or else functional disorders(2) For diarrhea

of various parts of the body. Thus, therapy has the*In case of prolonged diarrhea following acutemeaning of rectifying the digestive functions as

gastroenteritis: ninjinto, shinbuto

causative

By warming the abdominal cavity the decreased

improvement of symptoms / diseases not directly

functioning improves and shinbuto simultaneously

related to the digestive organs. This is a typicalimproves also the water metabolism.

Kampo concept and can be simplified in everyday*Prescription for diarrhea in the absence of any

language as 'harmonizing the gastrointestinal tractorganic causes: keihito→ recovering health → possibility that diseases may

This formula is similar to the above mentioned but

improve'.

even milder.

shokenchuto,(3) For constipation

Preparations improving this kind of decreased body

*The

below

mentioned

keishikashakuyakuto

decreases smooth muscle tone, or used with added
rhubarb having laxative action in the formula:keishikashakuyakudaioto

factorsinorder

Representative

rikkunshito

to

bring

about

preparations
and

are

hochuekkito.

functions are called "Qi supplementing formula" andrepresent a characteristic of Kampo treatment.

Shokenchuto is the most frequently used formulaand the preparation of first choice from infants tochildren in the first grades of elementary school,

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Volume 7, Number 2 | Summer 2012

where it is directed at generalized symptoms likeabdominal distension and similar symptoms ofcold sensitivity and lack of vitality as secondary

stagnant peristalsis are observed, or in case of

manifestations

lassitude.

little,recurrent

andsimilar(Many Kampo medicines used for other purposes

gastrointestinal symptoms. Rikkunshito improves

than improving digestive function too obviously or

the general conditions like lack of appetite,casually include crude drugs acting on decreased

abdominal distension as well as systemic symptoms

digestive functions and therefore are often used forlike bowel mobility disorders or lassitude, whilesecondary treatment regimens. I believe thishochuekkito is indicated in cases of easy fatiguability,

confirms, that the importance of the digestive

heaviness of arms and legs etc. as well as marked

function had been recognized since ancient times.)

abdominal

of

pain,

eatingtoo

softstoolsgeneralized malaise. These two preparations areoften used for comparatively older children, like

4. Kampo medicines with sedative actions

higher grade elementary school students. Moreover,Some Kampo medicines have an affinity for theby "improving the digestive functions" they could

respiratory tract and some formulas have been usedpossibly provide an effective supplementary therapy

for the treatment of respiratory disorders. Naturally,in cases, where the patients present with diseases

in cases of respiratory failure or similar severe

other than those of the digestive organs, like fordiseases various modern Western medical therapies

example allergic diseases, infections and similar

are far more effective, but some Kampo medicinesconditions marked by derangement of immune

have unique antitussive properties and can be usedfunctions. Within the scope of the author's research

as antitussives in children.
In pediatrics the first preparations that come tono substantial amounts of results could be foundmakyokansekito

mind

but there is a close correlation with the alreadybakumondoto. In conjunction with their antitussive

earlier mentioned concept of treating perianal

activity these preparations have different actions on

abscesses with juzendaihoto and atopic dermatitis

the respiratory tract. Shoseiryuto inhibits airway

with hochuekkit17) and the like.

secretions while also having a warming effect.

*Shokenchuto: Warms the body and relievesareshoseiryuto,

regarding this kind of Kampo medical application,andMakyokansekito too inhibits airway secretions, but

excessive tension of the intestinal tract. In cases ofisgeneralized symptoms like sensitivity to cold andinflammatory actions. Conversely, bakumondotolack of vitality as secondary manifestations of eatingpromotes

too little, recurrent abdominal pain, soft stools andmoistening effect.

consideredtoairwayhave

moresecretions

markedandthusantihasasimilar gastrointestinal symptoms. It is the formula

Accordingly, in patients presenting with copiousof first choice from infants to children in the lower

thin white sputum, for example asthmatic bronchitis,

grades of elementary school.

shoseiryuto is used, but in patients with infective*Hochuekkito: Slightly warms the body andinflammation,

presenting

mainlyas

copiousimproves a generalized hypotonic state. Used foramounts of yellow sputum like for example in acutepatients who fatigue easily, wish to lie down andbronchitis

complain of generalized malaise including heavinessconsidered, while in slightly dry conditions withof arms and legs.

little sputum but continuing cough bakumondoto is*Rikkunshito: Slightly warms the body andimproves in particular a hypotonic intestinal tractorpneumonia,

isused as a rule. Bakumondoto reportedly has thesame antitussive effect as dextromethorphan18).

and the water metabolism. If lack of appetite,8

makyokansekito

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

Volume 7, Number 2 | Summer 2012

A trial is considered worthwhile, when the effectsof the general antitussive drugs seems to be
insufficient.

saibokuto

Moreover,

is

used

for

supplementing functions
In Kampo medicine there are formulas to aid thegrowth and development of children. The world's

psychogenic cough.
*Makyokansekito:

5. Kampo medicines with growth and development

strongoldest pediatric textbook published during the Sung

expectorant effect, in cases of copious yellow

dynasty: "Xiao er yao zheng zhi jue" (around 1107)

sputum.

lists rokumigan as a representative formula, that

*Shosaikoto:Anti-inflammatory,anseems to have been used for inherently weak

expectorant, it is used for copious amounts of thin,children. Although it is naturally not possible towhite sputum, and frequently also for allergicchange the congenital disposition, there can possibly

rhinitis (in cases of large amounts of airway

be conditions associated with decreased activity, or

secretions the combination of makyokansekito andwhere greater maturity can be expected to lead to a

shosaikoto enhances the antitussive effect).
*Bakumondoto: Is suited for chronic, dry (no –remission of symptoms. Also, combined use oflittle sputum) cough, since it moistens the airway

functions like hochuekkito and the like make theand has relatively strong antitussive effects.

treatment even more effective.

*Saibokuto:

Since

it

acts

mainlyas

Kampo medicines with actions improving digestive

Combined formulation composed of* Rokumigan: In cases were delayed growth /shosaikoto and hangekobokuto. In the past is wasdevelopment or decreased activity is observed, or

frequently used during the intermissions in cases ofelse in cases of decreased activity due to chronic

pediatric bronchial asthma19). It is also effective fordisease etc.

psychogenic cough and tic-like cough.
Chronic

paranasal

sinusitisisinroutinepediatric care often related to cough, but equallyoften no effective Western medical pharmaceuticaltherapies can be found. In these cases Kampo
medicines can provide a useful therapeutic means.

Kakkontokasenkyoshini and shiniseihaito can belisted as therapeutic agents for the treatment ofchronic

paranasal

sinusitis.

Theoretically,shiniseihaito is used for conditions with moremarked inflammation and has reportedly been
useful in cases where low-dose macrolide therapy
had been ineffective20).
When nasal obstruction is prominent in cases ofparanasal sinusitis

6. Kampo medicines with actions regulating water
metabolism
Water comprises approximately 60% of thehuman body. Regulating functions related to any
insufficiencies, excesses or imbalances are very
important for the body. Sudden loss of water
resulting in dehydration, renal or cardiac failure
may be associated with severe edema and acuteencephalopathy can cause cerebral edema etc.
Needless to say, these conditions represent an
important therapeutic topic in modern medicine.
However, even not so severe conditions resulting in
only minimal insufficiencies, excesses or uneven
distributions are known to cause systemic or local

warming,

symptoms. In pediatric primary care diseases*Shiniseihaito: Moistens and cools, helps discharge

distributions may cause headache, vertigo, lethargy,*Kakkontokasenkyoshini:

Slightly

improving blood flow.
viscous nasal secretions (viscous nasal discharge,
sputum; yellow).

associated with even minimal excesses or unevenmalaise, nausea, loss of appetite and similar
symptoms are treated. The actions are not simply
restricted to promotion of miction, but are considered
to concentrate more on a balancing of the water
distribution.

In

Kampo

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

medicine

the

water
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Volume 7, Number 2 | Summer 2012

distribution has since ancient times been regarded

cystitis.

as important and several corresponding Kampo

components

medicines have been formulated. Also, even if water
regulation is not the primary target of the usedsaireito22), but has not been reported in relation totreatment with shosaikoto alone. Many extract

formulas, many of them contain water regulating

preparations use lactose, so that they should not be

crude drugs.

used in cases of lactose intolerance23).

Presumably
of

the

this

is

an

influenceofshosaikoto portion within

There is noRepresentative preparations used in pediatrics

sizable amount of reports from the field of pediatrics

goreisan,choreito,ryokeijutsukanto,
hangebyakujutsutenmato etc.
*Goreisan: The most frequently used formula, fordealing with allergies to crude drugs. In any case,areKampo medicines are generally considered to havefew side effects22,23).

nausea during the early phase of gastroenteritis,
Table 3

headache related to atmospheric pressure etc.
*Choreito: Simultaneously with promoting water
excretion it cools the body or for inflammations of thelower urinary tract like cystitis; in combination withorengedokuto it is used for atopic dermatitis
associated with much exudate.
*Chokeijutsukanto: In cases of marked malaise,difficulties getting up in the morning and orthostatic
regulation disorders etc.
*Hangebyakujutsutenmato:Fororthostatic

regulation disorders21) characterized by vertigo, lossof appetite etc.

Care is required when combining 2-3 formulas,
because many Kampo medicines contain licorice andtherefore could cause pseudohyperaldosteronism.
their

use

in

patients

withhyperaldosteronism, myopathies or hypokalemia iscontraindicated.
The main component of ephedra herb is ephedrine
thus

tachycardia

could
or

possibly

similarcause

symptoms

palpitation,
when

used

together with sympathomimetic drugs. Also, a mildstate of excitation may cause in some patients
insomnia and occasionally digestive symptoms likeloss of appetite may also develop.

Shosaikoto is known to cause in adults interstitial
pneumonia, but this reaction has almost not beenreported in children. The most frequently reported
adverse reaction in children is saireito induced
10

12 years
2/3

7 years
6 months
1/2

3 years

1 year6 months

1/3

1/4

1/5

2. Could mistaking the indication be a factor possibly
aggravating diseases?
Strictly speaking this does not refer to adverse
reactions, but in case the indication has been
mistaken, the possibility of an aggravation of the
distinction would be between heat and cold

1. Main side effects caused by the drug components

and

Age conversion (when defining adult as 1)

symptoms cannot be ruled out. An elementary

Adverse reactions of Kampo medicines

Naturally,

Children's doses according von Harnack

properties. Among Kampo medicines some warmand some cool the body, so that prolonged use ofstrongly cooling agents in patients sensitive to cold,or conversely agents warming the body in patients
sensitive to heat could possibly result in adverse
reactions and should therefore be kept in mind.
Application outside the recommended children's
dose and indication
Since Kampo medicines are covered by the
insurance 30 years have passed, but explanatory
booklets about generally used Kampo medicines still
include the remark, that "safety for children has notbeen established" (there is no experience). Thus
Kampo

medicines

have

like

many

Western

medications necessary for children many pediatricpharmaceutical off-label problems. Currently, nosolution seems to be in sight yet.

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

Volume 7, Number 2 | Summer 2012

For the same reasons given above the children's(1) Adjusting the way the medicine is taken

doses for Kampo extract preparations too are still* Crush it and administer it as a liquid dissolved in

not listed in those explanatory booklets. Generally,warm water.

they are calculated according to the von Harnack* For infants prepare a paste with warm water andmethod based on body surface (Table 3), or by

apply this with your finger to the upper jar.

conversion of body weight, but occasionally the dose

* After the late phase of infancy have the child takehas to be increased depending on the pathologic

some cold water in the mouth, add the extract

condition, so that those values cannot be much more

preparation and have it swallow it all at once.

than rough estimates.

* Wrap it in a wafer.

Moreover, it should be noted, that the daily dose(2) Mix with something that is easy to swallow

of extract formulas may vary depending on the* Yoghurt, milk, malt extract, juice, ice cream etc.

manufacturer and the type of Kampo medicine.

3) Change the path of administration

Basically the drugs are administered in 3 fractions

Regardingtheapplication

withrectalof

Goreisandaily, but it is also possible to use 2 fractions.

experiences

application

have

Principally, they are taken before meals, but there isaccumulated (enemas, suppositories), but the above

not much differences, when they are taken after

mentioned problems with off-label application are ameals24).

reality.

Instructions for taking Kampo medicines

Conclusions

Since many Kampo medicines have unique tastes

In this article I tried to describe the application ofand smells, they are in particular during early

Kampo extract preparations as the basics ofinfancywhypediatric Kampo as simple as possible, while at theingenious

same time trying to maintain the essential concepts

contrivances. Here I would like to briefly addressof Kampo. This remains, however, very elementary

some administration methods and refer the reader

and deepening one's understanding of other Kampo

for further details to other references25,26).

medicines, and further studies are required to1) Increasing the motivation of children and family

ascertain whether these can be combined with otherto take the drugs

extract preparations or decoctions and thereby

difficulttreatmenttoadminister. That

sometimes

requiresisFirst, I start by explaining to both the child(ren)and their guardians "what kind of Kampo medicines

therapeutic effects possibly be further improved totreat still more complex diseases.

there are and what they are for" to help them

Kampo does not stand in opposition to Westernunderstand the matter. In the late phase of infancy

medicine. By fully exploiting the characteristics of

the

Kampo

childrentoo

arealreadycapableofmedicines

withinmedicine,theframework

complementingofcomprehending the outline of the involved concepts

integrated

Western

and after providing gentle explanations the children

medicines, I believe we can broaden its application

can often be unexpectedly compliant. Fundamentally,in pediatrics.

I am creating a motivation for taking the medicine.
2) Concrete application methods
Due to individual differences whether a patient
can or cannot take the medicine at hand, theadministration too has to be adjusted on a case by

References
11) Koichiro Kawashima: Investigation about theusefulness of Kampo for pervasive developmental
disorder; Journal of The Japan Society for Oriental
Medicine 2007; 58: 175 (Abstracts)case basis. Generally the following methods are tried.
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

11

Volume 7, Number 2 | Summer 201212) Masaki Yoshida: Regarding the usefulness of24) Shinichi Tashiro: Correlation between the timing ofgoreisan suppositories for the treatment oftaking Kampo medicines and meals, Pharmacy
2001; 52: 1138-1144
25) Shigeyuki Hirose: Kampo treatment manual for
pediatric diseases, Tokyo: Modern Publishing
Planning, 2006
26) Ranko Mori: Ideas related to the compliance, The
Japanese Society of Pediatric Surgeons 2011: 43: 828-831

vomiting during infancy, Information from theMedical and Pharmaceutical Society for WAKANYAKU; 1990; 7: 506-507
13) Toshiki Otani et al.: Effects of daikenchuto forpediatric constipational diseases, The JapaneseSociety of Pediatric Surgeons 2005; 37: 300-304
14) Toru Kawano: Searching for evidence for daikenchuto,
Familiar Kampo treatment of pediatric diseases, 7,Tokyo Medical View 2007: 36-43
15) Minoru Yagi et al.: GER and Kampo ―Investigations using EGG, The Japanese Society ofPediatric Surgeons 2005; 37: 284-290
16) Hiroaki Kuroda et al.: GER and Kampo ―Investigations using RI, The Japanese Society ofPediatric Surgeons 2005; 37: 279-283
17) Yumi
Kobayashi:
Clinicalevaluationofhochuekkito for the treatment of atopic dermatitis,
Journal of The Japanese Pharmacological Society
2008; 132: 285-287
18) Yoshiharu Nonaka et al.: Experiences with theuse of bakumondoto for persistent pediatric cough,Journal of the Japan Pediatric Oriental Medical
Society 2004; 20: 15-21
19) Setsuko Ito et al.: Effects of saibokuto in thetreatment of pediatric broncial asthma, Basics andClinic 1992; 26: 39933-998
20) Mikikazu Yamagiwa: Kampo treatment for chronic
infections in the field of otorhinolaryngology,
Journal of the Japan Pediatric Oriental Medical
Society 2006; 21: 31-35
21) Tadayoshi Abe et al.: Experiences with use ofhangebyakujutusutenmato for the treatment oforthostatic dysregulation, The Japanese Society ofPediatric Surgeons 1984; 17: 93-104
22) Yoko Kimura et al.: Side effects and druginteractions of shosaikoto, Kampo and Latest
Therapy 2002; 11: 341-346
23) Hidekazu Haruki: Latest pharmacotherapy andcountermeasures against adverse reactions(Kampo medicines, crude drugs); Pediatrics 2008;
47: 829-835

12The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)