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 themedicine of Dongui bogam (The Precious Mirror ofOriental 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 identifypathogenicpattern)”

intheModern

ChineseMedicine. 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 theBenshou-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 getup 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, itand 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 werewere 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 inthe patient. Thus, it was concluded that deficient wasblood-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 wasimproved 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

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

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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 theDuring 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 affectiondiscomfort 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 wasshe 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 fromCourse
After 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 tothe 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 theexcluded 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 diseaseand anxieties, whereas Case 2 had excess syndrome

developments should be followed to judge the nature andcaused by qi depression and liver fire provoked by themomentum (dynamics) of disease and to establish anfeeling 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)

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