KAIM
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Thhee JJoouurrnnaall ooffK
Kaammppoo,, A
Accuuppuunnccttuurree aanndd IInntteeggrraattiivvee M
Meeddiicciinnee
INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 4, Number 2 ･ Summer 2009

Editorial

Best Part of Formulating Kampo Medicine
Hiromichi Yasui

Japanese Acupuncture - Current Research

Effect of Acupuncture & Moxibustion Treatment to Turn Breech Body
Shuichi Katai

Kampo Medicine - Current Research

Kampo Treatment for Psychosomatic Disorder – 1. Functional Dyspepsia
Shinji Nishida

Clinical Report 1 (Japan)

Peripheral Arterial Desease (PAD) and Acupuncture and Moxibustion
Fumiko Yasuno and Tomomi Sakai
Introduction of Tokyo Ariake University of Medical and Health Sciences (TAU)

Clinical Report 2 (Japan)
Functional Dyspepsia – Case 1
Shinji Nishida

Clinical Report 3 (Japan)
Functional Dyspepsia – Case 2
Shinji Nishida

Clinical Report 4 (Japan)
Athma Bronchitis
Yang Cholsong

Clinical Report 5 (Japan)

One Case having Effects of Senkyuchachosan on Headache
Mitsuyuki Takamura and Hiromichi Yasui

Kampo Dermatology – Clinical Studies

Treatment of Atopic Dermatitis with Kampo – Puberty and Adulthood (6)Fumino Ninomiya

Medical History in Japan

Sotetsu Ishizaka’s “Shinkyu Chiyo Ichigen” (2)Kenji Kobayachi

Book Review“Acupuncture Core Therapy – Shakuju Chiryo “Written by Shoji Kobayashi and Translated by Dan Kenner
Reviewed by Robert B. Gracey

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
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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.

ASSOCIATE EDITORS
Shuichi Katai
Ibaraki-ken, Japan

Hiromichi Yasui
Tokyo, JapanEDITORIAL 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

PUBLISHER

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

Volume 4, Number 2 ･ Summer 2009

TA B L E O F C O N T E N T S
1 Editorial
Best Part of Formulating Kampo Medicine

Hiromichi Yasui

2 Japanese Acupuncture - Current Research
Effect of Acupuncture & Moxibustion Treatment to Turn Breech Body

Shuichi Katai

7 Kampo Medicine - Current Research
Kampo Treatment for Psychosomatic Disorders – 1. Functional Dyspepsia

Shinji Nishida

10 Clinical Report 1 (Japan)
Peripheral Arterial Disease (PAD) and Acupuncture and Moxibustion
Fumiko Yasuno and Tomomi Sakai

Introduction of Tokyo Ariake University of Medical and Health Sciences (TAU)
20 Clinical Report 2 (Japan)
Functional Dyspepsia – Case 1

Shinji Nishida

21 Clinical Report 3 (Japan)
Functional Dyspepsia – Case 2

Shinji Nishida

22 Clinical Report 4 (Japan)
Athma/Bronchitis

Yang Cholsong

23 Clinical Report 5 (Japan)
One Case having Effects of Senkyuchachosan on Headache
Mitsuyuki Takamura and Hiromichi Yasui

25 Kampo Dermatology – Clinical Studies
Treatment of Atopic Dermatitis with Kampo – Puberty and Adulthood (6)Fumino Ninomiya

28 Medical History in Japan
Sotetsu Ishizaka’s “Shinkyu Chiyo Ichigen” (2)Kenji Kobayashi

32 Book Review“Acupuncture Core Therapy – Shakuju Chiryo” Written by Shoji Kobayashi and Translated by
Dan Kenner
Reviewed by Robert B. Gracey

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 4, Number 2 | Summer 2009

Editorial
Best Part of Formulating Kampo Medicine
Japanese Kampo medicine, which is based on “Shang Han Lun” and “Jinkui Yaolue,” has been
producing good results in the treatment of chronic disorders like osteoarthritis of the knee as well as acutediseases like influenza by adding its own inventions and innovations to the formulations described inthese classical writings.
Crude drugs constituting the formulations for these diseases are varied and abounding while about
200 kinds are kept available at each pharmacy specialized in prescriptions of Kampo medicine. Medicinal
substances for everyday use are limited to 50 to 60 kinds. Of them, cassia twig, peony, licorice root,
Chinese date, ginger, bupleurum root, and ephedra perform critical roles and are essential in thepharmacy’s drug cabinet.
Ephedra is the main ingredient of maoto, the first-line choice for influenza and it is also contained in
kakkonto generally used for common cold. Ephedra takes a key role in the two formulations ofkeishishakuyakuchimoto used for chronic rheumatoid arthritis and eppikajutsuto used for osteoarthritis of theknee. Unless shoseiryuto and maobushisaishinto were available, how could allergic rhinitis be cured? Unlessmakyokansekito was available for the treatment of the early stage bronchitis and bronchial asthma, how
could these diseases be handled?
There are many crude drugs that contain alkaloid that has strong actions such as ephedra. For
example, many pathological conditions can only be cured with aconite that is composed mostly ofaconitine. On the other hand, prescriptions made by combining crude drugs of relatively weak actions canprovide remarkable benefits. For example, licorice, wheat, and Chinese date are the main components ofkambakutaisoto that has sedative effects and they are edibles and flavors in our everyday living.
In this way, Kampo prescriptions are formulated under given rules by combining various
substances that have strong actions and/or those ordinarily contained in foods in consideration of theirindividual medicinal effects. To cure diseases using such prescriptions is one of the best parts of Kampo
medicine.
For this, minimum required drugs need to be lined up. Unlike in China, more than 600 kinds of
drugs are not necessary in Japan since prescriptions from “Shan Han Lun” and “Jinkui Yaolue” aremainly applied. At most 200 kinds are sufficient, with which different prescriptions are formulated forvarious diseases.
Tokaku Wada (1742-1803) who was a good doctor in Japan of nearly 200 years ago said as follows:”the medical technique of a doctor who uses a plenty of prescriptions becomes shoddy whereas the one ofa doctor who uses chosen few prescriptions becomes precise.”Japanese Kampo doctors and practitioners like his words more than a little.

Hiromichi Yasui
Japan Institute of TCM Research

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Volume 4, Number 2 | Summer 2009

Japanese Acupuncture - Current Research
Effect of Acupuncture & Moxibustion Treatment
to Turn Breech Baby

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

Department of Acupuncture and Moxibustion
Tshukuba University of Technology, Ibaraki, Japanrisks. Yoshida says “do not forget the attitude
thatvaginaldeliveries

must

be

performed

carefully”6).
In Japan, acupuncture and moxibustion areavailable for the treatment of breech babies.
Ob/gyn Nobuyasu Ishino, who had studied

1. Introduction

Oriental medicine, reported 7) in 1950 that

Breech babies (breech presentations) as wellmoxibustion to the acupuncture point of san yin

as the mothers often have risky conditions

jiao (SP6), generally contraindicated in pregnancy

including a longer time of delivery than in babies

since ancient times, was effective. In 1980s,

born head first and the departments of obstetrics

Kazuo Hayashida reported that the method ofand gynecology need cautious handling.

moxibustion that was usually administered for

For

the

treatment

breechdelivery difficulties had great effecs 8) in thepresentations, there are exercise of the so-called

treatment of a breech presentation, in whichbreechknee-chest

moxibustion was given to the meridian point of

positioning (kcp). However, no RCT reports havezhi yin (BL67) and the “kyutoshin”, warm

been published on the breech pregnancy exercise

needling with moxibustion was also given to theand its effectiveness is not clear 1) 2). And themeridian point of san yin jiao (SP6). Since then,

exercise imposes a heavy physical burden on thethe treatment with acupuncture and moxibustion

mother. On the other hand, although the kcp isfor a breech presentation has become popular inconsidered effective on the ground of certain RCTJapan. Now in other countries, this method is also

results 3), it cannot necessarily be recommended

adopted and RCTs are also being conducted 9),strongly because there may be the risk of10), 11).

pregnancy

to

turn

exerciseandtheaccompanying complications, such as placenta

And so, we searched for postwar literatures on

abruption, compression of the umbilical cord,

the treatment of the breech presentation withplacental

andacupuncture and moxibustion and went throughfeto-maternal transfusion syndrome. Moreover, asthem to study the effect of the treatment. And

the kcp is not a sure method 4), there are quite athen, we further analyzed literatures published,

number of medical professionals who do not

up until 2004, as “EBM in Japan in the treatment

employ this method, thinking of its probable risksof breech presentations with acupuncture andarising from it. To turn breech presentations,moxibustion.”

there are no medicines available that have direct“acupuncture and moxibustion treatment ofeffects.

breech presentations” with illustrations andRecently

hematoma

manyofformation,

theobstetricians

Then we reported the results inandphotos for learning purposes 12). Hereunder isgynecologists in Japan prefer performing an

the results with an addition of literatures after

elective cesarean section in the cases of a single

2004.

breech presentation, partly in response to the2004 report of the Committee of American College

2. Methodof Obstetricians and Gynecologists (ACCG). Even

Literatures reported after the war on breechso, cesarean sections do not always go without

presentation treatment with acupuncture and

2

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

Volume 4, Number 2 | Summer 2009

moxibustion were searched for through the

Of them twelve literatures showed a turn ratio ofjournal of “Ichushi” and on the “websites of

72.2% or above.

Ichushi”.

(3) Treatment method

Searched

were

original

paperspublished during a period of 2004 to July 2011.

In regard to the method of treatment, 15Then individual items in the searched papers

literatures showed the use of moxibustion, andwere analyzed, such as age, primiparity or para,eight literatures reported the use of acupuncture.

the number of weeks of pregnancy when the

Acupuncture alone was reported in one whereas

initial visit was made, the number of weeks whenthea breech baby turned around, turn ratio, use ofmoxibustion was reported in seven literatures.

meridian points, use of tools, method of treatment,

The use of “Kyuto-shin” was reported in fiveother method of treatment, complications, andliteratures.

combination

use

of

acupuncture

with

In reference to the meridian points foradverse events.

moxibustion that were shown in 15 literatures,
3. Results

zhi yin (BL67) was used in 14 literatures, san yin(1) Entirety of published literatures

jiao (SP6) in 9 literatures, and both points in 8

During a period of 61 years after the war fromliteratures. For other points, yongquan (KI1) was1945 to July 2011, 16 literatures were reported inselected in one literature and taichong (KI4) inJapan on case-series studies of correcting the

one literature. With an eye on the kinds ofbreechandmoxibustion for each point that are shown in 14

moxibustion. Of these 16 literatures, eight wereliteratures, direct moxibustion in 6 literatures,

published during six years from 1990 to 1995.

roll moxa in 2, indirect moxibustion in 5, andpresentation

withacupuncture

The total number of the cases reported was

mxibustion plasters in 1 were applied to zhi yin

2,150, including 969 cases in total in the seven(BL67), whereas direct moxibustion in 3, indirectliteratures reporting the number of primiparous

moxibustion in 5, and moxibustion plasters in 1

women and the number of parous women. The

were administered to san yin jiao (SP6). No

ratio of primiparous women (581) against parous

differences existed in the turn ratio depending on

women (388) was 1.5:1. In the 16 literatures,the points due to differences in the kind of

there was no reference to the method ofmoxibustion, except for direct moxibustion in one

randomization. However, there was one literatureliterature.

that made a comparison between the two groups –Relating

to

the

eight

literaturesforthe group (34 cases) of knee-chest positioning andacupuncture points for acupuncture treatment,

the group (34 cases) of knee-chest positioning

San yin jiao (SP6) was selected in all the

combined with moxibustion to zhi yin (BL67).

literatures, except for one that had no clear

Others are of retrospective case series.

mention. Zhi yin (BL67) was selected only in two(2) Turn around ratio

literatures. The use of filiform needles was

In terms of turn ratio, 1,712 (79.6%) cases of
the total 2,150 that were reported in the 16

reported in six, while intradermal needles wereused in one.

cephalic

The diameters of the needles and needlingpresentations with a turn ratio of 11.70% to 91.7%.

depths were reported in one literature. The effectliteratures

turnedaroundtoof the treatment only with acupuncture had no
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Volume 4, Number 2 | Summer 2009

difference from that of acupuncture only or the

4. Discussion

combination treatment of acupuncture with

It was considered all over the world up until

moxibustion of 12 literatures (other than Arai’s

1750s that the fetus was in a breech presentation

literature).

position to the brink of delivery and turns into a(4) Treatment frequency

cepharic presentation before labor starts. In these

The treatment frequency for both acupuncturedays, literatures were published for the first timeand moxibustion was 7 times a week in 7 cases,

reporting that the cepharic presentation wasand 1 (daily) to 3 times a week in 8 cases.

normal after five months of pregnancy 13),14).

At-home moxibustion was conducted in seven

For the reason, until these days, moxibustion hadcases with details of direct moxibustion in 2 cases,

been administered to zhi yin (BL67) at the time ofindirect moxibustion in 4, and moxibustiondifficult labor (delivery).
As mentioned in “Introduction” above, for theplasters in 1.
(5) Excluded

disordersandfactors

causing

non-occurrence of the cepharic presentation.

first time in the world, Ishino 6) performed
moxibustion treatment to expectant mothers in

The diseases excluded from the application ofpregnancy, not at the time of delivery, for theacupuncture and moxibustion were multiple

purpose of turning around the fetuses in a breech

pregnancy (3 cases), severe pregnancy (2 cases),presentation. He reported 80% of the turn ratio.

placenta previa (2 cases), fetal anomaly (2 cases),

Subsequently, in 1988 Hayashida 7) reported

hematologicaluterine

89.9% of the turn ratio in the treatment of 584

deformity (1 case), fibromyoma (1 case), andcases with acupuncture and moxibustion. And inhistory of uterine surgery (1 case). As the factors

1990s literatures relating to the turn ratio withnon attributable to the turn to the head down

acupuncture and moxibustion burgeoned.

disorders(2cases),

position, uterus bicornis, small amounts of

Of the 16 Japanese literatures, only one

amniotic fluid (oligoamnion), uterine myoma, andliterature was about a comparative study withloop of the umbilical cord were pointed.

the control group and most literatures were

(6) Adverse events

reports on case series studies. On the other hand,

Out of the 16 literatures, 10 literatures

there were three 9)-11) overseas RCT literatures,

reported no adverse events. No clear mentions

one of which was a Cardini’s RCT, which has been

were made in two literatures. One literature

criticized for the reason of insufficiency in thereported four cases of nausea. There were blisters

blind trial and placebo 15). However, it is difficultand pigmentation in one literature, and blisters

to conduct blind trials in acupuncture andand reddening in one literature. And in one

moxibustion treatment. Although there wereliterature, there were no adverse events althoughsome trails using placebo needles, perfect tests

the symptoms were claimed during the treatment

like using drugs have not been realized so far, so

period, such as the body becoming heavy andit may be unreasonable to make a valuation only

languid, feeling a fear as the abdomen felt heavily

from this point. Moreover, Cardini conducted

distended, worried as the baby (fetus) moved verysame trial in Italy as the first one he did withactively,unfavorable results. Together with this issue,

metrorrhagia(uterine

bleeding)

appearing, and tendency of threatened premature

conducting

delivery.

moxibustion treatment will be future tasks.

4

RCTs

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

foracupunctureandVolume 4, Number 2 | Summer 2009

The turn ratio in 16 literatures ranged widely

number of stimulation applications and thefrom 11.7% to 91.7%. Out of the 16, 12 literatures

amounts of stimuli, or “stimulation frequency”

showed 72.2% or above, which is not low whenneeds to be studied. This has shed light on one ofcompared with the turn ratio 3) of the external

the subjects to be discussed to ensure successful

cephalic version. As the number of weeks fromacupuncture

the start of treatment differs widely in thesebreech presentations.
Bicornate

literatures from 20 weeks to 37 weeks and manyandmoxibustion

uterusandtreatment

deformity,ofuterinecases of short terms (weeks) were included, amyoma, and loop of the umbilical cord have beenclose look at the 10 literatures having the clear

pointedmention of 32 weeks to 35 weeks revealed 11.7%

considered to exert a negative influence on theto 87.5% of the turn ratio after spontaneousturn ratio, and these are materials for security

turning around was taken into account. And eightand effectiveness studies.

out

as

organic

diseases

that

are

As to side effects, one literature reported

literatures had the turn ratio of 61.4% or above.
In regard to the method of treatment, one

complaints of nausea in four cases and twoliterature showed the use of acupuncture only

literatures reported blisters and pigmentation.

and all other 15 literatures indicated the use of

One literature showed uterine bleeding duringmoxibustion and the selection of zhi yin (BL67) –the treatment period, threatening premature

this may be an application of zhi yin (BL67)

delivery although there were no serious adverse

moxibustion usually performed for difficult labor

events. Except for two literatures that had nosince old days.

descriptions of side effects, 14 literatures reported

By the way, Arai 16) reported the turn ratio of

no serious adverse events. From this, it may be

11.7%, extremely low compared with othersaid that the methods of breech presentation

literatures. There were five literatures, including

treatment with acupuncture and moxibustion

Arai’s, that reported 1-3 times of treatment at

performed so far in Japan are safe.

hospitals,

insteadofeverydayat-homemoxibustion. Of these, two cases used Kampo

5. Conclusion

medicines together with antispasmodic agents for

Sixteen literatures on the breech presentation

uterus and the other one case had intradermal

published after the war were analyzed the results

needles inserted after moxibustion and left them

are reported in this article.

in place for 3-4 days. On the contrary, Arai 16) set
the frequency to “once in a week, or three times a

6. References

week at most.” From what I gather, the quantities

1) TAKEDA Yoshihara, NAKAMURA Masao:of stimuli and the dosage amounts, in other words

Ninshin-chu

the total treatment volume given to patients are

Kyosei-hou, Journal of Sanka to Fujinka

smaller compared to the 15 literatures. On this(Obstetrics andpoint, Arai 16) also states in the part of436-43.

Discussion in his literature that this will be a
problem,moxibustion“increasing
may

have

the
the

2)

no

Kanri

to

Kotsuban-Gynecology) 2005; 72 (4):MARUMO Genzo, et al.: Kotsubani ni taisuru

frequencyof

Shitukyoui Shidou no Yuyousei, Obstetricalpossibilityofand Gynecological Therapy, vol.100 no.1

increasing the correction ratio,” and that the2010 / 1:99-103

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

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Volume 4, Number 2 | Summer 20093)

4)

Hofmeyr GJ, Kulier R; External cephalic

Breech Version- A Descriptive Review ，version for breech presentationat term. The

ACUPUNCTURE IN MEDICINE 2002; 20(1):Cochrane Library, Issue 2, 2003, Oxford.

26-29

Hotton EK, Hofmeyr GJ, External cephalicversionforbreechterm(Cochranepresentation

Review),

Issue

2,

beforeEffective for Correction of Breech Preseatation?

2006

Acta

Chichester, UK
5)

ACOG

16) Tadashi Arai et al.: Is Acupuncture / moxibustion

Obst

pp1217-1220, 2001

committee,

ObstetGynecol.2001;

98(6): 1189-90
6)

YOSHIDA Koyo: Sanka Shikkan no Shindan,
Chiryou Kanri Kotsubani Bunben, Perinatal
Medicine, 2004; 34(7):1085-8.

7)

ISHINO Nobuyasu: Ijyou-taii ni taisuru
Saninkou Sekyu no Eikyou. Journal of The
Japan

Societyfor

Oriental

Medicine

1(3),7,1952.
8)

HAYASHIDA Kazuo: Toyo Igaku to Kotsuban
Kyousei, Toho Igaku, 1987;34(2)：196-206．

9)

Francesco Cardini, et al. Moxibustion for
CorrectionofBreechPresentation

Randomized Controlled Trial, JAMA 1998;
280: 1580-5.
10) I.Neri, et al., Acupuncture plus moxibustion

to resolve breech presentation: a randomized
controlled

study.

ROMA:

CIC

EdizioniInternazionali, 2003; 58-61
11) Francesco Cardini, A randomized controlled

trial of moxibustion for breech presentation,
BJOG: an International Journal of Obstetics
and Gynaecology. 2005; (112): 783-7
12) KOIDO Yoshihiko, KATAI Shuichi: Kotsubani

ni taisuru Shinkyu-chiryou no Nihon ni okeru
EBM, Irasuto to Shashin de Manabu Sakago
no Shinkyu Chiryou, written and edited by
KATAI Shuichi, Ishiyaku Publishers,Inc 2009
Tokyo: 28-36
13) KAGAWA Genetsu(1700-1777), “Shigenshi

San-ron”(“San-ron”)（1765）
14) KAGAWA Genteki (1739-1779), “ Sanron-yoku” (1775)
15) Ayman Ewies, Karl Olah 、 Moxibustion in
6

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

Jpn

Vol.53,No.8,

Volume 4, Number 2 | Summer 2009

Kampo Medicine - Current Research
Kampo Treatment for Psychosomatic Disorders –1. Functional Dyspepsia (FD)Shinji Nishida

Department of Psychosomatic Medicine,Japanese Red Cross Wakayam Medical Center,
Wakayama, Japan

Disease concept
Cases in which in spite of complaints ofepigastric pain, epigastric distension and similar
symptoms of the upper gastrointestinal tract
gastroscopy etc. cannot show explicable organic
lesions are called (functional dyspepsia: FD). This
comes close to what has been called chronic
gastritis or neurogenic gastritis in the past. FD isa very common disease and the international
epidemiological study DIGEST showed, that 9%of the adult Japanese population experiences thiscondition at a rate of once a week, presenting
with moderate or stronger symptoms of dyspepsia,
and among those people 34% reportedly visited
medical facilities1).
Currently, the Roma III criteria (Table 1) are
widely used worldwide for the diagnosis of FD.
Moreover, in this connection the condition inpatients presenting with epigastric pain or aburning sensation in the epigastric region isclassified into (1) epigastric pain syndrome (EPS)
and postprandial distress or a feeling of earlysatiety as (2) postprandial distress syndrome(PDS). There are patients, in whom both EPS andPDS coexist at the same time2). Regarding thecause of FD (1) anomalies of gastric motility(derangement of appropriate gastric fundus
relaxation, decreasing the pooling capacity of thestomach etc.), (2) visceral hypersensitivity(patients with FD are hypersensitive to gastric
stretching stimuli as compared to healthy
persons) and (3) central nervous problems(presence of depression or anxiety and similar
psychologicalsymptoms)
areconceivable.
Otherwise excessive secretion of gastric acid, H.

pylori infection, affection by food contents and avariety of other causes are involved.
Western medical pharmacological treatment
aims at bacteria elimination in cases of H. pylori
infections, in the group of patients with epigastricpain syndrome drugs inhibiting gastric acidsecretion and in the postprandial distresssyndrome
group
drugs
to
promotegastrointestinal motility are used. If thesemeasuresarenoteffective,
tricyclic
antidepressants are administered3).
Table 1 FUNCTIONAL DYSPEPSIA (Rome III)
Diagnostic criteria* Must include:
1. One or more of the following:a. Bothersome postprandial fullness
b. Early satiationc. Epigastric paind. Epigastric burning
2. No evidence of structural disease (including at
upper endoscopy) that is likely to explain thesymptoms* Criteria fulfilled for the last 3 months withsymptom onset at least 6 months prior to
diagnosis
Postprandial Distress Syndrome
Diagnostic criteria* Must include one or both of
the following:
1. Bothersome postprandial fullness, occurring
after ordinary-sized meals, at least several times
per week
2. Early satiation that prevents finishing a
regular meal, at least several times per week
* Criteria fulfilled for the last 3 months withsymptom onset at least 6 months prior to
diagnosis
Supportive criteria
1. Upper abdominal bloating or postprandial
nausea or excessive belching can be present
2. Epigastric pain syndrome may coexist

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

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Volume 4, Number 2 | Summer 2009

Epigastric Pain Syndrome
Diagnostic criteria* Must include all of thefollowing:
1. Pain or burning localized to the epigastrium ofat least moderate severity, at least once per week
2. The pain is intermittent
3. Not generalized or localized to other abdominalor chest regions
4. Not relieved by defecation or passage of flatus
5. Not fulfilling criteria for gallbladder andsphincter of Oddi disorders* Criteria fulfilled for the last 3 months withsymptom onset at least 6 months prior to
diagnosis
Supportive criteria
1. The pain may be of a burning quality, but
without a retrosternal component
2. The pain is commonly induced or relieved byingestion of a meal, but may
occur while fasting
3. Postprandial distress syndrome may coexist

Treatment
In Chinese medicine FD is understoodaccording to concepts of conditions like "epigastricpain" (wei wan tong), "epigastric stuffiness" (xinxia pi), "eructation" (yi qi), "anorexia" (na dai),"frequent vomiting" (fan wei), "gastric upset" (caoza). Possible causes for the pain are stomach heat,stomach yin deficiency, stomach cold, disharmonyof liver and stomach or blood stagnation and in
relation to the stomach upset stomach qi
deficiency and phlegm-dampness.
In Japan shigyakusan and saikokeishito areused in particular for EPS patients with marked
stress factors (disharmony of liver and stomach).
Moreover, for asthenic patients with chilling of
the epigastric region (stomach cold) Anchusan or
Ninjinto are used. In Patients with PDS with thedevelopment of phlegm-dampness due to an
irregular diet including excessive ingestion of

8water, alcohol, dairy products and meat or the likeheiisan, bukuryoin, bukuryoingohangekobokuto areused. Also, when in people with a weak constitution
a qi deficiency induced by a deficiency of spleen andstomach has led to the development ofphlegm-dampness, rikkunshito is used. Moreover,the presence of both epigastric pain and gastricupset is a form of EPS and PDS overlap for whichhangeshashinto is used.
EBM
In Japan almost all research reports are basedon the use of rikkunshito. In some studies
attempts were made to classify the FD according
to the type of morbidity, while others did not
distinguish between pathologies4). FD has in thepast also be called non ulcer dyspepsia (NUD) andthere are many trials based on the relevant
diagnostic criteria.
According to Harasawa et al. DB-RCT showed,that rikkunshito had therapeutic effects for the
postprandial distress syndrome5). Rikkunshito in
the normal dose and a 1/40th dose wasadministered over a period of 2 weeks to 235
NUD patients with postprandial distresssyndrome and the two groups then compared. The
results showed, that the ratio of symptom
alleviation in the group treated with the normal
dose was significantly higher. Classified
according to symptoms a marked improvement
was observed in particular regarding theinappetence, gastric discomfort and fatiguability
present prior to the treatment and regarding theusefulness too a significant difference wasobserved between the 58.8% in the regular dosegroup and the 39.3% in the low dose group.
Patient background factors influencing theelimination effects were an age in the 60s,
leptosomatic body type, SRQ-D<10 points, weakmuscle tone of the abdominal wall, regular facialcolor, for all of which significant differences wereobserved.

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Regarding RCTs there is a comparative study,
treating NUD patients with rikkunshito andcisapride6) by Miyoshi et al. In this study 246
NUD patients received the drugs at random. As aresult significant differences were observed,
showing a 'better than improvement' regarding
the general condition in 81.3% patients in therikkunshito group (marked improvement 49.5%),
as compared to 75.0% in the cisapride group(similarly 34.0%). Regarding the usefulness too
significant differences were observed for the ratioof 'better than useful', which was 80.7% in therikkunshito group (extremely useful in 45.9%), as
compared to 73.3% in the cisapride group(similarly 31.7%).

References
1) Stanghellini V: Three-month prevelance rates
of gastrointestinal symptoms and the influenceof demographic factors: results from theDomestic/International
Gastroenterology
Surveillance Study (DIGEST). Scand J
Gastroenterol Suppl 231:20-28, 1999
2) Drossman DA. The functional gastrointestinal
disorders and the Rome III process.
Gastroenterology. 130:1377-1390, 2006
3) Geeraerts B, Tack J: Functional dyspepsia:
past, present and future. J Gastroenterol
43:251-255, 2008
4) Okumi H et al.: Evidence for Kampo treatmentofpatients
withpsychosomaticandstress-related disorders1) EBM evaluation of
Kampo treatment for functional dyspepsia.
Journal of Japanese Association of Oriental
Psychosomatic Medicine 24: 70-75, 2009
5) Harasawa S: The role of Rikkunshito for thetreatment of NUD (functional maldigestion) ―in particular regarding its usefulness for
Dysmotility-like NUD－．Prog.Med.19:843-848,
19996) Miyoshi S et al.: Clinical evaluation of TJ-43
for the treatment of indefinite complaints
related to the gastrointestinal tract likechronic gastritis ― Multicenter comparative
study using Cisapride as control drug ．
Prog.Med.11:1605-1631, 1991

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Clinical Report 1 (Japan)

Peripheral Arterial Disease (PAD) and Acupuncture andMoxibustion
Fumiko Yasuno and Tomomi Sakai
Department of Acupuncture and Moxibustion
Faculty of Healthcare
Tokyo Ariake University of Medical and Health Sciences

Introduction
Japan is moving toward an aging society
unprecedently faster than any other country in
the world. The disease structure that used tomainly consist of acute disorders has changed,
and chronic lifetsyle-related diseases andgeriatric diseases occupy a large share of thestructure. Typical is arteriosclerosis among them.
If arteriosclerosis occurs in the cerebral bloodvessels, it results in cerebrovascular disease suchas cerebral infarction. If it occurs in the bloodvessels of the heart, ischemic heart disease suchas a heart attack or myocardinal infarction iscaused, whereas peripheral arterial disease(hereafter PAD) is caused by arteriosclerosis
occurring in the arteries of four limbs.
PAD is a disease that has narrowings or
blockage of arteries of four limbs due toprogression of limbs arteriosclerosis, resulting incirculatory impairment in the blood perfusionarea. It is anticipated that PAD will increasesignificantly with the growth of aging population.
And dietary problems from westernized lifestyles,
lack of physical activity or a sedentary lifestyle,and increased stresses are also contributing
factors to develop PAD.
Main symptoms of PAD are cold sensation andintermittent claudication and advanced cases
lead to ulcers and gangrene, both of which are
symptoms caused by circulatory obstruction in
the lower limb arteries.
Treatment of PAD differs depending on its
severity. For PAD of Stages I and II of Fontaine
proceduresareClassification1),nonsurgicalmainly used2). However, if they do not have effects,10

a surgery procedure may be used.
Meanwhile,
acupuncture
treatment
isrecognized as being effective for improving
disturbances of peripheral circulation. And a few
reports on effects of acupuncture treatment on
sensitivity to cold or cold sensation3) and
Raynaud's phenomenon symptoms4-6) have beenreleased.
Cases
of
PAD
that
showedimprovements in symptoms7-9) have also beenreported, although limited in number. From these,
there may be possibilities of acupuncture
treatment as a conservative procedure.
We have administered acupuncture treatment
to patients with PAD to verify clinical effects andthe range of indications and also eclucidate a partof these mechanisms. With the results being
analyzed, we will introducea a summary and thecases as below:

1. Clinical effects of acupuncture treatment on
PAD1) Subjects
Subjects were 21 patients (male 17, female 4,
average age 72.1±7.3) having subjective ischemic
symptoms in the lower legs (lower thighs) withthe diagnosis of PAD confirmed throughangiography (or MR angiography). In the
Fontaine Classification showing the levels ofischemia in the lower legs, PAD was categorized
as Stage I (cold sensation and numbness) in 1
patient , as Stage II (intermittent claudication) in
17 ptients, as Stage III (rest pain) in 2 patients,
and as Stage IV (ulcers and gangrene/necrosis) in
1 patient.
2）Methods
Measurement items were lower leg skintemperature (by thermography), heart rate, bloodpressure, plasma CGRP level, the ratio of theblood pressure in the lower limbs to the bloodpressure in upper limbs (arms); Ankle Brachial
Pressure Index (hereafter ABPI), intermittent
claudication distance, pain, and cold sensation(based on pain scores). In the treatment of two

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Volume 4, Number 2 | Summer 2009

patients (one with Stage I and the other with
Stage IV), ordinary acupuncture needling (leaving
needles in place and sparrow pecking technique)
was performed, whilst low frequency current wasapplied to insertion needles for the crural musclesof the lower limbs presenting ischemic symptoms.
The assessments of ABPI, intermittent
claudication distance, pain and cold sensation
were carried out before the beginning of thetreatment and after 16 times of the treatment(hereafter assessment time). The treatment period
was 1 to 3 months.
3) Results
The skin temperatures of the affected leg
regions were measured and a comparison wasmade with those of before-treatment against
those read during the period from 15 minutes
from the beginning of the treatment to 15
minutes from the end of the treatment, showing
significant increases. In terms of Fontaine
Classification, the patients with Stage I and thepatients with Stage II manifested more
distinguished increases than those of Stage III
and Stage IV. The heart rates and blood pressures
measuredsimultaneously
did
not
show
significant changes from the beginning to the endof the treatment. Plasma CGRP levels showedsignificant increases after 15 minutes from theend of the treatment compared to before thetreatment.
ABPIs in all patients remained same. At thetime of the assessment, intermittent claudication
distance showed a significant extension compared
to before the treatment.
Both pain and cold sensation showedsignificant decreases at the time of theassessment compared to the VAS values assessed
prior to the treatment. In view of Fontaine
Classificaton, the patients with Stage I andpatients with II had marked decreases, whereas
those with Stages III and those with IV had small
decreases.

Through the entire treatment period, any
adverse event causing disadvantages to thepatients was not observed.
A case of PAD will be introduced as follows.

2. Case of PAD (Fontaine Classification Stage
II)
Relatively
many
patients
who
wantacupuncture and moxibustion treatment visit
our hospital with the complaints such as cold
lower legs, pain, and pain when walking. Since
these symptoms may have developed due tospinal canal stenosis or PAD, knowing theirclinical conditions accurately is necessary andimportant when acupuncture and moxibustion
treatment is performed.
The following patient, who had been a patientof the hospital I had previously worked for, wasreferred to our hospital by her previous
orthopedist due to“crural muscle pain in thelower legs.” According to the patient, “the legs
became painful after dancing (social). Probably
dancing shoes did not fit.” The patient was a
68-year old woman. After the interview, arteriesof lower limbs were palpated, but below-knee
popliteal artery on one side could not be felt. Then,a queston was made to her whether or not she
had pain while walking and stopped walking to
get rest, and became able to walk after rest. She
said “yes.” Then another question was asked:“how far she could walk before she had to stop.”
She said “about 80 meters.” From theconversation, PAD was assumed and treatment
was started. At the same time, I made a hospitalreferral for her.

1) Case[Case] Female of 75 years old[Chief complaint] Pain in the right lower limb
(dull pain with a feeling of heaviness in the calfmuscles)

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[History of present illness] The patient began totake up dance lessons five months ago. Aroundthe time, the symptom of her chief complaint
appeared. She thought it was caused by the heels
she seldom wore and had shiatsu and massages.
Since there were no changes in the condition, shevisited the Orthopedics and had X-ray
photography with the diagnosis of lumber spine
osteoarthritis and osteoporosis. The pain in theleft lower limb was diagnosed as muscle pain
and the patient was referred to us for
acupuncture and moxibustion treatment.
[Past medical history] No special mention[Family history] Younger sister (cardiac disease,died at the ge of 50), younger brother (brain
hemorrhage, died at the age of 53)[Complication] High blood pressure (from theage of 68 to the present): receiving treatment(with drugs) by an internal medicine specialist ofa nearby hospital. Ischemic heart disease (fromthe age of 70 to the present): receiving treatment(with drugs) by an internal medicine specialist ofa nearby hospital.
[History of life] Smoking (-）, drinking a little
alcohol.
[Conditions at the initial visit] Height 152cm,
weight 43kg, blood pressure120/60mmHg, pulse
70/min (regular)
The range of lumber motion was sufficient.
Pain accompanied by motions (-), FFD 0 cm,
SLR-either right or left 90 degrees (-), kempsigns (-), lower limb muscular power - normal,
lower limb muscle atrophy (-), Babinski reflex (-),
PTR(+)/(+), ATR(±)/(±), tactile sense and pain
sense-normal. Limb skin temperatures - lowerd
on the left, and calf pain (+) left>right.
Pulse: Femoral arteries-right and left
palpable, popliteal arteries-right palpable, leftdecreased and weak.
Posteria tibial arteries; right - palpable, left difficult to palpate, dorsalis pedis arteries –12

palpable on the right and decreased and weak on
the left.
Lower limb pain appeared in the calf muscles
when the patient walked up to the distance of 80
meters at a slower pace. Constricting pain on theleft was marked, so she had to stop when she
walked 120 meters. Cold sensation: left legs (+),
feeling of numbness in the left sole (±), rest pain
and ulcers (-).
Straight leg raising test: Left (±), right (-).
Straight leg lowering test: Left (±), right (-),
edema (-), cyanosis (-), ABPI; Right 0.71, left 0.53

2) Acupuncture treatment and the purpose
Since the patient had pain behind the lower
thighs,theacupuncture
treatmentwasadministered by applying low frequency current to
the regions of triceps surae muscles of the calf withthe aim of relieving ischemic pain. The needlingpoints were heyang (the motion point of the triceps
surae muscles) and chengshan (paninful region ofcalf muscles) (Fig. 1) with the needling depth of 20
to 30 mm. Stainless needles 50mm long with adiameter of 0.22 mm were used. Stimulation
conditions were 1 Hz, pulse width 0.25 ms,
stimulating intensity 1 mA, at which the patient
did not feel unpleasant and is high enough tocause contractons of triceps surae muscles. The
time to apply current was 20 minutes. The low
frequency acupuncture equipment Ohm Pulser
4000A (for all medical cares) was used.
Drugs used previously were maintained during
the treatment periodd with same dosages.

3) Assesssment of treatment effects
Skin temperatures and heart rates, and theratio of the blood pressures in the upper limbs tothe blood pressure in the lower limbs; Ankle
Brachial Pressure Index (ABPI), intermittent
claudication distance, pain and coldness werereviewed and studied. Concerning ABPIs, theintermittent claudication distance, pain, and

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coldness were assessed before the beginning oftreatment and after three months.
(1) Lower limbs skin temperature and heartrate/blood pressure
Skin temperatures caused by acupuncture
were measured in a constant temperature room
maintained at 26.5±0.5 Celsius with humidity
55±5 % using a thermography machine(Thermoviewer JTG-5370 manufactured by
Nippon Denshi (JEOL Ltd.). Before measurements,
it was ensured that skin temperatures became in astable equilibrium state after the patient had beenat rest in the recumbent position for more than 15
minutes. Tempertures were taken 10 times in total
with the frequency of every 5 minutes: before theacupuncture treatment, during 20 minutes of thetreatment and till 20 minutes from the end of thetreatment. For analyzing variations in lower limb
skin temperatures, the nail bed of the second toe
finger on the affected side was determined as afixed point and temperatures were read from thethermographic images. At the same time, bloodpressures and heart rates were also measured(with Omron Automatic Blood Pressure Monitor).
(2) Ankle Brachial Pressure Index (hereafter
ABPI) (Ratio of the blood pressures in the leg
joints to the blood pressure in the upper arms)
Systolic blood pressures in the upper arms
and leg joints at rest were measured using an
ultrasonic Dopper bloodflow meter (ES-1000SPⅡ,ARS Inc.): specifically blood pressures in the rightand left brachial arteries, and posterior tibial
artery on the affectd side and dorsal pedis arteries.
The highest values were used, based on which
ABPIs were derived using the following equation.
Leg joint blood pressure（mmHg）
ABPI= ―――――――――――――――――――――
Upper arm blood pressure（mmHg）(3) Intermittent cludication distanceTo determine intermittent claudication
distance, the distance that the patient was able towalk on the flat (hospital level corridor) before
she had to stop due to pain was measured.
(4) Pain and cold sensation
Changes in subjective symptoms of pain andcold sensation were self-recorded by the patient on
the Visual Analogue Scale (hereafter VAS). In
regard to pain, the left end of the straight line 100
mm in length was made as “absolutely no pain.” Inregard to cold sensation, it was made as“absolutely no cold sensation.” The right end interms of pain was for “most cruel pain the patient
had ever experienced” whle in terms of cold
sensation, it was for “most unbearably cold thanever.” For the intensity of the symptom the patient
felt, the patient wrote the mark 「ヽ」 on the line.
Intensities were assessed by the length (distance)of the line from the left end.

4) Results(1) Lower limb skin temperature and heartrate/blood pressure
The leg skin temperature on the affected side
was 30.3 Celsius before the treatment. It rose to
31.4 Celsius when 5 minutes elapsed from the
beginning of the treatment and reached a peaktemperature of 31.4 when 5 minutes elapsed fromthe end of the treatment. Then, it lowered slightly
20 minutes from the treatment being finished to
31.0, which was higher than that of pre-treatment.
Heart rate, systolic blood pressure, and diastolicblood did not change practically from the
beginning of the treatment and to 20 minutes after
the end of the treatment.
(2) The ratio of the blood pressure in the upper
limbs and the blood pressure in the lower limbs;
Ankle Brachial Pressure Index (ABPI)The ABPI of pre-treatment was right 0.71and

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left 0.53, showing no changes from the values ofright 0.71and left 0.53 gained at the time ofassessment.
(3) Intermittent claudiction distance
Whereas the caludication distance ofpre-treatment was 120 meters, it extended to 200
meters when the assessment was made. The
patient became able to walk twice faster than she
could before treatment.
Further, the recovery time from becoming
unable to walk to resuming walking was
shortened.
(4) Pain and cold sensation
Whereas the VAS of pain before the treatment
was 85.0 mm, it became 70.9 mm at the time ofassessment.
(5) Adverse event
Through the entire treatment period, any
adverse event causing disadvantages to thepatient was not observed.
Moreover, as the patient was suspected ofhaving PAD as soon as the treatment began, an
examination request was made to the Departmentof Angiology. As a result, anteriography indicatedcommon femoral artery occulsons on both sides
with the diagnosis of PAD. In the patient, there
were risk factors of her being elderly (76) and acomplication of cardiac disease and hypertension.
The patient had also intermittent claudication.
Symptoms were prominent on one side. Lower
limb arteries could not be palpated. On the basis ofthese, PAD was presumed.

5) Discussion(1) Mechanism of acupuncture treatment (froma case series of 21 cases)
In order to elucidate part of the mechanism
producing acupuncture treatment effect in thepatient, skin temperatures and plasma CGRP

14levels were measured. The results showed that theskin temperature of the leg being treatedsignificantly increased during the time from 15
minutes from the beginning of the treatment to 15
minutes from the end of the treatment. Plasma
CGRP levels also significantly increased after theend of the treatment. However, almost no changes
took place in blood pressures. These results
suggest the possibilities that the rise in the skintemperature after the treatment was not caused
by a blood-pressure-dependent passive increase of
the blood flow but rather it was related to theperipheral circulation that was improved inassociation with vasodilation caused by thesecretion of CGRP, a vasodilatory substance.
In regard to effects of low frequency
electroacupuncture on the peripheral circulation,
there is a study by Sakai, et al.10) who performed
low frequency electroacupunture on triceps suraemuscles in a similar manner as we did for thepatient. With healthy adults as study subjects,
they have verified in the study that after applying
low-frequency electroacupuncture stimulation totriceps surae muscles, the lower thigh deep
temperature of the muscles rose and muscle bloodflow volume and skin blood flow as well as thepain threshold also increased.
Similarly, Tokutake, Yoshikawa, et al.11,12) havealso reported that stimulating the lower thigh by
low frequency electroacupuncture caused anincrease in the deep temperature of the targetedmuscles．They pointed out that its mechanism
might have involved the muscle pumping function
performed by muscle contractions. In the case of
the low frequency electroacupuncure we
conducted, a similar mechanism might haveworked, in addition to the action of thevasodilatory substance like CGRP.
For the treatment of PAD, bypass surgery or
percutaneous angioplasty is carried out. And there
is a document reporting that these procedures
significantly increase lower limb skin temperature

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Volume 4, Number 2 | Summer 2009

and that a strong correlationship exists between
an increase after surgery in ABPI, which is anindex of perfusion pressure in the peripheral siteof the lower leg, and an increase in skintemperature of the lower thigh peripheral site13).
These improvements are attributable to thesurgery resolving the stenotic lesion, resulting in amarked increase in the blood flow volume in the
major artery of the lower limb and the skin bloodflow volume. This means that in tissues of such asa PAD affected leg that have extremely reduced
supplies of blood, an increase of blood flow in the
major artery diretly induces skin blood flow and
the ABPI to increase. However, there were effects
on pain and cold sensation from 1-3 monthtreatment but no changes occurred in the ABPI.
This indicates that improvements in organic
lesions such as constriction or obstruction of ablood vessel cannot be expected from acupuncture
treatment for a short period of 1-3 months.
However, the result showing that theintermittent cludication distance, pain, and cold
sensation significantly improved prompted us tothink of the possibility that collateral blood
circulation paths gradually developed. Recently,
Oda, et al.14) conducted an experiment with ratsand histologically verified the findings of VEGF
production
byapplying
low-frequency
electroacupuncture stimulation using an ischemic
muscle model of rats’ anterior tibial muscles. From
the findings, it may be possible that theelectroacupuncture for PAD induced the
production of VEGF and the development ofcollaterial blood routes. We want to leave thismatter as one of the agenda to be investigated in
the future.
(2) Acupuncture indication range for PAD
For chronic artery obstructions such as PAD,
Fontaine Classification for lower limb ischemic
symptoms １） is widely used to classify diseasestages. Non-surgical procedures for PAD are used
for the patients with Stage I and the patientswith Stage II according to the Fontaine
Classificationc 2). Since acupuncture treatment is
one of non-surgical methods, acupuncture wasadministered mainly to the patients with Stage I
and the patients with Stage II. Furthermore, inorder to find out and study indications and thelimit of acupuncture treatment for PAD,
acpunture treatment was also provided to as few
as three patients with Stage III and Stage IV
respectively.
In terms of effects on clinical symptoms, bothpain and cold sensation of pre-treatment
significantly improved from post-treatment. Fromthe viewpoint of the Fontaine Classification, theintensites of these symptoms markedly decreasedin Stage I and Stage II while their improvements
in Stage III and Stage IV were slight.
The intermittent claudication distance after
acupuncture treatment improved significantly
compared to that before the treatment with anextension of the distance. On the other hand,almost no changes were shown in ABPIs in all
lpatients.
In regard to the method of PAD treatment,
severe cases of chief complaints such as ulcer,
necrosis, and rest pain are considered positive
candidates for surgery such as revascularization
surgery. In the case of the patient with Stage IV(necrosis developed on the toe) in this report, theskin temperature increased after the acupuncture
treatment but cold sensation and pain did notchange and subsequent treatment did not yield
effects, leading to a toe amputation. Ｉn the twopatients with Stage III of Fontaine Classification,
cold sensation and pain were relieved slightly, notto the extent that they could be assessed as clinicaleffects. Changes in ABPIs were also not observed.
As shown above, serious cases were only threepatients, but acupuncture has a limit to its effects
if the severity of ischemia from artery obstruction
is high, which exceeds the indication range ofacupuncture.

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From the results above, we consider that thetreatment with acupuncture for clinical symptomsof PAD with Fontaine Stage I and Stage II iseffective and Stage I and Stage II symptoms arewithin the indication range of acupuncture
treatment.

Stasis -. Journal of the Japan Society for
Oriental Medicine, 45 (4): 919-925, 1995.
4）ONO Takahiko, YOSHIDA Yoshinori, SO Heibun,
MATSUMOTO
Acupuncture

Katsuhiko:on

Peripheral

Effectsof

Circulation

Disturbance in Patients with Collagen Disease.
Journal of the Japan Society of Acupunctureand Moxibustion (jsam), 40 (3): 254-258, 1990.

Heyang (the motion point of the triceps
合陽（下腿三頭筋運動点）
muscles of calf)
Chengshan
承山（疼痛部）(paninful region of calf muscles)

Figure 1 Acupuncture points to insert needles
Fig. 1 shows acupuncture points to insert
acupuncture needles in the low frequeny
electroacupuncture stimulation method. The
insertion depth was 20-30 mm. Stainless steel
needles 50 mm long with a diameter of 0.20 mm
were used. Stimultion conditions were 1 Hz, pulse
width 0.25 ms, and pulse strength 1 mA, theintensity that did not make patient feel unpleasantbut strong enough to cause contractions of triceps
surae muscles.

References
1) FONTAINE R., KIM M., KIENY R.: Surgicaltreatment of peripheral circulation disorders.
Helvetica Chirurgica Acta. 21: 499-533, 1954.
2) MATSUO Hiroshi: Chiryou (1) Chiryoukijyun to
Sono Jissai. Heisokusei-Doumyakukoukashou
Shinryou no Jissai-Masshou Shougai no
Shinryou Shishin-, p29-32, Bunkodo, 2002.
3）SAKAGUCHI Shunji: The Effect of Acupuncture
Therapy on Cold Hands and Feet (“Hiesho) Relationship with Signs and Symptoms of Blood
165) APPIAH R., HILLER S., ALEXANDER L.,
CREUTZIHG A.: Treatment of primary
raynaud’s syndrome with traditional chineaseacupuncture. J Int. Med., 241: 119-124, 1997.
6) MAEDA M., KACHI H., ICHIHASHI N.,OYAMA Z., KITAJIMA Y.: The effect ofelectrical acupuncture-stimulation therapy
using thermography and plasma endothelin（Et-1） levels in patients with progressive
systemic sclerosis（PSS）. J. Dermatol Sci., 17:
151-155, 1998.
7) YASUNO Fumiko, SAKAI Tomomi: Geriatric
Disorders and Oriental Medicine (5) - peripheralarterial
obliterative
disease,especiallyarteriosclerosis obliterans and acupuncture
treatment - Riryou, 28 (1): 2-9, 1998.
8) YAGI Shinichi: Heisokusei
Doumyakukoukashou niyoru Sokushi-Kaiyou
nitaisuru
Sekichu-Kiritsukin
eno
Haritsuuden-Chiryou no Kouka. ClinicalAcupuncture & Moxibustion, 2: 8-13, 1996.
9) IMAI Kenji: Hari Tsuuden to Yakubutu no
Heiyou-Ryouhou
niyori
Rinshou
Shoujyouno
Kaizenga
Erareta
Heisokusei-Doumyaku-KoukashounoIchirei. Journal of Meiji Shinkyu Igaku, 23:
19-24, 1998.
10) SAKAI Tomomi, YASUNO Fumiko, TAWA
Munenori, YANO Tadashi: Clinical Study ofElectro-Acupuncture
Therapy(EAT):
Examination of muscle-EAT and nerve-EAT -.
Journal of The Japanese Society of Balneology,
Climatology and Physical Medicine, 67 (2):87-108, 2004.

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Volume 4, Number 2 | Summer 200911) TOKUTAKE Tadashi, YOSHIKAWA Keishi,
NAKANO Hideki: Teishuha Hari Tsuuden
Chiryouga Masshou-junkan ni oyobosu Eikyou.
Journal of Nissho Electrotherapy Association
11: 43-48, 1997.
12) YOSHIKAWA Keishi: Teishuha Tsuuden ni
okeru Hari-Denkyoku to Hyoumen Denkyoku
no Hikaku – Kin-nai Ondo, Shimpaku-suu,
Ketsuatsu ni Ataeru Eikyou. Journal of The
Japanese Society of Balneology, Climatology
and Physical Medicine, 62 (3): 141-146, 1999.
13) AMANO Ikuji: Heisokusei Doumyaku-Koukashou
niokeru Keihiteki-Kekkan-Seikeijyutsu Zengo no
Hifu-Ondo Henka. Biomedical Thermology, 16 (2):94-97, 1996.
14) ODA Tsuyoshi, IMAI Kenji, SHINBARA Hisashi,
SAKITA Masakazu: Rat Soketsu-Kashi eno
Hari-Chiryou niyoru Kin-Ketsuryu-Ryou noHenka. Journal of the Japan Society of
Acupuncture and Moxibustion, 54 (2): 163-178,
2004.

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Volume 4, Number 2 | Summer 2009

Introduction of Tokyo Ariake University of
Medical and Health Sciences (TAU)
About TAUTokyo Ariake University of Medical and Health
Sciences (TAU) opened in 2009 in Ariake of Tokyo
the capital of Japan is a four-year university.
Ariake is a waterfront area included in the new
Tokyo Waterfront Subcenter of the urban project
developed by the metropolitan government.
Ariake is one of the most promising areas inTokyo with good access to urban central areas as
there are two public transportation systems(Rinkai Line and Yurikamome Line) and the
networks of Tokyo Metropolitan expressways.
Hanada Gakuen, the mother organization of
TAU was founded in 1956 by Hanada Tsutou who
made great contributions to improving the status
of Japanese traditional medicine and developing
the traditional medicine after the war. The school
is a traditional college that has so far produced
over
15,000acupuncture/
moxibustion
practitioners and Judo therapists.
TAU is organized with the Faculty of
Healthcare to which the Department of
Acupuncture
andMoxibustion
andtheDepartment of Judo Therapy belong, and theFaculty of Nursing. Education is provided by 43
full-timeteachers
and
a
team
of
vastly-experienced part-time instructors. TAU
aims to contribute to the society by training
well-balanced specialists that have a wealth ofknowledge and solid techniques as well as aninvestigative point of view and can giveconsideration to the position of patients and theirneeds.
Department of Acupuncture and Moxibustion
In the Department of Acupuncture andMoxibustion of TAU, education is given by
full-time teachers (1 doctor, 1 doctor of traditional

18

Chinese medicine, 3 researchers of basic
researches, 13 practitioners of acupuncture andmoxibustion, and 1 athletic trainer (AT) who is acertified practitioner of acupuncture andmoxibustion) and other 90 part-time specialists.
The education aims to nurture practical humanresources so that it is not only designed forstudents to gain a wide range of medical
knowledge
relating
toacupunctureandmoxibustion but also field-oriented, focusing on
on-the-job
trainings
about
the
optimalimplementation method of acupuncture andmoxibustion under the modern medical caresystem and evidence-based indications andcontraindicationsofacupunctureandmoxibustion treatment. The education has also
an important purpose of contributing to thedevelopment of acupuncture and moxibustion
medicine through basic clinical research andstudies.
Adjunct facilities of TAU
A center for acupuncture and moxibustion with
17 beds will open as adjunct facilities of TAU in
September 2009. In the center, practitioners ofacupuncture and moxibustion of the Departmentof Acupuncture and Moxibustion will perform
clinical activities on a rotating system to help
maintain and improve health of the community
residents. And at the same time, students of the
Department of Acupuncture and Moxibustion will
have on-the-job trainings. Furthermore, a clinic ofmodern medicine (internal medicine andorthopedics) and a Judo-therapy center areplanned to open two years later. Through theircooperation, these centers will assume a role ofbecoming an implementation example ofintegrated medicine in Japan.

(Tomoaki Kimura, Department of Acupunctureand Moxibustion)

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Volume 4, Number 2 | Summer 2009

Tokyo Ariake University of Medical and Health Sciences (TAU)

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

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Volume 4, Number 2 | Summer 2009

Clinical Report 2 (Japan)
Functional Dyspepsia – Case 1

Shinji Nishida

Department of Psychosomatic Medicine,Japanese Red Cross Wakayam Medical Center,
Wakayama, Japan

Case 1: FD epigastric pain syndrome
Patient: 28-year-old female
Chief complaint: Pain in the epigastric region,
sense of abdominal fullness
History of present illness: The patient began
engaging in film developing work from August
XXXX-1. Her symptoms emerged after she began
to drink large amounts of cold tea to relieve
herself of the hotness of working in a closed darkroom. She received a gastroscopy exam in Octoberat a different hospital, and was told she has
erosive gastritis. She was administered an H2
blocker, dimethicone and mosapride citrate, but
to no avail. She thus resorted to folk medicine(Ota Isan, geranium herb), but is not certain of its
efficacy. In April XXXX, an aggravation of her
symptoms and weight loss led her to seek medical
attention at our hospital.

Observations from the perspective of Eastern
medicine: Tongue pattern—Thin white coating,regular tongue texture, no hypertrophy. Pulse
pattern—Thin, string-like, somewhat smooth.
Abdominal pattern—Chest side painfulness andepigastric discomfort, abdominal muscle tension
in upper abdomen, no tenderness in lower
abdomen.
Progress:

The patient was administeredsaikokeishito. In her visit two weeks later, shesaid her symptoms improved considerably. Her
prescription was continued until the fourth week
when her treatment was deemed completed.

Past medical history: Bronchial asthma until age
11. Family history: Nothing in particular.
Present status: The patient has a poor complexion,
and appears dispirited. Height 165cm, weight
49kg, blood pressure 130/78mmHg, pulse 86/min.
and regular. Abdomen is flat and soft. Decreased
bowel sound, tympanic sound heard in the upper
left abdomen by percussion.
Symptoms: The patient slept with a hot waterbottle or electric warmer on her stomach, as theweather was still cold during her first visit (April).
Loss of appetite, dry mouth, heartburn, chest
pain. She feels no particular emotional stress atwork. Regular bowel movement, regularmenstruation.

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Volume 4, Number 2 | Summer 2009

Clinical Report 3 (Japan)
Functional Dyspepsia – Case 2

Shinji Nishida

Department of Psychosomatic Medicine,Japanese Red Cross Wakayam Medical Center,
Wakayama, Japan

Case 2: FD postprandial distress syndrome
Patient: 56-year-old female
Chief complaint: Heavy stomach, loss of appetite,
feeling of fullness, coughing with phlegm
History of present illness: The patient’s stomach
began to feel poorly from XXXX-4, and graduallyworsened. She received a gastroscopy exam at adifferent hospital and was diagnosed withsuperficial gastritis. She was administered an H2
blocker, a proton pump inhibitor, and mosapride
citrate, to no avail. Her weight declined from38kg to 36kg, so sought medical attention again
in XXXX.

weak abdominal strength, thin subcutaneous fat,dry skin, minor chest side painfulness on rightside, marked splashing sound made by succusion,brisk pulsation in supra- and infra-umbilicalregions, weakness of the infra-umbilical region.
Progress:

First visit (Jan.)—Administeredrikkunshito. February—The patient became able
to eat a significant amount of rice, but thesplashing sound still remained. March—The
patient had coldness, so 1.0g powdered processed
aconite root was added to her prescription.
April—Sputum and respiratory distress wereobserved, so hangekobokuto was added.
May—The patient began to be able to eat. Foodtastes good. The phlegm decreased. Thereafter,
rikkunshito and hangekobokuto were gradually
decreased, and the patient’s treatment wasdeemed complete in October.

Past medical history: Ovarian cyst at age 17,
ischemic enteritis at age 52.
Present status: Height 146cm, weight 36kg, bloodpressure 156/91mmHg, pulse 96/min. andregular.
Symptoms: Sense of abdominal fullness, belching,loss of appetite, early satiety after eating, asplashing sound of gastric juice in the stomach,no heartburn or reflux symptoms. In the past, she
was prescribed shoseiryuto for coughing andphlegm, but it aggravated her gastrointestinal
symptoms.
Observations from the perspective of Eastern
medicine:
Pulse
pattern—Sunken,
thin,string-like,somewhat
deficient.
Tonguepattern—Tongue texture with teeth marks andcracks, thin white coating, overswelling ofsublingual vein. Abdominal pattern—Somewhat

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Volume 4, Number 2 | Summer 2009

Clinical Report 4 (Japan)
Athma/Bronchitis

Commentary

Yang Cholsong

Yang Herb Clinic

Being thin, hot flashes, dryness of the skin,thin pulse, deep red tongue without moss/dryness– these are all symptoms of Yin deficiency.
Coughing accompanied by thick phlegm not easily

Case: Female of 78 years oldloosen and in small amounts, and pains in the

Chief complaint: Wheezing

knees and low back due to fatigue were

History of present illness:
The patient had persistent wheezing andcoughing every day with breathing difficulty onceor twice a week although she had been using
steroid stimulation-inhaled ß2 for about a year.
Phlegm was viscous in small amounts and did noteasily loosen.
The patient was thin, easily had hot flashes,and her skin was dry.
Past medical history:
The patient with osteoarthritis of the knees
had fatigue causing pain in the knees and low
back.

considered to be the symptoms of lung and kidney
Yin deficiency. The lung and kidney Yin deficiency
is the sho often observed in chronic bronchitis in
the elderly, for which treatment a typicalbakumijiohen(Ophiopogonis,
Schisandra, Rehmannia Pill). For the use of
extract preparation, bakumondoto is used
together with rokumigan. For lung Yin deficiency
and Yin deficiency with exuberant fire, jiinkokato+ bakumondoto are used. Reduced amounts ofmedicineisingredients of the medicines were used inconsideration of the patient’s age.

Present conditions: A small build, and thin.
Pulse: Thin. Tongue: Deep red without moss anddry
Sho: Lung and kidney Yin deficiency
Method of treatment: Tonify lung and kidney Yin
Prescriptions: Extract of rokumigan 6g/3 +Extract of bakumondoto 7.5g/3
Course: After two weeks of the administration of
the above two prescriptions, phlegm became
easilyloosen

and

cough

and

wheezing

disappeared. Hot flashes improved. After that,
coughing and wheezing occurred only twice or
three times a month and they stopped as soon as
ß2 inhalation was used.

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Volume 4, Number 2 | Summer 2009

Clinical Report 5 (Japan)

Prescriptions and clinical course: In the initial

One Case having Effects of Senkyuchachosan on Headache

examination, it was considered the headache was

Mitsuyuki Takamura

Mie University Occupational Health Research Project

Hiromichi Yasui
Japan Institute of TCM Researchcausedbyryokeijutsukantophlegm-dampness

and

was

The

administered.

headache seemed slightly relieved, but a great
improvement was not observed. On October 25,

Case: Female of 43 years oldtheInitial visit: October 4 of year X

hengebyakujutsutemmato,

Chief complaints: Headache and dizzinessremained unchanged. On November 8, headache,

History of present illness: The patient had been

which was like the one occurring in a menstrual

suffering

initialperiod appeared, which, the author considered,development when the patient was at about 10

was due to the existence of stagnation of Qi andyears old. She had been using various medicines

blood stasis and two formulae were used:

but they became gradually less effective andkamishoyosan

eventually Selestamine was the only medicine

combination was effective and headache rarelythat worked. On August 16 of the year, she had aoccurred. The prescriptions were used till July of

total hysterectomy due to uterine fibroids. When

next year (year X+1). In August, headacheshe had an analgesics injection after the surgery,relapsed without dizziness but with squeezing

she had the attack of disabling dizziness.

pulsatile pain. So, It was considered that the sho

Subsequently, dizziness continued. The type of(pattern) of the patient changed and the formula

headache changed after the surgery: When pain

was changed to senkyuchachosan. Since then, no

occurred, dizziness developed. At the same time,headache has occurred till now (year X+4).

any medicine did not work. So she desired Kampo

However, the patient, who is afraid of relapse,

treatment.

continues this formula.

from

Appetite:migraine

since

its

formulawas＋changed
but

the

to

conditionryokeijutsukanto.

This

Consideration: In the case of the patient, formula

Ordinary

Sleep: Good

was changed one after another according to the

Defecation: Once/day (use Arozen® sometimes)

conditions, and eventually the headache was

Urine: 9 times/day, nocturnal urine: once

relieved with senkyuchachosan. Some of the

Menstruation:

formulas used, before the foregoing medicine,

None

after

the

uterinehysterectomy

were effective enough in their own way. In other

Neck stiffness (+), shoulder stiffness (+), lowwords, the headache in the patient was linked

back pain (+)

with phlegm-dampness and Qi stagnation and

Present conditions: 158cm, 64kg

blood

stasisandryokeijutsukanto

andPulse: Deep and smoothkamishoyosan

Tongue: Slightly dark colored, tongue moss (-),

exposing, as a result, the presence of the othermoist

underlying clinical condition. Generally, theAbdomen: Slightly distended and full, soft,senkyuchachosan is a formula for treating thesplashing sound (+)

factors that cause pathogenic wind to attack the

improved

these

conditions,

Diagnosis: Headache due to phlegm-dampness,exterior and harass the head, inducing headache.

stagnation of Qi and blood stasis and head windIf pathogenic wind does not go away and stay in

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Volume 4, Number 2 | Summer 2009

the liver, headache will not be cured and relapse.
This windt is referred to as “head wind” inChinesemedicine.

The

condition

remained

ultimately was “wind is in hiding in the liver” andsenkyuchachosan resolved this state. The patient
was finally freed from 30 years suffering by thisformula.

24

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

Volume 4, Number 2 | Summer 2009

Kampo Dermatology – Clinical Studies
Treatment of Atopic Dermatitis with Kampo – Puberty and
Adulthood (6)Fumino Ninomiya
Aoki Clinic
A major characteristic of atopic dermatitis isthat varied symptoms appear during puberty andadulthood and they cover the entire body. The
parts that are rubbed such as the underarms andinside elbows become lichenified (the skin become
thick

and

hard)

and

intractable.

Sweat

accumulation in the parts that are rubbed is alsoa major factor.

The skin surface consists of a variety ofstructural shapes and typically often develops
erythroderma. For erythroderma, medicines thatclear heat and induce water drainage, and resolve
blood stasis are mainly used appropriately, as
well as gorinsan, shofusan, or keishibukuryogan.
To remove intense inflammation, strong heatclearing medicines are used. In atopic dermatitis,
however, there are many cases of spleen-stomach
deficiency with internal cold. So, an excessive useof heat clearing medicines should be avoided.
Making adequate adjustments is important. It is
important

to

focus

on

heat

clearing

prescriptions.
If facial redness is intense and skin irritation
extends to the whole body, shishihakuhito,

orengedokuto,
keishikaogito,
andbyakkokaninjinto are used. Byakkokaninjinto isused to target hot flashes, sweating, and thirst.
If there is erythema, papules, and lichens on theunseiin,keigairengyoto, saikoseikanto, and saikokeishito

whole

body,

and shin’iseihaito are used.
If there are erythema, edemas, and moistening,the medications such as eppikajutsuto, choreito,

inchinkoto, goreisan, and shofusan are used.
These medicines should be used for a shortperiod to manage the symptoms.
If the lower body has intense inflammation, theprescriptions

such

as

ryutanshakanto

andsaiseijinkigan are used.
If there is an infection, medications such ashainosankyuto or jumihaidokuto are used.
If there is the presence of upper body sweatingwith a weak constitution, medications such as

Treatment of secondary aspects and prescriptions

also

body, the medications such as sammotsuogonto

medications

such

as

are used.
For erythema on the upper part of the upper

keishikaogito and boiogito are used.
If there is dry skin dermatitis on the wholebody,medicinestoenrich

yin

such

as

bakumondoto, tokito, and jiinkokato (even fortreating a secondary aspect of the disease) areused.
Some cases may need to combine medicines
inducing water draining. A typical medicine todissipate water damp is goreisan, which can beapplied to individuals of any generation. For
Hyperhydrosis and edemas, boiogito is used.

choreito, which has actions of nourishing yin anddraining water is used for heat symptoms.

Inchingoreisan is used for conditions witherythema – erythema is the symptom for thismedicine. ryokeijutsukanto is used for conditions
with moist eczema dermatitis due to the reversed
flow of fluids.
Treatment of the root/primary aspects and its
prescriptions
The basics to treat the root during puberty andadulthood are to improve the patient’s constitution
by supplementing deficiencies with the use of
medications mainly for tonifying qi, and yin.
For

the

syndrome

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)ofgastrointenstinal
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Volume 4, Number 2 | Summer 2009

weaknessandacquiredspleendeficiency,

medications such as rikkunshito, shikunshito,ninjinto,

andheiisan

are

used.

For

kidney-deficiency lacking kidney essence as aresult of acquired internal weakness, medications
such as hachimijiogan, rokumigan, and shimbuto
are used. For liver depression and qi stagnation
Before treatment

with which stresses are greatly connected,
medications such as shigyakusan, saikokeishito,

Before treatment

saikokeishikankyoto,saikokaryukotsuboreito,
yokukansan, and kamishoyosan are used. For
blood deficiency, shomitsuto is a typicalformulation (Table 2).
Atopic dermatitis has great influences ofcharacteristics of each season, which will bereported in a separate literature.
Case 1: Female of 31 years old with atopic
dermatitis and neurosis.
Present conditions: 159cm, 51kg
Whole body erythema. Psychoneurosis, SDS(psychological test) 65 scores. Difficulty
falling asleep, intensely irritable, worrisome,poor appetite, loss of nerve. The entire body
felt cold. Stiff shoulders (+). The patient was
helping with the housework.
Tongue condition: Moist with white furs.
Treatment and course:

yokukansankachimpihange
5.0g
andsammotsuogonto 5.0g were administered for six
weeks.
After a while, the skin inflammation improved
and a cure was attained.
Appetite came, and the patient became able toenjoy meals, and felt refreshed. Irritability
resolved. She could get a conversation with herfamily members to start moving. She spent every
day with fun and became hopeful about the future.
The overall QOL improved.

26

6 weeks after treatment
6 weeks after treatment

Case 2: Male of 20 years old with atopic
dermatitis and whole body chronic exudative
dermatitis
Present conditions: Atopic dermatitis developed
at the age zero. In mid-course, it was in remission,
but when he entered the university and started
living alone, it became gradually worse.
Past medical history: Allergic rhinitis. His father
had allergic rhinitis.
Present conditions: 172cm, 63kg
There was whole body erythema. Moist crusts
and lichens co-existed with exudative dermatitis
associatedwithasecondaryinfection.
Constipation (+), cold legs (+), abdominal pain (+),
frequency of urination 5 times, water intake 3-5
lit./day. In everyday life, the patient ate
in-between snacks, mostly sweets. She did nottake breakfast and mostly dined out. She ate very
few vegetables and fish.
Abdominal condition: Palpitations above theumbilicus, tenderness beside the umbilicus, and

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

Volume 4, Number 2 | Summer 2009

lower abdominal resistance.
Treatment and course
May 9. (1) choreito 7.5g, gorinsan 7.5g, andRoxithromycin 100mg 2 tablets wereadministered for 14 days.
(2) Procedures: Black light radiation. Patchesof shiunko, Bacitracin mixed ointment, andpioctanine Salbe were applied.

Before treatment

Before treatment(3) For the face wash, soap must be used. It was
explained that soft cottons are the safest forthe skin.
(4) Since stress was getting worse, instructions
were given for training the autonomic nerves.
With the three-day visits to the hospital, thesymptoms were nearly recovered and theconditions seem to become better.

After treatment

After treatment

May 21. The secondary infection was cured.
Erythema decreased.
(a) choreito 7.5g and hainosankyuto 7.5g
were administered for 28 days.
(b) Procedures were same as those of May 9.
June 13. Erythema further decreased and thepigment deposited. Itching (+), which wasintense on the face, chest, neck and upper body.
shin’iseihaito 5.0g, keigairengyoto 5.0g,
choreito 5.0g, and Ebastine 10mg one tablet
were administered for 14 days.
[Lifestyle guidance](1) The patient was told to get up early in themorning and eat breakfast. Explanations
were given about food materials and how toeffectively intake them. Go to bed at 23:00.
Get enough sleep.
(2) How to apply ointments after taking a bath
was explained. The effective method of taking
a bath to disperse cold in the legs was also
explained.

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Volume 4, Number 2 | Summer 2009

Medical History in Japan
Sotetsu Ishizaka’s “Shinkyu Chiyo Ichigen (2)Kenji Kobayashi
Guest researcher of Medical History Research Dept.
Kitazato University Oriental Medicine Research Center[Part 2 of this series]- Unless the reasons are known why needles curediseases, needling techniques become a uselessthing and cannot be put to practical use.
Once the significance of their application has
been understood, like pollution transforming into
cleanliness, or entangled things becoming undone
diseases can be cured. When the essentials havebeen sufficiently grasped, the criteria can clearly
be formulated in words.
Well, formulating the essentials in an easily
understood language, a bamboo or wood spine(splinter) piercing the body is not different from aneedle made of gold, silver or iron piercing thebody, in both cases similar splinters are inserted
into the body. The difference lies in whether these
splinters are stuck by mistake, or inserted for the
purpose of treatment.
When bamboo or wood splinters have pierced,
it is possible to remove them by pulling them out
with human strength, but if that person were notable to pull it out with his own strength, the vital
force of that particular person will cause thedevelopment of inflammation and calor at the siteof the splinter, gradually concentrating essence
and spirit as well as nutritive and protective qi(effects of nerves and blood vessels) forces, so thatthe fever at the site of the splinter becomes
exuberant, transforming the heat into pus so that
gradually even splinters that cannot be removed
with the strength of that person are discharged
together with pus and thereby removed from thebody. Drainage of the pus and following recovery
from the inflammatory symptoms, the bodynaturally returns to its whole, unharmed
condition.
During acupuncture & moxibustion treatment
28

gold, silver or iron needles are inserted at the siteof the disease and similar to the local
development of calor at the site where bamboo orwood splinters have pierced, essence and spirit aswell as nutritive and protective qi concentrate
and gather beneath the needle.
Retaining the needle in place for a while,
properly gathering these forces under the needle
and then removing it will finally scatter essence
and spirit as well as nutritive and protective qi
along with the pathogenic evil and result in asudden healing. This is exactly like the way windblows away clouds, after which a clear blue sky
emerges. In the classics too it says "Piercing threetimes will heal a person in whom 10 days havepassed since the onset of the disease. Piercing tentimes will heal a person in whom 1 month has
passed since the onset of the disease. Anyway,
regardless of whether the disease is mild orsevere, one treatment every three days is thestandard for the treatment."
Regarding the needling technique the sites ofthe pathogenic qi are needled, and throughtreatment of the evil the essence and spirit aswell as nutritive and protective qi gather properlyat the site. By removing the needle the gatheredessence and spirit as well as nutritive andprotective qi will eliminate the evil. In otherwords, this can be considered to be the same
technique as if drastic drugs like ginseng or
aconite were used to raise the weakened vitalenergy to achieve vitality.
- Sites that should not be needled are constantly
and widely moving organs. The two organs heart
and lungs and thick arteries (i.e. the aorta) as
well as along the course of major ('gathering placeof the heavenly vessels for essence and spirit" (i.e.
nerves)) "somyaku seishin", where needling could
result in various accidents. Thus, unless one hasa detailed knowledge of the course of the qi andthe courses of vessels the particular person is

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

Volume 4, Number 2 | Summer 2009

nothing more than a layman, poking a sick person.
When facing acute diseases people highly skilledin the art may achieve good effects by piercing
forbidden sites that usually should be avoided.
That is the same as using the “militia” in war.
- Needling technique is really all about direct
insertion, but not restricted to it. The skills ofproperly using the left and right hand, adopting aproper posture, serious concentration, relaxing
the arms and the skills to move the fingers freely
have to be acquired.
The index and middle finger of the left handare placed alongside each other and press on thesite to be needled, taking care to be able to change
at will between light touch and deep pressure,and between these two fingers the needle is heldin the right hand and pressed in.
Once the needle has been inserted, it is pushed
further in with the right hand. Here it isimportant to take care to keep it constantly
moving from the start to the end in a rhythmical
fashion. This is called the secret of the needle.
[Illustration 6] Illustration of twisting aneedle, “Shinkyu Chohoki” (Description ofacupuncture and moxibustion treasures) by
Masatoyo Hongo (1718)

hand governs the advancement of the needle,
while the left hand holds and controls the needle
and thus reins it.”
It is also said that “people practicing
acupuncture must believe their left hand”.
Unless the hand that inserts the needle is kept
heavy and rhythmically moving, the needle turns
into a lifeless thing. When there is only a minimal
amount of vital force left in the sick person’s bodyand the hand of the acupuncture practitioner is alifeless thing, it can have various harmful effects.
One has to be very careful about this.
For this reason the classics describe therelevant acquaintance as: "The person performing
the acupuncture must maintain a wakefulproficiency and a frame of mind as if looking intoa deep abyss, or walking on thin ice, kneeling infront of dignitaries, or as if grasping the tail of atiger with the hand." Various mistakes are allcaused by inattention.
- There is the phenomenon of the needlingsensation (resonance). From the site where theneedle has been inserted a phenomenon like a
flowing resonance always spreads up, down, left
and right and may cause a needling sensation in
the most unexpected places. Needles inserted into
hands and feet may for example affect the face,chest or back. Those are all due to effects on the"Somyaku" (zong mai; gathering place of theheavenly vessel essential vessels). It is not due tothe nutritive and protective qi channels called"Eie". Neither is it due to the muscles.

* Author's note: When Sotetsu refers to"Somyaku", he means nerves, while "Eie" refers toblood vessels.
[Illustration 6]

For that reason it says in the classics “the right-Gold, silver or iron is
manufacture of the needles.

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

used

for

the

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Volume 4, Number 2 | Summer 2009

The standard for the length of the needle metal in
Japan should be 3 "sun" (inches).
The vitality of the physician does not reach theneedle tip, when they exceed this length, so that
this would not be beneficial for the disease any
longer.
The thickness of the needle (thick, thin) is
restricted to needles of sizes between gauges No.
1 to No. 7.
In modern times through tapering during theprocess of the metalwork the needle body may be
manufactured with an initial thickness of gauge
No. 6-7 and that gradually becomes thinner down
to No. 1-2, but this is meaningless. It may
facilitate the insertion of the needle, but is notbeneficial for the disease.
- In case of tube needles a guiding tube is used
and the needle tapped in for only a portion of its
length.
The outer skin in most people is rather
insensitive to pain and itching. The needles areinserted to this pain insensitive depth. There isno harm.
But here too, if the acupuncture practitioner
performs this treatment rough and mindlessly,
inserting the needles in an unskilled manner,
there may be severe pain. This too has to be
performed very carefully, with watchful, vigilant
attention.
In case the needle is inserted without the useof a guiding tube, it is important that the needle
tip is pressed firmly pressed against the skin topierce it and then be manipulated.
[Illustration 7] Illustration of needling a guiding
tube, derived from "Shinkyu Bassui Taise"(Comprehensive Compilation of Excerpts about
Acupuncture and Moxibustion) by Ippo Okamoto(1699)

30[Illustration 7]- The needling method includes aspects oftonification-sedation,

receiving-following,anddeficiency-excess.
Tonification helps to boost the sick person’s
spirit and engorge the vessels, which is a method
to remove the harmful qi.
Sedation is a method of eliminating congestion of
the nutritive and protective vessels by purging
the blood. I have also heard that in the west there
is a purgative method using needles. Although I
don’t know any details of that technique, I believe
something like the three-edged needle is beenused for this purpose.
[Illustration 8] Illustration of twisting a needle,“Shinkyu Chohoki” (Description of acupuncture
and moxibustion treasures) by Masatoyo Hongo(1718)The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 4, Number 2 | Summer 2009

[Illustration 8]

The receiving-following technique resembles
the breathing method, when the needle has
already been inserted, that depends on carefulconsiderations of the coming and going in the
nutritive and protective qi in the vessels and is
performed with the practitioners mind set toeither meeting or following the flow. One has to bevery patient when entanglements of the disease
are disentangled, and has to pierce with theneedles carefully and concernedly.
The deficiency method is a technique where
the needle is quickly removed and both the spirit
as well as the nutritive and protective qi are used
to treat exuberant disease.
The excess method is the application of thereceiving-following technique. The needles are
slowly inserted over an extended period of time,
without causing any pain at all, only mild
needling sensation, and where the breathinginterval of the needle is gradually increased. Thisis used for persons in whom both essence andspirit as well as the nutritive and protective qi
vessels have fallen into a state of deficiency.

Well, in a certain patient the excess method
may be applied at one site and the deficiency
method at another site. Or else the deficiency
method is employed in the upper region, while theexcess method (or a similar technique) is
employed in the lower region.
Depending on whether the disease is locatedshallowly and whether the symptoms are marked
by deficiency or excess the choice of the needlingtechnique is used either shallowly or deep, or else
deficiency or excess, tonification or sedation,
meeting or following techniques are used
depending on the ingenuity of the physician.
Diseases have to be treated based on athorough comprehension of these techniques. The
question of whether the acupuncture physician iseither skillful or inexpert depends on whether
there is a profound knowledge of the body’s
interior and exterior, upper and lower portions,the twelve organs, essence and spirit, thenutritive and protective qi physiology, and thecauses of all diseases are carefully scrutinized.
Those who accomplish this can truly be calledsuperior docters.
With this the outline of the needling method iscomplete.

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Volume 4, Number 2 | Summer 2009

Book Review“Acupuncture Core Therapy – Shakuju Chiryo”
Written by Shoji Kobayashi and Translated by Dan Kenner
Reviewed by Robert B. Gracey
MAc, DiplAc (NCCAOM), LAc.
Acupuncture Core Therapy (ACT) is theculmination of over 30 years of study and clinicalexperience by Shoji Kobayashi and his first booktranslated into English. Kobayashi Sensei
explains his unique style of Japanese
acupuncture, starting with a discussion of its
roots in classical Chinese and Japanese medicine
and ending with a presentation of treatment
protocol.
In the west, ACT is referred to as Shakuju
Therapy (SJT) and I will use SJT to refer to thisstyle of acupuncture.
I will offer a brief overview, shed light on
Shakuju Therapy, summarize SJT’s key concepts
and show how these concepts work clinically. I
recommend reading Acupuncture Core Therapy
along with its companion DVD. Attending a SJTseminar is another way to learn more. Contacts
for purchasing Acupuncture Core Therapy and its
companion DVD and for SJT seminars can befound at the end of the article.
An Explanation of Cold (hie)The concepts of qi and yin-yang form thefoundation of SJT, as in other styles ofacupuncture. However, SJT also asserts thatdisease or disharmony stems from fundamental
jing qi deficiency or pathological cold/hie. The
cold/hie extends the concept of yin qi deficiency. It
embodies the sensation of physical cold to include
a more fundamental concept of jing qi deficiency.
How does cold/hie and the concept of jing qi
deficiency manifest? Over the course of one’s life,
there is a slow but steady depletion of jing qi.
During times of good health, the body canmaintain warmth reasonably well, until near32

death, where cold steadily overcomes the bodyand systems breakdown. Upon death, jing qi
becomes so depleted that the body becomes verycold. When we suffer from an imbalanced state,even before pathology manifests, a gradualdepletion of jing qi also takes place. Left
untreated, jing qi depletion can lead to disease.
Cold accelerates the normal, more gradualdepletion of jing qi, and in cases of serious disease,the outcome can be rapid leading to a total declineof jing qi or death.
The goal of SJT treatment is to return the bodyto a state of normal expenditure of jing qi toinsure a normal, healthy lifespan.
A Unique Diagnostic Approach
In SJT, cold manifests as imbalance,
congestion or stagnation of qi and blood which istermed shakuju, or “accumulations (shaku –deeper)” and “gatherings (ju – more superficial).”Diagnostically, the shakuju pattern is primarily
determined from areas of hardness, pulsations
and discomfort/pain on the palpated abdomen.
The deeper the congestion or shaku, the more
complex or serious the disharmony. See Exhibit A
for division of Abdominal Five Phase Zones.
SJT provides a unique symptom and signpattern classification used in evaluation of thepatient’s condition. This breaks from Traditional
Chinese medicine symptom-sign complexes withconventional disease names. As noted before, SJT
predisposes that the root of disharmony or
disease is jing qi or yin deficiency. To understanddisease patterns, the broader concept of jingqi/yin deficiency is explained within the context ofvacuity (deficiency) and repletion (excess) and theyin-yang paradigm. SJT groups these terms into
five symptom categories that can classify any
pathological condition. They are in progression ofsevereness: (1) yin deficiency, (2) yang excess, (3)yin excess, (4) yin and yang excess, and (5) yangdeficiency. The symptoms and signs within each

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

Volume 4, Number 2 | Summer 2009

category are determined through consultationand examination of the patient. While beyond thescope of this introduction, please keep in mind
that they reflect various degrees of yin or jing qi
deficiency.
Shaku Ju Therapy Treatment
Kobayashi Sensei’s takes this concept of coldand offers a comprehensive, yet relatively simple
root treatment to restore body/mind/spiritbalance. His treatment protocol is typicallyapplied to four of the five treatment zones
mapped on the back.
SJT treatment strives to correct the energetic
imbalances by warming the cold in the body, or
putting power (tonifying) into the jing qi. The
treatment follows a series of systematic steps toboth diagnose and treat the pattern of imbalance(shaku). It starts by working to correct thesuperficial imbalance, or ju, then moving deeper
to rectify the core level of disharmony, or shaku.
Diagnosis requires that the practitioner remainaware to past medical history and observational
stimuli, ranging from such things as birth trauma
to what the patient looks like to how he/shesounds and feels through palpation.
Treatment entails a high degree of focused
intention
andconnection
betweenthepractitioner’s and patient’s fundamental coreenergy or consciousness. This feature to SJTcannot be overstated. ACT clearly explains thefundamentals of directing consciousness inconcrete terms. ACT also offers easily understoodand fundamental suggestions in how to cultivate
qi through exercises, such as qi gong practices.
In treatment, a practitioner uses single needle(or teishin) and moxibustion to warm the body.
The needle helps “gather” qi, resulting in a morebalanced state of being, and ultimately revitalizes
jing qi. Most needling with SJT is non-insertiveby virtue of the technique. Because it is so gentle,

SJT is especially appropriate for children, seniors,
patients with chronic conditions and theneedle-phobic. Moxibustion is used when qi is in
short supply or when cold or illness is more
serious. In these cases, moxibustion helps gather
heat externally.
Treatment steps are briefly outlined below:
1. Observation and inquiry
2. Initial pulse analysis
3. Check reference points (supine position:
inner leg region)
4. Contact needling of the abdomen
5. Pulse diagnosis and adjustment
6. Abdominal
palpationandpattern
diagnosis
7. Check reference points (prone position:
primarily jaw, back, neck, legs and feet)
8. Contact needling of back9. Treatment of back-shū points
10. Re-examination of the abdomen (palpate
for positive changes)
11. Supplemental treatment (if needed)
12. Re-examination of pulses
13. Treatment
ofshoulderregion(GB-21/TW-15 area) in seated position
The needle used in SJT treatments consists of
a #3, 40mm SJ-type filiform needle with anoval-shaped point, designed by Kobayashi Sensei.
This blunted point allows for painless assessment
and stimulation in contact needling and of
individual acu-points. Treated back-shū points
generally follow the outer/inner Bladder lines, the
Huatuojiaji lines (vertebral edge line of the spine)
and/or the Governing Vessel (GV) that are foundin five element regions (see Exhibit B for divisionof Back Five-Element Zones). Treatment
sequencing follows four forms that follow thecreative cycle. All individual acu-points aretreated on the healthy or less reactive side (Steps
5, 8, 11 and 13 as shown above).
In SJT, a practitioner checks reference points

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33

Volume 4, Number 2 | Summer 2009

which are exhibited as symptoms and signs. They
include the patient’s complaints and what apractitioner observes with the senses — sight,
sound, touch, pulse, palpation, etc. Reference
points mirror fundamental cold. During
treatment the practitioner re-checks thereference points for change. For example, apatient comes in with back pain and during thetreatment the pain lessens which means that
there is less cold in the body and that the jing qi
has been successfully tonified. Because thepractitioner rechecks reference points during thetreatment process, he/she can alter strategies
resulting in a better outcome.
Contact needling begins the core of thefundamental treatment process starting with theabdomen and moving to the back. The SJT needle(or teishin) is used to lightly stimulate theabdomen from superior to inferior in a zigzag
fashion without regard to acupuncture points orchannels. It looks similar to sanshin, a touchingneedle technique, but its effect is one of
tonification rather than dispersion. Contact
needling is best understood by its visualpresentation in the DVD.
Much of SJT’s diagnostic and treatment
perspectives were originally published in myarticle from the North American Journal of
Oriental Medicine— Shakuju Therapy Seminar(Part 2): Clinical Application, NAJOM, Volume 16,
Number 45 (2009, March), pp. 34–37.
Clinical Perspective
ACT offers clinical strategies and cases
illustrating its approach to treatment. This
information is helpful to both the novice andexperienced practitioner. It offers perspectives
that enhance treatment flow and nuances that
may be overlooked. The DVD helps to paint aclearer picture of the diagnostic and treatment
process discussed in ACT.

34

Conclusion

Shakuju Therapy offers a unique approach toacupuncture. It is guided by the premise thatdisharmony/disease can be classified as an
expression of cold/hie, resulting in jing qi
deficiency. The treatment approach is systematic,
simple, and entails minimal stimulation to thepatient. Its goal is to restore balance by warming
the cold in the body through tonification of jing qi.
Furthermore, the practitioner can easily refine
treatment by repeatedly checking for patient
feedback through reference point evaluation. The
results foster longer-lasting healing than any
other form of acupuncture I have practiced orwitnessed.
Kobayashi Sensei’s book and DVD provides athorough basis for understanding this uniqueform of acupuncture and is an excellent reference
for all those looking to add it to their practice.
In conclusion, I wish to express my deep
gratitude to Kobayashi Sensei, as well as theeditors of KAIM for the opportunity to write thisarticle.
Book, DVD and Seminar Information
Book Reference and DVD: Kobayshi, Shoji.
(2008). Acupuncture Core Therapy – Shakujyū
Chiryō, Translated and Edited by Dan Kenner.
Taos, New Mexico: Paradigm Publications.
Contact Redwing Books to purchase the book andDVD http://www.redwingbooks.com/Browse.jmdx.
Seminar: Ellen Leifman, Shakuju Association of
North America eleifman@gmail.com

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

Volume 4, Number 2 | Summer 2009

Exhibit A

Exhibit B

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

35

Volume 1, Number 1 | Spring 2006

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

35

Volume 1, Number 3 | Fall 2006

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