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INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 12, Number 1 ･ Spring 2017

Editorial

The Power of Life
Shuichi Katai

Conference Report

International Conference of World Federation of Acupuncture-Moxibustion Societies (WFAS) Tokyo/Tsukuba 2016
Hiromichi Yasui

Integrating Kampo and Evidence-Based Medicine (9)Headaches that Emerge Accompanying a Decline in Atomospheric Pressure
Hiromichi Yasui

Clinical Report 1 (Acupuncture)

A Case of Acupuncture Treatment for Pain in the Extremities of Unknown Origin
Tomoko Sasaoka

Clinical Report 2 (Kampo Medicine)

A Case of Recurrent Intestinal Bleeding due to Radiation-induced Enterocolitis Successfully Treated with Kyukikyogaito
Takahito Saito

ISSN:1559-033X

College Logos
We believe it is necessary to create a new way of thinking
for the total understanding of "Life, Survival, and Health".
We decided to coin the world "Lifence" to express this.
Lifence means the combination of life sceince and medicine
as well as other disciplines such as health science, psychology,
ethics, etc.
Our college logos symbolizes the above.
The ripple effect represents the ocean and the birth of life.
The rainbow colored sphere represents a safe environment
and a barrier to protect us from negative influences.
The picture by Leonardo da Vinch represents a balanced
body and health.
Completing our logos is a ring which represents the unity ofspace fulfilling the total meanings of lifence.

―

The Journal of
Kampo, Acupuncture andIntegrative Medicine(KAIM)
Research on Theory, Practice and Integration

Volume 12, Number 1 ･ Spring 2017

EXECUTIVE EDITOR

Shuji Goto
Chairman, GOTO College ofMedical Arts & Sciences

TA B L E O F C O N T E N T S

Tokyo, JapanEDITOR-IN-CHIEF

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

1 Editorial
The Power of Life
Shuichi Katai

CA, U.S.A.

ASSOCIATE EDITORS
Shuichi Katai
Ibaraki-ken, Japan

Hiromichi Yasui
Tokyo, Japan

2 Conference Report
International Conference of World Federation of Acupuncture-Moxibustion Societies(WFAS) Tokyo/Tsukuba 2016
Hiromichi Yasui

EDITORIAL STAFF

Akihiro Souma
Hiromi Sasaki
Hiroshi Tsukayama
Hitoshi Yamashita
Junko Okubo
Kazunari Ozaki
Kengo Nakata
Masayuki Kashima
Naoya Ono
Noboru Mitsuhata
Sayaka Toda
Takao Namiki
Toshiaki Makino
Toshihiro Togo

PUBLISHER

Shuji Goto
International Institute of Health andHuman Services, Berkeley

9 Integrating Kampo and Evidence-Based Medicine (9)Headaches that Emerge Accompanying a Decline in Atomospheric Pressure
Hiromichi Yasui

13 Clinical Report 1 (Acupuncture)
A Case of Acupuncture Treatment for Pain in the Extremities of Unknown Origin
Tomoko Sasaoka

19 Clinical Report 2 (Kampo Medicine)
A Case of Recurrent Intestinal Bleeding due to Radiation-induced Enterocolitis
Successfully Treated with Kyukikyogaito
Takahito Saito

2550 Shattuck Avenue, Berkeley
California 94704-2724, U.S.A.

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

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)KOTARO PHARMACEUTICAL introduced in 1957 the world's first Kampo extract
preparations on the market. Later, in 1967, six of our preparations could be covered in Japanfor the first time by the health insurance and after 1976 more than 100 of our preparations
were used in hospitals and clinics. Now it is half a century since we put our Kampo extract
preparations on the market and believe, we made a major contribution to this industry.
In the future we intend to continue working in accordance with our company motto: "Still better
Kampo for still more people" and provide pharmaceutical products of still higher quality.

Origin of the company's name
The company was named "KOTARO" by its
founder Taro Ueda with reference to his birthplace. Close to the ancient city of Nara. Kotaro
is the name of an enormous sheer cliff, 700 m
wide and about 200 m high. Mr. Ueda felt anaffection rising to the heavens for this cliff andthus made it the company's name.

KOTARO PHARMACEUTICAL CO., LTD.
5-23 Nakatsu 2-Chome, Kita-ku, Osaka 531-0071, JAPANURL: http://www.kotaro.co.jp

Volume 12, Number 1 | Spring 2017

Editorial
The Power of Life
Medicine is made up of theories, techniques, and patients who are the subjects of medicine. However, medical
theories and techniques vary according to the times and region.
Modern Western medicine is founded on science. Eastern medicine, on the other hand, is said to be founded
not on science. This is because Eastern medicine is based on theories that are unrelated to science, such as the Theory
of Yin-Yang and the Five Elements and the Three Yin and Three Yang Theory.
Nevertheless, among the fields of Eastern medicine, the biological effects of acupuncture and moxibustion havealso been regarded in terms of physical stimulus and biological reaction, and have been scientifically studied andsupported as well. For example, it was proven in the 1980s that acupuncture stimulation has an effect on promoting
the secretion of β-endorphin, and ongoing studies that have continued from the mid-19th century to today haveshown that acupuncture and moxibustion has an impact on autonomic nerves (such as the somato-visceral reflex
increasing the functions of internal organs). In other words, while acupuncture and moxibustion are said to be
therapies founded on unscientific theories, they also have physiological effects that can be scientifically proven.
From an academic perspective, it might be meaningful to question the meaning of the efficacy of acupuncture
and moxibustion therapy by asserting it as a science on the grounds of the biological effects of their physicalstimulation. In fact, it is well known that the world of acupuncture and moxibustion in Japan after World War II wasparticularly focused on establishing scientific acupuncture and moxibustion therapies. In post-war Japan, being
scientific was a requirement for academic excellence, so proving the efficacy and value of acupuncture andmoxibustion in scientific terms had no doubt been necessary for asserting their existence, in light of their historical,
legal and social status in Japan.
However, the significance of acupuncture and moxibustion today is not necessarily conditioned on clarifying
whether they can be scientifically proven or not. Acupuncture and moxibustion emerged 2000 years ago as medicine of
the ancient Chinese people. They were not only meant to treat illnesses, but also noted that the way in which people
spend their daily lives is directly related to preventing illnesses. Historically, this precise thinking (“the concept of health”)
underlay the spreading of acupuncture and moxibustion in Japan. Kissa-yojoki (Treatise on Drinking Tea for Health),
written by Eisai in the early 13th century, and Yojokun (The Book of Life-nurturing Principles), written in the early 18th
century by Kaibara Ekiken, were instrumental to spreading the concept. Eisai writes from his capacity as a Buddhist monk
who acquired a mastery in Zen, and Ekiken writes from the perspective of health as regarded in Eastern medicine. It issignificant that Ekiken wrote from the standpoint of Eastern medicine. Yojokun consists of eight volumes, and in the 8thvolume with the first half written on the basics of the body and health theories, and the latter half on treatment using
Kampo, acupuncture and moxibustion. Indeed, the weight placed on the meaning of health and specific methods ofstaying healthy differ according to treatment. What Ekiken emphasized the most was that, in life it is important to know
one’s own body, and to know how to live and how not to become ill.
Herein lies the reason why giving scientific grounds to Eastern medicine is not an overriding concern. Without
depending on sciences, Eastern medicine more importantly teaches how to maximize one’s power to live and power
to stay healthy, how to eliminate elements that act negatively on one’s efforts to maximize those powers, and how
to reconcile the natural and social environments and one’s power of life.

Shuichi Katai
Associate Editor of the Journal of KAIM
National University Corporation
Tsukuba University of Technology

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

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Volume 12, Number 1 | Spring 2017

Conference Report
International Conference of World Federation of
Acupuncture-Moxibustion Societies (WFAS)Tokyo/Tsukuba 2016
Hiromichi Yasui
Japan Institute of TCM Research

The

International

Tokyo/Tsukuba

2016

Conference
was

held

of
at

WFAS
Tsukuba

International Congress Center on November 5 and 6,
2016. Headed by Shuji Goto as Conference President
and Shuichi Katai as Head of Vice President, and cohosted by the Japan Society of Acupuncture andMoxibustion and the Japan Traditional Acupuncture
andMoxibustion

Society,

some

1,800

Keynote Lectures
In this session, Dr. Baoyan Liu, President of
WFAS, first gave a comprehensive lecture, followed
by a lecture by Dr. Tadashi Yano, titled “Formationof Japanese Acupuncture and Role in Future
Society.” Dr. Yano presented a wealth of informationthat ought to be disseminated more and more
widely, such as that acupuncture has a significant
effect in preventing the impairment of motor
activity among elderly people, and that applying
acupuncture strengthens the immune system andhelps maintain a healthy mind and body in today’s
stressful society.

guestsattended from throughout the world. Under thetheme of “The Art of Acupuncture and Moxibustion,”it spotlighted the advancements that have been
made in the field of acupuncture and moxibustion
over a period of 23 years since the conference waslast held in Japan.

Dr. Tadashi Yano

The venue was filled with an air or excitement,
and all the sessions were packed full of avid guests.

Dr. Kenji Kawakita gave a lecturethatfocusedonhowJapanese

acupuncture exerts an effect withshallow

insertion.

His

approachtoJapanese

acupunctureevaluating

impressed the audience.

Dr. Kenji Kawakita

2

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

scientificsuchdeeplyVolume 12, Number 1 | Spring 2017

an era of technical profusion. The joint performanceHari-Kyu Technical Sessions
These sessions were divided into seven categories,

was a showcase of remarkable demonstrations byeach featuring lectures that centered on three to four

each school of practice, and provided a glimpse of thethemes.

diverse nature of Japanese acupuncture and

1. Diverse Hari-Kyu Therapeutics from Newborn tomoxibustion.
Just as diseases differ depending on age, so do theYoung Adults
2. Dealing with Young Adults to Patients in thepractices of acupuncture and moxibustion. The
series of presentations that demonstrated this also

Mature Stage of Life
3. Coping with Mid-Life Symptoms with Hari-Kyu

spotlighted the detailed and meticulous skills of

4. Coping with Mid-Life Symptoms with Hari-Kyu

Japanese acupuncturists. For example, Dr. Satoru

5. Acupuncture Solutions for the Elderly Patients

Yamaguchi’s approach to treating headaches by

6. Hari-Kyu Exhibition: When History and Art Meet

drawing fully upon all available information, is

7. Acupuncture for Common Diseases

probably unique to Japan.

The speakers used their allotted 25 minutes tothe fullest to demonstrate their own practice or thepractice of the school of acupuncture to which they
belong. They demonstrated acupuncture on model
patients while explaining each procedure, andshowed the changes that such treatment can bringabout.
This was a groundbreaking idea. What everyone
had been seeking for long, but what no one had so far
attempted, was realized at WFAS Tokyo/Tsukuba
2016. The audience turned its undivided attention to
the joint performance by each school of practice, and

Dr. Satoru Yamaguchi

gave a round of applause to each technique.
These technical sessions also included a 60minute luncheon technical seminar on both days ofthe conference.
Luncheon Technical Seminar 1: Meridian Therapy
LuncheonTechnical

Seminar2:

WisdomofJapanese Acupuncture and Moxibustion
Theoryisimportanttoacupunctureandmoxibustion, but the technical aspect is just as
important. Japanese acupuncture and moxibustion
blossomed in diverse ways from the late 16th century
to the mid-17th century, and thereafter developed byadopting Chinese acupuncture and moxibustion
practices that were standard at the time.
However, ongoing developments have produced
diverse acupuncture and moxibustion techniquesThis WFAS conference will no doubt go down inhistory as one where differing schools of practicecame together and put on a joint performance.
These schools included Daishi-Style Shonishin
Association, The Japanese Society of Ryodouraku
Medicine,

Toyo

Hari

Medical

Association,

Shakuju Association, Tohokai, Tokyo Kyuushin
Kenkyukai, Koshinkai—A Society for the Studies
of

Acupuncture,

Moxibustion

andMeridian,

General Incorporated Association Hokushinkai,
Nagano Method Clinical Study Society, The Japan
Society of Pediatric Acupuncture

and TheSociety for the Meridian Therapy. The conference
will furthermore mark a new starting point forJapanese acupuncture and moxibustion hereafter.

today, such that we are poised to once again welcome

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

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Volume 12, Number 1 | Spring 2017

A scene from a Hari-Kyu Technical Session
A future issue lies in making sure each techniqueleads to studies based on clinical evidence. Toward
this end, it is important to present case reports tomedia that is recognized by large numbers of people.
Well-writtencasereports

outweigh

poorlyconducted RCTs. Moreover, sharing each school’s
standard treatment methods for various diseases
provide a good reference to many people. Each schoolof practice should aim to achieve universality,
instead of remaining in its own shell. In this sense
as well, the technical sessions provided a good
opportunity for all acupuncturists to think about the
future of Japanese acupuncture and moxibustion.
Dr. Yong-Suk Kim from South Korea and Prof.
Jing-xian Han from China also participated in theProf. Jing-xian Han

Videos of the Hari-Kyu Technical Sessions, alongwith videos of other sessions, will soon be released
for sale as a DVD set by the WFAS 2016 executive
committee. It is expected to benefit front-line
acupuncturists.

technical sessions. In particular, the presentation on“San Jiao Acupuncture Method and Cognitive
Impairment,” which introduced the joint study
carried out by Prof. Jing-xian Han and Prof. Akira
Hyodo in Japan and the results thereof, captured theattentionofthemedia.

Warm

supportandencouragement are extended to the two gentlemen
for their study and practice that address head-on theissue of dementia, which is claiming an increasing
number of patients both in China and Japan.
WFAS Tokyo/Tsukuba 2016・Set of 15 DVDs

4

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

Volume 12, Number 1 | Spring 2017

Japanese Acupuncture Overseas
This session introduced Japanese acupuncture
and moxibustion that are practiced around the world.
Mr. Junji Mizutani, a Canada-based acupuncturist
involved in the publication of North American
Journal of Oriental Medicine (NAJOM), introduced
the significance of the bilingual journal. Mr. Yoshihiro
Odo from Brazil outlined the history of acupuncture
and moxibustion in Brazil, and described theirsomewhat tangled status in today’s medical industry.
Mr. Haruo Yamaki from Nicaragua discussed thehistory of Japanese acupuncture in Nicaragua since
1987, with a sense of pride and confidence as one who
has played a central role in its dissemination. The
establishment of the University of Oriental
Medicine’s five-year program is particularly worthy ofmention, and high expectations are pinned on theuniversity’s graduates. Dr. Mitsuharu Tsuchiya, whoboasts 40 years of clinical experience in Portugal,
spoke about the potentials and practice of Japanese
acupuncture and moxibustion. Mr. Tadanori Takada,
who works at the National Center of Traditional
Medicine, Ministry of Health in Cambodia, discussed
the possibilities of utilizing traditional medicine in
ASEAN developing countries, and introduced cases ofacupuncture and moxibustion treatment in the
country.
Japanese acupuncture is also widely practiced incountries in addition to those introduced in theconference. For the future of traditional medicine, it
shall become important to view Japanese
acupuncture from a comprehensive, global
perspective, and consider new styles that befit its
global status.
Public Seminar
Academic conferences generally offer a public
session, and this conference was no exception. Twohighly interesting lectures were offered to generalvisitors under the theme of “Moxibustion can change
the World,” and introduced the practice of Japanesestyle moxibustion in Africa and Nepal.
Ms. Yuki Itaya is a California licensed
acupuncturist, lives in the U.K. She lectured on theactivities of Moxafrica, where she works as a trustee.
Surprisingly, the activities attempt to provide relief
to tuberculosis and AIDS patients in Africa, throughJapanese-stylemoxibustion.
That
is,
the
organization teaches the patients the simple methodof applying moxa to just two points—the Zu San Li
on both legs—through a doctor or nurse, so that thepatients can apply the moxa by themselves. In her
lecture, she spoke fervently about how manytuberculosis and AIDs patients can be saved using
this simple method.
Ms. Minae Hata, representative of Yomogi No Kai,
is working to establish an acupuncture and anma
massage school and a moxa production factory in
Nepal, to export moxa from Nepal to Japan, and to
spread Japanese-style acupuncture and anma
massage in Nepal. She is also aiming to spread
Nepal moxa sticks in Japan.
These two women deserve our utmost respect for
their strong will to contribute to people’s healtharound the world through moxibustion, and theirenergy and capacity to realize that goal.
Moxibustion is a treatment that was developed in
China, but Japan is today the only country thatpractices the original moxibustion method ofburning moxa directly on the skin. Based on Dr.
Shimetaro Hara’s study, Moxafrica has developed atreatment against tuberculosis and AIDs, and has
applied it to clinical practice, with remarkable
results. Numerous people have regained their healthand prolonged their life.

A photo showing a Moxafrica team applying moxa to
the Zu San Li

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

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Volume 12, Number 1 | Spring 2017

Ms. Yuki Itaya lecturing about Moxafrica

Hari-Kyu Scientific Session
This session was composed of two parts.
1. Pleasantness in Acupuncture Therapy
2. Treatment of Tuberculosis Using Direct
Moxibustion
The first part on acupuncture focused on the roles oftactile afferents and reward system. Among thelectures, Professor Kenji Kawakita’s lecture proved to
be a highly significant one that emphasized the strong
importance of shallow insertion with soft stimulations
that are characteristic of Japanese acupuncture. The
second part on moxibustion discussed the future
potentials for implementing deeper studies and morewidescale treatment activities, in reference to the factthat studies that form the foundation of Moxafrica’s
activities, which had already been implemented in the
1930s, have been revived today. In Japan, there is theexpression, “onko-chishin.” In English, it means“developing new ideas based on a study of the past, andlearning from the past.” Dr. Shimetaro Hara’s study ofmoxibustion for tuberculosis had long been forgotten,
but its revival by Mr. Merlin Young illustrated to us
that the spirit of the saying is still alive today. Mr.
Young is the founder of Moxafrica.

Oral Presentation
Tsukuba International Congress Center has
many rooms with a capacity of approximately 50
people. The oral presentations were held in theserooms, each of which were filled with a lively air of
excitement. The lectures were diverse, ranging fromacupuncture and moxibustion case reports, to an
introduction of new technologies and a rediscovery ofold technologies, as well as reports of basic researchand studies of history of medicine. There is notenough space to introduce them all, so let us
introduce an exemplary moxibustion study by Mr.
Sumikazu Nakayama, on “Direct Moxibustion forJapanese and Non-Japanese Pilgrims; Researching
Differences in Research in Reaction to the Protocol.”In his study, Mr. Nakayama applied ancient directmoxibustion, which is practiced only in Japan today,
on Japanese pilgrims and foreign visitors to Japan,
and asked them to answer a questionnaire. As aresult, the negative image of moxibustion decreased,
and a positive image increased in both groups ofpeople. The study provided useful reference forpredicting whether the direct moxibustion method,
also practiced by Moxafrica today, will spread on a
global scale hereafter.
Poster Presentation
Poster presentations, which were divided into twodays, as they were so many of them, attracted large
crowds of people on both days. Particularly
conspicuous were scenes throughout the venue,
where visitors and presenters were seen engaged inheated discussion, asking and answering questions,in front of each poster presentation.

Crowds of people at the poster session

6

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

Volume 12, Number 1 | Spring 2017

There were also many presentations by overseas

could offer. This was perhaps the first time that thepresenters. The WFAS Tokyo/Tsukuba 2016, being

acupuncture and moxibustion community in Japanan international conference where the official

came together as one and demonstrated its

language is English, attracted many presentations

capabilities to foreign organizations and societies. In

from English-speaking countries.

this sense as well, WFAS Tokyo/Tsukuba 2016 was a

For example, the photo at right shows apresentation by Ms. Robyn Adcock from Acupuncture& Integrative Medicine College, Berkley (AIMC) in
California.
An interesting point
about her study is that she
examined the effects ofacupuncture
applying
acupuncture to medical
staff members of a hospitalin San Francisco. Because
the subjects were medical
staff
members,
they
understood
their
own
conditions
well,
and
applying
acupuncture
treatment to such people
meant that it was possible
to acquire direct feedback
from medical specialists.

truly groundbreaking event.
Other photos

Registration for the conference

Ms. Robyn Adcock from
AIMC Berkeley in California

The hospital has recognized Ms. Adcock’s study, andwill offer a grant to her group next year.
Summary of the Conference
WFAS Tokyo/Tsukuba 2016 was well planned

Exhibition hall filled with visitors

overall, and was implemented in great detail. It wasa remarkable event that illustrated how aninternational conference should be implemented.
The seven Keynote Lectures, the Hari-Kyu
Technical Sessions that included a Luncheon
Seminar,lectureson

Japanese

Acupuncture

Overseas, Hari-Kyu Scientific Sessions, 24 Oral
Presentations, 212 Poster Presentations, and 32
Student Poster Presentations, filled the entire venue.
The conference was an international conference,but taking advantage of its being held in Japan, theacupuncture and moxibustion community in Japan

Scene from the gala banquet

launched full-scale efforts to provide the best they
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 12, Number 1 | Spring 2017

Impressive displays of the Hari-Kyu Museum

8

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

Volume 12, Number 1 | Spring 2017

Integrating Kampo and Evidence-Based
Medicine (9)Headaches that Emerge Accompanying a Decline in
Atomospheric Pressure
Hiromichi Yasui
Japan Institute of TCM Research

Barometer apps
Soon after the principle of the barometer was
discovered in the 17th century, it was found thatweather deteriorations caused by the approach of alow-pressure system are preceded by a change inatmospheric pressure. The barometer thus came to
be used for weather forecasts, and became a

A rain-praying shrine maiden
Machio Kazeno, a Japanese novelist, writes
highly popular historical novels that are also
mysteries. Among his short stories, there is a story
called “The Disappearance of a Beautiful Rainpraying Woman”1). It is a story about a woman who
becomes the talk of the town, because it rains
without fail whenever she prays for rain. The story
thus begins, without anyone knowing why it always
rains when she prays for rain.
However, the main character of the story
eventually uncovers the truth. The woman has three
younger sisters and two younger brothers who live
off her earnings. The woman’s youngest sister closely
resembles her rain-praying eldest sister in physicalbuild.
The main character sees the resemblance, andsays to the youngest sister, “I bet you can tell whenis going to rain. Am I right?” The young girl answers,“Rain? Well, yes, it often rains a few days after I geta headache, feel lightheaded, or experience aburning sensation on my skin.”
The young girl’s eldest sister also experienced achange in her physical condition a few days before
whenever it rained and could thus predict rain, so as

particularly important and indispensable tool for
ship

navigation.

In

the

beginning,mercury

barometers were the most common, but thereafter,
the Aneroid barometer was invented, and the
Bourdon tube barometer also emerged. Today,
barometer systems that incorporate a semiconductor
sensor and output atmospheric pressure readings asdigital signals are widely used.
In fact, iPhone 6 is equipped with a built-in
barometer, which not only measures atmosphericpressure, but also warns users of headaches andother illnesses that might be caused by a drop in
atmospheric pressure, via a free dedicated app(English/Japanese).
Some types of headaches and migraines arecausedaccompanying

a

drop

in

atmosphericpressure. According to the above-mentioned app,seven million people suffer this symptom.
A considerably large number of people benefit
from this app, because when they receive a warning,they can promptly take a prophylactic or hold backon working too much, in anticipation of a headache.
It is said that 250,000 people use the app every
month.

a shrine maiden, she prayed for rain whenevershe predicted that it was going to rain. Therefore,
the truth was that the woman did not have thepower to make it rain, but had responded to herclients’ expectations only when she knew it wasgoing to rain.
Reading the above, there are apt to be people
who claim the story is unbelievable, and those
who claim that they have the same experience.
Actually, in Japan today, there are said to besome seven million such people.

Website for the “Zutool” barometer app

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

9Volume 12, Number 1 | Spring 2017

GoreisanDr. Haimoto discovered that when smoke from

In modern medicine, there is hardly any difference

the chimney of a paper mill in front of his clinic

between drugs that are administered for headaches

flowedinacertaindirection,and migraines occurring from a drop in atmosphericdeteriorated on the following day, and on such dayspressure and drugs that are administered forin particular, the number of headache patients

headaches occurring irrelevant to atmosphericincreasedpressure. That is, they are both taken to control theadministering goreisan to these patients prevented

onset of pain, and do not necessarily prevent pain.

the headache from occurring, or prevented it fromsignificantly.

He

also

the

weather

found

that

In Kampo medicine, however, there is a drug forintensifying even if it did occur. He thus launched apreventing headache pains from occurring. In 2005,

study with his fellow physicians to learn what types

I introduced a study conducted by Dr. Haimoto in theof headaches goreisan is effective against, andfirst issue of this journal (Vol. 1 No. 1). The study

achieved the above-mentioned result.

found that administering goreisan to patients whodevelop a headache prior to rain is 16.3 times more

Barometer apps and goreisan

likely to be effective than in patients who do not

You probably understand now why I introduced

experience a headache prior to rain. The odds ratio

the story about the rain-praying shrine maiden atwas 16.32).

the beginning of this paper. An extremely large
number of people develop a headache when there isa drop in atmospheric pressure. Some people may beable to sense a drop in atmospheric pressure like theshrine maiden, but since the majority of people are
not as susceptible to changes in atmosphericpressure, barometer apps like the one in iPhone
would probably be useful.
Proper diagnosis is the first step to treatment.
Kampo medicine provides treatment methods thatare not offered by modern medicine. In Vol. 1 No. 1of this journal, I introduced cases of this type3), butsince then, I have successfully treated many similar

Introduction of Dr. Haimoto’s paper
in Vol. 1 No. 1 of this journalpatients with goreisan. Below is an example of one
such case.

The remedy of using goreisan against headaches
was born from a Japanese physician more than 200
years ago. This clinical pearl had long been forgotten,
but was rediscovered approximately 60 years ago,
and

has

since

come

to

be

used

popularly.

Nevertheless, there was no knowing on what

Case: 31-year-old female
First visit: May 22, XXXX
Chief complaint: Headache
History of present illness: The patient developed aheadache at around the age of 18. Since then, theoccasions it ought to be used. Articles written in theheadache has continued till today. It mostly occurred

Shokanron (Treatise on Cold Damage) andKinkiyoryaku (Prescriptions from the Golden

frequently in summer than winter. It was not related

Cabinet) were of no use in this regard.

before the weather deteriorated, and occurred more
to menstruation. There was no pulsating, butvomiting occurred when it intensifies. It constituted
an atypical migraine.

10

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

Volume 12, Number 1 | Spring 2017

Good appetite. Ordinary sleeping pattern.

The patient visited my clinic for the first time in

Dry mouth.

May XXXX. The fact that her headaches occurred

Urination 5 times/day; Bowel movement once/day

more frequently in summer than winter was related

Menstruation: Regular pattern

to Japan’s unique weather conditions around thistime of year.

Present conditions: 158 cm, 58 kg

The Japanese archipelago lies in the path of

Pulse: Sunken
Tongue: Pale, teeth marks (+), thin white coating

typhoons from May to September. In fact, more than(+)

thirty typhoons travel through the Japanese islands

Abdomen: Intermediate abdominal strength, fluidat the most during this time. All the while, theretention in stomach (-). Nothing else in particular.

islands are subject to unstable weather, withPrescription: 6.0g Kracie goreisan, 3 times a day

atmospheric pressure dropping and rising.
The patient had typical symptoms that were

before meals
Progress: goreisan was first administered for two

susceptible to goreisan, so I administered the drug.

weeks. The headache stopped, so the medication was

As a result, her prognosis was good, and goreisan

terminated.

headache

was not no longer needed after a while. However, notsometimes occurred thereafter before the weather

many patients necessarily exhibit this progress, anddeteriorated, so she visited the clinic occasionally formore than a few patients continue to take the drug

a prescription and took the drug when she felt aover several years.

However,thepatient’s

headache might occur, because she knew that taking
the prescription would cure her of her headache.
After November, the headache was gone, and she nolonger needed to take goreisan. In May of thefollowing year (XXXX+1), the patient came to theclinic, saying a headache occurred for the first timein months, so two weeks’ worth of goreisan was
administered. It was typhoon season in Japan then.
For about a year thereafter, the patient did not makea visit to the clinic, until June of XXXX+2, when shecame regarding a different illness. She said she did
not experience a headache during the long interval,
so I did not administer goreisan.

Conclusion

This patient’s case was a typical case in which

goreisan applied. The only abnormity in themetabolism of water was dry mouth, and nothingelse was observed in particular. This meant that no
diagnosis

could

be

providedbytraditional

examination methods. In this patient’s case, theobservations that a headache frequently occurs
before the weather deteriorates, and that it occurs
more frequently in summer than winter, bore more
importance.

Typhoon information for the area around Japan on July 2, 2017

Most

headaches

andmigraines

that

occur

accompanying a drop in atmospheric pressure aresusceptible to goreisan . However, there are somepatients whose symptoms do not abate even after
taking goreisan . In this case, ryokeijutsukanto andhangebyakujutsutenmato are sometimes effective.
Dr. Yan, a friend of mine who runs a clinic in
Okinawa, says such headaches are rather more
susceptible to hangebyakujutsutenmato4). Theremay be a difference in what prescription is effective
depending on the region.

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

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Volume 12, Number 1 | Spring 2017

There are regions throughout the world that are
subject to large climate fluctuations. To headache
patients who live in these regions, goreisan might bea dream come true. Meteoropathy is also susceptible
to Kampo drugs.
References
1) Kazeno, Machio. Enma Sabaki (2) Amagoi no bijo

ga kieta (Enma’s Judgment (2) A rain-praying
beautiful woman disappears), Kadokawa Haruki
Corporation, 2016.
2) Hiromichi Yasui: Efficacy of “goreisan (Poria

Powder with five Herbs)” to the Headache, An
epidemiological research on relationship between
chronic headache and an atmospheric depression,
The journal of KAIM Vol.1 No.1, pp7-11, 2006
3) Yoshihide

Yakazu,Hiromichi

Yasui:

Twointeresting Cases of Headache using “goreisan(Poria Powder with five Herbs)”, The journal of
KAIM Vol.1 No.1, p23, 2006
4) Chorson Yan: Clinical Report Haedache, The
journal of KAIM Vol.4 No.1, p16, 200912

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

Volume 12, Number 1 | Spring 2017

Clinical Report 1 (Acupuncture)
A Case of Acupuncture Treatment for Pain in theEtremities of Unknown Origin

the patient to a doctor at the department of
Traditional Herbal Medicine of the Center for
Integrated Medicine affiliated with the Tsukuba

Tomoko Sasaoka

University of Technology. In this hospital, theAcupuncture Specialty, Department of Health Sciences,
Tsukuba Univercity of Technology

patient was subjected to thermography examinationand MRI (lumbar spine). His clinical examination
did not reveal any abnormalities.

1. Introduction
In this case report, the patient presented with an
unknown illness with symptoms similar to those of
neuropathy and signs of anhidrosis. The patient wassuspected of having Acquired Idiopathic Generalized
Anhidrosis (AIGA), which is an incurable disease.
The onset, mechanism, cause of symptoms, andeffective treatments of AIGA have yet to beelucidated. I report a rare case of treating a symptomof unknown origin and with similar characteristics
to those of AIGA using acupuncture.

Suspicionsofentrapment

neuropathy,

pesticide-induced

spondylopathy,
toxic

myelopathy,

diabetic

neuropathy,

neuropathy,

obstructive

arteriosclerosis, Sjögren’s syndrome, and restless leg
syndrome

were

clearedthroughvariousexaminations; the underlying cause of the symptoms
in

this

case

remainedundetermined.

The

examination dates have been summarized in Table 1.
The patient was subsequently referred to ourdepartment, and we started acupuncture treatment.

2. Case study

Chief complaint: pain of the extremities
A 78-year-old Japanese male patient presented withpricking and burning pain sensation in both
extremities that had started approximately 2 years
earlier. The pain was described as being similar to aburning sensation, with numbness and anhidrosis.
Immediately after the patient became aware of his
symptoms, he consulted a neighborhood internal
medicine clinic. The cause of the pain remained
unclear. However, because mildly elevated bloodpressure and cholesterol levels were detected, he wasadministered a hypotensive agent, lipid-loweringdrug, and Kampo medicine. After 1.5 years from theonset of the disease, the patient visited anotherhospital for a detailed examination by specialists inneurology and orthopedic surgery. The examinations
included blood tests, angiography of the lowerextremity

vessels,

cervicalmagnetic

resonance

spine

imaging

X-raysand(MRI),

andmeasurement of the nerve conduction velocity in all
extremities. However, the etiology of the condition
remainedundeterminedfollowingthese

examinations. Therefore, the neurologist referredFigure 1 Affected regions

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Table 2 Laboratory findings

Details of the chief complaint
The symptoms affected the entire forearms and thelower legs, and included sharp pain and numbness
continuously present, and the attacks intensified by

Nerve conduction velocity (m/sec)* latency in either case within
normal range

several aggravating factors (see below). Edema wasMedian nerve MCV (m/sec)

associated with heat sensation. The symptoms wereobserved in the same locations. During the attacks,theaffectedregions

additionallydeveloped

generalized rubor (Fig. 1).

Aggravating factors

Right

Left

55.1

52.4

SCV (m/sec)

57.9

59.1

F-wave (%)

81

63

51.7

52.4

SCV (m/sec)

58.3

58.1

F-wave (%)

94

94

Deep fibular nerve MCV (m/sec)

44.8

44.1

Ulnar nerve MCV (m/sec)

The symptoms were paroxysmally intensified by

SCV (m/sec)--

several aggravating factors, including bathing,F-wave (%)--

putting on shoes and walking, going to sleep, andPosterior tibial nerve MCV (m/sec)

39.2

44.4

-

-

SCV (m/sec)

eating irritants like red pepper.

Alleviating factors
The symptoms were alleviated by cooling andF-wave (%)

100

100

Sural nerve MCV (m/sec)--

SCV (m/sec)

7.0

12.3

F-wave (%)--

Pallesthesia (medial malleolus)

mildlydecreased
4/5

mildlydecreased
4/5

MRI, X-ray (neck)mild deformation of
cervical spine

MRI (lumbar region)

mild deformation oflumbar spine

Thermography (no endurance test)

N.P.

Angiography (lower extremities)

N.P.

Blood examination (general blood
tests (biochemistry, blood cells),
including renal function, liverfunction, blood glucose,
inflammatory reaction)

N.P.

stroking the extremities.
Other factors associated with the condition of thepatient included dry skin and dry mouth. As sleep
was also affected by attacks occurring before goingto sleep, the patient’s quality of life (QOL) was
markedly impaired.

Table 1 Overview of medications taken over time

14

Date

April of year X-1

Usedmedications

Olmetec
AtelecAdalatBezatol SR
Keishibukuryogan(Tsumura #25)

September ofyear X-1
Olmetec

February ofyear X
Olmetec）

May ofyear X
Olmetec

AtelecAdalatBezatol SR
Sanmotsuogonto
extract granules(Tsumura #121)

AtelecNifelantern CR
Bezafibrate
Keihikajutsubuto
extract granules(Tsumura #18)

Adalat
BI・Sifrol

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

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Volume 12, Number 1 | Spring 2017

Patient’s circumstances before the onset of theattacks
The patient was pruning the garden trees using a chain
saw under the care of the municipality in the residential
area when the attacks were first experienced. The
pruning time by far exceeded the vibration exposure
time (2 hours/day) specified in a notification by the
Labor Standards Bureau of the Health, Labor andWelfare Ministry. Immediately before the attacks, thepatient had sprayed pesticides onto the trees.

Patient’s social/mental environment
The patient lives with his wife, who is suffering from
cognitive impairment. As she requires constantsupervision, he has no time for physical and mental
rest. His role as head of the residents’ association isanother source of stress. However, as his position is

Other findings: (1) heat with agitation in the palms,
soles, and chest; (2) no sweating; (3) dry mouth; (4)large amounts of sputum; (5) loss of appetite; (6)tension of skin and muscles; (7) muddy stools; (8) low
back pain (aching pain); (9) increased muscle tensionof the entire legs; and (10) ingestion of 2 liters of water
per day.

Physical characteristics:
The patient was 162 cm tall, weighed 66 kg, and had abody mass index (BMI) of 25.1 kg/m2.

Medications
The administered medications included Olmesartan
medoxomil, Cilnidipine, Nifedipine, Bezafibrate,
Cinnamon Twig, and Poria Pill (桂枝茯苓丸エキス顆粒:Tsumura #25, Tsumura & Co, Tokyo, Japan).

a source of income, he cannot quit.

Past medical history

Oriental medical findings

The patient had previously experienced severe alveolar
pyorrhea and had many missing teeth .

Pulse patterns: Deep, moderate deficiency.
Abdominal patterns: Weakness of the lower abdominal
region, para-umblical tenderness, and resistance.
Tongue patterns: Dark red color, dry, and yellow coating.

Family history
There were no appreciable diseases noted in thepatient’s family history.

Figure 2 Symptom diary

Date

BedtimeTimeofrisingFrequencyof attacks
during thenightFrequency ofcooling arms
and legs withwater during
the night

Frequencyof attacks
during theday

Frequency ofcooling arms andlegs with water
during the day

NRS* Please referto the notes
below.

Comments
Changes in physicalcondition or events
during daily life etc.

NRS notation. The most uncomfortable condition before acupuncture treatment is given a score of 10 points, while total
absence of symptoms receives 0 points. Please evaluate in general how irritating your symptoms were today and assign ascore between 0 and 10 points to the condition.

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Volume 12, Number 1 | Spring 2017

Figure 3 Clinical course

Personal history
The patient was a smoker, with a Brinkman index (thenumber of cigarettes smoked per day multiplied by the
number of years of smoking) of 3,300; no alcohol
drinking was reported.

Social history
The patient is unemployed (no occupation) but isactive as the head of the residents’ association.

the regions of pain to alleviate the pain and reducemuscle tension. This treatment was combined withneedle retention on the lower back and legs. Afterthe 7th session, the goal of the traditional
acupuncture treatment was changed to draining
dampness, clearing heat, and nourishing yin; thus,
acupuncture was administered to Dazhong (KI6),
Sanyinjiao (SP6), and Qu Chi (LI11).

Evaluation method
Western medicine diagnosis

The Numerical Rating Scale (NRS) was used to score

Unknown.

the originally prepared symptom diary (Fig. 2).

Oriental medicine diagnosis

3. Results

A diagnosis of Bi-syndrome (fixed impediment andheat impediment) and kidney deficiency was made.

The results are shown in Fig. 3. Since we started
documenting the patient’s symptoms in the diaryfrom the 7th session, I wrote down the clinicalTreatment

process from the 1st to the 6th session based on theStarting from the 1st to the 6th session, a 50-Hz low
frequency
Transcutaneous
Electrical
Nerve
Stimulation (TENS) was administered for 20 min to

medical interview. From the 1st to the 6th session, adecrease in the frequency of the attacks and increasein the mobility of the legs were observed, with nomarked improvement. After changing the traditional

16

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

Volume 12, Number 1 | Spring 2017acupuncture treatment plan starting from the 7th

deficiency, invigorating spleen, and nourishing yin forsession,andtranquilization. The result was an alleviation of both

frequency of the attacks significantly decreased,

the chief complaint and the associated symptoms,

with day-to-day variations. The NRS score also

leading to an improvement in the QOL. In oriental

dropped to 3 by the 8th session. In conjunction withmedicine, the practitioner uses all five senses tothese changes, the large amounts of sputum also

perform the four forms of examination and arrive at adecreased by this time; by the 10th session, thecharacteristic diagnosis of the condition. Thesepatient had almost completely stopped expectorating.

characteristics resulted in a treatment plan in the

Furthermore, the mouth dryness had markedly

present patient, who had not been diagnosed based on

improved, and sweating could be observed by theWestern medicine, which has thus worked to his

16th session.

advantage.

bothseverity ofthesymptoms

On the other hand, the anhidrosis, burning sensation,
4. Discussion

and heat stagnation of unknown origin were

The etiology in this case remained unknown as per

identified as symptoms of AIGA. Until the 1990s,

Western medicine. However, as the chief complaint

there had been almost no reports on AIGA, which was

was pain, I first attempted to relieve the pain byrecognized as a new disease only over the past 20–30

applying TENS based on the gate control theory.

years. The disease is observed mainly in East Asia,

However, as the TENS did not induce sufficientwhile only a few hundred cases have been reported in

improvement and the patient had several otherJapan. Thus, only few facilities are capable ofsymptoms like anhidrosis, I switched to an oriental

diagnosing AIGA in Japan, where it has been

medicine-based treatment plan starting from the 7th

designated in 2015 as an intractable disease. Whilesession. The patient complained of severe pain

the mechanism of AIGA onset and etiology are still

associated with a burning sensation and heat

unknown, a characteristic type of inflammation of thestagnation. In terms of Oriental medicine, insufficientsweat glands is observed and treatment with steroids

chewing during meals because of missing teeth

is markedly effective, increasingly suggesting that it(kidney deficiency) and chronic inappetence (spleen

is an autoimmune disease. Moreover, based on

deficiency), frequent diarrhea (spleen deficiency),

characteristic findings obtained through sweating,edema (water-dampness), and ingestion of large

thermography endurance, and drug tolerance tests,

amounts of fluids (2 liters of water per day) (spleen

the effective diagnosis of AIGA has been established.

deficiency and water-dampness) were also noted. All

In addition, after the first treatment guidelines1) wereof these factors, due to aging and kidney deficiency,

published in 2013, a revised edition was published in

led to the deterioration of spleen deficiency and20152-3). Patients with AIGA present characteristic

stagnation of damp phlegm. Caring for his wife andclinical symptoms, including a decreased function ofgetting along with neighbors caused mental stress inthe sweat glands. Systemic destruction of the sweat

the patient (liver-spleen disharmony), which also

glands may subsequently lead to anhidrosis, burning

contributed to deterioration of the patient’s condition,

sensation, and flaring. Since the suppression of

causing heating up of the stagnant water, leading

sweating impedes heat dissipation, even mild exercise

subsequently to stagnation in the vessels in the fouror bathing may cause a heat stroke in patients with aextremities and probably to Bi-syndrome (heatsevere condition. Thus, the current guidelines provide

impediment). Local, symptomatic treatment was

patients with AIGA with clear instructions regarding

directed at clearing the heat and expelling phlegm,

body temperature control and cooling methods.

while root treatment served to improve the kidney

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

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Volume 12, Number 1 | Spring 2017

The present patient also presented with anhidrosis,

7. Referencesburning sensation, and flaring. His symptoms

1) Takahiro SATO et al.: Treatment Guideline forbecame aggravated following exercise, putting on

Acquired Idiopathic Generalized Anhidrosis, The

shoes, bathing, going to bed, and similar activities

Autonomic Nervous System, 50(1):67-74, 2013.

associated with a rise in body temperature or(Publish in Japanese)

impeded heat dissipation. Since walking barefoot on2) Health and Labour Sciences Research Granta cold floor or pouring water on the body relieved the(research project into the control of intractable

symptoms, this case closely resembled AIGA.

diseases), investigative research team for rare

As stated above, AIGA is a rare disease and canintractable skin diseases, committee for thecurrently be treated only at a few medical facilities.

preparation of the "Treatment Guideline for

Unfortunately, this patient was never checked andAcquired Idiopathic Generalized Anhidrosis" etc.,

treated based on a suspicion of AIGA.

Treatment Guideline for Acquired Idiopathic

In this case, diagnosis remained uncertain as per

Generalized Anhidrosis, The Autonomic Nervous

Western medicine, but the symptoms closely

System, 52(4):352-9, 2015. (Publish in Japanese)

resembled those of AIGA. The results suggested that

3) Takichi MUNETSUGU, Hiroo YOKOZEKI et al.,acupuncture treatment is effective for alleviating the

Revised guideline for the diagnosis and treatment

symptoms of AIGA or other diseases with similarof acquired idiopathic generalized anhidrosis in

symptoms.

Japan, The Journal of Dermatology 44(4), Version
of Record online, 2017.

5. Conclusions
Traditional acupuncture treatment was effective inrelieving pain of an unknown origin in both limbs
and significantly relieved both the chief complaint
and its associated symptoms. Detailed examinations
at the hospital did not reveal any anomalies, and the
diagnosis remained uncertain as per Western
medicine. Alleviation of the symptoms following
application of an oriental medicine-based approachsuggested that this approach can be expected to
improve the QOL.
6. Acknowledgement

I would like to thank Editage (www.editage.jp) for
English language editing.

18

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

Volume 12, Number 1 | Spring 2017

Clinical Report 2 (Kampo Medicine)
A Case of Recurrent Intestinal Bleeding due to Radiationinduced Enterocolitis Successfully Treated with
Kyukikyogaito

Takahito Saito1)2)

1) Medical Corporation Tomidahama Hospital2) Yokkaichi Medical Association,
Kampo Medicine Study GroupAn 88-year-old woman suffered from recurrent
intestinal bleeding because of radiation-induced
enterocolitis after radiation therapy for cervicalcancer of uterus about ten years ago. Recently, she
was diagnosed renal anemia and chronic heartandacceptediron,vitaminB

anderythropoietin therapy simultaneously.
On March 13th in 2015, she was admitted to thehospital due to exacerbation of anemia. On her
admission course, dark bloody stool was sometimes
detected. Blood transfusion was done three times
within about a month, but anemia was not recovered.
Judged that venous bleeding, “oozing”, repeatedly
continued and there are no indication to endoscopic
and surgical procedures, kyukikyogaito, Kampo
medicine, was started under this poor condition (“yindeficiency”) just after fourth blood transfusion. Afterthen, anemia was recovered sooner and bloody stool
was not detected. She was successfully treated withkyukikyogaito and discharged on April 22th. One
month after her discharge, anemia was recovery, sokyukikyogaito was stopped.
Radiation-induced enterocolitis is well-known tohematochezia. There are several strategies for thisdisease such as hemostatics, blood transfusion,
drug’s enema, endoscopic and surgical procedures.
According to experience of this case, kyukikyogaito
isLower gastrointestinal bleeding is commonly
known

to

be

causedbyradiation-induced

enterocolitis after radiation therapy for prostatic
cancer or cervical cancer. Generally if the bleeding is
not remarkable, and can be expected to stop
naturally by itself in most cases. However, in caseswith continuing bleeding, a hemostatic may be
administered, or blood transfusion may be given.

Abstract

failure,Introduction

effective

toradiation-induced

enterocolitis

repeating intestinal hemorrhage.
Keyword: radiation-induced enterocolitis, venous
bleeding, Kyukikyogaito

Endoscopic treatment and surgical resection are also
attempted, but resection may be difficult in somecases1).

Kyukikyogaito is made from seven types of crude
drugs: Rehmanniae Radix, Paeoniae Radix,
Angelicae Acutilobae Radix, Glycyrrhizae Radix,
Cnidii Rhizoma, Asini Corii Collas andArtemisiae Folium. It is known as a type ofhemostatic

that

is

effectiveforgynecological

bleeding, urologic bleeding, hemorrhoidal bleeding,and other venous bleeding in the lower body. It is aprescription that acts against yin deficiency (poorcomplexion,

pallidcomplexion,

ectomorphism,

sensitivity to cold), and has been used for female
genital bleeding, as written in the section on
gynecologicalandpregnancy

illnesses

intheKinkiyoryaku (Essential Prescriptions from theGolden Cabinet)2). It is said to be effective tosymptoms of anemia in patients who are sensitive tothe coldness and experienced longer bleeding, suchas hemorrhoidal bleeding, post-traumatic internal
bleeding, postpartum bleeding or anemia.
In this particular case, the patient’s anemia
advanced despite of receiving blood transfusions
three times. Though chronic, persisting venous
bleeding was suspected, and natural hemostasis was
judged to be difficult. Thus, kyukikyogaito waschosen as a hemostatic, and good progress wasachieved, as reported below, in reference to relevant
literatures.
Case study
Subject: 88-year-old woman

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Volume 12, Number 1 | Spring 2017

Chief complaint: General malaise and fatigue
Past medical history:Age 40: Appendectomy
Age 75: Cervical cancer (radiation therapy),
adhesive intestinal obstruction
Age 81: Cataract
Age 85: Lumbar compression fracture
Age 87: Gouty arthritis, adhesive intestinal
obstruction, lower-leg cellulitis
Family medical history: NA
Clinical course 1 (history of present illness):
The patient had been receiving medical care at a
hospital nearby for high blood pressure andhyperuricemia. In 2002, she received radiation
therapy for cervical cancer. Thereafter, sheoccasionallydeveloped
adhesive
intestinal
obstruction and venous intestinal bleeding caused bychronic ischemic entero colitis (radiation enteritis)
after irradiation. Each time she developed theseillnesses, she received therapy in hospital under agastroenterologist. In June 2011, she was diagnosed
with atrial fibrillation and chronic heart failure, andwas given anticoagulant therapy, but the therapy
was discontinued due to exacerbation ofgastrointestinal bleeding. Thereafter, she wasdiagnosed with chronic heart failure, chronic renal
failure and renal anemia, and was treated with anerythropoietin preparation in addition to an ironpreparation, on a continuous basis. From around
March 10th, 2015, she began to experience a sense ofmalaise and fatigue when walking. On March 13th,
she visited our clinic. She was found to be anemic(Hb 5.6g/dl), and was admitted for blood transfusion.
Because she was taking iron, she continued to pass
black stool intermittently.
Physical findings from the perspective of Western
medicine:
Normal body temperature; SpO2: 95%; pulse
45/minute, irregular, blood pressure 96/60mmHg;
body weight 42kg; anemia in palpebral conjunctiva;
cardiopulmonary functions: nothing abnormal
detected; abdomen: flat, soft
Examination findings from the Eastern medicine
perspective:
20

Subjective symptoms: Sense of malaise and fatigue
when walking
Objective findings: Poor, sallow complexion uponinspection. Ectomorphic. Sunken, thin and weakpulse. Thin white coating on tongue. Sublingual
venous dilatation. Weak abdominal strength andweakness of the lower abdominal region.
Examination results:
Blood exam: White blood cell count 2800dl, red blood
cell count 1.67million, hemoglobin 5.6g/dl,
hematocrit 17.9%, urea nitrogen 51mg/dl, creatinine
3.14mg/dl, uric acid 12.1mg/dl
Abdominal CT: Change in pelvic (ileum and adnexa)
adhesions (Fig. 1)

Fig. 1 Abdominal CT findings
An adhesion is seen in the pelvic organs.

Admission

Fig. 2 Clinical Course Discharge

2015
3/13

3/23

3/16

3/27

4/7

4/14

Erythropoietin preparation

Hb(g/dl)
6.4
5.6

Erythropoietin prepara

Dark red stool
Black stool
Once/dayOnce/dayIron + vitamins (B2 B6 B12)

Dark red stool
3 times/day
Blood transfusion
2 units

2 units

2 units

5.6

Kyukikyogaito
9g/day2 units

6.9

6.8
5.6

4/18 4/22 5/15

7.1

7.3

5.9

Fig. 2 Clinical Course

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Volume 12, Number 1 | Spring 2017

Clinical course 2 (course after hospital admission): Fig. 2

perforation, hyperbaric oxygen therapy or surgical

After being admitted to the hospital, the patienttherapy are chosen1). In this particular case, thereceived

blood

while

patient experienced both early and late effects, andreceiving an iron and vitamin B preparation, but

received inpatient treatment each time, such thatdark red stool occasionally appeared in addition to

the pattern of her daily life was sometimes disrupted.

black stool (due to the iron preparation), and her

Kyukikyogaito is regarded as an effective

anemia did not improve. Due to persistent venous

hemostatic for venous bleeding that does notintestinal bleeding caused by chronic ischemic

accompany febrile symptoms in the lower body. This

enterocolitis, natural hemostasis was consideredis understandable when considering that licorice isdifficult. Judging from signs of renal deficiency,

added to Shimotsuto, a representative prescription

blood deficiency and blood stasis, a prescription offor blood deficiency, in addition to the Artemisia

kyukikyogaito (9g/day) was begun after her fourthprinceps leaf and donkey hide gelatin, which also

blood transfusion. Thereafter, no advancement of

have a hemostatic effect2). Today, it is consideredanemia was seen, so the patient was discharged on

effective against hemorrhagic anemia in people with

April

after

a weak constitution, like the patient in this caseadministering kyukikyogaito, the prescription was

study. With regard to literature, there are reports

stopped, because the anemia was found to havemainly in reference to bleeding in the lower body,

improved.

such as radiation enteritis3), hemorrhoidal bleeding4),

22th.

The

iron,

transfusion

On

May

vitamin

three

15th,

B

a

and

times

month

erythropoietin

diverticular bleeding5), Crohn’s disease6), ulcerative

preparations were continued after the termination ofcolitis7), 8), uterine bleeding9), 10), and hematuria andkyukikyogaito, but no longer intestinal bleeding or

urinary

advancement of anemia were detected.

Kobayashi’s report5) indicates a hemostatic effecttract

bleeding11),

12).

Among

them,

against diverticular bleeding, but the subject had
Observations

been taking an anticoagulant and an antiplatelet

Radiation enterocolistis is well known as adrug, so it is difficult to clearly determine whether

disorder of the pelvic tissue and particularly thethe effect was a result of a cessation of medication or

gastrointestinal tract, caused by radiation therapy

the administration of kyukikyogaito. Other casefor prostate cancer or cervical cancer. There arereports also include the administration of Westernearly effects and late effects, and may take morehemostatics in addition to kyukikyogaito, and do notthan ten years for the effects to occur. It causes

distinctly present the sole effect of kyukikyogaito.

hemorrhagic transformations such as inflammation

However, it is worth noting that Iwabuchi’s report9)

and ulcers in the rectum, sigmoid colon, or small

compares kyukikyogaito with Western hemostatics,

intestine. Radiation enteritis can be classified byand discusses the efficacy of kyukikyogaito. Also, in

progress, severity and pathology, and requires an

Matsumoto’s report12), which focuses on bleeding

efficienttreatment

caused by bladder cancer, kyukikyogaito is used withguidelines have yet to be established. Normally, thethe expectation of temporarily stopping the bleeding,

bleeding is expected to stop on its own, and either aand certainly not as a fundamental treatment, but it

hemostatic drug is administered or conservative

is considered important for avoiding psychologicaltreatment through blood transfusion is chosen instress and blood transfusion.

treatment

strategy,butmost cases. At the same time, in cases of frequency

Meanwhile, there have also been experiential

bleeding, endoscopic hemostasis or drug infusioncases where kyukikyogaito was effectively used totherapy is chosen, and in cases of stenosis orstop venous bleeding in the upper body, such as

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

21

Volume 12, Number 1 | Spring 2017

upper gastrointestinal bleeding (lower esophageal

References

bleeding, so-called the Mallory-Weiss syndrome)

1.

Masako Chino, Takanori Suganuma, Naoyuki

that does not accompany decrease in blood pressure

Urakamihypotension,

Gastroenterological Endoscopy, 2010, 52: 1381-

respiratory

tract

bleeding,orhematobilia (hemorrhagic cholecystitis). There isalso a report13) that discusses the efficacy of

et

al.:

“Radiation

Enteritis,”

1392.
2.

Kazumoto Inaki: “Basics and guide to practice –kyukikyogaito against chronic subdural hematoma

Manualincluding an upper body illness.

prescriptions: Kyukikyogaito,” Kampo Shinryo,

Furthermore, cases have been experienced wherekyukikyogaito stopped the bleeding after a colonofimportant

Kampo

medicine

1996, 15: 10-13.
3.

RyusukeObi,

KentaroTezuka,Yoko

polyp biopsy, post-resection bleeding, melena caused

Tamagawa: “A case in which kyukikyogaito wasby ischemic colitis, and tumor bleeding caused byeffective against bleeding caused by radiation

advanced colon cancer. In all cases, the bleeding

enteritis,” Kampo Medicine, 2014, 65: 248.

clinically disappeared within two days, and no4.

Kiyoshi

Ishida:“Kampotherapyforanemia or blood pressure drop was observed, buthemorrhoidal bleeding – kyukikyogaito usage

because other Western hemostatics were also used

experience,” Prog. Med., 1989, 9: 590-596.

at the same time, it is difficult to determine the sole

5.

effect of kyukikyogaito.
itprovedthe

Kobayashi:

“Five

cases

in

which

kyukikyogaito was effective against internal

Thus, this particular case is very significant in
that

Ataru

efficacy

of

using

hemorrhoidal

bleeding

anddiverticulular

only

bleeding of colon under treatment by ankyukikyogaito. Kyukikyogaito was applied, because

anticoagulant and antiplatelet drug,” Science ofthe patient also displayed a yin deficiency pattern,

Kampo Medicine, 2015, 39: 128-131.

such as blood deficiency and blood stasis in addition

6.

Satoshi Utsumi, Noboru Arai, Hiroshi Sato et

to renal ischemia. It had a more immediate effectal.: “A case in which kyukikyogaito withthan expected, and was found to be effective against

senkinnaitakusan was effective against Crohn’sdisease associated with colon cancer,” Kampo
Medicine, 2004, 55 (separate issue): 242.

repeating radiation enterocolistis like this case, atthe least.
Based on this case study, literature reports and7.

TsuneoOzeki,

ShuichiMizuno:“Aboutexperimental cases, there was a renewed awarenessulcerative colitis – Centered on differentialthat the selection target for kyukikyogaito is notdiagnosis and treatment,” Jpn. J. Med. Pharm.

activeSci., 1987, 18: 1723-1726.

bleeding(bleeding

that

has

surgicalindications, such as arterial bleeding and varicose

8.

Takatoshi

Noguchi:“Kampotherapyforvein ruptures), but rather a bleeding pattern likeulcerative colitis – Polypharmacy and combined

this case study with oozing (venous bleeding), or

usage with Western drugs,” Kampo Shinryo,chronic bleeding (continuously runny bleeding) that

1996, 15: 23-25.

is not so fresh blood.
Itshould

be

noted

9.
that

no

reportsonkyukikyogaito exist in the PubMed database, sointernational evaluations have yet to be made.

Shinsuke

Iwabuchi:“Hemostatic

effectofkyukikyogaito on functional uterine bleeding –Comparison with Western hemostatics,” Kampo
Medicine, 2000, 50: 883-890.
10. Naohisa Ushiroyama, Wataru Sakuma, Sakura
Nosaka et al.: “Clinical effect of kyukikyogaito
against22

threatened

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

miscarriage,”

RecentVolume 12, Number 1 | Spring 2017

progress of kampo medicine in obstetrics andgynecology, 2006, 23: 100-103.
11. Hiroyasu Yoshikawa, Takao Ikeuchi, Shoki Kai:
“Clinical effect of kyukikyogaito and saireito
against idiopathic microhematuria,” Kampo &the Newest Therapy, 1997, 6: 55-58.
12. Kazuo
Matsumoto:“Kyukikyogaito
forhematuria from bladder cancer,” Journal of
Kampo Medicine, 2013, 60: 1855-1857.
13. Shinichiro Yoshihara, Katsuyuki Hirakawa,
Toru Inoue: “Experience in using kyukikyogaito
againstchronic

subduralhematoma,”

Proceedings of the 20th Scientific Meeting of theJapanese Society for Kampo Medicine and
Neurological Surgery, 2011, 33-35.

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

23

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