KAIM
T
Thhee JJoouurrnnaall ooffK
Kaammppoo,, A
Accuuppuunnccttuurree aanndd IInntteeggrraattiivvee M
Meeddiicciinnee
INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 5, Number 4 ･ Winter 2010

Editorial

Medical Care in a Sustainable Society
Naoya Ono

Japanese Acupuncture - Current Research
Reality of Japanese Acupuncture and Moxibustion
Masahiro Minowa

Kampo Medicine - Current Research

Effectiveness of Goreisan for Eliminating Brain Edema due to Intracranial Malignant Brain Tumors
Akimune Hayashi

Clinical Report 1 (Europe)
Shonishin in Europe (2)Thomas Wernicke

Clinical Report 2 (Japan)
A Case of Recurrent Folliculitis
Takao Namiki

Clinical Report 3 (Japan)

Kamishoyosan was Effective for a Patient having Vomit

Mihoh Koga

Kampo Formula Developed in Japan (4)Futeri Fukui’s Jizusoippo
Hiromichi Yasui

ISSN:1559-033X

Volume 1, Number 1 | Spring 2006

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

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

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

Volume 5, Number 4 ･ Winter 2010

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
CA, U.S.A.

ASSOCIATE EDITORS
Shuichi Katai

1 Editorial
Medical Care in a Sustainable Society
2 Japanese Acupuncture - Current Research
Reality of Japanese Acupuncture and Moxibustion

Naoya Ono

Masahiro Minowa

Ibaraki-ken, Japan

Hiromichi Yasui
Tokyo, JapanEDITORIAL STAFF

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

10 Kampo Medicine - Current Research
Effectiveness of Goreisan for Eliminating Brain Edema due to Intracranial Malignant Brain
TumorsAkimune Hayashi
17 Clinical Report 1 (Europe)
Shonishin in Europe (2)Thomas Wernicke

22 Clinical Report 2 (Japan)
A Case of Recurrent Folliculitis

Takao Namiki

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

26 Clinical Report 3 (Japan)
Kamishoyosan was Effective for a Patient having Vomit
Mihoh Koga

28 Kampo Formula Developed in Japan (4)Futei Fukui’s Jizusoippo
Hiromichi Yasui

PUBLISHER

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

MISSIONTo disseminate peer-reviewed information on the use of acupuncture and herbs, and integration with western
medicine, based on research from an international perspective; thereby stimulating further research, application of
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 5, Number 4 | Winter 2010

Editorial
Medical Care in a Sustainable Society
Modern Western medicine forms the backbone of current medical care in industrialized countries,
and is founded on a consumer society based on mass production and mass consumption. In medical
settings, saving lives is an overarching imperative, and in the name of saving lives, how much of the
Earth’s environmental capitals are spent is never questioned, although the amount of human resources
and physical resources (medical materials) that are spent, sometimes are. For this reason, most healthcare
professionals do not have much interest in environmental issues. However, human beings are part of the
Earth’s ecosystem and cannot exist completely outside it. As long as human beings live on Earth, human
lives can only survive within the allowable limits of the global environment (although this condition may
change depending on future advancements in space development).
Today, the world is focusing its concerns on environmental issues, such as reduction of carbon
dioxide, and various energy issues, including the peak oil issue (global oil production reaching peak andthereafter declining), safety of nuclear power stations, and alternative energy sources. Under thissituation, the countries of the world are examining and exploring such topics as slow life and slow food,zero emission, and financial and industrial crises, toward building a recycling society that is sustainableboth environmentally and economically. The sustainability of medical care per se will also come to bequestioned. It will become inevitable to depart from medical care founded on a consumer society andnecessary to create a “new medical model” or “new health care model” for saving human lives while also
giving consideration to the world’s ecosystem. Sustainability of medical care cannot be achieved simply
by the current medical model alone, as it is based on modern Western medicine founded on a consumer
society.
Whatever the case may be, it will become necessary to establish eco-medicine, or to go a step further
to provide eco-health care, which includes medical care that is ecological, economical and ethical, or
elements referred to as “green medicine” in foreign countries. Here, “hybrid medicine,” or “integrative
medicine,” is medicine that combines modern Western medicine with traditional, complementary andalternative medicine that does not rely on electricity, fuel, medical equipment and parts, and harbors thepossibility of developing into eco-medicine or eco-health care.
All capitals on Earth, whether human or material, are finite. When pursuing medicine for asustainable society, traditional medicine will come to play a large role along with modern Western
medicine. It would not be an exaggeration to say that our future medicine depends on how welltraditional knowledge could be applied.

Naoya Ono
Center for Lifenhance in 22nd Xwnruey, Institute for Future Engineering
Department of Health Informatics, Division of Health Administration
School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, JapanThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

1

Volume 5, Number 4 | Winter 2010

Japanese Acupuncture - Current Research
Reality of Japanese Acupuncture and Moxibustion- A Review of History of Acupuncture and Moxibustion
System Masahiro Minowa
Visting Researcher of National University Corporation
Tsukuba University of Technology,
Faculty of Urban Environmental Sciences
Tokyo Metropolitan University Tokyo Graduate School,
Vice President of Shakai Shinkyu Kenkyukai

The conduct of “acupuncture and moxibustion” ismedical care services or medical

treatment to heal

diseases or relieve symptoms in humans. With its
roots going back to China, it is believed to have beenbrought to Japan during the period between 4th and
The “Taiho Code (Taiho Ritsuyo)”enacted in 701 expressly defined acupuncture andmoxibustion as a medical system in the clauserelating to diseases1). As civilization was progressingin the Edo period which was under the closed door
policy, acupuncture and moxibustion made their own
development independent from the original styleand became a representative medicine of Japanreferred to as Kampo medicine.
However, the new Meiji government establishedin the period of Meiji Restoration decided to adopt
Western medicine (German medicine) as the official
medicine of Japanand radically advanced theestablishment of Western medical system and its
education

together

with

the

enactmentof“Healthcare System and Laws” in 1874 (Year 7 of
Meiji). In the situation, it was generally thought that
Kampo medicine died out and similarly acupuncture
and moxibustion was extinct from the Japanesesociety.

However, in 1886 (Year 18 of Meiji) the

Meiji government officially permitted the operationof acupuncture and moxibustion as business under
the supervision of the authorities. In 1911 (Year 44
of Meiji), the “act regulating acupuncture and2national ordinance, was established. Similarly its
education system was permitted by the government2).
Thereafter, with rising health consciousness ofthe people, needs for acupuncture and moxibustion
also increased. Then the outbreak of the Second
World

War

devastatedthesurroundingsofacupuncture and moxibustion. After the War, theGHQ’s reform drove it close to the brink of extinction.
However, the “banning” was avoided by the

1. Introduction

5th century.

moxibustion business” (Regulatory Rules), the firstprotesting campaigns of the people who had
supported acupuncture and moxibustion medicine.
In 1947 (Year 22 of Showa), the original Business
Law concerning Japanese Traditional Massage,
Finger Pressure, Acupuncture, Moxacautery, andJudo-Orthopaedy

wasestablished

in

the

Constitution of Japan (Act No. 217 so-called AHAKI

Law).
After the War, there were no major institutionalchanges and stable conditions continued. In 1988
(Year 63 of Showa), substantial amendments to the
AHAKI Law were made for the purpose of improving
the qualifications and quality of practitioners. And
then and up until today, those who want to practiceacupuncture and moxibustion are required to receive
unified national examinations.
In China and South Korea where traditional
medicine of each country is valued given the social
background of individual countries, acupuncture
and moxibustion is categorized under traditional
Chinese medicine (physician of traditional Chinese
medicine) in China and traditional Korean medicine(physician of traditional Korean Medicine) in Korea
and is accepted equally to modern Western medicine.
In the United States, it has rapidly become
popular since the 1970s’ media report about
acupuncture anesthesia and is now being positioned
as a method of primary care. In European countries,
people have begun to acknowledge the value. The
world surrounding acupuncture and moxibustion

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

Volume 5, Number 4 | Winter 2010

has also begun to make dynamic changes along withmodern medical care.] He suggests [the necessity ofthe progress of integrative medicine.

conducting

In Japan of modern age, on the other hand,acupuncture and moxibustion is not regarded as

medicalsociologicalanalysisofacupuncture and moxibustion practice from theinstitutional and structural points of view 3).]

medical practice in terms of institution but isregarded as “quasi medical practice or acts similar to

2-2 Contradicting interpretations - inside or outside

medical practice,” so that under the medical

the medical systeminsurance of Japan it is not provided by way ofConcerning acupuncture and moxibustion, the“performance in kind” and the cost of the practice is

Ministry of Health & Welfare’s understanding shown

non-refundable. Some medical sociologists call thisin the 50-Year History of the Ministry of Health &medical system as a “half-institutionalized system”3).

Welfare (50-Year History) published in 1988 is […inThe modern history of Japanese acupuncture

view of the fact that Japanese traditional massage,and moxibustion has many unclear points, like a

etc. having a long history play a certain role inkind of “black box.” The main contributing factors, in

health care, four types of business including

the first place, may be that research environment

Japanese traditional massage (note by the author:

has not adequately been cultivated and there are a

acupuncture, moxibustion, Judo-Orthopaedy, etc.

limited number of researchers in Japan. There has

are referred to herein) are institutionally granted

been 100 years since the enforcement of the

only outside the medical system4).] Accordingly, in

Regulatory Rules and it is a matter of urgency toreference to the understanding of the Ministry that

dredge up facts being buried for these 100 years or

governs the nation’s healthcare, the author has

rather about 150 years after the Meiji Restoration

presented ‘acupuncture and moxibustion’ until now

for verification.

as a healthcare that is outside the healthcare
system,” which is like aniethesis, SUZUMURA, who

2. Research background

was an official and a technical officer of the Ministry2 – 1 Suggestions from medical sociology

of Health & Welfare, and Mr. Teizo ASHIDA gave

Medical sociologist Prof. Junichi Sato, says

their interpretation of acupuncture and moxibustion

about acupuncture and moxibustion: [Although

in their co-authored book [Anma, Hari-Kyu, Jyudo“medical care with acupuncture and moxibustion” isSeifuku, nado Eigyou Hou no Kaisetsu] that […that

legally bounded and regulated by “AHAKI Law,” etc.,

is to say, licensing referred to herein is the act of theits definition is made partially and very ambiguously

nation which lifts a partial banning of medical

in a polysemous and arbitrary way compared tobusiness and those who have been licensed will be

modern medicine, and it is “institutionalized

allowed to conduct a part of medical business within

partially and to a limited extent” on the premise thatthe range of individual business5).]

modern medicine has been institutionalized in

In short, from this interpretation, acupunctureadvance, so that it can be said that it is a half

and moxibustion was a “part of medical care” andinstitutionalized non-modern medicine.] He further

placed “inside.” Their interpretation was madepointed out that [it exists as “one system for giving

almost in real time, no time lag from thetreatment” in the modern Japanese society and it

establishment of the law.

functions as the second largest medical sector after

carries the recommendation from Yutaro AZUMA,The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Moreover, this book3

Volume 5, Number 4 | Winter 2010

then Director General of the Ministry of Health &3.

Welfare, at the beginning of the book. Forty years

acupuncture and moxibustion legal system

after

3-1 Summary of changes in the acupuncture andSuzumuraandAshidapublished

theirinterpretation, the Health & Welfare Ministry’s

Consideration

concerningthehistoryofmoxibustion system

understanding was expressed in printed form in the

The major changes in the acupuncture and

50 Year History. It is no wonder that there mightmoxibustion system that were made during thehave been some arbitrary manipulation as theperiod from the “enactment of Healthcare System

medical sociologist Jyunichi SATO said. In a sense,and Laws” in 1874 (Year 7 of Meiji) (which was thethe institutional double standards were applied to

Meiji government policy) to the current days are

the official standing of acupuncture and moxibustion

summarized in Table 1.

in the Japanese society. And the author thinks it aSince the decision by the Fukuoka District Court

problem that the level of awareness regarding theof 1998 for the “case of request for reversal of non-inside interpretation is low in the acupuncture andresignation

moxibustion world.

orthopaedic practitioners” (hereafter Fukuoka Court

of

the

training

schoolof

Judo-decision), vocational colleges have newly been
established one after another and new departments
have been increasingly set up, which, if notinstitutional innovations or restructuring, is aphenomenon reflecting the social conditions and asignificant fact in the institutional history6).
Table 1 Summary of changes in the acupuncture and moxibustion system
1874 (Meiji era 7) Enactment of Healthcare System and Laws
→ Principles of westernization of medical care of modern Japan, and prohibition of acupuncture andmoxibustion practice outside medical care management
1885 (Meiji ear 18) Regulatory measures for acupuncture and moxibustion business (Interior Ministry’s
notification Ko 10-go)→ supervision was transferred to local governors
1911 (Meiji era 44) Regulatory rules for acupuncture and moxibustion business (Interior Ministry’s
notification Ko 11-go)→Enactment of the first national law. Education system was explicitly described in statutory form forthe first time.
1947 (Showa 22) “The business law of anma-massage, acupuncture, moxibustion and Judo-Orthopaedics,
etc.” (Law number 217-go referred to as AHAKI Law in shortened form)→Passage of the bill after GHQ’s reform challenges.
Later, the law was revised into the law of status “concerning anma-massage-shiatsu therapists,
acupuncturists, moxibustionists, etc.”
1988 (Showa 63) Major revisions were made to the AHAKI Law designed to enhance qualifications.
→ The examination system in which examinations were held by prefectural governors was changed tothe system of uniform national examinations.

4

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

Volume 5, Number 4 | Winter 2010

3-2

An aspect of the acupuncture and moxibustion

system in modern Japanand moxibustion was controlled under the Article
537).

The Meiji Restoration was the transition period

In 1877 (Meiji 10) and onward, individual

to the modern country from the period of shogunate

prefectures began to maintain statistical records ofand han (domain) system and to the era of opening

the number of practitioners who was doing theup Japan. The Meiji government had the overriding

business of acupuncture and moxibustion in Japan.

imperative of joining the ranks of powerful advanced

In 1885 (Meiji 18), the Internal Ministry issued thecountries and was engaged in the country’s“Regulatory

measuresfor

acupuncture

modernization process with the slogans of cultural

moxibustion

business”

toprefectural

enlightenment, prosperous country and strong army.

entrusting them to permit and regulate or control

However, the domestic scene was devastating; thethe business of acupuncture and moxibustion. In fact,

Boshin War broke out, then the Seinan War followed

the original intent and purpose of the law to place

and a cholera epidemic was raging (Meiji 11).

the practice of acupuncture and moxibustion under

When Sensai NAGAYO who took the office ofandoffices,a doctor’s supervision were not achieved. In the

Deputy General of Medical Affairs of the Education

meantime,

Ministry in 1873 (Meiji 6), he issued an order forgovernment policy, ordering local governments tonationwide investigations concerning health andadopt the permission system in which they checked

medicine and submitted a draft medical law

applications and evaluate qualifications of those who

consisting 76 articles prepared based on the researchwanted to do the business of acupuncture andresults to the central government (equivalent to themoxibustion and if qualified, issued permission.

present cabinet) in 1874 (Meiji

7)7).

the

Meiji

government

issueda

The Law of

Medical System and Laws was the guidelines for

Table 2 Number of acupuncturists and physicians inJapan to undergo drastic westernization andmodern Japan

introduce Western ideas of healthcare as the

Acupuncturists

Physicians

modernized country. Article 53 of the law stipulated

1887 (Meiji 20)

12,14540,343that the practice of acupuncture and moxibustion

1897 (Meiji 30)

24,39339,392was only allowed in effect under a doctor’s
supervision. If this clause is viewed from a different

Prepared by the author based on the statisticalangle, it may be said that the Law was the official

data of NDL (National Diet Library) Modern Digital

document that recognized the existence of the people

Library and data from 50-Year History of the

who were engaged in acupuncture and moxibustion

Ministry of Welfare & Health. (The total number ofas their business – the business of acupuncture andphysicians in 1887 includes 32,839 physicians who

moxibustion was documented for the first time in thewere traditionally on their own business. The total

modern system of Japan. At the same time, thisnumber of physicians in 1897 includes 23,596

indicates the fact that acupuncture and moxibustion

physicians who were traditionally on their own

treatment was continuously being practiced duringbusiness.)

and after the period of Meiji Reformation. The Law

The 12,145 acupuncturists of 1887 (Meiji 20)

of Healthcare System and Laws did not have a

include those who started practice before thestrong binding and it is not a fact that acupuncture

notification

of

the

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

measuresfor5Volume 5, Number 4 | Winter 2010acupuncture and moxibustion business”. After the

3-3 Westernization - Modern Japan’s imperative

notification, the number of acupuncturists steadily

In line with the objectives of the “Medical Systemincreased to 24,393 in 1897 (Meiji 30). The number

and Laws” of 1874 (Meiji 7), the Meiji governmentof acupuncturists almost doubled during these 10

steadily carried out the modernization process by

years, whereas physicians remained at the sameenacting decrees, in rapid succession, of the “Rules

level. It is more interesting to note that the number

for the National Medical Practitioners Qualifyingof the traditionally independent physicians focusing

Examination” in 1879 (Meiji 12), “General Rules andmainly on Kampo medicine decreased by about 9,000

Regulations for Medical Schools” in 1882 (Meiji 15),in these 10 years. In other words, although theand “Regulations concerning Doctor Licenses in

reduced number of physicians went into Western

18838).

medicine, the number of acupuncturists increased.
In those days, Western medicine was not an easy

In formulating the acupuncture related law of“Regulatory

measuresfor

acupunctureandaccess for the people of Japan from economic andmoxibustion business,” no descriptions were madelimited institutional standpoints. With roughly

concerning matters relating to Western medicine in

40,000 physicians of Western medicine, needs andthe regulatory. However, it is not correct to say thatdemands for healthcare services from the people
could not be met. In the situation, it may be said that
acupuncture and moxibustion absorbed the unmet
requirements. The Meiji government certainly kept
a tally of the number of people who were engaged in
acupuncture and moxibustion and regulated andcontrolled them. It can be gathered that because thegovernment took a national policy of adopting
Western medicine with the intention of Kampo
medicine fading away, the Meiji government had to
grant acupuncture and moxibustion as “business”
instead of medical practice.
The momentum led to the establishment of the firstnationa1911 (Meiji 44) ordinance of the “Regulatory
rules for acupuncture and moxibustion business.”
Then the education system for acupuncture andmoxibustion was put in statutory form for the first time
and the acupuncture and moxibustion education stoodat the dawn of a new era.

acupuncture and moxibustion was not involved in
the westernization at all.

Movements in concert

with the westernization were seen.
In 1889 (Meiji 22), “Tokyo Shinkyu Chi Kai (Toyo
Acupuncture Moxibustion Treatment Associatioin)
was inaugurated for the purposes of organizing an
association for practitioners engaged in the businessof acupuncture and moxibustion in Tokyo-fu and forthe enhancement of their qualifications. The key
persons in setting up the organization were Shouzou
HIROSE and Genshi OKAMOTO who were doctorsof the Imperial Household Ministry.

ceremony was attended by 1,500 people including
Shokichi TAKE (medical officer of Tokyo-fu) who
delivered a speech and Noritami KAWASAKI(anatomical physiologist of Medical School) who gave
a lecture9). After that, the association provided
voluntary education in the form of lecture or speechthrough workshops of Western medicine in order toimprove qualifications of practitioners.

6

The opening

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

Volume 5, Number 4 | Winter 2010

When referring to the purpose of the enactmentof the 1911 (Meiji 44) Regulatory Rules, Noda, who

4. Unrealized enactment of “Medical Law for
acupuncture and moxibustion physicians”

was then a technician of the Internal Ministry,

With the establishment of the institutional systemexpressed his opinion that it was necessary toat the end of the Meiji period, acupuncture andurgently prepare school educational environment

moxibustion began to be recognized by the society.

and its substantiation, and that it was important to
conduct

research

to

study

mechanismsofacupuncture and moxibustion in the (Western)
medical method10). The Regulatory Rules had theprovisions concerning examinations for obtaining
license/license tag for conducting the business ofacupuncture and moxibustion. The examination
subjects provided in the Rules were related

to

Then

in

the

Taishoperiod,acupunctureandmoxibustion also began to satisfy needs of the people
with their increasing health consciousness. At the endof the Taisho era, “Shinkyu Ihou Kisei Doumei(Association)” was organized. Ryosai YAMAZAKI, anacupuncturist of Osaka, who was the main player fororganizing the association, invited Ichiro KIYOSE(who was a lawmaker of the House of Representatives)
as Adviser of the association. About lobbying activities

Western medicine such as “human body structure,andfunctions of main organs, and relations between

moxibustionists in order to advance reforms throughmuscles and neurovasculars” and “synopsis ofcorrecting institutional disparities and enhancing

sterilization.” It was the end of the Meiji era that

their status, the then “Nippon Shinkyu Zasshi

Western(Journal of Acupuncture and Moxibustion of Japan)

medicine

was

also

standardized

institutionally in acupuncture and moxibustion.

schemesofmodernacupuncturists

andmade detailed reports.

Table 3 From “Nippon Shinkyu Zasshi (Journal of Japanese Acupuncture and Moxibustion)” of the modern age
Nippon Shinkyu Zasshi Vo. 213 issued on September 10, 1921 (Taisho 10)(Dainippon Shinkyushi Kai [Great Japan Acupuncturists and Moxibustionists Association])[Legislatively, necessity of enacting the law of acupuncture and moxibustion physicians] Law maker of theHouse of Representatives, Lawyer, Bachelor of Laws-Ichiro Kiyose (Advisor of the association)[Problems of the law of acupuncture and moxibustion physicians in terms of social policy] Law maker of theHouse of Representatives Kotaro Nakagawa (his background not known)[Shinkyu Ishi-hou Ron (Discussing the Law of Acupuncure and Moxibustion Physicians)] Ryousai
Yamazaki[Shigyousha toshite Shinkyu-I-Hou Hissu no Kaname (Necessity and Important points of the law ofacupuncture and moxibustion physician as a person engaged in the business)][Problems of the law of acupuncture and moxibustion physicians viewed from the position of a physicist]
Physician Kazumi Ishimitsu
Nippon Shinkyu Zasshi Vo. 247 issued on October 10, 1924 (Dainippon Shinkyushi Kai)
[Statement of the reasons for the petition concerning the enactment of the law of acupuncture andmoxibustion physicians]
Nippon Shinkyu Zasshi Vo. 275 issued in March, 1927 (Dainippon Shinkyushi Kai)
[The petition concerning the law of acupuncture and moxibustion physicians passed both Houses ] Ryousai
Yamazaki

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

7

Volume 5, Number 4 | Winter 2010

After the passage of the bill at the Lower HouseThe United States brought acupuncture andin 1923 (Taisho 11), no progress was made toward its

moxibustion into the country 40 years ago andenactment at the House of Lords and it was scrapped.

has rapidly arranged the education and system

Then, the “petition for the enactment of the law ofduring these 30 years. This means that theacupuncture and moxibustion physicians” was re-United States has the environment in which an

46th Imperial

institutional position can be given and actuallysubmitted to theDiet. Eventually it

was not enacted.

has been given to the method of treatment by

As legal revisions and legislation were not

manualadjustment/correction

such

as

realized, a series of processes are weathering. The

chiropractic and osteopathy and such method has

author thinks it necessary for future development ofbeen accepted culturally. It is obvious that theJapanese acupuncture and moxibustion to verify thefact that is going to be forgotten by people.

and the United States are quite different nationsin terms of the social background, of course, and

5. Conclusion
In 1978, the two-year college of acupuncture andmoxibustion was founded in Japan. And then thecollege became a university of four year system. Now
there are nine universities of acupuncture andmoxibustion in Japan, of which three universities
have the master’s program and one university has
the doctoral program. Even so, no major changes
have

taken

1997 NIH statement created a momentum. Japan

place

in

the

socialstatusofacupuncturists and moxibustionists during theperiod from the enactment of the post-war law No.
217 to the present. There may have been minor

the healthcare system. However, what the author
will be or is concerned about is dynamic
movements

betweenacupunctureandmoxibustion and the people of the U.S.
Japan,

which

begun

acupunctureandmoxibustion practice much earlier than European
countries and the United States, finds itself left
behind in the world and is becoming shadowed under
the influence of China. The underlying causes arelack of the base on which visions and strategies are

institutional changes in response to their request.

planned and a manpower shortage. This may be

Today 100 years have elapsed since the enactment ofcontributed,

inthe nationwide ordinance of 1911 (Meiji 44), theambiguous

existenceauthor thinks that no dynamic changes have been

moxibustion in the Japanese society.

the author’s opinion,ofbyacupuncture

the
and

seen in the relationship between the people andThe

acupuncture and moxibustion.

authorthinksitnecessary

that

the

In the United States, there are 60-70 schools oftransitions Japanese acupuncture and moxibustion

acupuncture and moxibustion (university or university

went through in about 150 years from the Meiji

graduate school), of which 60 schools are accredited as

Restoration to the present be verified from theeducational institutes for master’s level programs byviewpoint of research. We urgently need to dig up

ACAOMfacts that are still berried, observe unearthed facts,(The

Accreditation

Commission

Acupuncture and Oriental Medicine)12).

8

forapprehend with philosophy and create the meaning.

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

Volume 5, Number 4 | Winter 2010

6. References
1) Written by FUJIKAWA, Yu. Nihon Igakushi6) OKUMIYA N: Jyudo Seifukushi touno Yousei

Youkou. Toyo Bunko 258. Heibonsha Limited,

Shisetsu no Kaisetsu Seigen to Dokusen Kinshi

Publishers. 10th reprint from the initial print.

Hou no Kisei – Judo Seifukushi Yousei Shisetsu

1990: 20-23.

Fushitei Shobun Torikeshi wo Megutte. Shakai

2) MINOWA M: Nihon no Igaku, Iryou to Shinkyu no
Ichi – Nihon Kindai-ki no Shiritsu Shinkyu Gakko
no Seiritsu Katei ni Chakumokushite. Shakai
Shinkyu-gaku Kenkyu 2010 Extra Edition. Shakai
Shinkyu-gaku Kenkyu-kai. 2010.
3) SATO J: Gendai Iryou no naka-deno Shinkyu Iryou– Iryou Shakai-gaku no Shiten kara Kangaeru.
Shakai Shinkyu-gaku Kenkyu 2009 Vol. 4. Shakai
Shinkyu-gaku Kenkyu-kai. 2010: 8-20.

Shinkyu-gaku Kenkyu-kai 2006 Inaugural issue.
Shakai Shinkyu-gaku Kenkyu-kai 2007.
7) SOEDAY:

Naimu-shouno

Shakai-shi.

University of Tokyo Press. 2007:104-10.
8) SUGAYA A: Nihon no Iryou Seido-Shi (revisedand expanded edition) Tokyo. Hara Shobo. 1978 :25.
9) Tokyo Shinkyu Hakkaishiki Shukuji Enzetsu(NDL library) edited by: Genshi OKAMOTO, a4) The Editorial Committee of 50 Year History of theworrier class member of Tochigi Prefeture.

Ministry of Health & Welfare. Kousei Mondai

Published by a printer in Tochigi Prefecture.

Kenkyu-kai. 1988.

18795) SUZUMURA S, ASHIDA T: Anma, Hari-Kyu,

10) NODA T: Kisoku Happu ni Tsuite. Tokyo

Judo-Seifuku tou Eigyou-Hou no Kaisetsu.

Shinkyu Zasshi Sankou10-go, 1912. (Edited by

Initial print. Daiichi Shorin. 2nd Chapter 2nd

Hidetaro MORI, Reprint 9 of Toyo Igaku Zasshi,

Clause No. 2 Sejyutsusha no Mibun no Shutoku

Oriet Shuppan Sha 2005.)– Menkyo no Seishitsu. 1948:23-4.

11) http://www.acaom/

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

9Volume 5, Number 4 | Winter 2010

Kampo Medicine – Current Research
Effectiveness of Goreisan for Eliminating Brain Edema due
to Intracranial Malignant Brain Tumors

Akimune Hayashi, M.D.

Department of Neurosurgery, Kanagawa Cancer Center
Yokohama, Japan[Introduction]
Treatment of cerebral edema is a critical issue
in the field of neurosurgery, but, for several
decades, almost no advancement has been made to
the therapy.
Current

ABSTRACT

medicaltherapyforreducing

intracranial pressure in cerebral edema is limited

Objectives:

Hypertonic

andto two types of medicine: hyperosmotic diuretics

corticosteroids are widely used to eliminate

and adrenocortical hormones. No new medical

brain edema complicated by malignant brain

treatment has been introduced for at least 30

tumors.

years; that is the current situation surrounding

However,side

solutionseffects

sometimes

prevent long-term use of them.

To reduce

brain edema, the author studied a traditional
oriental medical prescription, goreisan, which
promotes diuresis and eliminates dampness,and is known for inhibiting the aquaporin 4
activity.
Methods:

BetweenFebruary

2003

and

October 2010, goreisan was prescribed to 60

cerebral edema. In clinical practice, excluding Dsorbitol and D-mannitol infusion used mainly inthe acute phase, concentrated glycerin/fructose
infusion, isosorbide liquid (oral), and adrenal
corticosteroids (oral/ drip infusion) are the mostcommonly-prescribed

hyperosmotic

diuretics.

However, they have some challenges that need topatients (73 cases) with malignant brain tumors

be resolved.

(Male 33, Female 27. Age: 24 to 82 years old,

The

most

problematic

point

is

that

Mean 56.5). The efficacy was evaluated by theconcentrated glycerin/fructose infusion can only

level of improvement of subjective symptoms orbeneurological deficits: excellent (improvement

disadvantage is that the current national health-rate≧50%), good (improvement rate 30~50% or

insurance system in Japan defines the estimated

50% or more reduction in other medical

usage period as 2 weeks, or at most 3 weeks.

decompression

Dehydration and electrolyte abnormalities must

agents),andnoeffect(improvement rate <30 %).
Results: An acceptable level of symptom
relief was observed in 52 cases (71.2 %). There
were

no

cases

of

deterioration,

and

no

significant complications were observed.
Conclusion ： goreisan

can

be

used

for

eliminating mild to moderate brain edema andcan be a substitute for hypertonic solutions andcorticosteroids.

beadministeredcarefully

intravenouly.

checkedforAnotherlong-termuse.

Corticosteroids can be taken either orally or
intravenously and are significantly effective.
However, they can cause complications including
higher susceptibility to infection and hemorrhage
in the upper gastrointestinal tract. Hence,
corticosteroids are not suitable for long-term use.
Isosorbide, an oral agent, is difficult to takebecause of the taste (too sweet/ bitter). It is a liquid

Key words: goreisan,edema,

10aquaporin

brain tumor,

brain

medicine, which can be inconvenient.
From a kampo (Japanese traditional medicine)

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

Volume 5, Number 4 | Winter 2010

point of view, the pathological condition of cerebral

manufactured by Tsumura Co., Ltd. Patients withedema was diagnosed as local stasis of body fluid

raised intracranial pressure that required urgent(suidoku). Therefore, appropriate diuretics should

administration of hyperosmotic diuretics andimprove the condition. In this report, the author

adrenocortical hormones were excluded from thistakes up goreisan (Poria Powder with Five Herbs),

study. In this study, goreisan was prescribed, nota representative Kampo diuretic prescription, tobased on Kampo medical findings ( sho ) , but on

examine its efficacy in improving the symptoms of

the Western medicine diagnosis of cerebral edema.

cerebral edema. The author also reviewed thePrior to the commencement of the therapy,

efficacy from a modern medical point of view topatients were informed that “edema” is one of thedetermine whether goreisan can become an

indications for goreisan covered by the national

alternative drug to the modern drugs for reducing

health insurance system. Patients received 3

brain edema.

packs per day, in accordance with the instructionof usage. When the improvement of the symptoms[Cases and methods]
From February 2003 to October 2010, 60 patients(73 cases in total) with malignant brain tumors
were treated with goreisan: 33 male and 27 female.

Age 24-82 years old (mean 56.5). The following isthe details of the brain tumors by type: 18 patientswith primary brain tumor (8 glioblastoma, 5malignant glioma, 3 primary cerebral malignant
lymphoma,1meningioma,

neuroectodermal

tumor);

and

39

1

primary

patientswithmetastatic brain tumor (13 lung cancer, 9 breast
cancer, 3 stomach cancer, 3 kidney cancer, 2esophageal cancer, 2 colon cancer, and 1 each ofpancreatic cancer, bladder cancer, ovarian cancer,
thyroidcancer,melanoma,andhepatic

cancer,nasopharyngeal

malignantcancer);wasgoreisan was immediately

insufficient,replacedbysteroids

or

another

cerebraldecompression therapy.
The efficacy was assessed based on the
improvements of subjective symptoms of raised
intracranial pressure or neurological symptoms
using the overall ratings: markedly improved (≧50%),

effective

improvement),

(30%
or

to

less

than

concomitant50%

cerebraldecompression drugs reduced to at least 50% or
discontinued.);ineffective

(less

than

30%

improvement).
[Results]
Improvements were observed in 52 cases

3(71.2%): markedly improved in 19 cases (26.0%),

patients with delayed radiation necrosis of theeffective in 33 (45.2%), and ineffective in 21

brain.

(28.8%). Some of the patients who showed no

31 patients showed symptoms related to raised

improvement with goreisan did not respond to

intracranial pressure such as headache, nausea

steroids

andvomiting,

neurological

and

54

symptoms

patients

hadmarkedly improved in 11 (35.5%), effective 15(48.4%),

Granules(31patients),

improvement was observed in 26 cases (83.9%):

Goreisan used in this study was TSUMURA
Extractheadachefocal

multiple symptoms).

goreisan

For

with

patients(someeither.

(2.5g/pack),

ineffectivein

5(16.1%),

andnoaggravated case. When a favorable response wasobserved, the efficacy appeared in a short time, at

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

11

Volume 5, Number 4 | Winter 2010

the latest within several days. Furthermore, nocausing neurological deficits, no improvement inside-effects were reported for goreisan.

neurological symptoms was observed. They did
not respond to steroids either.

[Representative case]
Effective case (Fig. 1). 52 year-old female with

[Discussion]

metastatic cerebellar tumor caused by lung cancer.

In Shang Han Lun (Treatise on Febrile andShe complained of headache, nausea and vomiting,

Miscellaneous Disease), goreisan is mainly used

and ataxic gait. She is very close to developing

for symptoms of wind-stroke (syndrome of Taiyang

obstructive hydrocephalus.

stricken by wind) associated with fever, which do

According to her diagnostic images, mostphysicians

wouldchoosethenot resolve in 6 to 7 days, and a severe condition

cerebellar

with exterior and interior symptoms, become

decompression therapy by infusion. In this study,

thirsty and crave for water, but drinking of water

however, both goreisan (TJ17) 7.5g and saireito

makes patients vomit like a non-stop fountain.

(Minor Bupleurum Decoction) (TJ114) 7.5g were

These

administered. Then the above symptoms were

gastrointestinal symptoms. However, when windrelieved. The co-administration of the two drugs

stroke, heat sensation, and vomiting are examined

was intended to double the dosage of goreisan.
Ineffective case (Fig. 2/ Left). 66-year old
female with metastatic brain tumor from lungcancer. Left-sided hemiparesis. No improvement

descriptions

are

often

explainedasfrom the perspective of neurosurgery, they could
resembled a headache, disturbed consciousness,and vomiting attributable to a raised intracranialpressure. The pathological concept of “symptoms

in neurological symptoms with goreisan becausecoming from the increased intracranial pressure”

the motor area in the brain was directly damaged.

likely did not exist when the Shang Han Lun was
written. However, there is a strong possibiliy that

Right side: 82-year-old male with metastatic

goreisan was prescribed based on the diagnosis ofbrain tumor from colon cancer which triggered

signs and symptoms. In addition, there is aagnosia. goreisan was not effective. Oral steroids

published article confirming that our Japanese

were not effective either. The potential factors that

pioneers were using goreisan at the dawn of therender goreisan ineffective are as follows:

history of brain tumor treatment1).

1) Large tumor,
2) Growth speed of tumors is fast,3) Rapid development of edema associated brain
tumors,4) Associated cerebral edema is small in volume.
The above factors were more prevalent in tumors
developed in smaller areas with scarce space forbuffering intracranial pressure such as in theposterior cranial fossa. When a tumor was directly

12

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

Volume 5, Number 4 | Winter 2010

Treating the symptoms of raised intracranialpressure complicated with cerebral edema isessential for treating not only the brain tumors,
but also head injury and cerebrovascular disorder.
Urea, 50% hypertonic glucose, and other diuretics
used to lower the pressure at the early stage of thetreatment have become outdated. That was due tothe rebound phenomenon where the intracranialpressure is elevated again after administration oftheagentsmentioned

above.

Hyperosmotic

diuretics and adrenocortical hormones are the two

best

drugs,amongthecurrently

available

therapies, for lowering the intracranial pressure.
However, as mentioned before, they cannot be
regarded as the ideal treatment due to various
constraints on the usage and side effects.
On the other hand, oriental medicine defines
Figure 1

cerebral edema as a localized stasis of cerebral

Effective case. 52-year-old female with metastatic

fluid (suidoku). Therefore, the “promoting diuresis

cerebellar tumor caused by lung cancer.

and eliminating dampness” therapy could be used
as one of the treatment methods. Goreisan, one of
the representative diuretics2)3) has a very different
diuretic

property

fromWestern

medicines.

Although it acts to adjust the systemic waterbalance,itrarelycauseslocal

electrolytes

abnormality. The risk of creating dehydration4) islow. This makes goreisan a highly safe drug forusage.
Left
左Left
左 Right
右右Right
Figure 2

The efficacy of goreisan for cerebral edema
complicated with intracranial malignant brain

withtumor was examined in this study. The overall

metastatic brain tumor caused by lung cancer. Her

improvement rate was 71.2%. The improvement inleft hemiparesis did not resoled by gireisan.

headache alone was 83.9%. Since the relieving ofRight: 82-year-old male with metastatic brain tumor

theby colon cancer complained of agnosia. Did notneurological damages caused directly by tumors,

Ineffective

case.

Left:

66-year-old

respond to oral steroids either.

femalecerebral

edema

will

not

improvethethe overall improvement rate of 71.2% issatisfactory.

In spite of a selection bias, thisstudy still supports the value of goreisan as an
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

13

Volume 5, Number 4 | Winter 2010

option against mild to moderate symptoms.

tumor, trauma, cerebrovascular damages, and“suidoku” -which result in forming vasogenic

The pharmacological mechanism of the water

cerebral edema- it is known that the expression of

goreisan hasn’t been

AQP4 increases in the perivascular glial endfeet,

uncovered yet; however, the effects on aquaporins

which is an important component of the blood-(AQP), known as a water channel has gathered

brain barrier. Hence, it is assumed that AQP4 re-attention5)6) in recent years.

absorbs extracellular fluids, functioning in thedraining

propertyindirectionofrelieving

cerebraledema.

In

AQP, a membrane protein, was reported inmalignant glioma, the expression of AQP4

1990 as a water channel that selectively transport

significantly increases in the tumor itself rather

electrolytes7).

than in the area of tumor infiltration, i.e. edema

Thirteen types of AQPs have been identified so far.

in tumor periphery. The degree of expression andExpressions of AQP13,4,5,8,9,11,12) have been verified

the extent of brain edema formation seem to havein the brain but the major AQP subtypes are twoco-relation11). AQP4 seems to have bilateraltypes; AQP1 and AQP48). AQP1 mainly appears

natures, edema formation and edema relief, but

in the choroid plexus epithelia. AQP4, whichfurther functions of AQP4 remain unknown.

appears mainly in the central nervous system, isHowever, it is currently expected that theprevalent in the subarachnoid cavity, ventricles ofinhibition of the AQP4 could lead in reduction of

the brain, and neuroglia cells close to cerebral

cerebral edema12).

water molecules without moving

blood vessels. They are all believed to be deeply
engaged in the water metabolism of the brain.

The expression of AQP1 increases in the

Therefore, the study on AQP4 has now become one

cytoplasm of malignant glioma. The level of theof the most advanced research areas9).

expression co-relates with the degree of themalignancy and the expansion of the edema in the

Factors attributable to cerebral edema aretumor periphery. There is a report13) that evenclassified into five types; vasogenic, cytotoxic,

when the expression of AQP1 is not observed inosmotic, hydrostatic, and interstitial. Major ones

metastatic cerebral tumor, the increase in theare vasogenic and cytotoxic. The most common

AQP1 expression was confirmed in the edema intype of cerebral edema caused by brain tumor isvasogenic edema triggered by a damage or loss ofthe blood-brain barrier.

the tumor periphery. Based on this report, AQP1
inhibitors may also bring about a new treatment
modality for cerebral edema complicated withAccording to an animal experiment using AQP4

malignant cerebral tumor.

null mice10), AQP4 works to protect cells against acytotoxic cerebral edema, whereas it aggravates
cerebral edema if it is vasogenic. This signifies
that AQP4 promotes water flowing into cells if
cerebral edema is cytotoxic, while promoting theexcretion of water in vasogenic cerebral edema. In
fact, with pathological conditions of malignant

14

Out of crude drugs composing goreisan (Arisma
Rhizoma, Polyporous Schlerotium, Atratylodes
Lancea Rhizoma, Tuckahoe, and Cassia Bark), it
isreported

that

Polyporous

Schlerotium,

Atratylodes Lancea Rhizoma, and Tuckahoe
inhibit AQP4 and control it in a concentrationdependent manner the water permeability of cell

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

Volume 5, Number 4 | Winter 2010

membraines14)15). Since no aggravation of the[References]

symptoms by goreisan was observed in any case in

1)

YAMADA K: Kampo no Kuden – Chikuan nothis study, at least, the AQP4 inhibiting effect ofHitorigoto – Taniguchi Shoten (Tokyo), p31,

goreisan does not seem to promote brain edema.

2009.

This suggests that goreisan could be a safe drug

2)52-57, 2007

for an AQP4 inhibitor, and it is expected to reduce
cytotoxic edema in tumors as well as vasogenic
edema in the peripherial area of tumor.

3)

Nie Yimin: goreisan [2], Chui Rinshou 28(3):80-83, 2007

4)

TASHIRO S: goreisan no Risui-sayo. Kidney and
Dialysis, Supplementary volume 34-37, 1989

For the future, measures must be taken toenhance goreisan’s clinical efficacy. Japanese

Nie Yimin: goreisan [1], Chui Rinshou 28(2):5)

DonaldE.

G.

Griesdale,

Honey

CR:

extracts contain lower volumes of crude drugs

Aquaporins and brain edema. Surg Neurol

compared to decoctions of Traditional Chinese

61:418-421, 2004

Medicine. Thus, it is assumed that medicinal

6)

edema and aquaporin 4. Shinkei Shinpo,

efficacy of Japanese extracts is inferior. To
enhance the efficacy in a regular clinical practice,which uses the extracts as the main drug, the7)dosage-increase or combination with choreito(Umbellate Fungus Decoction) or bukuryoin(Tuckahoe Decoction) for the purpose of increasing
the total volume of Polyporous Schlerotium,

SATO S, ADACHI K, KANOU T, et al.: Brain

8)50(2): 183-189, 2006
Gregory M. Preston, Agre P: Isolation of thecDNA for erythrocyte integral membraneprotein of 28 kilodaltons: member of anancient channel family. Proc Natl Acad Sci
USA88: 11110-11114, 1991
SOBUE K, HIRATA H, IIDA Y, TAKAYANAGI

Atratylodes Lancea Rhizoma, and Tuckahoe may

T: No-Fushu no Hasshou Kijyo to Mizu-

be considered. From the perspective of thechanneru [Aquaporin] no Kinou. Anesthesia

combination usage of goreisan and steroids, the21 century 10:51-55, 2008
9) Marios C. Papadopoulos, Verkman AS:
Aquaporin-4 and brain edema. Pediatr
Nephrol: Pediatr Nephrol 22(6):778-784, 2007
10) Geoffrey T. Manley, Binder DK, Papadopoulos
MC et al: New insights into water transportand edema in the central nervous system fromphenotype analysis of aquaporin-4 null mice.
Neuroscience 129(4): 983-991, 2004
11) Arne Warth, Simon P, Capper D, et al:
Expression pattern of the water channel
aquaporin-4 in human gliomas is associatedwith blood-brain barrier disturbance but notwith patient survival. J Neurosci Res 85:
1336-1346, 200712) Orin Bloch, Manley GT: The role of aquaporin4 in cerebral water transport and edema.
Neurosurg Focus 22:1-7, 2007use of saireito (Minor Bupleurum Decoction) that
could induce endogenous hormones is also worth
considering.
[Conclusion]

Goreisan can be applied for treating cerebral
edema complicated with malignant brain tumor.
Since goreisan is safe and suitable medicine forlong-term usage, it can be used as an alternativeand complimentary medicine to Western oral
drugs such as steroids and isosorbide.

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

15

Volume 5, Number 4 | Winter 201013) Samira Saadoun. Papadopoulos MC, Davies
DC, et al: Increased aquaporin 1 water
channel expression in human brain tumors.
Br J Cancer 87: 621-623, 2002
14) ISOHAMA Y: Risuizai “goreisan” no Sayo
Mekanizum. Kampo Igaku 29(5): 213-215,
2005
15) ISOHAMA Y: Kampoyaku no Risui Sayo to
Aquaporin. Shoni-Kanjya no Mijikana Kampo
Chiryou.

10th

NipponShouniKampo

Kondankai Kiroku-shu. Medical Review Sha(Tokyo), p8-31, 200916

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

Volume 5, Number 4 | Winter 2010

Clinical Report 1 (Europe)
Shonishin in Europe (2)has noticed a dramatic decrease of the recurrence
rate from 20-25% to below 3%. Since then he could

Thomas Wernicke
Therapeuticum rhein-main, Germany

3. Treatment of asymmetric babies with Shōnishin (astudy)
Backgroundobserve the cervical blockages dissolving again
and again due to the exclusive application of
Shōnishin only (which means without manualintervention ).
So the question arises, if the dissolution of the

There has been no study outside Japan up to

blockages with Shōnishin were only individual

now, which proofs the effectiveness of Shōnishin.

cases or if they are reproducible. In case they are,

The present study about the treatment options of

it would be interesting to determine the likehood

asymmetricshouldof a successful dissolution of the blockage in thecontribute to the effectiveness of Shōnishin as aarea of the atlantoaxial joint and therewith atreatment method taking scientific criteria into

reduction of the related mostly vegetatively

account.

caused co-occurring symptoms when using thebabieswith

ShōnishinShōnishin method only.
Till the year 2002 the author used to treat
asymmetries in the early childhood using manual-

Apart of the proof of efficacy of Shōnishin as atherapeutic methods (infantile chiro therapy,

treatment method, it was another aim of thiscraniosacral treatment, osteopathic techniques). A

study to establish Shōnishin as an effective

dysfunction in the area of the cervical spine

treatment method which is pleasant for the child(C0/C1 and/or C1/C2) caused by obstetric traumas

and cost-saving for the parents.

(mostly in the sense of a blockage) can usually beconsidered as the reason for the asymmetry.

Methodology

Typically, these babies attract attention because of

Shōnishin was applied as exclusive treatment

their head tilt, a scoliotic posture of the torso as

method in a prospective clinical research using awell as because of disorders concerning vegetative

standardized process with babies between thefunctions due to the proximity of the vegetative

ages of six weeks to twelve weeks suffering from a

nervous system (Ganglion cervicalis superius) toblockage C0/C1 and C1/C2.

the cervical spine. Left untreated, these children
may suffer from retarded development, damaged

Diagnostic Basics

postures or concentration disorders later on.

- Examination form before/after treatment- Entry questionnaire for the parents (anamnestic

The author made the experience that acollection of data about pregnancy and birth,reoccurrence of the blockage after two to four

symptom description of their baby before theweeks could be noticed with about 20-25% of alltreatment)

successfully treated babies when using purely- Questionnaire after completion of treatment for

manual treatment only. Since 2003 he has

the parents (symptom description of their baby

integrated Shōnishin in his treatment concept inafter the treatment, estimation about success

addition to the manual treatment. In this time heand acceptance of the treatment

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

17

Volume 5, Number 4 | Winter 2010

- Photo-/Video-documentation

Treatment

Primary target parameters were changes in

The treatment took place following a standardized

the movement functions in the area of theatlantoaxial

joints(inangle

degrees).

Secondary parameters involved changes in thesensomotor- and vegetative system as well as
the acceptance of the treatment method by theparents.

procedure. Each baby received three treatments in
one-week intervals. The duration of the treatment
itself was between three and five minutes. A
manual-diagnostic

whole-bodystatuswithparticular focus on the cervical spine was taken at
the beginning of the treatment series and one
week after the last treatment.

Basic treatment (stroke-technique along the to regulate the Ki
extremities and the trunk) (Fig.1)
Vibration technique onLu 9, LI 4

St 36, Sp 3



SI 3

to emphasize the „centre“

because of its close relationship to the cervical
spine



Li 3 (Fig.2)

to reduce thegenerally increased muscle tone



GV 14

for relaxation of the shoulder girdle



SI 9

because of its close relationship to the shoulder
blade (scapula)



Bl 28

because of its close relationship to the sacroiliac
joint



Bl 60

because of its erection supporting effect (allows
a better head control in prone position)

Tapping technique periumbilicalto emphasize the „centre“ (Stimulation of thespleen-zone around the navel)

Tapping technique along the Bladder Meridian to provoke

a certain neonatal reflex (the so-on the level of the shoulder blades (scapulae) or called Galant Reaction) to activate the Gbin the lumbar area (Fig.3)

18

Meridian

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

Volume 5, Number 4 | Winter 2010

Results
The proof of efficacy could be provided withfollowing treatment results:
1. There was a dissolution of the blockages in theupper cervical area with 57, 5 % of all babies
treated with Shōnishin only.
2. A breakup of the asymmetry could be proved inapproximately 43% of the cases of all treatedasymmetric babies.
3. An improvement of secondary symptoms could
be seen in many cases. This concerned inparticular crying patterns, sleep patterns andthe acceptance of the prone position.
Fig. 1The study shows that Shōnishin is a gentle
treatment method, which is free from side effects
and pleasant for the baby. The effectiveness of
Shōnishin can be documented by the treatment ofbabies suffering from blockages in the upper
cervical area.
The advantages with regard to conventional
treatment methods are that- there is no need for a manipulation or
Fig. 2

mobilization of the cervical spine- the feasibleness of the treatment is simple- the treatment can even be done with crying or
restless babies
Further advantages of Shōnishin are:
- Short duration of treatment (1-3 sessions)- Short treatment time (3-5 minutes)- Little effort (short treatment time, easy
handling)- Very good compliance with the parents
The present study allows us to conclude that
Shōnishin is an effective treatment method. The
standardized proceeding in the treatment ofasymmetric babies has proven its worth and is at

Fig. 3

least equal to other therapy methods.

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

19

Volume 5, Number 4 | Winter 2010

for the use in neonates with NAS. As soon as the

4. Future prospects

study is authorised by the Ethics Committee, it

Fields of application with Shōnishin
For acupuncturists, especially for those, whose

can be implemented in the mentioned clinic.

treatment focus is in the area of children, a new

Another field of application for Shōnishin will

field of action comes in appearance with Shōnishin,

be in the treatment of very old people. In

respectively an existing one can be widened.

particular parameters like skin condition and

Furthermore,mental condition seem to show retrogression into

Shōnishinisaninteresting

supplement - or even an alternative for any
therapist with acupuncture knowledge using
manual methods.

childhood:
Skin - Just like children's skin, old people's skinis very vulnerable because of its parchment-like

For that reason experiences of different nature

structure(Fig.4).

Concerningthestroking

are made in women's shelters, mother- childtechniques this means that old people are notfacilities and nurseries with Shōnishin. In thistreated with the stroking technique for adults, butcase women and children, who are in difficultin a more tender way, just like the age group fromsocial or monetary situations, abandoned, without

eight to twelve or even younger.

any perspective and obviously no way out, areMental condition – The older people get, thesupported. These include e.g. traumatised womenless they seem to be living in the present.

and children (for instance after being raped), who

Memories or situations in the childhood dawn toare only able to permit touching, as due to theawareness increasingly more and more again and"interposed" Shōnishin instrument no dermal

do often influence the person’s mood. Often,

contact with the skin happens.

“childish” patterns of behavior become apparent,

The experiences of being able to influence posttraumatic disorders positively by Shōnishin set an
impetus for another study which is to be made at
the Medical University of Vienna, Department of
neonatology,

pediatric

unadjusted behavior.
First experiences with Shōnishin in homes forthe aged show promising treatment approaches.

Non-invasive

Even here it becomes obvious, that treatment withJapanese Pediatric acupuncture (Shōnishin) fora Shōnishin -instrument is advantageous: Seniors

supporting neonatal abstinence syndrome (NAS).

often suffer from a shortage of touching. WithThe motivation for this study is to apply a non-Shōnishin the contact doesn’t take place directly,

invasive, cost effective method without known

but indirectly with an instrument. For that reason

side effects to reduce withdrawal symptoms andseniors have no fear of contact and are willing toasallow the treatment.

aProjectconsequencetotitle:

reducecarebeing cleaned, loss of bladder control andandneuropediatrics.

intensivefor example being fed, being brought to toilet,

the

need

of

pharmacological therapies in neonates with NAS.

Another advantage of treating elderly people

We believe that the treatment approach iswith Shōnishin is that many of them have to takecompletely novel in the field of neonatology. This

blood-thinning medicines. Due to the non-invasive

study intends to provide reliable data with aand gentle treatment technique with Shōnishin,

responsible

there is no contraindication.

assessment

of

the

use

and

effectiveness of Japanese pediatric acupuncture
20

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

Volume 5, Number 4 | Winter 2010

Reference
Wernicke T.
Shōnishin–japanische

Kinderakupunktur.

München: Elsevier; 2009
Kalbantner-Wernicke K, Wernicke T.
Baby-Shiatsu – eine energetische Ergänzung zur
osteopathischen Behandlung. Osteop Med 2010;
11,2:10-13
Tanioka M.
Taishiryū-Shōnishin: Verlag Rikuzensha; 2005
Wernicke T.
Fig. 4

Shōnishin – die japanische Kinderakupunktur.
Standortbestimmung

Conclusion- Shōnishin is about to play an important role in
the treatment of children. An increasing
number of doctors and non-doctors (alternative
practitioner,

physiotherapists,

Shiatsu-practitioners)

midwives,

discoverthis

exceptionally gentle and effective type oftreatment. Shōnishin finds its application in
doctor’s or acupuncturist’s surgeries, midwife
work and increasingly in clinics.
- In

the

frameworkof

congresses(TCM,

pediatrics) there is an increasing demand for
Shōnishin -lectures, respectively Shōnishin events.

einer

bei

uns

noch

weitgehend unbekannten Therapiemethode. Dt
Ztschr f Akup 2006; 49,2:18-24
Wernicke T.
Baby-Shiatsu und Shōnishin. Grundlagen und
Voraussetzungen für die Behandlung von Babys
und Kindern. Shiatsu-Journal Herbst 2006;46:1618
Wernicke T, Kalbantner-Wernicke K.
Kinderakupunktur

mitentwicklungsphysiologischShōnishin-Methode.

Dt

der

orientierten

Ztschrf

Akup

2009;52,3:19-22
Thomas Wernicke (Vita)
Specialistingeneralmedicine,

additional- Shōnishin offers a valuable support for the

trainings in naturopathy, manual medicine,

treatment of traumatized children and mothers.

acupuncture, homeopathy and manual treatment- Amongst others, it is thanks to Shōnishin, thatof infants and children. Member of Nihon Shōni

there is an increasing interest in traditional

Hari Gakkai (Japanese scientific society forJapanese medicine, especially in Japanesechildren acupuncture). Founding member andacupuncture.

first chairman of “Internationale Gesellschaft für
Traditionelle Japanische Medizin e.V.”

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

21

Volume 5, Number 4 | Winter 2010

Clinical Report 2 (Japan)
A Case of Recurrent Folliculitis

Takao Namiki, M.D.,Ph.D

Associate Professor,
The Department of Japanese-Oriental (Kampo) Medicine,
Chiba University Hospitallesions on the head with oozing exudate. They wereparticular marked at the frontal hair line, the back of
the head and on the vortex (figure 1, at the first visit).

Introduction

Jizusoippo is a formula created in Japan. It iscomprised of 9 crude drugs and indicated mainly forswellings of the epidermis (to dispel dampness) and
improvement of blood flow (activate blood) and acts
to improve the skin condition (clearing heat andremoving toxins). It is often used as a formulaspecifically for skin diseases like atopic dermatitis or

Figure 1: Before treatment, Rash on hairline

seborrheic dermatitis. On this occasion we would
like to present a case of recurrent folliculitis
refractory to western medical treatment, where diet,lifestyle guidance and treatment with Jizosoippo led
to improvements.
The patient was a 19-year old male.
Chief complaint: recurrent folliculitis
The anamnesis of the present illness showed, thatdying his hair in October during his third year insenior high school led to the development of a largeswelling on his head. The lesion reached the size of a

Figure 2: Before treatment, tongue

golf ball and its contents was aspirated by a local

Prescription from the dermatology department:

physician. This was not a malignancy, but he wastetracycline ointment, betamethasone lotion

nevertheless referred to a university department ofSymptoms and complaints

dermatology. He was diagnosed with multiple•

dry mouth, marked spontaneous sweating

folliculitis.

•

meat centered diet•

constipation (once every few days, feeling of

According to his mother, the above mentioned

residual stools)

swelling developed by the time, the admission to auniversity had been settled. Later, the patient•auniversity

departmentofdermatology

historyofvagal

reflexes,

occurrence of syncopes

tended to stay up late, indulged in an unbalanced
diet and neglected his health. Even after consulting

dizziness:•

micturition: Micturition desire triggered bytension. High urinary frequency

exacerbations recurred and because the condition

Complicating factor: greasy foods (he like to eat

did not show any signs of improvement, he was

Hamburgers and ice cream), constipation, stress, atreferred in August of the following year to thetime of catching cold, lack of sleep.

Department of Japanese-Oriental (Kampo) Medicine,

Kampo medical examination

Chiba University Hospital. At the time he came for
consultation there were protuberant folliculitis
22

The pulse was in between the deep and superficial
layer, of intermediate size and strength.

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

Volume 5, Number 4 | Winter 2010

The tongue had a slightly dark red shade, was a

According to the patients wish the treatment was

little enlarged, showed no teeth marks and wascontinued over half a year and then terminatedmarkedly moist with a white coat; sublingual veinsbecause of improvement.
Profile – Jizusoippo (Hodokubenkai)were slightly engorged.
Abdomen: intermediate abdominal strength, mild

The formula jizusoippo was created by Futei

tension of the rectus abdominis muscle, presence of

Fukui (birth 1725 – death 1792) and its contents

tenderness to the left and right of the umbilicus.

later slightly modified by Asada Sohaku to become

Based on the above findings of eczema above theneck, a condition between deficiency and excess,mild degree of blood and water retention andconstipation, we used only jizosoippo. During thenext visit 2 weeks later the flares had decreased toabout half their original scope and the itching
showed a decreasing tendency too.
After treatment over a period of 3 months, theforehead lesions had disappeared and a decrease in

the formula used today. Its naming suggests, that it
is a "formula to treat eczema of the skull", but today
it is used for skin diseases everywhere on the body.
It carries the nickname daikyuoto.
The formula has the following composition.
3 g of Cnidii Rhizoma
3 g of Atractylodis Lanceae Rhizoma
3 g of Forsythiae Fructus

papules on the back of the head and its vortex was

2 g of Saposhnikoviae Radix

observed (figure 2).

1 g of Glycyrrhizae Radix
1 g of Schizonepetae Spica
1 g of Carthami Flos
0.5 g of Rhei Rhizoma
2 g of Lonicerae Folium Cum Caulis[Efficacy] Expels wind and activates blood, clears
heat and remove toxins, expels dampness[Main indication] Wind -dampness, heat toxin[Explanation of the formula]

Figure 3: After 3 months, Rash on hairline

Schizonepetae Spica and Saposhnikoviae Radix
disperse wind evil; Atractylodis Lanceae Rhizoma
and Ledebouriellae radix remove dampness; Cnidii
Rhizoma activates blood and at the same time
supports the free coursing function of the liver andin conjunction with Atractylodis Lanceae Rhizoma
dispels the wind evil from the blood. Forsythia,
Lonicera japonica and Glycyrrhizae Radix clear heatand remove toxins, and together with Rhei Rhizoma
cool and remove heat toxin from the blood. Carthami
Flos in conjunction with Cnidii Rhizoma and Rhei

Figure 4: 3 months later, tongue

Rhizoma alleviates blood stagnation and prevents
evil from remaining in blood. The combination of theascendingproperties

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

of

CnidiiRhizomaand23

Volume 5, Number 4 | Winter 2010

descending properties of Rhei Rhizoma ensure anumber of case reports or case series studies hasbalance of the ascending and descending properties.
Clinical Application

been submitted.
Seki et al. reported a case of a 55-year old woman

This formula is used specifically for skin diseases.

with adult atopic dermatitis. By the age of 40

Originally it was used for infants with eruptions onerythematous patches associated with pruritus andthe skull, secretions, itching and eschar. While it isdesquamation developed in this woman on the facecurrently used not only for eruptions on the skull,and were treated by a local physician with topicalbut anywhere on the body, also in adults, its

steroids, but because neither this resulted inapplication is not surprisingly particularly high forcomplete recovery nor did similar treatments in

eruptions on the skull or the face. It is particularly

several other clinics led to any remission and afrequently used for cases with atopic dermatitis, so

topical steroid induced rosacea-like dermatitisthat research has been carried out regarding thisdeveloped as a complication, Kampo treatment was

indication. Rhei Rhizoma in this formula may not be

initiated. After the patient had been treated withnecessary for people with daily regular bowel

shosaikoto (Xiao Chai Hu Tang) for 6 months, themovements, but the addition of a small amount ofcondition had healed almost completely2).

Rhubarb probably gives better results.
1. Atopic dermatitis

Yamamoto et al. evaluated the results after
treating 36 patients with adult atopic dermatitis

Otsuka Keisetsu (1900-1982) was the first personwith jizusoippo (7.5-15.0 g) over a period of 4 or 8

to use this formula for the treatment of atopic

weeks and reported marked improvements in 9

dermatitis. The historical record mentions that inpatients (25%), improvements in 8 patients (22.2%),

1970 this disease was rare and there were only few

mild improvements in 10 patients (27.8%) and no

refractory cases. Like for example as follows.

changes in 9 patients (25%)3).

The patient was a 5-year old boy. Shortly after

Cases where atopic dermatitis is associated withbirth eczema developed and he received various

bronchial asthma often receive a combination

treatments, but because the condition failed totherapy

improve he was brought to consultation. Most of the

Otsuka mentioned that addition of Ephedra andlesions were located on the arms and neck, as well as

gyps to jizusoippo improves not only the eczema buton the medial side of the knees. He caught easily cold,

also the asthma4).

withmakyokansekitoorshoseiryuto.

which then led to a congested nose and his voiceSome cases of atopic dermatitis also respond totended to get hoarse. Occasionally there were nose

Eppikajutsuto. That is because the combination of

bleedings. Appetite varied extremely and was not

Ephedra and gyps can dispel damp heat. Even in

constant. He drank plenty of water. One bowel

cases without asthma the combination of jizusoippo

movement per day. After 2 weeks of treatment withand makyokansekito can achieve similar results.

jizusoippo the skin became smooth and almost all of

Ito reported the markedly effective treatment of athe eruptions had receded. After continuing the

1-year old girl with atopic dermatitis using a

medication for another 4 weeks the eruptions had

combination of makyokansekito and jizusoippo5).

disappeared without a trace1).
Later, physicians inspired by this case used theformula for the treatment of atopic dermatitis andthus accumulated relevant clinical experience. A
24

2. Seborrheic eczema

Jizusoippo has originally been developed for thetreatment of pediatric seborrheic eczema. Today

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

Volume 5, Number 4 | Winter 2010

this disease can quickly be alleviated throughreported a marked improvement in 3, improvements

topical application of steroid ointments, but inin 2 and no changes in 3 patients3).

former times there was no really good treatment.

3. Furunculosis

When Otsuka used jizusoippo for a 4-year old girlThis formula is often effective for the treatment

in whom shortly after birth erythematous lesionsof erythematous lesions of the head, regardless of thedeveloped on the head and face, who complained of

diseases causing them.

pruritus, formation of thick scabs from which serum

A dermatologist referred a middle-aged man withoozed out if they were removed only to form new

furuncles continuously developing on the head non-scabs, the pruritus was alleviated after about 10

responsive to treatment with antibiotics to Terutane

days and after about 40 days the condition had

Yamada, who advised the patient to take thiscompletely been cured. Administration of the same

formula. After about 1 months of administration theformula over a period of 2 months following apatient had almost completely recovered9).

recurrence again led to a complete recovery6). This

References

was in 1953.
The number of physicians using this formula for

1) Otsuka K: Otsuka Keisetsu Collected Works 1980

seborrheic eczema in infants increased after the2) Seki T, Masaaki Morohashi: A case of adult atopic

publication of this report. I will cite a case reportdermatitis successfully treated with jizusoippo,

from Yakazu.

No. 13 Records of the Dermatologic Oriental

The patient was a 4-month old girl. One and a half

Medical Society, No.6, 31-38,1995

month after birth apparently itchy erythematous

3) Yamamoto I: A case of adult atopic dermatitis

lesions developed on the head, that were associatedsuccessfully treated with jizusoippo, No. 16

with copious secretions and the skin started to peel

Records of the Dermatologic Oriental Medical

off. The regions affected gradually increased in size

Society, No. 9, 29-39, 1997

and by the time of the first consultation had spread4) Otsuka K: Otsuka Keisetsu Collected Works 1980

to the back, the entire abdomen and buttocks. At a5) Ito N: A case of atopic dermatitis in which

department of dermatology the condition was

makyokansekito and jizusoippo combination

diagnosed as pediatric seborrheic eczema andtherapytreated,Treatment Vol.13, No.8, 1994

but

did

not

improve.

administrationofjizusoippo

half

Followingoftheerythematous lesions disappeared after about one

wasmarkedlyeffective,

Kampo6) Otsuka K: Pediatric skull eczema, 30 Years of
Kampo Treatment, 378, Sogensha, 1959

month, 2 months later approximately 80% had

7) Yakazu D: jizusoippo for pediatric seborrheic

healed and after 3 months the condition had healed

dermatitis, A Hundred Kampo Stories, 134

almost completely. Since the administration of the

Idononipponsha 1960

drug appetite increased, the infant gained weight8) Terutane Yamada: Examination and Treatment of
Kampo

and got well7).
This formula is currently also used for adult

Medicine[Practical

Application],

Taniguchi Shoten

seborrheic eczema. It is indicated for erythematous
lesions developing on the head and face.
Yamamoto et al. administered this formula to 10
patients (adults) with seborrheic eczema and
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

25

Volume 5, Number 4 | Winter 2010

Clinical Report 3 (Japan)
Kamishoyosanwas Effective fora Patient having Vomit

painful.
Menstruation tended to be delayed withmenstrual cramps.

Mihoh Koga, M.D., Kampo Specialist

Palms were sweaty.

Research Assistant of Division of Clinical Pharmacology
and Therapeutics and Division of General Medicine
Jikei University School of Medicine[Case]

Good sleep.
Did not get irritated.
Palpation; Pulse – floating, string-like, and fast.

Female of 16 years old

Abdomen – the entire abdominal region[Chief complaint] Epigastric abdominal pain andwas hard, abdominal rectus muscles onnausea[Past

medicalhistory/family

history]both sides were tense with stuffiness andNo

rigidity below the heart, and tenderness

particular mention

in the right para-umbilical region.

[Current medical history]
Two days ago, she had a discomfort itchingsensation in the epigastric region and then nausea
appeared. Vomiting started at the night. On thefollowing day, vomiting did not stop and she madea visit to the psychosomatic medicine of a nearby
hospital, where she received psychotropic agentsand anti-anxiety drugs. At nightfall, vomiting
stopped. However, epigastric abdominal pain andvomit were not relieved and she visited ourdepartment.
Similar symptoms had appeared sometimes
since she was 12 years old. The symptoms tended

Prescription: kamishoyosan（Tsumura & Co., Ltd.,Tokyo, Japan）5.0g/2 x

Inspection: Moderate body frame. Tongue: with

Kamishoyosan (modified merry life powder)
Bupleuri Radix 9.0 (3.0), Atractylodis Ovatae
Rhizoma 9.0 (3.0), Menthae Herba 1.0 (1.0),
Glycyrrhizae Radix 4.5 (1.5), Angelicae Acutilobae
Radix 9.0 (3.0), Poria 9.0 (3.0), Gardeniae Fructus
3.0 (2.0), Atractylodis Rhizoma 9.0 (3.0), Zingiberis
Rhizoma 3.0 (1.0), Moutan Cortex 3.0 (2.0)

white furs.

Efficacy: Activation of the flow of liver-qi andto develop when she was tired or the abdominal
area became cold. Once developed, the symptoms
persisted for two days to one week. Examinationsat other hospital revealed no abnormalities.
[Present condition]

Inquiry:26

She claimed that usually she had

elimination of its depression, harmonization of theappetiteblood, and purge of fire.

and

the

gastrointestinal

condition was good.

Major indication: Liver-qi depression with blood

Defecation was regular /once a day.

deficiency and transformation into fire.

Urine amount was a lot.

Course:Limbs became cold and easily frostbitten.

Two weeks later, she could take the medicine. The

Easily caught a cold. Although a high

day after the start of the internal use of the medicine,fever did not develop, the condition was

abdominal symptoms disappeared. The patient

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

Volume 5, Number 4 | Winter 2010

became able to sleep well. She was aware that theprescription was appropriate for her.

Four months later, she was well. Menstrual
cramps were becoming eased. Hands were still cold.

String-like pulse. There were fullness in the chest

Fullness in the chest and hypochondrium resolved.

and hypochondrium on both sides, tension in the

She was instructed to adjust the dose amount toabdominal rectus muscles on both sides, tenderness

2.5-5.0g/day based on the extent of coldness.

in both para-umbilical regions, and lower abdominal

Seven months later, she was in good shape withnumbness. The same prescription was maintained.

the use of 25g of the medicine before sleep. If she

Two months later, stomachache developed before
the menstruation cycle began. Although nausea
occurred resulting in vomiting, the condition
recovered quickly. The tongue was dark red. There
were fullness in the chest and hypochondrium on
both sides, tenderness in both para-umbilical regions,
and

lower

abdominal

numbness.

The

same

prescription was maintained.

forgot to take it, a sense of discomfort appeared.
The diagnosis of the abdomen revealed only mild
tenderness in the para-umbilical regions.
Nine months later, she was feeling well andstopped the use of the medicine. Then she vomited at
a night, so she took the medicine. In the following
morning, nausea and vomiting resolved. Recovery
became fast.
One year and ten months now, with no symptoms,
she is in good condition.

At the first visit

After 2 weeks

After 2 months

After 4 months

After 7 months

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

After 9 months

27

Volume 5, Number 4 | Winter 2010

Kampo Formula Developed in Japan (4)Jizusoippo
Hiromichi Yasui
Japan Institute of TCM Researchevil from remaining in blood. The combination of theascendingproperties

ofCnidiiRhizomaanddescending properties of Rhei Rhizoma ensure abalance of the ascending and descending properties.
Clinical application

ProfileThe formula jizusoippo was created by Futei Fukui(1725-1792) and its contents later slightly modified
by Sohaku Asada(1815-1894) to become the formulaused today. Its naming suggests, that it is a "formula
to treat eczema of the skull", but today it is used forskin diseases everywhere on the body. It carries thenickname daikyuoto.

This formula is used specifically for skin diseases.
Originally it was used for infants with eruptions on
the skull, secretions, itching and eschar. While it iscurrently used not only for eruptions on the skull,
but anywhere on the body, also in adults, its
application is, not surprisingly, particularly high for
eruptions on the skull or the face. It is usedparticularly

Prescription composition

frequent

for

cases

with

atopicdermatitis and thus led to the conduction of research

Cnidii Rhizoma 3 g

relevant to this indication. The Rhubarb in thisAtractylodis Lanceae Rhizoma 3 g

formula may not be necessary for people with daily

Forsythiae Fructus 3 gregular bowel movements, but the addition of a small

Saposhnikoviae Radix 2 gamount of Rhei Rhizoma probably gives better

Glycyrrhizae Radix 1 g

results.

Schizonepetae Spica 1 g
Carthami Flos 1 g

1. Atopic dermatitis

Rhei Rhizoma 0.5 g

Otsuka Keisetsu (1900-1982) was the first person to

Lonicerae Folium Cum Caulis 2 g

use this formula for the treatment of atopic

Efficacydermatitis. The historical record mentions that inExpels wind and activates blood, clears heat and1970 this disease was rare and there were only few

removes toxins, expels dampness

refractory cases. Like the following example.

Main indication

The patient was a 5-year old boy. Shortly after birthWind -dampness, heat toxin

eczemaExplanation of the formula

treatments, but brought to consultation because the

Schizonepetae Spica and Saposhnikoviae Radix

condition failed to improve. Most of the lesions weredisperse wind evil; Atractylodis Lanceae Rhizoma

located on the arms and neck, as well as on theand Ledebouriellae radix remove dampness; Cnidii

medial side of the knees. He caught easily cold,

Rhizoma activates blood and at the same time

which then led to a congested nose and a tendency tosupports the free coursing function of the liver andin conjunction with Atractylodis Lanceae Rhizoma
dispels the wind evil from the blood. Forsythia,
Lonicera japonica and Glycyrrhizae Radix clear heatand remove toxins, and together with Rhei Rhizoma
cool and remove heat toxin from the blood. Carthami
Flos in conjunction with Cnidii Rhizoma andRhei

Rhizoma alleviates blood stagnation and prevents

28

developedandhereceivedvariousdevelop hoarseness. Occasionally there were nose
bleedings. Appetite varied extremely and was notconstant. He drank plenty of water. One bowel
movement per day. After 2 weeks of treatment withjizusoippo the skin had become smooth and almost
all of the eruptions had receded. After continuing the
medication for another 4 weeks the eruptions had
disappeared without a trace1).
Later, physicians inspired by this case used the

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

Volume 5, Number 4 | Winter 2010

formula for the treatment of atopic dermatitis and2. Seborrheic eczema

thus accumulating relevant clinical experience. A

Jizusoippo has originally been developed for thenumber of case reports or case series studies havetreatment of pediatric seborrheic eczema. Today thisbeen submitted.

disease can quickly be alleviated through topicalSeki et al. reported a case of a 55-year old woman

application of steroid ointments, but in former times

with adult atopic dermatitis. By the age of 40

there was no really good treatment.

erythematous patches associated with pruritus andWhen Otsuka used jizusoippo for a 4-year old girl indesquamation developed in this woman on the facewhom shortly after birth erythematous lesions

and were treated by a local physician with topicaldeveloped on the head and face, who complained ofsteroids, but because neither this resulted inpruritus, formation of thick scabs from which serum

complete recovery nor did similar treatments inoozed out if they were removed only to form newseveral other clinics led to any remission and instead

scabs, the pruritus was alleviated after about 10

a topical steroid induced rosacea-like dermatitis

days and after about 40 days the condition had

developed as a complication, Kampo treatment wascompletely been cured. Administration of the same

initiated. After the patient had been treated withformula over a period of 2 months following ashosaikoto (Miner Bupleurum Decoction)for 6

recurrence again led to a complete recovery6). This

months,almostwas in 1953.

thecondition

hadhealedcompletely2).

The number of physicians using this formula for

Yamamoto et al. evaluated the results after treating

seborrheic eczema in infants increased after the

36 patients with adult atopic dermatitis withpublication of this report. I will cite a case reportjizusoippo (7.5-15.0 g) over a period of 4 or 8 weeks

from Yakazu.

and reported marked improvements in 9 patients

The patient was a 4-month old girl. One and a half(25%), improvements in 8 patients (22.2%), mild

month after birth apparently itchy erythematous

improvements in 10 patients (27.8%) and no changes

lesions developed on the head, that were associatedin 9 patients (25%)3).

with copious secretions and the skin started to peel

Cases where atopic dermatitis is associated withoff. The regions affected gradually increased in size

bronchial asthma often receive a combination

and by the time of the first consultation had spreadmakyokansekito

shoseiryuto.

to the back, the entire abdomen and buttocks. At a

Otsuka mentioned that addition of Ephedra anddepartment of dermatology the condition was

gyps to jizusoippo improves not only the eczema but

diagnosed as pediatric seborrheic eczema andalso the asthma4).

treated,

but

did

not

Some cases of atopic dermatitis also respond toadministrationofjizusoippo

Eppikajutsuto. That is because the combination oferythematous lesions disappeared after about one

Ephedra and gyps can dispel damp heat. Even inmonth, 2 months later approximately 80% had

cases without asthma the combination of jizusoippo

healed and after 3 months the condition had healed

and makyokansekito can achieve similar results.

almost completely. Since the administration of theIto reported the markedly effective treatment of a 1-

drug appetite increased, the infant gained weight

year old girl with atopic dermatitis using aand thrived7).

combination of makyokansekito and jizusoippo5).

This formula is currently also used for adulttherapywithor

improve.
half

Followingoftheseborrheic eczema. It is indicated for erythematous
lesions developing on the head and face.
Yamamoto et al. administered this formula to 10

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

29

Volume 5, Number 4 | Winter 2010

patients (adults) with seborrheic eczema andReferences

reported a marked improvement in 3, improvements

1.

Keisetsu Otsuka: Otsuka Keisetsu Collected
Works, Vol. 4, 24-25, shun-yo-do, 1980

in 2 and no changes in 3 patients3).
2.

Taisuke Seki, Masaaki Morohashi: A case of

3. Furunculosis

adult atopic dermatitis successfully treated withThis formula is often effective for the treatment ofjizusoippo, No. 13 Records of the Dermatologic

erythematous lesions of the head, regardless of the

Oriental Medical Society, No.6, 31-38,1995

diseases causing them.

3.

Izumi Yamamoto ：A case of adult atopic

A dermatologist referred a middle-aged man withdermatitis successfully treated with jizusoippo,

furuncles continuously developing on the head non-

No. 16 Records of the Dermatologic Oriental

responsive to treatment with antibiotics to Terutane

Medical Society, No. 9, 29-39, 1997

Yamada, who advised the patient to take this4.

formula. After about 1 months of administration thepatient had almost completely recovered8).

Keisetsu Otsuka: Otsuka Keisetsu Collected
Works, Vol. 4, 40-41, shun-yo-do, 1980

5.

Norio Ito: A case of atopic dermatitis in which

makyokansekito

andjizusoippo

combination therapy was markedly effective,
Kampo Treatment Vol.13, No.8, 1994
6.

Keisetsu Otsuka: Pediatric skull eczema, 30 Yearsof Kampo Treatment, 378, Sogensha, 1959

7.

Domei Yakazu: jizusoippo for pediatric seborrheic
dermatitis, A Hundred Kampo Stories, 134
Idononipponsha 1960

8.

Terutane Yamada: Examination and Treatmentof Kampo Medicine [Practical Application],
Taniguchi Shoten

30

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

Volume 1, Number 1 | Spring 2006

Ominedo is the only professional manufacturer of herbal extracts.

Poria Powder with Five Herbs
Wu-Ling-San
goreisanComposition
Arisma rhizoma
Tuckahoe
Atractylodes ovatae rhizoma
Umbellate pore fungus
Cinnamon bark

Ominedo Pharmaceutical Industry Co., Ltd.
574, Nenarigaki, Yamatotakada-City, Nara 635-0051, Japan
URL：WWW.ominedo.co.jp
Contact：info@ominedo.co.jp
Phone: (81) 745-22-3601 Fax: (81) 745-23-2540
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

35

Volume 1, Number 3 | Fall 2006

Kanebo Pharmaceutical, Ltd.
Like the cherry trees along Potomac River, Kanebo wishes
to play a role of the bridge for friendship and healthbetween Japan and U.S.A.

History of the Cherry Trees in Washington, D.C.
The plantings of cherry trees originated in 1912 as gift of friendship to the United Statesfrom the people of Japan. In Japan, the flowering cherry tree or “Sakura”, as it is called by
the Japanese people, is one of the most exalted flowering plants. The beauty of the cherry
blossom is a potent symbol equated with evanescence of human life and epitomizes thetransformations Japanese Culture has undergone through the ages.
2

Excerpted from National Park Service

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