Volume 9, Number 3 | Fall 2014

Kampo Medicine - Current Research
Clinical Applications of Kakkonto – Part 3

Case 1: Stiff shoulders
Patient: 53-year-old male teacher

Hiromichi Yasui
Japan Institute of TCM Research

Chief complaint: Stiff shoulders, dizziness
Past medical history: None in particular
History of present illness: From about a month ago,

Kakkonto is a prescription that first appeared in
the great Chinese classic Shokanron (treatise on cold
damage) and came to be widely used in Japan fromthe latter half of the 19th century. Particularly since
Yodo

Odai

(1799-1870)

introduced

variousindications for the prescription, it came to be usedwidely for a variety of diseases. In Japan, it is known
as a representative Kampo drug and a popularprescription that also appears in the traditional

the patient developed a stiffness from his shoulders
to the scapular region. He also felt as though his
body were floating at times, and experienced
dizziness and a ringing in his ears.
Condition at the time of hospitalization: Height
160cm, weight 58kg. Medium build and muscular,
good complexion. Recently, his stomach has felt
heavy after eating due to poor gastrointestinal
condition, but he showed no tendency of hot flashes,

Rakugo comic story of “Kakkonto Doctor.”

chills or sweating.

Clinical applications (continued)

no objective findings other than the tenderness in his

His cervical spine had good mobility, and there were

In Shokanron, indications for kakkonto are acuteinfectious diseases. However, from Japan’s morethan 150 years of experience, kakkonto is known tohave an extremely wide range of indications and is
today

appliedtomanydiseases.

These

are

introduced below, in continuation from the previous

shoulders and scapular region. X-ray images showeda narrowing and osteophyte formation in theintervertebral space between the C5-C6 spinal
segment.
His pulse was floating and excessive, and his tongue
was covered with a rather moist white coating. His

issue.

abdominal muscles were moderately tense, and

11. Stiff shoulders

paraumbilical resistance or tenderness, there was a

while

Shokanron paragraph 31 contains the passage, “Ingreater yang disease with a stretched stiff nape andback, absence of sweating, and aversion to wind,kakkonto

governs…”

Based

on

a

broad

interpretation of this passage, kakkonto is also
applied to stiff shoulders that are not caused by aninvasion of external pathogens.
Needless to say, there are various causes of stiffshoulders, and only some of them are indications for

kakkonto.
However, kakkonto is frequently used for stiffshoulders in daily practice. Its effect may appear inseveral hours or may not appear for several days.
Kitanami et al. have presented many cases inwhich kakkonto was used on an as-needed basis forstiffness in the neck, with good results.1) 2)

10

there

was

no

chest

side

painfulness,slight splashing sound in the epigastric region.

Kakkonto plus bukuryo (Poria) and byakujutsu(Atractylodis Rhizoma) was administered in thiscase, and good progress was observed over six weeks
without applying cervical traction.
Yoshihiro Fukuda, The Journal of Traditional Sino-

Japanese Medicine, Vol. 3, No. 4, p. 16, 1982
Case 2: Stiff shoulders accompanied by obesity andallergic rhinitis
Patient: 49-year-old female
Chief complaint: Stiffness in left shoulder
As a child, the patient was pale, thin and tall. Her
family feared tuberculosis and had her receive chest
X-ray and a blood sedimentation test once every year,
but she has never suffered a severe illness. She gave

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

Volume 9, Number 3 | Fall 2014

birth to two children at the ages of 29 and 31. From

was thus first attempted, but it was not all thataround the age of 40, her weight began to increase.

effective against the pain in the outer shoulder point.

At the time of her first visit, she weighed 54kg andFrom

November

of

this

year,

I

began

was 154cm tall. She found it troublesome to sit down

administering kakkonto extract in the place ofdeeply or to climb up and down the stairs. She had acervical traction. The patient took the preparation

darkish complexion with spots that stood out. She

for 16 days during the year and a total of 132 days

tended to get hot easily and sometimes slept with her

during the following year. In the beginning, the effectarms and legs sticking out from the blanket. She also

was not readily apparent, but she gradually began toexperienced spontaneous sweating. She had thirst,

stop experiencing any severe stiffness in theand frequently quenched her thirst with small sips

shoulder, and unexpectedly, she gradually lostof green tea. She passed urine 4 to 5 times a day andweight and became 44kg by the end of the following

had regular bowel movement every day. She had ayear after shedding 10kg. Furthermore, before she

normal appetite, but liked sweets and ate a cakerealized it, the fits of allergic rhinitis that she

during the day and a daifuku rice cake at night.

suffered since she was young had stopped.

The stiffness in her shoulder began afterHeartened by the effect of Kampo, she took thechildbirth and persisted for 20 years. The outer

preparation for 126 days during the following year

shoulder point of her left shoulder was stiff andand another 182 days during yet the year after that.

caused pain throughout the year. When it got bad,

By winter of the year, any stiffness in her shoulder

the pain traveled up from the attached branch of thewas almost negligible, but a tenderness still

inner upper margin of the left scapula and theremained in her outer shoulder point. Her weight“gyokuchin(BL9)” of the left occipital lobe andincreased slightly thereafter but was basicallydeveloped into a headache on the left side. Further

maintained at the 46kg level. Her fits of allergic

aggravation caused pain at the back of the left eye

rhinitis also disappeared.

and eventually caused her to throw up gastric juices.

Kensuke

Nakamura,Kampo

gyuhoroku(23)

When this happened, she could neither eat nor drink(detailed accounts of Kampo), Journal of Kampo

anything. If she were to receive an intravenous drip

Medicine, Vol. 30, No. 2, p. 24, 1983

for fear of dehydration, her vomiting would havebegun again perhaps due to gastric juices collecting

12.

in her stomach, so she could not receive an

syndrome

intravenous drip. All she could do was to burrow her

Cervicalspondylosis

andcervicobrachial

In Kampo shinryo iten, it is written as follows

head in the pillow and remain quietly still. Afterregardingcervicobrachialabout two days of neither eating nor drinking, the[kakkonto]fornausea would subside, and she would suck on anumbness from their shoulder to arm. Aim tosmall piece of ice. If this went down well, she would

improve the tension in the pulse and muscles in thegradually try something else to eat, but if not, she

initial stage of development. yokuinin (Coicis

would continue “fasting” and let her body dry up.

Semen) may also be added in some cases.”3)

patients

who

syndrome:

“Use

have

and

pain

When this happened, she did not even pass urine.

Fumio Nishina administered kakkonto to a total

Such terrible spells occurred four to five times a year,of 78 patients, including 41 patients with cervicalall triggered by fatigue.

spondylosis, 31 patients with cervicobrachial

An X-ray showed a narrowing in the intervertebral

syndrome, 3 patients with trauma, and 3 patients

space between a spinal segment and osteophyteof other disorders and reports that it was effective

formation toward the nerve root. Cervical traction

in two-thirds of the patients based on two

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

11

Volume 9, Number 3 | Fall 2014

criteria—(1) they have an moderate or higher levelto her right shoulder, I prescribed 5g/day of kakkontoof physical strength and have pain in the neck inin addition to NSAIDs. After commencing Kampo

the acute stage or the exacerbation stage oftherapy, the neck pain abated from the second week,

symptoms, and (2) they have a pulse that isand because an improvement was seen where

floating and strong. It was similarly effective inpreviously she could not walk to go shopping in her

patients who tested positive (weak pulse) whenneighborhood because her neck would hurt andpressure was applied to the nerves and blood

make her feel nauseous, NSAIDs was reduced to two

vessels in their neck and upper chest, but the rate

to three times a week on an as-needed basis. Fromof efficacy was a low 50% among young andthe fourth week, she no longer felt pain when she

middle-aged women and particularly among

was at home, and her objective symptoms improved

patients who also had abnormal tendon andto approximately one-tenth, with a headache

periosteum reflexes in their upper extremity.4)

occurring only once in a while after making an outing.

The following are cases that have been reported toHersymptoms

subsided

kakkonto

fourmonthsafter

date. Cases 1 and 2 show the effect of kakkonto alone,commencing

but most cases require a blending of sojutsuprescription was terminated. (Observations omitted)(Atractylodis Lancea Rhizome) and hobushi (Aconiti

Kosuke Tajima, Science of Kampo Medicine, Vol. 29,

treatment,

and

the

Radix Processa).

No. 1, p. 39, 2005

Case 1: A case in which kakkonto had a marked

Case 2: Cervical spondylosis

effect on neck pain that had not improved for a long

Patient: 52-year-old maletime

Chief complaint: Numbness and pain in the rightPatient: 82-year-old female

handEight years ago, the patient visited a nearby

First visit / Present illness: The patient visited ourinternal medicine clinic chiefly complaining ofclinic on June 19, 1995. He said that when he wasposterior neck pain and difficulty in walking due toswinging a golf club, his nape began to hurt, and his

the pain. She was told to take NSAIDs, but this had

right hand became so numb that he could not evenno effect, so in April 2000 she was introduced to ourhold his chopsticks properly. Judging from theclinic.

findings of a neck X-ray, he was diagnosed with

The patient complained of pain that felt as thoughbrachial neuralgia caused by cervical spondylosis.

she had slats pasted on the area from the back of her

He was prescribed an anti-inflammatory analgesic

head to her right shoulder. A simple X-ray image

and vitamins B1 and B12, and physical therapy wasshowed cervical spondylosis mainly in the lower

also begun.

cervical vertebrae, but no neurological abnormalities

A week later, the pain showed signs of abating andwere found, so she was prescribed NSAIDs in thegood progress was thus expected, but the patient stillsame manner as before. Physical therapy was also

complained of numbness in his right thumb andbegun, including traction of the neck. However, thebegan to say that it had exacerbated such that hepatient continued her visit without her symptoms

could not even hold a pencil. When his sensations

improving whatsoever.

were examined, areas of hypersensitivity and

In February 2004, I examined the patient, andhypoesthesia were found from said thumb to the

because she hardly perspired due to a medium

back of his hand. No eruption was observed, but pain

pattern of deficiency and excess and complained of

caused by herpes zoster was suspected. Treatment

strong pain and stiffness from the back of her neckmainly by Western drugs was continued until July

12

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

Volume 9, Number 3 | Fall 2014

26, but because no improvement was seen, thePresent

Western drugs were switched to kakkonto extract

Adequate sleep. Stiffness in nape and shoulder.

(Tsumura 7.5g/day). A week later on August 1, theCold-sensitive legs and hip. Bowel movement: once apatient said the pain subsided for the first time.

day (smooth defecation). Urination: wakes up once

After taking the prescription for two weeks or so, theduring the night. Menstruation: menopause at age

pain decreased to 40%, and after a little more than

53. Predilection for fruits.

three weeks, it was down to 20%. The patient took

Tongue was covered with light-brown coating andthe prescription for a total of 33 days and stopped

was moist. Pulse was sunken and weak. Abdominal

coming to the clinic on September 5.

region was weak. Moderate degree of subcutaneous

Kensuke

Nakamura,Kampo

gyuhoroku(138)

illness:

Mediumbuild.

Easilytired.

fat. Umbilical pain.

Shushitsu no yonrei (detailed accounts of Kampo (138)

Treatment / Progress: Kakkonkajutsubuto was

Four cases of finger and hand pains), Journal of Kampo

administered. After taking the prescription for 14

Medicine, Vol. 42, No. 11, p. 44, 1995

days, the patient’s pain significantly abated. She wascured after taking it for another 18 days.

13. Shoulder periarthritis

Genpo

In Kampo shinryo iten, it is written as follows
regarding the indications for kakkonto in shoulder

Ogata,

Kampo

shinryooboegaki(126)(Memorandum of Kampo therapy), Journal of Kampo

Medicine, Vol. 37, No. 12, p. 32, 1990

periarthritis: “Use [kakkonto] in the relatively earlystage of development of the disease, for patients who

Case 2: Kakkontokasojutsuyokuinin for shoulder

exhibit a strong pulse, good tension in the muscles

periarthritis of the left shoulder

and a strong digestive system.”5) Byomei Kampo

Patient: 27-year-old female; pianist

chiryo no jissai recommends Kakkonkajutsubuto forFirst visit: November 18, 1976

stiff shoulders and shoulder periarthritis. In these

History of present illness: From November 15, 1986,

diseases, the pain in the shoulder joint andthe patient felt pain in her left shoulder joint

surrounding organization is frequently accompanied

whenever she raised her left arm. She received aby edema, so it notes that sojutsu (Atractylodis

doctor’s treatment, but she saw no improvement.

Lanceae Rhizome) and hobushi (Aconiti Radix

However, she strongly desired to perform at a

Processa) that have the effect of removing edema

concert that was scheduled in four days’ time.

should be added to kakkonto, which has an analgesic

Present condition: Medium build, but slightly thin.

effect, and used as kakkonkajutsubuto. In extract

Adequate

form, the preparation blends kakkonto, extract +Stiffness in nape and shoulder. Bowel movement

ryokeijutsukanto

once a day, regular stool, smooth defecation.

+

powderofAconitiRadix

sleep,

goodcomplexion.

Red

eyes.

Predilection for fruits and sweets.

Processa.6)
The following are cases that have been reported todate. They contain sojutsu and hobushi.

Her tongue was covered with a thin white coating,slightly dry. Pulse appeared sunken and strong but
disappeared when pressure was applied. Soft andCase 1: Shoulder periarthritis

weak abdomen.

Patient: 57-year-old female

Local findings: When engaging in exercise to raise

History of present illness: The patient began

the left shoulder joint, the patient complainedcomplaining of pain in her right shoulder joint onstrongly of pain when pressure was applied to theexertion since the beginning of March.

upper one-fourth region of the humerus. The armraising exercise itself also caused her pain.

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

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Volume 9, Number 3 | Fall 2014

Treatment / Progress: Because the patient had justdeveloped the disease, kakkonto+sojutsu+yokuinin

Keisetsu Otsuka, 30 Years of Kanpo, p. 118, Sogensha,
1959

was administered for three days with the thoughtthat it should be sufficient to cure the disease. When

Case 2: Lumbago

the patient made a visit three days later, her pain

This is about my own recent experience. My lower

had disappeared as expected, but she was given

back began to hurt, even though I had no conscious

seven more days of the preparation, to be certain.

awareness of having done anything to become tired.

Genpo Ogata, Kampo chiryo shorei senshu 1

I ignored it at first, thinking it would go away in two(Collection of selected cases of Kampo therapy 1), p. 248,

to three days, but the pain gradually increased to the

Gendai Shuppan Planning, 1988

point that it became difficult to stand or sit. I
therefore blended and drank Hachimigan. I drankthis for two to three days, but to no avail. It seems I

14. Lumbago and sciatica

Kakkonto has been reported to cure not only neckdid not have the pattern for Hachimigan. Not onlyand shoulder pains, but also lumbago, as shown in

did my lower back hurt, but my whole body also felt

the cases below. There has also been a report inheavy, and my shoulders were stiff. I thought maybe

which lumbago was coincidentally cured when

I had a cold. When I felt my pulse, it was floating andkakkonto was taken for a different reason.

strong. Therefore, I thought that kakkonto mightwork. I took a dose and my body became light, andCase 1: A strong man with lumbago

after taking kakkonto for a day, the pain in my lower

The patient was a heavyset 38-year-old male. He hadback subsided.

lumbago for several months and received an
injection

among

other

treatment,

but

no

Keisetsu Otsuka, 30 Years of Kanpo, p. 119, Sogensha,
1959

improvement was seen.
His first visit was on June 5, 1933. He had a floating

Case 3: Sciatica

and strong pulse and tense muscles. The lumbago

Patient: 60-year-old housewife

was not exacerbated by pressure, but he experienced

Past medical history: The patient developed goitera pain that felt like something was pulling at his

7 years ago. She was prescribed Shakanzoto at mylower back when he bent and stretched his back. No

clinic, and the swelling subsided considerably. Her

abnormality was observed in his spine.

minimal blood pressure was high, but she was not

In Shokanron, kakkonto is used for tension in thetaking any medication for it.

nape and back. As the lower back is part of the back,History of present illness: The patient began to feelI regarded the lumbago as a symptom of nape andpain in the area from her left hip to the foot. She wasback tension, and thus administered kakkonto.

told she has sciatica at a local clinic and took aWithin a few days, the pain disappeared completely,

medication, but because it was not effective, she

and I was highly appreciated by the patient.

visited our clinic.

kakkonto worked well with this patient because he

There was extreme pain from the left hip to the foot.

had good tension in his muscles and his pulse was

It worsened in the early evening and caused extreme

floating and strong. For patients whose pulse ispain. The patient was sensitive to cold, especially inweak and muscles are relaxed, kakkonto would not

her feet and hips. Normal bowel movement. Passed

only be non-effective, but it could even exacerbate

urine twice during the night.

the symptoms.

Present condition: Height 156cm, weight 46kg. Bloodpressure 144/94.

14

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

Volume 9, Number 3 | Fall 2014

She had a pale complexion and her pulse was

Her tongue was covered with a thick, light-yellow

scrambled. Her tongue showed no abnormality.

coating and was dry. Pulse was sunken and tense.

An abdominal examination found nothing in

The abdominal region displayed a light-brownish

particular.

skin color and was generally weak. Umbilical pain.

Progress: She was first given Hointo. She took thisTreatment / Progress: The patient had a deficiency

for a month, but to no avail. She began to complain

pattern, but because she also had umbilical pain, shethat even her back has begun to hurt, and she felt a

was given kakkonkajutsubuto. By the time she took

stiffness in her nape.

the prescription for approximately 30 days, most of

Around this time, the patient came down with a cold,

the pain disappeared. However, she said her

so I gave her kakkonto. During the time she was

symptoms worsened when she ate the fig from thetaking kakkonto, she said her hip and feet did nottree in her yard. Before commencing Kampo therapy,

hurt so much.

she was instructed not to eat raw vegetables andI therefore changed her prescription to 5.0g eachfruits because they bring dampness inside the body.

kakkonto+sojutsu (Atractylodis Lanceae Rhizoma)
and toki (Angelicae Acutilobae Radix), and her

When she came in for a visit on October 4, 1980, hersciatica began to improve quickly. By a month later,

Genpo Ogata, Kampo chiryo shorei senshu 1

her pain mostly disappeared. After a month of taking(Collection of selected cases of Kampo therapy 1), p. 269,

the prescription, it was terminated, with the patient

Gendai Shuppan Planning, 1988

joint pain and muscle pain had disappeared.

saying that she was surprised that the pain that was
so intense disappeared without taking any other

Case 2: Muscle pain of unknown cause and namemedication.

11-year-old boy. The patient had the tendency of

Kunio Matsuda, Shorei ni yoru Kampo chiryo no

autointoxication when he was small, but he did notjissai (practical Kampo therapy by disease name), p.

know of any other ailment. From around six months

213, Sogensha, 1992

ago, he began complaining of pain in his back andthigh and could not go to school. Even at home, the15. Joint pain and muscle pain

pain bothered him, and he could not study at all.

Kakkonto has the effect of curing pain related toThree months ago, his right arm also began to hurt.

muscle tension in the nape and back, but there have

Various treatments were applied, but to no avail.

been reports of cases where kakkonto cured the pain

Recently, his doctor said the pain was a matter ofin joints and muscles other than in the nape, backnerves, and that it was not a problem.

and shoulders.

He had an ordinary build and good nutrition. His

Case 1: Arthralgia in all four extremities

pulse was floating, large and rapid, and had

Patient: 51-year-old housewife

palpitations. This was perhaps because the patient

History of present illness: About a year ago, thewas slightly nervous about his first visit to our clinic.

patient began to complain of joint pain and muscle

The pain was in the muscles on the right side of thepain in all four extremities. She had been receiving

interscapular region, the right forearm, and thetreatment from a doctor but saw no improvement.

inner side of his left and right thighs. An abdominal

Present condition: Medium build. Stiffness in theexamination found slight tension in the abdominalback and nape. Frequent bowel movement andrectus muscle is his left abdomen but no otherurination. Menopause (end of 1979). Good appetite,significant findings. I used kakkontokayokuinin forlikes warm foods. Favorite foods: fruits, meat, fish,

this. After taking the prescription for two weeks, thecoffee, Japanese sake.

patient was able to go to school without giving any

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

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Volume 9, Number 3 | Fall 2014

thought to his disease, and was completely cured

Ephedrae Herba and Gypsum Fibrosum releases thethereafter.

heat accumulated in the triple energizer to outside

Keisetsu Otsuka, Shukindo chikenroku (3) (Records
of clinical trials at Shukindo (3)), Journal of Kampo

Medicine, Vol. 11, No. 4, p. 16, 1964

the body.
In Kampo shinryo iten, it is written as follows:“[kakkonto] is generally used in the initial stage,
when the patient feels cold or has a temperature and

16. Rheumatoid arthritis (RA)the skin is red, hard, widely swollen and itchy. In

Kakkonto is rarely used for rheumatoid arthritis.
However, in Kampo shinryo iten, it is written as
follows: “Use [kakkonto] in the initial stage of RA

case of a high temperature, add 5.0g Gypsum

when symptoms are light. It works well for chronic

the symptoms may temporarily worsen after taking

RA at the level where several joints of the finger are

the preparation, but this is not a concern.”8)

Fibrosum. In cases where the patient tends to beconstipated, add 1.0g Rhei Radix. As it is a sudorific,

swollen and hurt in the morning when waking up,
but the pain is mitigated after a while.”7) The

Case 1: Kakkonto extract for urticaria

following is a case reported by Keisetsu Otsuka.

Patient: 39-year-old female, skinny
Past medical history: Nothing in particularCase 1: Rheumatoid arthritis

History of present illness: About three months ago,

18-year-old male. Around two weeks ago, he began

the patient began to develop urticaria in the late

to feel pain in his back and joints of his hands andafternoons.

feet when waking up in the morning, but the pain

Progress: The patient’s child had atopic dermatitis

would lighten when he began working. The affected

when she was little, but the symptoms improved byparts showed hardly any conspicuous swelling. He
had a regular appetite. He sometimes felt a chill, andjumihaidokuto and had not recurred.
Therefore, I prescribed jumihaidokuto to the patient,

his body temperature would increase to up to 37.7-

thinking that she has the same physical constitution

37.8°C. The pain was strongest in his nape and back.

as her child. However, three days of taking theI gave him kakkonto, three days’ dose three times.

prescription did not improve the patient’s condition.

After a total of nine days of taking kakkonto, theNext, I prescribed Kososan, but also to no avail. Thus,

patient was fully cured. After about two months, he

I prescribed kakkonto extract. When the patient took

had a recurrence of the previous symptom, but thiskakkonto at the first sign of urticaria, the rash

was fully cured by taking kakkonto again for three

disappeared. However, it reappeared after the effectdays. Kakkonto was used for this patient because theof kakkonto wore off in several hours. Therefore, thepain was strongest in his back.

patient needed to take the prescription three to four

Keisetsu Otsuka, 30 Years of Kanpo, p.120, Sogensha,takingtimes a day, but the frequency of the rash gradually
decreased,

1959

and

her

frequencyoftakingtheprescription also decreased.
17. Urticaria, eczema and other skin diseases
There are several causes of urticaria, including

Hiroki Mizobe, Journal of Kampo Medicine, Vol. 49,
No. 6, p. 25, 2002

those that are indications for kakkonto. For
symptoms that include insomnia, edginess andCase 2: Urticaria in a child

restlessness, Gypsum Fibrosum needs to be added

Just after the previous experience, I was consulted

for kakkonto to have an effect. This is because by

by a certain person. According to that person, a childadding Gypsum Fibrosum, the combination ofof one of his employees living in the same

16

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

Volume 9, Number 3 | Fall 2014neighborhood had urticaria that kept the child fromfloating and quick. His tongue was normal, his

sleeping even at night because of the severe itchiness.

abdomen was well-fleshed, and his upper abdomen

A local doctor gave the child a shot about ten days

was swollen but not an indication of chest sideago, but the itchiness did not subside, so he asked me

painfulness. No other abnormalities were found. I

if there was something I could do.

therefore prescribed jumihaidokuto for a week as a

The patient was a five-year-old boy whom I had

means of detoxification. However, when the patient

examined once before when he had the common cold.

made a visit again in a week, he said his symptom

In Ruijuhokogi (interpretations of the classified

had not improved. I thought again. The patient had

assemblage of prescriptions), it is written thata strong itching sensation on his skin but showed no

kakkonto “cures pediatric erysipelas” and thatkakkonkajutsubuto “cures rubella, pyemid andrash whatsoever. This resembled a previous casesevere pruritus.” Therefore, I regarded the patient’s

interpreted his rather floating pulse as an exterior

symptoms as a pattern for kakkonto, and also

pattern of the disease, and according to precedent,

thought to add gypsum, thinking that the itchyprescribed kakkonto+sekko (GypsinFibrosum) for asensation that kept the patient awake at night was

week.

a

sign

of

dysphoria,

andprescribedkakkontokasekko for three days.

where jumihaidokuto was noneffective. I therefore

After about ten days, I received a phone call fromthe patient. “This time, the itching stopped when I

I received a message after a while. It said the childtook the prescription. When I ran out, I became itchy

showed a strong dislike for the preparation andagain, so please send me more,” he said. I thus send

refused to take it, but he somehow took a day’s dose

him ten more days’ dose. I have not heard from thein two days. By the time he finished taking the dose,patient thereafter, so I assume he has recovered.

the itching that was so severe suddenly stopped, andTerutane Yamada, Clinical trials of urticaria andhe became able to sleep well at night. It seemed

athlete’s food using Kakkonto, Journal of Kampo

enough, but to make sure there was no recurrence,

Medicine, Vol. 6, No. 11, p. 17, 1959

the child was somehow coaxed to take two more days’
dose in five days and was fully cured during thisCase 4: Urticaria
I administered kakkon+kabokusoku (Quercus

period.
Terutane Yamada, Clinical trials of urticaria andCortex) and yokuinin (Coicis Semen) to a 44-year-old

athlete’s food using Kakkonto, Journal of Kampo

male who complained of urticaria every winter for

Medicine, Vol. 6, No. 11, p. 16, 1959

the past 25 years ago, with good results. kakkontoalone may have sufficed for this patient, but I added

47-year-old male. Every summer, the skin of his

bokusoku, mostly for my own reassurance. I am notcertain whether or not bokusoku had an effect, but I

entire body became itchy, and the itchiness worsened

made this decision because the patient complained

when he perspired. This year, the itchiness wasof nose congestion at night, which resembled a caseparticularly severe, and he sought medical attention.

where a patient with empyema and urticaria was

However, nothing changed, and he had left it at that.

cured by using kakkonto+bokusoku. Bokusoku

He was of medium build and relatively well-(Quercus Cortex) is a different name for kunugi

fleshed and solid. No abnormality was seen in his(Quercus acutissima). I also added yokuinin (Coicis

skin, but rubbing the inside of his forearm caused a

Semen) because the patient had a wart near the

reddening. This was a sign of dermographism. It

hyakue (GV20) point on his head.

Case 3: Urticaria

might also have been urticaria. His pulse was rather

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

17

Volume 9, Number 3 | Fall 2014

The patient developed urticaria in the winter, but

prescription to be certain, before terminating it. The

the rash disappeared in about 5 minutes after

diagnosis was confirmed by comparing the herpes

drinking water. The rash did not appear when hevirus antibody titer on the day of the patient’s first

had a fever. However, three years ago, he began tovisit and two weeks later.

feel a discomfort in his throat as though fish scales
were attached. He was told it was neurosis, or other

Katsutoshi Terasawa, Wakan shinryogaku (Japaneseoriental medicine), p. 120, Igakushoin, 1990

times that it was nasopharyngitis. He visited a noseand ear doctor for a year but did not get better.

Case 3: Ramsay Hunt’s syndrome

kakkonto+bokusoku(Quercus Cortex) and yokuinin (Coisis Semen), theWhenIadministered

The patient is a 35-year-old female.
Last year, the patient sought medical attention for

urticaria decreased and appeared only at times whenstomach pain, and received a surgery after a large

it was especially cold. From around the twentiethovarianday, the dry sensation in the patient’s nose became

examination. This time, she said she began to feel annegligible, and around the thirtieth day, the wart

unpleasant tingling sensation on her skin on the left

disappeared.

side of her face and forehead two days ago. There

cyst

was

found

in

an

ultrasoundKeisetsu Otsuka, Shoko ni yoru Kampo chiryo no

was a rash accompanied by minor blistera vesicles

jissai (practical Kampo therapy by symptom), p. 553,

from the left external auditory canal to the auricle.

Nanzando, 1963

The left parotid lymph node was also swollen. There
was no apparent facial paralysis yet, but the patient

18. Herpes zoster

said the left half of her face felt heavy. She also felt

Kampo shinryo iten notes the following about theindications for kakkonto in patients with herpes
zoster: “[kakkonto] may be used at the prodromal

her ears ringing and a cold sensation in her ear.

stage, when the patient has a fever and shows early

She was dark-skinned and had a paunch. Because

signs of blistera vesicles.”9) Generally, kakkonto does

she was overweight, her pulse was sunken yet strong,

not have an effect past the initial stage, in most cases.

and not rapid. She had a slightly cold sensation and

These were symptoms of Ramsay Hunt’s syndrome.
The patient was well-built and weighed some 80kg.

tension in her nape and back. Blood pressure 110-70.
Bowel movement (+). Fever (-). Sweating (-).

Case 1: Herpes zoster
72-year-old male. The day before, he noticed an

Considering her build, she appeared to be sensitive

unpleasant tingling sensation whenever he touched

to cold. Prone to developing ovarian cyst, she had

his hair on the right temporo-frontal area. In thewatermorning,

eruptionskakkonkajutsubuto extract 9g (regular dose 4.5g)

appeared on his right forehead. There was a sense of

was used. She said drinking this preparation

photophobia in his right eye. His pulse was excessive,

warmed and relaxed her body and lightened her stiffand he had a slight stiffness at the back of his head.

shoulders. Three days later, the cold sensation in her

He had no tendency of natural sweating. I prescribed

ear and ear ache also disappeared. The blistera

kakkonto, judging it to be herpes zoster in the earlyvesicles in the external auditory canal also began toyang phase. In around 30 minutes of taking the

dry up. This disease sometimes causes facial palsy

prescription, the pain from the rash decreased byabout two to three later, so she was prescribed thehalf, and after three days, the sense of photophobia

preparation for another two weeks. Naturally, there

in the patient’s eye and rash both disappeared. The

were no aftereffects thereafter.

patient

18

severalwaspainfuladministereddiscrete

for

more

days

poisoningof

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

andcoldness,

so

Sanwa

Volume 9, Number 3 | Fall 2014

Isao Iwasaki, Rinshorei (clinical trials), Journal of7)

Keisetsu

Otsuka,Domei

Yakazu,TotaroShimizu: Kampo shinryo iten (dictionary of

Kampo Medicine, Vol. 32, No. 10, p. 19, 1985

Kampo medicine), p. 153, Nanzando, 1969.
Case 3: Aftereffects of herpes zoster

8)

Otsuka,Domei

Yakazu,TotaroShimizu: Kampo shinryo iten (dictionary of

A man born in 1904. Herpes between his right ribs
had been causing him pain for a year and a half, but
said he had no other symptoms. At a glance, he

Keisetsu

Kampo medicine), p. 301, Nanzando, 1969.
9)

Keisetsu

Otsuka,Domei

Yakazu,Totaroappeared to be solidly built. He had a reddish face,

Shimizu: Kampo shinryo iten (dictionary of

had regular bowel movement, was not choosy about

Kampo medicine), p. 321, Nanzando, 1969.

what he eats, and liked tea. His pulse was sunken,
rapid, and very intermittent possibly because he has

To be continued in the next issue

a bad heart. An abdominal examination revealedtension in both the left and right hypochondrium.
Therefore, he was given kakkonkajutsubuto, and his
progress was decided to be monitored. Two weeks
later, the patient himself said he has become
extremely comfortable.
Kazuo Matsumoto, Toyodo keikenroku, daiisshu(Toyodo records of experience, Series 1), p. 568,
Taniguchi Shoten, 1993

References
1)

Akira Kitanami et al.: A case in which kakkonto
per request was effective against stiffness in thenape and neck (First report), Journal of Kampo

Medicine, Vol. 29, No. 7, pp. 3-9, 1982.
2)

Akira Kitanami et al.: A case in which kakkonto
per request was effective against stiffness in theneck (Third report), Journal of Kampo Medicine,Vol. 30, No. 1, pp. 15-21, 1983.

3)

Keisetsu

Otsuka,Domei

Yakazu,TotaroShimizu: Kampo shinryo iten (dictionary of
Kampo medicine), p. 158, Nanzando, 1969.
4)

Fumio Nishina: A kakkonto onto and pulses inorthopedic diseases, Kampo shinryo (Kampo
examination), Vol. 4, No. 3, pp. 48-50, 1985.

5)

Keisetsu

Otsuka,Domei

Yakazu,TotaroShimizu: Kampo shinryo iten (dictionary of
Kampo medicine), p. 155, Nanzando, 1969.
6)

Shozo Bando: Byomei Kampo chiryo no jissai(practical Kampo therapy by disease name),
Medical Yukon Publishing, p. 320, 2002.

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

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