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INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 11, Number 1 ･ Spring 2016

Editorial

The Importance of Case Reports
Hiromichi Yasui

Integrating Kampo and Evidence-Based Medicine (5) – Type 4 Case
Kampo Treatment for Patients to Whom Standard Treatment Cannot Be Applied
Hiromichi Yasui

Japanese Acupuncture - Current Research

Japanese Traditional Medicine Text (19) – Geriatric Department
Takashi Seki

Clinical Report 1 (Acupuncture)

Traditional Chinese Acupuncture and Moxibustion in Japan (1) – Pain and Numbness of the Low Back and Lower Extremities
Masanori Takashi and Katsuhiko Arai

Clinical Report 2 (Kampo Medicine)

Case Studies from Ehime Prefectural Central Hospital (4)– Situation Where Western Medicine Cannot be Used –Genki Shimizu, Hiroshi Kakuto, Den-ichiro Yamaoka

ISSN:1559-033X

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

―

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

Volume 11, Number 1 ･ Spring 2016

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, JapanASSOCIATE EDITORS
Shuichi Katai

1 Editorial
The Importance of Case Reports
Hiromichi Yasui

Ibaraki-ken, Japan

Hiromichi Yasui
Tokyo, JapanEDITORIAL STAFF

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

2 Integrating Kampo and Evidence-Based Medicine (5) – Type 4 Case
Kampo Treatment for Patients to Whom Standard Treatment Cannot Be Applied
Hiromichi Yasui
8 Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (19) – Geriatric Department
Takashi Seki

12 Clinical Report 1 (Acupuncture)
Traditional Chinese Acupuncture and Moxibustion in Japan (1) – Pain and Numbvness of
the Low Back and Lower Extremities
Masanori Takashi and Katsuhiko Arai

PUBLISHER

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

16 Clinical Report 2 (Kampo Medicine)
Case Studies from Ehime Prefectural Central Hospital (4)– Situation Where Western Medicine Cannot be Used –Genki Shimizu, Hiroshi Kakuto, Den-ichiro Yamaoka

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

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

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

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

Volume 11, Number 1 | Spring 2016

Editorial
The Importance of Case Reports
A certain patient’s certain clinical conditions were improved by a certain Kampo prescription. Some say it
was a coincidence, others say the patient’s condition would have improved even if left alone. Still others say
any drug would have improved the patient’s conditions by around 30% anyway, so the improvement was notnecessarily a result of Kampo. There may also be people who say the case is not credible, as it is not based onevidence. Different people say many different things, because the case that was reported was but a single
example.
Nangai Yoshimasu, a practitioner of Kampo medicine who was active during the end of the 18th century,
used goshuyuto to treat a patient with severe headache attacks. He included this case in a collection of casereports that he published. Around 150 years later, Dr. Keisetsu Otsuka (Kampo practitioner who was active
during the mid-20th century), who read the case report, used the same prescription to treat many patients who
suffered from headaches and migraines, and wrote a paper on the types of headaches the prescription iseffective against (see Journal of KAIM Vol. 10, No. 3, p.4-5). Physicians of later generations considered this paper
as secret guidelines for using goshuyuto.
During the days of Dr. Otsuka, the concept of evidence-based medicine (EBM) did not exist, andcomputers were not at the practical level. Moreover, the International Classification of Headache Disorders
had yet to be formulated. Having no such tools, Otsuka collected data on the symptoms of headache patients(including patients with migraines) and performed something similar to multivariate analysis in his brain.
Generally speaking, people’s brains cannot objectively process data as accurately as a computer. Dr. Otsuka
was a genius, but in hindsight, some of the symptoms goshuyuto was indicated were also general symptomsof migraines, so his guidelines were not perfect.
Nevertheless, many physicians have read Dr. Otsuka’s cases and used them as secret guidelines fortreating patients with headaches and migraines with goshuyuto, and have reported numerous cases as a result.
It is owing to these numerous cases that a general consensus has been reached in regard to the indication ofgoshuyuto against headaches and migraines. The statistical study by Dr. Odaguchi et al. (see Journal of KAIM
Vol. 10, No. 3, p.5-6) is built on this past history, and clinical studies of an even larger scale are expected to be
performed in the future.
What I wish to emphasize here is that the abovementioned story all began with a single case report.
Thereafter, the accumulation of more case reports led to the establishment of helpful tips, and clinical studies
have begun to be conducted as a result thereof. Well-written case reports embody a predictive view of future
clinical studies. In Kampo medicine, treatment is based on oral guidelines and evidenced data in many cases,
instead of on traditional medical theories. This was made possible by Japan’s unique system of Ho-sho So-tai(Japanese Kampo Diagnostic System) that was established by Todo Yoshimasu, but more important thananything was the existence of outstanding case reports.

Hiromichi Yasui
Japan Institute of TCM Research

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

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Volume 11, Number 1 | Spring 2016

Integrating Kampo and Evidence-Based
Medicine (5) – Type 4 Cases
Kampo Treatment for Patients to Whom Standard
Treatment Cannot Be Applied
Hiromichi Yasui
Japan Institute of TCM Research

Congress of Oriental Medicine (ICOM) held in 2014,
he gave a keynote speech as president of theorganization, in which he introduced an interestingcase example of using Kampo medicine on a patientto whom standard treatment cannot be applied.
Patient: 32-year-old man, 173 cm, 58 kg

Introduction

Chief complaint: The patient has hey fever, but

In this series, I define four types of use of Kampo
medicine in daily clinical practices within Japan’scannottakeantiallergenics

becauseofhypersomnia.

unified medical system, and discuss the diseases

First visit: Mid-April 20XX

that fall under each of these types, by giving relevant

History of present illness: The patient began tocase examples. In the previous issue of this journal,

experience sneezing, a runny nose, and nasal

I introduced four episodes, and explained that theycongestion since four years ago. He was diagnosed

fall under the four types of use of Kampo medicine inwith hey fever and received treatment through an

daily clinical practices. Let me recount them below.

antiallergenic. However, he became so sleepy soType 1: Kampo treatment is better than standard

that he could not work. Therefore, he took the drug

modern medical treatment
Type 2: The effects of standard modern medical

only before going to bed, but this undermined theeffectiveness of the treatment.

treatment and Kampo treatment are both

The patient is skinny and pale. An abdomen

strengthened when the two are used in

examination revealed a weak abdominal wall andcombinationsplashing sound in epigastric region.

Type 3: The side effects of standard modern

After an intermittent administration of 6.75 g/day

medical treatment can be mitigated inof shoseiryuto with processed aconite extract, thecombination with Kampo treatment
Type 4: Circumstances prevent the application ofstandard modern medical treatment, but
treatment is needed

patient’s rhinitis symptoms improved without anantiallergenic1).
The patient has hey fever. Because he would
become sleepy after taking an antiallergenic, he

Here, we shall take a close look at Type 4 cases,in which patients require treatment, but standard
modern medicine cannot be applied. As it is difficult
to present evidence and data for this type, however,visited Hosono Clinic, where Dr. Nakata is the
director, seeking a different type of treatment.
Judging by the fact that “The patient is skinny andpale. An abdomen examination revealed a weak

I shall introduce a number of case reports.

abdominal wall and splashing sound in epigastricEpisode 1

processed aconite extract. Hosono Clinic has its

Dr. Keigo Nakata, a friend of mine, is a skilled
Kampo doctor in modern Japan. He inherited theacademic lineage of Sohaku Asada, who was a
representative physician in Japan more than 210
years ago, and wields full command of prescriptions
based on this school. At the 17th International

2

region,” he was prescribed a shoseiryuto withown drug formulation factory, and produces all
extract formulations used by the clinic since 1950.
It produces extract for approximately 400 types ofprescriptions and approximately 170 types ofmonovalent crude drugs. The shoseiryuto withprocessed aconite that was prescribed to the above

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

Volume 11, Number 1 | Spring 2016

patient is also among the formulations made byheadaches occurred in the same way when

Hosono Clinic itself.

climbing a high mountain. In terms of time of day,

Shoseiryuto is effective against allergic rhinitis, as

they seemed to commonly occur in the earlyhas been found in a number of clinical studies.

mornings.

Among these studies, Prof. Baba’s paper on a double

The patient tried a number of analgesics up to now,

blind comparative study, which proved the effect ofbut because she has a weak stomach to begin with,shoseiryuto against perennial allergic rhinitis,

any analgesic would upset her stomach, and she

stands out2). Processed aconite was added to the

could not continue to take it.

above patient’s formulation, probably because theShe had high blood pressure and experienced

cold pattern was particularly notable.

multiple cerebral infarctions, and was still

Shoseiryuto contains ephedra, and has a slightreceiving treatment for them at a different

stimulant effect. For this reason, no sleepiness is felt.

hospital. She also complained of seeing things in

It is considered a perfect prescription for allergic

double, low motivation, listlessness, loss ofrhinitis.

appetite, and lower back pain. She came to Tokai
University Hospital as an outpatient after beingreferred to by a friend.

Episode 2
Dr. Makoto Arai, an associate professor at Tokai

Present symptoms: Height 156 cm, weight 53 kg,

University Hospital, is similarly a good friend ofblood pressure 156/88 mmHg. She had gray hair,mine. He is a young researcher who provides Kampo

but she had a clear complexion for her age. Her

medical care at the hospital and always gives me

pulse is floating and weak. She has white coating

reports of wonderful case examples. He writes aonseries of articles on case examples in the long-

abdominal strength was neither strong nor weak,standing Journal of Kampo Medicine (in Japanese),

and was tense within measure. In terms ofand introduced the following case3).

abdominal

hertongue,andpattern,decreased

there

gums.

was

Her

slighthypochondriac tenderness on the right side, butPatient: 79-year-old female physician

there was nothing else of particular mention. No

Chief complaint: Headache

bloating or coldness was observed in her legs.

History of past illnesses: Nothing in particular

Progress: I had just read a research paper that

History of present illness: Since around three years“goreisan is good for headaches that occur before aago, the patient began to experience intermittent

rainy day,” and had been waiting for an outpatient

headaches, although they did not trouble her

so I could immediately replicate the study at themuch at the time.

first opportunity. It so happened that the patient

Around springtime of last year, however, thecame to our hospital at just this time.

headaches and dull head pain intensified. The

In reference to the paper, the patient’s headacheheadaches were characterized by a throbbing pain

was of a type that could be treated with goreisan,

at the back of the eyeballs, but did not accompany

judging by how the headache tended to occur. I

nausea. They occurred when atmospheric pressure

therefore prescribed 7.5 g/day of goreisan extract

dropped before a typhoon or an approaching low-

(Tsumura Pharma, Ltd., Tokyo, Japan) with highpressure system. On close hearing, it was foundexpectations. A week later, the headaches hadthat the headaches intensified most on the day

lightened to almost six-tenths of their original

before a rainy day, but mysteriously abated whenintensity. A month later, intense headaches thatit began to rain steadily. Furthermore, thekept the patient in bed stopped occurring. Unlike

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

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Volume 11, Number 1 | Spring 2016

how it was with analgesics, the patient’s stomach

antiviral drugs have facilitated influenza treatment,

remained in good condition, and her sense of

but this is not to say that the use of such drugs is not

fatigue began to improve.

without its problems.

Two months have passed since the patient began
taking goreisan. Her headaches steadily alleviatedInstructions

for

using

Tamiflu

includethefollowing type of warning.

to two-tenths of their original intensity. However,

There have been reports of teenager cases have displayed

no changes have occurred in her complaints of stiff

abnormal behavior after taking this drug, although theshoulders and seeing things in double.

causal connection with Tamiflu remains unclear, and haveresulted in falls and other such accidents. For this reason,

Dr. Arai prescribed goreisan to this patient

teenager patients should, in principle, refrain from using thisbecause he had read Dr. Haimoto’s paper. For

drug, except in cases where they are judged to be high-risk

information on this paper, please see the paper I

patients with a complication or a history of past illnesses.

introduced in Vol. 1 No. 1 of this journal4). It

As a preventive measure against any possibility of an

essentially discusses how goreisan is particularly

accident occurring among pediatric and minor patients once

effective against headaches and migraines thattreatment by Tamiflu begins, explain to the patient and theoccur when atmospheric pressure drops.

patient’s family that (1) there is the possibility that theThis case report is valuable in terms of the factpatient may display abnormal behavior, and (2) guardians ofthat it substantiates the abovementioned research

the pediatric or younger patients should take care not to leave

paper, but it is not for this reason that I introduced

the patient alone for at least two days when recuperating at

it here. Take note of the passage, “The patient tried

home.

a number of analgesics up to now, but because she

Similar symptoms have been reported with regard to

has a weak stomach to begin with, any analgesic

influenza-associatedwould upset her stomach, and she could not continue

explanations should also be given as above in the case of suchto take it.” If the patient were able to alleviate her

illnesses.

encephalopathy,

so

the

same

headaches by taking an analgesic, she may havebeen able to live each day comfortably. However, her

On a certain day in 2007, a young girl came to my“constitution” made her stomach feel poorly after

clinic with a high fever. An examination using ataking this type of drug, so could not take it.

rapid antigen test revealed that she had influenza

Fortunately, not only did the patient’s headaches

type B. The progress of her illness was as follows.

improve after taking goreisan as prescribed by Dr.
Arai, but her stomach also regained its health as an

Patient: 11-year-old girladded benefit.

First visit: March 5, 2007, 10 a.m.
Chief complaint: Fever

Episode 3

History of present illness: The patient got a fever ofAn outbreak of influenza always occurs during

38°C at night on March 3. On March 4, she madewintertime in Japan. Although vaccination isan emergency room visit. The rapid antigen test

encouraged, many people nevertheless contract

was negative for influenza. She was prescribed an

influenza every year. Normally, influenza is not anantipyretic, which she took right away. At night,

illness of poor prognosis, but as it accompanies highher temperature was still 38°C.

fever, headaches, joint pains, and general pains.

In the next day morning (March 5), she came to

Many patients consult a hospital. The developmentof Tamiflu ○R (oseltamivir phosphate) and other4

my clinic and her temperature was 37.5°C.
Chills (-), heat sensation (+), headache (+), sore

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

Volume 11, Number 1 | Spring 2016

throat (+), nasal congestion (+), nasal discharge

The patient had contracted influenza B, but at the(+), coughing (+), sputum (-), dry mouth

time she made an emergency outpatient visit to the(-),sweating (-).

municipal hospital on March 4, it was yet too early
to make a diagnosis, and she was sent home after

Present condition: Temperature of 37.5°C
Pulse: Sunken, thin and rapid; slight tension.

prescribing an antipyretic. Her fever had not abated

96/min.

by the next day, so she visited my clinic. At this time,

Tongue: Light red, red at the tip, slight coating

she was able to be diagnosed with influenza B, but(white)because she was only 11 years old, she was

Diagnosis: Diagnosed with influenza (B) based on anaccompanied by her mother, who said she did notwish to use Tamiflu. Thus, the patient was

examination using a rapid antigen test
Prescription: 1.3g of keishito extract (Kotaro

instructed to take a dose of 1.3g of keishito extractof(Kotaro Pharma, Ltd., Osaka, Japan) + 1.0g of

makyokansekito extract (Osugi Pharma, Ltd.,makyokansekito extract (Osugi Pharma, Ltd., Osaka,

Osaka, Japan) for 1 dose

Japan) every two hours. These two prescriptions

Pharma,Ltd.,

Ossaka,Japan)+

1.0g

Progress: On the morning, the patient took the

together can mimic daiseiryuto, which is out of listprescription every two hours at her home. In thefrom commercially available Kampo extracts. The

late afternoon, her temperature was in the lower

patient was instructed to take the prescription every

37°C. She did not develop much sweating, but thetwo hours, based on instructions written in Shang

frequency of urination increased. She went to bed

han lun. By taking the prescription every two hours,in this condition. She had bowel movement, softshe developed some sweating and a large amount ofstool.

urination, and her condition improved. (It is not rare

In the next morning, the patient had a temperature

to see a large amount of urination during the declineof 36.5°C. Chills (-), heat sensation (-), headache (-),

of a fever. In such cases, there is only a small amountappetite (+), nasal congestion (+), sputum (+). Heroftemperature was 37.2°C in the later afternoon. I

disappeared by taking 6.0g of shosaikoto extractprescribed the abovementioned prescription for(Kracie Pharma, Ltd., Tokyo, Japan) + 4.5g of

three days.

makyokansekito extract (Osugi, Pharma, Ltd.,March 7: Her temperature was 36.7°C. Slight

Osaka Japan) three times a day.

sweating.)The

coughingthatremainedcoughing (-), Cogged sputum (-), Nasal congestion

In most cases, I prescribe a single administration(+). Pulse: fine and rapid. Tongue: Slight whiteof Kampo medicine to influenza patients andcoating (in the middle). Slight decreased appetite

patients exhibiting symptoms that suggest influenza,(-), Dry mouth (-), chills (-), heat sensation (-),

in consultation with the patient. In my office, I

headache (-).

prescribe a Kampo extract formulation that I think

Prescription: 6.0g of shosaikoto extract (Kracie

is best on a test basis. Then I give the patient a day’s

Pharma,ofdose after confirming it is alright, and have themakyokansekito extract (Osugi, Pharma, Ltd.,patient come in again the following day to see the

Osaka, Japan) 3 times/day

result. It is normal for patients to display the type of

The patient’s condition improved the following day,progress as seen in this case.

Ltd.,

Tokyo,

Japan)+and her symptoms disappeared thereafter.

4.5g

Pediatric patients frequently have indications for
maoto, while adults have indications for daiseiryuto,
keishinieppiichito,

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

keishimaokakuhantoand5Volume 11, Number 1 | Spring 2016

maobushisaishinto.

Persistent

coughing

that

The above three patients could not be treated bycontinues after the decline of a fever is frequently

standard Western medical treatment for respective

treated with chikujountanto, bakumondoto, andreasons. I sometimes encounter people like them inshosaikoto + makyokansekito as in the above casedaily practice, although they are not large in number,example5).

and tend to be glad that I have knowledge of Kampo
medicine.

The four types and their characteristics

Diseases subject to treatment
by Kampo medicine

Type 1Treatment is effective
by Kampo treatment
alone

Type 2Treatment effect isincreased in combination
with standard Western
medical treatment

Type 3The side effects of Western
medical treatment are
mitigated when combinedwith Kampo treatment

Type 4Situations whereWestsern medicine
cannot be appliled

In this issue, we took a look at a number of Type 4 case examples. This type includes all sorts of cases, as
shown by reports of diverse cases. Here, we introduced three cases: a case where antiallergenic agents were
not able to be used due to their potential to induce sleep, a case where antipyretic analgesics such as
NSAIDs were not able to be used due to a gastrointestinal disorder, and a case where antiviral drugs were
not able to be used due to the danger of inducing abnormal behavior.
In the future, if the number of reported case examples increase, the role of Kampo medicine for patientsfor whom standard treatment cannot be applied shall become much clearer.

6

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

Volume 11, Number 1 | Spring 2016

References[List of prescriptions]

1) Keigo Nakata: The Role of Kampo Medicine, 17th ICOM

shoseiryuto 小青竜湯Keynote Speech 2014.

Baba, Takasaka Tomomi, Inamura

goreisan 五苓散

Naoki, et al. Double-blind clinical trial of Sho-keishito 桂枝湯

seiryu-to (TJ-19) for perennial nasal allergy.

makyokansekito 麻杏甘石湯Jibiinkoka Rinsho (Practica otologica); 88: 389–405

maoto 麻黄湯2) Shunkichi(in Japanese with English abstract) 1995.
3) Arai, Makoto: “Goreisan for Headaches that Occur on the
Day before Rain.” Journal of Kampo Medicine Vol. 47-12,
59-66, (in Japanese) 2000.
4) Hiromichi Yasui: Efficacy of “Poria Powder with Five
Herbs” for Headache ― An epidemiological research study
on the relationship between chronic headache anddaiseiryuto

大青竜湯keishinieppiichito 桂枝二越婢一湯
keishimaokakuhanto

桂枝麻黄各半夏湯

maobushisaishinto 麻黄附子細辛湯chikujountanto 竹茹温胆湯bakumondoto, 麦門冬湯

atmospheric depression ― The Journal of KAIM Vol.1
No.1, 7-11 2006.
5) Japan Institute of TCM Research, ed.: “Kampo Treatment
for Influenza.” Japanese Journal of Traditional Chinese

Medicine, (in Japanese) 2007.

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

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Volume 11, Number 1 | Spring 2016

Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (19) –Geriatric Department
Takashi Sekifamily, residence, and economic status. It has beenreported that people who have undergone CGA
display lower mortality rates, higher survival rates
in the home, improved ADL, and greater cognitive
function compared to people who have not

A. The Geriatric Situation and Elderly Medical

undergone CGA2). Before today’s aging society,

Care in Japanemphasis was placed on providing life-prolonging

The population aging rate (percentage of thetreatment to keep patients alive, but in an aging

population over the age of 65) in Japan has beensociety, it is important to provide medical care that

increasing, such that in 2007, the aging rate

not simply allows patients to live longer, but thatexceeded 21% and Japan became a super-aging

allows patients to live in good health by placing

society. By 2055, the aging rate is estimated toimportance on healthy life expectancy and QOL.

reach 40.5%, with one in every 2.5 people a senior

Medical care that is vertically divided by type ofcitizen1).

organ is not suited to treating elderly people.

One of the characteristics of diseases developed

Medical care for the elderly is an area that could

among the elderly is the simultaneous disorder ofbenefit from traditional medicine, which treats

multiple organs, or multiple organ failure. Elderly

patients by examining their entire being. The

people have diminished internal organ functions,concept of CGA is also in a way similar to that ofsuch as the liver and kidney, so even drug doses

traditional medicine. Patient-driven team medicine

that are normally administered to adults take time

based on such comprehensive assessment isto metabolize and discharged, and frequently

indispensable to medical care for the elderly.

produce overly strong effects and side effects. It is

However, in Japan, the medical world still offers

not uncommon for elderly people to be prescribed

only a limited field of activities to acupuncturists. It

many different types of internal medicine from ais thus necessary to create more opportunities

multiplewhere acupuncturists can be active in the same way

numberofclinical

departments.

Conditions such as falls, stupor, memory loss,asphysicians,

nurses,physicaltherapists,

incontinence, bedriddenness, malnutrition, andoccupational therapists, nutritionists, pharmacists,

iatrogenic disorder are often observed among theand social workers.

elderly. Called geriatric syndrome, these conditions
simultaneously affect multiple organs, but differs

B. Acupuncture and Moxibustion Therapy forfrom organ diseases that are seen in people who are

Elderly Medical Carenot yet in old age, in that prolonged bed rest in theSymptoms that are commonly seen among the

hospital becomes a cause of disuse syndrome. To

elderly could be easily explained as stemming fromprovide medical care for elderly people with suchdecreased kidney function, in many cases. Kidney

characteristics,

Geriatricyang warms the organs and tissues, and deficiency

Assessment (CGA) was developed in England as aof kidney yang produces symptoms of coldness.

multidimensional method of assessing various

Decreased kidney function leads to a decrease infunctions in elderly people. CGA includes anbone marrow, heaviness and unsteadiness of theassessment of the activities of daily living (ADL),

lower back and knees, and eventually gait disorder.

the Mini Mental State Examination (MMSE) andUrination and defecation cannot be controlled, and

the Geriatric Depression Scale (GDS) as measures

hearing is impaired.

theComprehensiveof mental functions, and assessments of patients’8

There was a case in which an 80-year-old woman

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

Volume 11, Number 1 | Spring 2016

was wheelchaired to the hospital. Her family

rehabilitation for patients coping with the after-

requested to purchase a wheelchair, as she has

effects of a cerebrovascular disease. The list can godifficulty walking. The patient was sensitive to theon and on. Some case data are presented below.

cold, and developed coldness particularly in her
lower body. She was bent, had weak legs and a weak

1. Chronic pain

back, and was hard of hearing. She had nocturia and

A common complaint among the elderly is chronic

tended to produce loose stool. Mentally, she had apain, mainly in the lower back and knees. Large-

feeling of fatigue. Her pulse was sunken and slow,

scale studies have been conducted in Germany

and her tongue was pink. These symptoms all

regarding this.

disappeared with a moxa needle to the bladder

Brinkhausetal.

examinedtheeffectsofmeridian and kidney meridian and a salt moxa to theacupuncture therapy in 298 patients with chronic

navel, and the patient recovered to the point where

lower back pain with an average age of 59±9. The

she could go into the mountains alone to pick wild

patients were divided into three groups. One group

edible plants and answer the phone for the first time

was treated by Chinese acupuncture therapy.

in twenty years. The patient had a typical case ofAnotherkidney yang deficiency, and the various symptoms

acupuncture, which involves the shallow insertion ofthat extended into diverse areas, including theacupuncture needles in non-acupuncture points. The

locomotive organs, urinary organs, ear and throat,

third group composed a waiting list, and was notand mental condition, all improved by simple

given acupuncture therapy. Acupuncture therapy

acupuncture

By

and minimal acupuncture were administered twelve

examining clinical patterns called Sho, and applying

times over a period of eight weeks. The degree oftreatment suited to the Sho in question, this caselower back pain was evaluated according to theshowed that the symptoms of even multiple organ

Visual Analog Scale (VAS; 0 – 100mm). The VAS

failure as defined by Western medicine could beshowed an improvement of 28.7±30.3mm for the

improved all at once. The case can also be said toacupuncture therapy group, 23.6±31.0mm for theshow the usefulness of recognizing patterns from aminimal acupuncture group, and 6.9±22.0mm in theperspective that differs from Western medicine.

waiting list group. The difference in improvementandmoxibustion

therapy.

group

was

administeredminimalIt is also worthy of mention that while medical

between the acupuncture therapy group andcare by orthodox medicine is invasive in many cases,

minimal acupuncture group was 5.1mm and not a

acupuncture and moxibustion therapy causes little

significant difference, but the difference between thehealth damage. It applies physical stimulation to theacupuncture therapy group and waiting list groupbody surface, and provides treatment without thewas a significant difference of 21.7mm. In the 26th

addition of internal medicine. This is a large

and 52nd weeks, no significant difference in pain

advantage that even Kampo therapy does not offer,

was observed between the acupuncture therapy

although they both fall under the same traditionalgroup and minimal acupuncture group3).

medicine category.

Witt et al. examined the effects of acupuncture

Acupuncture and moxibustion therapy could

therapy in 300 patients of chronic osteoarthritis ofbenefit elderly medical care in many areas. For

the knee of Kellgren grade 2 and lower. 150 patients

example,cancer,were treated by Chinese acupuncture therapy, 76

cerebrovascular diseases, and pneumonia, which are

were administered the abovementioned minimal

the top causes of death. It can also be used to relieve

acupuncture to non-acupuncture points, and thethe pain caused by cancer, or to supplement

remaining 74 composed a waiting list. Acupuncture

it

can

be

used

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

9Volume 11, Number 1 | Spring 2016

therapyandminimalacupuncture

wereon oral drug administration.

administered 12 times over a period of eight weeks.

Seki et al. administered acupuncture treatment to

The WOMAC index adjusted for baseline score was

the stomach meridian and kidney meridian in

used to judge the effects. In the eighth week, thepatients of cerebrovascular diseases who have a past

acupuncture therapy group scored 26.9, the minimal

history of aspiration, and reported an improvement

acupuncture group 35.8, and the waiting list groupin the swallowing reflex and a significant decrease in

49.6, and a significant improvement was observed inaspiration and pharyngeal residue according to

the acupuncture therapy group compared to thevideofluorography7),

other two groups. In the 52nd week, no significant

swallowing reflex was also observed when applying

difference was observed between the acupuncture

electrical stimulus to the same acupuncture points

therapy group and minimal acupuncture group4).

with a skin surface electrode9).

2. Dysphagia and aspiration pneumonia

3. Visual impairment

Pneumonia is the fourth highest cause of death in

Glaucoma

is

8).

the

An

improvement

number

one

cause

in

of

Japan, and more than 90% of pneumonia victims areadventitious blindness in Japan. There are anelderly people ages 65 and above. A salient

estimated 4 million patients, but the number ischaracteristic of pneumonia among the elderly is

expected to increase with age. As visual impairment

aspiration pneumonia. Swallowing and coughing

is a cause of falls, it can be said to be a disorder thatreflexes are defense mechanisms we all have, andcannot be overlooked from the perspective ofprotect our lungs from aspiration. A major cause of

preventing falls. Kurusu et al. administered

pneumonia

diminishedacupuncture therapy to glaucoma patients, andswallowing and coughing reflexes caused by areported a lowering of intraocular pressure andcerebrovascular disease of the basal ganglia5). Basal

improved vision10).

among

the

elderlyisganglia cerebrovascular diseases reduce the amountof dopamine that is produced in the nigrostriatal

C. Prospects

pathway, and this reduces the amount of substanceMeta-analyses and systematic reviews have been

P (SP) that is released from the sensory branch of themade, but the following issues exist.

vagus nerve to the membranes in the pharynx and

1) There are few clinical trials of acupuncture

trachea. As SP is an important trigger for thetherapyswallowing and coughing reflexes, a decrease in SP

2) There are few trial subjects

causes those reflexes to decline6). In cases of3) Protocols are insufficientdiminished swallowing reflex, aspiration occurs
unawares(silent

aspiration),andsalivaand

The greatest reason why protocols are insufficientis the difficult in establishing a control group.

intraoral bacteria get into the lungs.
In China, acupuncture and moxibustion therapy

Placebo acupuncture therapy is extremely difficult,has long been used for treatment of the after-effects

and so are double blind trials. For this reason, manyof cerebrovascular diseases and dysphagia.

clinical studies cannot be said to accurately assess

In some cases, patients with dysphagia cannot be

acupuncture and moxibustion therapy.

oral

In addition to these issues, there are the following

administration because of their swallowing disorder.

issues in the medical field and education in Japan.

Such patients require a new type of treatment to

One is the small numbers of clinical trials and trial

improve their swallowing reflex without depending

subjects.

given

10

drug

treatmentthatrequires

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

there

are

hardlyany

Volume 11, Number 1 | Spring 2016acupuncturists in medical institutions, it is difficult

Reference

to find subjects for clinical trials when they are

1)

Statistics Bureau, Ministry of Internal Affairs

needed. Another is that since acupuncture andand Communications. Population of elderly

moxibustion therapy requires manpower, it is not

people. Available ateasy to increase the number of subjects or to extend

http://www.stat.go.jp/data/topics/topi721.htm.

the follow-up period even when a large-scale clinical

2)

The Aging Society: Current Situation and
Implementation Measures, FY2008

study is attempted.
As mentioned earlier, elderly people are weaker

3)

AE, Siu AL, Wieland GD, et al.: Comprehensive

than young people. Therefore, elderly medical caregeriatric assessment: a meta ─ analysis ofrequires due care and attention especially whencontrolled trials. Lancet 342: 1032─1036, 1993

moving patients. However, as it is believed that

4)

Brinkhaus B, Witt CM, Jena S, et al.:acupuncture and moxibustion therapy offers vast

Acupuncture in patients with chronic low backpossibilities

pain: a randomized controlled trial. Archives ofinelderly

medical

care,

high

Internal Medicine 166: 450─457, 2006

expectations shall be placed on future studies.
5)

Witt C, Brinkhaus B, Jena S, et al.: Acupuncture
in patients with osteoarthritis of the knee: arandomised trial. Lancet 366: 136─143, 2005

6)

Nakagawa T, Sekizawa K, Arai H, et al.: Highincidence of pneumonia in elderly patients withbasal ganglia infarction. Archives of Internal
Medicine 157: 321─324, 1997

7)

Yamaya

M,

Yanai

M,

Ohrui

T,

et

al.:

Interventions to prevent pneumonia amongolder adults. Journal of the American Geriatrics
Society 49: 85─90, 2001
8)

Seki T, Kurusu M, Tanji H, et al.: Acupunctureand swallowing reflex in poststroke patients.
Journal of the American Geriatrics Society 51:
726─727, 2003

9)

Seki T, Iwasaki K, Arai H, et al.: Acupuncture fordysphagia

inpoststroke

patients:

avideofluoroscopic study. Journal of the American
Geriatrics Society 53: 1083─1084, 2005
10) Akamatsu C, Ebihara T, Ishizuka S, et al.:Improvementofswallowing

reflexafter

electrical stimulation to lower leg acupoints inpatients after stroke. Journal of the American
Geriatrics Society 57: 1959─1960, 200911) Kurusu M, Watanabe K, Nakazawa T, et al.: Acupuncture for patients with glaucoma. Explore(NY) 1: 372─376, 2005

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

11

Volume 11, Number 1 | Spring 2016

Clinical Report 1 (Acupuncture)
Traditional Chinese Acupuncture and Moxibustion in
Japan (1) – Pain and Numbness of the Low Back andLower Extremities
Masanori Takashi1) and Katsuhiko Arai2)
1) Tokai University Oiso Hospital,
2) Tokai University School of Medicine

Preface
Japanese acupuncture and moxibustion has its own
characteristic history and while Chinese thoughts
were introduced to Japan during the various periods,

Dr. Takashi in treatment.

Japan has developed its own original techniques andconcepts. The needle tube widely used worldwide
today is an invention made by a Japanese, theIntroduction

delicate treatment form called meridian therapy too

Our office in the Department of Oriental Medicine in

was developed by a Japanese. Yet, today there arestill many acupuncturists in Japan practicing
Traditional Chinese acupuncture and moxibustion.
In this series acupuncturist Masanori Taskashi of

the

Oiso

Hospitalaffiliated

with

the

Tokai

University School of Medicine has been establishedin 1984 by late Dr. Kumio Yamashita. The author(Takashi) has been employed at this office since April
2001 and performs here daily acupuncture andthe Oiso Tokai University affiliated hospital will

moxibustion treatment. In March 2008 Dr. Arai

introduce these TCM methodologies and current

joined the treatment and research.

clinical practice in four reports to be published from

We are treating many diseases with acupuncture

No. 1 through No. 4 of Volume 11.

and moxibustion. A part of this series introducessome case reports. We report cases with certain
diseases. In this first part we report a case with pain
and numbness of the low back and lower extremities
as it is commonly encountered in clinical practice.
[Case] 34 years old, male, employee[Chief complaint] Pain and numbness of the low back,numbness of lower extremities[Present illness]
The low back pain started during his senior highschool days when he was a field and track athlete
and for which he consulted a local physician. He wastold his symptoms were due to fatigue. Five years

Tokai University Oiso Hospitalago he visited this acupuncture and moxibustion
clinic because of his low back pain. The treatment
assuming the presence of kidney yang deficiency
slightly alleviated the low back, but it continued to

12

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

Volume 11, Number 1 | Spring 2016

recur thereafter in intervals of 1-2 months.

Deep tendon reflexes:

both Achilles tendon reflex

Whenever this happened he underwent acupuncture

and patellar reflex were normal

and moxibustion treatment.

Manual Muscle Testing (MMT)R

L

Late in June of this year he experienced a sudden

Tibialis anterior muscle

5－5

onset of low back pain immediately after jumping

Extensor hallucis longus muscle

5－5

into the water during swimming and consulted our

Flexor hallucis longus muscle

55

office for that reason. Immediately after the

Pain was 85 mm on a Visual Analog Scale (VAS) and

acupuncture and moxibustion treatment the pain

numbness on a similar (VAS) 60 mm.

had been reduced to half of its intensity, but thesymptoms improved slower than usual. By the
middle of July some discomfort developed whiledriving a car and during the night of that day severe
pain (as if being squeezed) developed in the low backand region around the sacrum. Since numbness of
the lower extremities had also newly developed, hevisited our office again walking with a cane. Due tothe pain his posture was bend laterally. Because I
found signs of radiculopathy when I performed a

Before treatment

After treatment
Figure 1physical examination, I referred the patient to theorthopedic outpatient department. The physician
diagnosed based on x-ray and MRI images of thepelvis a prolapsed disk at L5-S1 and prescribed an
antiphlogistic analgetic.
[Past history]
Four years earlier admission due to antibiotic
induced anaphylactic shock[Present status]
A squeezing type of pain of the low back and sacral
regions as well as a heavy, dull pain of the rightbuttock. Numbness of the right leg appeared on theposterior aspect of the thigh and the lateral side ofthe lower leg. The pain caused a tendency toward
insomnia. Micturition frequency was high with 10
times/day.
Pulse:

deep, wiry

Tongue:Western medical findings:
SLR:

Figure 2

tongue body dark red, white coat
MRI findings (Figure 1)

R 20 degrees, L 60 degrees (pain in the right

low back region), no dysfunction of bladder and[TCM diagnosis]
Blood stagnation and channel blocking
Kidney deficiency

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

13

Volume 11, Number 1 | Spring 2016

[Therapeutic principle]

were almost no impediments to ordinary life. During

Activating Blood and eliminating stagnation

work he put on a corset.

Tonifying the Kidney

Fourth session (1 month later): The score for both[Acupoint selection]

pain and numbness was 0 mm. Two weeks earlier he

BL23 - tonification using twirling

had stopped taking the antiphlogistic analgetic.

BL17 / BL32 /right BL51 / BL54 / BL57 / GB34 / SP6

Fifth session (2 month later): No symptoms. Only

/ LV3: all neutral supplementation and drainage

development of a feeling of heaviness in the low backright GB30 - lifting-thrusting reduction

region when tired. The acupoint selection focused on

BL17 / BL32 / BL54 – cupping. (Figure 2)

supplementing the kidneys (BL23, BL26, KI3, CV4,

Used needles: sterile Seirin acupuncture needles,

ST36, SP6). The herniated L5-S1 disk found on thelength: 1 cun 6 fen, No.3 and 2 cun No.3

MRI images taken 2 weeks before the patient visited[Explanation]

our office had disappeared. By this time we

Based on the concept that the 'low back is theconsideredmansion of the kidney'1) the back transport point ofterminated the treatment.

thecondition

almostcured

andthe kidney BL23 was used to tonify the kidney. To
free the flow of Qi of the bladder channel a[Discussion]

combination of BL322), BL543) and BL574) was used.

Acupuncture and moxibustion treatment led in thisAt BL175) as the meeting point of the blood andpatient to pain relief in the same way Yamashita et

BL323) as a point on the greater yang bladderal. have described in “The journal of Japanesechannel in the sacral region as well as BL544) for

Society of Lumbar Spine Disorders” and could

Blood stagnation as its main indication cupping was

improve activities of daily living7). Conservative

performed

eliminatetreatment of lumbar disk herniation is known to leadstagnation. And the combination of BL17, SP6 andto spontaneous remission. According to a report by

LV3 was needled to strengthen the activation of

Dr. Hijiguro et al. the shrinkage or disappearance ofBlood and resolving stasis function6). At GB30 as thelumbar disk herniation (except in cases with ameeting point of the bladder and gallbladderhistory of surgery or spinal canal stenosis) requires

channels we used a 2 cun No.3 needle, inducing a

an average time between 4.0 and 6.6 months8).

needling sensation extending down to the lower leg

Considering that in this case a shrinkage wasto free the flow of Qi between the two channels.

observed in less than 2 months the possibility istoactivate

Blood

and

conceivable, that acupuncture and moxibustion[Course]treatment has some influence on the shrinkage ofFirst session: Immediately after the treatment theherniations.

pain score on the VAS changed to 60 mm. Numbness

This patients was diagnosed during his first visit

did not change. Yet, pain increased again during thewith kidney deficiency. Later, since symptoms

night, bringing the VAS score back to 80 mm.

improved and exacerbated several times, theSecond session (next day): Upon arrival in our clinic

condition led to impaired blood circulation and thethe score for both pain and numbness was 40 mm. At

development of Blood stagnation. This matches thethe time he came into the office he used a cane, but

description in "Jing Yue's Complete Works" saying

forgot it when he returned home after the treatment.

'Kidney deficiency is often associated with low backThird session (1 week later): After the treatment thepain. However, this state of deficiency can also bescore for both pain and numbness was 30 mm. There

superimposedbyconditions'9).

14

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

excesspatternpathologicalVolume 11, Number 1 | Spring 2016

Trauma, contusions, Blood-cold, Blood-heat, Qi

Reference

stagnation,

Blood1) Yellow Emperor’s Canon of Internal Medicine

stagnation which then may impair the functionality(Huang di nei ching Su-wen 黄 帝 内 経 素 問 )of the organ and viscera channels. For that reason

Chapter 17 The Essentials and Fundamentals of

the condition impedes a smooth movement of Blood

Diagnostic Palpation 脈要精微論 (in Chinese)Qi

deficiency

may

cause

throughout the body and leads to stagnation.

2) LI Shi-zhen 李世珍: Clinical Elaboration of theThis case presented with the clinical characteristics

Common Shu Points 常用腧穴臨床発揮, P483-490,

of Blood stagnation. The pain was of stabbing or else

Peaple’s Medical Publishing House Co., LTD 人民

squeezing nature and its site fixed. Moreover, refusal

衛生出版, 1985 (in Chinese)of pressure (a condition in which application of3) LI Shi-zhen 李世珍: Clinical Elaboration of thepressure at the site of the pain exacerbates the pain)

Common Shu Points 常用腧穴臨床発揮, P491-591,

and nocturnal exacerbation were also observed. In

Peaple’s Medical Publishing House Co., LTD 人民

this case the laterally bend posture was one of the

衛生出版, 1985 (in Chinese)

indications suggesting the refusal of pressure. Also,4) LI Shi-zhen 李世珍: Clinical Elaboration of thethe disengagement and prolapse of the nucleus

Common Shu Points 常用腧穴臨床発揮, P502-510,

pulposus too was considered to be the Blood

Peaple’s Medical Publishing House Co., LTD 人民

stagnation. Based on these characteristics we

衛生出版, 1985 (in Chinese)presumed the patient condition to be the result of5) HONMA Shohaku 本間祥白: Research of Nan Jing

kidney deficiency and Blood stagnation obstructing

難 経 の 研 究 , 179-180, IDO NO NIPPON SHA,

the channels, administered a suitable treatment and1965 (in Japanese)

therefore obtained good results.

6) KANEKO Asahiko 金子朝彦: Toigakukenkyu 東医学 研 究 , 25-28, Toigakukenkyukai, No.112 (inJapanese)
7) YAMASHITA Hitoshi 山 下 仁 : The journal ofJapanese Society of Lumbar Spine Disorders,
Vol.3 No.1, 27-32, 1997 (in Japanese)
8) HIJIGURO

Taiji

et

al.:

JournalofMusculoskeletal System, Vol.14 N0.7, 665-668,
2001 (in Japanese)
9) Zhang Jing yue: Collected Treatises of Jing yue(Jing yue quan shu 景岳全書) Vol.25 section of
Low back pain 1640 (in Chinese)

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

15

Volume 11, Number 1 | Spring 2016

Clinical Report 2 (Kampo Medicine)
Case Studies from Ehime Prefectural Central Hospital (4)– Situations Where Western Medicine Cannot be Used–

Genki Shimizu, Hiroshi Kakuto, Den-ichiro Yamaoka
The Internal Departement of East Asian Traditional
Medicine of Ehime Prefectural Central Hospital

cold knees and feet and stiffness in his lower back, so he
was referred to the East Asian Traditional Medicine
Department in September 2015.
[Physical health]his feet are susceptible to swelling. He tends to get leg[Case 10 (Dr. Shimizu’s case)]
Successful treatment of cold feet and ambulation difficulty
in a 90-year-old man

cramps in the morning when waking up. He cannot sit on
the heels of his feet on the tatami mat. He has a lot of urine
at night, and goes to the toilet every hour. No symptoms[History of past illnesses]
Herpes zoster at age 40, compound fracture of left leg andfracture of right hand as traffic injuries at age 56, onset of
diabetes at age 64, development of high blood pressure atage 65, surgery for bladder tumor at age 89

of hot flashes. No sense of fatigue. Good bowel
movement. Good sleep. Good appetite.
[Observations]
Uses a wheelchair to visit the hospital. Tongue:
Geographic tongue, dark red. Pulse: Smooth. Abdominal[Oral medicine]
Linagliptin 5mg, 1 tablet once a day after breakfast
Glimepiride 0.5mg, 0.5 tablet once a day after breakfast
Silodosin table 4mg, 2 tablets twice a day after breakfast
and dinner

symptoms: Abdominal strength 2/5, weakness of thelower abdominal region. Strong coldness in lower legs.
[Diagnosis]
Kidney yang deficiency, fluid retention[Progress][External medicine]
Loxoprofen sodium hydrate 100mg, applied once a day
Diclofenac sodium 1% gel, applied to upper arm once aday

The patient was prescribed goshajinkigan extract granule7.5g three times a day after each meal, for three weeks. By
his return visit three weeks later, the coldness and edema
in his feet had improved, and his frequency of nighttime[Life history]
Smoking: 20 × 20 years (ages 23 – 42); no drinking;nursing care service 3 days/week

urination decreased, such that he goes to the toilet only
three times during the night, where he used to go every
hour. His feet had come to become warm even while[Occupational history]

sleeping at night.

Ex civil-service worker[Allergy][Case 11 (Dr. Kakuto’s case)]

None

Bukuryoshigyakuto for hiccups in a 61-year-old man[Chief complaint][Chief complaint]

Cold feet, ambulation difficulty

Hiccups[History of present illness]
The patient has been visiting the orthopedic department
2014

scapulohumeral

due

to

osteophytic

periarthritis

in

both

spondylosis,
shoulders,

osteoarthritis in both knees, and cervical spondylotic
myelopathy (C3/4). From January 2015, his leg
movements became difficult. Surgery was recommended,
but due to his old age, the patient did not wish to undergo
survey, so the wait-and-see approach was decided to be16

improved somewhat, but he still displayed symptoms of

The patient has had lower back pain for some time, andType 4 Cases

sincetaken. With rehabilitation, the patient’s leg movements[History of past illnesses]
The patient visits the dermatology department in our
hospital every three months for MCTD treatment
Oral medicine: Prednisolone 5mg, Nifedipine, Beraprost,
Alendronic acid
[Life history]
Smoking: 8 × 40 years
Drinking: 7 times/week; Type: 1 canned beer

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

Volume 11, Number 1 | Spring 2016

Eating: 3 meals/day regularly
Occupation: Assembly of farm equipment[History of present illness]
On October 8, XXXX, the patient developed a fever andsore throat, and came to our hospital. Diagnosed withacute epiglottitis, he was immediately admitted that day
and received treatment by antibiotic and a steroid. He
showed good progress, but from around October 13,
hiccups began to occur along with nausea. He consulted
the Gastroenterological Medicine Department, where hereceived gastroscopy and other inspections, but noabnormalities were found. Even after being discharged on
the 14th, the hiccups continued, such that the patient said
he could not sleep at night and could not stand it anymore.
He therefore made a return visit to the General Medicine
Department after being discharged.
[Progress]
On the patient’s first visit (Oct. 20), he was prescribed
Chlorpromazine 25mg to be taken as needed + Tsumura
Hangeshashinto

7.5g.

The

patientsaid

theChlorpromazine had an immediate effect, but made him
dizzy and unsteady, and that the effect lasted for only
about 30 minutes.
Second visit (Oct. 22): The patient was referred to the East
Asian Traditional Medicine Department and wasprescribed shiteito (decoction), but it did not work
effectively.

[Summary]
I have three teachers. One is the late Dr. Yoshinaru
Fujioka, a cultural anthropologist who developed theimage theory, another is the late Dr. Judo Ono, whotaught me Jungian psychology and psychiatric hospitaltreatment, and the other is Dr. Hidehiko Mitsufuji, first
director of the East Asian Traditional Medicine
Institute, who developed the chronological (timeseries) analysis method and taught me about
moxibustion and Kampo. Owing to these threeteachers, I have found the path to take and a place tostand, and now have two apprentices. I have also
received supervision from Dr. Hiromichi Yasui inpresenting case reports herein. Needless to say, it ismeaningful to summarize daily cases, but to have theopportunity to present them within KAIM has been atruly great honor. We hold a conference every morning,and begin by offering a silent prayer so that we mayinteract with all patients who come to our hospital, theirfamilies, and other staff members in a safe, appropriate
and caring manner. To this, we have recently added thephrase, “from the rural bedside to the global podium,”with hopes of presenting our daily clinicalachievements on the global stage. Through theadministration of East Asian traditional medicine, we
aim accumulate clinical practice with an eye towardeven higher global podiums.

Third visit (Oct. 24): The hiccups continued, and thepatient said he was so tired that he wants to lie down.
Tongue: Slightly dark purple, small amount of yellow
coating toward the back, slight varicosis
Pulse: Sunken and weak
Moderate abdominal strength. Epigastric discomfort
and resistance.
When bukuryoshigyakuto (Kanzo (licorice) 4.5g, hobushi(prepared aconite tuber) 2g, ninjin (ginseng) 2g, kankyo(steamed ginger) 1.5g, bukuryo (poria) 4g) wasprescribed, the hiccups disappeared in half a day and did
not occur thereafter.

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

17

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