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Meeddiicciinnee
INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 6, Number 4 ･ Winter 2011

Editorial

The Pharmacopedics in Japan
Toshiaki Makino

Japanese Acupuncture - Current Research

Japanese Traditional Medicine Text (2) – Internal Medicine B
Tomomi Narushima and Eitaro Noguchi

Kampo Medicine - Current Research

Investigation of Clinical Indications of Goreisan in Patients with Epigastralgia in the Summer Season－From the “Goreisan Symposium 2010”－
Yoko Kimura

Clinical Report 1 (Acupuncture)

The Cases of Acupuncture and Moxibustion Treatment for Pollakisria and Nocturia during Pregnancy Thought to be Effective
Naoko Maeda and Shuichi Katai

Clinical Report 2 (Kampo Medicine)
Headache 3
Mihoh Koga

Front Line of Kampo Pharmacology

Review of Research Presentations on Kampo Medicine 5
Toshiaki Makino

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.
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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 6, Number 4 ･ Winter 2011EXECUTIVE EDITOR

Shuji Goto
Chairman, GOTO College ofMedical Arts & Sciences

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

Tokyo, JapanEDITOR-IN-CHIEF

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

ASSOCIATE EDITORS

1 Editorial
The Pharmacopedics in Japan
Toshiaki Makino

2 Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (2) – Internal Medicine B
Tomomi Narushima and Eitaro Noguchi

Shuichi Katai
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

9 Kampo Medicine - Current Research
Investigation of Clinical Indications of Goreisan in Patients with Epigastralgia in theSummer Season －From the “Goreisan Symposium 2010”－
Yoko Kimura

15 Clinical Report 1 (Acupuncture)
The Cases of Acupuncture and Moxibustion Treatment for Pollakisria and Nocturia during
Pregnancy Thought to be Effective
Naoko Maeda and Shuichi Katai

19 Clinical Report 2 (Kampo Medicine)
Headache 3
Mihoh Koga

PUBLISHER

Shuji Goto
International Institute of Health andHuman Services, Berkeley

22 Front Line of Kampo Pharmacology
Review of Research Presentations on Kampo Medicine 52550 Shattuck Avenue, Berkeley
California 94704-2724, U.S.A.

Toshiaki Makino

26 Medical History in Japan”Historical Significance of Standardization of Acupoint Locations”, the Second Japanese
Acupoint Committee (4)Makoto Mayanagi

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 6, Number 4 | Winter 2011

Editorial
The Pharmacopedics in Japan
In 2006, pharmacy education in Japanese universities was changed into two different curriculums offeredin parallel. One is six-year program that was strengthened with the addition of a two-year program allotted tothe subjects relating to clinical pharmacy to the conventional four-year program and mainly aimed to develop
pharmacists who work in the medical field. Another is the four-year program mainly focused on developing
pharmaceutical researchers and engineers. Under the new system, those who wish to take the national
examination for pharmacists must graduate from the six-year program. These changes have come to be madein response to growing expectations for the pharmacists to play active roles in healthcare, also as a possible
measure for addressing diverse issues facing the future of healthcare in Japan, including the issue of declining
birthrate and aging population.
Against this backdrop, there are high expectations for Kampo medicine, or traditional Chinese herbal
medicine, within the medical field in Japan. In fact, 90% of physicists in Japan prescribe Kampo as appropriate,and 8% of all prescriptions that are given include Kampo. Thus, Kampo is a requisite part of clinical pharmacy
education, and many universities with a pharmacy department have begun to offer classes on Kampo.
However, as the most universities do not have faculty members who specialize in Kampo medicine, it was
decided that pharmacognosy teachers would teach Kampo, as pharmacognosy relates most closely to Kampo
medicine.
In a period when the most pharmaceutical products were not synthetic but crude drugs derived fromnatural sources, pharmacognosy aimed to eliminate fraudulent and inferior products to assure the quality ofpharmaceutical products, and secure their safety and effectiveness. In order to secure the quality of such crude
drugs, it was most important to clarify the pharmacologically active chemical ingredients they contain andmanage their content to a certain level. Thus, in recent years, pharmacognosy had come to be regarded as astudy for isolating chemically pure compounds from crude drugs and developing new drugs. Still more
recently, however, as it has become rare to find new compounds contained in crude drugs that are used as
ingredients for Kampo, pharmacognosist shave shifted their attention to natural resources such as
microorganisms and marine organisms that were not conventionally used as crude drugs, and have basicallylost interest in Kampo.
The recent changes in pharmacy education are prompting pharmacognosists to return to pharmacognosy
in its original sense. As matters stand, Kampo is used in the medical field despite its various issues as a drug,but modern society demands that these issues be addressed through research. Therefore, in response to suchdemand, it is hoped that Kampo studies will be actively pursued in the future.

Toshiaki Makino, Ph.D.
Associate Professor, Department of Pharmacognosy
Graduate School of Pharmaceutical Sciences
Nagoya City University

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

1

Volume 6, Number 4 | Winter 2011

Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (2) – Internal Medicine

become the subject of research. In response theTomomi Narushima1), Eitaro Noguchi2)

announced in Rome 2000, the resulting large supply

1) East-West Integrative Medical Centerof public funds for acupuncture research for treating

Tsukuba University of Technology

IBS led to a sudden increase in research reports. As2) Graduate School of Technical Sciencesa result, Takahashi (2006) 8 as well as Yin et al.

Tsukuba University of Technology

B Influences on Digenstive Tract Function due to
Acupuncture

started a long history of scientifically researching
the effects of acupuncture and moxibustion on thedigestive system.
In 1912, Jujiro Kashida et al., studied the effects ofmoxibustionondomesticatedrabbits

intestinalusing

peristalsisainmanometer.

Stimulating ST36（足三里）as well as abdominal
points with moxibustion they reported a transient
acceleration that gradually became a resistance
response to the stimulation1. Further, in 1914,
Michio Goto observed an acceleratory response tomoxibustion stimulation in the intestinal movementof rabbits2. Additionally, in 1929, Shuji Fujii et al.,reported a resistance response to moxibustion in thesmall intestinal movement of rabbits3. Later, in the
1970's, Sato et al., and Noguchi, who played aleading role as Japanese researchers performed
basic research, gradually clarified the mechanism bywhich acupuncture and moxibustion treatment
somato-autonomic

nerve

reflex

thereby influencing the digestive system4,5.
Concerning clinical research, in 1992, Li et al.,presented Chinese acupuncture and moxibustion
research on the subject of the digestive tract. In 1999,
at a Symposium sponsored by the Japanese Societyof Acupuncture and Moxibustion, a comprehensive
review of basic and clinical research outcomes waspresented7.
Recently in foreign countries, due to increased publicneed, Irritable Bowel Syndrome (IBS) has frequently
2reported

acupunctureaandcomprehensive
moxibustion

reviewoftreatment

fordigestive disorders. The crux of the matter will beof the reviews introduces research on salivary

Compared to other countries, at an early date Japanthe(2010)9

introduced below, where a relatively high proportion

1. General Overview of Research

influences

introduction of clear standards for IBS diagnosis,

secretion, gastric acid secretion and gastrointestinal
disorders, especially IBS.
2. Acupuncture and Salivary Secretion
Research on Acupuncture and salivary secretions
precedes the conditions of clinical research, Blom etal. (1992)10 reported, when compared to the placebo
control group, patients with dry mouth associatedwith Sjogren’s syndrome experienced significant
increases in salivary secretions following needle
retention acupuncture. Additionally, Dawidson et al.,reportedly confirmed the mechanism for increased
salivary

secretions

following

acupuncturewasthought to be due to an increase in blood vessel
dilatory factors such as CGRP11 and VIP12 leading to
improved circulation to salivary glands. O’Sullivan etal.13 emphasized the importance of extremely
accurate acupuncture RCTs to assure clinicaleffectiveness and patient safety. This groups clinicallyevaluated 3RCTs demonstrating that acupuncture
effectively mitigated the dry mouth that often results
as a side effect of radiation therapy for head and neckcancer patients. Omata et al., conducted clinicalresearch and reported in Japan that high frequency
electro-acupunctureonsalivary

andsecretions

facialpointsmitigated

increased

dry

mouth

symptoms associated with Sjogren’s syndrome14.
Further, Omata et al. reported in 2007 that at the
time

of

stimulationhighfrequency

(1Hz

and

30Hz)

electro-acupuncture
measurable

VIP

emissions caused blood vessel dilation that led to

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

Volume 6, Number 4 | Winter 2011

significant increases in secretions such as tears, theamount of salivary secretions and facial skintemperature changes. Tears and salivary secretions
were confirmed to increase with 30 Hz electroacupuncture stimulation15.
As reported above, acupuncture treatment has beenclinically shown to increase salivary secretions,however, the functional mechanism of that process
has yet to be convincingly clarified. It has beensuggested that increased blood flow to an area as aresult of increased blood vessel dilation factors in thearea would accelerate secretions, however further
research is thought to be necessary (Table 1).
Table 1 Salivary Secretion
AuthorBlom M.

Year of

Subject,Object

Number of

Publicationof study

Cases

1992

Xerosis21

Method of stimulation

Conclusion

Journal

Needle Retention

Salivary Gland Secretion increase

Oral Surg Oral

Technique vs. Shamdue to shallow needling

Med Oral Patho

needling(Shallow needl ing)
Blom M.

1996

HNC

38

Sham Acupuncture (1 cm

Salivary secretion increase due to

Eur J Cancer, B.

far from acupoint &acupuncture,shallow acupuncture andOral 0ncol

shallow needling) vs.

no significant difference Manual

Manual Acupuncture

acupuncture stimulation

stimulation
Dawidson

1998

Xerosis patient

65

I.
Dawidson

1999

Xerosis patient

65

I.
Omata H.

2000

Manual Acupuncture with

Increased Salivary secretion, increased

Qi arrival

VIP concentration within the saliva

Manual Acupuncture with

Increased Salivary secretion, increased

Qi arrival

CGRP concentration within the saliva

Neuropeptides

Neuropeptides

In both

Healthy

Electro-acupuncture in the

Effectiveness of facial electro-

The Japan

Sjogren’s

subjects

cervical (neck) area/ Facial

acupuncture (20Hz), Dray Score

Society of

syndrome and=10

area electro-acupuncture

improvement

Balneology,

healthy subjects

Subjects

Climatorogy andwithPhsical Med

Xerosis =10
Omata H.

Cho JH.

Pfister DG.

2007

2008

2010

In both

Healthy

Facial electro-acupuncture

Increased tears volume following 30Hz

The Autonomic

Sjogren’s

subjects

1Hz vs. 30Hz

electro-acupuncture, 1 and 30Hz

Nervous System

syndrome and=10electro-acupuncture causes increased

healthy subjects

Subjects

saliva volume, facial epidermis

withtemperature increase with 1 Hz electro-

Xerosis =11

acupuncture

HNC

NHC

12

58

Needle Retention

Acupuncture and shallow acupuncture

J Altern

Technique vs. Shamcauses an increase in salivary gland

Complement

needling

secretion, subjective symptoms

Med(Shallow needl ing)

significantly improved

Manual acupuncture

XI Score significantly decreased withstimulation vs. standard

acupuncture

J Clin Oncol

acupuncture treatment

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

3

Volume 6, Number 4 | Winter 2011

3. Acupuncture and Gastric Acid Secretion

Also, Jin et al., observed that acupuncture stimulation

It is thought that Sodipo et al.16, were among thewas capable of inhibiting amino acid induced gastricfirst European and American researchers to reportacid secretion in under conscious dogs. Because thison the effects of Acupuncture therapy on gastric acidreaction was eliminated by naloxone, it was thoughtsecretions. These researchers used a 6 week protocolthat endogenous opioids must be related to the painofelectro-relief mechanism of acupuncture related pain relief 18.

acupuncture on patients with duodenal ulcers andOn the other hand, Noguchi et al., observed

non-ulcerative indigestion. The patients reported

accelerated gastric acid secretion in anesthetizedelimination of stomach pain and, within therats treated with electro-acupuncture at ST36.

duodenal ulcer group, because there was a reduction

Because this reaction was eliminated by severing thein maximum-stimulation gastric acid secretion the

Sciatic and/or Vagus nerves, it was reported that the

researchers concluded that acupuncture inhibits

accelerated gastric secretions must involve thegastric acid secretion in these patients.

somato-autonomic nerve reflex19.

Within the field of basic research, Zhou et al. (1984),

Currently, there are numerous reports concerning

treated and unanesthetized dog with a gastric fistula

gastric

using electro-acupuncture on ST36(足三里), PC 6(内stimulation,

unfortunately

関 ), and UB 21( 脾 兪 ) for 2 hours and observed

hypothesizedmechanisms

remaininhibition of gastric acid secretion, this response wasFurthermore,

given

developments

reported as inhibition of gastric acid secretion by thepharmaceutical treatments and elucidation of thesomato-autonomic nerve reflex because the reaction

mechanisms involved in ulcer occurrence, thedisappeared with the administration of the Vagal

importancenerve blocker Atropine and/or local anesthesia,

acupuncture’s role in controlling gastric acid has

procaine17.

been diminished (Table 2).

acupuncture,

moxibustion

andsecretionofresultingfromacupuncture

theresults

recentclarifying

and

and

unclear.

reportinginonTable 2 Gastric Acid Seretion
AuthorSodipo J

Year of

Subject,Object

Number of

Publicationof study

Cases

1979

Gastric Ulcer

10

patient

Zhou L1984

Conscious

5

dogs

Jin H

1996

Conscious

5

dogs

Method of stimulation

Conclusion

JournalRetention method of Acup.,

Reducing gastric ulcer pain is related to

Am J Chin Medelectro-Acupuncture, Moxa

reducing the amount of gastric acidon sliced ginger

secretion

Electro Acup. vs. Manual

Sham Acup. <Manual Acup.<Electro-

Acup.

acup. reduces gastric acid secretion

No stimulation vs. Shallow

Acupuncture shown to suppress gastricAcup. vs. Electro-Acup.

acid secretion following amino acid

Life Sci

Am J Physiol

ingestion

Noguchi E

1996

Anesthetized
rats

4

56

Electro Acup. on St 36 (足三Electro-Acup. at ST36 accelerated里) vs. LI 10 (手三里)Gastric acid secretion

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

Volume 6, Number 4 | Winter 2011

4. Acupuncture and Gastrointestinal Dysfunction

effectiveness of acupuncture, sham acupuncture

Li et al.(1992) , reviewed 25 reports, published(shallow acupuncture) or another intervention for

between 1979-87, on the role of acupuncture in

IBS.

gastrointestinal function and disorders. A majority

In 2007, Schneider et al., investigated all the clinicalof the reviewed papers (17) used basic research

papers related to acupuncture used to treat

papers, whereas only 8 reports used human subjects

gastrointestinal disorders on MEDLINE (submitted

for functional and clinical research 6.

until 2006) (Table 3).

Since 1997, the National Institutes of Health, NIH

Their results included 18 extracted reports, fromhave announced a general consensus with respect tothese they selected 4 RCTs that met the standard

acupuncture and have generously made funds

criteria and used these for their systematic review.

available for further research. As a result, numerous

The subject of two of these papers was Irritable

reports on the usefulness of acupuncture for stomach

Bowel Syndrome (IBS) and Chrohn’s Disease (CD),and intestinal function have been published by

one paper discussed Ulcerative colitis and one

American Medical Universities 20. Takahashi (2006)8

discussed

reportedon

Discussion within these papers related to thegastrointestinal

usefulness of acupuncture and sham acupuncture

on

the

acupuncture

andfunctional

disorders.

thefollowing

In

above

results,

focusing(IBD).

(shallow acupuncture) for these conditions as well assummarize the Yin et al., report on gastrointestinal

whether or not the patient’s quality of life (QOL)

motility disorders (2010) 9.

significantly improved. Acupuncture treatment was

Recent studies on acupuncture treatment forfound to be significantly more effective for patients

gastrointestinal disorders reflects a growing social

with Chrohn’s Disease and Colitis than shamneed, so IBS research has been conducted quite

acupuncture(shallow acupuncture) regarding theenergetically. For these reasons the following two

activity of the disorders (CAI score). From thesereports (2006, 2007) were selected for this systematic

results, it has been thought that the effectreview. Lim et al.(2006), used online databases

acupuncture may have on QOL for IBS patients is

PubMed,ofnon-specific, but because the possibilities areControlled Trials (CENTRAL) on The Cochranedetectable, there is a clear imperative for further

Library,

research 22.

Cochrane

EMBASE,

CentraltheChineseweBowel Disease

will

the

sectionInflammatory

Register

Biomedical

Database, the Cumulative Index to Nursing andIn this way, it has been suggested that acupuncture

Alliedhas the potential to be effective for IBS, Chrohn’s

Health(CINAHL),

and

the

AlliedandComplementaryMedicineDatabase (AMED) to

Disease,analyze and extract 6 relevant clinical studies (Table

gastrointestinal

3).

conclusion has not been fully verified.

The

resultsdid

notconfirm

statistically

Ulcerative

colitis,functionetc.,

disorders,

and

other

but

this

significant differences in studies where sham

However, according to MacPherson et al.(2010), they

acupuncture was set up as a group to be compared tocurrently have 233 IBS patients whose results are

standard acupunctures, but did report that whenbeing analyzed and they anticipate publishing a newacupuncture was set as the control group symptoms

systematic review 23(Table 3).

often improved 21. However, a large portion of the

So while these two systematic reviews at once give

reviewed clinical papers were of low quality andthe impression that the possibility of effective

although meta-analysis was attempted, only 2acupuncture exists, there is also the impression thatreports were worth analyzing. For these reasons, itboth acupuncture and sham acupuncture provideisdifficult

to

make

a

judgment

about

the

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

5

Volume 6, Number 4 | Winter 2011little more effect than a Placebo. The origin of these
conclusions are strongly reflected in the current
research model that equates “sham acupuncture”
with a “non-invasive control”, when this assumption
has not been universally approved. When using
sham acupuncture as a control (non-invasive, nonstimulation=

placebo)differing“doses”

ofstimulation have been confirmed. That is to say, thestimulation from sham or non-invasive stimulation(as a control or a placebo) is thought to be sufficient

As for Japan, conducting acupuncture andmoxibustion RCTs has been relatively difficult, infact, in recent years Japan has contributed almost no
meaningful clinical research RCTs. However, in lightof some outstanding recent report using acupuncture
to treat IBS that utilizes an inversion method, it is
now being thought that methods besides RCTs thatare still evidence based medicine (EBM) arecertainly possible 24. Moving onward from this point,
it is now necessary to confirm acupuncture andmoxibustion research methodologies in Japan.

to provide a therapeutic effect.
Table 3 Lim’s Systematic Review, The Cochrane Library, 2005
No

Author.

Year ofCategory

Publication

Subject,

NumberObject ofof Cases

Method of stimulation

Conclusion

JournalLI4(合谷) stimulation vs.

Comparing Acup. with Sham Acup.

Digestion

Sham acup. (UB60:崑崙)

treatment, Abdominal pain as well as

study
1

Fireman

2001

RCT

Z

Israeli

25

Patient
with IBS

over all complaints were improved,
there was no significant difference inimprovement between the 2 groups.

2

Forbes A

2005

RCT

English IBS

59

out patient

Chinese Acup. vs. ShamAcupuncture seems to be superior toWorld J

acup. using non-meridian

Sham treatments, but there is no

Gastroenterol

pointssignificant difference.

Accordingly,

Acupuncture has relatively little effecton IBS
3

Liao YC

2000

RCT

Chinese IBS

97

Patient

Chinese Acup. withAcupuncture with PsychologicalClin Acup &Psychological CounselingCounseling is more effective thanMox

vs. Chinese Herbal

Chinese Herbal Medicine with

Medicine with

Psychological Counseling

Psychological Counseling
4

Liu M

1995

RCT

Chinese IBS

37

Patient

Chinese acup., Ear acup.,

Ear acup. is more effective thanShanghai J

Western ｄrugWestern drug treatment

Acup & Mox

Chinese Acup. vs.

Compared to using Acup. alone,

Chin Acup &Chinese Acup. with

Combining Acup. with some

Mox

Psychological Counselingcounseling is more effective

Chinese Acupuncture vs.

Acupuncture is not especially effective

Gastroenterol

Sham Acupuncture by

for IBSogy

treatment
5

Liu GZ

1997

RCT

Chinese IBS

50

Patient

6

Lowe C

2000

RCT

Canadian
Patient

28

blunt needles

6

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

Volume 6, Number 4 | Winter 2011

Table 3 Schnelder’s Systematic Review, World J Gastroenterol, 2007
No

Author.

Year ofCategory

Publication

Subject,

NumberObject ofof Cases

Method of stimulation

Conclusion

JournalChinese Acup.vs. ShamAcupuncture is superior to ShamWorld J

Acup. (Non-meridian

Acupuncture but there is no

Gastroenterol

points)significant difference. Further,

study
1

Forbers A

2005

RCT

IBS Patient

59

Acupuncture is not especiallyeffective for IBS
2

Joos S

2004

RCT

Patient with51

Chinese Acup. and Mox.

In line with CAI, acupuncture is

Chrohn’s

vs. Sham Acup. (shallow

considered more effective than

Diseasestimulation on meridian

Sham acupuncture.It appears thatpoints)Acupuncture is moderately effectivefor

3

Joos S

2006

RCT

29

Digestion

Chrohn’s Disease

Chinese Acup. and Mox.

In line with the Colitis Activity

ScanJ

vs. Sham Acup. (shallow

Index (CAI), Acupuncture is

Gastroenterol

stimulation on meridian

considered more effective thanpoints)Sham acupuncture, but considering
QOL there is no difference between
the two. It appears that
Acupuncture is moderately effective
for ulcerative colitis (UC).

4

Scheider

2006

RCT

IBS Patient

43

A

Chinese Acup. vs. Sham

Both Acup. and Sham Acup.

(Streitberger) acup.

contribute to an improved QOL for

Gut

the patient. Acupuncture`s effect ismostly attributed to the Placebo
effect.
5

Liu GZ

1997

RCT

Chinese IBS

50

Patient

6

Lowe C

2000

RCT

Canadian

28

Patient

Chinese Acup. vs.

Compared to using Acup. alone,

Chinese Acup. with

Combining Acup. with some

Psychological Counselingcounseling is more effective

Chinese Acupuncture vs.

Acupuncture is not especially

Sham Acupuncture byeffective for IBS

Chin Acup & Mox

Gastroenterology

blunt needles

References

4.

General view of research
1.

JujiroKashida,somatosensory input on autonomic functions.
Kazuo

Harada:About

Rev Physiol Biochem Pharmacol 130: 1-328,

Acupuncture and Moxibustion. Journal of theMedical Society of Tokyo 26: 735-762, 1912
2.

3.

Michio

Goto:

Sato A, Sato Y, and Schmidt RF: The impact of

About

Head's

zone

1997
5.

Noguchi E: Acupuncture regulates gut motility

andand secretion via nerve reflexes, Autonomic

Acupuncture technique. Medical Journal of the

Neuroscience: Basic and Clinical 156: 15–18,

Kyoto Medical Society 11: 303-330, 1914

2010

Fuji Shuji, Takeuchi Goro: Influence of PediatricAcupunctureon

Digestive

6.

Li Y, et al: The effect of acupuncture on

motility

gastrointestinal function and disorders. The(Investigative Research). Medical Society ofAmerican Journal of Gastroenterology 87(10):Osaka 28: 2029-2032, 1929

1372-1381, 1992

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

7

Volume 6, Number 4 | Winter 2011

7.

8.

Etaro Noguchi, Kenji Imai, Eiji Sumiya, et al.:on Facial Autonomic Nerve Function. The

The Effects of Acupuncture and Moxibustion on

Autonomic Nerve System 44 (5): 379-382, 2007

Visceral Pain, Digestive Function and Digestive

Gastric Acid

Symptoms. Journal of the Japan Society of

16. Sodipo JO, Falaiye JM: Acupuncture and gastricAcupuncture and Moxibustion 51: 466-491, 2001.

acid studies. Am.J.Chin.Med. 7 (4 ): 356-361,

Takahashi

1979

T:

Acupuncture

forfunctional

gastrointestinal disorders. J Gastroenterol 41:
9.

17. Zhou L, Chey WY: Electic acupuncture stimulates

408–417, 2006

non-parietal cell secretion of the stomach in dog.

Yin

Life Science 34: 2233-2238, 1984

J, Chen JD: Gastrointestinal motility

disordersandacupuncture.

Autonomic

18. Jin HO, Zhou L, Lee KY, Chang TM, Chey WY:
Inhibition

Neuroscience; Basic and Clinical 157: 31-37, 2010

of

acid

secretionbyelectrical

Salivaacupuncture is mediated via beta-endorphin and

10. Blom M,Dawidson I, Angmar-Månsson B: The

somatostatine. Am J. Physiol G 524-530, 1996

effect of acupuncture on salivary flow rates in

19. Noguchi E, Hayashi H: Increases on gastricpatients with xerostomia. Oral Surg Oral Med

acidity

Oral Pathol 73: 293-8, 1992

stimulation of the hindlimb of anesthetized rats.

E,

LundebergT:

Sensory

response

electroacupuncture

IBS

stimulation (acupuncture) increases the release

20. Hideo Anzai: Research on Complementary andof vasoactive intenstinak polypeptide in the

Alternative Medicine in America. Clinicalsaliva of xerostomia sufferers. Neuropeptides

Herbal Medicine 51 (8): 1132-1137, 2004
21. Lim B, Manheimer E, Lao L, Ziea E, Wisniewski

32(2): 543-8, 1998
12. Dawidson I, Angmar-Mânsson B, Blom M,
Theodorsson

E,

LundebergT:

Sensory

stimulation (acupuncture) increases the releaseof calcitonin geno-related peptide in the saliva of

J, Liu J, Berman BM: Acupuncture fortreatment of irritable bowel syndrome (Review).
Cochrane Database Syst Rev. 18: 1-37 2006
22. Schneider

A,

Streitberger

xerostomia sufferers. Neuropeptides 33(3): 244-

Acupuncture

treatment

250, 1999

diseases:A

systematic

13. O’Sullivan

EM,

Higginson

IJ:

Clinicaleffectiveness and safety of acupuncture in the

in

K,

Joos

S:

gastrointestinal

review.

World

J

Gastroenterol 13: 3417-3424, 2007
23. MacPherson H, Bland M, Bloor K, Cox H,

treatment of irradiation-induced xerostomia in

Geddes D, Kang'ombe A, et al:patients with head and neck cancer : a systematicfor irritable bowel syndrome: a protocol for areview. Acupunct Med 28(4): 191-9, 2010

pragmatic randomised controlled trial. BMC

14. Hiroshi Omata, Satoru Yamaguchi, Shuji Ono et

Acupuncture

Gastroenterol 10: 63, 2010

al: Effectiveness of acupuncture treatment for

24. Jun Matsumoto, Naoto Ishizaki, Kenji Namura,the dry symptoms associated with Sjogren

et al: Effect of Acupuncture Treatment in

Syndrome. The Journal of the Japanese Society

Patients with Irritable Bowel Syndrome – AofSeries of Single Case Study-. Journal of theBalneology,

Climatology

andPhysicalMedicine 63 (2): 79-90, 2000
15. Hiroshi Omata, Satoru Yamaguchi, Naotoshi

Japan Society of Acupuncture and Moxibustion
55: 56-67, 2005

Tamura et al: Influence of Electro-Acupuncture

8toJapan Journal of Physiology 46: 53-58, 1996

11. Dawidson I, Angmar-Mânsson B, Blom M,
Theodorsson

in

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

Volume 6, Number 4 | Winter 2011

Kampo Medicine - Current Research
Investigation of Clinical Indications of Goreisan inPatients with Epigastralgia in the Summer Season－From the “Goreisan Symposium 2010”－[Introduction]

Goreisan is based on ancient Chinese medical
books “Shanghanlun” (Treatise on Cold Damage
Diseases)

and“Jinguiyaolue”(Synopsisof

Yoko Kimura

Prescriptions of the Golden Chamber), and is a

Institute of Oriental Medicine,

representative prescription used for all types ofTokyo Women’s Medical University,“Water toxin”, such as edema, vertigo, headaches,

School of Medicine

and diarrhea. In clinical practice, it is applied forvomiting,[Abstract]waterydiarrhea

and

other

such

gastrointestinal colds, as well as for cyclic vomiting,

Teian Azai classically described that summer

migraineheadaches,heat was caused by humidity in addition to hot

hangovers,

vertigo,weather. It may occur after getting chilled while

syndromei). Signs for using goreisan include dry

asleep, enjoying the evening cool and taking cold

mouth, low urine output, water-counterflow-likefoods and drinks. Humidity and high temperature

vomiting, and splashing sound in the epigastricprevent qi circulation in the stomach. Therefore, heregion1).

trigeminal

nephritis,

neuralgia,

andnephrotic

insisted that goreisan, a formula improving water

Recently, I saw patients who developed epigastriccirculation, could be applied for diverse symptoms

pain triggered by consuming cold foods during thecaused by summer heat. We present two cases ofsummer, and improved after taking goreisan. Therepatients with epigastralgia caused by cold foods andhave been no case reports published that describeddrinks in air-conditioned environments, whose

epigastric pain improved by goreisan. Thus, asymptoms were improved by goreisan. In priorretrospective comparison study was performed,

treatment, anchusan in case 1, and rikkunshito incomparing effective cases using goreisan withcase 2 were not effective for their epigastralgia.

ineffective cases. The study aimed to clarify what

Nineteen cases of epigastralgia after taking cold

types of epigastric pain goreisan is effective against.

foods and drinks in summer, including these twocases, revealed that goreisan was efficacious against

A) Cases of improvement of epigastric pain by

the summer epigastralgia with white fur on thegoreisantongue and a stuck feeling in the pit of the stomach.

[Case 1] 47-year-old female care manager

Abdominal fluid congestion is a major abdominal

Chief complaint: Epigastric pain

sign for an indication of goreisan, but a stuck feeling

Past medical history: None in particularin the pit of the stomach appeared in some effective

History of present illness: From around 2 years ago,cases of goreisan. We concluded that epigastralgia

the patient’s symptoms of cold sensitivity andcaused by cold foods and drinks with white fur on the

menstrual

tongue and a stuck feeling in the pit of the stomach

tokishakuyakusan
tokishigyakukagoshuyushokyoto

could be a target for the application of goreisan.

pain

had

lightenedafter

taking
and

that

was

prescribed by the hospital. From mid-July, the[Keywords]

humid heat of summer prompted her to frequently

goreisan, epigastralgia, summer heat, cold drinks

consume ice cream and cold beverages in an air-and foods

conditioned

environment,

and

she

began

to

experience piercing pains near her stomach. She
thus sought medical attention.

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

9Volume 6, Number 4 | Winter 2011

Subjective symptoms: The patient complained of

Subjective symptoms: The patient complained of coldthirst, excessive consumption of liquids, epigastricsensation (feet), general malaise, dry mouth,

pain, loose stool, and edema in her legs. She

excessive consumption of liquids, loss of appetite,

experienced no excessive sweating or low urine

heavy stomach feeling, epigastric pain and nausea.

output.

She had regular bowel movement, and experienced

Physical observations: 155cm, 50kg (BMI 20.8),

no excessive sweating or edema.

blood pressure 108/68 mmHg, pulse 68/min.

Physical observations: 161cm, 54kg (BMI 20.8),

Normal facial complexion. No vacuous nor forceful

blood pressure 118/64 mmHg, pulse 68/min.

pulse. Pale red tongue with a white fur. Medium

Normal facial complexion. No vacuous nor forcefulabdominal muscle strength, and signs of epigastricpulse. Pale red and enlarged tongue with a white anddiscomfort and resistance.

greasy fur. Weak abdominal strength, and signs ofProgress: The epigastric pain was thought to be

epigastric discomfort and resistance and splashingcaused by consuming cold foods and beverages. The

soundpatient was treated by 7.5g/day of anchusan for two

extremities was also observed.

weeks containing crude drugs such as Corydalis

Progress: Because rikkunshito did not completely

Tuber, Alpiniae Officinari Rhizoma, Amomi Semen,
Foeniculi Furctus and Cinnamomi Cortex that warm

improve the patient’s symptoms, her epigastric pain

the body and act against stomach pains. However,cold foods and beverages. A splashing sound in theher symptoms did not ameliorated, and 7.5g/day ofepigastric region indicated 7.5g/day of goreisan. Twogoreisan was prescribed, focusing on the symptoms

weeks later, her epigastric pain improved, but she

caused by “Water toxin”, characteristics of which

continued to take goreisan, as she claimed that she

includes loose stool and edema in the legs. As afelt better when she took goreisan.

in

the

epigastricregion.

Coldnessofand nausea were thought to be caused by consuming

result, the patient’s epigastric pain had improved by
the time she visited the hospital two weeks later. As

B) Study of effective and ineffective cases of goreisan

her symptoms resolved, the goreisan prescription

Goreisan was administered to 19 patients who

was terminated, but the epigastric pain relapsed thecomplainedofepigastricpain

triggeredbyfollowing day, and she was prescribed a continued

consuming cold foods and beverages, and thedose of 5 to 7.5g/day of goreisan, and her symptoms

effective cases (16 cases) and ineffective cases (3have been improving.

cases) were summarized in the Table. In all cases,
epigastric pain occurred after consuming cold foods[Case 2] 57-year-old housewife

and beverages when the weather became hot. The

Chief complaint: Epigastric pain, nausea

epigastric pain was mostly described as a “heavy

History of present illness: She had been taking

pain,” “piercing pain” or “tingling pain.” Among the

rikkunshito for upset stomach due to chronic

effective cases, the epigastric pain improved withgastritis, and her symptoms had been contained.
However, around July, when the summer heat begangoreisan, after switching from anchusan (cases 1, 7,
8, 10), rikkunshito (cases 2, 3, 5) and heiisan (caseto set in, she started to consume cold foods such as

13),

ice cream and watermelon, and came to experience

formulae. Among the ineffective cases, epigastricepigastric pain and nausea. Her symptoms would

pain and canker sores improved with orento andlighten somewhat after taking rikkunshito, but she

hangeshashinto.

sought medical attention, as the epigastric pain andnausea continued.

10

which

indicatedineffectiveness

of

these

No clear different characteristics were seen
between patients in the effective and ineffective

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

Volume 6, Number 4 | Winter 2011groups with regard to such symptoms as thirst, low

the summerheat-heat but also by the yin pathogen

urine output, diarrhea and edema; however, aor unhealthy qi. One gets chilled while asleep andsignificant difference was observed with respect toenjoying the cool of the evening, and one is affected

tongue fur. Among cases in which goreisan wasby the yin-qi of the night. In addition, one takes raw

effective against epigastric pain, the patients’foods and cold drinks because of hotness, andtongues had a white fur or a white and greasy fur.

exterior side receives a yin-cold qi and interior side

Among the ineffective cases, the patients’ tongues

is harmed by cold foods and drinks. This is seen in

had a yellow fur. Additionally, regarding abdominal

70% to 80% of cases of summerheat-strokes.” 3) It

findings, patients in the effective group had

explains that heat strokes are caused not only by

epigastric discomfort and resistance (15 out of 16

heat but also by humidity, and that seven to eightcases) more than they did a splashing sound in thetimes out of ten, it is caused by cooling the body, such

epigastric region (5 out of 15 cases). Furthermore,as by sleeping with chills, sitting out in the cool

theirbreeze, or consuming cold foods and beverages.

epigastricdiscomfort

andresistanceameliorated as their epigastric pain improved.

It also notes, “If the heat enters the exterior,behind which it includes dampness and yin-qi, and[Observations]water-dampness

accumulates

inside,itis

Two cases were presented in which goreisan wasrecommended to administrate medicine for theeffective against epigastric pain accompanying thesummer-heat stroke. For this reason, when treating

consumption of cold foods and beverages during thesummer-heat, formulae like byakkoto will be

hot summer, and 19 cases were examined toprescribed for internal and external heat; formulae

determine the types of epigastric pain goreisan islike goreisan for the exterior summerheat andeffective against. Among patients who complained ofinterior dampness; formulae like seishoekkito for the

epigastric pain that was triggered by cold foods andexhaustion of source qi and yang-qi. These three

beverages, goreisan tended to be effective in thosemethods should be differentiated and combined towho had a white coating on their tongue andtreat summerheat” 3) It explains that goreisan

displayed epigastric discomfort and resistance in anshould be used when there are signs of exterior

abdominal examination.

summerheat and interior dampness.

The “Byomeiikai” (Collected Explanations ofWith regard to summer health, “Shiki Choushin

Disease Names) by Keishu Ashikawa describes

Tairon” (Si Qi Tiao Shen Da Lun, On Presenting

damp stroke as a disease caused by summerheat.

Health in Accordance with the Four Seasons) ofDamp stroke is divided into “external damp” and“Huang-di Nei-jing, Su Wen” Chapter 2 contains the“internal damp”. The former occurs when the patientphrases“Don’t detest the sun” and “Let qi leak, likeis rained upon in a marshy place or goes into theloving place is outside.”4) Shibasaki5) explains themwater, while the latter occurs when the patient

as meaning that in the summer, one must bask inconsumes an excessive amount of foods that are cold

the sun without disliking the sun, and take care notraw foods, fruits or noodles, and drinks a large

to be preoccupied with seeking shades, pursuingamount of liquor or tea.” 2

coolness and avoiding the heat. Furthermore, one

The summer heat section of “Hoikuketsu” (Themust allow the qi inside the body to flow out of theClinical pearls of Prescription Collection) by Teian

body at all times, and prevent it from being pent up

Asai writes, “Summerheat stroke is a common

inside the body.

manifestation; however, it occurs often not only by

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

11

Volume 6, Number 4 | Winter 2011

Goreisan is composed of Alisma Tuber, Polyporus
Sclerotium, Poria Sclerotium, Atractylodis Rhizoma
and Cinnamomi Cortex. The early yang stage section

the way of the water. Thirst, oliguria, and stoolof “Shang-Han-Lun” contains the passages, “Whenis disturbed by dampness, and this is the target ofin greater yang disease, after sweating is promoted
stomach, vexation and agitation with insomnia, andgoreisan. Understanding its main indication, you
can apply goreisan to various situations.”3) Thismeans that goreisan may be widely used for heata desire to drink water, giving a small amount ofstrokes in general to remove fluids that accompany

water will harmonize the stomach qi so that recovery“dampness” when it is hot and hinders the[will ensue]. If the pulse is floating and [there is]circulation of qi inside the stomach.

and great sweat issues, [if there is] dryness in thedysregulation are signs of poor water circulation.
The circulation of yang-qi in the Spleen and Stomach

inhibited urination, slight heat and dispersion―

Additionally, since anchusan, rikkunshito andthirst, goreisan governs it.” And “When sweating has

heiisan were ineffective in half of all effective cases

already been promoted, the pulse is floating and(8/16 cases), it was thought that dissipating

rapid, and [there is] vexation and thirst, goreisan“dampness” with goreisan is also important togoverns it.” 6) (This translation is quoted from "Shang

alleviating epigastric pain occurring from consuming

Han Lun: On Cold Damage" written by Craig

cold foods and beverages.

Mitchell et.al, 1999). This means goreisan should be
used in the early yang stage when consuming fluids

In this study, no certain trend was seen with

mitigates the symptoms of irritability and dry mouth

regard to dry mouth, low urine output and edema,

following sweating, but the patient has a floating

which were considered signs for utilizing goreisan,pulse, abnormal urination, low-grade fever and dry

but in cases where goreisan was effective against

mouth. It also states that goreisan is the chief

epigastric pain, white tongue coating was observed

treatment for patients who have yet to sweat

and epigastric discomfort and resistance wassufficiently, whose exterior pattern remains, andobserved in an abdominal examination. In the 16

who have a sunken pulse and extreme thirst.

effective

cases

that

were

studied,epigastricdiscomfort and resistance was more predominant
Due to the spreading of air conditioners today, we

than a splashing sound in the epigastric region, as atend closely to “seek shades, pursue coolness andresult of abdominal examination. The passage, “Ifavoid the heat,” as mentioned above, and do notthere is the palpitations below the heart, give

sweat or give vent to our qi enough. At such times

shashinto. If it does not heal, goreisan governs it”7)when we do not sweat sufficiently when it is hot and(This translation is quoted from "Shang Han Lun:allow “dampness” to accumulate in our body,

On Cold Damage" written by Craig Mitchell et.al,

goreisan or other such medicine that dissipates1999) in the Greater yang disease stage section of

fluids becomes necessary.

“Shang-Han-Lun” states that goreisan should be
used for epigastric discomfort that cannot be

The summer heat section of “Hoikuketsu” bymitigated with shashinto preparations. This implies

Teian Asai contains the following passage aboutthat epigastric discomfort may occur due to fluid

goreisan,alldisturbance. As a case report on treating abdominal

summerheat stroke. …When it is hot, the closed

pain with goreisan, it is written in “Kohobinran”, “A

atmosphere contains dampness. It contains the qi ofpatient presented with thirst, epigastric palpitations

yin-dampness. Therefore, to eliminate summerheatand severe abdominal pain to the level that he could

evil to treat heat stroke, eliminate the heat utilizing

not sit down. Dr. Todo Yoshimasu examined this

12

“This

prescription

is

used

for

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

Volume 6, Number 4 | Winter 2011

patient and said ‘This is an indication of goreisan

References

pattern,’” referring to cases in which Todo Yoshimasu

1) Ishino, Shogo: Goreisan. Shinpan Kampo Igaku

successfully treated abdominal pain with goreisan8).

2nd Edition: 257-259, Institute of Kampo

Additionally, Furuya et al. reports on a case in which

Medicine, Tokyo, 1999.

epigastric pain of unknown cause was alleviated2) Ashikawa,

Keishu:Chushitsu.

Byomeiikaiwith goreisan9). In this case, the patient had a(Commentary of the Name of Diseases) vol. 2,

gripping pain in the epigastric region, and an

Kinsei Kampo Igakusho Shusei 64: 182, Meicho

abdominal examination found epigastric discomfort

Shuppan, Tokyo, 1982.

and resistance in the same way as other cases in thisstudy, in addition to bilateral rectus abdominis.
As discussed above, the comorbidity of epigastricpain due to consumption of cold foods and beverages,

3) Asai, Teian: Chushomon. Hoikuketsu (TheClinical pearl of Prescription Collection), vol. 3,
Kinsei Kampo Igaskuho Shusei 77: 283-311,
Meicho Shuppan, Tokyo, 1981.

white coating on tongue, and epigastric discomfort4) Koteidaikeisomon, Kojutoku-bon (Huang di Nei

and resistance may be signs for the administration

jing Su Wen, Gù Cóng-dé version)” Chapter 2of goreisan.

“Shiki Choushin Tairon, Si Qi Tiao Shen Da Lun,On Preserving Health in Accordance with theFour Seasons”. Jukohochu Koteidaikeisomon No.

[Conclusion]Heat strokes are caused not only by heat by also

1: 8-10 (1-11a – 1-14b), in the “Sì kù shànběn

by “dampness” that hinders the circulation of qi

cóngshū”, Nippon Keiraku Gakkai, Tokyo, 1992.

inside the Stomach and intestine. For this reason, it5) Shibasaki, Yasuzo: “Shiki Choushin Tairon

is important to eliminate the “dampness,” and

Hen“

Part

II.

Shinkyu

Igakutaikei

1goreisan, which is effective for heat strokes in

Koteidaikeisomon Josetsu – Main part No. 1 – 4:

general, was applied to cases in which epigastric259-270, Yukonsha, Kyoto City, 1979.

pain occurred on occasion of consuming cold foods

6) Cho, Chukei (Zhang Zhong-jing): Shokanron (Shang-and beverages in an air-conditioned environment. In

Han-Lun, Zhào kāiměi version) vol. 3: 134-135 (3-cases of epigastric pain for which goreisan was

17b–3-18a), Ryogen Shoten, Tokyo, 1988.

effective, white tongue coating and epigastric

7) Cho, Chukei (Zhang Zhong-jing): Shokanron

discomfort and resistance were observed. Since it is(Shang-Han-Lun, Zhào kāiměi version )necessary to eliminate the “dampness” to alleviate

166 (4-3b), Ryogen Shoten, Tokyo, 1988.

vol. 4:epigastric pain that is triggered by the consumption8) Rokkaku, Shigeto: Kohobinran, Nihon Kampo

of cold foods and beverages, goreisan is thought to be

Meii Shoho Kaisetsu vol.1 Kohokei1: 430-431,

an effective prescription.

Orient Shuppansha, Tokyo, 1989.
9) Furuya, Yoichi; Nogami, Tatsuya; Watanabe,

Supplementary note: Hachimigan from Uchida

Tetsuro; Shimada, Yutaka: A case in which

Wakanyaku Ltd. was used in case 18, but all othergoreisan was effective against epigastric pain of

medical Kampo extract preparations were fromunknown cause. Journal of Kampo Medicine

Tsumura & Co.

53(10), 2006.
(This report has been prepared by partiallyrevising “Kimura et al.: Kampo Medicine 61(5):722-726, 2020”.)(This report has been prepared by partially revising “Kimura et al.:Kampo Medicine 61(5): 722-726, 2020”.)The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

13

Volume 6, Number 4 | Winter 2011

Table：Breakdown of the 19 cases in which goreisan was used for epigastric pain
14

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

Volume 6, Number 4 | Winter 2011

Clinical Report 1 (Acupuncture)
The Cases of Acupuncture and Moxibustion Treatment for
Pollakisuria and Nocturia during Pregnancy Thought to be
Effective
Naoko

Maeda1),,

Shuichi

59 kg before pregnancy).
The present illness started in the 21st gestational
week, when she was diagnosed during a pregnancy

Katai2)checkup with gestational diabetes because of urinary

1) Ayumi Acupuncture and Moxibustion Clinic2) Department of Health Science,
Tsukuba University of Techonology

sugar (3+). The condition could later be controlled

Women undergo various physical and mental
associatedwithpregnancy. Indefinite

complaints classified as minor trouble are associatedwith suffering and pain that decrease the quality oflife of the women during pregnancy. Yet, many of theindefinite complaints improve after the pregnancy
and are mostly not actively treated with western
medicine based on

considerationsofpossible

influences on the fetus. For those reasons folk
medicines are adopted in the care for pregnant
women, but currently the expecting mothers often
endure these conditions until delivery. Here we
report two cases in which the acupuncture andmoxibustion

through diet and urinary sugar (+) was later foundonly once during a pregnancy checkup in the 39th
gestational[Introduction]changes

cm, weight 64 kg (weight increased by 5 kg from thetreatment

wasconsideredtobemarkedly effective in pregnant women visiting aclinic for acupuncture and moxibustion treatment,
who were particularly aware of pollakisuria andnocturia among indefinite complaints.
Further, in this manuscript we followed thetreatment guidelines1) for overactive bladder of the
Neurologic Bladder Society and classified thecomplaints of patients with a too high frequency of
micturitions during the daytime as pollakisuria, andcomplaints about getting up more than once during
the night to void as nocturia.
The patients consented to the publication of thiscase report after receiving oral explanations.

week.

Otherwise

thepregnancy

proceeded uneventful.
Complaints during the first visit were low backpain and shoulder stiffness. The fetus was incephalic presentation. There was no chilling, but
over a distance of about 8 cm above the ankles a ringlike edematous region was observed. Micturition
frequency was once every 30 minutes to 1 hour andabout 2-3 times per night. Both the pollakisuria andnocturia developed around the time morning
sickness resolved by the 14th gestational week.
Five acupuncture and moxibustion treatments
were administered in intervals of approximately 4
weeks. The basic treatment was bilateral moxaneedling of SP6 with 3 cones of moxa and a selectionof appropriate acupoints for the complaints made ateach visit (Table 1).
The pregnant woman assumed a semi-Fowler
position during the acupuncture and moxibustion
treatment to prevent the development of supine
hypotension syndrome and the moxa-needlingtreatment was performed in the flexed knees
position.
Moreover, we instructed the patient to treat
herself with moxibustion daily on the left and rightSP6 for 5 minutes each using stick moxa. The patientreported to have performed the self-moxibustion
daily.
At the fourth treatment the region around the left
and right SP9 was slightly depressed, representing[Patient No. 1]
A 36-year old woman, primapara, housewife.
She visited our clinic in order to prepare herself
physically for the delivery. During the first visit thea state of deficiency, so that daily self-moxibustion
treatment with stick moxa on the left and right SP9
for 5 minutes each was added.

gestational age was 22 weeks and 6 days, height 165
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

15

Volume 6, Number 4 | Winter 2011

For the moxa-needling we used 50 mm Seirin L-

correction of the breech presentation. Before thetype needles with a diameter of 0.20 mm and 0.769

second treatment abdominal palpation showed ag portions of Kamaya moxa for moxa-needling

cephalic presentation of the fetus, but because theformed into spheres with a diameter of 20 mm, thatpatient

were then attached to the needle heads and burned.

moxibustion treatment until delivery for the sake of

For retaining needles we used J-type Seirin needles

physical conditioning, a basic treatment of bilateralwith a length of 40 mm and a diameter of 0.16 mm.

moxa-needling at SP6 with 3 cones of moxa and

The indefinite complaints were evaluated using
the entries in a 5-stage, 40-item (Table 2) evaluationindefinite complaints questionnaire with numbers
from 0 to 4 made by the patient herself before eachacupuncture and moxibustion treatment.
The course showed that following the first visit
the nocturia improved and the pollakisuria improvedto achieve micturition intervals of 2 hours. After thatthe pollakisuria and nocturia did not recur during
the pregnancy until delivery (see Figures 1-3).
Delivery was a natural childbirth and although
there was copious bleeding during delivery, no iron
medication was used and the patient was not unwell.

continued

acupunctureandneedles retained in a selection of appropriate
acupoints for the complaints at that particular visit(see Table 3) was administered.
The same types of needles and moxa as used forpatient No. 1 were employed and for the directmoxibustion the Yamasho moxa "Nippon Ichi
Ogonzan" was used.
The indefinite complaints were evaluated like forpatient No.1 during each treatment.
The course showed that micturition intervals had
lengthened to 2-3 hours and rising during the nightfor micturition occurred only once during the 3-day
period from the first to the second treatment. Fromthe second treatment the course preceded without[Patient No. 2]
16-year old woman, primapara, senior high school
student.
Chiefrequested

complaintwascorrectionofbreechpollakisuria and nocturia (see Figures 1-3).
Delivery was a natural childbirth and the
postpartum course was uneventful.

presentation. The gestational age at the first visit
was 29 weeks and 3 days. Height was 153 cm, weight[Discussion]

was 59 kg (weight increased by 7 kg from the 52 kg

During the individual stages of pregnancy various

before pregnancy). The pregnancy had proceeded inindefinite complaints may develop in pregnant

breech presentation since the 25th gestational week.

women and tend to change in conjunction with

The pregnancy was otherwise uneventful.

alterations in physical condition. Common self-careDuring the first visit, chilling of the feet andof indefinite complaints include aerobics, swimming,edematous over a distance of about 7-8 cm above theyoga and similar exercises, while belts are used foranklessplinting the pelvis in case of low back pain1).

inaring-likeregionwere

observed.

Micturition frequency was once every hour and on 3-

Both pollakisuria and nocturia are classified as

4 nights per week about 1-2 times per night.

indefinite complaints and according to Shimada etTreatment frequency until correction of the breechal.3) report, pollakisuria and nocturia are ranked top

presentation was twice a week and after that once aamong indefinite complaints developing during theweek.

first and second trimester, while ranking top during

During the first visit, left and right SP6 werelate gestation with an incidence of 95.4%. Thus,

treated with moxa-needling and direct moxibustion

almost all pregnant women experience pollakisuria

with half-rice grain sized cones on BL67 for the16

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

Volume 6, Number 4 | Winter 2011

and nocturia (see Table 4). That report, however,moxibustion treatment for pollakisuria and nocturia

does not mention nocturia.

in pregnant women, but among the reports about

Regarding the reason for the easy development oflower urinary tract disorders, Tomita et al.7) noted

pollakisuria is considered to be that the "enlarging

that "according to RTCs warming moxibustion

uterusduringtreatment for nocturia led to a significantly

pregnancy presses on the bladder and flattens it indecreased number of nocturnal micturitions." Again,

anteroposterior direction. That is why a micturition

the mechanisms behind the marked effectiveness ofdesire occurs so easily." 4) Also, regarding kidney

the acupuncture and moxibustion treatment are notfunction4) "the glomerular filtration and blood

clear, but careful inspection of the abdomen of theplasma flow increase during pregnancy, so that the

pregnant

glomerular filtration reaches by the 16th gestational

moxibustion treatment shows marked changes

week a peak that is about 1.5 times higher than in(Figure 4-1, Figure 4-2). The entire abdomen seems

the non-pregnant state, subsequently maintaining

to be becoming firmer, the position of the protruding

this high value until late gestation. The kidney blood

uterus comes to lie higher and the bulge above theplasma flow reaches a peak by the 15-16th week too,inguinal and suprapubic regions decreases. Thesebut there is no agreement among reporters, sincefindings suggest that acupuncture and moxibustionsome reports describe a decrease towards latetreatment exerts some influence that is mediated via

gestation, while other reports state the level isthe autonomous nervous system, causing changes inmaintained."

the position of the uterus and bladder, leading toamong

Incidentally,thephysicalHirose5)changesnotedregardingthecorrelation between pollakisuria and sleep disorders

woman

after

an

acupuncture

andvariations in the bladder capacity, surmised to cause
the alleviation of the pollakisuria.

in the various pregnancy periods that "the frequency

Collecting data pertaining to improvements ofof nocturnal urination had markedly increased inpollakisuria and nocturia in pregnant womenpatients with sleep disorders during the first, second

through acupuncture and moxibustion treatment

and third trimester of the pregnancy. (omission)

represents a task for the future. The clarification of

Nocturia

sleepchanges in uterine position and size as well as

maintenance disorders." Sleep disorders during late

bladder capacity before and after acupuncture andgestation may cause accumulation of fatigue andmoxibustion treatment represents yet another task.

isaconceivable

cause

for

could thereby possibly influence delivery. Regarding
fatigue during gestational periods Yano6) pointed out,

[Conclusions]that this fatigue might be a non-obstetrical etiologic

Thefactor for uterine inertia. Moreover, uterine inertia

moxibustion treatment is effective for pollakisuria

may easily develop into protracted labor andand nocturia in pregnant women.

results

indicatedthat

acupunctureandinvasive measures at the time of delivery could affectthe pueperal period. Thus, pollakisuria and nocturia
during pregnancy may affect the QOL during
pregnancy and the delivery, therefore representing
important symptoms for the expecting mothers thatshould be alleviated.
On the other hand, there seem to be no reports
about

the

effectivenessof

acupuncture

and

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

17

Volume 6, Number 4 | Winter 2011

≪References≫
1.

Treatment Guidelines for Overactive Bladder,
Neurologic Bladder Society: 20092.

Midwife skills for gestation periods, support ofminor troubles, Perinatal Care, Summer Special
Edition 2010: 54-58

3.

Mieko Shimada, Haruko Niikawa: Current
situation about minor troubles in pregnant
women; Midwife 2011; 65 (3): 42-45

4.

TakeshiMaruo,

Takashi

Okai:

Standard

Obstetrics and Gynecology; Tokyo, Igaku Shoin,
2008: 312-313
5.

Kazuhiro Hirose, Shinichi Hoshi, Shuichiro
Shirakawa: Longitudinal study about sleep
disorders in pregnant and parturient women;
Acta Obstetrica et Gynaecologica Japonica,
2002; 53 (2): 527

6.

Tadashi Yano: Inertia Uteri; Tadashi Yano
Edition of the Illustrated Guide to Acupuncture
andMoxibustion

Techniques;Tokyo;KOBUNDO Co.,Ltd.; 2012:344-350
7.

Kenichi Tomita, Hiroshi Kitakouji, Hisashi
Honjou,Masahiro

Nakao:

The

effectsofwarming moxa on nocturia - investigation of arandomized controlled study; Journal of theJapan Society of Acupuncture and Moxibustion,
2009, 59 (2): 116-124

18

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

Volume 6, Number 4 | Winter 2011

Clinical Report 2 (Kampo Medicine)
Headache 3

Mihoh Koga, M.D., Kampo Specialist

Research Assistant of Division of Clinical Pharmacology
and Therapeutics and Division of General Medicine
Jikei University School of Medicine< Migraine, chronic continuous dysentery, yangdeficiency, blood deficiency, blood stasis, liver qi
stagnation >Case (8): age 35 years, female, pharmacist, visited in
March XY
Chief complaint: headache, sense of coldness of thelower half of the body, constipation, insomnia, easy
susceptibility common cold, menorrhalgia
Present illness:
Since her high-school days she developed every
afternoon a headache that radiated to the left
temporal region and required in severe cases the useof commercial analgesics. Recently she has been
under the impression that the effectiveness of theanalgesics

hasdecreased.

Severeheadaches

occurring once or twice a month require that she
takes to bed, but they seem not to be related to her
menstrual cycle. Although she has sufficient energy,
she lacks physical strength. When tired, the musclesof the right upper arm produce a dragging pain, after
which she reports the development of pharyngeal
pain and fever. She has been constipated since her
youth with one bowl movement every 10 days, or 1-2
bowl movements per week, if she took 1.5 times thenormal amount of senna. Serious of character.
Previously the use of tokakujokito for constipation
caused the onset of severe dizziness and headaches.
Findings upon first visit:
Average height and weight with a normal bodytemperature of 36.3℃, little facial expression andspeech as if suppressing her voice. Menstrual cycleof approximately 30 days, containing blood clots,
menorrhalgia. The pulse was thin and wiry, thetongue dark red and moist with a white fur, engorgedsublingual veins, presence of fullness, tenderness or
discomfort of the hypochondrium, chilling of theepigastric region and tenderness on the left side of
the naval.
Pattern: yang deficiency, blood deficiency, bloodstasis, liver qi stagnation
First prescription: tokishigyakukagoshuyushokyoto
Course:The prolonged use of senna had led to chronic
continuous dysentery and thereby induced bloodstasis, while the liver qi stagnation was considered toprevent recovery. First, in order to relief the chronic
continuous dysentery tokishigyakukagoshuyushokyoto
was chosen, the use of senna for the constipation
discontinued and instead Mashiningan once dailyprescribed. This also improved the effects ofanalgesics used for the treatment of the headache, theseverity of which gradually decreased, but since theirfrequency did not change, they still caused anxiety.
Bowl movements improved to once every three days.
Taking the formula prescription over a period ofhalf a year improved the sense of coldness of hands
and feet, but the sense of exhaustion did not even
improve with sleep and increasingly strong stress atwork influenced also the pulse and abdominal
findings, so that the prescription was switched to
yokukansankachinpihange. Although the coagula in
the menstrual blood disappeared and themenorrhalgia improved, the patient suffered fromsevere headaches during the latter half of themenstrual cycle. Prescription after half a year:
shakuyakukanzoto (each 2/3 of the dose).
After one month of treatment improvements ofboth the frequency and severity of the headaches
were observed and after half a year the use ofanalgesics had become unnecessary and headaches
were
alleviatedwithsingledoses
oftokishakuyakusan. By then the patient had
comfortable bowl movements even without the use of
Mashiningan once every 1-2 days.
■ Discussion
1.

"Pain"In Kampo medicine pain is considered to have thefollowing causes. "For the activities of mind and bodyqi, blood, and body fluids must circulate without

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

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Volume 6, Number 4 | Winter 2011

excess or deficiency. However, when there are

2. Types of headache and pathologic condition

deficiencies in the functions of qi, blood, and body

Here I would like to discuss, adding a few

fluid or a stagnation of their flow preventing theircomments about the individual cases, the types ofeven distribution pain will result." This may beheadache and their correlation to the patterns.

caused by influence of the six excesses or seven

1) Tension headacheemotions, exhaustion, unwholesome dietary habits

Tension headache is characterized by a sense ofand similar factors, variations in the body's internaltightening of the head with a heavy, dull kind of pain

environment or disorders causes by exogenousthat continues typically on a daily basis and which ispathogenic factors.

usually triggered by increased muscle tension or stress.

The clinical aspects of headache too have to be

The heavy, dull pain is characteristic for aconsidered depending on the pathologic condition. In

stagnation of dampness. It also resembles thisother words, there are three different views of thecondition in that it is alleviated by massage etc. The

condition, including the questions A) Is there ageneration of dampness due to spleen deficiency isstagnation of qi, blood or body fluids?; B) Is there

considered to be one of the distal factors andmaybe a deficiency of qi and blood or yin essence orillustrated in the cases (1), (2) and (3). Improvement

else nutrients (nourishment)?; and C) Are there anyof all symptoms after administering bukuryoin tomental factors leading to aggravation of the pain?

patients visiting our clinic with headache andThese different aspects A, B and C do influence eachchronic gastritis is something we experience on aotherobserved

rather regular basis in our outpatient department.

simultaneously. It is important to ascertain the real

Again, a state of muscle tension can be considered tonature of the pathologic condition, but depending on

represent a state of malnutrition for the muscles

the symptoms this may often prove to be difficult.

themselves and considering that the spleen ismutually

and

are

often

Yet, among these aspects the one mentioned andsupposed to nourish the skin and underlying flesh,b) "presence of deficiency" causes pain and isrelaxation of the muscles is an essential aspect of thetherefore called "deficiency pain". Qi and blood

treatment

mutually generate each other and supplement

correlation between the state of the health of spleen

shortages, so that states of deficiency continuing

and stomach on the one hand and tension headacheover extended periods of time will eventually resulton the other hand. Among these patients inin deficiencies of both qi and blood. For this reasonsparticular case (2) was interesting, considering thepain that has become chronic, will also become

fact, that the effective prescription for single use

refractory to treatment and the deterioration of thevariedbodily environment and the ensuing insufficiency ingastrointestinal symptoms.

pharmacokinetics may then possibly result in adecrease of the efficacy of analgesics.
Also,"chronic

diseasesinevitably

andsuggests

depending

on

that

with

there

the

is

some

presenceofMoreover, in cases of blood deficiency thereactivity towards the pain decreased and theseareaccompanied by blood stasis" and it is said, that "inpatients characteristically presented often with amild, but nagging and continuous pain.

the presence of blood stasis, treat this first".

This resembles the pain of tension headache.

Therefore, in cases of chronic headache it isWhen like in case No. 3 the condition was based on

important to take blood stagnation = blood stasis

anemia, or in case No. 4 where the condition was

also into consideration.

triggered by a pregnancy, a post partum or postmenstrual headache should be considered.

20

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

Volume 6, Number 4 | Winter 2011

Case No. 5 is an example of qi stagnation causedby the stress after employment.

daiobotanpito, indicating that the nature of theheadaches and constipation as well as the mental
condition are important criteria for the treatment.

2)

Migraine

Otherwise, I often experienced that during the

Migraine is characterized by a throbbing pain

therapeutic course following treatment of malignant

occurring several times a months in form of attacks,

tumors or treatment of a collagen diseases and theassociated with nausea, hypersensitivity towards

like conditions migraine may develop and treatment

light and sound and similar symptoms. Generally,

were found to be markedly effective in cases

compared to tension headache, the pain is severe.

complicated by agitation and constipation.

Regarding severe pain there is a marked

The cold deficiency of spleen and stomach induced

correlation with excess patterns. In cases of excess ofby prolonged use of senna in case No. 8 led to thethe blood this manifests as blood stasis, while qi

development of a yang deficiency. Since "Bloodexcess gives rise to qi stagnation or rebellious qi. On

circulates by being warmed" coldness obstructs thethe other hand, fluid in these cases often occupies thecirculation of blood. For chilling of the hands and feetthird space and causes quietly concealed infiltration.

in the presence of chronic continuous dysentery and blood

Therefore, it is considered that even in cases ofstasis in the pelvis tokishigyakukagoshuyushokyoto isexcess there is no sudden rise in local internalvery effective. Moreover, circulation of the blood alsopressure and thus severe pain. Naturally, if fluid

requires the flow of qi. The stress at work impeded

were to be enclosed within cerebral ventricles or therecovery from the blood stasis further and thus I

capsule of surrounding tumors, it may come to excess

focused on regulating qi once the coldness had been

condition in these restricted spaces producing severe

alleviated, but the treatment still required the use of

pain. Also, the hyperesthesia's that often occur intokishakuyakusan with its blood stasis expelling

conjunction with the migraine are a pathologicalaction to supplement the blood.

condition in which the evil of an excess pattern ispresent and may easily imaginable trigger either
locally or systemically an state of high tension,suggesting a correlation with the excess pattern.

■ Conclusion
Among the forms of chronic headache tension
headache and migraine are frequently observed inBlood stasis is often responsible for locally fixed,

the Kampo outpatient practice. I presented a few

stabbing or else lancinating pain, while qi stagnation

cases and discussed them briefly. I also offered one

often produces wandering pain that feels like

opinion pertaining to the characteristics of bothstretching or swelling. In case No. 6 the "pain likeconditions and their pathological conditions in the

being hit" is a form of lancinating pain often

Kampo medical sense.

observed with blood stasis. The "pain as if a heavystone lies inside" improved with treatment toregulate qi and thus is possibly related to qi
stagnation. In this patient the treatment should
probably have aimed from the beginning at expellingstasis and regulating qi.
In case No. 7 too blood stasis and qi stagnation

Combination of western medical diagnosis with
TCM theory appears to be useful for providing the"individualized therapy" mentioned at the beginningrecommended by the AHA. Integration of TCM
theory into the therapy is considered to contributealso to the development of western medical care.

induced symptoms were prominent and tsudosan
proved to be markedly effective. The persistentconstipation required combination therapy withThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

21

Volume 6, Number 4 | Winter 2011

Front Line of Kampo Pharmacology
Review of Research Presentations on Kampo Medicines 5

Toshiaki Makino, Ph.D.

Associate Professor, Dept. of Pharmacognosy
Graduate School of Pharmaceutical Sciences
Nagoya City University

This series will introduce the recent research andstudies relating to Kampo medicines presented atacademic conferences. This installment of the series
provides presentations made at The 28th Annual
Meeting of Medical and Pharmaceutical Society for
WAKAN-YAKU held in Toyama on August 27-28,
2011.
Quality

Horii, et al. of Kracie Pharmaceutical, Ltd. reported
that they have investigated differences between theextract form and the liquid form of kakkonto(Pueraria

Decoction)

in

the

digestive

absorption

of

tract

ephedrineandpseudoephedrine

contained in kakkonto with the findings that there
were no differences in the absorption but plasma
concentration-time curves were equivalent.
Basic pharmacological study on crude drugs andKampo formulas
Fujikawa, et al. of Fukuoka University reported thatthey have observed that in a cerebral ischemia-

control

of

crude

drugs

and

their

reperfusion-induced rat model, spatial memory

discrimination

disturbance

improvedbycontinuous

oral

Doui, et al. of Kanazawa University have clarified

Powder), which further enhanced the releasing

administration of yokukansan (Liver-Inhibitingthat when Ginger is heat-processed, the content
amounts of shogaol and gingerol, which are theingredients that change by processing, correlatewith the values measured by a colorimeter based on
the property that the color of heat-processed gingerchanges depending on the heating method used
and/or the heating time applied. They reported thatamounts of acetylcholine from the hippocampus,
inhibiting neural cell death.
Nakada et al. of University of Toyama reported thatthey have used kamikihito (Modified Back to theSpleen Decoction) in a Alzheimer’s disease model intransgenic mice that had excessive expression ofcolors can be used for quality evaluation.

mutantPharmacokinetics of crude drug components

recognition memory significantly improved with a

Ochiai, et al. of Hoshi University reported that they

hippocampus.

significant decrease insanshool ( -HS) and hydroxy- -sanshool ( -HS)
contained in Zanthoxylum fruit (Japanese pepper) in-HSbecomes the ground substance or matrix of theexcrete type transporter and the digestive tract
absorption is in the state of being controlled, andwhen daikenchuto (Major Middle-Strengthening
Decoction) which includes Zanthoxylum fruit is used,
the transporter becomes inhibited and the digestive
tract absorption is promoted.

22

human

genes

neuron-specificallyinduced, with the results that the ability of object-

have investigated the absorption of hydroxy- -the digestive tract with the finding thattype

-amyloid deposition in the

Ouchi, et al. of University of Toyama reported
improvements in carelessness-like behaviors in mice
exposed to isolation-rearing stress by the continuous
administration of sansoninto (Wild Jujube seed
Decoction). And they suggest that sansoninto
possibly has effects on attention deficit hyperactivity
disorder (ADHD).
Kitamura, et al. of University of Toyama reported
that they have evaluated the actions of Kampo
medicines for neuropathic pain, a side-effect of the

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

Volume 6, Number 4 | Winter 2011

anticancer drug paclitaxel or vincristine, with the

They found the crude drugs of Ginger and Platycodi

findings that shakuyakukanzoto (Peony and Licorice

Radix

Decoction)

bofutsushosan inhibits the absorption of cholesterol

andgoshajinkigan(Life-Preserving

have

the

activity,suggestingthat

Kidney-Qi Pill) are very useful.

while eating

Yoshihisa, et al. of University of Toyama observed

Bai, et al. of Nagoya City University administeredthat keishibukuryogan (Cassia Twig and Tuckahoe

shichimotsukokato (Seven Herbs Decoction For

Pill) inhibited the production of inflammatory

Hypertension) to 5/6 nephrectomized rats andcytokines

wasobserved it had no effects on renal functions but

induced to activate in human dermal endothelial

produced a significant improvement in renal

cells, suggesting that this formula is effective for

hypertension,

explaining

microvascular inflammation in patients with dermal

mechanism

where

inflammatory diseases.

dimethylaminohydrolase

whenlipopolysaccharide(LPS)

lowering
Tamiya, et al. of Osaka City University observed

the

this

improvement

dimethylarginine(DDAH)

concentrationofisinduced,asymmetric

dimethylarginine in blood.

that the administration of tokiinshi (Angerica
Decoction, Antipruritus) yielded an increase in the

Chiba, et al. of Meijyo University administeredwater containing of the stratum corneum and a

juzentaihoto (Ten Strong Tonic Herbs Decoction) tosignificant decrease in trans epidermal water loss,

hapten applied mice and then removed andsuggesting the possibility of this formula totransferred their lymphnodes into naïve mice, which

revitalize the turnover time of the stratum corneum

causedslowed down with age and to improve the moist-

reporting that juzentaihoto has the action ofretention ability and the skin barrier function.

inducing regulatory T cells.

Aburada, et al. of Hoshi Pharmaceutical University

Hoshina, et al. of University of Toyama reported thatobserved that in the mice fed the diet containing theinextracted matters from gypsum, the expression ofStrengthening Decoctoin) has the ability to enhanceaquaporin 3 mRNA in the skin increased. They alsopresentation of antigen when dendritic cells areobserved similar effects in the mice fed CaSO4, asensitized by ovalbumin, suggesting that themain ingredient of gypsum.

formula may be useful as an adjuvant for oral

thevitro,

inflammatory

ogikenchuto

activityto(Astragalus

appear,Middle-vaccines. Likewise, Yamada, et al. of University ofNamaki, et al. of Gifu Pharmaceutical University

Toyama reported on the same activity of juzentaihoto

reported that maoto (Ephedra Decoction) inhibits(Ten Strong Tonic Herbs Decoction) and theirairway inflammation provoked by the activation of

successful isolation of its effective ingredient of

toll-like receptor ligands in the mouse trachea.

1,2,3,4,6-penta-O-galloyl- -D-glucose contained inPaeoniae Radix.

Tachi, et al. of Nagoya City University observed that

Fukui, et al. of University of Tokushima reported

bofutsushosan

Saposhnikovia

that the extracted matter from Sophorae Radix

Miraculous Powder) controlled Niemann-Pick C1-

inhibits the production of interleukin-4 released

like protein responsible for the absorption of

from rat basophilic leukocytes and they havecholesterol in the small-intestinal epithelial cells.

isolated the effective ingredient of trifolirhizin.

(Divaricate

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

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Volume 6, Number 4 | Winter 2011

Hyuga, et al of Kitasato University reported that

Licorice promotes the action of sennoside A andmaoto (Ephedra Decoction) inhibits the ability-to-

individual types of antibiotics significantly inhibit

move of human breast cancer cells stimulated by thethe purging action of sennoside A.

hepatic growth factor and Ephedra Herba containedin the formula causes the inhibition of tyrosine

Endo, et al. of Kitasato University administeredkinase.

rikkunshito (Six Gentlemen Decoction) to mice andobserved an increased activity of gastric motility and

Yamada, et al. of Yokohama City University observed

emptying in healthy mice and, on the contrary, an

increased flows of the intraorbital posterior ciliary

inhibiting effect in food-deprived mice, reportingarteries and extraocular arteries in rabbits after thethat rikkunshito has complex mechanisms withadministration of shosaikoto (Minor Bupleurum

multiple points of action.

Decoction), suggesting that this formula is useful for
obstructive angitis in patients with various types ofJo, et al. of University of Toyama reported thatcancer.

peripheral edema in rats induced when pioglitazone
is administered can be improved by the use of

Yamaguchi, et al. of Fukuoka University reportedthatyokukansan(Liver-Inhibiting

goreisan (Poria Powder with Five Herbs).

Powder)improves anxiety-like behaviors in rat cerebral

Ito, et al. of Kitasato University have clarified theischemia-reperfusion injury models, explaining that

antidepressant action of kososan (Cyperus andthe improvement is caused by the 5-HT2A receptor

Perillamediated mechanism.

depression-like mouse model, reporting that the

Leaf

Powder)usingastress-induced

regulation of orexin and neuropeptide Y nervous
Iwaoka, et al. of Hyogo University of Health Sciences

system network in the brain is involved in theremoved and cultured rat dorsal root ganglia with anmechanism. Nagai, et al. further made proteome

addition of Euodiae Fructus thereon and observed

analysis of mouse serum and observed a decreased

the increasing of Ca2+ concentration in neurons,

level of complement C3 due to kososan. Okuda, et al.

suggesting that the analgesic effect is permitted byconducted proteome analysis of hipocampi of thethe mechanism of mediating TRPV1 activation

mice and reported that tropomyosin -1 chain can beaction. They also reported they have isolated therecovered.

effective ingredient of evodiamine.
Yamamoto, et al. of University of Toyama isolated
Oda, et al. of University of Toyama liberated various

CD4+ Tcells, which recognize OVA, from mouse

crude drugs for the cells having TRP channels

lymphatic tissues and showed that kakkonto

expressed forcibly and observed the action of(Pueraria Decoction) inhibits the proliferation ofactivating TRPV1 in Rhubarb and isolated thecells when stimulated with OVA. They reported that

effective ingredient of senidine, which, they found,the action of improving food allergies can be expected

was unrelated to the purging effect of Rhubarb.

in kakkonto.

Takayama,

University

Kigasawa, et al. of University of Toyama clarified

investigated mechanisms of the purging action ofthat in mice, byakkokaninjinto (White Tiger plus

daiokanzoto (Rhubarb and Licorice Decoction) in

Ginseng Decoction) inhibits the differentiation ofmice with the findings that liquiritin contained infemoral bone marrow cells into mature dendritic

24

et

al.

of

Fukuyama

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

Volume 6, Number 4 | Winter 2011

cells and reported that this formula has the action of
immune regulation.
Nishimoto, et al. of Kitasato University analyzed
active ingredients of immunoregulatory factors
induced by having hochuekkito (Middle-Reinforcing
and Qi-Benefiting Decoction) act on rat duodenumderived epithelial cell lines and then isolated fourtypes of sugar chains with a molecular weight of
37,000-40,000/each.
Kimura, et al. of University of Toyama evaluatedcurative effects of kigikenchuto (Angelica Root
Middle-Strengthening Decoctoin) in a rat model withpressure ulcers induced by applying repetitive
pressure, observing the enhanced growth of new
blood

vesselsandincreasedactin-positive

myofibroblastic cells. They suggest that the formula
is potentially useful for pressure ulcer treatment.
Yanagihara, et al. of Osaka City University reportedthathochuekkito(Middle-Reinforcing

and

Qi-

Benefiting Decoction) improves skin hazards inhairless mice caused by ultraviolet radiation
through the antioxidant action of the formula.

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

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Volume 6, Number 4 | Winter 2011

Medical History in Japan
Historical Significance of the Standardization of Acupoint
Locations”, the Second Japanese Acupoint Committee (4)“Detailed Guide to the Location of Acupoints” from thecalssics to the WHO standardization”, pp411-422, Tokyo,
Ishiyaku Publishing, June 2009 (partially revised)
Makoto Mayanagi
Graduate School of Humanities
Ibaraki University

a family from the early Han dynasty along withvessels for making decoctions that had thecharacters "medical craft" engraved on them [6].
Judging from both material and form of these goldand silver needles allows to rule out that they were
sewing needles and they are currently the oldest
metallic needles for use on the human body inexistence. However, they are not as thin as thefiliform needles and could probably only be inserted
to a depth of about 5 mm below the skin.

(continued from KAIM Joural vol.6 no.1, no.2 andno.3)

3. Spread of metal needles and increase in thenumber of acupoints

Figure 3 Silver needle (the two on the left) and gold
needles (the four on the right)

The excavation of the Mawangdui medical texts
revealed, that the meridian concept had been used
for therapeutic purposes prior to the second century
BC, using mainly moxibustion. However, as thecenturies passed by, this too changed. From the early
Han period in the second century BC the regular useof iron vessels in China began to replace the former
use of bronze vessels. In the late Han period of thefirst century filiform iron needles also seemed tohave spread. Also, for the royalty and aristocracy
gold and silver needles were used.
Figure 3 shows replicas of gold needles (the four on
the right) and silver needles (the two on the left) that
had been buried in 112 BC in the Han dynasty tombof Mancheng 満 城 漢 墓 , along which a modern
Chinese long needle (12 cm) is placed for comparison.
These artifacts have been excavated form the tombof Liu Sheng, Prince Jing of Zhongshan, member of26

Figure 4 Stone relief (second century BC)

On the one hand, materials allowing to speculate
about the acupuncture treatment include about 8
stone reliefs unearthed in Shandong province that
had been decorating the tomb walls [7]. All of whichdate back to the first half of the second century BC,
where a creature with a human face and a bird's
body takes a hand of a person facing it, while it holds
something up towards the person with the other
hand (Figure 4, 5). On these stone reliefs thecreature with a human face and a bird's body does
something to the persons, all of whom have longflowing head hair. Appearing with not formally tiedhair is considered to be a characteristic of sick people.
In Figure 4 a crow like bird is sitting on the wings ofthe creature with a human face and a bird's body.
This bird is said to be a magpie and the Chinesename for magpie is "鵲" = Que. Moreover, what thecreature with a human face and a bird's body isholding over the sick person is big and thick and

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

Volume 6, Number 4 | Winter 2011

therefore considered to be a stone needle that wereused to drain pus etc.
By the way, in the "Historical Records" (Shiji) there is
description of the legendary famous doctor "扁鵲" =Bian Que. The first character of the name "扁" and thefirst character in the term for stone needle = " 砭" =bian had in the past and today still have the samepronunciation. It may thus be surmised, that stones(bian) were used und the magpie (que= 鵲) was a
symbol for a bian que called group of physicians. The
motif depicted on these stone reliefs, where Bian Que
takes the hands of the sick people is conceivably asymbolic representation of the pulse diagnosis. Pulse
diagnosis is a major characteristic of the Bian Que
school and it has presumably been recognized at thattime. Further, as a reproduction of the rubbed copy
shown in Figure 5 unearthed in the same Shandong
province shows, there are also stone reliefs depicting
the retaining of thin metallic needles. It can be
deducted from these materials that metal needles had
spread throughout the entire region of the Shandong
province by the first half of the second century BC.
Considering the migration of people at the time andthe transmission of knowledge, it can be inferred, thatthese had been transmitted to a considerably large
area throughout China.

In the original form of the "Sun Wen" and "Ling Shu"of the first century a unification of the 12 regularmeridians, the conception and governor vessels aswell as the 365 acupoints was attempted, but inpractice the number of acupoints was only about 130
points. Yet, by setting the ideal number to 365 points
and the spread of metal needles the number ofacupoints doubtlessly increased rapidly thereafter.
However, because determination of individual point
locations varied with period, school and region, theoccurrence of differences was inevitable. The
recognition that the meridians have a certain course
and

that

there

new

extraordinary

meridians

probably led to confusion on a theoretical level.

Figure 5 Stone relief (first half of the second centuryBC) rubbed copy, reproduction

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

27

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Make the most of Kampo in modern medicine

Foundation: 1905
A century of tradition ――――We are a manufacturer consistently controlling the entire process fromthe import of crude herbs to the manufacture of Kampo extracts and assuch have contributed to the development of Japanese Kampo.
We sincerely hope to continue in the future with our contribution tomodern medicine through "Kampo".

OHSUGI Pharmaceutical Co., Ltd.

1-1-2 Tennojicho, Minami, Abeno-Ku, Osaka, Japan
Phone: +81-6-6693-3301

The crude drugs like many other creatures on earth areraised by bountiful NATURE.
Humankind earns as well grace from Mother Natureand is blessed as a member of natural world.
PROFILE of

TOCHIMOTO

Since Tochimoto was appointed as aJapan-China friendship trading firm in
1963, we have expanded our businessoverseas, mainly with China.
We import a variety of quality-controlled
natural resources from all over the world
for maintaining wellness.

TOCHIMOTO TENKAIDO CO., LTD.
3-21 Suehiro-cho, Kita-ku, Osaka 530-0053, JAPANwww.tochimoto.co.jp