Volume 8, Number 4 | Winter 2013

Report from Association
A cynical hermit’s record of “The Six Prefectural Joint
Congress (Rokken-goudou-kyouiku-kouenkai) of the Japan
Society for Oriental Medicine (On February 24, 2013),
Kansai branch, in Japan”
Kazunari Ozaki*1)2)3)4)5)
1)
2)
3)
4)
5)

Department of Geriatric Medicine, Itami City Hospital,
Itami, Hyogo, Japan
Department of Clinical Gene Therapy, Osaka University
Graduate School of Medicine, Suita, Osaka, Japan
Division of General Medicine and Hypertension, Osaka
University Hospital, Suita, Osaka, Japan
Department of Japanese-Oriental (Kampo) Medicine,
Kobe Century Memorial Hospital, Kobe, Japan
Nishimoto Clinic, Nishinomiya, Hyogo, Japan

Kanto Ko-Shin-Etsu, Tokai, Hokuriku, Kansai,
Chugoku-Shikoku, and Kyushu offices.
The Congress this time started by the opening
remarks of Dr. Shogo Yamamoto, “Chairperson of

Wakayama sectional meeting, Kansai branch office,Japan Society for Oriental Medicine" and then thefollowing presentations had been given according to"Formula comments and differentiation of formula My administration classification with introductionsof a rare case, a complete response case, and so on".
As the themes: Presentation of "On kuoketsuzai
medicine ( 駆 瘀 血 剤 , combinations of agents fordispellingbloodstasis),especiallyon

The Six Prefectural Joint Congress (Rokken-

keishibukuryogan ( 桂 枝 茯 苓 丸 , Cassia Twig andgoudou-kyouiku-kouenkai) of the Japan Society for

Tuckahoe Pill) " by Prof. Takahisa Ushiroyama,

Oriental Medicine, Kansai branch was held in Osaka

Health Science Clinic, Osaka Medical Collage;

University Nakanoshima Center on February 24,

presentation of "On goreisan (五苓散, Poria Powder

2013. In the following, I will make the summary ofwith Five Herbs) as agents for removing dampness"this congress in public.

by Dr. Takashi Mine, Mine clinic; "On saikozai

First, I will show the summary of the Six

medicine ( 柴 胡 剤 , combinations of the agents

Prefectural Joint Congress. The Six Prefecturalcontaining mainly saiko (柴胡, Bupleurum root, orJoint Congress is one of the Science Council of the

Bupleuri, Radix (1)) and ogon (黄芩, Scutellaria root,

Kampo

traditionallyor Scutellariae Baicalensis Radix ( 2 )), which werepracticed in Japan, based on ancient Chinese

used in interior-fever conformations (such as half-

medicine) and is hosted by each prefectural sectionalsurface/half-interior conformations)), especially on

meeting of six prefectures, namely, Osaka, Kyoto,saikokeishito (柴胡桂枝湯, Bupleurum and Cassia

Hyogo, Nara, Wakayama, Shiga prefectures in Kinki

Twig Decoction) by Prof. Kazuo Mitani, Mitani(Kansai) prefectures which belong to the Japanfamily clinic; and "Explanation of crude drugs: On

Society for Oriental Medicine Kansai branch office.

sojutsu ( 蒼 朮 , Atractyloides Rhizoma ( 3 )) andIn addition, the Japan Society for Oriental Medicine

byakujutsu ( 白 朮 , Atractyloides Macrocephalae

is an academic society with the purpose for

Rhizoma (4))" by Prof. Toshiaki Makino, Laboratory

contributing to advancement and popularization ofoforiental medicine, scholarly activities, and culture

Pharmaceutical Sciences, Nagoya City University.

through the presentation of the study on oriental

There were many newsy lectures and also many

medicine (including Kampo medicine, acupuncture

questions and answers. In the following, I will show

and moxibustion, and so on). It is also the one of thethe main points as to the contents of these

subcommittee members of the academic society inpresentations.

medicine(the

medicine

Pharmacognosy,

Graduate

Schoolofthe Japanese Association of Medical Sciences. It has

As for "On kuoketsuzai medicine ( 駆 瘀 血 剤 ,eight branches offices, namely, Hokkaido, Tohoku,

combinations of agents for dispelling blood-stasis),
especially on keishibukuryogan (桂枝茯苓丸, Cassia

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

21

Volume 8, Number 4 | Winter 2013

Twig and Tuckahoe Pill)" by Prof. Ushiroyama,"Shokanron (傷寒論, Discussion of Cold Damage, orquoted "Jin Kui Yao Lue, or Essentials from theShang Han Lun)" published in the Later Han

Golden Cabinet, an original text of keishibukuryogan"(Eastern Han) Dynasty (25AD–220AD). Originally,

which was an indispensable Kampo item among thegoreisan is the medicine for a cold damage, namely,

medicalheacute febrile illnesses, and it is frequently used toemphasized that keishibukuryogan was a therapeutic

acute infective gastroenteritis in particular at theagent for an intra-abdominal mass (choko) that

present day. The characteristics of the treatment

associates with pregnancy, threatened abortion or

targets of goreisan are thirst, difficulty in excretion

threatened premature labor. In other words, it wasof urine, such vomiting so-called as "suigyaku (水逆,shown that the main therapeutic object of thiswatery vomiting)" or vomiting immediately afterprescription was the treatment for the blood stasis. On

eatingthe other hand, Prof. Ushiroyama quoted the

distribution of the water and improves water"Formulary and Mnemonics from 'No Mistake'metabolism when disturbance in water metabolism

Pharmacy (5) (Futsugo-yakushitsu-hokan-kuketsu)"

exists in the body. The diuretics of the contemporary

by Sohaku Asada; and Prof. Ushiroyama showed

medicine forcibly excrete urine even if there isthat the keyword, pregnancy, did not appear in thedehydration; however, goreisan makes it difficult toarticle of keishibukuryogan, showed the explanation

excrete urine when there is dehydration. This actionof the secret oral teachings of Sohaku Asada, andhas been proved by the experiment of Prof. Shinichi

showed that the actual dosing of keishibukuryogan

Tashiro et al. As for the other indications of thewas not only given to women, but also to men. Prof.

goreisan, it is effective for many symptoms caused by

Ushiroyama understands that the reason why

the atmospheric pressure change. For example,

keishibukuryogan is classified in the combinations of

uneven distribution of moisture occurs before it rains

agents for dispelling blood-stasis lies in theand then headache and dizziness occur. Goreisan"Formulary and Mnemonics from 'No Mistake'will produce improvement of them at that time. Also,

Pharmacy". Prof. Ushiroyama presented that we

it is effective when we have dizziness and ringing in

could not only expect the role of keishibukuryogan as

our ears by the atmospheric pressure change in thethe blood stasis-dispelling formulas, but also the

airplane. It is also effective in prevention of the

improvement

climactericmountain sickness. In addition, it is effective whencomplaints including depressive tendency, mild

body fluid volume is excessive. For example, theedema, and so on because it could circulate "qi" orgoreisan can achieve a complete response when avital energy and remove dampness due to thepatient feels dull in the body due to having swelling

containing of keishi ( 桂 枝 , Cassia Twig orby nausea and vomiting in mother during the

Cinnamomi, Ramulus ( 6 )) and bukuryo ( 茯 苓 ,pregnancy or by a hangover. The action mechanism

Tuckahoe, or Poriae (7)).

of goreisan had been unknown for a long time, but intreatments

of

for

many

women

kinds

and

of

then

or

drinking.

Goreisancures

unevenDr. Hisashi Mine emphasized in his lecture, "Onlate years a water channel called as aquaporin has

goreisan (五苓散, Poria Powder with Five Herbs) as

been discovered, and there is a report that goreisan

agents for removing dampness" that among manyshows drug efficacy by acting on the aquaporin.

Kampo extract products, "goreisan" can show the

Therefore, the application of it spreads more.

highest effectivity immediately after its dosing

Goreisan is applied to cerebral edema and to thealthough it is the formula described in theabsorption of chronic subdural haematoma and has

22

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

Volume 8, Number 4 | Winter 2013

produced good results. There is an idea of phlegm-

theory of five circuits and six qi) (ibid. p.77) diseases

rheum (痰飲 , Tan-Yin) in the traditional Chinese

and also the accumulation of pathogen in chest (結胸medicine. This is the disease in which a pathological証 ). This accumulation of pathogen in chest

substanceiscorresponds to pleurisy and asthma bronchial by theaccumulated in the body and then causes aname of diseases of the contemporary medicine. The

pathological reaction. Both of the phlegm and rheum"Discussion of Cold Damage" says that the exhale ofare pathological water; however, phlegm means a

the pathogenic qi of the exterior syndrome issticky liquid with high viscosity while rheum means

considered as the first choice in the greater yangno-sticky liquid like water. It is the latter liquid thatdisease and that after having sweat, a purgative

goreisan is chiefly effective on. Goreisan cannot

formula will be given. It is described that theremove the sticky sputum. Anyway, goreisan is theaccumulation of pathogen in chest will develop, if aprescription that we can use for whatever kinds ofpurgative formula is given before having sweat. As

case, if there is uneven distribution called as rheum

for the symptoms of the accumulation of pathogen incaused by abnormality in water metabolism in thechest, “resistance and distention at epigastric region

body. Therefore, it is necessary for us to improve thewill develop and then pain will develop”.

dysfunction of these viscera and bowels together

Mitani quoted the "Formulary and Mnemonics fromwhen we think about radical treatment. Dr. Mine

'No Mistake' Pharmacy (Futsugo-yakushitsu-hokan-

lectured that we could perform more effective

kuketsu)" by Sohaku Asada and then emphasized thattreatment when treating the symptoms of thesaikokeishito was not a simple "medicine for cold". Also,

disease by goreisan and treating the cause of thehe presented that the "saikokeishitokadaio (柴胡桂枝湯disease by adjusting the functional balances among

加 大 黄 , Bupleurum and Cinnamon Twig Decoction

five viscera and six organs.

plus Rhizoma Rhei)" was more efficient for menstrual

so-calledasphlegm-rheumProf.

As for “On saikozai medicine ( 柴 胡 剤 ,disorders (Traditionally called as chinomichi-sho

combinations of the agents containing mainly saiko(literally meaning blood-way symptom). He also

(柴胡, Bupleurum root) and ogon (黄芩, Scutellariaemphasized that it was upper abdominal muscle

especially on saikokeishito (柴胡桂枝湯,strain ( 心 下 支 結 ) that a type of patients whom

Bupleurum and Cassia Twig Decoction)”, Prof.

"saikokeishito" tended to exert better effect on had

Kazuo

the

such abdominal pattern as. Therefore, we should"Shokanron (Discussion of Cold Damage, or Shang

have understood the clinical condition of the upper

Han Lun)" that “When in cold damage [that has

abdominal muscle strain as to the type of patients

lasted for] six or seven days, [there is] heat effusion,

whom "saikokeishito" tend to work better on.

root)),

Mitanishowedthesentenceinmild aversion to cold, vexing pain of the limb joints,

As for the "Explanation of crude drugs: On sojutsu

mild retching, propping bind below the heart, and(蒼朮, Atractyloides Rhizoma) and byakujutsu (白朮,exterior pattern is still present, Bupleurum andAtractyloides

Cinnamon Twig Decoction governs” (8). Prof. Mitani

Toshiaki Makino explained the difference between

also showed that the "saikokeishito" is indicated forthem in the scientific standpoints during his lecture.

the patients who have the combination diseases ofAt first, he showed that some of the plant species

greater yang (太陽, Tai-Yang (referring to cold qi inwhich belong to the same Atractylodes genus in

the theory of five circuits and six qi) (9) and lesser

Asteraceae family in Japan and the China wereyang (少陽, Shan-Yang (referring to fire qi in thecalled in the similar crude drug names for the

Macrocephalae

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

Rhizoma)",

Prof.

23

Volume 8, Number 4 | Winter 2013

original

crude(Atractyloides

drug

plantsRhizoma)

and

of
the

the

sojutsu

byakujutsu

had "hot, bitter, warm; having those effects of drying
damp

and

strengthening

digestivefunction,(Atractyloides Macrocephalae Rhizoma). He said

removing pathogenic wind-dampness, improvingthat this brought much troubled condition. In othereyesight" in the second version of the Dictionary ofwords,

the

Traditional Chinese Medicine (Zhong Yao Da Zi Dian,

byakujutsu (Atractyloides Macrocephalae Rhizoma)

中薬大辞典)" compiled by the Nanjing University ofis defined as a rhizome of “okera (Atractylodes

Traditional Chinese Medicine. He described thejaponica Koidzumi ex Kitamura ( 和 白 朮 )) orabove-mentioned

oobanaokera (A. macrocephala Koidzumi (or A.

obtained for clinicians in each Chinese Dynasty to

ovata De Candolle)) in Compositae”, while theactually use the sojutsu (Atractyloides Rhizoma) andsojutsu (Atractyloides Rhizoma) is defined as atherhizome of "hosobaokera (A. lancea De Candolle (古Rhizoma), and he then presented the following

立 蒼 朮 ), or A. chinensis Koidzumi ( 津 蒼 朮 ), or

problem.

intheJapanesecrossbred of them"
Chinesepharmacopeia,(10). On the other hand, in the( 中 国 薬 典 ),byakujutsu

effectiveness(Atractyloides

had

been

Macrocephalae

The problem is: The clinicians of those days had

thedifferentiated the effectiveness of drugs between the

Atractyloides Macrocephalae Rhizoma (Bai Zhu, 白sojutsu (Atractyloides Rhizoma) and the byakujutsu

朮(白术)) is defined as a rhizome of "A. macrocephala(Atractyloides Macrocephalae Rhizoma), and what

Koidzumi", while the Atractyloides Rhizoma (Cangkinds of the rhizome of any Atractylodes genus plantZhu, 蒼朮(苍术)) is defined as a rhizome of "A. lancea

species were used? The effectiveness of drugs in theor A. chinensis". Therefore, A. japonica has not been

above-mentioned second version of the Dictionary ofused in China. Also, Prof. Makino showed that theTraditional Chinese Medicine has been being

rhizome of A. japonica which is called as Chinese

determined from the past China to current China.

white atractylodes rhizome (唐白朮) in Japan has the

Therefore, he pointed out that there was possibility

distribution name of "Guan Cang Zhu (关苍术(関蒼that the effectiveness of "Japanese byakujutsu朮))" in China and thus it was regarded as one type

(Atractyloides Macrocephalae Rhizoma) may haveof the sojutsu (Atractyloides Rhizoma). As for the

been unknown", because the Atractylodes genus

effectiveness of drugs in the traditional medicine,

plant species which was equivalent to JapaneseProf. Makino then cited that the byakujutsu

byakujutsu (Atractyloides Macrocephalae Rhizoma)(Atractyloides

wasseemed to have no evidence to be used as theclassified into the herbs that tonify the spleen-qi,

Atractyloides Macrocephalae Rhizoma (Bai Zhu, 白while the sojutsu (Atractyloides Rhizoma) was朮 ( 白 术 )) in China". In the meanwhile, he alsoclassified into the (aromatic) herbs that transform

pointed out that there was no guarantee for thedampness in the traditional Chinese medicine. And

clinicians of those days to use the crude drug which

he also showed that the byakujutsu (Atractyloides

was identified correctly and that the different

Macrocephalae Rhizoma) had "bitter, sweet, warm;

effectivenesshaving those effects of strengthening digestive

understood as to whether it was fact or not. In thisfunction and replenishing qi, drying damp andregards, however, Todo Yoshimasu's “Yakucho (Oninducing diuresis, stopping sweating, and anti-

the efficacy of medicines, Yao Zheng, 薬徴)” written

abortion", while the sojutsu (Atractyloides Rhizoma)

in the 18th century in Japan described Atractylodes

24

Pharmacopoeia

drug

Macrocephalae

Rhizoma)between

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

them

could

not

been

Volume 8, Number 4 | Winter 2013( 朮 , Jutsu, Zhu) as having "removing action of

As stated above, there were many active

dampness first and then pain relief action secondly"

questions and answers from researchers, clinicians,

and as "removing action of the sojutsu (Atractyloides

physicians, pharmacists, and so on who participatedbyakujutsu

in the congress for the four lecturers. It was only held

(Atractyloides Macrocephalae Rhizoma)", if thefor one day, but it was considered that there werename of Atractylodes (Jutsu) was used when the

many projects and also it seemed that both the

Rhizoma)exceeded

that

of

the

difference

betweenthesojutsu(Atractyloides

beginners and learners and experts could be

Rhizoma)andbyakujutsu(Atractyloides

satisfied with the congress. Please refer to the

Macrocephalae Rhizoma) were not classified. This

homepage(11) of the Six Prefectural Joint Congress ofaccords with the written order of the effectiveness of

the Japan Society for Oriental Medicine for thethe drug, drying damp, in "the second version of thedetails.

theDictionary of Traditional Chinese Medicine" andIn the next year, this congress is going to be heldwith the fact that sojutsu (Atractyloides Rhizoma) isin the Medical Science Information Center, Osakaclassified into the (aromatic) herbs that transform

City University School of Medicine on Sunday,

dampness group in the major category of the Chinese

February 16, 2014 ( 12 ). It is expected that those

medicine.

thepresentations having richer contents and more

identification methods of an original crude drug

active questions and answers are expected thanplant might be not too much different between Japan

those in the congress this time.

and China.

References

Therefore,hesuggestedthat

According to the Preparation Guide, California

ration.pdf (California Acupuncture Board 444 N 3rd

Acupuncture Licensing Examination, February 2011: p.25.

Street, Suite 260 Sacramento, CA 95811) [the last

http://www.acupuncture.ca.gov/students/exam_prepa

date of access Nov30, 2013]

ration.pdf (California Acupuncture Board 444 N 3rd

5

Street, Suite 260 Sacramento, CA 95811) [the last

Medicine: Formulas & Strategies (2nd Edition).

date of access Nov30, 2013]

Seattle, Eastland Press, 2009. P.946.

1

2

According to the Preparation Guide, California

6

Translated by Bensky, D., et al. : Chinese Herbal

According to the Preparation Guide, California

Acupuncture Licensing Examination, February 2011: p.27.

Acupuncture Licensing Examination, February 2011: p.26.

http://www.acupuncture.ca.gov/students/exam_prepa

http://www.acupuncture.ca.gov/students/exam_prepa

ration.pdf (California Acupuncture Board 444 N 3rd

ration.pdf (California Acupuncture Board 444 N 3rd

Street, Suite 260 Sacramento, CA 95811) [the lastStreet, Suite 260 Sacramento, CA 95811) [the lastdate of access Nov30, 2013]

date of access Nov30, 2013]3

According to the Preparation Guide, California

7

According to the Preparation Guide, California

Acupuncture Licensing Examination, February 2011: p.25.

Acupuncture Licensing Examination, February 2011: p.26.

http://www.acupuncture.ca.gov/students/exam_prepa

http://www.acupuncture.ca.gov/students/exam_prepa

ration.pdf (California Acupuncture Board 444 N 3rd

ration.pdf (California Acupuncture Board 444 N 3rd

Street, Suite 260 Sacramento, CA 95811) [the lastStreet, Suite 260 Sacramento, CA 95811) [the lastdate of access Nov30, 2013]

date of access Nov30, 2013]4

According to the Preparation Guide, California

Acupuncture Licensing Examination, February 2011: p.24.

8

http://www.acupuncture.ca.gov/students/exam_prepa

Mitchell, Feng Ye, and Nigel Wiseman. Shang Han Lun:

Zhong-Jing Zhang. Edited and translated by Craig

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

25

Volume 8, Number 4 | Winter 2013

Chinese Medicine – Clinical Pharmacognosy). Ishiyaku
On Cold Damage, Translation and Commentaries.
Paradigm Publications, Brookline, MA, USA. 1999. p429.
9

WHO Library Cataloguing in Publication Data. WHO

Pub,Inc (医歯薬出版), Tokyo, Japan. 2009. pp303-305.
11

Homepage of the Six Prefectural Joint Congress of

the

Japan

Societyfor

Oriental

Medicine.

International Standard Terminologies on Traditional

http://homepage3.nifty.com/kansaikanpou/H24%20Ro

Medicine in the Western Pacific Region. 2007: p.77.

kken3.pdf [the last date of access Nov30, 2013]

http://www.wpro.who.int/publications/docs/WHOIST_26
JUNE_FINAL.pdf) [the last date of access Nov30, 2013]

12ofHomepage of the Three Prefectural Joint Congress
the

Japan

Societyfor

Oriental

Medicine.

Edited by Toshiaki Makino ( 牧 野 利 明 ). Kampo-

http://homepage3.nifty.com/kansaikanpou/25%20san

Chuigaku Koza-Rinshoshoyakugakuhen (漢方・中医学

kengoudou.pdf [the last date of access Nov30, 2013]10

講座 臨床生薬学編, Invitation to Clinical Traditional

26

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