Volume 11, Number 1 | Spring 2016

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

Hiromichi Yasui
Japan Institute of TCM Research

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

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