KAIM
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Kaammppoo,, A
Accuuppuunnccttuurree aanndd IInntteeggrraattiivvee M
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INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 6, Number 1 ･ Spring 2011

Editorial

Acupuncture-Moxibustion and Modern Medicine
Shuichi Katai

Japanese Acupuncture - Current Research

Current Research of Acupuncture for Chronic Prostatitis/Chronic Pelvic Pain Syndrome
Hisashi Honjo

Kampo Medicine - Current Research

Three Cases of Severe Bradyarrhythmia in Elderly Dementia Patient Successfully Treated with Goreisan (Powder of Five Ingredientswith Poria) Extract Formulation for Prescription
Kazunari Ozaki, Mitsuru Kageyama and Hiromi Rakuga

Clinical Report 1 (Acupuncture)

Two Cases that had Treatments Effect with Infant Acupuncture Therapy
Takeshi Matsumoto

Clinical Report 2 (Kampo Medicine)
Headache 1
Mihoh Koga

Front Line of Kampo Pharmacology

Review 1 of Pharmacology-related Academic Meetings
Toshiaki Makino

Medical History in Japan“Historical Significance of the Standardization of Acupoint Locations”, the Second Japanese Acupoint Committee (1)Makoto Mayanagi

ISSN:1559-033X

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

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

Volume 6, Number 1 ･ Spring 2011EXECUTIVE EDITOR

Shuji Goto
Chairman, GOTO College ofMedical Arts & Sciences
Tokyo, JapanEDITOR-IN-CHIEF

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

TA B L E O F C O N T E N T S
1 Editorial
Acupuncture-Moxibustion and Modern Medicine
Shuichi Katai

3 Japanese Acupucture – Current Research
Current Research of Acupuncture for Chronic Prostatitis/Chronic Pelvic Pain Syndrome

ASSOCIATE EDITORS

Hisashi Honjo

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

7 Kampo Medicine - Current Research
Three Cases of Severe Bradyarrhythmia in Elderly Dementia Patient Successfully Treatedwith Goreisan (Powder of Five Ingredients with Poria) Extract Formulation for Prescription
Kazunari Ozaki, Mitsuru Kageyama and Hiromi Rakuga

16 Clinical Report 1 (Acupuncture)
Two Cases that had Treatments Effect with Infant Acupuncture Therapy
Takeshi Matsumoto

23 Clinical Report 2 (Kampo Medicine)
Headache 1
Mihoh Koga

27 Front Line of Kampo Pharmacology
Review 1 of Pharmacology-related Academic Meetings
Toshiaki Makino

PUBLISHER

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

29 Medical History in Japan“Historical Significance of the Standardization of Acupoint Locations”, the Second Japanese
Acupoint Committee (1)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, application of
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 1 | Spring 2011

Editorial
Acupuncture–Moxibustion and Modern Medicine
Acupuncture is a form of medicine that originated from ancient ideologies, philosophies andscience 2,000 years ago along the Yellow River valley. Based on the observation of nature, it
considers nature and human beings as inseparable and that human beings exist under the
influence of nature. It builds on and theorizes the Qi energy, and explains the relationship between
the internal organs and the body surface according to meridians and acupuncture points.
Furthermore, it recognizes that the mind and body mutually influence each other, and that therelationship between society and human beings is a factor in the development of diseases. These
acupuncture theories were born out of the strong influence of ideologies and philosophies of themasters of various schools of thought that emerged over several centuries prior to the birth ofacupuncture, during the Spring and Autumn Warring States period.
Modern medicine, on the other hand, emerged in Europe after the 18th century, based on theideologies, philosophies and science of modern and contemporary Europe. Modern science andphysics achieved rapid progress during the 17th to 18th centuries and formed the basic conceptthat gave rise to modern Western medicine, which in effect negated the religious medicine ofMedieval Europe. Modern medicine separated from superstition and magic, and stressed thatdiseases are not punishment by the gods, but a result of environmental factors, nutrition andlifestyle habits. It also acknowledged the body’s spontaneous cure, but greater emphasis wasplaced on anti-bacteria drugs (chemico-pharmaceutical preparations) and surgical procedures forexternal injuries as the underpinnings of its significance.
Given the 2,000-year passage of time between the rise of the two forms of medicine, a simple
comparison by time period reveals large differences in historical background, ideologies andphilosophies between the two.
However, acupuncture, at the time it emerged, eliminated the spiritual influences of medicine
that existed up to then, analyzed life and diseases based on an observation of nature from thescientific stance of the times, and addressed phenomena that occur to living organisms as they are.
This approach is basically the same as the approach of observing nature from the standpoint ofscience, and relates to modern medicine, which is based on science.
Additionally, acupuncture’s theorization of the inseparable relationship between nature andhuman beings could be said to correspond to modern life theories.
Furthermore, acupuncture correlated the parts of the body by identifying the relationshipbetween the inside and outside of the human body according to meridians. Although the existenceof meridians has yet to be proven, the development of the system that unifies and integrates theentire body could be said to be in common with the nervous system and circulatory system ofmodern medicine.
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 6, Number 1 | Spring 2011

Moreover, when considering the fact that acupuncture defined the influence of social
relationships on the physical body as a causal factor of diseases and focused on the issue as one ofits pillars, it could be said that acupuncture had already recognized, 2000 years ago, the bud of theissue that is addressed by modern mind-body medicine and psychosomatic medicine.
In these ways, acupuncture’s fundamental perception of nature and the development of its
system share common aspects with modern medicine.
However, because the study of acupuncture was founded on ancient Chinese books of
medicine such as “Suwen,” “Lingshu” and “Nanjing,” it tried to categorize and fit all phenomena
into the framework of the Yin and Yang, Five Phase Theory and the Three Yin and Three Yang
Theory that were considered outstanding theories at the time. It is thought that this eventually led
to a lack of perspective that also embraces the diversity of uncertain elements that are observed inphenomena displayed by nature and the human body.
In thinking about the future of acupuncture, it would be important to contemplate how best
to deal with phenomena expressed by the physical body and incorporate that perspective into a
new theoretical system while also giving consideration to Modern Medical theories.
Shuichi Katai
Associate Editor of the Journal of KAIM
National University Corporation
Tsukuba University of Technology

2

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

Volume 6, Number 1 | Spring 2011

Japanese Acupuncture - Current Research
Current Research of Acupuncture for Chronic
Prostatitis/Chronic Pelvic Pain Syndrome
Hisashi Honjo
Department of Clinical Acupuncture and Moxibustion,
Meiji University of Integrative Medicine,
Nantan, Japanaccounts

prostatitis.5

Currently, several studies of acupuncture for

95%

of

cases

with

chronic

Therefore, CP/CPPS is diagnosedby the symptoms following exclusion of urinary
tract infection. To assess the symptoms inpatients with CP/CPPS a validated and reliable
symptom assessment tool in chronic prostatitis
has been used worldwide. The tool is the
National

Introductionfor

Institutes

ProstatitisofSymptom

HealthIndex

Chronic(NIH-CPSI)

lower urinary tract symptoms including urinary

developed by the NIH Chronic Prostatitis

frequency, urinary urgency, urinary incontinence

Collaborativeand genito-urinary pain or discomfort have reported.

(Appendix).6

Research

Network

in

1999This article reviewed for the acupuncture treatment

This questionnaire is formed by 3 mainof chronic prostatitis/chronic pelvic pain syndrome.

headings as the pain or discomfort of symptoms

Prostatitis is a common disease in urological(locations, frequency and severity), the urinary

outpatients with an estimated account of about 2

symptoms (irritative and obstructive voiding

million visits per year in United States.1 Community-

symptoms) and the impact of these symptoms on

based studies disclosed that the prevalence ofthe patient’s quality of life. Nine separate items

prostatitis-like symptoms ranged from 9.7% to 12% of

could be addressed the important issues ofmen.2,3 Chronic prostatitis/chronic pelvic pain

chronic prostatitis. The domain of pain or

syndrome is defined as a new category of

discomfort is rated on a scale of 0-21. The

prostatitis syndrome by the National Institutes ofurinary symptoms are rated on a score of 0-10

Health established an International Prostatitis

while the impact on quality of life is rated on a

Collaborative Network in 1995.4 The classification

score of 0-12. Each of these three domains could

is described as follows:

be assessed independently. To take an instanceCategory I. Acute bacterial prostatitis

of clinical study in Japan using Japanese

Category II. Chronic bacterial prostatitis

version of the NIH-CPSI, the pain or discomfort

Category III. Chronic prostatitis/chronic pelvic

domain score was significantly higher in thepain syndrome

chronic prostatitis group than in the control

III A. Inflammatorygroup (9.79 vs. 0.72, respectively).7 Additionally,

III B. Non-inflammatory

a total score of NIH-CPSI that added the threeCategory IV. Asymptomatic inflammatory

domains and rated 0-43 could be evaluated theprostatitis

responsive measure of the treatment options,
including acupuncture treatment.

Chronic

prostatitis/chronic

pelvicpain

There are multiple treatment options forsyndrome (CP/CPPS) is a syndrome with long

CP/CPPS,

history (at least 3 months or longer) of genito-

antibiotics, anti-inflammatories, alpha-blockers,

urinary and pelvic pain or discomfort, associatedphytotherapeutics agents and other medical

withagents. Conservative therapy for the symptoms

irritative

symptoms

and/orandobstructive

sexualvoidingdysfunction,

andincludingconservative

therapy,of CP/CPPS is mainly several suggestions for the

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

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Volume 6, Number 1 | Spring 2011

patients about diet (avoid spicy food, acidic food,ultrasonography (TRUS) in conveniently screening

alcohol, caffeine), lifestyle (avoid psychologicalintrapelvic

stress and anxiety), activity (avoid long period ofresonance venography (MR venography) as well as

sitting and bicycling) and exercise (walking). By

clinicalthe NIH definition, Category Ⅲ CP/CPPS is non-prostatitis symptom index (NIH-CPSI) and thebacterial prostatitis, the majority of patients

international prostate symptom score (IPSS)

with CP/CPPS, however, have been treated bywere compared before and after the treatment.

antibiotics.8 Approximately 50% of patients withIn the results, pain and QOL scores of the NIH-

CP/CPPS

CPSI

treatedwithantibiotics

showedvenoussymptoms

1weekcongestion
using

after

and

the

the

magnetic

NIH

5thchronic

acupuncture

improvement of their symptoms. Alpha-blockers

decreased significantly (p < 0.05 and <0.01,

which are the most effective medical therapy torespectively), compared with the baseline in all

lower urinary tract symptoms related to benign

patients. The maximum width of the sonolucent

prostate hyperplasia (BPH) have been also usedzone 1 week after the 5th treatment also

for the treatment of CP/CPPS.

decreased significantly (p < 0.01, compared with

Recently,

combinations of antibiotics and alpha-blockers

thebaseline,

Figureappeared to achieve the greatest improvement

Intrapelvic venous congestion demonstrated byin clinical symptom scores compared with

MR venography was significantly improved in 4

placebo, which reported by a systematic review

patients.

and meta-analysis.9 Anti-inflammatories would

Thus,

we

1

believe

andthat

Figure2).

acupuncture

be one of the common agents for CP/CPPS as

treatment is effective for the symptoms ofwell

CP/CPPS.

asphytotherapeutics(CernitinpollenFurthermore,otherresearcher

extract) in Japan. After all, these medical agents

reported the same kind of results in the similar

are not effective for all patients with CP/CPPS.

therapeutic methods as our study. 12 In the study

Additionally, a 50% improvement in symptom

ninety-seven CP/CPPS patients received six

score could be considered as an excellent

sessions of acupuncture to the BL-33 acupoints

response to the therapy in CP/CPPS.10

once a week. Each patient compared NIH-CPSI
before and after the treatment and on 12th and24th weeks following the treatment. As the

Acupuncture for CP/CPPS
We have performed acupuncture therapy forresults, there was a statistically significant

In this study, ten

decrease in all of the subscores evaluated at all

male patients with non-inflammatory chronic

periods compared with the baseline. Eighty-six

pelvic pain syndrome with intrapelvic venous

patients out of 93 (92.47%) were NIH-CPSI

congestion were treated by acupuncture. Eight

responders (more than 50% decrease in total

patients had previously received pharmacotherapy,

NIH-CPSI score from baseline) at the end of thewhich was unsuccessful.

treatment.

the patients with

CP/CPPS. 11

Acupuncture was

Theseresultssuggestthat

performed using disposable stainless needles,

acupuncture appears to be a safe and potentiallywhich were inserted into the bilateral BL-33 points

effective treatment in improving the symptoms

and rotated manually for 10 minutes. The

and quality of life of men clinically diagnosed

treatment was repeated every week for 5 weeks

with CP/CPPS.

without other therapeutic maneuvers. Transrectal
4

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

Volume 6, Number 1 | Spring 2011

BeforeAfer

Figure 1 (Modified by Int J Urol, 11:607, 2004.)
Figure 1 Changes in the findings of intrapelvic venous congestion by transrectal ultrasonography
before and after acupuncture
Transrectal sonograms of the prostate show the changes in a patient before and after
acupuncture. The arrows show the dilation of the sonolucent zone. The maximum width of thesonolucent zone is 4.5 mm before and 1.3 mm after acupuncture.

Figure 2 Changes in the maximum width of the sonolucent zone by transrectal ultrasonography
before and after acupuncture

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

5

Volume 6, Number 1 | Spring 2011

8. McNaughton-Collins M, MacDonald R Wilt TJ:

Conclusion
This article reveals the therapeutic effects ofDiagnosis and treatment of chronic abacterial

acupuncture for non-inflammatory chronic pelvic

prostatitis: a systematic review. Ann Intern Med,

pain syndrome. However, long-term effects still

133: 367-381, 2000.

remains unknown. Further studies are needed,

9. Anothaisintawee T, Attia J, Nickel JC et al:

therefore, to clarify the effects of acupunctureManagement of chronic prostatitis/ chronic

treatment for non-inflammatory chronic pelvic pain

pelvic pain syndrome: a systematic review andsyndrome in a larger number of patients in a

network meta-analysis. JAMA, 305: 78-86, 2011.
10. Nickel JC: Practical therapeutic strategies for

randomized, placebo controlled trial.

the prostatitis patients: development of aReferences

treatment plan. In: Nickel JC, Bladon Medical

1. Collins MM, Stafford RS, O’Leary MP et al: How

Publishing, 55-80, 2002.

common in prostatitis? J Urol, 159: 1224-1228, 1998.

11. Honjo H, Kamoi K, Naya Y, Ukimura O, Kojima

2. Nickel JC, Downey J, Hunter D et al: Prevalence

M, Kitakoji H, Miki T: Effects of acupuncture forof prostatitis-like symptoms in a population

chronic pelvic pain syndrome with intrapelvic

based study using the National Institutes ofvenous congestion: preliminary results. Int J

Health Chronic Prostatitis Symptom Index. J

Urol, 11: 607-612, 2004.
12. Tugcu V, Tas S, Eren G, Bedirhan B, Karadag S,

Urol, 165: 842-845, 2001.
3. Roberts RO, Jacobson DJ, Girman CJ et al:

Tasci A: Effectiveness of acupuncture in patients

Prevalence of prostatitis-like symptoms in awith category IIIB chronic pelvic pain syndrome:community based cohort of older men. J Urol,a report of 97 patients. Pain Med, 11: 518-23,

168: 2467-2471, 2002.

2010.

4. Nickel JC, Nyberg LJ, Hennenfent M for The
International Prostatitis Collaborative Network:
Research

guidelinesforchronic

prostatitis:

consensus report from the first national institutesof health international prostatitis collaborative
network. Urology, 54: 229-233, 1999.
5. Krieger JN, Nyberg LJ, Nickel JC: NIH
consensus

definition

andclassificationofprostatitis. JAMA, 282: 236-237, 1999.
6. Litwin MS, McNaughton-Collins M, Fowler FJJ
et al: The National Institutes of Health chronic
prostatitis symptom index: development andvalidation of a new outcome measure. J Urol, 162,369-375, 1999.
7. Monden K, Tsugaya M, Ninomiya Y et al: A
Japanese version of the National Institutes of
Health Chronic Prostatitis Symptom Index(NIH-CPSI, Okayama version) and the clinicalevaluation of cernitin pollen extract for chronic
non-bacterial prostatitis. Jpn J Urol, 93: 539-547,
2002 (abstract in English, article in Japanese).
6

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

Volume 6, Number 1 | Spring 2011

Kampo Medicine - Current Research
Three Cases of Severe Bradyarrhythmia in Elderly
Dementia Patient Successfully Treated with Goreisan(Powder of Five Ingredients with Poria) Extract
Formulation for Prescription
Kazunari Ozaki1)2), MD, Mitsuru Kageyama3)4),
MD, PhD, Hiromi Rakuga2), MD, PhD
1) Department of Clinical Gene Therapy, Osaka
Univerisity Graduate School of Medicine,
Suita, Osaka, Japan
2) Department of Geriatric Medicine and Nephrology,
Osaka University Graduate School of Medicine,
Suita, Osaka, Japan
3) Kageyama Clinic, Sakai, Osaka, Japan
4) Department of Obstetrics and Gynecology,
Osaka City University Graduate School of Medicine,
Osaka, Japan

Key words:
bradyarrhythmia, bradycardia
Goreisan (五苓散, Wu-Ling-San, or Powder of Five
Ingredients with Poria)
Kampo (漢方, the medicine traditionally practiced inJapan, based on ancient Chinese medicine)
Kampo extract formulation for prescription
sick sinus syndrome (SSS)
sui-doku (水毒, disorders of the body’s fluid metabolism)

Introduction: Sick sinus syndrome (SSS), or sinus
node dysfunction (SND), is a heterogeneous clinicalsyndrome of various etiologies, such as sinus
bradyarrhythmia, sinus arrest, and sinoatrial (SA)block, with periods of bradyarrhythmia. In thispaper we would like to describe three patients withelderly dementia who had severe bradyarrhythmia,
and who have shown remarkable improvementswith Goreisan (Powder of Five Ingredients withor

bradycardia and sui-doku (disorders of the body’s
fluid metabolism). Two of the patients had severe
bradycardia with minimum pulse rate of less than 40
beats/min (bpm). All patients were treated with

Goreisan extract formulation for prescription for suidoku.

Allpatients

startedrecoveringfrombradycardia within a few days from the beginning of
the treatment. Severe bradycardia associated withlatent SSS (case 1), severe bradycardia associatedwith drug-induced bradycardia with SSS (case 2)
and moderate bradycardia with infectious diarrhea(case 3) were controlled successfully with Goreisan.

Discussion: There is little literature for treatment of
SSS with Kampo formulation. For treatment ofbradyarrhythmia

and/orslow-pulse

in

Kampo

formulation, on the other hand, some doctors take it
for symptoms for cold and use drugs with Processed
Aconitine Root (Processi Aconiti Tuber) or with
Processed Ginger (Zingiberis Rhizoma). Ebe, et al.
reported that Keishi (Cinnamomi Ramulus, or
Cinnamon Twig, Gui-Zhi) and Keihi (Cinnamomi
Cortex, Cassia Bark, Gui-Pi (Rou-Gui)) increase
heart rate in his book: Keihou-Igaku (Theoretical
Explanations and Assemblage of Prescriptions of"Cold Damage" and "Golden Chamber"). Goreisan

Abstract

Poria,

Case reports: All three patients had dementia,

Wu-Ling-San), which is a Kampo(traditional Japanese medicine) formula for sui-doku

contains Cinnamon which can increase pulse rate.

Conclusions: This report suggests the possibility ofusing Kampo medicine for the treatment of severe
bradyarrhythmia including SSS in elderly dementia
patients. Our data and some reports suggest that

Goreisan may be useful not only for the managementof dizziness, edema, vomiting and diarrhea, but also
for that of severe bradyarrhythmia in aged dementia.
Further accumulation of the similar cases might behelpful for us to interpret the mechanism of rate
control with Goreisan in future.

(disorders of the body’s fluid metabolism).

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

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Volume 6, Number 1 | Spring 2011

Background:

The sick sinus syndrome (SSS), or[Western medical findings:]Height of 153cm. Weightsinus node dysfunction (SND), is a combination ofof 54.5kg. Body temperature (BT) of 36.2℃. Blood

symptoms (dizziness, fatigue, syncope, pre-syncope,pressure (BP) of 169/95 mmHg. Pulse rate (PR) of

and palpitations) caused by sino-atrial (SA) node

38bpm (regular). Conscious level was clear: GCS15

dysfunction

sinus(E4,V5,M6). Dementia-level was observed with

bradyarrhythmia, SA block, or sinus arrest ( i ).

MMSE (Mini-mental State Examination) scores,

Although the term SSS has been popular since thewhich were 19points.

definition by Rubenstein (ii), the more comprehensive

Results of physical examination were normal except

title SND is gaining prevalent. In this paper we wouldthat the bowel sounds were slightly hyperactive.

like to use the term SSS instead of SND. SSS is quite

Schellong’s test (head-up tilting test) was withincommon, and its incidence increases with advancing

normal limits (W.N.L.).

age (iii ). Symptomatic SSS patients are treated with

Blood chemistry findings were all within normal

implantableoflimits except the one-hour postprandial blood

bradyarrhythmia at which to consider pacing is

glucose was 111mg/dL. Thyroid function tests andgenerally accepted to be “a rate of less than 40

CK-MB was within normal limit.

beats/min (bpm) during waking hours” ( iv ). In SSS

Electrocardiogram

without

pacemaker

bradyarrhythmia at a heart rate of 38bpm, left axis

implantation, drug therapy approaches, occasionally,

deviation, inverted T-wave in V4-5, and minor ST-

have been temporarily introduced (v).

segment depressions in V6.

andmanifested

pacemakers.

absolute

bysevereThe

indications

degreefor(ECG)

markedsinus

On the other hand, there is no evidence-based

Chest X-ray films, computed tomographic (CT) scan

Kampo

of the brain and the neck: W.N.L. for her age,guideline

fortreatment

of

SSS

with

although there was mild brain atrophy in theformulation.
We report a patient suffering from severe

subcortex.

bradyarrhythmia treated effectively with Goreisan

Ultrasound study of the neck and the heart: W.N.L.

(Powder of Five Ingredients with Poria, or Wu-Ling-

for her age.

San) extract formulation for prescription.

[Kampo findings:] On general diagnosis: Thirsty.
Little urine. Pulse diagnosis: Superficial and slow.

Case Reports:

Tongue diagnosis: Light-red tongue with teeth

Case one: 82-year-old female.

indentation. Also, slightly dry, thin and white fur.

[Chief complaint:] Dizziness.

Abdominal diagnosis: Slightly weak abdominal[History:] The patient and her family consulted astrength. Sound of fluctuating liquid.

local clinic due to dementia, just after death of her

Level of sui-doku (disorders of the body’s fluid

daughter, in the spring of 200X. Her family rejected

metabolism) : At least 32points with water retention

nursing by themselves, so they consulted H hospitalscores (vi) (Table 1).

and admitted its old people’s home (elder care

[Progress notes (Figure 1)]: Because of ECG findings,

facility: H-home) on June 15. On the second post-

she should be admitted to another hospital with theadmission day, she had dizziness, vomit, and loose

cardiac care unit for arrhythmia monitoring, but thestools, therefore the nurse at H-home brought her tofamily selected palliative treatment. The patient did

our department on June 18.

not meet the diagnostic criteria of orthostatic[Past history:]Hypertension, latent SSS (the family

hypotension ( vii ). From physical examinations andsaid, “A series of alphabet ‘S’ or something likeroentgenological studies, there were little possibility

that.”)of orthopedic, oto-rhino-laryngologic, and neurosurgeric

8

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

Volume 6, Number 1 | Spring 2011

diseases. An ECG was characteristic of SSS (Rubenstein

Her condition was diagnosed as sui-doku (disorders

type I). The presumative diagnosis, therefore, wasof the body’s fluid metabolism) from Kampo findings.

dizziness due to severe bradyarrhythmia.

Goreisan (6g / day, b.i.d., Kracie Pharmaceutical, Ltd.

Initially, atropine (0.5mg, intramuscularly) was(KB-17) was introduced orally. The dizziness andgiven. However, the patient reported thirsty without

bradycaridia improved within 30 minutes. Before

pulse rate improvement. We did not continue

administration of Goreisan, although, minimum

injection

heart rate was 30bpm at night and 38bpm atofatropineenoughtoblock

daytime, after administration of Goreisan theparasympathetic nerve.

minimum heart rate was about 55bpm at daytime forfive month. The patient says, “Thismedicine (Goreisan) is very tasty and I

Table 1: Diagnostic score of water retention

always feels good by taking thisBody feels heavy

3

Nausea, Vomitting

3

Pulsating headache4

Increased gurgling3

Dull headache

3

Morning stiffness

7

Case two: 87-year-old female.

Getting motion sickness easily

5

Tendency toward edema, gastric clapotage

15[Chief complaints:] Loose stools, legLightheadedness, dizziness

5

Pleural effusion, cardiac water retention, ascites

15

edema, excessive daytime somnolence,

Syncope5

Epiumbilical palpitaion1)

5

Watery nasal discharge

3

Watery diarrhea

5Hypersianosis

3

Decrease urinary volume

7

carbamazepine

Foamy sputum

4

Diuresis5

severalmedicine.”

respiratory failure.
[Past History:] Cerebral infarction (76
y.o.

in

1997),

epilepsy(with

600mg/dayt.i.d.),

contusions

andfractures,

behavioral and psychological symptoms

Diagnostic criteria: A score of more than 13 points indicates water retetion.
Note 1: Epiumbilical palpitaion refers to an increased pulsation of the abdominal
aorta that is felt during light massage of the umbilical area.

of dementia (BPSD, in 2005)[Present History:] The patient and her

Cf.：The Journal of Kampo, Acupuncture and Integrative Medicine 2005;1Special Edition:12

familyconsulted

S-clinic

andshe

admitted its old people’s home (S-home)
in September, 2005. On October 5, 2008,

Atr: Atropine (i.m.)
WLS: Wu-Ling- San

Atr
0.5
mg

she had a cold and this preceded theonset of pneumonia (Pn).

Goreisan (WLS) 6g/d

The use of antibiotics (CTM, 2g/day,

Vommitingd.i.v.) and oxygen (Ox) therapy for four
HR
(PR)
1-Nov

25-Oct18-Sep20-Aug17-Jul

?

25-Jun

WLS p.o18-Junpost

18-Junpre?
HRminmum?
Admission?

days showed good effectiveness fortreatment of Pn, so antibiotics was
switchedfrom(300mg/day,
SBP

Figure 1: Clinical course of case 1
Change in BP, HR(PR),and VAS of dizzinessmeasured before and after Goreisan administration

1-Nov

25-Oct18-Sep20-Aug17-Jul

25-Jun18-Junpost

18-JunpreHRminmumDBP

15-JunmmHg 200or mm 180
160
140
120
100
80
60
40
20
0

Loose Stools

15-Jun

bpm

65
60
55
50
45
40
35
30

VAS of
Dissiness

VAS:Visual Analogue Scale

CTM

p.o.)

and

to

CEPN-PI

Ox

therapytapered off. On Oct.14, loose stools, legedema and sleep disorders were shown,so she and the nurse consulted S-clinic
and we made a house-call on the nextday.

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

9Volume 6, Number 1 | Spring 2011

[Western medical findings:] Height of 151cm. Weight

bradycardia developed with decreased level ofof 41.6kg. BT of 36.6℃, BP of 114 / 68 mmHg with aconsciousness.

PR of 36bpm (regular). Conscious level was GCS10

prescriptions as of Oct.15 immediately (Goreisan,(E3,V3,M4). Her dementia-level was 15points withtulobuterol-tape, and aspirin were reintroduced andMMSE.

SpO2：98% (O2 3 l/min), Moist rale (coarse

carbamazepine was discontinued). On the next day,crackles) was heard at the right upper lung field. Her

her status improved again. She had had no trouble

legs were slightly edematous.

with heart rate of 55 bpm until November 12, andLaboratory data on admission are shown in Figure 2.

subsequently the Goreisan was tapered off.

Therefore,wechangedthe

An ECG performed in a comatose state (Oct.23)
revealed

episodesofsevereAspirin 100mg/d

bradyarrhythmia at a rate of 20bpm. A

Tulobuterol-tape 2mg/d
WLS 6g/d

12-lead ECG tracing on the next day
showedepisodesofrates of 37bpm.
[Kampofindings:]

On

Carbamazepine 600mg/d

sinus

bradyarrhythmia with minimum heart
generaldiagnosis: Thirst, sweat and little urine.
knottedpulse.

Tonguediagnosis:

Unknown.

The

patient

rejected to open her mouth. Abdominal
diagnosis by palpation: Slightly weak
abdominal

strength,

sound

of

CEPN-PI 300mg
p.o.

SD

140
SBP
or
DBP
120
(mmHg)

WLS: Wu-Ling-San, (Goreisan)
CBZ: Carbamazepine
CEPN-PI: Cefcapene pivoxilhydrochloride
LS: Loose Stools
LE: Leg Edema
SD: Sleep Disorders(excessive daytime somnolence)

CBZ

Cefotiam (CTM)2g
d.i.v.

CTM2g
d.i.v.

SD

SD

LS, LE

100

HR
(bpm)

HR

80

SBP
60

Pulse diagnosis: Superficial and slow.
Sometimes

WLS 6g/d

Lactomin 3g/d

DBP

40
20
S24 HR S30 O1 O2 O5 O6 O7 O8 O9 O10 O11 O12 O13 O14 O15 O16 O17 O18 O20 O22 O23 O28 N1 N3 N5 N12 N19
min

25
CRP
(Mg/dl)
20
or
W BC
15
3
(×1000/mm )
10
or
O2
5
(l/min,nasal)

CBZ discontinued
and WLS introduced orally

CRP

?

WBC(×
1000)
Oxygen

0
S24

S30

O2

O5

O6

O8

O12

O14

O15

O16

O17

O18

O19

O22

fluctuating liquid, epigastric discomfort

Figure 2: Clinical course of case 2slightly.

: (Top), Change in BP and HR(PR) measured before and after Gorei-san administration.
: (Bottom), Change in CRP, WBC, and Oxygen.

Level of sui-doku : At least 26points.
[Progress notes (Figure 2):] Although the family
hoped palliative care at S-home, her condition wasbad enough to be referred to the other hospital for
immediate

admission.

As

her

condition

wasdiagnosed as sui-doku, Goreisan (6g / day, b.i.d; KB17) was introduced orally. CTM was reintroduced.
Tulobuterol-tape 2mg/day and aspirin 100mg/day
were continued and the other drugs (carbamazepine
600mg/day etc.) were discontinued. Within two days,
her loose stools, leg edema, severe bradyarrhythmia,
conscious level, and respiratory failure improved.
Four days later, she did not need antibiotics (CTM)
and oxygen therapy. Seven days later (Oct.22), herlaboratory findings such as CRP were improved, andthe drugs (carbamazepine etc.) were reintroduced
and Goreisan was discontinued. Within one day, her

10Case three: The third case was a 72-year-old female.
[Chief complaints:] Watery diarrhea, vomiting.
[Past History:] Cerebral infarction.
[Present History:] The patient and her family
consulted S-clinic and she entered its old people’s
home in October, 2001. On February 21, 2008, she
noted the onset of nausea and vomiting. And for thefollowing several days she had had recurrent waterydiarrhea, which remained unresponsive despite
lactominanddomperidone,

accompaniedbyvomiting and sweating.
[Western medical findings:] Height ;145cm, Weight ;54kg, BT; 37.3℃, BP; 127/ 71 mmHg, PR; 48bpm(regular). Conscious level; clear. Dementia-level;
16points (MMSE). There were no resistance and no
tenderness, but the bowel sounds are hyperactive.

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

Volume 6, Number 1 | Spring 2011

ECG findings: Sinus bradycardia, abnormal Q

in patients with SSS are listed in the ACC/AHA/

waves in III and aVF.

NASPE 2002 guideline ( viii ). Due to limitations of[Kampo findings:] On general diagnosis; thirst,

space, a detailed discussion on the indications for

sweat, little urine, slight cold sensitivity. Pulse

pacemaker implantation is not possible here. Pleasediagnosis: Superficial and slowed-down (Huan).

refer the guideline for more information.

Tongue diagnosis: Dark-red tongue with teeth

In SSS without absolute indications for pacemakerindentation, slightly dry, thin and white fur.

implantation, drug therapy, occasionally, have been

Abdominal diagnosis: Slightly weak abdominal

temporarily introduced (ix). Drug treatment of sinus

strength, sound of fluctuating liquid.

bradyarrythmia

Level of sui-doku : At least 33points.

asymptomatic patients. While intravenous atropine[Progress notes:] Examination disclosed infectious

has aided some patients transiently, most patients

diarrhea due to norovirus-related gastroenteritis.

ultimately require placement of a pacemaker.

Her condition was diagnosed as sui-doku. On

Although in the past, isoproterenol was used quite

February 25, Goreisan (6g / day, b.i.d; KB-17) werecommonly

introduced orally for sui-doku. By the next day,further appreciation of its substantial risks of theabdominal symptoms subsided and besides her

increasemoderate bradyarrhythmia improved. She had had

diminished

its

role.

no trouble with heart rate of 50-60 bpm until Marchtheophyllineorcilostazol

4, when Goreisan were discontinued. Since then, thethough these are drugs of off-label use under healthheart rate has been decreased gradually to 45-

insurance

50bpm.

bradyarrhythmia secondary to therapeutic use of

is

in
in

usuallypatients

withmyocardialinJapan.

notindicatedbradyarrhythmia,

oxygen
Some

In

for

for

demandhas

physiciansusebradyarrythmia,

patients

with

sinus

digitalis, beta-blockers, carbamazepine or calcium

Summary of three cases: All three patients had
dementia, bradycardia and sui-doku. Two of thechannel blockers, simple discontinuation of the drug
are often all that is necessary.

patients had severe bradycardia with minimum PRof less than 40 bpm. All patients weretreated with Goreisan for sui-doku.

Table 2: Baseline characteristics of three patients
No.

case1

case2

Severe bradycardia associated with SSS

Age, Gender

82、Female

87、Female

72、Female(case 1), severe bradycardia associatedDiseases other thanbradycardia

Dementia(AD)、HT

Dementia+Brain infarction,knee-OA, Asthma

Dementia+Brain infarction,
Fx at Lumbar discs, HTwith drug-induced bradycardia with SSS

Level of the Dementia

MMSE 19/30
HDS-R 18/30

MMSE 15/30
HDS-R 16/30

MMSE 16/30
HDS-R 16/30(Active) Symptoms

Dizziness, Thirst, Oliguria

Loose stools, slight leg edema
and sleep disorders

Diarrhea (norovirus-related
gastroenteritis)

ADL (Barthel Index)

95/100 ? 100/100

0/100 ? 45/100

20/100 ? 55/100

Water Retention Score(Terasawa)

32/100At least 26/100

At least 33/100

WLS(Gorei-san)

6g/day b.i.d.

6g/day b.i.d.

6g/day b.i.d.

ECG

Sinus bradyarrhythmia ata heart rate of 38bpm.
Rubenstein type I .

Sinus bradyarrhythmia withminimum heart rates of
37bpm .

Sinus bradyarrhythmia at aheart rate of 38bpm.

Change in HR(PR) HR(PR)of pre-administration ?
HR(PR) of postadministration

30bpm at night, 38bpm at
daytime ?
about 55bpm at daytime

20bpm at night(with CBZ),
37bpm at daytime ?
about 55 bpm at daytime

48 bpm ? 50-60 bpm (withWLS) ? 45-50 bpm (without
WLS)(case 2) and moderate bradycardia with
infectious

diarrhea

(case

3)

were

controlled successfully with Goreisan(Table 2). All patients started recoveringfrom bradycardia within a few days fromthe start of the treatment without any
adverse reaction.

case3

Discussion
Standard

treatmentofbradyarrythmias including SSS: The

Abbreviations:
MMSE, Mini-Mental State Examination; HDS-R,Hasegawa Dementia Scale-Revised ; AD, Alzheimer's disease.
HT, Hypertension; ADL;Activities of Daily Living, WLS;Wu-Ling-San,or Goreisan（Kracie Pharmaceutical, Ltd., (KB17)）, OA; Osteoarthrities, DM; diabetes mellitus, Fx;fracture

indications for pacemaker implantation

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

11

Volume 6, Number 1 | Spring 2011

Treatment of bradyarrythmias including SSS with

inhibited urination, slight heat, and dispersion-

Kampo formulation: On the other hand, there islittle literature for treatment of SSS with Kampo

thirst. Goreisan governs. (xi)”And the “Jin-Kui-Yao-Lue” says “When a thin person presents withformulation. For treatment of bradyarrhythmia

palpitation below the umbilicus, drooling andand/or slow-pulse with Kampo formulation, on the

foaming at the mouth, withdrawal, and dizziness,other hand, some doctors take these symptoms forthis indicates water. Goreisan governs. ( xii )”kan-sho (cold pattern) and use drugs with bushi

Indications for Goreisan is acute and chronic(Aconiti Later Radix, Processed Aconitine accessory

diseases due to sui-doku, such as headache, severe

root, or Fu-Zi) or with kankyo (Zingiberis Rhizoma,

thirstDried Ginger Rhizome, or Gan-Jiang) ( x ). Somedifficulty,

Japanese doctors have used Kampo drugs forfluctuating liquid in the epigastric region, vomiting

treatment of bradyarrhythmia and/or slow-pulse as

frothy saliva, and vertigo.

Table 3 shows.

Author

Literature

Organisation

Cardiacdiseases

Age
Sex

Pulse
Diagnosis

HR change

Kampo fomula

TauchiN. et al.

The Japan
Pediatric
society for
Oriental
Medicine
2003 Vol.19
pp.5-12

Dept. of
Pediatric
Cardiology and
NICU, Ogaki
Municipal
Hospital, Japan

Advancedatrioventricular(AV)
block(2:1)

5y.o.
male

Not
commented

63bpm?
improvementof AV block(HR:
unknown)

Ling-Gui-ZhuGan- Tang (Extract
Granules)
2.0g/day t.i.d.

Kampo-noRinsho,
46(5)(1999)

Watanabe
OB/OG,
Fujieda-city,
Japan

Left
Ventricular
Hypertrophy(LVH),
extrasystolicarrhythmia,
Mitral Stenosis(MS) susp.

66y.o.
femaleUnknown
Origin88y.o.
femaleSakamoto T.

KampoKenkyu
No.444, pp.3
68-369(2008)

vomiting

edema,

after

generaldrinking,

urinary

fatigue,diarrhea,

Medicinal Constituents of Goreisan:

Table 3：Cases with Kampo formula for bradycardia

Watanabe Y.

withSakamoto
Clinic,Hirosaki-city,
Aomori, Japan

Goreisan is not a simple preparation of
medicine, but contains multiple herbal
medicines such as

Deep
and
Slow
?
Big and
SlowedDown

45bpm ?
59bpm

Deep,
Weak,
Fine,
and
Slow
? Not
commented

30bpm ?
70bpm

(Pharmaceutical
Manufacturers unknown)

Ren-Shen-Tang(Extract Granules)
4.0g/day(OHSUGIPHARMACEUTICAL
Co.,LTD.), Da-JianZhong-Tang(Extract Granules)
5.0g/day(Tsumura &Co.)

San-Huang-XieXin-Tang (Extract
Capsules) 6g/day
t.i.d (for 2 weeks)(Kotaro Kampo
Pharmaceutical Co., Ltd. )Bukuryo (茯苓, Poria, Hoelen, or
Fu-Ling) 3g :For drain dampness and(1)

tonify spleen Qi.
(2)or

Chorei (猪苓, Polyporus, polyporus,
Zhu-Ling) 3g. For eliminate

dampness and promote urination.
(3)

Byakujutu ( 白 朮 , Atractylodis

Macrocephalae

Rhizoma,White

Atractylodes Rhizome, or Bai-Zhu) 3g:
For tonify spleen-Qi and promotes
transformation and transportation of
the spleen-Qi.

How dose they describe Goreisan in classics:

Goreisan comes from the “Shan-Han-Lun (On Cold
Damage)” and “Jin-Kui-Yao-Lue (Synopsis of Golden
Chamber)”, which classical textbooks written by
Zhang-Zhong-Jing during the Latter (East) Hun era.
The “Shan-Han-Lun” says, “When in Greater-Yang
disease, after sweating is promoted and great sweat
issues, if there is dryness in the stomach, vexation
and agitation with insomnia, and a desire to drink
water, giving a small amount of water will
harmonize the stomach-Qi so that recovery will leadto ensue. If the pulse is floating and there is
12(4) Takusha ( 沢 瀉 , Alismatis Rhizoma, Water
Plantain Rhizome, or Ze-Xie) 5g: For drains
dampness and promotes urination.
(5) Keishi (桂枝, Cinnamomi Ramulus, Cinnamon
Twig, or Gui-Zhi) and Keihi (桂皮, Cinnamomi
Cortex, Cassia Bark, or Gui-Pi (Rou-Gui)) 2g:
For warm vitality gate and tonify yang.
The presumable reasons for successful treatment
for this case of bradyarrhythmia with Goreisan
were:

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

Volume 6, Number 1 | Spring 2011

1: Cardiologically, Goreisan, which is diuretics forincreases amount of Qi and this leads to increase ofeliminating dampness, made an improvement of theheart rate.

extravascular volume overload. This improvement in

In Japan, although, some researches on Kampo

the extravascular volume overload led to an

formulation have been carried out from theimprovement of bradyarrhythmia.

viewpoint of the Koho-ha School (the classical school),

2:

From

the

pharmacologic

point

of

view,

they

use Keishito-group (Ramulus Cinnamoni

withdrawal and discontinuation of the medicine that

Decoction group) for treatment of reversed-Qi (Ki-inducestogyaku or rising of Qi), which is manifested by so-

improvement of bradyarrhythmia. In second case,called hot flush. There are two types of hot flush as

discontinuation of carbamazepine can be effective forfollows (xv): Active-type hot flush that observed when

improvement of bradyarrhythmia. serum half-life

individuals feel nervous, disappearing when thebradyarrhythmia

cancontribute

From Keihou-Igaku point of view, Keishi moves

stress is removed. And fixed-type hot flush is always

the Qi from Stomach and increases amount of Qi toobserved, increasing in the face due to tension as

outside-tract and this leads to increase of heart rate.

well as blood engorgement. The patients with active-

According to Ebe, et al.( xiii ), the Qi runs fromtype reversed-Qi normally experience “palpitation”

Stomach to outside-tract through Epigastric region

or “tachycardia”.

(Xin-Xia), Chest, Lung and Pericardium (Xin-Bao:

At first glance, the usage of Keishito-group forconnecting channel of the envelope of the Heart). If

treatment of reversed-Qi, which usually contains

the Qi from Lung to Pericardium is difficult to bepalpitation or tachycardia, seems to be inconsistentdispersed (sen-san), the amount of Qi to Pericardium

withdecreases, this leads to “slow-pulse”. According tobradyarrhythmia or for augmentation of Qi. Where“Keihou-Igaku (six-channel pattern indication)”, thethis contradiction comes from?

factor which decides pulse rate is the amount of

One possible reason for this contradiction comesLung-Qi, which runs from Lung to Pericardium.

from our intention to discuss has not been on Ketsu

Goreisan contains Gui-Zhi which can increase pulse
rate. Gui-Zhi moves the Qi and increases amount(Blood) and Sui (all bodily fluids other than Ketsu)

of Qi, from Stomach to Pericardium and this makesof Ki (Qi), Ketsu, and Sui, because a balance of these

the pulse increased.

three concepts is,

3: From a viewpoint of traditional Chinese medicine

indispensable in order to take full advantage of the(TCM), Goreisan contains Gui-Zhi, which is an acrid,

bradyarrhythmia-relieving aspect of the treatment.

warm medicinal which enters and warms the

If the increase in pulse rate by an improvement ofchannels and network vessels, dissipates cold andthe extravascular volume overload with Goreisan ismoves the Qi and blood (xiv). Furthermore, Gui-Zhi

much greater than the decrease in pulse rate by anwarms the yang specifically of the Heart, Spleen,

improvement of the active-type reversed-Qi withand Kidneys. If Qi is plentiful, then Yang is warm

Gui-Zhi, Goreisan, which contains Gui-Zhi, may

and energetic enough. If Qi is weak and empty, Yang

have effect of increase in pulse rate or improvement

is lacking and the systemic body and extremitiesof bradycaridia in the total amount.

become cold. If Heart-Qi and/or Heart-Yang are weak

Another possible reason for this contradictionand empty, the pulse rates become slow andcomes from “Our argument has been done with thesometimes irregular, and also Blood and Qi are notconcept of Qi.” This may be said, “Are both Kampo,

circulated throughout the whole body. Gui-Zhi,

traditional Chinese medicine (TCM), and Keihou-

which is contained in Gorei-san, moves the Qi andIgaku based on metaphysical consepts of which there

that

of

Gui-Zhifortreatmentofbut on Ki (Qi) in this argument. Now, we must think

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

like three wheels in tricycle,

13Volume 6, Number 1 | Spring 2011

are no plausible scientific rationale for understanding

where the idea that “the care of the elderly is theQi?” Or “Are there any effects of Gui-Zhi or its

responsibility of the family” has long been strongly

ingredients on the improvement or decrease of pulse

held. Sometimes we encounter patients who arerate pharmacologically?” To the best of our knowledge,

within indications for aggressive treatment in

there has not been any report on the in vitro

medically, but are out of curative indications ofcardiotonic action of Gui-Zhi like that of Fu-Zi. But, itaggressive treatment in socially. For example, a

may be said that “A drug may have two opposite

super-aged dementia patient, whose family rejected

effects on the disease”, like the efficacy of low-dose

nursing by themselves, is within indications for

dopamine as a renal-protective agent during vigorous

aggressive treatment in medically. In this case, thediuresis for CHF associated with moderate renal

patient and one’s family might choose palliative careinsufficiency and that of high-dose dopamine without

instead of aggressive treatment. And this may lead

diuretic effect for CHF(xvi). According to some reports,

to worse prognosis of the patient compare to that of

cinnamaldehyde in Gui-Zhi is a central nervous

the patient who took aggressive treatment. In thosesystem (CNS) stimulant at low-doses and a sedative
at high-doses (xvii), (xviii), (xix). And we may attributesuch CNS stimulation (low-dose) and sedation (highdose) to acceleration and suppression ofcases, through Kampo

medical diagnosis andtreatment,

teams

catecholamine (mainly adrenaline) release from the

medicalcandevelopcomprehensive geriatric assessment (CGA) and offer
true whole-person medicine, and this will lead to
improvement of the patients’ quality of life (QOL).

adrenal glands. Briefly, it may be said that, on the one
hand low-dose Gui-Zhi accelerates pulse rate throughConclusions:

CNS stimulation directly and through promotion ofThis report suggests the possibility of using Kampo

urination by warming yang for dieresis or by

medicine

eliminating dampness and diuresis indirectly. On thebradyarrhythmia including SSS in elderly dementia

other hand, high-dose Gui-Zhi suppresses pulse ratepatients. Further accumulation of the similar cases

through

CNS

sedation

directlyandthrough,forthetreatmentofseverefrom patients in clinical settings and extensive

indirectly, promotion of harmonizing yingfen andmolecular

weifen by relieving exterior syndrome with pungent

syndromes are required to gain insight into severe

and warm natured drugs like Keishito (Ramulus

bradyarrhythmia, including SSS, and to develop new

Cinnamoni Decoction, or Gui-Zhi-Tang).

target therapies and preventive strategies.

andcellularresearch

into

these

So far we have outlined on the presumable reasonsdizziness, edema, vomiting and diarrhea, but also for

Additional remark (Acknowledgements):(OZAKI K., et al. have been reported as “Threecases of severe bradycardia including Sick Sinus
SyndromeinElderly
Dementia
Patients
Successfully Treated with Herbal Medicine Goreisan (Wu-Ling-San, or Poria Powder with Five
Herbs).” at the 6th World Congress of Chinesethat of severe bradyarrhythmia in aged dementia.

Medicine 2009 Melbourne, Australia, Dec. 2009.

for successful treatment for bradyarrhythmia in aged
dementia

withGoreisan. Briefly, functions ofGoreisan are not only to promote urination and todrain damp accumulation, but also to warm yang Qi.
Our data and some reports suggest that Goreisan
may be useful not only for the management ofGoreisan is thought to be effective for the treatment

We would like to thank Dr. Nelson Yoshiokiof bradyarrhythmia in elderly patients whose sinus

YAMAWAKE for his suggestions, some of which wenode and heart function are aggravated withhave adopted, in particular the translation ofadvancing age.

technical terms of Kampo from Japanese into

We are facing a prominent aging society in Japan,
14

English.

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

Volume 6, Number 1 | Spring 2011

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On Cold Damage. Brookline, Massachusetts,
USA:Paradigm Publications,1999, 1-800.
12Sung Yuk-ming.: Understanding the Jin-Gui-YaoLue. Beijing, China:,2009, 1-726.
13
Ebe Y. , Yokota S. : Keihou-igaku; six-channel patternindication (1), Toyo Gakujutsu Shuppansha, Tokyo,
Japan, 2000, 1-212. [江部洋一郎、横田静夫：『経方医学〈1〉「傷寒・金匱」の理論と処方解説 第2版』東洋学術
出版社, 2000, 1-212. ]14
Becker S., Flaws B., Casañas R. : The treatment ofcardiovascular diseases with Chinese medicine.
Boulder, Colorado: Blue Poppy Press, 2005. 1-638.
15 Sato Y., Hanawa T., Arai M., et al. (eds.):.
Introduction to Kampo : Japanese traditional medicine/ [by] the Japan Society for Oriental Medicine. Tokyo :Elsevier Japan, 2005. 1-286.
16 Varriale P., Mossavi A.: The benefit of low-dose
dopamine during vigorous diuresis for congestive heart
failure associated with renal insufficiency : Does it
protect renal function?
Clinical Cardiology 1997;
20(7):627-630.
17
Natural Medicines Comprehensive Database,
1999(www.naturaldatabase.com/)[the last date ofaccess Mar.31, 2011]18
Natural Medicines Comprehensive Database,2007(www.naturaldatabase.com/)[the last date ofaccess Mar.31, 2011]19 Khare C.P. (ed.): Indian Medicinal Plants:An
illustrated Dictionary, Berlin/Hidelberg : SpringerVerlag, 2007. 1-900.

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

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Volume 6, Number 1 | Spring 2011

Clinical Report 1 (Acupuncture)
Two Cases that had Treatments Effect with Infant
Acupuncture Therapy
Takeshi Matsumoto
Center for Environment, Health and Field Sciences,
Kashiwanoha Acupuncture Clinic of Chiba University[Introduction]
Since old days, there has been a special type ofacupuncture called “infant acupuncture therapy” forthe treatment of children in Japan. Although its
origin is not fully elucidated, it is one of traditional
acupuncture styles.1)
Infant acupuncture therapy was popular in the
Edo period (about 1600-1867) and mainly practiced
in the surrounding areas of Osaka (Figure 1).2) It has
been administered to treat various major conditions
generally seen in children of not only cries at night,
enuresis, infantile malnutrition but also diseasesof the respiratory system and diseases of thedigestive system problems. For the treatment ofpediatric patients, special needles of different shapes
specifically designed for children are used. The
modality of this type of acupuncture stimulates thewhole body using non-insertive techniques such as
touching and rubbing.

Figure 1

16

In recent years, fewer parents bring theirchildren to pediatric acupuncture practitioners forthe treatment of their children even in Osaka.
According to a report, there are more people who do
not know of the existence of a method of treatment
for children, compared to those who do.3)
During the initial opening period of our clinic,
only adult patients visited us and there were no
chances of treating children. However, in the area
where Chiba University Kashiwanoha Campus islocated, one of leading corporations started thedevelopment of this area as a new residential areafrom about 2005 and many condominium buildings
stood side by side. As a result, the households withchildren increased and the population of the area
also grew year by year, and our acupuncture clinic
had visits of infant patients. And so, for familiarity
with and easy access to infant acupuncture, a half
price discount on the regular adult fees has beenoffered for children of 10 years old or below since2008. This discount information has been and isbeing distributed through such media as our website,
fliers, and posters. Moreover, the activity of lecture
meetings has been carried out even now todisseminate
theinformation
about
infantacupuncture and to obtain people’s understanding.

Map of JapanThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 6, Number 1 | Spring 2011

As above, our clinic is performing everyday

showedstrongresponses

totensions

weretreatment aiming for a clinic open to children. The

stimulated with pressing force with the relatively

cases that had excellent results of Shonishin will bepointed part of the pediatric needle.

introduced below.
Case I[Object and method]
Patient: N.H. 8 years old elementary school boy
Chief complaint: Nocturnal enuresis
Present condition: Height 130 cm, weight 25 kg.
As his father was the manager of a boys’ rugby team,the patient also played ruby with him. The patient,
who was all dark sunburned, was a thin type withless muscle. The body was stringy and hard. He
Figure 2 Disposable infant needles

always had a smile on his face. He was dependent on
his mother and the youngest of three male siblings.

Cooperated by SEIRIN Co., Ltd.

Anamnesis and complications: No special mention
Diagnosis: No special mention[Course]Present illness: Although he was an elementary

The frequency of enuresis is shown in Figure 3.

school boy, the frequency of bedwetting had been four

In 2009

times a week since he was little. His mother woke

1st treatment (March 14): The patient felt well.

him up once at 12:00 midnight, but he became wet in

2nd treatment (March 23): After the previous

the morning. As he was scheduled to go out for antreatment, the frequency of four times a weekextended learning (with lodgment), his motherreduced a little.

wanted to manage to improve by that time. The child

3rd treatment (April 11): Went to the grandmother’s

did not seek medical care from clinics or hospitals.

and stayed there for a long time, which changed
his life rhythm.

Assessment method

4th treatment (April 27): The frequency reduced after

The patient was asked to paste a seal with his
favorite pattern on the date of a calendar when hereturning home.
5th treatment (May 18): Due to consecutive holidays

did not wet his bed.

for a long time (Golden Week), the bed time

Treatment method

became irregular, and the rhythm changed.

He loved sports and was a good worker but he wasskinny with stringy muscles of the entire body.

In

6th treatment (June 15): Arouse without being woken
when he has an urge to urinate.

consideration of internal body cold, the whole body

7th treatment (July 13): Became able to hold up urine

was stimulated for five minutes with disposabletill 5 o’clock in the morning without being woken.

infant needles made by SEIRIN Co., Ltd. (Figure 2).

When it became 5 o’clock, went to the toilet andEspecially the lower legs that were found intensely

then returned to bed.

tense on palpation were smoothly rubbed with theflat part of the needle to ease tensions. And the

8th treatment (August 31): Was able to withstand
until the time to rise.

nearby areas of 築 賓 (K19) zhubin, 三 陰 交 (SP6)sanyinjiao, and 郄 門 (PC4) ximen acupoints that

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

17

Volume 6, Number 1 | Spring 2011

morning,

回

10Number of times
9
7
6

and

evening, to cut down on salt

9

8

8

afternoon,

intake, and to prevent him

7from becoming chilled. The

6

patient

wet

his

bed

5

frequently in April and May

4since he often went out and3

had the long holidays in

2

2

1

1
0

these months and the life
rhythm

MAR.

APR.

3月

MAY

4月

（３月１４日以降）(AfterMarch 14)

5月

JUN

6月

JUL

AUG

7月

8月

Figurefrequency
図 33 Enuresis
夜尿回
数

of

the

patientchanged.

Afterward,

heresumedhis

stableandnormallife

rhythm.

He

looked forward to showing
the practitioner the seals pasted on the calendar[Consideration]
Many of the mothers who visit our clinic forand trustful relations could be built up, which

treatment of nocturnal enuresis of their children

further inspired him to strive for improving his life

desire the approach that does not require wakening

rhythm. Although not many documents have been

the child during the midnight. And such mothers

released on treatment effects of nocturnal enuresis

visit our clinic as they may have concerns and fears

in children, effectiveness has, in effect, beenfrom various sources of information, like websites,

reported.5)that awakening children at midnight will cause toinhibit growth hormone release, affecting their

The patients who visits clinics with the chief

growth, and that the disturbance of antidiuretic

complaint of nocturnal enuresis are of relatively

hormone secretion will affect the control of urine

higher age and the insertive treatment for thesevolume during the night. However, the Guideline

children is often performed using Goushin.5)6)7) For

presented in June 2004 for diagnosing nocturnal

the subject patient, infant needles were used as heenuresis prepared by The Japanese Society on

had a strong fear, targeting to ease excessive whole

Enuresis4)

providesmodalities

of

main

treatment

body tensions confirmed on palpation. As a result,guidance,

behavioral

stringy excessive tensions in the body were eased;

treatment, and medicinal treatment.

The alarm

the muscles became moderately elastic condition astreatment for enuresis in the behavioral treatment

a whole; and his physical rhythm had adjusted -category where you wake the child during the nightthese may have caused the improvement of

to toilet has stable effects is used as treatment. The

nocturnal enuresis in this case.

threelifestylematter of wakening during the night needs to be
discussed. However, upon consultation with theCase II

patient’s mother, treatment was carried forward for[Object and method]

the time being by wakening the patient to take to

Patient: S.A. one year and 8 month old boy

the toilet. The patient’s mother had the instructions

Chief complaint: Difficulty falling asleep, poor

to adjust the patient’s life rhythm, to spread theappetite, sleep lightly.

amount of fluids the patient drank through the

Present condition: Height 89 cm, weight 12 kg.

18

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

Volume 6, Number 1 | Spring 2011

Anamnesis and complications: No special mention

walk to the kitchen, but groaned a moment andDiagnosis: No special mention.

fell back asleep. His mother did not need to read

Present illness: The patient was one year and eighta picture story book to him. So she really felt

months old. He began to wake up during the night

greatly relaxed.

from a year ago. He had been waking up every two

O: Skin turgor on the body surface became

hours for five months and when waking up, he

adequate and the balance of muscle tensions

walked to the refrigerator to drink milk. After

became appropriate.

drinking in sips, he went back to bed and sleep. He

3rd treatment (July 22)

became very picky about food and his food intake

S: After this, he was in good condition and slept

was reduced.

well. He fell asleep easily and had appetite.

He went to bed about 8:00 pm and it took him two

A: As the patient was in good shape, thehours to fall asleep.

treatment was finished on the day.

Daytime napping was once a day from about 13:00
to 14:00.

[Consideration]

Cow’s milk was started from 8 months. At thepresent time, he took a mixed diet with food.

Stimulating the skin is essential to mental andphysical developments of children. According to a
study by Schanberg and Field,8) rats of 8 to 10 days

Treatment method:

old that were being separated from their mothers

The whole body was stimulated for five minutes

for two hours showed lowered levels of growthwith infant needles made by SEIRIN Co., Ltd.

hormone secretion, but rats that had tactile stimuli

Especially the upper arms and lower legs were

did not show a reduction in the secretion of growthsmoothly rubbed with the flat part of the infant

hormone. They also reported that in immatureneedle to ease strong tensions confirmed onbabies who had the skin stimulated every day, thepalpation.

body weight increased faster than those who did nothave it.

[Course]In 2010Skin stimulation in children is significantly

1st treatment (July 12)

linked to their growth. For this reason, the state of

S: The patient had difficulty falling asleep, his

inner surface such as being excessively sensitive

seep cycle was short. He has little appetite.

and emotionally unstable appears readily on the

O: No hardness was found in the abdomen, andbody surface. In performing infant acupuncture

the condition was not so bad.

therapy, the acupuncturist reads the information

Arms and legs were lacking of power, he did notfrom the body surface and gives stimulations

have much energy.

appropriately according to the information. The

A: He did not show reluctance to infantskin of children, which is thin and sensitive,

acupuncture therapy and quietly received it. He

responds acutely to external stimulations or

was in a good mood.

irritations, so that small amounts of stimulation

2nd treatment (July 15)

easily cause effects. Thus, the effects appeared with

S: From the day of the previous treatment

the fewer number of the treatment in the patient.

onward, he went to bed at 8 o’clock in the evening.

Usually

Although he woke up at the midnight, he did notacupuncture therapy is finished in minutes.9) The

one

time

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

treatment

withinfant19

Volume 6, Number 1 | Spring 2011

time to simulate was only about five minutes in the

Kashiwanoha area in Kashiwa-shi of Chiba-

patient. Too much stimulation may make the child

prefecture of Japan.15)16) In the campus, which was

exhausted or develop fever. When the author first

formerly

began the infant acupuncture therapy, some of theKashiwanoha Kampo Clinic of Chiba University

children became feverish. From the experiences,

was established in June 2004 to realize the “town-

the length of one treatment was determined as fivebuilding based on environment and health,”

minutes.

implementing the tradition and philosophy of

The suitable ages of the children to receive

Orientalusedmainlymedicine.17)18)

for

This

horticulture,

Clinictheprovidesinfant acupuncture therapy are generally from thetreatment using mostly Kampo medicines andages that can have an understanding of insertingprescribes extract products and decoctions madeneedles down to a few months of age. However,with medicinal herbs covered by the national healthinfant acupuncture therapy is not only for children.

insurance

It may be applied to aged people who are sensitive

Tsukuba Express, a new railway line, opened nearto stimuli or the patients who have depression.

the campus of the university. In conjunction with

Yoshimura10)

this, Kashiwanoha Acupuncture Clinic of Chiba

uses infant needles to prevent the

progression of dementia.

program.

In

November

2006,

the

University opened in a giant commercial facility

A right amount of stimulation is comfortable tonear the Kashiwanoha station.19) This acupuncture

people of any age. In recent years, there is a touchclinic was founded based on the idea that if thetherapy appealing to the importance of skin-to-skinfacility is a shopping mall with many people

contact between mother and child, which iscasually milling around, physicians of Chiba

the

University could grapple with disease-prevention

modern age of Japan when it is easy to noticemeasures with Oriental medicine. It is the first casechildren who caused or are causing problems orin Japan that a national university corporation has

those who are emotionally unstable, the importanceopened an acupuncture clinic. Furthermore, it isof skin ship or physical contacts during infancy hasquite unusual for the acupuncture clinic to be

attracting

worldwide

attention.11)12)13)

been brought to realize once

again.14)

In

We as

operated as a tenant of a commercial facility. Chiba

practitioners of acupuncture and moxibustion think

University launched this project for the purpose ofthat there comes the time when we have to makecontributing to the community people.

once again the method of skin contact stimulus,
which has been taken over from the ancient times,

The numbers of patients who visited the Clinic

and infant acupuncture therapy, which is theduring the one-year period from the opening date of

culmination of tradition and techniques and theNovember 22, 2006 to November 22, 2006 were 448

method of providing treatment by acupunctureof new patients, 312 of female, 136 of male, and thepoints or catching responses, more familiar or

total of 2,774 patients. The number of treatment

accessible to people.

days during the one year period was 234 days andthe average number of patients who visited theIntroduction of facilities:
Chiba

university

and the age distribution was in their 50s, 60s, 30s,

corporation, has the campus of the Center forand 70s in descending order. Generally among theEnvironment, Health and Field Sciences in thechief complaints of the patients who receive

20

University,

Clinic was 11.9 per day. The average age was 53.8
anational

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

Volume 6, Number 1 | Spring 2011acupuncture and moxibustion treatment, motor

As of April 2011, four years have passed. The one-organ disorders accompanied by pain, such as stiffstoried Kampo Clinic and the Acupuncture Clinic

shoulders and low back pain accounts for 80% instand in the idyllic campus where there are vegetable

Japan.20)21) Similarly the most patients visiting thefields and fruit field (Figures 4, 5). With facilities of 3

Clinic complained of motor organ disorders followedcare beds and 1 massage bed, 4 practitioners (one is aby headaches, sensitivity to cold, noise in the ear,general malaise, and sleeplessness.
The

numberofpatientsofKashiwanoha

Acupuncture Clinic of Chiba University began toincrease year by year after the third anniversary
and the Clinic as business grows steadily. However,it has been relocated into the present Kashiwanoha
Kampo Clinic of Chiba University on April 2010 inorder to place a strong emphasis on research andstudies, which are now being progressed from thestaff member specialized in massage therapies)
providestreatments

withmoxibustion and massages.

acupunctureandIn this campus,

professionals from different areas of horticulture,
education, pharmaceuticals, and medicine have cometogether and this enables to take approaches fromdifferent angles for a single purpose. In the study on
growing mugwort leaves used for moxa, its selection,and house cultivation – these are now taking place - acollaborative project is now being carried out between
the professionals who have knowledge of moxa, its

aspects of both acupuncture and moxibustion, andproperties,

Kampo.

professionals who have the knowledge of qualities of

production

andresearch,

and

the

mugwort leaves (a material of moxa), its cultivation,and proliferation. As such, a study that reflects thecharacteristics of the field scientific center is being
carried forward.

Figure 5 In the treatment room
Figure 4 Kashiwanoha Acupuncture Clinic of Chiba University

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

21

Volume 6, Number 1 | Spring 201111) Tiffany

References
1)

2)

3)

M

Field,

etal.,(1986).

TactileHitoshi NAGANO, et al. (2010). Shonishin no

Kinesthetic stimulation effects on preterm

Kigen ni tsuite (About the origin of infantneonates. Pediatrics. 77, 654-658.

acupuncture), Shonishin no Tanjyou to sono
Rekishiteki-haikei. (Birth of infant acupuncture
Journal of
and its historical background)12) Tiffany M Field. (1995).Massage Therapy forJapanese Society for the History of Medicine.

13) Tiffany

infants

andchildren.

M

Field,

al.,(1996).Massage

Hirohisa YONEYAMA, Hidetaro MORI. (1964).

depressed

Hou(Pediatricacupuncturetechniques).

The

Japanese

Journalofand

Behavioral Pediatrics. 16, 111-115.

56(3), 387-414.
Shonishin

Developmental
Nanay

Therapymothers.

Infantfor

Grizzle,etinfants

Behaviorofanddevelopment. 19,107-112.
14) Takeo HASHIMOTO, (2001). Touch Care no

Acupuncture & Manual Therapies.

Nagare to Sono Rikai. The Japanese Journal of

Yuko YAMAGATA. (1998). Shoni no Chiryou

Midwives, 55(2), 101-105.

Zatsukan.Shinkyu Osaka.14 (1), 41-43.

15) http://www.h.chiba-u.jp/center/english/top.htm

4)

http://www.jsen.jp/guideline/

16) Ando. T., et al., (2006). Human Health Science

5)

ShuichiK,

Kazusi N.

(1991).

Effects of

Acupuncture on Nocturnal Enuresis, Skin-17) http://www.h.chiba-u.jp/center/hospital/top.htm

temperature, swelling and tension of the18) Kyowa Kikaku. Ltd. (2007). Kashiwanoha

suprapubic region, and skin temperature of the

Kanpo Clinic of Chiba University in Japan.

pedal

Sciencefingers.

The

Japanese

SocietyofBalneology, Climatology and Physical Medicine.
6)

7)

8)

Project in Japan. Science House. Ltd.

of

ClinicalInformation Center, Ltd. 31, 2: 41-44.
19) http://www.h.chiba-u.jp/center/hari/hari.html

Shin SUZUKI, et al. (2006). Yakudatu Tsukaeru20) Tsukayama. H, Yamashita. H. (1994).Report

Shinkyu Shinpou. IDO-NO-NIPPONSHA INC.

Acupuncture Practice for Five Years in Tsukuba

28-32

College of Technology Clinic in Japan. Tsukuba

Hisashi HONJO, et al., (2001). Yanyousho

College of Technology Techno Report., 5, March,

Kanjya ni taisuru Harichiryou ni yoru Yanyou

217-221.

no Chiryou Katei no Kenkyu. Journal of the21) Ogawa.

T.

(1994).

Businessconditions

Japan Society of Acupuncture and Moxibustion.

questionnaire total result of present age

51(3), 372.

Acupuncture in Japan. Ido no Nippon Mag., 600,

Schanberg SM, Field TM. (1987). Sensory

586.

stressandsupplemental

stimulation in the rat pup and preterm humanneonate. Child
Naomichi SHIMIZU, (2001). Shonishin ni
taisuru Chousa to Shimizu-ryu Shonishin no
Jissai.

Journal

of

the

Japan

Societyof

Acupuncture and Moxibustion. 51(3), 335-336.
10) Haruo YOSHIMURA, (2010). Shinkyushi no
Ninchishou ye no Taiou to Shonishin niyoru
Shinkou Yobou Koka. Shinkyu Osaka. 25(4),407-415.

22

Medicine.

54(3), 178-190.

deprivation

9)

Kampo

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

Volume 6, Number 1 | Spring 2011

Clinical Report 2 (Kampo Medicine)
Headache 1

In the present paper I would like to briefly
discuss a few cases of tension headache andMihoh 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 I have seen in our outpatient department.
Each case will be discussed focusing on the qi-bloodbody fluids aspects, trying to keep the terminology
as simple as possible.

[Introduction]
Headache is a symptom frequently encountered■ Casesin an outpatient office specialized on Kampo.

<Tension headache; prolonged cold, phlegm>

Generally, this condition is classified into

Case (1):46 years, female, housewife, clinic visit

primary headache, which in turn is classified into

in January XX

1) migraine, 2) tension headache, 3) cluster

Chief complaint: right shoulder pain, headache,headache, 4) headache associated with overuse of

dizziness (floating feeling), pollinosis

theAnamnesis: at age 35: enucleatic myomectomy

medications,andsecondaryheadacheoccurring in the presence of an underlying disease.

At age 45: total hysterectomy because of myoma

Even

induced anemia

thoughremarkableprogress

has

been
of

At this time there were adhesions of the small

headache, the number of patients suffering fromintestines, requiring reoperation, during which aheadacheportion of the small intestines was removed.

achieved

regarding
still

the

remains

pharmacotherapy
high.

The

migraineguidelines of the American Headache Society®
(AHS)

recommend

that"treatment

of

acute

conditions should be individualized". Moreover,regarding the ideal pharmacotherapy for theprevention of attacks.
The relationship between diagnoses according to
the above described classification and specific"patterns" has not yet been clarified. Yet, throughintegration of TCM diagnostic methods a usefulconcept pertaining to the "individualized therapy"
can possibly be provided.
Practicing Kampo therapy and looking back at
cases with chronic headache, it appears that often
several patterns are involved. So far there has beena tendency of patterns like cold, blood deficiency,
blood stasis and phlegm being rather frequent, but
I believe the heat excess patterns are also on therise. Moreover, in cases of headache associated withrefractory diseases or overuse of the medications,
I have often experienced that the use of theformula that expel blood stasis led to an early
alleviation of the symptoms.

At age 45: pollinosis
Present illness:
Development of a chronic sense of fatigue
following the total hysterectomy, at rest discomfort
that felt like the right were about to solidify andpain of the right shoulder joint was so severe, thatit prevented sleep; chilling around the waist andthe thighs and a generalized feeling of edema overthe entire body. Considering the presence of pain as
if from pinching the right upper arm and stagnationof liver qi as well as blood deficiency into account,the formula nijutsuto and kamishoyosan wereprescribed. After 4 months of treatment theshoulder

pain

had

been

alleviatedalmostcompletely and the pollinosis considerably.
By the sixth months of the treatment theheadache and sense of floating grew worse andsymptoms were highly sensitive to low atmosphericpressure. The headache was reportedly associatedwith a slightly depressive heaviness. Recurrence ofthe temporarily relieved edema of the legs. The
patient

originally

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

hasatendency

towards
23

Volume 6, Number 1 | Spring 2011indigestion. The husband is currently living alone

nervous and anxious. At that time she wasabroad because of his work.

diagnosed with amyloidosis of the skin and Sjörgren
syndrome. Headache often developed in case ofFindings:
Moderate build, skin slightly brown. Good
appetite, bowel movements and micturition normal,
but has a tendency towards constipation whennervous. During bathing the patient felt on thecontrary cold. She was the type of person that doesnotsweat.

Her

physicalcondition

used

to

deteriorate in spring. Pulse was deep, slippery andwiry / weak right cun pulse, the tongue was pale redfatigue or when she had been under stress;
endurance of the symptom generally led to a
gradual increase in the pain, so that she had to takeanalgesics and lie down. The stomach responded
sensitively to the mental status and she complained
about heartburn, stomach disorder and a sense of
distention.
Findings upon first visit:

but had a thick white fur coating its entire surface

Fair-skinned and leptosomatic habit, sloping

and teeth marks, sublingual veins were somewhat

shoulders. Visible amyloid depositions on theengorged. Mild degree of fullness, tenderness orabdomen and lumbar regions. Easily sweats on the

discomfort of the hypochondrium.

palms. Poor sleep. Occasionally soft stools. Thin

Pattern: Spleen – stomach deficiency -> phlegm,

and weak pulse, the tongue being pale red with aupward harassment of wind phlegm

thick, greasy white fur, stickiness within the mouth.

Prescription: hangebyakujutsutenmato

Engorgement

Following the third day of taking the prescriptionofabdominal wall.

patient

Pattern:reportedly

invigorated.

The

veins.

Abdominal

palpation reveals clapotage and tension of thethe perceived fog in the head cleared and left the
feeling

sublingual

spleendeficiency,qistagnation,

heavyheadedness too improved. She experienced

countercurrent of phlegm

regular bowel movements, became able to sweat

Prescription: bukuryoingohangekobokuto

when bathing and thus felt fine. Temporarily
switching the prescription to ryokeijutsukanto
resulted in recurrences of the headache, regularadministration of hangebyakujutsutenmato twice
daily and an additional dose when symptomaticallowed to control the symptoms and the patient iscurrently continuing this schedule. The patientreported that taking the medication helps to brace
her physically and makes her feel lighter both
physically and mentally.

Course:She started to enjoy her meals, the severity of theheadaches decreased and often she even forgot
about them. No use of analgesics. Use of single
doses of goreisan produced marked relief in case shehadaheadache.

Later,

targeting

the

easy

fatigability, xerophthalmia, poor sleep and the skin
symptoms her condition improved using a combinedprescription with ninjinyoeito, she could sleep
soundly and the headaches disappeared.

<Tension headache; spleen deficiency, countercurrent

Four years later, after she finally came to termsof phlegm>

regarding the death of her husband and her

Case (2): age 47, female, dental assistantstomach maintained a good functional condition,

Chief complaint: headache, stomach disharmony,treatment with bukuryoingohangekobokuto was

amyloidosis of the skindiscontinued. The nature of her work facilitated theAnamnesis:

development of high tension and easily led to theAfter the death of her husband she became24development of posture induced shoulder stiffness,

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

Volume 6, Number 1 | Spring 2011

which resulted in headaches (dull pain), but sinceFindings:

the condition of her stomach had improved, theFair-skinned obese, normal appetite, sleep andgoreisan had weakened, while
shakuyakukanzoto now had become markedly

excretion. Becomes easily nauseated. Her condition

effective. It turned out to be a medication, which in

was enlarged, pale white, had teeth marks,

single doses provided refreshing relief and bestowed

sublingual veins had disappeared, the pulse wasupon her a feeling, as if the neck were straightening

deep and thin, the abdomen showed a generalized

and sometimes even extended to the head.

hardness and was mildly tender, there was fullness,

effectsof<Tension headache; spleen deficiency, cold phlegm,
blood deficiency >Case (3): age 40 years, female. Assistant in former
family business (restaurant)

used to vary with the menstrual cycle. The tongue

tenderness or discomfort of the hypochondrium andchilliness of the lower abdomen.
Pattern: blood deficiency, phlegm
Prescription: ryokeijutsukanto plus tokishakuyakusan

Chief complaint: headache, anxiety

Headaches tended to become worse during theAnamnesis:

latter half of the menstrual cycle and the lingual

At the age of 20 iron deficiency anemia (shefindings too suggested the necessity to take blood

sometimes takes iron supplements)

deficiency into account, but since the so far

At the age of 37 hypertension (initiation ofprescribed ryokeijutsukanto could not be expectedantihypertensive pharmacotherapy)toPresent illness:

tokishakuyakusan was added. After the ingestion

have

any

blood

supplementing

effects,

From the age of 38 her nervousness increased, amarked improvements were observed and four days

sense of her body floating and palpitations

later the symptoms had disappeared. Later, while

appeared;type

the dose was adjusted according to the findings,

tranquilizers 2 to 3 times a day; from the age of 39

after continued treatment using the combined

she took ryokeijutsukanto for about one year after

formulation with tokishakuyakusan the headaches

which the symptoms had almost be alleviated. The

did not occur any longer.

she

used

benzodiazepine

use of western medications was reduced to about

And yet, severe headaches occurred on days

once per month for preventive purposes and she

typhoons hit the country and on these occasions thestarted to work as a kindergarten assistant. Yet,patient complained, that she would on the contrary

she used to complain about headaches lasting 2-3

like to cool her head. The body felt hot and she

weeks. The headaches were located on the foreheadbecame restless and nervous. Originally she did not

like a headband, producing a pain as if thislike the summer. senkyuchachosan was prescribedheadband were tightened, so that she used to press

and had marked effects, leaving her feelingdown on the painful areas while taking deep

refreshed and comfortable.

breaths and reported that warmth provided some

After

that

the

administrationofincreased in the evening with increasing fatigue.

tokishakuyakusan from autumn through spring
and a combined formulation with senkyuchachosan

On this occasion the symptoms had appeared 5 days

from the rainy season through summer prevented

ago on the last day of her menstruation.

aggravation of the headaches and stabilized therelief of the symptoms. Severity of the symptoms

patient both physically and mentally.

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

25

Volume 6, Number 1 | Spring 2011

Front Line of Kampo Pharmacology
Review 1 of Pharmacology-related Academic Meetings

used as a crude drug. And they brought out thefinding that several horticultural varieties can be

Toshiaki Makino, Ph.D.

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

applied to medicinal uses.
Research of the origins of crude drugs

This series will introduce the recent research andAsahina, et al. of Ochanomizu University tried tostudies relating to Kampo medicines presented at

identify the origin of Sekkoku being distributed as aacademic conferences. The second installment of thecrude drug on the markets in China and Hong Kong

series provides the presentations made at The 57th

and clarified that most of Sekkoku available in the

Annualofmarkets originate from the root of Dendrobium

Pharmacognosy held in Tokushima in September
2010.

officinale and some originate from the root of D.
devonianum.

Research for quality preservation of crude drugs andOoi, et al. of Kanazawa University studied on thetheir discrimination

origin of “the root of Hedysarum polybotrys (Shingi

MeetingofJapanese

Societyin Japanese name)” from its growing areas in
Shimura, et al. of Mie Prefecture Health andmainland China and by referring to documents andEnvironment Research Institute reported that they

have clarified that a certain volume of Hedysarum

have developed a method of analyzing ephedrine

polybotrys (Fabaceae) has been used as Astragalus

species

Rhizome since the period of North and South

contained

inover-the-counter

Kampo

extracts and established a HPLC analytical methodtoefficiently

isolateandpseudoephedrine,

quantify

ephedrine,

norephedrine

andDynastie.
Study on the cultivation of crude drug materials

methylephedrine.
Kabau, et al. of Kochi University reported that they
Wakaba, et al. of the National Institute of Healthhave established conditions satisfying the Japanese

Sciences reported that metabolome analysis using

Pharmacopia standards for the cultivation, in Kochi

1H-NMR

correctly

prefecture, of Atractylodes lancea for the use as thediscriminating Pinellia Tuber from Arisaematis

raw material of a crude drug Sojutsu, (Atractylodes

Rhizoma, both of them have very similar outward

Lancea Rhizome).

isausefulmethodforappearances.
Basic pharmacological study on crude drugs andKobayashi, et al. of Osaka University reported that

Kampo medicines

matabolome analysis by UPLC-TOF-MS and GCTOF-MS is an effective method for identifying the

Chiba, et al. of Kitasato University obtained

original plant of Japanese Angelica Root.

differences of traditional usages between Ginger andProcessed Ginger in terms of TRPV1 agonist activity,

Nakamura, et al. of Osaka University reported thatclarifying that although the titers of 6-gingerol andthey have made cluster analysis based on ICP-MS

6-shogaol of guiding components apparently differed,data to study the possibility of substituting

there were no differences as crude drugs.

gardening varieties for the root of Paeonia lactiflora

26

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

Volume 6, Number 1 | Spring 2011

Shimato, et al. of Nagoya City University reported

glucose levels in mice. They also reported theirthat they have investigated differences between

finding that suggests Ginger’s usefulness for

Atractylodes Lancea Rhizome and Atractylodes

metabolic syndrome.

Rhizome based on the inhibition of NO production
from macrophages in the extract prepared from

Morinaga, et al. of Kobe Pharmaceutical University

appropriately DNA-tested 48 plant specimens, with

reported that they have evaluated the analgesic

the results that although there were no differences

action of Belancandae Rhizoma in mice and isolatedinthe active ingredient of hydroxytectorigenin.

pharmacologicaltitersbetweenbetween

Atractylodes Lancea Rhizome and Atractylodes
Rhizome. However, the activity was significantly

Morikawa, et al. of Kinki University reported thatweak in A. ovata, if the discrimination of species wasthey have evaluated the action of Picrorrhizae

necessary, compared to other plant species.

Rhizoma on the inhibition of hepatic impairment inmice

Yasui, et al. of Aichi Gakuin University reported thatandisolatedtheactiveingredientsofplantamajoside and isoplantamajoside.

they have searched for active ingredients of Aralia
Rhizome as a measure of retinoic acid receptor

Joan, et al. of Kyoto University reported that the oralagonist activity and isolated ent-pimara-8(14),15-

administration of Cinnamon Bark powder to micedien-19-oic acid.

withgastric

ulcersinducedbyethanolandhydrochloric acid have shown that Cinnamon Bark
Fukuda, et al. of Pola Kasei Kenkyusho reported
that they have studied PPAR
Coix

Seed

and

isolated

has effects on the prevention of gastric ulcers.

agonist activity of
9-oxo-10(E),12(E)-

Muroga, et al. of Kanazawa University haveevaluated the in vitro anti-inflammatory action of

octadecadienoic acid.

Lycii Cortex and identified active substances of (10E,
Fukai, et al. of University of Toyama reported that

12Z, 15Z)-9-hydroxy-10, 12, 15-octadecatrietic acidthe essence of Bambusae Caulis extracted by the hotthat inhibit the histamine release from basophilicwater extraction method has the action of inhibiting

leukocytes.

viral infection in vitro and polysaccharides are theactive substances.

Yonekura, et al. of Meijo University reported of theinductive action of regulatory T cells of juzentaihoto

Somehara, et al. of Nagoya City University reported(Ten Strong Tonic Herbs Decoction), clarifying thatthat evodiamine contained in Euodia Fructus has

not only CD4+CD25+ T cells but also CD4- cells are

the action of promoting the absorption of glucamine

involved in this action.

in the digestive tract.
Sugimoto, et al. of Yokohama College of Pharmacy
reported that neferine contained in a Nelumbo Seedgives antidepressant actions mediated by theserotonergic nervous system in mice.
Ishida, et al. of Showa University reported of theaction of Ginger on suppressing an increase in blood

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

27

Volume 6, Number 1 | Spring 2011

Medical History in Japan"Historical Significance of the Standardization of Acupoint
Locations“, the Second Japanese Acupoint Committee (1)Makoto Mayanagi

Graduate School of Humanities
Ibaraki University

Makoto Mayanagi "Historical Significance of theStandardization of Acupoint Locations", thesecond Japanese acupoint committee "Detailed
Guide to the Location of Acupoints" from theclassics to the WHO standardization", pp 411-422,
Tokyo, Ishiyaku Publishing, June 2009 (partiallyrevised)The historical significance of the present day
will only be known in the future. Nevertheless bygoing back into history it should be possible tocatch a bird's eye view of the historical role of thestandardization of acupoint locations made on thisoccasion.
In the past acupoints were standardized threetimes. The first time was approximately during
the first century and constituted standardization
on a "conceptual level". This had the common
purpose of a conceptual clarification of themeaning of meridians (channels) as prerequisite
for acupoints and the very nature of acupoints
themselves. The second standardization in thesecond century represented a unification andstandardization of various ideas about meridians
and acupoints that hat sprouted from the firststandardization on a "theoretical level". The third
standardization occurred after acupuncture andmoxibustion therapy has spread all over China in
the 11th century and the Chinese government
realized the necessity of a support for this usefultherapy,leadingtoaunification
andstandardization on a "national level".
These first to third implementations werestandardizations based on the subjective views of
one or several scholars. And today, at a time when
acupuncture and moxibustion is about to assume

28

a role in the medical care worldwide, based onmodern scientific views, a standardization
allowing an objective verification was needed. And
that is precisely the nature of the current
standardization. Historically the fourth of its kind
it probably can be designated as an objective
standardization on a "global level".
Based on the above I would like to trace thehistory of the discovery of meridians, acupoints
and their changes, as well as the standardization
process.
1 Meridian concepts and moxibustion treatment
prior to the second century BC[text excavated from the Mawangdui tomb]

Figure 1 足臂十一脈灸経 Zubi Shiyi (11) mai Jiujing

The oldest firmly established text pertaining
to meridians is not a text that has been handed
down above ground, but has slept under ground
until its excavation. The tomb No. 3 site of
Mawangdui in Hunan province in China, in theoutskirts of Changshayao is the site of the
excavation of a group of medical texts. One ofthese has been written on a silk cloth and named
after its excavation the "『足臂十一脈灸経』. Figure
1 shows that it was written in the seal-engravingstyle of writing Chinese characters and is a text
dealingwithmoxibustion

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

treatmentof11Volume 6, Number 1 | Spring 2011

meridians on the arms and legs, but its content

have been transcribed sometime between the Qin

antedates

dynasty and the early Han dynasty, so that thethecontents

ofthechapteron

inception of the content probably goes back to pre-meridians (jing mai) in the Ling Shu.
These

characters

are

today

completely

deciphered [1]. For example, the first line in

Qin times.
These Mawangdui medical texts offered the

Figure 1 can be interpreted as "The greater yangfollowing

warm (meridian) begins at the hollow of thecorresponding to the five viscera and six bowels of

external malleolus ...". However, in the underlined

later generations were recognized, but no vessels

character "warm" the portion meaning "speak"corresponding

may actually represent "eye" and therefore

meridian, conception and governor vessels areinterpreted as the character for (blood) vessels or

mentioned. In other words, the twelve meridians

meridian (mai). This section corresponds to thefor six viscera and six bowels described in the"The greater yang meridian ... (and its branching

chapter on meridians in the "Ling Shu" arevessels) ... behind the external malleolus ..." part

apparently a concept of later ages. While there areappearing in the chapter on jing mai in the Ling

many entries pertaining to moxibustion treatment,

Shu.

Further, line 5 shown in Figure 1 denotes

indicating "use moxibustion on the greater yin"The lesser yang (warm) meridian of the footmeridian of the foot for all kinds of diseases", nooriginates in front of the malleolus ..." and this

acupoint locations are given. Moxibustion wascorresponds to the "The lesser yang gallbladderapplied mainly on the hands and feet only, but

meridian ... (and its branching vessels) ...

seemingly not on the torso. Needling methods

originates in front of the malleolus ..." partwere not mentioned either.

appearing in the chapter on jing mai in the Ling

insights.

toFirst,

the11

modernmeridians

pericardium

In other words, the meridian concept was

Shu. The "Ling Shu" was thought to be a forgedpresumably

text from the later period of the Qing dynasty, but

discovered later. These texts also suggest that

this example here clearly provides its firmly

moxibustion treatment based on this meridian

established evidence.

concept had been developed first and acupuncture

Moreover, not only the 『足臂十一脈灸経』, butdeveloped

first

and

acupoints

only later.

also the texts named the first and second volumeof the "Yin-yang shih-yi mo-chiu ching" and[Origin of moxibustion treatment]materials of similar contents have been unearthedWhy has moxibustion been developed firstsimultaneously with aforementioned silk texts [2].

and has mugwort (Artemisia princeps) been used?

These Mawangdui medical texts have been burial

Professor Jianmin Li from the Academia Sinica inaccessories for a woman who died a few years

Taiwan has focused on the employed ignition

before 168 BC. The woman's body had not been

method [3]. In other words, in China mugwort has

decomposed and was unearthed as a still moist

customarily been used since ancient times as acorpse, suggesting that it had been buried

fumigation smoke to drive away evil qi and since

immediately after death and therefore themugwort contains a lot of essential oils, it easily

Mawangdui medical texts also had remained

ignites. For that reason the focus of round carved

buried since the second century BC. Yet, theice lenses has been used to ignite the mugwort.

characteristics of the ideograph form used in theThis ignition technique has been used since

Mawangdui medical texts suggests, that theyancient times.

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

29

Volume 6, Number 1 | Spring 2011

Adding the authors own conjectures, amongexcavated, the body of which is painted in black

the various ignition methods since ancient times

lacquer [4]. Judging from the coins excavated at

this method was probably considered to be

the same time allows to infer that the burial took

strongest in its yang nature, since the sunplace between 179 and 141 BC. As Figure 2 shows,provided the source of the ignition. On the other

there are on the body surface 9 pairs of

hand,

gradually

symmetrical lines running up- and downward as

decreases over time and at the end of this process

well as a midline on the back drawn in red

death is recognized. This was considered to belacquer. However, no markings or characters thatcaused by evil qi. In other words, because evil qi

might denote acupoints are found. Althoughdeprives the body of its temperature, it has beeninterpretation of these red lines as blood vessels

thought since ancient times to be a form of yin qi.

may not be impossible, there is no vessel in theIthecenter of the back, so that these lines indicate

interpretation that mugwort was ignited by themore likely meridians than blood vessels. If thatsun to expel the evil qi and the elimination of yin

is so, the central line on the back conceivably

qi using this yang qi led to the development of

indicates the governor vessel and the other 9

moxibustion treatment.

lines the three yin and three yang vessels of thehumanbelievebodytherefore

temperature

that

this

justifies

hand and the three yang vessels of the feet. It[Excavation of dolls in Mianyang]should be noted then, that there are no three yin
vessels of the feet.
The above mentioned Professor Jianmin Li
also directed his attention to the drawn governor
vessel that is not correlated to the viscera andbowel concept and discussed in detail the originof this governor vessel. I can add my own
speculations to this. The part of the body surface
most resistant when exposed to cold is the face,
so that the face was envisioned as of an area
where yang qi accumulates. For this reason all
the yang meridians gather on the face, whileconversely the yin meridians follow a course
gathering in yin areas. On the other hand,human (male) external secretions apart from theexcretions are saliva from the mainly yang mouthand semen form the mainly yin reproductive
organs. For that reason the concept that large

Figure 2 Wooden black lacquer doll (early Han period)

On the other hand, from a grave dating backto the early Han period in the city of Mianyang of
Szechuan province a wooden doll has been
30

amounts of secreted saliva flow via the spinal
cord, that is the governor vessel, into yin regions
to supplement semen has also been formed inancient times. The concept that the governor
vessel is the route for the circulation of saliva and

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

Volume 6, Number 1 | Spring 2011

semen is correlated to the origin of thedevelopment of Taoist sex practices (fang shi) or
the gymnastic breathing exercises called "guiding
and pulling" (Tao yin) and later the governor
vessel was considered to be of great importancefor the Taoist sex practices and the guiding andpulling exercises.
Moreover, on this figure no lines were drawn
for the conception vessel and the three yin
meridians of the foot. The conception vessel is a
meridian also related to pregnancy and sinceancient times there seem to have been the conceptthat viewed the conception vessel as a meridian of
women. And since all of the six yang meridians,
the governor vessel and the three yin meridians on
this figure are strongly yang in nature, Professor
Jiro Endo of Tokyo University of Science suggested,that the figure probably represents a male.

iKasper D. L., Braunwald E., Hauser S., Longo D., Jameson
J. L., Fauci A.S. : Harrison's Principles of Internal
Medicine, 16/e, n.p. : McGraw-Hill Professional, 2004.
p.1335.
ii
Rubenstein J.J., Schulman C.L., Yurchak P.M.,. DeSanctis
R.W. : Clinical spectrum of the sinus syndrome. Circulation,.
1972; 46 : 5-13.
iii
Peters R. W., Vijayaraman P., Ellenbogen K.A. :Indications for permanent and temporary cardiac pacing.
(Edited by Ellenbogen K.A. and Wood M. A. : Cardiac
Pacing and ICDs, 5th edition.), n.p. : Blackwell Publishing,[Development and fusion of the meridian
concepts]
Based on the above description it seems that
there have been different concepts regarding theorigin of the conception vessel, governor vesseland 12 regular meridians of the six viscera and six
bowels. The 11 meridians recorded in the medical
texts of the Mawangdui correspond to five visceraand six bowels and are considered to be a concept
designed for therapy. Thus, the 12 regularmeridians of the six viscera and six bowels havedeveloped during later ages. On the other hand,the figure from Mianyang reveals the initialstages of a combination of the concepts pertaining
to the conception vessel and governor vessel
through the Taoist sex practices in correlation to
reproduction and birth with the yin and yang
meridians. In the various chapters of the "Su Wen"and "Ling Shu" the main differences in the dialog
represent differences among schools and since
several school regarding the meridian concept
were established, their fusion undoubtedly
proceeded along several distinct stages.

2008. 17-21.
iv
Libby P., Bonow R.O., Mann D. L., Zipes D. P. :Braunwald's Heart Disease: A Textbook of Cardiovascular
Medicine, 8th Edition: n.p. : Saunders, 2007. 831-835.
(CHAPTER 34 – Cardiac Pacemakers and CardioverterDefibrillators(Hayes D. L., Zipes D. P.) Indications for
Cardiac Pacing)v
Kodama I, Aizawa Y, Inoue H, et al. : Guidelines for Drug
Treatment of Arrhythmias (JCS 2004) Circulation Journal
2004; 68(Suppl IV): 981-1053.)
vi
The Journal of Kampo, Acupuncture and Integrative

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

31

Volume 6, Number 1 | Spring 2011

Medicine 2005;1Special Edition:12 (Originally Terasawa
Katsutoshi :Shorei-kara-manabu, Wakan-shinryo-gaku, 1stedition. Igaku-shoin, Tokyo, Japan. 1990,1-300. [寺澤捷年：
症例から学ぶ和漢診療学, 医学書院, 東京, 日本1998；
1-300])
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The Consensus Committee of the American Autonomic
Society and the American Academy of Neurology. :Consensus statement on the definition of orthostatic
hypotension, pure autonomic failure, and multiple system
atrophy. Neurology 1996;46:1470.
viii
ACC/AHA/NASPE 2002 Guideline Update for
Implantation of Cardiac Pacemakers and Antiarrhythmia
Devices: Summary Article
A Report of the American
College of Cardiology/American Heart Association Task
Force on Practice Guidelines (ACC/AHA/NASPE
Committee to Update the 1998 Pacemaker Guidelines) This
document was approved by the American College of
Cardiology Foundation Board of Trustees in September 2002,
the American Heart Association Science Advisory and
Coordinating Committee in August 2002, and the North
American Society for Pacing and Electrophysiology inAugust 2002. Committee Members: Gabriel Gregoratos,
Jonathan Abrams, Andrew E. Epstein, Roger A. Freedman,David L. Hayes, Mark A. Hlatky, Richard E. Kerber,
Gerald V. Naccarelli, Mark H. Schoenfeld, Michael J. Silka,
Stephen L. Winters, (Circulation. 2002;106:2145.)
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Circulation Journal 68(Suppl IV): 981-1053, 2004.
(Kodama I, Aizawa Y, Inoue H, et al. : Guidelines for Drug
Treatment of Arrhythmias (JCS 2004) Circulation Journal
68(Suppl IV): 981-1053, 2004.)x
Li-Zhong-Zi “Yi-Zong-Bi-Du(Essential Readings from
the Medical Tradition)”(Mai-Fa-Xin-Can), Beijing: People’s
Medical Publishing House, 2006, 1-464. [李中梓：醫宗必

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讀, 人民衛生出版社, 北京,中国 2006. 1-464.)「脈遲為寒當用乾薑附子溫之矣(p.66)」
xi
Mitchell C., Feng Ye, Wiseman N.: Shang-Han-Lun: On
Cold Damage. Brookline, Massachusetts, USA:Paradigm
Publications,1999, 1-800.
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Sung Yuk-ming.: Understanding the Jin-Gui-Yao-Lue.
Beijing, China:,2009, 1-726.
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Ebe Y. , Yokota S. : Keihou-igaku; six-channel patternindication (1), Toyo Gakujutsu Shuppansha, Tokyo, Japan,
2000, 1-212. [江部洋一郎、横田静夫：『経方医学〈1〉「傷寒・金匱」の理論と処方解説 第2版』東洋学術出版社, 2000, 1-212. ]xiv
Becker S., Flaws B., Casañas R. : The treatment ofcardiovascular diseases with Chinese medicine. Boulder,
Colorado: Blue Poppy Press, 2005. 1-638.
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Sato Y., Hanawa T., Arai M., et al. (eds.):. Introduction to
Kampo : Japanese traditional medicine / [by] the Japan
Society for Oriental Medicine. Tokyo : Elsevier Japan, 2005.
1-286.
xvi
Varriale P., Mossavi A.: The benefit of low-dose
dopamine during vigorous diuresis for congestive heart
failure associated with renal insufficiency : Does it protect
renal function?
Clinical Cardiology 1997; 20(7):627630.
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Khare C.P. (ed.): Indian Medicinal Plants:An illustrated
Dictionary, Berlin/Hidelberg : Springer-Verlag, 2007. 1-900.

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