KAIM
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INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 11, Number 4 ･ Winter 2016

Editorial

WFAS Tokyo/Tsukuba 2016
President Message
Shuji Goto

Introduction to WFAS Tokyo/Tsukuba 2016

Conference Information

Integrating Kampo and Evidence-Based Medicine (8)The Efficacy of Daiobotanpito against Colon Diverticulitis
Hiromichi Yasui

Clinical Report 1 (Acupuncture)
Dropped Head Syndrome
Masanori Takashi and Katsuhiko Arai

Clinical Report 2 (Kampo Medicine)

Case of Effective Administration of Saikanto for Left Chest Pain
Keiko Ogawa-Ochiai

ISSN:1559-033X

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

―

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

Volume 11, Number 4 ･ Winter 2016

EXECUTIVE EDITOR

Shuji Goto
Chairman, GOTO College ofMedical Arts & Sciences

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

Tokyo, JapanEXECUTIVE EDITOR

Shuji Goto
Chairman, GOTO College ofMedical Arts & Sciences

1 Editorial
WFAS Tokyo/Tsukuba 2016
President Message
Shuji Goto

Tokyo, JapanASSOCIATE EDITORS
Shuichi Katai
Ibaraki-ken, Japan

3 Introduction To WFAS Tokyo/Tsukuba 2016
Conference Information

Hiromichi Yasui

Editorial Staff

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

PUBLISHER

Shuji Goto
International Institute of Health andHuman Services, Berkeley

8 Integrating Kampo and Evidence-Based Medicine (8)The Efficacy of Daiobotanpito against Colon Diverticulitis
Hiromichi Yasui

13 Clinical Report 1 (Acupuncture)
Dropped Head Syndrome
Masanori Takashi and Katsuhiko Arai

16 Clinical Report 2 (Kampo Medicine)
Case of Effective Administration of Saikanto for Left Chest Pain
Keiko Ogawa-Ochiai

2550 Shattuck Avenue, Berkeley
California 94704-2724, U.S.A.

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

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

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

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

Volume 11, Number 4 | Winter 2016

Editorial
Annoucement of WFAS Tokyo/Tsukuba 2016
President Message

The Art of Acupuncture and Moxibustion– For sustainable health care and health promotion

Shuji Goto, President of WFAS TOkyo/Tsukuba 2016

The history of acupuncture and moxibustion reveals their development based on tradition andinnovation. During the Neolithic era the Henseki was invented in China. The Henseki is said to be one of
the first hand-made medical tools used to fight some forms of illness developed through creative
imagination. As civilization advanced through the Bronze and Iron ages, the treatment and tools ofacupuncture were developed in accordance with timely innovations. Acupuncture was a practical andeffective medical treatment at that time. As civilization moved forward it continued to be improved.
Knowledge and information of treatment and care experience accumulated for many centuries has
been analyzed and eventually systematized as an oriental medical philosophy. It deals with the quest andsearch of the substance of life even in science and philosophy in the field of space physics. As we look
into the development and innovation of its treatment skills, theories and tools we consider the relationshipof nature, the social environment and the balance of illness and health.
Today acupuncture medicine is spreading as an integral part of integrated medicine which requires
close collaboration with western medicine. Oriental medicine is now known to be useful in the fields ofdisaster emergency care, care for the aged, terminal care, preventive medicine and the overall health ofindividuals.
Acupuncture medicine, as one of the oldest forms of medical treatment, has continued to develop
and is widely accepted worldwide. Its focus on the latest notion of a healthful life makes a definite
contribution to the wide diversity of different cultures.
The future of acupuncture medicine will continue to develop while calling on us to solidify theconnections between life, survival and health care. These actions will continue to sustain the value of
acupuncture as a positive medical resource. We should not limit ourselves in the framework of tradition
itself. We must stay flexible as we deal with changes in medicine and social development while showing
our dynamic contribution to the model of sustainable health care.

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

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Volume 11, Number 4 | Winter 2016

The “Art of Acupuncture and Moxibustion” has for many centuries helped sustain the shining
power of life. The “Art of Acupuncture and Moxibustion” lives on with a very bright future.
In accordance with the above themes we are striving and expecting to make this coming academic
conference in Japan after 23 years absence so fruitful and meaningful to every participant.
The renowned beauty of autumn leaves of November will also await your visit with cordial welcome.
Hoping to meet everyone of you there.

2

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

Volume 11, Number 4 | Winter 2016

IntroductionTo
WFAS Tokyo/Tsukuba 2016

Conference Information
Date: November 5 - 6, 2016
Venue: Tsukuba International Congress Center
Address: 2-20-3, Takezono, Tsukuba, Ibaraki, 3050032, Japan
Tel: +81-29-861-0001／Fax: +81-29-861-1209
Organized by:
The Japan Society of Acupuncture andMoxibustion (JSAM)
The Japan Traditional Acupuncture andMoxibustion Society (JTAMS)
Official Language: English, Chinese, Japanese

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

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Volume 11, Number 4 | Winter 2016

Keynote Speakers
Prof. Baoyan Liu(President, World Federation of
Acupuncture and Moxibustion
Societies, China)“The Past, Present and Future of
Acupuncture and Moxibustion of
TCM”

Prof. Yoshinori Hiroi(Professor, Kokoro ResearchCenter, Kyoto University, Japan)“Sustainable Health Care and the
Expectations to Integrative
Medicine, Acupuncture andMoxibustion”

Prof. Tadashi Yano
(Professor, Meiji University ofIntegrative Medicine, Japan)“Formation of Japanese
Acupuncture and Role of
Acupuncture in Future Society From the Viewpoints of History,
Education and Research-”

Prof. Caroline Smith(Professor, National Institute ofComplementary Medicine,
University of Western Sydney,
Australia)“Acupuncture as an Adjunct to
IVF Findings from a
Randomised Controlled Trial”

Zen Master Daito Noda
(Zen Buddhism priest, Japan)“Mind of Zen Philosophy and
Acupuncture”

Prof. Toku Takahashi(Professor, Department ofSurgery Medical College of
Wisconsin, USA, Takahashi
Clinic of Integrative Medicine,Japan)“The Role of Acupuncture forDisaster Refugees”

Prof. Kenji Kawakita(Professor, Meiji University ofIntegrative Medicine, Japan)“Characteristics of Japanese
Acupuncture and its Effect on
Bioregulatory Systems”

4

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

Volume 11, Number 4 | Winter 2016

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Hari-Kyu (acupuncture-moxibustion) Technical Sessions
From Head to Toe: Understanding the true spiritof Meridian Therapy
Akizo Okada (Traditional Japanese Medicine)
Denmei Shuto (Traditional Japanese Medicine)
Shonishin (Japanese Pediatric Acupuncture)
Masanori Tanioka (Daishi-Style Shonishin
Association)
Parent-child skin touch therapy –The project forthe spread of pediatric acupuncture–
Shinsaku Shinohara (Japanese Skin Touch
Therapy Conference)
Acupuncture treatments for sports injury of youth
athletes –the effectiveness of Acu-Zone therapy–
Takeshi Komatsu (California Sports Medicine
Center)A moxibustion technique, "Shiunko-Kyu" for lower
back pain
Matsue Kosiishi (Koshiishi Shinkyuin)
Maternity Acupuncture; Our new combined
methods for Mother-Baby BondAki Fujiwara (Tenshi no Tamago group)
The treatment to the infertility female byacupuncture and moxibustion and a self
moxibustion
Keiko Tsujiuchi (Serie Acupuncture andMoxibustion Clinic)
Acupuncture for mood disorder based on the Kstyleacupuncture score (KSAS)
Arata Ito (Kanagawa Psychiatric Center)
Skills of nine classical needles -shear needle •spoon needle • round-pointed needle The theory
and techniques
Katsumi Ishihara (Tokyo Kyuushin Kenkyuukai)
Meridian-based Cosmetic Acupuncture
Yoko Ooasa (Shikoku Medical College)
Ryodoraku treatment to the complaint diagnosedof middle-aged patient
Kimiya Goto (The Japanese Society of Ryodouraku
Medicine)

Multiplication of skills: Introducing Sugiyama
style Fukushin, Sugiyama Shinden style Kanshin
methods
Syungo Matsumoto (Koshinkai, a society for thestudies of acupuncture, moxibustion andmeridian)
The World of Dashin (Needle Tapping)
Renpu Fujimoto (General Incorporated Association
Hokushinkai)
Using Shōni-hari for Atopic dermatitis and otherdiseases for children
Etsuko Inoue (Nihon Shounihari Gakkai ; The
Japan Society of Pediatric Acupuncture)
Nagano Method: Treating shoulder stiffness
Koji Nagano (Nagano method clinical study
society)
Approaches to patients with gastrointestinal
weakness by Jingei-Kikou method
Souji Toyabe (Tokyo Kyuushin Kenkyuukai)
Acupuncture & Moxibustion Treatment for "Wind"
Illnesses caused by External Pathogens–The different approaches for Yang Excess andYang Deficiency–
Keiko Murata (THE NEW JAPANESE MEDICALASSOCIATION (Shin-I-Kyo))
Wisdom of Japanese Acupuncture and Moxibustion Elaboration and Development
Renpu Fujimoto (General Incorporated Association
Hokusinkai)
Shinpu Fujimoto (General Incorporated
Association Hokusinkai)
Trigger Point Acupuncture Treatment for Myofascialpain syndrome (MPS) and fibromyalgia (FM)Kazunori Itoh (Meiji University of Integrative
Medicine)
Effects of acupuncture on primary headache:
Targeting muscles, peripheral nerves, andintervertebral joints
Satoru Yamaguchi (Saitama Medical University)
Acupuncture moxibustion treatment for life stylediseaseKoryo Nakada (Toyo Hari Medical Association)

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

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Volume 11, Number 4 | Winter 2016

Acupuncture or electroacupuncture treatment for
low back pain and lower limb symptoms;
Introduction to treatment methods andexplanations of clinical and basic data
Motohiro Inoue (Meiji University of Integrative
Medicine)
Acupuncture for knee pain in middle age, ananatomical point of view
Tomofumi Ozaki (The Japan Conference ofClinical Acupuncture and Moxibustion)
Acupuncture treatment for stroke patients in
Korea

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Yong-Suk Kim (Kyung Hee University)
A Pain in Various Places of a Senior's Body
Shoji Kobayashi (Shakuju Association)
Palliative Care and Acupuncture
Hiroko Ono (Tohokai)“San Jiao” acupuncture method and cognitive
impairment
Jing-xian Han (First Teaching Hospital of Tianjin
University of Traditional Chinese Medicine)

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Hari-Kyu Scientific Sessions
1. Pleasantness in acupuncture therapy -Role of C
tactile afferents and rewarding systems
Pleasantness and touch - a microdialysis study ofneurotransmitter release in the brain
Mieko Kurosawa (International University of
Health and Welfare)
Pleasantness and touch-a f-MRI study (tentative
title)
Masahiro Umeda (Meiji University of Integrative
Medicine)

Younbyoung Chae (Kyung Hee University)
2. Treatment of tuberculosis using directmoxibustion: Prof. Shimetaro Hara and MoxAfrica
Medical Research on Moxibustion
Hiroshi Hara (Haradoi Hospital)
Does Japanese research from the pre-antibiotic
era give us real clues how a deadly drug-resistantplague might be more usefully fought in a
postantibiotic one?
Merlin Young (MoxAfrica)

The role of touch in acupuncture treatment

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Special Sessions
Japanese acupuncturist in overseas: How they have become successful
Goals and Ambitions of Publishing the North
American Journal of Oriental Medicine (NAJOM)–A Japanese/English Journal on Japanese
Acupuncture and Moxa–
Junji Mizutani (NAJOM Director/Publisher)
Japanese Acupuncture on Brazil
Yoshihiro Odo (Shinkyu Dojoh)

Japan acupuncture practiced in Portugal –Acupuncture treatment for intractable diseases–
Mitsuharu Tsuchiya (CLINICA TSUCHIYA)
Traditional Medicine and Acupuncture in SouthEast Asia
Tadanori Takada

30 years of the History of Oriental medicine in
Nicaragua
Haruo Yamaki (Rector of the Japan - Nicaragua
Oriental Medical University)

6

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

Volume 11, Number 4 | Winter 2016

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Oral / Poster Sessions
Oral: 90 sessions
Poster: about 240 sessions (tentative)

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Morning “Zazen” (meditaiton) Session
Zen Master Daito Noda, one of the Keynote speakers, will coach this session.

Post-conference Event in Tokyo (technical demonstration andtraining of Japanese acupuncture and moxibustion)
The session will be carried out for a small group of participants. If there are many applications, overseas
participants will be given priority. Please note that participation only in this Post-conference event is notpossible: conference registration is required. Please see
http://www.wfasjapan2016.org/program/post_conference.html
for more details.

For those who are interested in WFAS Tokyo/Tsukuba 2016, please
visit:
http://www.wfasjapan2016.org/program.html

Here is another facebook site you may be interested for more
information:
https://www.facebook.com/wfas.tokyo.tsukuba2016.en/

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

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Volume 11, Number 4 | Winter 2016

Integrating Kampo and Evidence-Based
Medicine (8)The Efficacy of Daiobotanpito against Colon Diverticulitis
Hiromichi Yasui
Japan Institute of TCM Researchtenderness also in the paraumbilical area. No
suspicion of peritonitis, such as rebound tenderness
or muscular defense.
Non-contrast abdominal CT: There is marked
thickening and fecal calculus in the ascending colon

Professor Keiko Ogawa of Kanagawa University

wall and an inflammatory change in the surrounding

Hospital is a pediatric surgeon, but she treats a wide

tissue. The appendix can be seen away from therange of diseases as a specialist of Kampo medicine

center of the inflammation.

today, and is now an indispensable presence to thehospital. She is a precious friend of mine, and we
often mutually share our experiences.
In a seminar held in 2016, she presented an
extremely interesting case1). It was a case in whichcolon diverticulitis was treated with a decoction of
the Kampo drug daiobotanpito, in addition to an
antimicrobial. The case is introduced below.
Case report
Case: 35-year-old woman
Past medical history, family history: None inparticular

Photo 1

History of present illness: After giving birth, thewoman experienced no abnormal progress inparticular, but a condition of poor bowel movement
continued. Around three weeks after giving birth,
her poor bowel movement worsened, and her entire
stomach felt heavy. It did not improve even when she
took a Tokakujokito extract. From a little past noon,
she began to feel sudden pain in the right lower
quadrant.

The

pain

intensified,andbecameexacerbated when she walked.
Present condition: Height 166cm, weight 54kg, bloodpressure 110/60mmHg, body temperature 38.7°C
Pulse pattern: Moderately floating and sinking but
excessive, somewhat rapid, string-like, somewhatsmoothTongue pattern: Red, covered with a slight whitecoating
Abdominal

pattern:

Intermediate

abdominal

strength, strong tenderness from the right side of theileocecal
8

area

to

the

right

lower

quadrant,

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

Photo 2Volume 11, Number 4 | Winter 2016

The bold treatment surprised the audience who

Diagnosis: Colon diverticulitis
Treatment:

listened to this report. The standard treatment for1st day: Immediately after diagnosis, a decoction ofcolon diverticulitis, which presents acute symptoms

daiobotanpito(Cortexsuch as abdominal pain and fever, is through fasting

Moutan) 4.0g, Tonin (Semen Persicae) 4.0g, Togashi

or intravenous antimicrobial therapy, and requires(Semen Benincasae) 4.0g, Bosho (Natrii Sulfas)

hospitalization in most cases. It therefore drifted

4.0g, Daio (Radix et Rhizoma Rhei) 2.0g).

through the minds of the audience that treatment

At 8 p.m., the patient took a dose of thethat relies on Kampo may be dangerous.

was

prepared(Botanpi

Seeing everyone’s reactions, Dr. Ogawa smiled

daiobotanpito decoction.
Around 11 p.m., she passed a large amount of stool

and said as follows: “Actually, the subject of this casethat she had not passed during the past severalis me.” She had used her own body to monitor thedays. Body temperature of 37.3°C.

efficacy of Kampo medicine. As an outstanding

The pain in the right lower quadrant decreased insurgeon, Dr. Ogawa had monitored her own clinicalfrequency and intensity, such that she rated it a 4/10

condition with conviction, but to those of us in theon the Numeric Rating Scale (NRS).

audience, it was a surprising case presentation.

2nd day: The patient underwent abdominal echo and

The case is highly instructive.

CT inspections. Her appendix was 6.5mm and wasFirst, Dr. Ogawa received an intravenous drip

slightly swollen, but the layer structure wasinfusion of an antimicrobial, the standard treatment,

maintained. Body temperature of 37.3°C. WBC 9700,

but without being hospitalized. There was no need

neutrophil 76%. CRP 5.6.

for her to be hospitalized. As a result, her treatment

A 1g intravenous drip of the antimicrobial CEZ wasperiod was able to be shortened compared to the

begun. Daio was increased to 3g/day.

average length of treatment, and she was able to3rd day: Daio was increased to 4g/day. Two bowel

resume breastfeeding quickly. This was possible

movements. Regular stool.

because Dr. Ogawa was thoroughly familiar with the

4th day: Daio was increased to 6g/day. Three bowel

disease, and she knew fully the efficacy of standard

movements. Slightly loose stool.

treatment and the potentials of Kampo medicine.

The jarring pain that accompanied movement

After the above experience, Dr. Ogawa thought

disappeared, but there was a slight tenderness in thethat using daiobotanpito for colon diverticulitis

right lower quadrant.

would be useful to many patients, and thus carried

The antimicrobial was terminated.

out a clinical study with her surgeon colleagues at

6th day: Body temperature of 36.0°C, three bowel

the Japanese Red Cross Kanazawa Hospital. The

movements, loose stool.

study was published in e-CAM under the title,

Only an extremely slight tenderness remained in the“Effectivenessright(Kampo) Medicine, daiobotanpito, in Combination

lower

quadrant.

Thepatient

resumedof Traditional

Japanese

Herbalbreastfeeding.

with Antibiotic Therapy in the Treatment of Acute7th day: Three bowel movements, diarrheal stool.

Diverticulitis: A Preliminary Study”2).

Daio was decreased to 5g/day, and the abdominal

Let me introduce the paper below.

tenderness disappeared.
8th day: The drug was terminated, and treatment
was completed.
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

9Volume 11, Number 4 | Winter 2016

An examination of the progress of treatment

The study by Dr. Ogawa et al.
Dr. Ogawa et al. visited the Japanese Red Cross

among cases in which conservative treatment was

Kanazawa Hospital from January 2010 to Marchsuccessful showed that the number of days until the2012, and studied 34 patients who were diagnosed

patient’s fever subsided was 2.3 days in thewith acute colon diverticulitis. The patients were an

daiobotanpito

average age of 45.1 years (ages 22 to 79), andsignificantly shorter than the 3.4 days in the non-consisted of 28 men and 6 women. 28 patientsadministration group. The number of days until thesuffered colon diverticulitis in their right quadrant,

patient’s

and 6 in their left quadrant.

disappeared was 4.8 days in the administration

administration

abdominal

pain

group

and

and

tenderness

Diagnosis was based on physical findings andgroup and significantly shorter than the 5.8 days incomputed tomography (CT) images. CT findings ofthe non-administration group. The number of days

colon diverticulitis would show a diverticulum-like

until the patient was able to commence meals was

structure in the region affected by abdominal pain

5.1 days in the administration group and tended toand tenderness, as well as a thickening of thebe shorter compared to the 6.1 days in the non-intestinal wall, an increase in the concentration ofadministration group. The number of days until thepanniculitis, an exteriorization of fascia, andpatient was discharged from the hospital was 7.6

accumulation of exudate. The standard treatmentdays in the administration group and tended to be

for acute simple diverticulitis consists of bowel rest

shorter compared to the 9.0 days in the non-(fasting),

administration group.

rehydration,andintravenous

The result of the preliminary study was asadministration of an antibiotic.
The patients who were selected as subjects of thepresented above. As the number of subjects wasstudy were administered an antibiotic until theirsmall, it is difficult to say with certainty, but it

CRP level reached a normal level. Of the 34 patients,

appears that combining daiobotanpito with standard

10

treatment has a favorable effect on mitigating

were

administered

three

days’

worth

of

daiobotanpito 7.5g/dayNote 2. The other 24 composed

symptoms and shortening treatment periods.

a non-administration group.
Of

these

patients,

onepatient

who

was

Daiobotanpito and its indications
daiobotanpito is a prescription that is mentioned

administered daiobotanpito had to undergo surgery

Chapter18

ofKinkiyoryaku(11 days of conservative treatment failed to improveinthe patient’s symptoms, and the patient had

Prescriptions from the Golden Cabinet), a Chinese

intestinal stenosis), and three patients in the non-classic written some 1800 years ago, and intestinaladministration group also had to undergo surgery

welling abscess is purulent inflammation in the(one patient’s symptoms worsened after five days of

abdominal cavity. As this is an ancient concept of theconservation treatment, another patient’s symptoms

disease, it is difficult to identify the modern disease

failed to improve after 18 days of conservation

it corresponds to. However, appendicitis was likely

treatment and the patient had stenosis and abscess,the main lesion.

(Essential

and the other patient’s symptoms failed to improve

The prescription has been used in Japanafter 7 days of conservation treatment and thefrequently since 300 years ago, when the studies ofpatient had abscess).

Shokanron (Treatise on Cold Damage Disorders) andthe above-mentioned Kinkiyoryaku became popular.

10

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

Volume 11, Number 4 | Winter 2016

These medical texts contain diverse case reports,
including not only intra-abdominal inflammation,
but also rectovaginal fistula, perianal abscess,hemorrhoid, anal prolapse, and renal calculus.
Dr. Keisetsu Otsuka, a pioneer in the renaissanceof Kampo medicine, states that daiobotanpito
needed to be administered to many appendicitis
patients in the 1930s, but thereafter, the number ofappendicitis cases to which the prescription applied
decreased.

Eventually,theincidence

itselfofappendicitis declined. As a result, the prescription
applies more to colon diverticulitis today.
It must be noted, however, that the prescription
contains Rhubarb and Magnesium sulfate, which arepurgative, so patients may experience diarrhea.
Nevertheless, as seen in Dr. Ogawa’s personal case,mostly regular stool is passed initially after taking
the prescription, and frequently turns to diarrhea
after the inflammation subsidesNote3). In the above
preliminary study as well, hardly any patients
experienced diarrhea.
Conclusion

Note 1) daiobotanpito (Da Huang Mu Dan Pi Tang)
The nominate is daiobotanto (Da Huang Mu Dan Tang). It isa prescription mentioned in Kinkiyoryaku, a medical classic
written some 1800 years ago.
Intestinal welling-abscess manifests with swelling andglomus in the lesser abdomen that is Painful when pressedas with strangury, regular urination, frequent heat effusion,
spontaneous sweating, and aversion to cold. With slow andtight pulses, pus has not yet formed and purgation can beapplied. There should be blood in the stool. With surging andrapid pulses, pus has been formed and purgation isprohibited. Daiobotanpito (Da Huang Mu Dan Tang,
Rhubarb and Moutan Decoction) is indicated.
Da huang (Radix et Rhizoma Rhei) 4 liang
Mu dan pi (Cortex Moutan) 1 liang
Tao ren (Semen Persicae) 50 Pcs
Dong gua zi (Semen Benincasae) 1/2 sheng
Mang xiao (Magnesii Sulfas) 3 ge
Decoct all ingredients except mang xiao (Natrii Sulfas) in 6
sheng water until 1 sheng remains.
Discard the dregs, add mang xiao (Natrii Sulfas) and bringto a boil.
Take warm as one dose.
If pus is present, it will be purged; if there is no pus, blood
will be purged.

Dr. Ogawa’s personal case report, as presented
earlier, and the above study revealed that standard
treatment

for

colon

diverticulitis

progresses

favorably in many cases in combination with theadministration of daiobotanpito, and there havebeen many replication studies of this result. New
clinical studies are also being planned3), so in a few

Note 2) The quantities of each drug contained in Tsumura
daiobotanpito were as follows in the preliminary study:
Radix et Rhizoma Rhei 2.0g
Cortex Moutan 4.0g
Semen Persicae 4.0g
Semen Benincasae 6.0g
Magnesii Sulfas 1.8g

years’ time, the applicability of this prescription forcolon diverticulitis is expected to become evenclearer.
With respect to my classification, this case falls
under Type 2.

Note 3) Diarrhea experienced after taking daiobotanpito
Dr. Kunio Matsuda, who studied under Dr. Otsuka, wrote
about his experience in using daiobotanpito to treat his wife’s
appendicitis, and noted that his wife experienced no diarrhea inthe beginning despite the prescription containing Magnesium
sulfate 10g and Rhubarb 10g. However, she began passing
severe diarrhea after her pain and fever subsided4). This should
be taken into consideration from a clinical perspective.

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

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Volume 11, Number 4 | Winter 2016

Cited References
1. Keiko Ogawa: “The Effectiveness of daiobotanpito in theTreatment of Colon Diverticulitis,” Kampo Medicine
Seminar for Medical Students, 2016 (in Japanese).
2. Keiko Ogawa, Koji Nishijima, Fumino Futagami, Takashi
Nakamura and Genichi Nishimura: Effectiveness of
Traditional Japanese Herbal (Kampo) Medicine,
Daiobotanpito, in Combination with Antibiotic Therapy in
the Treatment of Acute Diverticulitis: A Preliminary Study,
Evidence-Based Complementary and Alternative Medicine
Volume 2013
3. Hiroshi Koike et al.: “Examination of the Effectiveness of
daiobotanpito against Colon Diverticulitis: Research Plan
for an Open-Label Randomized Controlled Trial,” Kampo
Medicine Vol. 67, Collection of Summaries of Presentations
Given at the 67th General Academic Meeting of the Japan
Society for Oriental Medicine, p. 308, 2016 (in Japanese).
4. Kunio Matsuda: Case Studies of the Reality of Kampo
Treatment, p. 261, Sogensha, 1992 (in Japanese).

12

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

Volume 11, Number 4 | Winter 2016

Clinical Report 1 (Acupuncture)
Dropped Head Syndrome

hospital, and diagnosis of “dystonic dropped head”
was determined. With joint diagnosis with theMasanori Takashi1) and Katsuhiko Arai2)
1) Tokai University Oiso Hospital,
2) Tokai University School of Medicine

Dropped

Head

Syndromeistheclinicalcondition where the neck drops in the sitting or
standing at rest position, and was reported by
Gerlier in 1887 for the first time１ ). This condition
has been observed in Parkinson’s disease, multiple
atrophydegeneration,(MSA),

amyotrophic

spinocerebellar
lateralsclerosis,

cervical spondylosis, myopathy, myasthenia gravis,
and hypothyroidism. Moreover, dopamine-agonist
and DPP-4 inhibitor have gained attention as
causal agents.
In

this

to increase cervical muscle force was sought.
However, symptoms fluctuated between better andworse depending on the season, and the patient

Introduction

systemdepartment of rehabilitation, palliative treatment

case,

clear

cause

could

not

be

ascertained and rehabilitation was carried out
under the diagnosis of “dystonic dropped head.”
However, recovery of symptoms was up and down,

noticed that dropping head increased to more thanten times a day by June of the same year. Droppingneck occurred more frequently in the afternoon, but
decreased when a hot pack was applied before therehabilitation training. However, sinuous sensationand sharp pain occurred around the GB-21 肩井during training, and disrupted exercise therapy.
Subsequently, the physical therapist suggested
combining the use of eastern medicine treatment,
and the patient then visited an acupuncture clinic.
Overall body symptoms: Heartburn when sweets
are eaten. It is possible to eat but no appetite.
Heavy sweating (occurring when neck discomfort
appears), frequent urination, and urination once atnight.

so acupuncture and moxibustion therapy were

[Past history] Follow-up at the local medical clinic

suggested by a physical therapist, and we provided

for hypertension over the past 10 years.

such treatment.

[Present status] 139cm height, 37kg weight, bloodpressure 132/71mmHg. Sinuous induration in[Case] 73 year-old woman

abdominal trapezius muscle, especially near the[Chief complaint] Dropped head
[Prsent illness]Neckflexion“kensei” was observed. Neck dropped forward 45°,
anddiscomfort

appeared in October X-1. From December, shebegan experiencing dropped head especially when
walking and visited a local orthopedics clinic.
However, since cause could not be ascertained,
follow-up observation was carried out. Shoulder

neck rotation are R45°, and L50°.
Sunken pulse, Tongue dark red and slightly coated.
[TCM diagnosis]
Deficiency of Qi and blood stasis, and descent of Qi
in the Middle Heater

stiffness increased, and the patient visited the[Therapeutic principle]

neurology department at a general hospital.

Tonify Qi and activate blood, Tonify Qi in the middle

However, cause could not be ascertained, so inheaterJanuary X, she was referred to the neurology
department of this hospital for examination. The
cause could still not be ascertained even at this
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Volume 11, Number 4 | Winter 2016

[Acupoint selection] LI-4, CV-6, ST-36, SP-6, BL-20,[Course]BL-23 (all reinforcing treatment), GB-21 (reducing

Second session: No feelings of fatigue wastreatment)

experienced after the previous treatment. During

Used needles: Seirin-made sterilized acupuncture

treatment, when GB-21 was warmed by electricneedle, length1cun6fen, No.1 and No.3

moxibustion after acupuncture, the patient said
she felt a tingling on thesurface. Hence warming GB21 was discontinued, and only
acupuncture was performed.
Third session: At this time,
the patient felt that “kikai”
was hot. This was considered
to indicate decreased defense
function of Qi, LU-9 and CV17 were added in order totonify defense Qi, and inattempt to tonify lung Qi anddefense Qi.
Fourth session: Frequency ofdropping

headchangedslightly. However, shoulder stiffness remained, so[Explanation]
Tonifying Qi was attempted by combining ST-36

heating was attempted again. The patient said it

and g LI-4 2) and CV-6 3) which functions to regulate

felt good and that induration loosened up.

the mechanism of Qi (strengthening the spleen,

Fifth session: The sinuous feeling of GB-21 began

tonifying the kidney, regulating Qi) of the lower

to decrease. Stimulation of the shoulder finallyburner and tonifies source Qi, was added to tonify

began to show results. Acupuncture of the GV-20

while activating Qi. Since CV-6 has kidney

was carried out in order for Qi to accumulate in thetonifying function, this combination tonifies source

upper region. The reinforcing method was carriedQi.3) Elevating was attempted after sufficient

out in order to elevate the Qi, by points

tonification. Moreover, tonification with twirling

arrangement of LI-4, ST-36, and GV-20 6）

was added on SP-6, to tonify the blood which is

From here, elevating the Qi in the middle heatermother of Qi.4) In addition, purgation with lifting

was added to the medical principle.

and thrusting was applied to GB-21, and to improve

Sixth session: No change.

blood circulation for a smoother Qi route.5)

Seventh session: Sweating of the neck decreased.
Before treatment, sweating and wetness occurredfrom the neck to the back shoulder, but was nolonger14

present.

Frequency

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)ofdroppedneckVolume 11, Number 4 | Winter 2016

decreased, and the patient said she could exercise

Reference

until the afternoon.

1) Gerlier: Une epidemie de vertigge paralysant Rev.

Eighth session: Recently the patient has anappetite (has a sense of hunger), and does notexperience heartburn even after eating sweets.
Tenth session: Frequency of dropped neck has
become several times a day. Frequency of urination
was also reduced.
Twelfth session: Experiences dropped neck only
before bedtime.

Med, Suisse Rom., 7: 5-29, 1887
2) LI Shi-zhe: Clinical Elaboration of the Common
Shu

Points,P178-179,

People’s

MedicalPublishing House Co., LTD, 1991 (in Chinese)3) LI Shi-zhen: Clinical Elaboration of the Common
Shu

Points,P797-798,

People’s

MedicalPublishing House Co., LTD, 1991 (in Chinese)4) Acupuncture Treatment, p24-25, China Press of
Traditional Chinese Medicine, 2005 (in Chinese)

Fourteenth session: The patient no longer has toconsciously hold up her head, and the sinuous
feeling of the shoulder disappeared.

5) Dictionary of acupuncture points, p285－286, Toyo
Gakujutsu Shuppansha, 1986
6) LI Shi-zhen: Clinical Elaboration of the Common
Shu Points, P192, People’s Medical Publishing
House Co., LTD, 1991 (in Chinese)

Discussion:
This case was diagnosed as dystonic dropped
head due to neck muscle contraction. As a result of
determining this condition as dropped neck due todecreased Qi in the middle heater and induration
due to Qi deficiency and blood stasis, the symptoms*This case report was inserted in “The Journal of
Kampo Medicine” (Japanese Edition) Vol.61 No.4.
and translated into English with some additionalchanges.

could be significantly improved. Two causes for theappearance of pain (tingling) on GB-21 肩井 on thesecond visit, could be determined. One reason was
stagnant heat caused by shoulder induration
worsened due to Qi deficiency and blood stasis, andthe other was considered to be caused by a decreasein defense function of Qi due to Qi deficiency.
However, according to conditions on the fourth visit,
discomfort experienced on the second visit wasconsidered to be a reaction to the defense function,
not due to stagnant heat, but Qi deficiency of
exterior. In other words, heating stimulation was
too strong.
The author considers that “descent of Qi in the
middle heater” means a decrease in all supporting
power in many clinical conditions. For example, inthis case, a reduction in the supporting power of theskeletal muscle is thought to be within this range.

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Volume 11, Number 4 | Winter 2016

Clinical Report 2 (Kampo Medicine)
Case of Effective Administration of Saikanto for Left
Chest Pain
Keiko Ogawa-Ochiai
Kanazawa University Hospital

Main complaint: Left chest hurts every time thepatient coughed
Past history: 38 year old HELLP syndrome after
giving birth to child
Current clinical history: The patient contractedin

September,

XXXX

year.

Antibiotics were prescribed for fever, coughing, andyellow sputum. Fever subsided, but coughing
continued. Two weeks after becoming ill, sharp painin the left chest after coughing and Pressure pain on
the axillary line of the 10th thoracic vertebra wereexperienced. Symptoms intensified with breathing,
body

movement,

administered,andcoughing,

NSAID

was

the

analgesic

effectwasbutinsufficient. A chest fixing band was put on but
breathing became difficult, so the band was not worncontinuously.

A

tramadol-acetaminophen

combination was administered and the patient could
finally sleep. However, when this drug wasadministered during the day, dizziness, nausea, andfatigue made it difficult to work.
Findings at the initial visit:

Pulse: 72/min.

satO2 98％
Pulse: Right: Slightly floating and string-like,slightly soft pressed, thin and rough pulse
String-like, pressed, rough pulse Slightly
andstring-like,slightly

soft,pressed, thin and rough pulse
Left: Slightly floating, slightly string-like,pressed, thin and rough String-like, pressed,rough pulse

Slightly floating and string-

like, soft, pressed, thin and rough pulse
Tongue: Swollen, teeth marks, and white coated
16

under

the

heart

Discomfort when pressed in exhalation Tightened
rectus abdominis, right-dominant side chest pain.
Clinical course:
Saikanto was administered for chest pain andbecame 5/10 in numerical rating scale (NRS)
immediately after administration, and frequency of
coughed-up sputum and coughing also decreased.
Sensation of dyspnea disappeared the next day. Two
combination

was

not

needed,andsufficient

analgesic effect could be achieved by NSAID alone.
Three days later, NSAID was also no longer required.
Discussion
Saikanto used here is a combination of shosaikoto
and shokankyoto. It is a traditional prescription firstmentioned in 12th Century Chinese literature.
Although not well known in China today, it isfeatured as a Kampo medicine in Japan, inheriting
the experience of skilled doctors from 100 years past.
Indications include bronchitis and pleurisy, and it issometimes used for chest pain with unclear cause.
In this case, rib injury occurred due to coughing
caused by bronchitis. The impression was thatadministration of saikanto was effective not only in
reducing pain as it decreased coughing, but also was
effective on the pain itself.

166cm, 52kg

Blood pressure: 110/74mmHg

floating

harddays after administration, tramadol-acetaminophen

Family history: Nothing in particularbronchitis

Slightly

coughed-up sputum, pain experienced by the patient

Case: 43 year old woman

acute

Abdomen:Pain experienced by this patient was strong andthe usual NSAID did not have effect, but could
finally be controlled by tramadol-acetaminophen
combination. However, by administration of thislatest and superior medicine, pain experienced by
the patient could be reduced, but side effects such asdizziness, nausea, and fatigue appeared, making her
work difficult.
Saikanto was prescrived to reduce coughing andcoughed-up sputum in hopes that the patient could
return to a normal life. The trial was successful, andthe patient could return to the work site within

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

Volume 11, Number 4 | Winter 2016

several days. This prescription was effective to not
only reducing coughing and coughed-up sputum, butalso to pain itself.
When reviewing this case from the viewpoint of“Yasui Classification of the Indications for Kampo
treatment,” the successful combination of NSAID
and saikanto satisfies Type 4, by improving thecondition of “difficulty in daily life due to the adverse
effects of tramadol-acetaminophen combination,” aswell as Type 2.

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

17

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