KAIM
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Meeddiicciinnee
INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 7, Number 2 ･ Summer 2012

Editorial

Transition of Indications for Kampo Medicine in Japan
Hiromichi Yasui

Japanese Acupuncture - Current Research

Japanese Traditional Medicine Text (4) – Orthopedic Disorders A
Daisuke Mine

Kampo Medicine - Current Research
Essentials of Pediatric Kampo Medicine (2)Hideaki Yamaguchi

Clinical Report 1 (Acupuncture)

Oriental Medical Acupuncture and Moxibustion Treatment Based on Multifaceted Body Surface Observation– A Case of Low Back Pain and Diarrhea –Kazuma Ito

Clinical Report 2 (Kampo Medicine)

A Case of Continual Leg Cramps Successfully Treated with Shigyakusan
Satoshi Yamamoto, Keiko Ogawa-Ochiai and Tetsuo Akiba

Medical History in Japan“Historical Significance of Standardization of Acupoint Locations”, the Second Japanese Acupoint Committee (6)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 7, Number 2 ･ Summer 2012EXECUTIVE EDITOR

Shuji Goto
Chairman, GOTO College ofMedical Arts & Sciences

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

Tokyo, JapanEDITOR-IN-CHIEF

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

1 Editorial
Transition of Indications for Kampo Medicine in Japan
Hiromichi Yasui

CA, U.S.A.

ASSOCIATE EDITORS
Shuichi Katai

3 Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (4) – Orthopedic Disorders A
Daisuke Mine

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

6 Kampo Medicine - Current Research
Essentials of Pediatric Kampo Medicines (2)Hideaki Yamaguchi

13 Clinical Report 1 (Acupuncture)
Oriental Medical Acupuncture and Moxibustion Treatment Based on Multifaceted
BodySurface Observation – A Case of Low Back Pain and Diarrhea –Kazuma Ito

21 Clinical Report 2 (Kampo Medicine)
A Case of Continual Leg Cramps Successfully Treated with Shigyakusan
Satoshi Yamamoto, Keiko Ogawa-Ochiai and Tetsuo Akiba

PUBLISHER

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

24 Medical History in Japan”Historical Significance of Standardization of Acupoint Locations”, the Second Japanese
Acupoint Committee (6)Makoto Mayanagi

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

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

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

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

Volume 7, Number 2 | Summer 2012

Editorial
Transition of Indications for Kampo Medicine in Japan
Before Western medicine was introduced to Japan, any diseases were indicative of Kampo
medicine. In 1869, following the Meiji Restoration, the new Japanese government adopted
German medicine as well as the medical education and the system as a standard. Thoughremarkable progression had been made in some basic medicines such as pathology andbacteriology and development in public health, western therapeutic science around that time wasstill developing; a definitive way to treat diseases was not established. On the other hand, Kampo
medicine had shown many therapeutic effects with application of appropriate prescription use
for many diseases in its long history.
Japanese traditional medicine once declined was reviewed in the 1930's for its prominent
therapeutic effects and for many literatures that a few excellent Kampo doctors left with favorable
results of their treatment. These became a foundation of today's Kampo medicine. "Practice ofClinical Kampo medicine"(1941) was a representative book that these doctors wrote, which
attracted an attention from medical community of the day. It was later revised upon request of
the times and was published in 1969 under the name of "Norm of Kampo Medicine". This book
was translated into English by Hong-yen Hsu from Taiwan and published in the United States in1982 under the name "Natural Healing with Chinese Herbs".

Norm of Kampo medicine

Natural Healing with Chinese Herbs

Meanwhile, western medicine has developed significantly in the last half century andtreatment methods have also advanced. With the development of modern Western medicine, anumber of clinical indications of Kampo medicine have been steadily decreasing, and completelychanged from 50 years ago.

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

1

Volume 7, Number 2 | Summer 2012

and antiviral
agents Medicine
took overSociety
and becamea main street
in the treatment
of
InAntimicrobial
2010, the European
Union Geriatricand 4 European
and internationalsocieties
related to diseases.
nutrition The
jointly
establishedthe EuropeanGroup
on Sarcopenia
in OlderPeopleinfectious
latestscience createda largeWorking
number of
medications
in all areas.
A method). Based onandthisadvances
definition,
diagnosis
of(EWGSOP),
which proposeda definition
for sarcopenia
thatinjects medication
directly
into the bloodvessel was( 1developedin asurgery
havesarcopenia
can betomade
therethatis decreased
skeletalmuscle mass(essential) and either reduction inmadeit possible
treatifareas
no one had
been imagined
before.
muscularstrength
or locomotor function,
or both,are present.
The parametersassessed
to diagnose
frailtyUnderthese circumstances,
a numberof clinicalindications
for Kampo
medicine
were greatly
include attenuation of physical function and reduction in muscular strength. This indicates that sarcopenia
reduced,but instead, therapeutic areas indicative of Kampo medicine have clearly been
is closely associated with frailty. The presence of sarcopenia is associated with dizziness, fall/fracture, andhighlighted. It is a new therapeutic field in which Western and Kampo medicines are integrated.
frailty in elderly individuals, and correlates closely with physical dysfunction and conditions requiring
In the future, Kampo medicine
will acquire new indications in the new world.
assistance with daily living (1).
2. The term “asthenic” was seemingly used in the early 20th century.
Hiromichi
Yasui
Concepts such as frailty, locomotive syndrome, and sarcopenia, which correspondto the Japanesetermthcentury
Western“Kyojaku” or “weak constitution” were already in use at the beginningthe 20 ofJapan of
Institute
TCM inResearch
countries. In 1908, a publication in the journal Lancet used the term “asthenic constitution” to indicate thegroup of diseases causing “atonic habit of body” in the broader sense of the term. These conditions
included floating kidney, gastroptosis, enteroptosis, nervous dyspepsia, and neurasthenia (1). The term“asthenic” seems to have been a word that was prevalent in those days. This term was also used in the
famous paper on body build and physical constitution typing by Kretschmer. Kretschmer described three
types of body build: pyknic (stocky and rounded), athletic (with strong development of muscles andbones), and asthenic or leptosomatic (lean and narrow) (1).
3. What is the traditional medicine term corresponding to frailty, locomotive syndrome, and sarcopenia?
Before discussing Kampo medicine terms corresponding to frailty, locomotive syndrome, and sarcopenia,
we will focus only on the physical aspects of frailty without considering the mental/psychological andsocial aspects mentioned in its definition to simplify the discussion. We will thus treat locomotive
syndrome and frailty as the same concept and explore Kampo medicine terms corresponding to thisconcept.
The Kampo medicine or traditional Chinese medicine terms corresponding to locomotive syndrome andfrailty seem to be “leg weakening/adynamia” and “weakening/adynamia,” which were used in“Dokkatsukiseito, or Pubescent Angelica and Taxillus Decoction (Du Huo Ji Sheng Tang, 獨活寄生湯)” in themonograph “Important Formulas Worth a Thousand Gold Pieces (Bei Ji Qian Jin Yao Fang, 備急千金要方)”(1). “Pubescent Angelica and Taxillus Decoction” is an Eight-Treasure Decoction (Ba Zhen Tang, 八珍湯)
made of a Four-Substance Decoction (Si Wu Tang, 四君子湯) with blood-replenishing activity and a FourGentlemen Decoction (Si Jun Zi Tang) with Qi-replenishing (補気) activity. This herbal mix has been used
to treat (1) conditions characterized by physical senescence (kidney deficiency according to traditional
Chinese medicine); and (2) those condition involving shortages of Qi and blood accompanied by cold
sensation and pain in the lower back and knees due to moisture or water retention, and by fear of coldness,pleasure with warmness, weak/powerless legs, and paralysis/neuralgia/swelling attributable to external
factors (invasion by disturbing factors, such as wind, coldness, and moisture). In Japan, Pubescent Angelica
and Taxillus Decoction is often replaced with an herbal extract called “Relax the Channels and Invigorate
the Blood Decoction (Hu Jing Huo Xue Tang, 疎経活血湯),” which is covered by the national healthinsurance system.

2

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

Volume 7, Number 2 | Summer 2012

Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (4) – Orthopedic
Disorders A

Although both groups reported less shoulder discomfort
in the majority of cases, neither group reported
improved range of motion.

Daisuke Mine

Further, no difference in therapeutic result was seen

Physiotherapy Section,either with or without therapeutic encouragement1).

Central Rehabilitation Service,

Since the late 1990s, an increase in the number of

The University of Tokyo Hospitalsystematic reviews of acupuncture for shoulder pain
have appeared as systematic reviews, especially with

A Shoulder Joint

an increase of RCT papers. A representative report by

1. Clinical Studies from Abroad

Green (2005) will be discussed here (Table 4).

Concerning the efficacy of Acupuncture treatment for

Subjects were included if they met the evaluation

Conditions of the Shoulder Joint, until recently there

criteria (older than 3 months of age, rheumatoid

havemostlyarthritis or radiating pain from the neck area,

concerning the alleviation the pain associated with

excluding fractures, etc.). The investigators analyzed

arthritis of the shoulder joint and injury of the rotator

results from 9 trials. Unfortunately, the small sample

been

many

reportsfromabroad,cuff. The earlier research from Moore (1976), was arandomized controlled trial treating chronic shoulder
pain, they divided subjects into 2 groups, traditional
Chinese acupuncture or a superficial placebo protocol,
and investigated the effects of patient encouragement
between the groups.
Table 4andwidevariationininterventions

andevaluation points diminished the clarity of the results.
In conclusion, acupuncture was found to be effective inthe short-term for shoulder pain and may be valid given
standardized

futureinterventions

appropriate

evaluations.

includingRecommendations

fornecessary future studies are proposed 2).

Green et al. adopted a systematic review article

First Author / Yearof Publication
Moor ME
1976

Target(Subjects)
chronic
shoulder pain
42 cases

Berry H1980

shoulder - cuff
lesion60 cases

Lin ML
1994

frozen shoulder
150 cases

Yuan
1995
Kleinhenz
1999

periarthritis
98 casesrotator cuff
tendinitis
52 cases
painfulshoulder24 casesshoulder’smyofascial pain
44 caseschronic
shoulder pain
20 casesshoulder pain
35 casesRomoli M
2000
Ceccheerelli F
2001
Dyson TA
2001
Sun
2001

size,

Intervention

Conclusion*Traditional Chinese Medicine (with encouragement/
without encouragement)*Sham Treatment (with encouragement/ without
encouragement)*Acupuncture needles*Steroid injection + Placebo Medication injection*Steroid Injection + Oral Medication*Ultrasonic Waves*Placebo Ultrasonic Waves + Placebo Medication
Injection*Stellate ganglion block + supra-scapular nerve block*Electro-acupuncture*Electro-acupuncture + Nerve Block*Meridian Theory Based Acupoint Location*Acupoint Location based on Chinese Medical Etiology*Acupuncture (needles)*Sham Acupuncture

Both groups reported improvementin their level of discomfort
No significant difference between
groupsAll groups reported improvement
No significant difference between
groups*Acupuncture+ Mobilization*Mobilization*Auricular Acupuncture + Mobilization*Shallow Needling (2mm)*Deep Needling (Muscle layer)

No significant difference between
groups*Acupuncture*Trager psychophysical integration*Acupuncture + Exercise*Exercise

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

Effectiveness of Electroacupuncture + Nerve Block
Effectiveness of Acupoint Location
based on Meridian Theory
Effectiveness of Acupuncture

Pain was inhibited in both groups
Deeper needling showedremarkable
Effective for/in both groups
No significant difference between
groups
Efficacy of Acupuncture combinedwith Exercise3Volume 7, Number 2 | Summer 2012

2. Prospectus and overview of Current Studies in Japan

greater increases in range of motion. Therefore the

In Japan, numerous reports are available on Shoulder

researchers suggested that, for best results, treatment

joint inflammation and Frozen shoulder. Katayama etshouldal., divided 12 subjects (thirteen shoulders) diagnosed

spontaneous pain and contracture occur5). There arewith shoulder joint arthritis into 2 groups based on

many such reports demonstrating the effectiveness of

their limited range of motion. The Japan Orthopedic

acupuncture for shoulder joint pain and limited range

Society of Shoulder Joint Disease Treatment andof motion. However, there are several confounding

Performance Criteria (JOA score) was used to evaluate

points that must be addressed, 1) most of the available

pain, function and range of motion. Most notably, thereports have been drawn from compilations of clinicalextremely limited range of motion group reportedly

reviews and clinical case study reports, there are no

experienced the greatest improvement in pain and bothother treatment methods reported in the literature. 2)groups demonstrated improved results for all criteria 3).

Because inflammation of the Shoulder Joint and

The treatment protocol involved treating acupuncture

Frozen shoulder are general terms that include a range

points and/or appropriate Trigger Points in the Deltoid,

ofBiceps and Supraspinatus muscles; retention time waspathophysiological description of these complaints

short with thrusting or embedded needles for longer

should be defined or systematized. 3) Although there isretention. Hori et al. reported on the observed changes

sufficient evidence pointing to the effectiveness of thein shoulder pain and range of motion in patientstreatment methods and evaluation techniques, thefollowing low frequency electro-acupuncture in 21

current conditions do not provide affirmative evidence

patients with Frozen Shoulder. Seventy-one percent ofthat acupuncture and moxibustion are effective. In

participants reported slight relief of their subjective

order to clear away these confounding factors,

symptoms, 29% of subjects with extreme pain also

appropriately designed research studies allowing forreported some relief 4). Also, Sakai et al. investigated 41

collaboration with medical institutions and medical

people with Shoulder joint inflammation. These

specialists

subjects were divided into an admissible contracture

acupuncturegroup (21) and the no contracture group (20),

Originally, acupuncture therapy was a treatment

respectively. Changes in pain scores and range ofsystem corresponding to each patient's individual

movement were re-evaluated following one month ofcomplaints, different patients with the same disease

weekly treatments. The purpose of this treatment was

should receive unique treatment, and further it is well

to reduce muscle tension and improve blood circulation

known that the skills of the individual practitioner

in the rotator cuff, long head of the biceps andgreatly influence treatment efficacy. However, in ansurrounding tendons. Depending on the presenting

attempt to improve the level of acupuncture anddysfunction, level of radiating pain and location ofmoxibustion treatment efficacy in the future, othermuscle tension, treatment might include needle

treatment methods should be compared and consideredretention and low frequency electro-acupuncture.

complementary and clarifying the effects of these

Results suggest that, without respect to effectivenesstherapies for shoulder arthritis should be a priority.

for contracture, comparing patients presenting withStandardized

spontaneous pain to those without spontaneous pain,

methods are required for specific disease stage andthose without spontaneous pain reported reduced pain

pathophysiology.

beinstigatedmore

specificaretreatments

evaluation

changes in range of motion, the research confirmed thatpatients without significant contracture enjoyed much

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

theconditions,

urgently

following the treatments. In terms of effectiveness for4

duringneeded
and

phase

the

beforeprecisetoevaluate

researchmethods.

criteria

andtreatment

Volume 7, Number 2 | Summer 2012

References
1) Moor ME, Berk SN: Acupuncture for chronic
shoulder pain. An experimental study withattention to the role of placebo and hypnotic
susceptibility. Ann Intern Med 84(4): 381-384,
19762) Green S, Buchbinder R, Hetrick SE: Acupunctureforshoulderpain.

Cochrane

Databaseof

Systematic Reviews 2005, Issue 2
3) Kenji Katayama, Tatsuo Katsumi, Tatsumi
Nakamura,

et

al.:

Effectofacupuncture

treatment for PERI-ARTHRITIS of the shoulder
joint. Eastern Medicine 12 (3): 1-11, 1996
4) Noriko

Hori,

HitoshiYamashita,

Hiroshi

Tsukayama, et al: Effects of acupuncture forfrozen shoulder ─ an integrated case study ─.
Japan Society of Acupuncture 46 (4): 340-344,
1996
5) Tomomi Sakai, Yasushi Mizude, KasuyaDaichi etal.: The effect of acupuncture treatment for PERIARTHRITIS of the shoulder joint. Medical
Journal of Day Temperature 60 (4): 200-208, 1997.

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

5

Volume 7, Number 2 | Summer 2012

Kampo Medicine - Current Research
Essentials of Pediatric Kampo Medicines (2)Hideaki Yamaguchi

or episodic apnea and so is yokukansan for diaphragmatictics.
In recent years the importance of developmental
disorders in general practice has increased, in

2. Kampo medicines with emotionally stabilizing
functionsAmong various crude drugs, even though there
are certain differences in the strength of the effects,
many drugs have emotionally stabilizing functions
and if Kampo formulas contain several such crude
drugs, they may correspondingly be expected tomanifest such emotionally stabilizing actions. It is
well-known that mind and body can only hardly beseparated in children and any mental problem has ahigh tendency toward somatization. The relevant
Kampo medicines act simultaneously on stabilizing
the emotional state and improve the physicalcondition (for example, improve the gastrointestinal
function) and are precisely for this reason well suitedfor children. Characteristics of these formulas
include them being mild, not inducing drowsiness,
dry mouth or gastrointestinal dysfunction or similarside effects. Therefore they are not suited for therelief of severe symptoms, but they can be consideredto act by transforming both mind and body of thechildren little by little (providing relief). The use ofpsych mimetic drugs in pediatrics is currently moredifficult than in adults. Kampo medicines therefore
can probably considered to be easily applicable drugs
for emotional and psychological problems.

Yokukansan, kanbakutaisoto, saikokaryukotsuboreito
can be listed as representative tranquilizers that canbe used in children.

Yokukansan (or yokukansankahangechinpi) is aformula that has been devised in ancient times forpediatric convulsive diseases and because of its
sedative actions it is therefore indicated for
conditions associated with irritability and easy
excitation. Kanbakutaisoto and saikokaryukotsuboreito
are thought to have mainly anti-anxiety action, but thismay not always be taken literally. Based on experience isparticular for pervasive developmental disorders or
attention deficit hyperactivity disorder and theabove mentioned three preparations are useful andreportedly have been found to be effective even inpatients

non-responsive

Apart

from

the

methylphenidate11).

mentioned

preparations

orengedokuto, kamikihito etc. can also be used.
* Kanbakutaisoto: anti-anxiety activity, improving
gastrointestinal function* Saikokaryukotsuboreito: sedative, anti-anxiety
activity, anti-inflammatory

activity* Yokukansan:

strongly

sedative,

gastrointestinal

function,

improving

circulation,

original

text

the

improvingblood

recommends

simultaneous application to mother and child.
3. Kampo medicines with gastrointestinal function
improving actions
In Kampo medicine gastrointestinal function are
expressed as "spleen/stomach = digestive system".
The meaning of this term is thought not to be
restricted simply to the gastrointestinal function,
but includes the more comprehensive concept ofmaintaining the functioning of the entire body.
Naturally, both aspects are closely related, but forthe sake of convenience I would like to discuss here
the following 2 separately.
1) Treatment of diseases of the gastrointestinal tract
in a general sense
Basically, gastrointestinal symptoms representing
problems in pediatric clinical practice include
vomiting, diarrhea, constipation and abdominal pain.
These may be caused by a variety of pathologic
conditions

andwhile,

differential

diagnosis

needlessandtotreatment

say,

their

is

very

important, Kampo medicines may prove to be helpful
in cases difficult to treat with Western medications.

kanbakutaisoto the drug of first choice for pavor nocturnus

6to

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

Volume 7, Number 2 | Summer 2012

It has long been known that oral administration*A formula particularly for warming the intestinalof Goreisan is markedly effective during the earlytract and improving blood flow to increase

phase of acute viral gastroenteritis presenting

peristalsis: daikenchuto.

mainly as vomiting. Yet, in recent years the use of(4) For abdominal pain

dissolved*Formula

extract

preparationsasenemasorforwarming

the

body

and

suppositories has also been reported. Regarding

simultaneously relieving smooth muscle tone:

these application forms Yoshida12) and others haveshokenchuto, keishikashakuyakuto

published many reports, each of which indicates, aUsed for example for recurrent umbilical colics,

quick inhibition of the vomiting and improvement of

irritable bowel syndrome.

the general condition had been achieved.
Like in adults too daikenchuto is effective forchronic constipation13).

Although it is not acathartic, it promotes peristalsis by improving blood2) Treatment of digestive organs and not directly
related symptoms and diseases using the "Kampo
medical concept of digestive function"
Maintaining the function of the body depends

flow in the intestinal tract14).

Shokenchuto warms the body and relaxes smoothaccording to Kampo medical concepts on respiratory

muscle tone and therefore is used to treat recurrent

function (lung), digestive function (spleen andumbilical colics, while rikkunshito is used forstomach) and the genetic life force (kidney). In

gastroesophageal reflux and thus has been variously

developing children the digestive function is viewed

studied in the field of pediatrics15-16).

as particularly important among these. In this casedigestive function refers not simply to the functions(1) For Vomitingof the digestive organs in the Western medical sense,*Vomiting in the early phase of acute gastroenteritis:

but is presumed to mean the energy production

Goreisansystem related to food ingestion in general. In*Gastroesophageal reflux (GER): rikkunshito

Kampo medicine impairment of digestive functions

Slightly increasing peristalsis of the stomach

for any reasons is thought to easily cause secondary

results in an alleviation of the vomiting.

generalized dysfunction or else functional disorders(2) For diarrhea

of various parts of the body. Thus, therapy has the*In case of prolonged diarrhea following acutemeaning of rectifying the digestive functions as

gastroenteritis: ninjinto, shinbuto

causative

By warming the abdominal cavity the decreased

improvement of symptoms / diseases not directly

functioning improves and shinbuto simultaneously

related to the digestive organs. This is a typicalimproves also the water metabolism.

Kampo concept and can be simplified in everyday*Prescription for diarrhea in the absence of any

language as 'harmonizing the gastrointestinal tractorganic causes: keihito→ recovering health → possibility that diseases may

This formula is similar to the above mentioned but

improve'.

even milder.

shokenchuto,(3) For constipation

Preparations improving this kind of decreased body

*The

below

mentioned

keishikashakuyakuto

decreases smooth muscle tone, or used with added
rhubarb having laxative action in the formula:keishikashakuyakudaioto

factorsinorder

Representative

rikkunshito

to

bring

about

preparations
and

are

hochuekkito.

functions are called "Qi supplementing formula" andrepresent a characteristic of Kampo treatment.

Shokenchuto is the most frequently used formulaand the preparation of first choice from infants tochildren in the first grades of elementary school,

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

7

Volume 7, Number 2 | Summer 2012

where it is directed at generalized symptoms likeabdominal distension and similar symptoms ofcold sensitivity and lack of vitality as secondary

stagnant peristalsis are observed, or in case of

manifestations

lassitude.

little,recurrent

andsimilar(Many Kampo medicines used for other purposes

gastrointestinal symptoms. Rikkunshito improves

than improving digestive function too obviously or

the general conditions like lack of appetite,casually include crude drugs acting on decreased

abdominal distension as well as systemic symptoms

digestive functions and therefore are often used forlike bowel mobility disorders or lassitude, whilesecondary treatment regimens. I believe thishochuekkito is indicated in cases of easy fatiguability,

confirms, that the importance of the digestive

heaviness of arms and legs etc. as well as marked

function had been recognized since ancient times.)

abdominal

of

pain,

eatingtoo

softstoolsgeneralized malaise. These two preparations areoften used for comparatively older children, like

4. Kampo medicines with sedative actions

higher grade elementary school students. Moreover,Some Kampo medicines have an affinity for theby "improving the digestive functions" they could

respiratory tract and some formulas have been usedpossibly provide an effective supplementary therapy

for the treatment of respiratory disorders. Naturally,in cases, where the patients present with diseases

in cases of respiratory failure or similar severe

other than those of the digestive organs, like fordiseases various modern Western medical therapies

example allergic diseases, infections and similar

are far more effective, but some Kampo medicinesconditions marked by derangement of immune

have unique antitussive properties and can be usedfunctions. Within the scope of the author's research

as antitussives in children.
In pediatrics the first preparations that come tono substantial amounts of results could be foundmakyokansekito

mind

but there is a close correlation with the alreadybakumondoto. In conjunction with their antitussive

earlier mentioned concept of treating perianal

activity these preparations have different actions on

abscesses with juzendaihoto and atopic dermatitis

the respiratory tract. Shoseiryuto inhibits airway

with hochuekkit17) and the like.

secretions while also having a warming effect.

*Shokenchuto: Warms the body and relievesareshoseiryuto,

regarding this kind of Kampo medical application,andMakyokansekito too inhibits airway secretions, but

excessive tension of the intestinal tract. In cases ofisgeneralized symptoms like sensitivity to cold andinflammatory actions. Conversely, bakumondotolack of vitality as secondary manifestations of eatingpromotes

too little, recurrent abdominal pain, soft stools andmoistening effect.

consideredtoairwayhave

moresecretions

markedandthusantihasasimilar gastrointestinal symptoms. It is the formula

Accordingly, in patients presenting with copiousof first choice from infants to children in the lower

thin white sputum, for example asthmatic bronchitis,

grades of elementary school.

shoseiryuto is used, but in patients with infective*Hochuekkito: Slightly warms the body andinflammation,

presenting

mainlyas

copiousimproves a generalized hypotonic state. Used foramounts of yellow sputum like for example in acutepatients who fatigue easily, wish to lie down andbronchitis

complain of generalized malaise including heavinessconsidered, while in slightly dry conditions withof arms and legs.

little sputum but continuing cough bakumondoto is*Rikkunshito: Slightly warms the body andimproves in particular a hypotonic intestinal tractorpneumonia,

isused as a rule. Bakumondoto reportedly has thesame antitussive effect as dextromethorphan18).

and the water metabolism. If lack of appetite,8

makyokansekito

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

Volume 7, Number 2 | Summer 2012

A trial is considered worthwhile, when the effectsof the general antitussive drugs seems to be
insufficient.

saibokuto

Moreover,

is

used

for

supplementing functions
In Kampo medicine there are formulas to aid thegrowth and development of children. The world's

psychogenic cough.
*Makyokansekito:

5. Kampo medicines with growth and development

strongoldest pediatric textbook published during the Sung

expectorant effect, in cases of copious yellow

dynasty: "Xiao er yao zheng zhi jue" (around 1107)

sputum.

lists rokumigan as a representative formula, that

*Shosaikoto:Anti-inflammatory,anseems to have been used for inherently weak

expectorant, it is used for copious amounts of thin,children. Although it is naturally not possible towhite sputum, and frequently also for allergicchange the congenital disposition, there can possibly

rhinitis (in cases of large amounts of airway

be conditions associated with decreased activity, or

secretions the combination of makyokansekito andwhere greater maturity can be expected to lead to a

shosaikoto enhances the antitussive effect).
*Bakumondoto: Is suited for chronic, dry (no –remission of symptoms. Also, combined use oflittle sputum) cough, since it moistens the airway

functions like hochuekkito and the like make theand has relatively strong antitussive effects.

treatment even more effective.

*Saibokuto:

Since

it

acts

mainlyas

Kampo medicines with actions improving digestive

Combined formulation composed of* Rokumigan: In cases were delayed growth /shosaikoto and hangekobokuto. In the past is wasdevelopment or decreased activity is observed, or

frequently used during the intermissions in cases ofelse in cases of decreased activity due to chronic

pediatric bronchial asthma19). It is also effective fordisease etc.

psychogenic cough and tic-like cough.
Chronic

paranasal

sinusitisisinroutinepediatric care often related to cough, but equallyoften no effective Western medical pharmaceuticaltherapies can be found. In these cases Kampo
medicines can provide a useful therapeutic means.

Kakkontokasenkyoshini and shiniseihaito can belisted as therapeutic agents for the treatment ofchronic

paranasal

sinusitis.

Theoretically,shiniseihaito is used for conditions with moremarked inflammation and has reportedly been
useful in cases where low-dose macrolide therapy
had been ineffective20).
When nasal obstruction is prominent in cases ofparanasal sinusitis

6. Kampo medicines with actions regulating water
metabolism
Water comprises approximately 60% of thehuman body. Regulating functions related to any
insufficiencies, excesses or imbalances are very
important for the body. Sudden loss of water
resulting in dehydration, renal or cardiac failure
may be associated with severe edema and acuteencephalopathy can cause cerebral edema etc.
Needless to say, these conditions represent an
important therapeutic topic in modern medicine.
However, even not so severe conditions resulting in
only minimal insufficiencies, excesses or uneven
distributions are known to cause systemic or local

warming,

symptoms. In pediatric primary care diseases*Shiniseihaito: Moistens and cools, helps discharge

distributions may cause headache, vertigo, lethargy,*Kakkontokasenkyoshini:

Slightly

improving blood flow.
viscous nasal secretions (viscous nasal discharge,
sputum; yellow).

associated with even minimal excesses or unevenmalaise, nausea, loss of appetite and similar
symptoms are treated. The actions are not simply
restricted to promotion of miction, but are considered
to concentrate more on a balancing of the water
distribution.

In

Kampo

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

medicine

the

water
9

Volume 7, Number 2 | Summer 2012

distribution has since ancient times been regarded

cystitis.

as important and several corresponding Kampo

components

medicines have been formulated. Also, even if water
regulation is not the primary target of the usedsaireito22), but has not been reported in relation totreatment with shosaikoto alone. Many extract

formulas, many of them contain water regulating

preparations use lactose, so that they should not be

crude drugs.

used in cases of lactose intolerance23).

Presumably
of

the

this

is

an

influenceofshosaikoto portion within

There is noRepresentative preparations used in pediatrics

sizable amount of reports from the field of pediatrics

goreisan,choreito,ryokeijutsukanto,
hangebyakujutsutenmato etc.
*Goreisan: The most frequently used formula, fordealing with allergies to crude drugs. In any case,areKampo medicines are generally considered to havefew side effects22,23).

nausea during the early phase of gastroenteritis,
Table 3

headache related to atmospheric pressure etc.
*Choreito: Simultaneously with promoting water
excretion it cools the body or for inflammations of thelower urinary tract like cystitis; in combination withorengedokuto it is used for atopic dermatitis
associated with much exudate.
*Chokeijutsukanto: In cases of marked malaise,difficulties getting up in the morning and orthostatic
regulation disorders etc.
*Hangebyakujutsutenmato:Fororthostatic

regulation disorders21) characterized by vertigo, lossof appetite etc.

Care is required when combining 2-3 formulas,
because many Kampo medicines contain licorice andtherefore could cause pseudohyperaldosteronism.
their

use

in

patients

withhyperaldosteronism, myopathies or hypokalemia iscontraindicated.
The main component of ephedra herb is ephedrine
thus

tachycardia

could
or

possibly

similarcause

symptoms

palpitation,
when

used

together with sympathomimetic drugs. Also, a mildstate of excitation may cause in some patients
insomnia and occasionally digestive symptoms likeloss of appetite may also develop.

Shosaikoto is known to cause in adults interstitial
pneumonia, but this reaction has almost not beenreported in children. The most frequently reported
adverse reaction in children is saireito induced
10

12 years
2/3

7 years
6 months
1/2

3 years

1 year6 months

1/3

1/4

1/5

2. Could mistaking the indication be a factor possibly
aggravating diseases?
Strictly speaking this does not refer to adverse
reactions, but in case the indication has been
mistaken, the possibility of an aggravation of the
distinction would be between heat and cold

1. Main side effects caused by the drug components

and

Age conversion (when defining adult as 1)

symptoms cannot be ruled out. An elementary

Adverse reactions of Kampo medicines

Naturally,

Children's doses according von Harnack

properties. Among Kampo medicines some warmand some cool the body, so that prolonged use ofstrongly cooling agents in patients sensitive to cold,or conversely agents warming the body in patients
sensitive to heat could possibly result in adverse
reactions and should therefore be kept in mind.
Application outside the recommended children's
dose and indication
Since Kampo medicines are covered by the
insurance 30 years have passed, but explanatory
booklets about generally used Kampo medicines still
include the remark, that "safety for children has notbeen established" (there is no experience). Thus
Kampo

medicines

have

like

many

Western

medications necessary for children many pediatricpharmaceutical off-label problems. Currently, nosolution seems to be in sight yet.

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

Volume 7, Number 2 | Summer 2012

For the same reasons given above the children's(1) Adjusting the way the medicine is taken

doses for Kampo extract preparations too are still* Crush it and administer it as a liquid dissolved in

not listed in those explanatory booklets. Generally,warm water.

they are calculated according to the von Harnack* For infants prepare a paste with warm water andmethod based on body surface (Table 3), or by

apply this with your finger to the upper jar.

conversion of body weight, but occasionally the dose

* After the late phase of infancy have the child takehas to be increased depending on the pathologic

some cold water in the mouth, add the extract

condition, so that those values cannot be much more

preparation and have it swallow it all at once.

than rough estimates.

* Wrap it in a wafer.

Moreover, it should be noted, that the daily dose(2) Mix with something that is easy to swallow

of extract formulas may vary depending on the* Yoghurt, milk, malt extract, juice, ice cream etc.

manufacturer and the type of Kampo medicine.

3) Change the path of administration

Basically the drugs are administered in 3 fractions

Regardingtheapplication

withrectalof

Goreisandaily, but it is also possible to use 2 fractions.

experiences

application

have

Principally, they are taken before meals, but there isaccumulated (enemas, suppositories), but the above

not much differences, when they are taken after

mentioned problems with off-label application are ameals24).

reality.

Instructions for taking Kampo medicines

Conclusions

Since many Kampo medicines have unique tastes

In this article I tried to describe the application ofand smells, they are in particular during early

Kampo extract preparations as the basics ofinfancywhypediatric Kampo as simple as possible, while at theingenious

same time trying to maintain the essential concepts

contrivances. Here I would like to briefly addressof Kampo. This remains, however, very elementary

some administration methods and refer the reader

and deepening one's understanding of other Kampo

for further details to other references25,26).

medicines, and further studies are required to1) Increasing the motivation of children and family

ascertain whether these can be combined with otherto take the drugs

extract preparations or decoctions and thereby

difficulttreatmenttoadminister. That

sometimes

requiresisFirst, I start by explaining to both the child(ren)and their guardians "what kind of Kampo medicines

therapeutic effects possibly be further improved totreat still more complex diseases.

there are and what they are for" to help them

Kampo does not stand in opposition to Westernunderstand the matter. In the late phase of infancy

medicine. By fully exploiting the characteristics of

the

Kampo

childrentoo

arealreadycapableofmedicines

withinmedicine,theframework

complementingofcomprehending the outline of the involved concepts

integrated

Western

and after providing gentle explanations the children

medicines, I believe we can broaden its application

can often be unexpectedly compliant. Fundamentally,in pediatrics.

I am creating a motivation for taking the medicine.
2) Concrete application methods
Due to individual differences whether a patient
can or cannot take the medicine at hand, theadministration too has to be adjusted on a case by

References
11) Koichiro Kawashima: Investigation about theusefulness of Kampo for pervasive developmental
disorder; Journal of The Japan Society for Oriental
Medicine 2007; 58: 175 (Abstracts)case basis. Generally the following methods are tried.
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

11

Volume 7, Number 2 | Summer 201212) Masaki Yoshida: Regarding the usefulness of24) Shinichi Tashiro: Correlation between the timing ofgoreisan suppositories for the treatment oftaking Kampo medicines and meals, Pharmacy
2001; 52: 1138-1144
25) Shigeyuki Hirose: Kampo treatment manual for
pediatric diseases, Tokyo: Modern Publishing
Planning, 2006
26) Ranko Mori: Ideas related to the compliance, The
Japanese Society of Pediatric Surgeons 2011: 43: 828-831

vomiting during infancy, Information from theMedical and Pharmaceutical Society for WAKANYAKU; 1990; 7: 506-507
13) Toshiki Otani et al.: Effects of daikenchuto forpediatric constipational diseases, The JapaneseSociety of Pediatric Surgeons 2005; 37: 300-304
14) Toru Kawano: Searching for evidence for daikenchuto,
Familiar Kampo treatment of pediatric diseases, 7,Tokyo Medical View 2007: 36-43
15) Minoru Yagi et al.: GER and Kampo ―Investigations using EGG, The Japanese Society ofPediatric Surgeons 2005; 37: 284-290
16) Hiroaki Kuroda et al.: GER and Kampo ―Investigations using RI, The Japanese Society ofPediatric Surgeons 2005; 37: 279-283
17) Yumi
Kobayashi:
Clinicalevaluationofhochuekkito for the treatment of atopic dermatitis,
Journal of The Japanese Pharmacological Society
2008; 132: 285-287
18) Yoshiharu Nonaka et al.: Experiences with theuse of bakumondoto for persistent pediatric cough,Journal of the Japan Pediatric Oriental Medical
Society 2004; 20: 15-21
19) Setsuko Ito et al.: Effects of saibokuto in thetreatment of pediatric broncial asthma, Basics andClinic 1992; 26: 39933-998
20) Mikikazu Yamagiwa: Kampo treatment for chronic
infections in the field of otorhinolaryngology,
Journal of the Japan Pediatric Oriental Medical
Society 2006; 21: 31-35
21) Tadayoshi Abe et al.: Experiences with use ofhangebyakujutusutenmato for the treatment oforthostatic dysregulation, The Japanese Society ofPediatric Surgeons 1984; 17: 93-104
22) Yoko Kimura et al.: Side effects and druginteractions of shosaikoto, Kampo and Latest
Therapy 2002; 11: 341-346
23) Hidekazu Haruki: Latest pharmacotherapy andcountermeasures against adverse reactions(Kampo medicines, crude drugs); Pediatrics 2008;
47: 829-835

12The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 7, Number 2 | Summer 2012

Clinical Report 1 (Acupuncture)
Oriental Medical Acupuncture and Moxibustion Treatment
Based on Multifaceted Body Surface Observation- A Case of Low Back Pain and Diarrhea Kazuma Ito
Kyoto University Graduate School of
Human and Environmental Studies,
Kyoto University
Furokaku, Acupuncture and Moxibustion Clinic

body surface". Thus, "body surface findings" isdefined as findings obtained through observation of
the body surface. "Healthy qi" is defined as a generic
term

for

primordial

original

vital

energyenergy), ancestralqi,(vitalenergy,nutrient qi,

protective qi, yin qi and yang qi.
II. Case
Age: 35 years; male, first examination in December

I. Introduction
In modern Japan acupuncture and moxibustionof 20XX.

treatment employs various forms of examinations,right inguinal region; #2 diarrhea (watery)therapeutic theories and techniques1). These forms[Examination details]of acupuncture and moxibustion treatment currently[Anamnesis (medical interview)]

practiced in Japan are defined in the body of this text

[Present illness]

as acupuncture andmoxibustion2).

characteristics

JapaneseofRegarding theacupuncture

andChief complaint: #1 pain from the right hip to the#1 pain from the right hip to the right inguinal
regionmoxibustion the extensive amount of information

Junior high school period: He practiced basketballobtained through touching and observing the bodyand started to experience pain in the right lumbar

surface has been described many times before3-12).

region from that time on.

Touching the body surface is not restricted to pulse

In April 20XX: Started hang a heavy bag over his

diagnosis, but includes the palpation of theright shoulder. From that time on the patient started

meridians according to Oriental medical concepts as

to experience the pain in the right lumbar region.

well as the palpation of skin, muscles, tendons, bones

November of the same year: Started to strongly feel

etc. according to Western medical concepts. Thesedull pain in the right lumbar region (because hetechniques play an important role in the assessment

carried luggage on the right side).

of pathologies based on these findings and theCurrently:

evaluation of therapeutic results.

Type and severity of the pain is the same as it was in

In

the

present

multifaceted

November. The pain extends from the right lumbar

observations based on the conduction of the four

region to the right inguinal region. As long as he isexamination techniques, in particular palpation, in

working, it does not bother him, but during rests, thea case with low back pain and diarrhea. And I believe,

pain starts to bother him. When he is exhausted or

the Oriental medical treatment was effective.

it is cold, the patient experiences numbness down

Additionally I would like to make some observations

into the right leg.

regarding

Relieving factors: taking a bath; warming; extendingthereportI

madecharacteristics

ofJapanese

acupuncture and moxibustion.

the hip.

Moreover, the term body surface observation used in

Aggravating factors: hanging luggage over the right

this text is defined as the Oriental medical

shoulder; upon rising in the morning.

examination#2 Diarrhea (watery stool)techniques

observation,

listening,smelling and palpation. Observation, listening,

4-5 days ago: He attended a drinking party but

smelling and palpation are considered to represent

drank only iced tea. Later, diarrhea developed.

an "observation of phenomena manifesting on the

Frequency was 4-5 times per day.

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

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Volume 7, Number 2 | Summer 2012

Currently:[Present status]

The watery stool continues. Frequency is 4-5 times○ Height: 175 cm. Weight: 68 kg.

per day; there is almost no smell. After its onset the○ Diet: Has appetite; eats three meals a day; timing

low back pain developed almost daily in the morningof meals: breakfast 6:40～7:00, lunch after 12:00;

after which he then passed loose stools. After thedinner 20:00～21:00 (or 22:00). Approximately one

onset of the diarrhea the low back pain was neither

month ago the patient started to crave cake orrelieved nor aggravated. After a bowel movement insimilar sweet foods and eats them. He did not do thatthe morning there is no feeling of residual stools, but

before.

otherwise there is a feeling of residual stools○ Micturition: 7-8 times/day; sensation of incomplete

following bowel movements. The patient experiences

emptying.

a mild degree of fatigue after bowel movements.

○ Bowel movements: Normal condition is 1-2
times/day; always somewhat soft (slipping out○ Normal stool condition: 1-2 times/day; always

stools).

somewhat soft (slipping out stools).

○ Sleep: Goes to bed around midnight or half past

[Past history]

midnight; rises at 6:30; no nocturia; almost does not

March 20XX-1: Pancreas cancer; underwent surgery;dream; stays for a while in bed after awakening in

resection of pancreas body, head and spleen; surgicalthe morning.

removal of aortic lymph nodes.

[Physical examination]

August of the same year: liver metastases were

○ MMT (manual muscle testing):

discovered.

extensor hallucis power: right = 5, left = 5

October of the same year: Initiation of chemotherapy,

flexor hallucis power: right = 5, left = 5

because the metastatic lesions had grown. Therapy○ Sensory test of legs: the right 5th digit is a little

consisted of daily administration of TS-1. Gemzar

numb.

administration once/week. After the chemotherapy○ SLR (straight leg raising test): negativeloss of appetite and diarrhea developed.

○ FNS (femoral nerve stretch test): negative

By July 20XX:○ Thomas test: negativeloss of appetite and diarrhea did not

develop any more.
Currently:[Oriental medical findings]

TS-1 is used for 2 weeks followed by one week rest.

○ Tongue diagnosis

Gemzar is no longer administered.

Tongue surface: dark pink tongue; there is darkened[Family history]color, slightly soft consistency (lifeless swelling), no

The father had hypertension. Currently the patient

fissures or no dental indentations, somewhat

lives with his father and mother in a 3-person household.

marked moisture, no ecchymosis or petechiae, white[Social history]

coat.

Between the age of 22 and 31 the patient was a

Tongue underside: dark faintly red – red color; there

company employee (salesperson).

is darkened color; markedly engorged sublingual

Currently: attending vocational school.

veins.

[Personal history]○ Meridian diagnosis*):Alcohol consumption: has not been drinking.

Listed here in the order of the severity of deficiency

Smoking: Had been smoking until the discovery ofof both channels and collateral channels13) (sweating

the pancreas cancer (20 years).

→ surface weakness → dimpling, coolness).

Twenty cigarettes/day.

Note)

14

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

Volume 7, Number 2 | Summer 2012

Meridian diagnosis refers to a diagnostic method,

Inch pulse (cun mai) … the width from the skinwhere careful palpation of the skin over both

surface to the radial bone (below called pulse width)channels and collateral channels from the very

extends from the floating to the deep position.

superficial down to the deep layers and thus allows

The shape of the pulse is distinct, albeit somewhat

to assess a variety of conditions (example: sweating,soft.

weakness, dimpling, tension, induration, bulging,

Bar pulse (guan mai) … the pulse width extends

coolness, heat etc.).

from the floating to the deep position. The pulse on
the right side is a little hard.

(1) Tai yang bladder meridian of the foot … weakness

Cubit pulse (chi mai) … the pulse width extends fromand coolness (right > left). (← this indicates left andthe middle to the deep position. The pulse lacks aright as viewed from the therapist; same applies

little strength, but in the deep position has viscous

below.

properties. This is particularly marked on the right(2) Lesser yin kidney meridian of the foot …

side.

weakness and coolness (right > left).
(3) Greater yin spleen meridian of the foot …

tensioncoolness (right ≧ left).
(4) Greater yin lung meridian of the hand …
sweating and weakness (right ≧ left).
○ Abdominal diagnosis (Figure 1):
hypochondrial region … tension (right > left); flanks… tension (right > left).
paraumbilical region … tension (right > left);hypogastric region … weakness and coolness.
○ Back diagnosis (Figure 2):
Left and right BL12 (Fengmen), left and right BL13
(Feishu) … weak; left and right BL15 … tension (left> right).
Left and right BL17 (Geshu) … weak surface,

Weakness, coolness

subcutaneous tension. Tension in the region of theupper back in general is stronger on the left side.

Figure 1

Left and right BL18 (Ganshu), left and right BL19

(The shaded portion indicates tension; increasingly darker(Danshu), left and right BL20 (Pishu), left and right

Abdominal diagnosis

slanted lines indicate increasingly higher tension)

BL21 (Weishu), left and right BL22 (Sanjiaoshu), left
and right BL23 (Henshu), left and right BL24
(Qihaishu), left and right BL25 (Dachangshu) …
weak surface, subcutaneous tension.
The lumbar region of the back in general shows aweaker surface on the right than on the left, while
subcutaneously there is strong viscous tension.
○ Condition of the toes: pain in the left and right fifth
digit, difficulties moving the toes.
○ Pulse diagnosis:

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

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Volume 7, Number 2 | Summer 2012

deficiency), <the diarrhea is considered mainly be
due to kidney deficiency>[Pattern identification]
First the individual patterns are indicated and thentension in the depth

the details of the pattern identification shown.
[Eight-principle pattern identification]
The surface was in general softer on
the left than the right, showing astrong, viscous

Exterior and interior: exterior pattern (floating pulse,neck stiffness, chills) is not observed. Therefore thisis an interior pattern.
Concrete details will be verified through the qi, bloodand body fluid pattern identification, yin-yang
pattern

identification

andorgans/visceraandmeridians/channel pattern identification.
Cold and heat: cold pattern. Concrete details will beverified through the qi, blood and body fluid pattern
identification and yin-yang pattern identification.
Deficiency and excess: complex deficiency and excess
pattern; the large number of dental impressions

Figure 2 Back diagnosis△: tension ○: weakness □: tenderness: widened spaces between the spinous processes

found during tongue diagnosis verify a qi and yangdeficiency.
Other concrete details will be verified through the qi,[Assessment of the pathophysiology][Modernwestern

medicalassessment

blood and body fluid pattern identification, yin-yangofthepathophysiology]

pattern

identification

andorgans/visceraandmeridians/channel pattern identification.

#1 Suspicion of myofascial low back pain (problemsof the iliocostal, longissimus, lumbar quadrate[Qi, blood and body fluid pattern identification]muscles as well as the oblique and transverse

Qi stagnation: #1 during

muscles of the abdomen are conceivable)

development of discomfort during rest.

Suspicion of some anomaly of the first sacral

Extension of the lower back is a relieving factor for

vertebra (however, a herniated intervertebral disc is

#1.

based

Conditiononthefindings

ofvariousphysical

found

work

through

alleviation

abdominalanddiagnosis

examinations unlikely)(tension of hypochondral regions and flanks).

#2 The acute diarrhea raises suspicions of aQi deficiency: verified through organs/viscera andnoninfectious diarrhea

meridians/channel pattern identification.
Yang deficiency: Bathing and warming (note that

[Oriental medical assessment of the pathophysiology]

this phenomenon also appears in cases of qi#1 Kidney deficiency (mild form of kidney yangstagnation) is a relieving factor for #1.

deficiency centering on a kidney qi deficiency), qi#2 Watery stools (kidney yang deficiency symptom).

stagnation in the greater yang bladder meridian of#2 The stools have almost no smell.

the foot#2 Prior to the onset of the diarrhea the patient#2 Kidney deficiency (kidney qi and kidney yangingested large amounts of cold drinks.

deficiency), spleen deficiency (mainly spleen qi

16

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

Volume 7, Number 2 | Summer 2012

[Organs/visceraandmeridians/channel

pattern

Tai yang bladder meridian of the footidentification]#1 Manifestation of lumbar symptoms (note theKidney:course of the tai yang bladder meridian of the foot).

#1 Low back pain since junior high school (kidney qi

Meridian diagnosis showed some weakness in the

deficiency)

course of the tai yang bladder meridian of the foot,#1 Condition of the low back (kidney (qi, yang)surface findings of coolness.

deficiency that affected the tai yang bladder

Lesser yin kidney meridian of the foot:meridian of the foot).

Meridian diagnosis showed weakness in the course#2 Diarrhea early in the morning (wu geng xie:of the lesser yin kidney meridian of the foot, surface

kidney yang deficiency condition).

findings of coolness.

#2 Fatigue after bowel movements (kidney (qi, yang)

Greater yin spleen meridian of the foot:deficiency condition).

Meridian diagnosis showed surface coolness in theAnamnesis showed that the patient had undergone

course of the lesser yin kidney meridian of the foot.

surgery (injury of the congenital qi).
Abdominal diagnosis showed weakness and coolness[Cause and mechanism of disease] (Figure 3)of the abdomen.

Presumably the kidney qi and yang deficiency

Back diagnosis showed surface findings at the leftcondition had been present from before. At the sameand right BL23, BL24, BL25 and BL22.

time the presence of problems with the middle

Pulse diagnosis showed intermediate chi pulse.

energizer, in particular the spleen, was also

◎ Both kidney qi and kidney yang deficiency are

surmised. They probably led to the development ofconceivable.

the pancreatic cancer. The surgery for the pancreatic

Spleen:cancer and the chemotherapy caused a progression,#2 Occurrence of diarrhea (spleen (qi, yang)leading to an aggravation of the kidney qi and yangdeficiency condition).

deficiency and the spleen qi deficiency. From April#2 Bowel movement induced fatigue (spleen (qi,20XX hanging a heavy bag over the right shoulderyang) deficiency condition).

presumably disturbed the body balance and impeded

Normal stool condition (tends to be soft).

the flow of qi, leading to a qi stagnation. Pathogenic

Began to crave sweets about one month ago (sweet isqi caused by qi stagnation often influences sites of

one of the five tastes associated with the spleen).

weakened healthy qi. In this patient the qi

Development of pancreas cancer (presumably there

stagnation is considered to have influenced the tai

has been a problem with the middle energizer).

yang bladder meridian of the foot. Before aUpon initiation of the chemotherapy the patient lostbackground of a weakened tai yang bladder

his appetite and developed diarrhea (spleen (qi,meridian of the foot there is a kidney deficiency. Iyang) deficiency condition).

assume, the chief complaint #1 has developed for

The back diagnosis revealed body surface findings atthat reason. Further, drinking large amounts of cold

the left and right BL20, BL21 and BL22.

drinks during a drinking party led to an aggravation

Pulse diagnosis showed somewhat hard properties ofof the kidney (qi and yang) deficiency and spleen

the right guan pulse.

deficiency◎ A spleen yang deficiency is conceivable as adevelopment of the chief complaint #2.

problem with the spleen and because of the absence

The author places great importance on body surface

coolness as a body surface finding, this was

findings from the back transport points and theconsidered mainly due to spleen qi deficiency.

meridians in order to learn more about the pastandI

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

assumed,

this

led

to

the

17

Volume 7, Number 2 | Summer 2012

condition of the patient's body. In this patient the

manipulated, applying the thrusting and lifting andtime of development of the current findings of thethe twirling techniques.

individual back transport points and meridians is

After treating (1) the body was in the following state.

unknown.

Tongue diagnosis: appearance of some brightness as

However,

based

on

the

author's

experiences of the condition of those back transportcompared to before treatment of (1).

points and meridians have probably developed years

Pulse

diagnosis:

improvement

of

the

(1)

pretreatment intermediate guan pulse position, but
the pulse was still hard and viscous in its deep

[Cause and mechanism of disease]

position.

Middle energizer(spleen) problem

Kidney (qi, yang)deficiency: surmised

Right low back pain: some pain remained. VAS:

Development ofpancreas cancer

Surgery,
chemotherapy

Progression of kidney(qi, yang) deficiency

Carries a bag
always over
the right
shoulderInfluence on the tai yang
bladder meridian of the foot(before a background of kidney
deficiency)(pretreatment) 10→2 or 3 (after treatment of (1)).

Spleen qi
deficiency

Pathogenic qi often influences
regions of weakened healthy qi

Disturbance ofbody balanceleads toQi stagnation#1 Pain from theright lumbar to theright inguinal
region
Excessive
amounts ofcold drinks

Drinking
party(2) Right KI3; 0.14/40 mm (Seirin made stainlessinsertion under the skin) for 3 minutes.

Further progression of kidney (qi, yang)deficiency and spleen qi deficiency

After treatment of (2) the body was in the following*It is unknown when the current findings of the individual back transport points andmeridians have developed. However, based on the author's experiences the conditionof those back transport points and meridians have probably developed years ago.

state.
Tongue diagnosis: appearance of some brightness ascompared to before treatment of (1).

ago.

Pulse diagnosis: pulse strength and width increased

Figure 3

in the guan pulse position. The hardness of the pulse[Cause and mechanism of disease]

had improved in particular on the right side in the
deep position.

[Treatment plan and objective]
The treatment plan was to treat the right-sided low
back pain and diarrhea. Treatment was carried out
mainly according to Chinese medical and Oriental
objectives.

Concreteobjectives

were

tonification of kidney and spleen (tonification of bothspleen and kidney), while promoting qi flow
(regulating qi).

Abdominal diagnosis: chilling of the hypogastricregion decreased and it became slightly warmer. The
weakness also become a little firmer.
III. Results[Effects immediately afterward] (after treatment (2))
#1 Right low back pain: patient almost did not feelpain. VAS: (pretreatment) 10→1 or 2.
Right inguinal region: the patient did not feel any

Treatment details
Acupuncture was the chosen treatment technique.
First the problems of the organs were addressed.
(1) Right BL20; 0.14/40 mm (Seirin made stainlesssteel needle)(1) Right BL23; 0.14/40 mm (Seirin made stainlesssteel needle)
The needles were retained in both points for 8
minutes. While retaining the needles, they were also18

I next used a meridian approach.
steel needle); applied twirling at the skin surface (no#2 Diarrhea

medicalSince problems at the right inch pulse still remained,

pain but still experiences some discomfort. VAS:
(pretreatment) 10→3 or 4.
#2 Diarrhea: currently under follow-up.
#1 The symptom remains, but since the surface
findings of tongue, pulse and abdominal diagnosis
showed improvements, the treatment was cut off at
this time.
[Health preservational instructions]

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

Volume 7, Number 2 | Summer 2012

Refrain from cold drinks and food. Return for a

to independently assess treatment induced changes

reexamination in 3-4 days.

in symptoms and conditions.
For this patient I performed multifaceted body

[Reexamination report]

surface observations and emphasized in particularThree days later the patient contacted me.

palpation. As palpation I performed not only pulse#1 On the day following the acupuncture treatment
the discomfort in the right inguinal region had been
alleviated. The right-sided low back pain had
improved to a degree, where it did not bother thepatient any longer.
#2 Diarrhea had stopped immediately after theacupuncture treatment. The stools had return totheir usual consistency. Based on this condition thetreatment was terminated.
One month later I had a chance to meet the patient.

diagnosis, but also meridian, abdominal and backdiagnosis. This practice can be called a concrete
example for "the richness of palpatory quality andthoroughness" said to be a characteristic of Japanese
acupuncture.

The

multifacetedbodysurfaceobservational findings also provide the ground forhighly varied Oriental medical interpretations of thefindings. This is conceivably one of the reasons
giving rise the high degree of diversity of Japanese

When I inquired about the above describedacupuncture and moxibustion.

symptoms, he replied that neither the right-sided

In this case the examination also included physicallow back pain nor the diarrhea had recurred since.

examinations.

Theobtained

physicalfindings

allowed to assume the Western medical assessment
IV. Discussionof the pathophysiology of #1. Japanese acupuncture

For this patient I performed a multifaceted bodyand moxibustion school education comprises thesurface observational examination centering on

study of both Western and Oriental medicine. Also,

anamnesis and palpation. This information was thenmany study meetings held in Japan provide theanalyzed according to Chinese medical and Oriental

opportunity to study a great variety of subjects

medical concepts to assess the pathophysiology. For

pertaining to acupuncture and moxibustion. The

the treatment I chose only few acupoints. As shownconcretein this case is a treatment with few acupoints one

acupuncture and moxibustion dealt with during

effective method, when the therapist is aware of thethose various study meetings depend on the specifictherapeutic effects of the individual acupoints andviews of the relevant study groups, their concepts of

their compatibility with examination results anddiseases, treatment, examination techniques anddiagnosis. It is also a good method to comprehend thethe relevant theories as well as therapeutic

Oriental medical body and illness concepts.

techniques. Study of these various concepts allows

The evaluation of the therapeutic effects was madethe practitioner to broaden his/her therapeuticin this case based on changes in body surface

horizon. A broader range of treatment options thenfindings

thanmakes it possible to treat patients with a variety ofobservations of changes in the symptoms. The

different diseases. The abundance of acupuncture

author thinks, these changes in body surface

and moxibustion treatment options forms the basis

findings reflect alternations in symptoms andof the great diversity of Japanese acupuncture anddisease status (improvements, aggravations, nomoxibustion, and at the same time also the basis forchanges). This conceivably enables the practitioner

the complexity of Japanese acupuncture and

in

the

supinepositionratherdetailsofsubjects

pertaining

tomoxibustion.

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

19

Volume 7, Number 2 | Summer 2012

V. Conclusions

studiesA patient presenting with low back pain extending

Conference

from the right lumbar to the right inguinal region

Moxibustion, 2010

and diarrhea was treated with acupuncture. Based

7)

from

Shin
of

Kinoshita–",

ClinicalJapan

Acupuncture

Shoji Shinohara, Nao Wazuchi, Katsuyuki

on the therapeutic results I came to the conclusion,

Watanabe: "Current Situation and Problems ofthat the acupuncture treatment was effective.

Japanese

Examination particularly emphasized multifaceted

Treatment Forms", supervised by Kazushi

body surface observations centering on palpation.

Nishijo,This was also used to evaluate the therapeutic

Acupuncture

effects. Body surface observations effectively allow

Ishiyaku, 2000, pp. 3-28

the practitioner both for the evaluation of the

8)

Takao

and

Kumazawa

andMoxibustion"Science

MoxibustionofClinics",

Denmei Shudou: "Recommendation of Meridian
Therapy", Ido no Nippon, 1988, pp.126-198

therapeutic effects and an assessment of possible
future conditions of the patient. Multifaceted

Acupuncture

9)"Obtaining

Body

SurfaceFindings",

observation, in particular palpation, lie at the base"Acupuncture and Moxibustion OSAKA", Vol. 19,of the diversity of Japanese acupuncture andNo. 3 (2003), pp.4-90
10) Renpu Fujimoto: "Body Surface Observation –moxibustion.

theKazuma Ito: "Current situation of the various11) Hirokimi Matsuda: "Collection of Interviews

Schools"; in "Research into Social Acupuncture

Acupuncture and Moxibustion I"; Midori Shobo

and Moxibustion 2011", Vol No. 6; 2012, pp.5-9

Co., Ltd., 2010, pp.250-253

AcupunctureandShuichi Katai: "Acupuncture and MoxibustioninJapan"

and"Japanese

Acupuncture and Moxibustion" in "Research
into Social Acupuncture and Moxibustion 2011",

4)12) Kanpu Yokota, Shuichi Katai: "Touch, talk 9";
Ido no Nippon Vol. 69, No.1 (consecutive Vol. 796,
2010), pp.227-237
13) Renpu Fujimoto: "Body Surface Observation –Vol No. 6; 2012, p.i.

thewisdomSodou Okabe: "Acupuncture and Moxibustion

Moxibustion; Midori Shobo Co., Ltd., 2012,

Meridian Therapy"; Sekibundo, 1974, pp.68-79

pp.66-67

Shuichi Katai, Hirokimi Matsuda: "Japanese
Acupuncture and Moxibustion in Crisis; facing
various problems pertaining to global strategies
of Chinese acupuncture and moxibustion" in"Oriental Medicine; Journal of Acupuncture &Moxibustion", Vol. 12 (2010), pp.15-33

5)

Shuichi Katai: "Development of the Hands ofClinicians – Essay on reactivity and palpation",
Rokuzensha, 2002

6)

Shinichi Kinoshita (author), Kenji Okamoto,
Yoshiki Sano, Shin Suzuki et al. editors:

20

Acupuncturewith Hirokimi Matsuda; in search of Japanese

Treatment

3)

Japanese

Moxibustion

Japanese2)ofMoxibustion; Midori Shobo Co., Ltd., 2012

[References]1)

wisdom"Textbookfor

MasteringTechniques

–the

Basic

Needling

teacher-student

education

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

ofJapanese

Acupuncture

Volume 7, Number 2 | Summer 2012

Clinical Report 2 (Kampo Medicine)
A Case in of Continual Leg Cramps Successfully Treatedwith Shigyakusan

but they only reduce the incidence or severity of leg
cramps and are not for the acute therapy to reducethe cramps and the related pain themselves at theSatoshi Yamamoto1), Keiko Ogawa-Ochiai2) and

Tetsuo Akiba3)
1) Center for Kampo Medicine, School of Medicine,
Keio University
2) Clinic of Japanese-Oriental (Kampo) Medicine,
Department of Othorhiolarygology andHead and Neck Surgery,
Kanazawa University Hospital
3) AKIBA Clinic of Traditional Medicine

to offer relief, but the frequent occurrence of
hypotension makes use unpractical. Kampo isJapanese traditional herbal medicine based on theancient Chinese medicine. Kampo prescriptions arecovered under the National Health Insurance Planof Japan, and are easily available to clinicians.

Shakuyakukanzoto is the most common prescription
for the leg cramp which cures acute state of the

Abstract

cramp. Some study showed that shakuyakukanzoto

Objective:
The authors report a case of continual leg cramps
successfully

onset of cramps. Nifedipine likewise has been foundtreatedwithshigyakusan—aprescription of Kampo (Japanese traditional herbal
medicine).

is effective on leg cramps seen in patients underhemodialysis.1,2 However, some of the patients are
sufferingfromrecurrent

cramps

even

after

shakuyakukanzoto administration. Shigyakusan(sinisan, in Chinese) is traditionally prescribed for
irritation, stress and spasm of the abdominal rectal

Subject:
A 31-year-old male with continual leg cramps
consulted our clinic. He has no past medical history
except pollen allergy and was normal in the physicaland blood examinations. His cramps temporarily
relieved with shakuyakukanzoto — a common
Kampo prescription for leg cramps, but had beenrecurring soon after a while.

muscle, and possibly effects on chronic restraint
stress-related disorders.3 A case with continual leg
cramps effectively treated with shigyakusan isreported.
Case Report
A 31-year-old male with continual right leg
cramps was seen in our clinic. He has no past
medical history except pollen allergy. For several

Result:By 30 minutes after shigyakusan administration, hisleg cramp completely stopped, and no cramp
recurred.

months, he was in stressed condition because thedecision of his boss had been frequently changing.
Since several days before visit, frequent leg cramps
on his right leg began and he had difficulty inwalking due to remaining continuous pain. He

Conclusion:
It was found that shigyakusan might be an effective
prescription for idiopathic continual leg cramps.

complained of leg cramps, irritated condition, tightpressure on his chest, and nightmare almost everyday. Physical examination and blood examination
findings

Introduction
There were no reliable therapies to reduce muscle
cramps and pain immediately when muscle cramps
happened even in hospitals or clinics. It is reported
that some drugs such as quinine, vitamin E,

werenormal.

Shakuyakukanzoto(TSUMURA Shakuyakukanzoto Extract Granules
for Ethical Use, Tsumura, Tokyo, Japan) 7.5g/day
was prescribed for his leg cramps. Leg cramp
temporarily relieved soon after administration, but

chloroquine phosphate, and L-carnitine are effective,
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

21

Volume 7, Number 2 | Summer 2012

recurs after a while. He visited our clinic for further

that shakuyakukanzoto has an inhibitory effect on

Kampo treatment.

excessive muscle contraction.

Shigyakusan (TSUMURA Shigyakusan Extract

As for shigyakusan, it contains Bupleuri radix and

Granules for Ethical Use, Tsumura, Tokyo, Japan)
medicine. By 30 minutes after administration, his

Aurantii
fructusbesidesofshakuyakukanzoto (Table 1). From the concept of
Kampo medicine, Bupleuri radix, or saiko inleg pain ceased. He continued shigyakusan for one

Japanese, spreads Liver qi and relieves constraints,3week, and no cramp appeared in the period. Since

and immature Aurantii fructus promotes the flow ofthen, he is taking the medicine as needed, when heqi. It has been said that stagnation of qi causes pain.

had the prospect of leg cramp.

The

7.5g/day on the basis of the concept of Kampo

immatureeffectinqi

circulationisstrongerinshigyakusan than in syakuyakukanzoto.
Discussion

Shakuyakukanzoto is commonly prescribed for leg
cramps, but it is not enough effective in some

Table 1
Compositions of shigyakusan and shakuyakukanzoto extract

patients. When the patient is with mental stresses
which affect on the “liver”, shigyakusan is one of theConstituent herbs

Weight (g)Shigyakusan

Shakuyakukanzoto

5.0

-

2.0

-

Paeoniae radix

4.0

6.0

Glycyrrhizae radix

1.5

6.0

skeletal muscles. Shakuyakukanzoto is a hot water

The

of

shigyakusan

extract from a mixture of equal parts of Paeoniae

shakuyakukanzoto are listed. After drying, theradix and Glycyrrhizae radix. The main components

herbs (total amount, 12.5g and 12.0g) shown in theof the roots are paeoniflorin and glycyrrhizic acid.

Table were boiled in 10 times of their weight of water

shakuyakukanzoto in thefor one hour. The resultant extracts were spray-dried.

inhibition of muscular contraction remains to be

The daily dosages of shigyakusan (7.5g) andfully elucidated. Previous reports claimed that ashakuyakukanzoto (7.5g) contained 2.25g and 2.5g of

mixture of paeoniflorin and glycyrrhizic acid had no

the resultant extract, respectively.

candidates.
The

extract

shakuyakukanzotoofinhibited

Bupleuri radix

contraction of skeletal muscles in rats.4,5 This

immature Aurantii

inhibition was observed in both the directly andfructusindirectly stimulated contractions, and was notchanged by addition of neostigmine, an acetylcholine
esterase inhibitor. These findings of the experiments
indicate that shakuyakukanzoto acts directly on

Themechanismofcompositionsandeffect or no coordinative effect on skeletal muscles.4
One report, however, stated that paeoniflorigenone,

Conclusions

a component of Paeoniae radix, indirectly blocked

It was found that shigyakusan might be an effective

stimulated

twitchprescription for idiopathic continual leg cramps.

confirmed

that

the

response.5

Anotherstudy

blendedpaeoniflorin

andglycyrrhizic acid indirectly blocks the stimulated

Disclosure Statement

twitching isolated sciatic nerve-sartorius muscle

No competing financial interests exist.

preparations in frogs (Rana nigromaculata), and inisolated or in situ phrenic nerve-diaphragm muscle
preparations in mice.6 Therefore, we also suggest

22

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

Volume 7, Number 2 | Summer 2012

References
1.

Hinoshita F, Ogura Y, Suzuki Y, et al. Effect ofOrally Administered Shao-Yao-Gan-Cao-Tang(Shakuyaku-kanzo-to) on Muscle Cramps in
Maintenance

Hemodialysis

Preliminary

Study.

Am

Patients:
J

Chin

A
Med

2003;31:445–453.
2.

Hyodo T, Taira T, Takemura T, et al. Immediate
Effect of Shakuyaku-kanzo-to on Muscle Crampin Hemodialysis Patients. Nephron Clin Pract
2006;104:c28–c32.

3.

Wang UT, Tan QR, Sun LL, et al. Possible
therapeutic effect of a Traditional Chinese
Medicine, Sinisan, on chronic restraint stressrelated disorders, Neurosci Lett 2009;449:215–
219.

4.

Kimura M, Kimura I, Takahashi K, et al.
Blocking effects of blended paeoniflorin or its
relatedcompoundswithglycyrrhizinonneuromuscular junctions in frog and mouse. Jpn
J Pharmacol 1984;36: 275–282.
5.

Kimura M, Kimura I, Takahashi K, et al.
Blocking

effectsofpaeoniflorigenone

in

a

new
paeonycomponent,
root

on

neuromuscular junctions of frog and mouse. Jpn
J Pharmacol 1984;35: 61–66.
6.

Takagi K, Harada M. Pharmacological studies
on paeony root. III. Effects of paeoniflorin on
circulatory and respiratory systems and isolatedorgans.

Yakugaku

Zasshi1969;89:893–898[Japanese, abstract in English].

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

23

Volume 7, Number 2 | Summer 2012

Medical History in Japan
Historical Significance of the Standardization of Acupoint
Locations”, the Second Japanese Acupoint Committee (6)“Detailed Guide to the Location of Acupoints” from thecalssics to the WHO standardization”, pp411-422, Tokyo,
Ishiyaku Publishing, June 2009 (partially revised)

The oldest extant text with acupoint charts currently
known is the Yellow Emperor's Toad Prohibitions for
Moxibustion & Cauterization Huáng Dì Xiā Má Jing
(Figure 7) and based on the works listed in the
Record of the Bibliographic Catalogs of the Sui

Makoto Mayanagi
Graduate School of Humanities
Ibaraki University

dynasty it seems likely that the roots have been
established in the 3rd century. Not surprisingly,
similar to the "Ming Tang”, these have been
scattered and lost in China and have been preserved(continued from KAIM Joural vol.6 no.1, no.2, no.3,
no.4 and vol.7 no.1)

and

5. Acupoint charts up to the Tang period and changes
in acupoints
Since acupoints are located on the body surface theirvisualization through illustrations has undoubtedly

handed

down

only

in

Japan.

The

oldmanuscripts were discovered during the late Edo
period by Mototsugu Taki of the Shogunate Medical
School. Figure 7 shows a replica of the Shogunate
Medical School's copy and names of acupoints alongstarted from an early point in time. Therefore, thethe hairline or Renying (ST9) can be seen. Moreover,"Ming Tong Illustrations" have probably been drawn

it includes a description that like the imaginary toadaround the creation of the original "Ming Tong Jing".

and rabbit on the moon moxibustion treatment ofBecause no directly derived drawings exist, there aresome acupoints should be avoided in correlation withno concrete clues, but it can be imagined based on

the waxing and waning of the moon.

acupoint illustrations up to the Tang period.

Figure 7 Huáng Dì Xiā Má Jing

24

Figure 8 Ishinpo

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

Volume 7, Number 2 | Summer 2012

In the Heian period Yasunori Tamba compiled theregulated by the oriental zodiac signs characteristic

text "Ishinpo" based mainly on works from before theof the birth year, seasons, months and days, while at

Sui and Tang periods and presented this to thethe end there is a transcription of the year 861. Thus,

emperor in 984. In the 22nd volume are illustrations

this book shows clearly that during the Tang period

for each of the 10 months of pregnancy, for each anprior the year 861 textbooks about moxibustion haveillustration of a naked pregnant woman, fetus,

already been published in Xi'an. At the same time

viscera and bowels, meridians and acupoints. All of

this is also the oldest extant medical book publishing

which are derived from the Chang Jing. Among theserecord.

the contents related to the correlation between fetal
developmentandviscera-bowels-meridiansoriginates and has been transmitted from the "TaiChan Jing" (text on fetuses and birth), placing its
origin extremely far into the past. The date ofcreation of the Chang Jing quoted in the Ishinpo is
not clear, but considering the 5th century appears tobe acceptable and most likely. Figure 8 shows a
reproduction of the "National Treasure Seikido
Library [12], but the book of the Seikido library is anassociated book that has diverged from the Nakarai's
national treasure book during the Edo period, so thatit cannot definitely be concluded, that the red lines
indicating meridians are actually derived from the"Chang Jing".
A text with acupoint charts of the Tang period wasunearthed in Dunhuang. Figure 9 shows the Stein
Text No. 6168 from The British Library in London

Figure 9 Stein Text No. 6168 (London, The British

andLibrary)iscalledthe"Illustrated

Moxibustion

Technique" of the "Moxibustion Scripture". Like the
Xia Ma Jing no meridians are drawn and only points

On the other hand, paying attention to the hair style

not used today like "Shou Suikong" or " Wuzhou"

shown in Figures 7-9 reveals that although only

have been marked. Also, the Pelliot text No. 2675

Figure 8 shows a woman, all are very much alike.

[13], which is in the possession of the La

The drawing style of the bodies too is strikingly

Bibliothèque nationale de France, mentions at thesimilar. This shows, that until the Tang period the

beginning a "First Volume of the New Adorned

acupoint charts adopted a standardized style. What

Scripture of Moxibustion for Acute conditions". In

is more, in Pelliot's text No. 2675 there is a large

other words, this texts was a reproduction of the one

inscription of "Ming Tang" above the body, revealing

volume work " Xinxiu Beiji Jiujing" published by thethat acupoint illustrations have been called "Ming

Li family living a business area in the eastern

Tang". If that is so, the "Ming Tang Tu" prepared inmarket of the capital (today called Xi'an). On thethe third century too was drawn in this style andbackside of the paper the second half of this booklater presumably followed until the Tang period.

describes the location of the "human-spirit" elements

Yet, changes occurred in the acupoints. The points"

correlated to the suitability for treatment as

Shou Suikong" or " Wuzhou 2 shown in Figure 9 are

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

25

Volume 7, Number 2 | Summer 2012

not found in the "Ming Tang", and in Pelliot's text No.
2675 the point GB21 jianjing (肩井) is called bo jing(膊井), the point TE20 jiaosun (角孫) is recored as yin
hui (陰会), the point GV23 shengting (神庭) is calledzhu shen (住神) and the point between the eyebrowsEX-2 yin tang is called guang ming. During the time
following the "Ming Tang" too different names for
acupoints and new acupoints appeared and different
schools and theories using those names continued tobe established.

26

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