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INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 9, Number 2 ･ Summer 2014

Editorial

Recommendation of Addressing the “99”Junko Okubo

Japanese Acupuncture - Current Research

Japanese Traditional Medicine Text (12) – Orthopedic Medicine
Keisho Ishimaru

Kampo Medicine - Current Research
Clinical Applications of Kakkonto – Part 2
Hiromichi Yasui

Clinical Report 1 (Acupuncture)

Acupuncture and Moxibustion Treatment for a Patient with Chronic Complex Health Problems, where the Cooperation by the Family too
Contribued to the Improvement
Takara Yamami

Clinical Report 2 (Kampo Medicine)

A Case in Which Shokenchuto was Effective for a 10-year-old Girl who was Easily Tired, Sensitive to Cold, and had a Weak Digestive
Function
Hideaki Yamaguchi

Report on Visit to AIMC

A Letter from the Acupuncture and Integrative Medicine College (AIMC) in Berkeley, USA
Kazunari Ozaki and Mitsuru Kageyama

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 9, Number 2 ･ Summer 2014

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, JapanASSOCIATE EDITORS
Shuichi Katai

1 Editorial
Recommendation of Addressing the “99”Junko Okubo

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

2 Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (12) – Orthopedic Medicine
Keisho Ishimaru

6 Kampo Medicine - Current Research
Clinical Applications of Kakkonto – Part 2
Hiromichi Yasui

16 Clinical Report 1 (Acupuncture)
Acupuncture and Moxibustion Treatment for a Patient with Chronic Complex Health
Problems, where the Cooperation by the Family too Contributed to the Improvement

PUBLISHER

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

Takara Yamami

21 Clinical Report 2 (Kampo Medicine)
A Case in Which Shokenchuto was Effective for a 10-year-old Girl who was Easily Tired,
Sensitive to Cold, and had a Weak Digestive Function
Hideaki Yamaguchi

23 Report on Visit to AIMC
A Letter from the Acupuncture and Integrative Medicine College (AIMC) in Berkeley,USA
Kazunari Ozaki and Mitsuru Kageyama

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 9, Number 2 | Summer 2014

Editorial
Recommendation of Addressing the “99”The workings of the human body are gradually being brought to light, albeit little by little.
For example, where it was previously thought that adipose cells simply accumulated fat, they are
now recognized as an endocrine organ, and it has been found that the secretion of adiponectin, atype of good adipocytokine, decreases when visceral fat increases. Skeletal muscles also secrete aphysiologically active substance that involves an effect on regulating metabolism. Irisin, which issecreted during exercise, increases energy metabolism by acting on fatty cells and causing
precursor cells to differentiate into cells that have the properties of brown adipocytes, andimproves glucose tolerance. With regard to estrogen receptors, they were found to exist on cell
membranes (although it is a shame in terms of endocrinological classification that the clear
distinction of water-soluble hormones binding to membrane receptors and fat-soluble hormones
binding to nuclear receptors no longer applies). There are reports that this type of receptor, which
differs from the conventional nuclear estrogen receptor, reacts to estrogen, and also responds wellto daidzein and other such phytoestrogens. The elucidation of such workings fills us with a senseof amazement at their sophistication, and reminds us of the importance of such lifestyle habits as
eating and exercising.
Yoshio Marumoto, an author and food researcher who has published many books based on
the latest in nutrition, writes as follows in How to Redeem Home Cooking: “Say death equals zero, theonset of a disease equals 1, and health levels range from 1 to 100. We believe that medicine is ascience that ranges from zero to 100, but it is actually a special skill that is applied between zeroand 1. It is a skill for prolonging the life of patients who have finally consulted a doctor after theirhealth level has gradually fallen to 1.” Addressing the 99 levels between 100 and 1 is precisely what
preventive medicine is about, and the achievements of numerous researchers prove that there isno greater medicine than paying proper attention to lifestyle habits. It also stands to reason that
Kampo and acupuncture are options for addressing the 99 levels.
We modern people have gained longer lifespans compared with the past. However, theexistence of living beings appears to place weight on reproductive age, as can be seen by chronic
inflammation caused by senescent cells and the involution of the thymus gland. We hope for healthand long life, but the odds are somewhat against us. Only by practicing good lifestyle habits andreceiving early treatment, we can age while maintaining quality of life.
It may be easy to understand the importance of addressing the 99, but there is a high barrier
to execute it. We must act now to extend our health span. Let us strive to “live well and die well.”Junko Okubo, Ph.D., L.Ac.
Medical Science Research Division
Goto College of Medical Arts and Sciences, Tokyo, JapanThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

1

Volume 9, Number 2 | Summer 2014

Japanese Acupuncture – Current Research
Japanese Traditional Medicine Text (12) –Orthopedic Medicine

Keisho Ishimaru

Professor
Department of Health Sciences
Ryotokuji University

St36, appeared to provide similar analgesic effects
for post chest and abdominal surgery patients.
Please refer to Figure 8 for these clinically useful
results. (Table 8)2-8)

Potentially relevant publications originallyidentified and screened for retrieva（l n＝126）

B. Post-operative Pain
Post-operative

specific point and treatment area, notably, LI4 andadvancesinanesthetic

management have been shown to decrease theNot RCTs （n＝61）

incidence of post anesthesia pain and complications.
However, the remaining challenges are to minimize

No postoperative pain measurements
reported（n＝39）

the side effects and over-reliance on pain relief drugs,
such as morphine. In recent years, there has been

TENS at no acupuncture points（n＝2）

interest domestically to inhibit post-operative pain
and complications. To this end, numerous reports
from the of practices complementary and alternative

Paediatric studies（n＝1）

medicine (CAM) using acupuncture analgesia which
may activate the descending pain inhibitory system

Trials where control intervention wasneither placebo control nor shamcontro（l n＝8）

as a means to reduce reliance on morphine.
1. The current situation of Clinical research abroad
We conducted a PubMed search using the

RCTs suitable for inclusion（n＝15）

keywords “postoperative pain” and “acupuncture” for
RCTs included in systematic review but
excluded from meta─analysis becauseof unsuitable data presentation（n＝5）

all post-operative pain research up until 2010 andfound 174 relevant references. Several reports
included SR and RCT evidence based research. Sun
et al.1) of Duke University discusses the details of

RCTs suitable for inclusion（n＝15）

post-operative pain relief through acupuncture in asurvey style systematic review of 15 papers (Figure

Figure 7 Systematic Review of Acupuncture for Post

7). The articles referring to acupuncture treatment

operative pain by Sun Y et al.

for post-operative pain included 8 papers on chest
and abdominal surgeries, 4 on general orthopedic

2. Current Situation of Clinical Research in Japansurgeries and the last 3 focused on oral surgeries.

We searched relevant medical search engines for

Various acupuncture methods were used fromthe key words “Neuropathic pain” and ”Acupunctureauriculartoand Moxibustion treatment” for references between

stimulation

1983 and 2010 and extracted 44 references. However,(TEAS). These researchers found reductions inmost of these reports were case studies and only one

numbers of postoperative complaints, amounts of

was an RCT5). It is clear that most Japanese

analgesics requested and noted the pain-relieving

acupuncture

effects of these modalities. Excluding the effects ofmanagement uses electro-acupuncture and TEAS

the auricular acupuncture, the aim of using arather than auricular acupuncture.

andtranscutaneous2

electro-acupuncture

electricalacupoint

research

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

forpost-operativepainVolume 9, Number 2 | Summer 2014

Additionally, in a consensus statement issued by
the United States National Institute of Health (NIH)
it was concluded that acupuncture is effective for

3. Management challenges for the application ofacupuncture analgesia for post- operative pain
Post-operative pain following abdominal andchemotherapy-

chest surgeries may vary with incision length,

induced nausea and vomiting and postoperative

invasiveness of the procedure, length of timedental pain (1997). With a few references omitted,

required for the procedure. Pain management begins

published literature is presented providing evidencewith preoperative epidural anesthesia (pre-emptivethat

analgesia)

postoperative

pain

acupunctureinisgeneral,effective

for

chest

and

(leading

analgesic)

and

is

then

abdominal post-operative pain (Table 8). Many ofsupplemented with postoperative intravenous painthese reports on acupuncture analgesia use electro

medication controlled by the patient with a button

acupuncture at distal points on the arms or legs. The(patient controlled analgesia PCA)6). These methods

mechanism advocated by many researchers refers toare quite stable way to manage pain. PCA methods,

the descending pain inhibitory system, thereby

combined with the application of acupuncture

stimulating endorphins, and other endogenous

analgesia,

analgesia mechanisms. Clinical efforts to reduce themanagement needs to be better understood in an

amount of analgesics, such as morphine, especiallyanticipation of reducing the dose of analgesics

in the early post-operative stages, to reduce theinjected into the epidural. Further research isincidence of such as gastrointestinal motility bynecessary to investigate the potential of effectively

postoperative ileus4). We compared acupuncture

reducing postoperative complications such as POVN

analgesia for pain management after abdominal

and PI by implementing complementary, alternative

surgery with a “no-intervention” control groupand integrative medicines.

including

perioperative

anesthetic(Table 9). Ten of the 11 subjects in the control grouprequired normal doses of analgesics, whereas for the
11 subjects in the acupuncture treatment group(Table 10) only one was not to reduce the amount ofnecessary analgesics. We attribute these results tothe involvement ofβ endorphins5).

Table 8

Acupuncture Analgesia for Chest and Abdominal Post-Operative Pain Management

Researcher (year)

Treatment area

Acupoint stimulation area

Wang2) (1997)
Chen3) (1998)

Lower abdomen (digestive organs)
Lower abdomen (uterus)

LI4
ST36

Ishimaru5) (1999)

Abdominal area (digestive organs)LI4, ST36

Kotani4) (2001)

Abdominal area (digestive organs)

Urinary bladder channel(BL17 ─ 26)

Lin6) (2002)

Lower abdomen (uterus)

ST36Sim7) (2002)

Lower abdomen (uterus)

LI4

Wang8) (2006)

Chest/trunk area (lungs)

LI4, GB34 etc.

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

Acupuncture pain
management (minutes)
TEAS (30 minutes)
TEAS (30 minutes)

Electro-acupuncture(3 hours)
Embedded needles(4 day retention)
Electro-acupuncture(20 minutes)
Electro-acupuncture(45 minutes)
Electro-acupuncture(20-30 minutes)

3Volume 9, Number 2 | Summer 2014

Table 9Relationship between the Degree of Postoperative Pain and Analgesic Use

No

Age

Sex

1

63

M

Surgical procedure
Subtotal

Anesthesia
time(minutes)

Right
after
operaton

150

2

gastrectomy
2

68

M

Colorectal

high

225

1

150

2

anterior resection
3

70

M

Colorectalhighanterior resection

3 hours
after
operation
2

6 hours after
operation3
pentazocine 1A

1

1

2

diclofenac sodium

9 hours after
operation

12 hours
after
operation

1

0

1

1

1

0

1

0

3
50mg

4
5

81
74

M
M

Cholecystectomy

120

Subtotal

215

2

2

3
pentazocine 1A2

gastrectomy322

diclofenac

1

sodium 25mg
6

71

M

Colorectal

lower

210

2

anterior resection

3
1

2

diclofenac

1

sodium 25mg
7

8

74

31

M

M

Total gastrectomy

Subtotal

225

180

1

3

3

pentazocine

diclofenac sodium

1A

25mg

2

diclofenac sodium

2

gastrectomy

2

2

0

0

0

0

1

0

2

2

3
25mg

9

80

F

Cholecystectomy

50

2

3
2

diclofenac sodium
25mg

10

69

M

Subtotal

290

1

gastrectomy

32

diclofenac sodium
25mg

11

70

F

Subtotal

205

2

gastrectomy

32

diclofenac sodium
50mg

Post Surgical Pain Evaluation

4

0: no pain,

1: low degree of pain,

2: persistent pain,

3: persistent pain and analgesic use.

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

Volume 9, Number 2 | Summer 2014

Table 10

Relationship between the use of acupuncture analgesia for post-operative pain and the use ofanalgesics
No

Age

Sex

Surgical procedure

Anesthesia
time(minutes)

Right
after
operaton

1

67

M

Choledochojejunos

220

2

170

2

-tomy
2

71

M

Right

hemi-

cholectomy

3 hours
after
operation

Elctroacupuncture
6 hours after
operation

9 hours
after
operation

12 hours
after
operation

1

0

0

0

1

1

0

0

3

71

M

Total gastrectomy

395

2

0

0

0

0

4

57

M

Cholecystectomy

160

2

0

0

0

0

5

67

M

Cholecystectomy

75

1

1

0

0

0

6

41

M

Subtotal

175

2

1

1

0

0

210

2

1

0

0

1

0

0

0

1

0

0

0

0

0

0

0

1

1

0

0

gastrectomy
7

57

M

Subtotalgastrectomy

3
diclofenac
sodium 50mg

8

65

M

Colorectal

high

166

1

225

2

200

2

anterior resection
9

88

F

Abdominalperineal resection

10

82

M

Subtotalgastrectomy

andcholecystectomy
11

53

F

Subtotal

166

2

gastrectomy
Post Surgical Pain Evaluation

0: no pain,

1: low degree of pain,

2: persistent pain,

3: persistent pain and analgesic use.

References

requirement, and sympathoadrenal responses.

1) Sun Y, Gan TJ, Dubose JW, et al.: Acupuncture

Anesthesiology 95: 349─ 356, 2001

and related techniques for post-operative pain: a5) Keisho Ishimaru, Kenji Imai et al.: Effect ofsystematic review of randomized controlled

acupuncture analgesia for post-operative pain

trials. Br J Anaesth 101: 151─ 160, 2008

following abdominal surgery – peripheral blood2) Wang B, Tang J, White PF, et al : Effect of theβ-endorphin and ACTH as indicators ─. Journal

intensity of transcutaneous acupoint electricalof the Japanese Pain Clinic Society 1 (6): 10─16,

stimulation on the postoperative analgesic

1999

requirement. Anesth Analg 85: 406─ 413, 1997
3) Chen L, Tang J: The effect of location of6) Lin JG, Lo MW: The effect of high and low
frequency electroacupuncture in pain after lower

transcutaneous electrical nerve stimulation on

abdominal surgery. Pain 99: 509─ 514, 2002

postoperative opioid analgesic requirement:

7) Sim CK, Xu PC: Effects of electroacupuncture on

acupoint

versusnonacupoint

stimulation.

N,

HashimotoH:andpostoperative

analgesic

requirement. Acupunct Med 20: 56─65, 2002

Anesth Analg 87: 1129─1134, 1998
4) Kotani

intraoperative

Pre-operative

8) Wong

RH,

Lee

TW:

Analgesic

effectofintradermal acupuncture reduces postoperativeelectroacupuncture in post-thoracotomy pain: apain,prospective randomized trial. Ann Thorac Surg

nauseaandvomiting,

analgesic

81: 2031─ 2036, 2006

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

5

Volume 9, Number 2 | Summer 2014

Kampo Medicine - Current Research
Clinical Applications of Kakkonto – Part 2

also be applied to some cases of hypertrophic
rhinitis and nasal polyp. It may also be used for

Hiromichi Yasui

recurrences after surgery and when symptoms do

Japan Institute of TCM Research

not improve.”1) Additionally, Hosono et al. write as
follows regarding the emergence of effect: “For such

Kakkonto is a prescription that first appeared in
the great Chinese classic Shokanron (treatise on cold
damage) and came to be widely used in Japan fromthe latter half of the 19th century. Particularly since
Yodo

Odai

(1799-1870)

introduced

variousindications for the prescription, it has become afrequently-used prescription that is applied to a wide
variety of diseases.

nasal conditions, kakkonto commonly works byincreasing the amount of nasal discharge over the
first several days and even making the discharge
even thicker and more purulent than usual, andthereafter gradually decreasing the nasal discharge
so that is becomes less thick and eventuallydisappears.”2)

Byomei Kampo chiryo no jissai (practical Kampo
therapy

Clinical applications (continued)
In Shokanron, indications for which kakkonto isused are acute infectious diseases. However, fromJapan’s more than 150 years of experience, kakkonto
is known to be a prescription that is effective for an
extremely wide range of indications and is todaybydiseasename)defines

kakkontokasenkyushin’i as the basic prescription
for acute rhinitis, and recommends the addition of

kikyosekko (Platycodi Radix+ Gypsum Fibrosum;in the case of viscous rhinorrhea) or yokuinin(Coicis Semen; in the case of watery rhinorrhea).3)
Hanawa writes that for chronic sinusitis, using

below, in continuation from the previous issue.

kakkonto alone has a sharper effect than
kakkontokasenkyushin’i4), and notes that because
kakkonto has a strong drainage effect, using it

3. Rhinitis, allergic rhinitis, sinusitis

when the discharge opening is blocked sometimes

applied to many diseases. These are introduced

Kakkonto is widely known to cure inflammatory
diseases of the face, such as the ears, nose, throat
and eyes, and is frequently used for this purpose. A
particularly large number of cases has beencauses a severe headache because the discharge has
nowhere to go.4) He also reports that due to thisdischarge effect, there was a case where a child withnasal allergy took the prescription with goodreported regarding diseases of the nose.

progress but the closing of his wound after surgery

Kampo shinryo iten (dictionary of Kampo
medicine) mentions the application of kakkonto forthis reason, he warns that kakkonto may be used insinusitis as follows: “It is used in the initial stage ofthe acute phase, and works well when used for such
symptoms as fever, heavy head, nasal obstruction,
purulent discharge, and stiff shoulders.”1) It also
states that “For cases that become chronic, 2.0g
each of kakkonto+senkyu (Cnidii Rhizoma), ogon
(Scutellariae Radix), kikyo (Platycodi Radix), andshin’i (Magnoliae Flos) are used. For cases thathave a tendency of inner heat or constipation, 5.0g

sekko (Gypsum Fibrosum) and 0.5 to 1.0g daio
(Rhei Rhizoma) are added. The preparation may

6

for acute appendicitis took longer than usual.4) For
cases where there is a natural discharge route, but
if not, it should not be used readily.4)
Chronic sinusitis
The following cases have been reported regarding
chronic sinusitis. Kakkonto is frequently used as adecoction blended with something else. There arealso many cases of kakkontokasenkyushin’i andkakkonkajutsubuto. Kikyosekko extract or yokuinin
extract are also added to kakkonto in some cases.

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

Volume 9, Number 2 | Summer 2014

temperature of 37.8°C. She had a floating andCase 1: Chronic sinusitis

slightly rapid pulse.

Patient: 13-year-old girl
The patient suffered nasal congestion, rhinorrhea

When she was given kakkonto with 10.0g of

and a heavy head that persisted for several years.

Yokuinin, her face suddenly felt lighter in the

There was nothing to note in particular in her family

morning after taking the prescription at night, andmedical history or past medical history. Height

she slept soundly. As she woke up, a large amount of

151cm, weight 43kg, both eardrums normal. Herpus poured out to her throat. Furthermore, after fivenasal mucosa was red and slightly swollen, and adays of taking the preparation, no new inflammation

large amount of discharge and viscous secretion wasappeared in the affected area, and the patient

observed in both nasal passages. The pharynx had

completely forgot about the pain. Yokuinin was

mucosal redness and postnasal discharge. Paranasal

added to kakkonto, as it has drainage and analgesic

sinus X-ray examination found a moderate shadow

effects.
Keisetsu Otsuka, Shoukou ni yoru Kampo chiryo no

in both maxillary sinuses.
Diagnosis: Chronic sinusitis of both paranasal

jissai (practical Kampo therapy based on symptoms, p.

sinuses21, Nanzando, 1963

Observation of present illness from the perspectiveof oriental medicine: Medium build, somewhat wellmuscled, good facial complexion, floating and tense

Allergic rhinitis
Meanwhile, kakkonto is also effective against
some types of allergic rhinitis. In Kampo shinryo iten,

pulse, slightly dry tongue.
A daily dose of 5g kakkontokasenkyushin’i was

it is written: “Some types of allergic rhinitis that isprescribed as the symptoms suggested an excessive

accompanied by constant stiffness in the shoulders,pattern.

susceptibility to colds and frequent sneezing, may be

Afterapproximatelytenweeks,

thedischarge from both nasal passages decreased

treated by this prescription (kakkonto).”5)

significantly, nasal congestion was alleviated, and an
improvement was seen in the shadow that appearedin the paranasal sinuses in the sinus X-ray
examination.

Case 1: Allergic rhinitis
44-year-old male. From around four years ago, thepatient began to experience bouts of sneezing, runny

Shigeto Osako, Cases of chronic sinusitis, Gendai nonose and minor eye irritation in spring, which lasted

Kampo chiryo (modern Kampo therapy), p. 582, Toyofor roughly a whole month. He was diagnosed with

Gakujutsu Shuppansha, 1985

cedar

pollenallergyandsomehowkept

the

symptoms at bay with Intal nasal drops and an
Case 2: Maxillary empyema

antihistamine.

However,

becausetakingtheA 39-year-old woman with chronic maxillaryantihistamine made him sleepy and lethargic such

empyema complained that the right side of her facethat he could not concentrate on his work, he visited

began to hurt intensely since a few days ago such

us four days after a bout occurred. He had a steadythat she cannot eat or sleep at night.

pulse, stiffness at the back of his neck and no

An examination found that the center of her rightdyspepsia, dry mouth or coldness, so he was told toupper jaw was swollen to the size of the tip of atake kakkontokasenkyushin’i extract for a week.

thumb and was slightly red. Even rubbing the area

Efficacy of the prescription appeared immediately

caused strong pain. Her right nasal cavity wasafter taking it, and the patient’s bouts completely

blocked, and her right shoulder was particularly stiff.

disappeared in four days. He said he was able to

She sometimes felt chills, and had a high bodyspend the spring season this year in comfort.

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

7

Volume 9, Number 2 | Summer 2014

Katsutoshi Terasawa, Shin Kampo shohou manual(new Kampo prescription manual), p. 54, Shibunkaku

Case 1: Nasal congestion caused by taking anantipsychotic drug
16-year-old male student in his first year of highShuppan, 1991

schoolFamily medical history / Past medical history:

Case 2: Allergic rhinitis
A 28-year-old woman complained that, since

Nothing in particularseveral years ago, she was prone to sneezing for a

History of present illness: From around May 1990

while every morning after she woke up. It was minor

when the patient entered high school, he began toin summer but worsened from autumn to winter. Her

suffer from paranoia, thinking that others are trying

doctor diagnosed her with allergic rhinitis and gave

to set him up. He pushed himself to go to school, but

her medicine, but she said the sneezing still has not

on August 1, he was told by a friend that he isstopped.

“gloomy.” This triggered a sense of strong anxiety in

The patient is a tall, fair-skinned, plumpish

him, to the point that the thought of suicide crossed

woman. Her pulse was slightly floating but not rapid.

his

Her abdominal pattern showed that a spot above thehospitalization on that same day.

umbilical region that was sensitive to pressure. I

Progress in hospital (Fig. 1): A general biochemicalgave her kakkonto for this. No changes were

blood examination and neurological examination

observed over the first seven days, but her symptoms

conducted

improved

completely

abnormality. Diazepam (DZP) and thioridazine (TR)disappeared after four weeks, and she experienced

were administered, and in roughly two weeks, theno frequent sneezing after that.

patient’s paranoia and anxiety abated. Suddenly on

after

two

weeks.

They

mind.

He

therefore

upon

had

hospitalizationanemergency

showedno

Keisetsu Otsuka, Shoukou ni yoru Kampo chiryo no

August 26, he displayed psychomotor agitation,jissai (practical Kampo therapy based on symptoms), p.

punching the wall while yelling, “I’m famous. I’ve

73, Nanzando, 1963

done nothing wrong. Why is everyone saying suchbad things about me?” The erroneous perception

Nasal congestion as a side effect of a psychotropic

disappeared in roughly four weeks, after injections

drugof haloperidol (HP) and levomepromazine (LP) andKakkonto is also used at times for nasal

oral

administrationofmainlyLP.

However,congestion that is not caused by inflammation. For

immediately after administering HP and LP, severe

example, there are cases where it has been usednasal congestion and mouth dryness emerged. Fromagainst nasal congestion that occurred as a side

the perspective of otorhinolaryngology, a slighteffect of an antipsychotic drug.

swelling of the nasal mucosa was observed. Theofpatient was therefore given kakkonto (daily dose of

kakkonto extract by administering the extract to five5g). On the following day, the nasal congestion

patients of schizophrenia who developed nasal

improved so that he was able to breathe more easily,congestion as a side effect of an antipsychotic drug.

and disappeared after about a week of taking the

As a result, he reports that two cases showed marked

prescription. The patient gained consciousness of the

improvement,disease and was discharged on October 4.

Akira

Kurokouchi

twostudied

cases

the

showedefficacy

moderate

improvement, and one case with a history of chronic

Akira Kurokouchi, The efficacy of kakkonto on nasal

sinusitis showed slight improvement, and that nocongestion caused as a side effect of an antipsychotic

side effects were observed whatsoever.6)

drug, Kampo Medicine, Vol. 43, No. 2, pp. 79-83, 1992

8

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

Volume 9, Number 2 | Summer 2014

Other nasal diseases

4. Otitis media and others

Kakkonto is also used for nasal polyps. Hanawa
recommends kakkonto or kakkontokasenkyushin’i

indications to use kakkonto. In Kampo shinryo iten,

for allergic nasal polyps (type I allergy).7) There is a

it is written as follows: “Use [kakkonto] when there

famous case in which Yodo Odai (1799—1870) used

is pain inside the ear, chills, fever and headache ina prescription of kakkonto blended with otherthe initial stage, and the pulse is floating andsubstances for a patient with chronic sinusitis

strong. It may also be used when the patientaccompanied by nasal polyps. In roughly half a year,

complains of stiff shoulders or displays symptoms

the nasal polyps dropped off and a sudden

resembling those of meningitis. If the symptoms

improvement was seen.8)

accompany vomiting, add 5.0g Hange (pinellia

Symptoms of acute otitis media are frequently

Additionally, there are reports of cases in whichtuber), and if the patient complains of severe

kakkonto was used for such symptoms such as

dryness of the mouth, add 3.0g kikyo (Platycodi

snoring caused by rhinitis and erosion of the skin

Radix) and 5.0g sekko (Gypsum Fibrosum).”9)

below the nose due to nasal discharge.

Cases that have been reported to date are
introduced below. Case 5 is a case of discomfort

Case 1: Pediatric snoring caused by hypertrophic

around the auricular region and not a case of otitis

rhinitismedia, but it has been included as a case related to

The patient was a four-year-old boy. His firstthe ear.

medical visit was in June 1965. Immediately after
birth, he became susceptible to colds, and when he

Case 1: A patient who developed otitis media from acame down with a cold, it was habitual for his nosecold

to become blocked, produce a large amount of

A two-year boy developed otitis media after

discharge, and bleed. An ear, nose and throat doctor

catching a cold and was seeing an ear and nose

treated him for hypertrophic rhinitis and tonsillitis,

doctor, but he came to see me at the recommendation

but he was not cured. Moreover, he was the talk ofof a neighbor. His chief complaint was the discharge

his family because he had stiff shoulders and snoredof pus from his left ear. This was verified, but there

profusely even though he was only a child. He also

was nothing else of particular note. No abnormality

complained of stomach aches sometimes, had night

was seen in his defecation or urination, and he had

sweats from his neck to head, and had a palea healthy appetite. He was given kakkonto, and on

complexion although he had good nutrition. Both of

the third day, the pus stopped, and he washis abdominal rectus muscles were tense.

completely cured after three weeks.

To treat the patent’s stiff neck and nasal blockage,

Keisetsu Otsuka, 30 Years of Kanpo, Sogensha, 1959

kakkonto extract powder 1.0g was administered
twice. The prescription works well when it works,

Case 2: Tubal obstruction (?)

and the patient no longer caught a cold after taking

37-year-old female

it. His nasal blockage lightened considerably, heAround six to seven years ago, the patient says

became able to breather more easily, and the awful

her hearing became poor and her ear began to feel

pediatric snoring completely disappeared, thereby

blocked, causing her pain. Furthermore, the sound of

making the entire family happy.

her breathing echoed strongly in her ear, and at theDomei Yakazu, Kampo chiryo hyakuwa (hundredstories of Kampo therapy), Part 5, p. 200, Ido-noNippon-Sha, 1971

same time, her voice became a falsetto voice.
Since then, she complained that the same
symptoms occurred whenever she rode an airplane.

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

9Volume 9, Number 2 | Summer 2014

When I asked if she has a bad nose, she did notknow, but she said she often has a runny nose.
An examination found her to be of medium heightand build with an abdominal strength that was

Yet after another three weeks in mid-spring, thepatient said her symptoms of allergic rhinitis that
occurred every year, such as runny nose and blocked
nose, were extremely minor this year.

slightly weak, minor clapotage and palpitation in the

Around three-and-a-half months after taking theepigastric region, and “Otsuka’s point of smallprescription, the patient said she felt stronger andresistance and tenderness just above the umbilicus.”

did not tire as easily as she used to, which she did

This small resistance and tenderness just above

not claim in the beginning, and the redness of her

the umbilicus is an abdominal pattern that Dr.

throat that was seen in the beginning of spring had

Keisetsu Otsuka defines in Kampo shinryo iten as adisappeared. As predicted, her deficiency patterntarget of kakkonto. However, the figure in the bookand chronic inflammation in the nose and throat

is difficult to understand. I have therefore provided

were of an allergic nature.

my own definition of “Otsuka’s point of resistanceand tenderness just above the umbilicus” as theAround four months later, she said her ear wasfine even when she rode an airplane.

cord-like

After six months, when she was climbing down

anatomical white line is felt above the naval whenfrom the mountain on a hiking trip, her right ear

pressed in small circles with the tip of the index

began to hurt. She feared a recurrence of the disease

finger or middle finger in perpendicular direction toand sought the attention of a nose and ear doctor, but

the linea alba and that area is a source of pain to theshe was diagnosed with otitis externa, and waspatient, and regard it as an indication for kakkonto.

relieved that it was irrelevant to her previousThis

disease.

abdominal

patternmaydifferwhere

slightly

a

short

from

Dr.

Otsuka’s

explanation, but it generally holds true as the target
for kakkonto.

The patient, being an eager person, took theprescription for a year and continued to seek medical

I suspected that because this patient had rhinitis,pressure changes in high places probably made her

attention for quite some time after that before
terminating the prescription.

susceptible to tubal obstruction, and judging by her

Terutane Yamada, Kampo no shinryo to chiryo

abdominal pattern, I diagnosed her as having a(Ouyou-hen) (Kampo examination and treatment

kakkonto pattern. However, her abdominal pattern(Advanced edition)), p. 45, Taniguchi Shoten, 1993

trended slightly toward deficiency, so I added 3.0g
Jutsu (Atractylodis Rhizoma), and to reduce the

5. Tonsillitis and pharyngitis

inflammation of her rhinitis and salpingitis (?), I also

Tonsillitis is generally said to be caused by thedecided to add 1.5g each of senkyu (Cnidiui

invasion of the wind-heat pathogen, but it also

Rhizoma) and kikyo (Platycodi Radix).

occurs when a person with heat accumulation (liver

The result was such that approximately two
weeks later, she had less nasal discharge, and she nofire and stomach heat) is invaded by an external
pathogen (whether it is wind-cold or wind-heat).

longer blew her nose as much as she used to,

Kakkonto alone is usually not effective against

although she admitted that she still had somepharyngitis and tonsillitis, and in many cases,

postnasal discharge.

gypsum is added, or other measures are taken to

Afteranothertwo

weeks,

therhinorrhea

disappeared, and the postnasal discharge becamealmost negligible.

dispel the accumulated heat. Extract preparations
should be supplemented with kikyosekko extract.
In Kampo shinryo iten, it is written as follows:“Use [kakkonto] when the patient has a fever and

10

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

Volume 9, Number 2 | Summer 2014

sore throat in the initial stage, to promote

Chief complaint: Finger tremor, pain in both eyes,

perspiration. If the patient has a high fever, add 2.0g

tearing,kikyo and 10.0g sekko ; if vomiting occurs, add 5.0g
hange (Pinelliae Tuber). This preparation iseczema on both palms.

commonly used for 1 to 2 days...”10)

treated for one-and-a-half years but is receivingeyedischarge,

photophobia,

vesicular

Past illnesses: Syphilis—The patient has beenongoing

treatment.

Arteriosclerosis—His

blood

pressure has increased to around 150/100 since a few

Case 1: Pharyngitis
18-year-old female; first visit on August 1973

years ago, and is causing heaviness of the head,

The patient had a sore throat since the night

insomnia, etc. to come and go. Due to sciatica on the

before, and said it was red and swollen. She also had

right side, he has pain from his right hip to lower

stiff shoulders and a temperature of 37.2°C. She didright leg that still persists. Since a few years ago, he

not cough or feel nausea, and had an appetite,began to experience fine finger tremors on bothalthough she did not each much. She also had a

hands along with high blood pressure, a condition

headache. She was given kakkonto+kikyo+sekko

that also still persists. Three years ago, he had

and told to take it after gargling. After taking two

surgery for cholelithiasis.

doses,

Present symptoms, history of present disease andsheforgot

about

the

pain,

and

her

progress: The patient was being treated in hospital

temperature also went down.
Tomie Omura, Kampo chikenrei (Kampo clinicalfor the above diseases. In early May, he suddenly

trials),developed a strong reddening of the conjunctiva in

Journal of Kampo Medicine, Vol. 22, No. 6, p. 37, 1963

both eyes, eye pain, photophobia and eye discharge
along with stiffness in both shoulders. A culture testof the eye discharge and a drug resistance test were

6. Conjunctivitis

Kakkonto is used against diseases (particularly

performed, and as a result, short bacillus was found.

inflammatory diseases) that are relatively close to

He was thus told to apply a few drops a day of an

the surface of the eye, such as the eyelid, conjunctiva

antibiotic eyedrop and steroid eyedrop. However, as

Kampo shinryo iten notes thatindications for kakkonto are found in the initial

this had no effect, internal medicine, including anstage of stye, marginal blepharitis, dacryocystitis,

administered but only slight improvement was seen,

conjunctivitis,

and the patient was not completely cured. Thisandcornea.

trachoma,andconjunctival

antibiotic and anti-inflammatory drug, were alsosuggested that he had bacterial conjunctivitis

phlyctenule.12)

Yunokiryu ganryou hidensho (secrets of Yunoki-accompanied by an allergic reaction. The stiffness instyle eye treatment), a book on ophthalmology fromboth shoulders was severe, so all Western medicine

the Edo Period, writes about the application of

was canceled with the aim of alleviating the

kakkonto preparations (such as Rhei Rhizoma) toinflammation in both eyes and the stiffness in the

inflammatory diseases such as of the conjunctiva

shoulders, and a switch was made to Kampo therapy.

and cornea. Ganka ichikagen (personal views of

The patient was administered 6g/day of kakkonto

ophthalmology) also contains cases of clinical trials

extract for three days, but already on the second daythat used kakkonto.

the symptoms in both eyes and entire body markedly
improved. The inflammation in the eyes, eyedischarge and other symptoms virtually disappeared,

Case 1: Conjunctivitis
Patient: 58-year-old male. Occupation: Gardener.
Small, slender build.

and the finger tremors and vesicular eczema on both
palms

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

improvement,

so

the

11

Volume 9, Number 2 | Summer 2014

prescription was continued for another week. The

they had disappeared before she realized it. Thispatient was thus cured of almost all symptoms

time, the same trigeminal neuralgia on the left side

except for the sciatica on the right side. This was

occurred from last autumn, but the pain was more

improved only somewhat and was not cured, so theintense than before. Clear saliva kept flowing inside

patient is continuing to take the internal medicine

her mouth, but she could not move her mouth due to(total of 10 days so far).

the pain and could neither swallow nor throw up.

Hiroshi Nishimura, Shorei hokoku (case reports),

Progress in Kampo Medicine, 1968 Vol. 7, p. 14, 1968

Presently, she is receiving various treatments by adoctor specializing in neuralgia, but hardly any
improvement has been seen. Recently, she said herhead hurts, and even a slight touch of her lips feels

7. Trigeminal neuralgia
With regard to this disease’s indications forlike an electric shock and is extremely painful. She

kakkonto, it is written in Kampo shinryo iten that“[kakkonto] is used in the initial stage of

can open her mouth only slightly, so she cannot talkdevelopment of trigeminal neuralgia, to achieve a

because she can neither chew nor swallow solids. In

condition characterized by a strong pulse andthis state, she says her shoulders, and especially her

tension in the muscles.”13) Kakkonto is thus

left shoulder, have become extremely stiff.

as she wishes, and all she can eat are liquid meals

commonly used in the initial stage of development of

The patient has sallow skin and complexion thatthe disease, but it is also effective in chronic cases if

give the impression of fluid retention. Her pulse is

the conditions are right.

rather sunken and somewhat string-like, tense andSaito conducted a study on 141 patients of

rapid. The pulse above her spleen is particularly

trigeminal neuralgia and reported that among 18

weak (spleen deficiency pulse). She has pressure

patients who were given kakkonto alone, thepain in the right Hiyu (bladder) point. Her tongue

prescription was non-effective or unreliable in 14

has a thick white coating and is well moist. When I

patients (77.8%) but significantly effective andtouch her abdomen, she cries out that it hurts, so I

effective in 2 patients each (total 22.2%).14)

cannot examine her abdomen carefully because theTayama et al. report that among 50 patients ofpain increases when I have her lie down. Even so,

idiopathic trigeminal neuralgia and symptomaticthe abdominal wall was found to be somewhat

facial pain (treated by the nerve block method andbloated with fat and water, and the skin at the corner

analgesic administration), 12 patients were givenof her lower left abdominal region was extremely

kakkonto with the result that kakkonto was effective

sensitive.

in 4 patients each of the two diseases.15)

tenderness in the left iliac region (abdominalI

suspected

resistance

and

sharp

These findings suggest that a certain rate ofindications for Tokakujokito). I therefore swiftly

efficacy could be achieved even if kakkonto isapplied Okibari needle patches to the left Kyousha

administered regardless of pattern.

(stomach) point and the left and right Rekketsu(lung) points, Okibari embedded needle patches toCase 1: Trigeminal neuralgia on the left side (female)the right Hiyu (bladder) point, and moxibustion to

Two years ago, the patient developed a severe

the Ketsuinyu (bladder) point (both sides). The paincase of trigeminal neuralgia in her left cheek. Her
doctor said that pain was coming from her teeth andpulled out her teeth one after the other, but her
symptoms did not improve at all. Even so, after
receiving shots in her mouth, gums and on her face,12

immediately subsided to a certain degree.
I

also

administeredadecoctionofkakkontokasojutsubushi (Puerariae Radix 4.5g,
Ephedrae Herba 2.5g, Cinnamomi Cortex 3.0g,
Paeoniae Radix 4.7g, Glycyrrhizae Radix 2.0g, Ziziphi

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

Volume 9, Number 2 | Summer 2014

Fructus 3.0g, Zingiberis Rhizoma 4 cloves, Atractylodis

Lanceae Rhizoma 5.5g, Aconiti Radix Processa 1.0g =Case 1: Facial palsy
A 56-year-old woman suddenly developed facial
palsy ten days ago. She complained that she could

daily dose).
Two days later, some signs of improvement
appeared. It is not certain whether the drug or the

not close her left eye, her mouth drooped on one side,and she felt depressed.

acupuncture took effect, but acupuncture was

Her pulse was floating and large, and she said herapplied some more to the Yoryosen (GB34) point, theneck was stiff, but there were no other abnormalities.

Rinkyu (GB41) point and the Tanyu (BL19) point on

She was given kakkonto. After taking five doses, sheboth sides. This, however, aggravated the patient’s

was 90% cured, and after another five days, she wascondition. Acupuncture stimulation was apparently

completely cured.
Keisetsu Otsuka, 30 Years of Kanpo, p. 119, Sogensha,

excessive.
I then administered kakkontokasojutsubushi
withslightlydifferent

ratiosofingredients(Atractylodis Lanceae Rhizoma 8.25g, Aconiti Radix

Zingiberis Rhizoma 5 cloves,
Puerariae Radix 7.0g, Ephedrae Herba 4.0g,
Cinnamomi Cortex 5.0, Paeoniae Radix 7.0g,
Glycyrrhizae Radix 1.5g, Ziziphi Fructus 4.5g = daily

Processa

1959

1.5g,

9. Temporomandibular arthrosis
The temporomandibular joint, or jaw joint, iswhere the middle yang (stomach) meridian flows.
Thus, when considering that it is a part of the middle
yang parts of the body, it is understandable why

kakkonto is used for this disorder.

dose) for two weeks.
Thereafter, I received good news from Tokyo. The

Kazuo

trigeminal neuralgia that was so painful gradually

kakkonto

subsided since taking the preparation, and thetemporomandibular arthrosis and observed thepatient became able to more or less eat and talkclinical efficacy two weeks later, with the result that

normally. However, she noted that she sometimes

out of 28 patients, the preparation was significantly

experienced stinging pain at unexpected moments,

effective in 6 patients (21.4%), effective in 7 patients

so I sent her three weeks’ dose of the previous(25%), somewhat effective in 9 patients (32.3%) andpreparation. When I saw her again in Tokyo, she was

non-effective in 6 patients (21.4%).17)

more than 90% better, and in about a month, she was

Onuma

Sano

et

extract

et

al.

al.

administered

granulestoadministered

Tsumurapatientsofkakkonto andcured, and her symptoms seemed long-forgotten.

Kamishoyosan to 50 patients of temporomandibular(@Tokyo clinic)

arthrosis and report that the prescription brought an

Shiro Hosono, Kampo igaku jikko (lectures on Kampo
medicine), p. 91, Sogensha, 1982

improvement or more in 80.0% of the patients, with
5 patients showing a marked effect, 35 patients an
improvement effect, and 10 patients no effect.18)

8. Facial palsy

Kakkonto is good for facial palsy in its initialstage of development. In Kampo shinryo iten, it is
written as follows: “Use [kakkonto] in the initial

Case 1: Temporomandibular arthrosis

stage of development. It is especially effective

Thereafter, he felt dull pain whenever he chewed oragainst facial palsy that occurs after a cold. The

yawned, so he visited our clinic. He could only open

target is a condition characterized by a strong pulse

his mouth 23mm without pain. A tenderness wasand tension in the muscles.” 16)observed in his left jaw joint and masseter muscle,

16-year-old male. From around two weeks ago, apain emerged in the patient’s left masseter muscle.

and there was pain ein his left jaw joint whenever he

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

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Volume 9, Number 2 | Summer 2014

moved his jaw laterally to the right. He also had stiff

osteoporosis for the past ten years. She sometimes

shoulders.

ofcomplained of stiff shoulders and headaches, but

kakkonto, and although there was still someinternal and external anti-inflammatory analgesics

tenderness a week later, it was gone after two weeks.

had improved them. From early-September of 1993,

He became able to open his mouth 54mm, and theshe developed a stiffness from the back of her neckstiffness in his shoulders also disappeared. The

to shoulder blades and a dull headache that felt as

clinical result showed marked efficacy.

though she were wearing a pot on her head. She was

He

was

administered

7.5g/dayKazuo Sano et al., Gakukansentsusho to kakkonto

diagnosed with tension-type headache (muscle(temporomandibular arthrosis and kakkonto), Kampo

contraction headache) and given 1.5mg etizolam

Medicine, Vol. 23, No. 1, p. 25, 1995

(divided into three portions), 150mg eperisonehydrochloride (divided into three portions) and 3.0g
pyrine analgesic (divided into three portions).

10. Headache
As with the mechanism of stiff shoulders, when

However, her symptoms failed to improve, and she

fluid from the neck does not flow, the muscle is notcomplained of nausea and vomiting, so she wasnourished, and when muscle tension becomes severe,administered 7.5g Tsumura goshuyuto extracta headache occurs in addition to stiff shoulders. In

granules (medical use) to be taken in three portions

most cases, this is a tension-type of headache.

before each meal.

Kakkonto also has the effect of curing such

However, no effect was observed, possibly because
the pattern was not right. The patient went toheadaches.
Yoichi Hashimoto et al. administered 7.5g ofanother hospital to receive a head CT examination

Tsumura kakkonto extract granules (divided into

because she was worried about an intercranial lesion,

three portions) to patients who complained of abut no abnormality was found. An occipital nerve

tension-type headache and examined the efficacy

block drug was also used in combination, but it wasfrom the subjective and objective viewpoints. Given

non-effective. The patient complained of stomachthat “marked improvement,” “improvement” orpain from taking the analgesic, so the analgesic was“slight improvement” were observed in more thancanceled, but because she had an excess pattern of

80% of the patients, he stated that kakkonto had a

stiff shoulders, she was newly given 7.5g Tsumura

greater effect on people who had greater muscle

kakkonto extract granules (medical use) to be taken

tension.19)

in three portions before each meal. From the second

Additionally, Hosono states that headaches thatday of taking the prescription, the headache andoccur from sinusitis are sometimes improved withstiffness in the shoulders improved and completely

kakkonto preparations and gives two case examples.

disappeared a week later. Presently, she is happy

There are thought to be many types of headaches

that she could treat her stiff shoulders and headachethat could be improved with kakkonto, but few cases

solely with kakkonto, without taking a muscle

have been reported, possibly because such cases arerelaxant or analgesic in combination.
Hiroaki Tanaka, A case in which kakkonto was

too ordinary.

effective for tension-type headache, Kampo Shinryo,

Case 1: Tension-type headacheVol. 12, No. 12, p. 5, 1993

75-year-old female. Height 152cm, weight 61kg,
sturdy and solid build. No cold sensitivity.
History of present illness: The patient has been
receiving treatment for high blood pressure and

14

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

Volume 9, Number 2 | Summer 2014

References
1)

Keisetsu

Otsuka,Domei

Yakazu,TotaroShimizu: Kampo shinryo iten (dictionary of
Kampo medicine), p. 250, Nanzando, 1963.
2)

Shiro Hosono et al.: Seikoen Clinical Report 6.
Clinical practice for headaches, Collection of

discussions written by Shiro Hosono, Vol. 3, p.
167, Gendai Shuppan Planning, 1995.
3)

Shozo Bando: Byomei Kampo chiryo no jissai(practical Kampo therapy by disease name),
Medical Yukon Publishing, p. 421, 2002.

4)

Hisashiko Hanawa: Kampo chiryo no ressun(Kampo therapy lessons), p. 206, Kanehara
Shuppan, 1995.

5)

Keisetsu

Otsuka,Domei

Yakazu,TotaroShimizu: Kampo shinryo iten (dictionary of
Kampo medicine), p. 248, Nanzando, 1963.
6)

Akira Kurokochi: The efficacy of kakkonto on
nasal congestion caused as a side effect of an
antipsychotic drug, Kampo Medicine, Vol. 43, No.
2, pp. 319-323, 1992.

7)

Hisahiko Hanawa: Kampo chiryo no ressun(Kampo therapy lessons), p. 205, Kanehara
Shuppan, 1995.

8)

Yodo Odai: Seikan igen, Part II, 1868.

9)

Keisetsu

Otsuka,Domei

Yakazu,TotaroShimizu: Kampo shinryo iten (dictionary of
Kampo medicine), p. 243, Nanzando, 1963.
10) Keisetsu

Otsuka,Domei

Yakazu,TotaroShimizu: Kampo shinryo iten (dictionary of
Kampo medicine), p. 253, Nanzando, 1963.

11) Keisetsu Otsuka: 30 Years of Kanpo, p. 122,
Sogensha, 1959.
12) Keisetsu Otsuka, Domei Yakazu, Totaro
Shimizu: Kampo shinryo iten (dictionary of
Kampo medicine), pp. 215-223, Nanzando, 1969.
13) Keisetsu Otsuka, Domei Yakazu, Totaro
Shimizu: Kampo shinryo iten (dictionary of
Kampo medicine), p. 158, Nanzando, 1969.
14) Takao Saito: Trials of Kampo administration fortrigeminal neuralgia, Gendai no Kampo chiryo(modern Kampo therapy), pp. 308-310, Toyo
Gakujutsu Shuppansha, 1985.
15) Fumitaka Tayama et al.: Sansashinkeitsuu tokakkonto (trigeminal neuralgia and kakkonto),
Science of Kampo Medicine, Vol. 8, No. 11, pp.
19-23, 1984.
16) Keisetsu Otsuka, Domei Yakazu, Totaro
Shimizu: Kampo shinryo iten (dictionary of
Kampo medicine), p. 165, Nanzando, 1963.
17) Kazuo Sano et al.: Usage experience of kakkonto
for temporomandibular arthrosis, Journal of theJapanese Society of Oral and Maxillofacial
Surgeons, Vol. 33, No. 8, pp. 204-210, 1987.
18) Katsuhiro Onuma et al.: Clinical study of the
combined use of kakkonto and kamichoyosan for
temporomandibular arthrosis, Abstracts of the
41st annual meeting of the Japan Society for
Oriental Medicine, p. 46, 1990.
19) Yoichi Hashimoto et al.: Study of the efficacy of
kakkonto for tension-type headaches, Abstractsof the 45th annual meeting of the Japan Society
for Oriental Medicine, p 213, 1994.

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

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Volume 9, Number 2 | Summer 2014

Clinical Report 1 (Acupuncture)
Acupuncture and Moxibustion Treatment for a Patientwith Chronic Complex Health Prblems, where theCooperation by the Family too Contributed to the
Improvement

visited our clinic because her husband strongly
recommended it.
I: Overview over the time-series analysis (Figure 1)
Figure 1 shows an overview over the time-series analysis

Takara Yamami

developed in this facility. Explanation of the frame fromAcupuncture Departemtn of Ehime Prefectural Central Hospital

the left shows first housing and work, in the middle daily
life events are entered and on the right side the start ofMany patients with chronic complex health problems visit

QOL impairments is recorded. In the left lower area theour facility affiliated with one of the local general hospitals

family structure is entered and allows to grasp the nursinginpotential of the family.

Shikoku.

On

thisoccasionweadministeredacupuncture and moxibustion treatment with the

From the time-series analysis it is possible to assess thatcooperation of the family and report our experiences withthe health problems seemed to be due to decreased stressa case with chronic complex health problems where thisresistance and a mild degree of blood stagnation. Again, we

treatment form led to their relief.

surmised the chief complaint developed before abackground of work related severe stress or problems

Patient: 57-year old female. Works at a loan counter in a

related to the marriage of the daughter. For the healthfinancial institution.

problems based on the time-series analysis presumably be

Chief complaint: insomnia, depressive mood, palpitation,

due to decreased stress resistance and a mild degree of

fatigue at the back of her eyes;

blood stagnation we considered the application of

Past history: underwent a hysterectomy at the age of 36;

moxibustion by the family to be most suitable.

no special health problems after the surgery;
Character traits from childhood: having an obsessive,

II: Findings at point locations (Figure 2)

depressive, pessimistic nature she had low resistance toAt the points on the back we observed depressions at SI14,

mental stress;

BL15, BL20, BL52, swelling from BL17-BL18, congestion

Family environment: lives in a family of three with her

in the back of the neck, floating fine vessels in the vicinity

husband and daughter; nothing specifically notable.

of GV14 and GV4 and edema on the anterior chest and on

Present illness: started her employment at the age of 20

the top of the head. Based on the findings at point locations

and since a change in her work duties in October X-2 began

we came to the conclusion, that the build-up of blood

noticing stiffness of the back, loss of appetite, sincestagnation and decreased resistance to mental stress led to

September insomnia developed and she started to takethe reported health problems.

Zolpidem prescribed by a local physician. She became
again able to fall asleep, but usually woke up at 3 o'clock inthe morning and then could not fall asleep again. Fromthat time palpitations, fatigue at the back of her eyes anddepressive mood also developed. She lost appetite anduntil now lost about 10 kg weight. The local physician
diagnosed "depression" and prescribed western-style
medicines like Fluvoxamine, Zolpidem, Ethyl Loflazepate,
Sulpiride, Estazolam, Domperidone etc. Her meal size
decreased extremely, she developed hypersensitivity tolight and sounds and spend the whole day in bed. She

16

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

Volume 9, Number 2 | Summer 2014

Figure 1

Overview over the time-series analysis

Figure 2

Findings at point locations

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

17

Volume 9, Number 2 | Summer 2014

Figure 3 Acupuncture and Moxibustion treatment

III: Acupuncture and moxibustion treatment (Figure 3)
Based on the findings of the time-series analysis and on
the findings at the point locations the treatment wasadministered according the findings at the point locations.
In this case (1) required care from the family. Regarding
(2)

the

familyrequestedmoxibustion

treatment.

Regarding (3) we considered self-treatment by the patient
herself to be appropriate. Thus, the treatment centered on
moxibustion. Moreover, regarding the moxibustion
treatment we concentrated on a persistent regimen (there
are two treatment concepts: switching formulas asrequired and maintaining the same regimen over time),
instructing the patient to treat herself at home using
mainly GV12, BL15, BL20, BL52, LI11, ST36, SP6, KI3.
Further, upon her visiting our clinic, we performed
additionally skin pricking in the vicinity of GV16.

18

IV: Course and evaluation (Figure 4)
This shows the course over a period of 12 years from thefirst visit. The patient visited our clinic in intervals of 4 to
8 weeks for acupuncture and moxibustion treatment andtreated herself at home with moxibustion 3 to 7 times a
week. She also took the prescribed medicine and her
condition followed a favorable course. In our clinic six
treatment sessions represent one set and after each set wechecked the changes using a questionnaire. Evaluation
criteria for the QOL included physical, mental and social
parameters. Regarding the physical aspects, we evaluatedthe various symptoms, as mental aspects her healthrelated worries and for the evaluation of the social aspects
the patient evaluated any inconvenienced during her daily
life herself.

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

Volume 9, Number 2 | Summer 2014

Evaluated symptoms included constipation, strained neck,

After 15 months a dose reduction of the westernsweating, flushes, back stiffness, inappetence, insomnia,

medications was attempted. Body weight had recovered todepressive mood, palpitations, fatigue at the back of the62.0 kg. The patient could later overcome her mother'seyes, easy fatiguability and hypersensitivity to sounds.

sudden death and the death of her father from disease

Evaluation results over the period of 12 years showed forwithout problems, remained stable and graduallyalmost all items an evaluation as either A or B, which we

improved.

assessed to be a highly satisfactory.

Currently she is on a western medical regimen of(A: improved; B: improved but occasionally worsening)

Fluvoxamine 25 mg ½ tablet and Zolpidem 10 mg ½ tablet.

Two weeks after initiation of the moxa treatment she

In her daily life she manages general household chores,

reported "I was no longer aware of palpitations and a sortseeing off and welcoming back her grandchildren,of black lump in the depth of my heart has dissipated".

attending swimming, table tennis and PC classes,

After half a year her body weight was 55.8 kg. After 10

indicating improvement of the QOL.

months we added treatment for blood stagnation in theback of the neck. At the same time we observed changes inappetite and sleep and while there were some fluctuations,the number of days of good physical condition increased.

Survey of the course over a period of 12 years from the first visit (excerpt)
Evaluation items

I-(1)

I-(4)

II-(4)

III-(4)IV-(4)

General physical condition

B

―

―

―

B

Health related worries

B

―

―

―

A

Inconveniences during daily life

C

―

―

―

A

Constipation

Neck muscles

A B

B B

A B

A A

A B

Sweating

Flushes

B B

B A

A B

A A

A A

Back stiffness

Inappetence

B C

A A

A A

A A

A A

Insomnia

Palpitations

C A

C A

B A

B A

B A

Eyestrain

Mood

B B

A B

B A

C A

B A

Phonophobia

Easy fatigability

― ―

A A

A A

A C

B B

Figure 4 Course and evaluation

A: improved

B: improved but occasionally worsening

C: remains bad

D: getting gradually wrose

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

19

Volume 9, Number 2 | Summer 2014

V: Conclusions and discussion
Insights into her inner life rather than her physical life
history based on the results of the time-series analysis led
us to the conclusion, that a decreased resistance towardmental stress and the formation of blood stagnation had
caused her health problems. Findings at the point
locations led to the same conclusion. The author believes
the moxa treatment administered by the family had ahealing effect on the patient and promoted the recovery
process of her resistance. Moreover, the main indication for
GV16 is "maniac behavior with death wishes, eye rollingand hallucinations" and its role in this case is highlyinteresting.

20

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

Volume 9, Number 2 | Summer 2014

Clinical Report 2 (Kampo Medicine)
A Case in Which Shokenchuto was Effective for a 10-year-old Girl
who was Easily Tired, Seneitive to Cold, and had a Weak
Digestive Function
Hideaki Yamaguchi
Tosei General Hospital

Case: 10-year-old girl
Chief complaint: Easily tired, easily chilled
History of present illness: The patient tended to
eat very little and was sensitive to cold since
infancy. She became easily tired after entering
primary school, and had many days of absence(more than 40 days in a year). It also bothered herthat she could not swim in the pool because she
felt cold even in the summer. For this reason, shevisited us in mid-July (summertime), desiring
Kampo therapy.
In a medical interview, she noted that she isextremely sensitive to cold, her lips turned purple
when she was cold, she tired easily, sufferedfrequent stomach aches, had no appetite, disliked
cold foods, was prone to coughing, and had anervous temperament. Appearance-wise, she had
fair skin, was quiet, and had cold hands and feet.
Diagnosis: Spleen yang deficiency (unable toproduce sufficient heat due to weak digestive
function)
Treatment/Progress:
To warm the body and improve the digestive
function, shokenchuto extract was administered 3
times/day.
1 month later (August): Slight improvements wereseen in the patient’s tendency to tire easily andcold sensation, but she still could not swim in thepool.
2 months later (September): An improvement wasseen in the patient’s appetite. She became able tokeep up with the school schedule.
6 months later (January): The patient tended tofeel some coldness, but was otherwise well, andhad no absence during the second term.

12 months later (July): The patient was very well,and became able to swim in the pool. Her fatigue
also disappeared.
The treatment was completed after 18 months.
The patient was able to live an ordinary life
thereafter.
Observation: In this case, the patient had spleenyang deficiency since infancy, which was
aggravated by the burden of primary school life
such that it might have even affected the kidney.
Shokenchuto does not have a strong effect ininvigorating the yang (warming), but it isexcellent as a spleen invigorating drug (prokinetic
agent) for children. By improving the digestive
function, it induced an improvement of othersymptoms and conditions. Shokenchuto is also
said to have the effect of invigorating the kidney,
and is used frequently in the field of pediatricKampo in Japan.
Reference:

Shokenchuto
Warms the body and mitigates excessive tension
in the digestive tract.
Improves digestive symptoms such as small
appetite, recurrent abdominal pain and softstool, and whole-body symptoms such as
secondary chilliness and lack of vitality.

Hochuekkito
Warms the body somewhat and improves thegeneral state of low tension.
Used in cases where the patient feels a strong
sense of general malaise, such that he/she tires
easily and tends to want to lie down, or feels aheaviness in the arms and legs.

Rikkunshito
Warms the body somewhat and improves thestate of low tension particularly in the digestive
tract.
Improves stagnant intestinal movement
symptoms such as poor appetite and feeling offullness, and the sense of heaviness, etc.

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

21

Volume 9, Number 2 | Summer 2014

Crude

drug

components

andefficacyofShokenchuto
・ Keishi (cinnamon): Warms the body, induces
light sweating
・Shakuyaku (peony): Relieves muscular tension,
improves microcirculation
・Taiso (jujube): Improves the digestive function,
promotes emotional stability
・Shoga (ginger): Warms the body, improves thedigestive function
・ Shakanzo (honey-fried licorice): Improves thedigestive function, relieves tension, provides
medicinal relief
・Koui (malt sugar): Nutritional support, coughsuppressantShokenchuto thus warms the body, improves thedigestive function, relieves muscular tension, andpromotes emotional stability. For children, inparticular, it is used to warm the body, mitigate
excessive tension in the digestive tract, andimprove the digestive function. It is used in a wide
range of applications.

22

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

Volume 9, Number 2 | Summer 2014

Report on Visit to AIMC
A Letter from the Acupuncture and Integrative Medicine
College (AIMC) in Berkeley, USA

Kazunari Ozaki*1) and Mitsuru Kageyama2)3)4)

1) Department of Geriatric Medicine, Itami City Hospital,
Itami, Hyogo, Japan
2) Kageyama Clinic, Sakai, Osaka, Japan
3) Department of Obstetrics and Gynecology,
Osaka City University Graduate School of Medicine,
Osaka, Japan
4) Department of Gynecology and Obstetrics, Kyoto
University Graduate School of Medicine, Kyoto, Japan

Introduction: In Western countries, complementary
and alternative medicine (CAM) is very popular. In
the last several decades, traditional medicine in
Asian countries has been developing as a type of
CAM. Under these circumstances, the problem is
how to position Kampo medicine, which is lagging
behind in terms of international strategy. We had an
opportunity to visit the Acupuncture and Integrative
Medicine College (AIMC) (President & CEO: Yasuo
Tanaka) located in Berkeley, California USA in
September 2013. We report the current status oftraditional Chinese medicine (TCM) in the USA
compared with the internationalization of Kampo
medicine.

Furthermore, 83% of those above had alreadyconsulted

physicians

of

the

modernWestern

medicine. The total expenditure incurred for CAM(13.7 billion dollars) was also higher than that spentout of pocket for all hospitalizations that year (12.8billion dollars). These suggest that the current
status of modern Western medicine does not always
meet the demands of patients. Since then, researchin the field of CAM has intensified, and in 1999, theOAM was promoted to the National Center for
Complementary and Alternative Medicine (NCCAM),
which seems to be commissioning various studies
related to CAM to multiple institutions including
Harvard University and the University of California.
Although some institutions have introduced CAM
into their medical education, in terms of the so-called
traditional

medicine

inacupuncture-moxibustion

East
and

Asia

utilizingdecoctions,i.e.,traditional medicine in the Western Pacific Region[2], education in acupuncture-moxibustion schools in
the USA is based on TCM, and not on Kampo
medicinecurrently

practiced

in

Japan

nor

traditional Korean medicine practiced in South
Korea. However, there are a few Korean schools
whereacupuncture-moxibustionof

traditional

Korean medicine is taught. There are absolutely no(1) Overview of traditional Chinese medicine in theUSA
In the USA, the National Institute of Health(NIH) established a special office for alternative
medicine, namely, the Office of Alternative Medicine(OAM), in 1992 and initiated active involvement in
the alternative medicine research, promoting CAM
research. In the year after the establishment of the
OAM, Eisenberg et al. at Harvard University
conducted “a survey of utilization rate of CAM in theUSA” with 1,539 American citizens aged 18 years orolder, and reported that approximately one third of
the respondents utilized at least one type of CAM in
the previous year and that the highest use was bynonblack persons aged 25 to 49 years, who wererelatively more educated and had higher incomes [1].

schools where education is based mainly on Kampo
medicine used in Japan. Only at AIMC located inBerkeley, California [3], which we visited in this trip,
Japanese acupuncture-moxibustion is taught inparallel

with

TCM.

Promotional

activitiesofJapanese acupuncture-moxibustion and Kampo
medicine in the USA have originated from this school.
Details of AIMC are described in the latter half of
this paper. In the USA, qualifying examinations for
acupuncture-moxibustion
supervised

by

the

practitioners
National

are

Certification

Commission for Acupuncture and Oriental Medicine(NCCAOM®) in 44 states and areas that participate
in the NCCAOM, but the states of California and
New York have their own qualifying examinations.
NCCAOM has issued approximately more than

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

23

Volume 9, Number 2 | Summer 2014

21,000 licenses to practice acupuncture, oriental

Berkeley, and Dr. Yasuo Tanaka, President & CEO of

medicine, decoctions, and Tui Na since 1982. In thethe school, showed us around the school himself

state of California, approximately 500 applicants per(Figure 1).

year pass qualifying examinations held by the
Acupuncture Board, the Department of Consumer
Affairs, which are based on the state law, namely, theAcupuncture Licensure Act. As described above,
education in each acupuncture-moxibustion school ismostly based on TCM, and qualifying examinations
conducted in each state are also based on TCM.
Textbooks have been improved, and a few of them
are at a high level, comparable to those in China. For
example, explanations in books by Bensky et al. [4][5] and by Mitchel et al. [6] are excellent. Almost all

Kampo products in the USA are extract products.
They are handled as health foods and can beavailable at pharmacies and drugstores to somedegree. However, no one at conventional stores
knows how to use them. Therefore, acupuncturemoxibustion practitioners usually prescribe them at

Figure 1[The above photo]
President Yasuo Tanaka (middle) showed Dr.
Kageyama (left) and Ozaki (right) around the
AIMC himself.

acupuncture-moxibustion clinics and the patientspurchase them out of pocket. Many of the
manufacturers/sellers
Taiwaneseofcompanies

extract

products(Sun-ten,are

Ming-tong,Evergreen, etc.), and some of them already have anearly 40-year history. In the USA, “Medicare” and“Medicaid” are public insurance; however, transition
to private health insurance is recommended, andsome insurance plans in America’s Health Insurance
Plans seem to cover acupuncture-moxibustion andacupressure. However, in the USA, decisions in thehealthcare administration are not made purely fromthe viewpoint of medical welfare, and political andeconomicinterference

in

the

healthcare

administration seems to be causing confusion.
(2) Visit to AIMC (Acupuncture and Integrative
Medicine College)of

The authors participated in the World Congress[The above photos]

ChineseThe classrooms at the AIMC

Medicine(WCCM)

2013

held

on

September 21 and 22 in Santa Clara, California [7].
During the trip, we stopped by at AIMC located in

24

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

Volume 9, Number 2 | Summer 2014

AIMC is located in downtown Berkeley, California,

AIMC

Berkeleyoffersarigorous

andwith a great access to public transportation.

comprehensive education in Traditional ChineseStudentsa

Medicine and Integrative Medicine. Their program

progressive culture, a casual urban environment,

allows students to first build a strong foundation indiverse education environment nearby UC Berkeley

theory, and then put the students’ knowledge into

campus, and close proximity to San Francisco, apractice in their clinical internship courses. Theirrevitalized Oakland, and Silicon Valley (8).

curriculum

enjoy

a

Mediterranean

climate,We provide a brief history of AIMC. The AIMC

has

six

distinctsubject

areas:

Acupuncture, Western Biomedicine, Integrative

formerly known as Meiji College of Oriental

Medicine,

Herbology,

Medicine (MCOM) was established in San Francisco

Professional Practice.

Oriental

Medicineand

in 1990 by the Meiji School of Oriental Medicine in

AIMC students performed very well in theJapan and its alumni. In January 1999, the school

qualifying examinations based on the state law, therelocated to Berkeley. In 2002, Dr. Shuji Goto

Acupuncture Licensure Act. The pass rate of the 1st(chairperson of GOTO College of Medical Arts andtime takers in the August 2012 examination result

Sciences) was assigned to be a chairman of the board

was 100% (based on a document from California

for the MCOM. In April 2003 the name of the school

Acupuncture Board [Department of Consumer

was changed to Acupuncture and Integrative

Affairs]) (9).

Medicine College (AIMC) and new management has
started under the new chairman's leadership.
AIMC

is

grantedmoxibustion schools in Japan, students in the USA

Accreditation Commission for Acupuncture andare serious for economic reasons.” We realized that

Orientalthemany of the college students in the USA are living

recognized accrediting agency for freestanding

an independent life in dormitories or apartments

institutions and colleges of acupuncture or Oriental

away from their parents’ home, even when their

medicine that offer such programs. The ACAOM iscolleges are within a commutable distance from thethe national accrediting agency recognized by thehome, and that many students use scholarships andU.S. Department of Education to accredit Master's-

student loans to pay for tuition and are also

level programs in the acupuncture and Oriental

economically independent.

(ACAOM),

which

by

CEO, Tanaka, “Unlike students in acupuncturethe

Medicine

accreditation

We were impressed with the words of President &ismedicine profession.
As described above, education in acupuncture-

Additional remark: We have described above, anmoxibustion schools in the USA is based on TCM;

overview of traditional Chinese medicine in the USA

however, only in this school, Japanese acupuncture-and our visit to AIMC. The history of how the so-moxibustion are taught in parallel with TCM, andcalled traditional medicine in East Asia was spreadpromotional activities of Japanese acupuncture-mainly by Overseas Chinese in the West Coast andmoxibustion and Kampo medicine in the USA have

New York, or through Japan and the Netherlands tostarted from this school (Figure 2). There are

Europe, is very interesting; however, it has been

approximately 150 students with 30 to 40 students

omitted due to limitations of space. We would like to

per grade. We heard that on an average, they study

present it at another time in this journal.

for more than 3,300 hours in 4 years. The curriculum
is equally divided into 3 parts: modern medicine,
acupuncture-moxibustion, and decoctions.

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

25

Volume 9, Number 2 | Summer 2014

Postscript: Part of this manuscript was presented
at the 65th Annual Meeting of Japan Society for
Oriental Medicine (Tokyo, June 29, 2014). The
authors have no conflict of interest to be disclosed.

Figure 2[The left above] The single crude drug products on the shelves at the AIMC.
[The right above] The acupuncture and moxibustion instruments in the cabinet at the AIMC.
[The left below] The conventional crude drug products on the shelves at the AIMC.
[The right below] The cabinets for classification of drugs at the AIMC.

26

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

Volume 9, Number 2 | Summer 2014

1

Eisenberg DM. et al. Unconventional medicine in the5

Bensky, D. , et al. : Chinese Herbal Medicine:
Materia Medica (Third Edition). Seattle, Eastland
Press, 2004

6

Zhang Zhong Jing, Shang Han Lun On Cold Damage:

United States. NewEngland Journal of Medicine. 328,
246-252, 1993.
2

World Health Organization, Regional Office for theWestern Pacific, “WHO International Standard

Translation and Commentaries, Translated and edited byTerminologies in Traditional Medicine in the Western

Mitchell C., Ye Feng, Wiseman N, Brookline, MA:

Pacific Region”, World Health Organization, Western

Paradigm Publications, 746 pages, 1999.

<http://www.wpro.who.int/NR/rdonlyres/14B298C6-

Homepage of the WCCM2013<http://www.2013wccm.com/>. [the last date of

518D-4C00-BE02-

access Jan. 30,2014]

Pacific Region, Manila, 2007, available from

FC31EADE3791/0/WHOIST_26JUNE_FINAL.pdf>.

7

8[the last date of access Jan. 30,2014][the last date of access June30,2014]
3

4

Homepage of the Acupuncture and Integrative
Medicine College (AIMC). https://www.aimc.edu/[the last date of access Jan. 30,2014]

Homepage of the AIMC < https://www.aimc.edu/>.

9

Data from California Acupuncture Board

Scheid, V., et al. : Chinese Herbal Medicine:Formulas &(Department of Consumer Affairs)<
http://www.acupuncture.ca.gov/about_us/materia
ls/20130219.pdf >[the last date of access Jan.

Strategies (pharmacy science) (2nd ed.). Seattle,

30,2014]

Eastland Press, 2009

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

27

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