KAIM
T
Thhee JJoouurrnnaall ooffK
Kaammppoo,, A
Accuuppuunnccttuurree aanndd IInntteeggrraattiivvee M
Meeddiicciinnee
INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 2, Number 4 ･ Winter 2007

Foreword

Guideline for Diagnosing and Treating Lower Back Pain and the Role of Kampo
Akihiro Soma

Japanese Acupuncture - Current Research
Acupunture for Respiratory Disease in Japan: A Review
Masao Suzuki

Kampo Medicine - Current Research

Can Kampo Formulations become First-Line Drugs for Rheumatoid Arthritis?
Hiromichi Yasui

Clinical Report 1 (Japan)

A Case of Acupuncture Treatment for Left Shoulder Pain Thought to be Caused by Neuralgic Amyotrophy
Noriko Hori, Hitoshi Yamashita, Hiroshi Tsukayama

Clinical Report 2 (Japan)

A Patient Suffering from Rheumatism
Yoichiro Ebe

Clinical Report 3 (Japan)

A Case of Palpitation in which Hangeshashinto had been Effecitive
Keigo Nakada

Introduction of Japanese Acupuncture
Considering the Therapist’s Hand (8)Shuichi Katai

Medical History in Japan

Todo Yoshimasu and his Medicine (2)Hiromichi Yasui

ISSN:1559-033X

Volume 1, Number 1 | Spring 2006

A good motive creates a selfless devotion.
“I just want my customers to feel better, body and soul. Just to see
their faces light up with hope and happiness, I’d do anything,”
remarks Masao Tsuji, President of Ominedo Pharmaceutical Industry
Company. He visits various sites where raw herbs and substances foruse in their Kampo products are picked. And he believes this is the
tradition Ominedo had maintained for over a century now since thecompany was founded in 1900.
The same philosophy is applied in handling the numerous
high-quality formulas created at their labs where highly advanced
scientific and pharmacological researches are conducted. The
company’s state-of-the-art facilities that comply with GMP standards
turn out various extracts to be incorporated into their pride products.
“Every merchandise is the by-product of our sincere devotion todelivering a lineup of products that not only work for the customers’
body, but also bringing peace of mind as well,” Tsuji concludes,“delivering the right product to customers who appreciate ourknowledge and devotion is our ultimate goal.”

Ominedo Pharmaceutical Industry Co., Ltd.
574, Nenarigaki, Yamatotakada-City, Nara 635-0051, Japan
URL: www.ominedo.co.jp
Contact: info@ominedo.co.jp
FAX (81) 745-23-2540

The Journal of
Kampo, Acupuncture andIntegrative Medicine(KAIM)

T
Thhee JJoouurrnnaall ooff
K
Meeddiicciinnee
Kaammppoo,, A
Accuuppuunnccttuurree aanndd IInntteeggrraattiivvee M

Research on Theory, Practice and Integration

EXECUTIVE EDITOR

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

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

Volume 2, Number 4 ･ Winter 2007

TA B L E O F C O N T E N T S
1 Foreword
Guideline for Diagnosing and Treating Lower Back Pain and the Role of Kampo
Akihiro Soma

2 Japanese Acupuncture - Current Research
Acupuncture for Respiratory Disease in Japan: A Review
Masao Suzuki

ASSOCIATE EDITORS
Shuichi Katai
Ibaraki-ken, Japan

Hiromichi Yasui
Tokyo, Japan

11 Kampo Medicine - Current Research
Can Kampo Formulations become First-Line Drugs for Rheumatoid Arthritis?
Hiromichi Yasui

EDITORIAL STAFF

Akihiro Soma
Hiroshi Tsukayama
Hitoshi Yamashita
Naoya Ono
Noboru Mitsuhata
Yoshiro Sahashi

14 Clinical Report 1 (Japan)
A Case of Acupuncture Treatment for Left Shoulder Pain Thought to be Caused by
Neuralgic Amyotrophy
Noriko Hori, Hitoshi Yamashita, Hiroshi Tsukayama

EDITORIAL BOARD
Denmei Shuto
Hajime Haimoto
Hideaki Yamaguchi
Hidemi Takahashi
Katsutoshi Terasawa
Kazushi Nishijo
Keigo Nakata
Keishi Yoshikawa
Koji Ebe
Shohachi Tanzawa
Tadashi Yano
Takahisa Ushiroyama
Tomomasa Moriyama
Toshihiko Hanawa
Yoichiro Ebe
Yoshiharu Motoo
Yoshiro Yase

20 Clinical Report 2 (Japan)
A Patient Suffering from Rheumatism

Yoichiro Ebe

22 Clinical Report 3 (Japan)
A Case of Palpitation in which Hangeshashinto had been Effective
Keigo Nakata

24 Introduction of Japanese Acupuncture
Considering the Therapist’s Hand (8)27 Medical History in Japan
Todo Yoshimasu and his Medicine (2)Shuichi Katai

Hiromichi Yasui

PUBLISHER

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

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

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

Volume 2, Number 4 | Winter 2007

Foreword
Guideline for Diagnosing and Treating Lower Back Pain and the Role of Kampo
The Guideline for treating lower back pain was first documented in the U.S. in 1994 and has since been
prepared in other countries. The latest Guideline was released in 2004 by experts from 14 European countries(Austria, Belgium, Denmark, Finland, France, Germany, Israel, Italy, the Netherlands, Norway, Spain, Sweden,
Switzerland, and England). Each country’s efforts are designed to present appropriate interventions for lower
back pain since a large population with lower back pain has a significant influence on productivity andincremental medical and social security costs. The 2004 Guideline is the first guideline that refers both to acutelower back pain and chronic lower back pain whereas previous versions refer only to acute lower back pain.
It is said that as long as humans walk on two legs, lower back pain is unavoidable. Recent studies,
however, reject this notion as groundless. Although the root causes of lower back pain remain to be explained,some people who experience organic changes do not complain of pain. However, many people who do notexhibit medical abnormalities are plagued by persistent pain. If the cause is identified as lumber spine
degeneration for example, patients will undergo treatment no matter how painful it may be, and accept thedisease by making necessary changes in their lifestyle. If the cause is not known, patients may try one form oftreatment and switch to another. The aforementioned European Guideline contains the additional viewpointthat lower back pain whose onset is associated with stress is pain that is ongoing, or caused by biological or
sociopsychological factors including economic insecurity, as well as the conventional viewpoint that regards
lower back pain as physiological, structural, or biological damage.
Do YOU recall the male mummy (Ötzi the Iceman), frozen in the ice for 5,000 years, that was accidentally
discovered in 1991 near the Austrian-Italian border? The discovery is important in terms of both archaeology
and the history of anthropology. From the X-ray analysis of the mummy which indicates lumbar vertebral
degeneration and wear and tear of the knee joints, it is easy to assume that he was suffering from lower backpain and knee joint pain. What is further surprising is that the locations of the tattooes on his body closely
correspond to the meridian points for treating lower back pain and knee joints.
Although the cause of Ötzi’s lower back pain was identified by radiography, today’s guidelines do notrecommend the use of diagnostic imaging unless there is a strong reason to suspect a certain specific cause.
These guidelines also reject all traditional treatments based on common sense, and sound a warning against
the trend that operative treatment is easily opted for. The Guideline prepared in the U.S. in 1992 for treating
acute lower back pain recommends only administration of acetaminophen and NSAIDs as well as vertebral
manipulation for symptom amelioration. Complete rest is rejected, and physical therapy, acupuncture andwearing a corset are not deemed worthy as recommendations. The 2001 Guideline prepared in Japan does not
reject diagnostic imaging due to the importance of differential diagnosis of major diseases and recommends astreatment a combination of pharmacotherapy, physical therapy, therapeutic exercise and an educational
approach depending on the stage of the disease.
In Japan, acupuncture, moxibustion, and Kampo medicines are frequently used either on their own or
combined with other treatments. These are used based on an understanding of general body condition
associated with functional improvements or chronicity, with the aim of relieving symptoms as well as
enhancing the emotionally and psychologically damaged QOL, as pointed out in the European Guideline.
Moreover, Kampo medicines are expected to prevent gastrointestinal disorders and liver function impairment,
and to reduce the dosing frequency of NSAIDs.

Akihiro Soma
Editorial Staff
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

1

Volume 2, Number 4 | Winter 2007

Japanese Acupuncture - Current Research
Acupuncture for Respiratory Disease in Japan: A Review

Masao Suzuki

Department of Clinical Acupuncture and Moxibustion
Meiji University of Integrative Medicine

Background: In Japan, studies on acupuncture andmoxibustion therapy for respiratory disease haverarely been reported. Additionally, most of thereports are difficult for overseas researchers toaccess because they are written in Japanese andcannot be located using Medline.
Purpose: To review studies on acupuncture andmoxibustion

therapyforrespiratory

diseaseconducted in Japan.
Data Sources: The results of a literature searchusing ‘Igaku Chuo Zasshi Web’ (Japana Centra
Revuo Medicina) and the Medical Online Library,both of which are Japanese databases, covering theperiod between 1983 and 2008.
Study Selection: We reviewed references cited in
retrieved documents and selected original articles
and case reports on acupuncture and moxibustion
therapy for respiratory disease.
Data Excluded: Animal studies, surveys, excerpts
and news articles were excluded.
Data Extraction: The search terms used were
“acupuncture” and “respiratory disease”, along with“respiratory”, “asthma”, “COPD”, “bronchitis” and“common cold”.
Result: We retrieved 38 papers on acupuncture
treatment

forrespiratory

diseasewritteninJapanese (9 full papers, 22 case reports and 7 caseseries). The papers dealt with such conditions asasthma (14 trials), cough variant asthma (CVA; 3
trial), chronic cough (2 trials), chronic obstructive
pulmonarydisease(COPD;

7

trials),chronic

bronchitis (1 trial), diffuse pan bronchitis (DBP; 1
usual/idiopathic

interstitial

pneumonia(UIP; 1 trial), and the common cold (2 trials). We
also found 8 trials dealing with cold prevention. The
effects of acupuncture treatment on respiratory

2

Conclusions:

A smallacupunctureandnumbermoxibustionofreportsontreatment

forrespiratory disease were found in the Japanesedatabases.

Somereported

that

acupuncture

treatment was conducted for refractory respiratory

Abstract

trials),disease were reported in 33 papers.

disease, such as COPD, for which modern medicine
has, to date, found no remedy. However, we foundonly inadequate evidence for its effectiveness.
Future studies must use more rigorous evaluation
methods, such as RCT, to measure the effectivenessof

acupunctureandmoxibustion

therapyfortreating respiratory diseases.
Key

words:

respiratory

disease,acupuncture,

moxibustion, asthma, COPD.
Introduction
Acupuncture, a non-invasive therapy based on
traditional Chinese Medicine (TCM), may be avaluable modality in managing symptoms (1).
Moreover, the World Health Organization has
recognised that acupuncture may be effective intreating chronic pulmonary disorders (2), and it is
widely used in Japan for the treatment of chronic
disease. The theory behind the use of acupuncture isto restore the balance of “vital flows” by inserting
needles at particular points on the body surface
where the “meridians” of these flows lie. The specificpoints can also be stimulated with pressure or laser
application (3).
In

many

advancedpatients,

particularly

pulmonarydisease,

those

with

symptomatic

measures are required in addition to other therapies,
and may even be the mainstay of treatment (4).
Acupuncture

is

one

of

the

most

popularalternative therapies. Needle acupuncture has beenused to treat various complaints for hundreds ofyears in Japan and has been reported to be oftherapeutic benefit in controlling pain. However, inJapan, reports on respiratory disease patients who
have

received

acupunctureandmoxibustion

therapy are rare and clinical trials intended toassesstheeffectiveness

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

of

the

therapyforVolume 2, Number 4 | Winter 2007

respiratory disease are even rarer. Moreover, mostResultsof the papers on acupuncture published in Japan

We found a total of 38 Japanese papers on

are written in Japanese and cannot be retrieved

acupuncture that was applied to respiratory diseaseusing major English-language medical databases.

(22 case repots, 7 case series and 9 full papers).

Thus, the purpose of this review was to evaluate(1) Case reports and case series

and introduce the current status of clinical trials

1.

conducted in Japan on acupuncture in treating
respiratory disease.

Diagnosis
A list of 29 case reports and case series is shownin Table 1. The conditions examined in these types

We are sending before more and used to alsoof papers were asthma (13 trials) (5–17), coughupdate this paper for the information on an

variant asthma (CVA) (2 trials) (18-19), chronic

acupuncture and moxibustion therapy over a

cough (2 trials) (20,21), COPD (5 trials) (22–26),

respiratory ailment to this.

chronic bronchitis (1 trial) (27), diffuse pan

Methods

bronchitis (1 trial) (28), UIP (1 trial) (29) and theAccessing the literaturecommon cold (2 trials) (30,31). We also found studies

A computer-assisted search was used to examine
the Igaku Chuo Zasshi (Japana Centra Revuo
Medicina)

andMedicalOnlinedealing with cold prevention (2 trials) (32,33).
2.

Intervention

Library

Twenty-one of 29 case reports used TCM as the(Meteointergate, Inc.) databases. The period covered

standard method of acupuncture treatment. Of thewas from January 1983 to December 2008. We also

rest, some applied special acupuncture treatments,

investigated the references that were cited in eachsuch as electric acupuncture treatment (7,14), roller

retrieved document and selected relevant papers.

acupuncture (30), skin implant needles (15), Doushi

The keywords used in the database searches were(17) and ryoudouraku (8).

"respiratory

3.

Duration of treatment

disease","acupuncture","asthma",obstructive

pulmonarydisease",The duration of treatment observation for"bronchitis", "common cold", "pulmonary disease"respective research was over 1 month for 13 reports,and "clinical trial". The search was limited to

but only 1 day in 4 reports (13,15,17,21). The rest

original papers and case reports.

did not report the period of treatment observation

Study selection criteria(5,8,9,16,20,31,33).

"chronic

Clinicaltrials(casereports,

parallel-or4.

Outcome measurescrossover-designed trials and controlled clinical

The main outcome was not measured bytrials (CCTs)) that assessed the efficacy of needle

commonly validated methods in 16 papers. These

acupuncture were included. Experimental studies,

papers measured their outcomes by conducting

animal studies and duplications of published papers

unstructured individual interviews of the patients.

were excluded.

The rest carried out reliable examinations, such as

Data extraction

testing

For each study, the following items were

improvementin

respiratory

keeping asthma diaries or measuring exercise

reviewed: trial design, randomization, blinding,tolerance (6,7,12,14,18,19,22-26,28).

handling of dropouts, publication year, health5.

condition

examined,treatment

andfunction,

Results

control

All trials but one indicated positive results (24),procedures, number of participants, main result,although unusual techniques of acupuncture were

number of treatments, type of control used, mainused in some case reports. In one study, the common

outcome measure, descriptions of informed consent,

cold was treated with roller acupuncture (30). In

affiliations of authors and publication types.

another study, the Acupoint (suitotsu; ST10) was

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

3

Volume 2, Number 4 | Winter 2007

applied to the frontal cervix to treat bronchialtests, such as respiratory function inspection andasthma (Japanese: Doushi) (17).

exercise tolerance. Similarly, one measuring the(2) Full papers: Controlled clinical trials

effects

1. Diagnosis

measurements, such as requiring patients to keep

We found a total of nine papers regarding CCTs

onbronchialasthmausedvalidatedasthma diaries and conducting respiratory function

on acupuncture in treating respiratory disease andinspections.

in cold prevention. One of the first CCT papers on

7. Results

acupuncture was published in 1996 (34). A list of

The results were positive in five trials (55.6%)

these CCTs is shown in Table 2. The conditions(35-37,39,40). In these trials, it was suggested thatexamined in these CCTs were asthma (1 trial) (35)

acupuncture treatment for COPD (36,37) andand COPD (2 trials) (36,37). We also found 6 trials

asthma (35) was very effective. TCM acupuncture

on cold prevention (34,38-42).

was used in all these positive trials for COPD and2. Study design

asthma.

Of them, three were regarded as genuine RCTs
(38-40). No subjects were blinded. Dropouts or

Discussion

withdrawals from the studies were indicated in〈Design〉
Wethree trials (35,38,39).

examined

acupuncture

3. Intervention

thetreatment

methodologicalquality,characteristics

andThe method of acupuncture used was TCM (3respiratory outcome of nine CCTs on acupuncture

trials) (35-37), specific acupoint needles (4 trials)

for respiratory disease in Japan. For most, the(34,39,40,42) and moxibustion (2 trials) (38,401).

research

4. Control

inappropriate (i.e., not randomized, controlled

methods

used

were

inadequateorRegarding controls, no trial used sham or placebo

and/or blinded, and without any quantitative

procedures, six trials employed drugs or vaccine

measurement). Furthermore, even the CCTs that a

injections (343-37,41,42) and three trials employedthird person had assessed them, and thus theno treatment (38-40) (Table 2).

validity of their results cannot be guaranteed to be

5. Duration and frequency of treatments

high.

The duration of all trials was over 1 month. The
mean frequency of treatments was 16.8 times (range〈Duration and frequency of treatment〉
Most case reports and case series dealt with

8–32).

chronic disease, such as bronchial asthma, COPD

6. Outcome measuresand UIP. Chronic diseases require relatively long

Of six papers that intended to measure theperiods of acupuncture treatment and monitoring.

effects of acupuncture and moxibustion therapy on

However, several these case reports and case series

cold prevention, two required research participants

conducted treatment and monitoring for only short

to maintain diaries to record changes in cold

periods of time. Thus, we cannot know the long-term

symptoms and three conducted blood tests that

effects, beyond the periods covered by the respective

revealed

particularstudies. The validity of acupuncture treatment inbiomarkers (CD4, CD8 and CD53) and patients’ coldthese studies must be gauged in this light.

symptoms. However, one paper measured the effects

Nevertheless, a few studies have carried out

based

relatively long periods of acupuncture treatment

relationships

solelyon

betweenself-reports

byparticipating

andpatients.

monitoring.

Thesestudies

are

of

great

Two papers measured the effects of acupuncture

importance in assessing the realistic effects ofand moxibustion therapy for COPD using validated

acupuncture treatment on these chronic diseases.

4

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

Volume 2, Number 4 | Winter 2007

Japanese citizen to seek mainstream modern〈Results〉
Because only 3 complete RCTs were found out of38

papers,wecannotstronglyargue(Western) medicine treatments offered by medicalthat

institutions at relatively low cost. Because mostacupuncture was effective in treating respiratory

CAM treatments are not covered by insurance, it isdisease. As Martin et al. argued, the effect of aunlikely that Japanese patients with respiratory

treatment can be systematically assessed only by

disease would choose acupuncture or moxibustion

improving study quality (43). In this review, thetherapy as their first choice of treatment. In someresult was positive in 28 papers (case reports andWesterncase series). However, in 15 of these 28 papers, thetreatments for respiratory diseases have beenassessment was based solely on patients’ complaints,

reported to be more effective and less costly than

indicating that these results are weak in terms oftreatments by modern medicine (46-48).

countries,

however,

acupuncture

validity and reliability. This result suggests the

It is, of course, true that acupuncture has been

publication bias was present, in the sense that only

practiced much more widely in Japan than in thepositive outcomes tended to be published.

West. Of 2,000 respondents, 6.5% had received

Our review clarified that weaker study designs

acupuncture treatment in Japan (49), whilst the

may bias study results and overestimate positive

number was only 2% in Australia (50) and 1% in theeffects of the treatment consistent with the findings

Unitedof Martin et al. (43). Despite the weaknesses

treatment has been used primarily for relievingobserved, some studies demonstrated the potential

pains, such as back pains and stiff shoulders inof acupuncture in the sense that it may be effective

Japan,

in treating certain diseases, such as COPD and UIP,

Czechoslovakia, the treatment has been used morewhich are currently incurable by modern medicine.

for bronchial asthma, allergy or mental disorders,

Likewise, some papers suggested a possibility ofthan for pain relief (52,53). Particularly interesting

using acupuncture in health promotion, such as coldis that whilst 3.1% of respondents had received

prevention. These cold prevention studies, alongacupuncture treatment for respiratory diseases inwith the RCT study of 326 subjects reported by

the United States, none had done so in Japan.

et

al.

showingwhilst(51).

in

However,

Britainand

acupuncture

theformersignificant

Another difference is that in Euro-American

improvements in preventing colds in the treatment

countries, doctors practice acupuncture treatmentgroup, are seminal in that they examined theat hospitals, whilst in Japan doing so is illegal. That

possibility of applying acupuncture and moxibustionis, when patients seek acupuncture treatment fortherapy as preventive medicine.

respiratory diseases in the West, they actually have<Comparison between situations in Japan andeasier access than their Japanese counterparts whooverseas>must seek treatment from acupuncturists who

Kawakita(44)

StatesThe Japanese CCTs that measured the effects oflargely do not work at hospitals, but at CAM clinics.

acupuncture in treating respiratory diseases lag far

Moreover,behind in quality compared to those conducted intreatments in Japan are not covered by thethe West. Whilst studies in the West began to apply

universal health insurance, which does cover most

RCTs in the 1980s (45), the Japanese counterparts

modern medicine, making it relatively harder for

did not do so until 2000 (40).

Japanese patients to seek acupuncture treatment.
Japanese acupuncture has developed some
culturally unique methods whilst being practiced for
hundreds of years. Some papers reviewed here dealt
with such unique methods as roller acupuncture

The overall scarcity of reports on acupuncture
and moxibustion therapies for respiratory disease inJapan is probably due to the medical insurance
system. The system enables practically everyasstatedThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

previously,

most

CAM

5

Volume 2, Number 4 | Winter 2007

(Roller-shin in Japanese). For roller acupuncture
treatment, practitioners apply a roller with a warty
surface across a patient’s skin, which stimulates
cutaneous vessels and results in their dilation.
Because no needle penetrates the skin, roller
acupuncture is considered to be easier to practicethan the orthodox method. Yamashita reported thatroller acupuncture was a safe and effective method
for cold prevention (30).
〈Conclusion〉
In conclusion, future trials should have larger
sample sizes, more rigorous methods and reflect
principles and practices of acupuncture as appliedin practice today. Furthermore, to complete
systematic reviews on acupuncture, we encourage
researchers in Japan and elsewhere to publish
relevant results of RCTs in English, so that they will
be listed in major English-language databases. We
believe that conducting English reviews of Japanese
papers on RCTs in a collaborative effort amongst
researchers from different countries would promotea more thorough scientific evaluation ofacupuncture treatments.

bronchialasthmathat

improvementofvariegated whole body symptom was effective to
reduction of respiratory organ symptom. Jap
Joun Acup Moxi Thera. 2003;718(9):61-66.
(in Japanese)*
7.

Nakano T, Yamashita H, Sawada Y, Nishijoh K.
Exampleofenforcingnewacupuncture

moxibustion program to bronchial asthma
treatment.

Clinicalacupuncture.

2002;17(2):32-40. (in Japanese)*8.

Gotou K. Treatment results of asthma andexaminationof

Ryoudouraku

chart.

Jap

Medical Ryoudouraku. 2000;45(3):198-206.
(in Japanese)*
9.

Matsuzawa M, Kaneko S, Sai S, Oho G, Sugiura
H, Go S, Nigel W, Ka K, Shuku, S, Aikawa, Y.
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Oriental Medicine. 1995;21(8):85-87.
(in Japanese)*

10. Su, Y, Ozaki T, Nonoi K, Adati S. Two cases ofbronchialasthma.

Clinicalacupuncture.

1995;10(3):19-25. (in Japanese)*
11. Hashimoto K, Kamino H, Oyagi T, Okumura Y,

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Remarkable

Improvement of Chronic Cold Syndrome by theSoci.

Parient with “fei qi ying liang xiu zhen”. J Jap
Soci Acupu Moxi. 2000;50(3):463-469.

Yano T, Fujiwara H. A case of successful
with

by

Application of Acupuncture Therapy to a

23. Suzuki M, Ohno Y, Akao S, Egawa M, Asai T,
emphysema

improvedby

2005;43(5):289-295. (in Japanese)*

acupuncture

symptom

30. Yamashita Y. A case whom cold improved bytreatment

22. Suzuki M, Ohno Y, Namura K, Asai T, Yuugetu
of

UIP

Thera. 2003;715(6):71-76. (in Japanese)*roller

21. Murai K. Acupuncture treatment of cough by

case

whom

bronchial(in Japanese)*
33. Tanioka M. Two cases who treat acupunctureforinfanttobronchialasthma.

ClinicalAcupuncture. 1998;14(1):58-59. (in Japanese)*

asthma. Kampo Med. 2005;56(4):567-575.

34. Kobayashi(in Japanese)*Y,

AkitsuM,

OhoyamaF,

24. Tsuru H, Egawa M, Takahashi N, Matsumoto T,

Kuribayashi H, Kondou T, Shinohara M, et al.

Kenzi N. A case of pulmonary emphysema of

Infection prevention effect of vaccine nose

severe grade treated by acupuncture in a healthvaccination and acupuncture treatment. J

care facility for the elderly. J Jap Soci Acupu

Oriental school Medicine. 1996;20:38-43.

Moxi. 2005;55(2):150-158. (in Japanese)*(in Japanese)*

25. Katayama Y, Egawa M, Yano T, Namura K. A

35. Suzuki M, Namura K, Egawa M, Tano T. Effectcase of emphysema that breathing difficultiesof Acupuncture Treatment in Patients withandBronchial Asthma. J Jap Soci Acupu Mox].

state

of

nourishment

improvedbyacupuncture treatment. Jap Joun Acup Moxi
Thera. 2004;727(5):53-58. (in Japanese)*
26. Suzuki M, Egawa M, Yano T, Namura K,
Yamamura Y. A Case of Chronic Obstructive

2006;56(4):616-627. (in Japanese)*
36. Egawa M, Yano T, Namura K. Case whom
symptomofemphysema

improvedbyacupuncture treatment. Jap Joun Acup Moxi

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

7

Volume 2, Number 4 | Winter 2007

Thera. 2005;745(11):85-90. (in Japanese)*

45. Jobst K, Chen JH, McPherson K, et al.

37. Suzuki M. The Effects of Acupuncture in
Patients with Chronic Obstructive Pulmonary
Disease.

Bull

Meiji

Univ

OrientMed.

2004(33);83-97. (in Japanese)*

Controlled trial of acupuncture for disablingbreathlessness. Lancet 1986; 20: 1416-9.
46. Branco K, Naeser A. Carpal tunnel syndrome;
Clinical

38. Takahashi N, Tsuru H, Egawa M, Matumoto T,

outcomeafter

acupuncture,

low-level

micr ） oamps

laserTranscutaneous

Kawakita K. Effects of Indirect Moxibustion onelectrical

Common Cold Symptoms in Elderly Subjects

alternative therapies; An open protocol syudy. J

LivedAltern and Comple med. 1999; 5: 5-26.

inNursing

Home:Single-caseExperimental Design. J Jap Soci Acupu Moxi.
2005;55(5):706-715. (in Japanese)*

stimulation

and

other

47. Johansson K, Lindgreen I, Widner H, Wiklund I,
Johansson

39. Shichidou T, Isobe Y, Yu S, Kozima T, Inoue E,

nerve

BB.

Can

sensory

stimulation

improve the functional outcome in stroke

Kawakita K, Tannzawa S. Protective efficacy ofpatients?. Neurology. 1993; 43: 2189-2192.

cold that uses acupuncture treatment by

48. Liguori A, Petti F, Bangrazi A, Camaioni D et al.

randomized controlled trial. Jap Joun of Acup

Comparison

Moxi

versus acupuncture treatment for migraine

Thera.

2001;695(12):130-143.

(inJapanese)*of

without

40. Isobe Y, Yu S, Inoue E. Protective efficacy ofcold that uses acupuncture treatment byrandomized controlied trial. J Oriental School

pharmacologicalaura:

treatment

Analysisofsocio-medicalparameters. J Trad Chin Med.
2000; 20:231-240.
49. Ishizaki N, Iwa M, Yano T, Ono N, Nisimura S,

Medicine. 2000;24:94-97. (in Japanese)*

Kawakita K, Tanzawa S. Survey research on

41. Tanaka J, Satou Y, Ouji I, Konisi T, Kondou J,

prevalence, aim and image of acupuncture andSayama O, et al. Infection prevention effect ofmoxibustion in Japan(1): Prevalence and aim ofvaccine nose vaccination and moxibustion

acupuncture and moxibustion. JJSAM. 2005;

treatment.

55: 697-705.

J

Oriental

SchoolMedicine.

2000;23:112-117. (in Japanese)*

50. MacLennan AH, Wilson

42. Kaneko I, Asayasu Y, Kaneko T, Kondou A,
Saitou K, Saitou H, et al. Infection prevention
effectofvaccinenose

vaccination

AW.

Prevalence and cost of alternative medicine inAustralia. Lancet. 1996; 347: 569-573.

and51. Eisenberg DM, Davis RB, Ettner SL, Appel S,

acupuncture treatment. J Oriental School

Wilkey S, Rompay MV et al. Trends in

Medicine. 1998;21:72-77. (in Japanese)*

alternative medicine use in the United States,

43. Martin J， Donaldson ANA， Villarroel R，etal ： Efficacyofacupunctureinasthma:1990-1997. JAMA. 1998; 280; 1569-1575.
52. Tsuru H, Ishizaki N, Taniguchi K. Analysis ofof2967 patients who visited acupuncture clinic ofpublished data from 11 randomized controlled

Meiji College of oriental medicine in thetrials．Eur Respir J 2002；20：846-852．

U.S.A.(1996-1999). Bulletin of Meiji Univer

systematic

review

andmeta-analysis

44. Kawakita K, Shichidou T, Inoue E, Nabeta T,

Orient Med.2003; 33: 61-81.

Kitakouji H, Aizawa S, et al: Preventive and

53. White A, Ernst E. Public usage of acupuncture

curative effects of acupuncture on the common

in the West. In: Ernst E and White A (ed).

cold: a multicentre randomized controlled trial

Acupuncture: a scientific appraisal. Oxford.

in

Butterworth Heinemann. 1999: 5-7.

Japan.

CompleTherapMed.

2004;12:181-188.

8

DH, Taylor

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

Volume 2, Number 4 | Winter 2007

Table 1 Summary of case reports on acupuncture and moxibustion in the Japanese literature.
COPD, chronic obstructive pulmonary disease; CVA, cough variant asthma; DBP, diffuse pan bronchitis; UIP,
usual interstitial pneumonia; +, positive; -, negative.
Authoryears

DiagnosisnStudydesignIntervention

Duration

No.oftreatment

Outcome Measures

ResultReferences
No.

Suzuki M

2007

DPB

1

Case reportacupuncture (TCM)

50 weeks

50 times

symptom, Respiratory
function, blood test+

28

Tokuchi J

2006

Chronic
couhg

2

Case reportacupuncture (TCM)

unenrolled

unenrolled

sympotm+

20

Egawa M

2006

CVA

1

Case reportacupuncture (TCM)

12 weeks

12 times

categorical scale+

18

Murai K

2006

Chronic
couhg

4

Case series

medication add on
acupuncture(TCM)

1 to 20 days

1 to 40 times

sympotm+

21

Yamashita
Y

2006

Common cold

1

Case report

Roller acupuncture

104 weeks

160 times

symptom+

30

Suzuki M

2005

COPD

1

Case reportacupuncture (TCM)

10 weeks

10 times

exercise tolerance test,
Respiratory function, attack+

22

Suzuki M

2005

COPD

1

Case reportacupuncture (TCM)

10 weeks

10 times

exercise tolerance
test,Respiratory function+

23

Tsuru K

2005

COPD

1

Case reportacupuncture (TCM)

20 weeks

33 times

exercise tolerance
test,Respiratory function-

24

Katayama
Y

2004

COPD

1

Case reportacupuncture (TCM)

7 weeks

33 times

nutrition, symptom+

25

Uematsu Y

2004

CVA

1

Case reportacupuncture (TCM)

9 weeks

10 times

Asthma diary, PEFR+

19

Oyagi T

2004

Asthma1

Case reportacupuncture (TCM)

nodescription

no description

symptom+5

Uematsu Y

2003

UIP

1

Case reportacupuncture (TCM)

50 weeks

50 times

exercise tolerance,
Respiratory function, symptom+

29

Egawa M

2003

Asthma1

Case reportacupuncture (TCM)

72 weeks

60 times

attack diary, PEFR+

6

Nakano T

2002

Asthma10

Case series

Electroacupuncture,acupuncture

10 weeks

10 times

attack diary, Medicine+

7

Tokuchi J

2000

Cold
prevention

1

Case reportacupuncture (TCM)

4 weeks

8 times

symptom+

31

Suzuki M

2000

COPD

1

Case reportacupuncture (TCM)

61 weeks

60 times

attack diary, PEFR, symptom+

26

Gotou K

2000

Asthma17

Case series

acupuncture(ryoudouraku)

nodescription

13 timesryoudouraku, symptom+(availableness:
9, nvariability:7)

8

Tanioka K

1998

Cold
prevention

2

Case reportchild acupuncturenodescription

no description

symptom+

33

Matsuzawa
M

1995

Asthma30

Case series

acupuncture,
Kampo (TCM)

nodescription

no description

scandding Classification
effective: 90%

+

9

Yu S

1995

Asthma2

Case reportacupuncture (TCM)

12 weeks

26 times

symptom+

10

HashimotoK

1994

Asthma1

Case reportacupuncture (TCM)

28 weeks

47 times

symptom

+

11

Rin S

1993

chronic
broncitis

1

Case reportacupuncture, Kanpo(TCM)

8 weeks

8 times

symptom+

27

Seki Y

1992

Common cold

3

Case reportacupuncture (TCM)

nodescription

no description

symptom+

32

Category
scale(+),
Emergency
outpatient(+),
medication(+),
ABG(-)

12

Shinohara
M

1990

Asthma1

Case reportacupuncture (TCM)

84 weeks

30 times

Category scale, Emergency
outpatient, medication, ABG

Hayasaki Y

1989

Astham3

Case reportacupuncture (TCM)

1 day

Once

symptom+

13

14

Tsukada Y

1987

Asthma12

Case series

Electroacupuncture,acupuncture

56 weeks

28 times

symptom, PEFR, blood test

symptom(+),
PEFR(10%
improvement),
blood test (-)

Fu Y

1987

Asthma21

Case series

acupuncture(implant a needl)

1 day

Once

symptom+(Effective: 90%)15Sugiura R

1982

Asthma1

Case reportacupuncture (TCM)

nodescription

no description

symptom+

16

TakishimaT

1979

Asthma10

Case series

acupuncture(Japanese: Doushi)

1 day

Once

symptom+

17

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

9Volume 2, Number 4 | Winter 2007

Table 2 Summary of controlled clinical trials on acupuncture and moxibustion in the Japanese literature.
COPD, chronic obstructive pulmonary disease; RCT, randomized controlled trials;
No.of

No

Authoryears

Diagnosis

Study designnIntervention

Control

Duration1

Suzuki M

2006

AsthmaN-of-1

6

A: acupuncture

B: iv (drugs)

40 weeks

20 times

2

Egawa M

2005

COPD

N-of-1

1

A: acupuncture

B: iv (drugs)

64 weeks

32 times

RCT, N-of-1

2

A: moxibation

B: i (waiting lists)

16 weeks

24 times

Parallel37

A: acupuncture

B: iv (drugs)

10 weeks

10 times

RCT

24

A: acupuncture

B: i (waiting lists)

4 weeks

9 times

RCT

24

A: acupuncture

B: i (waiting lists)

4 weeks

8 timesparallel60

A: moxibustion

4 weeks

16 times

4 weeks

16 times

48 weeks

16 times

3

4

5

N

Suzuki M

Shichidou
T

2006

2004

2001

6

Isobe Y

2000

7

Tanaka J

2000

8

9

10

Takahashi

Kaneko I

Kobayashi
Y

1998

1996

Cold
prevention

COPD

Cold
prevention

Cold
prevention

Cold
prevention

Cold
prevention

Cold
prevention

treatment

B: iv(wacchin +moxibustion),
C: iv(wacchin)
B: iv(wacchin +parallel60

A: acupuncture

acupuncture),
C: iv(wacchin)

Outcome Measures

Asthma diary,

ResultReferences
No.

A>B

35

A>B

36

A=B

38

A>B

37

symptom diary

A>B

39

symptom diary

A>B

40

A=B>C

41

A=B>C

42

A=B=C

34

Respiratory function

exercise tolerance,
Respiratory function

symptom

exercise tolerance test,
Respiratory function

sympotom,CD4+, CD8+, CD53

sympotom,CD4+, CD8+, CD53

B: iv(wacchin +parallel40

A: acupuncture

acupuncture),
C: iv(wacchin)

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

virus serum antibody titerVolume 2, Number 4 | Winter 2007

Kampo Medicine - Current Research
Can Kampo Formulations become First-Line Drugs forRheumatoid Arthritis?

contains a description of RA. Practitioners today useprescriptions from this classical textbook to someeffect. After the concept of the disease was clarified

Hiromichi Yasui

in recent years, RA has been treated with Kampo

Japan Institute of TCM Research

medicine under stricter diagnostic guidelines. Mostof the treatments, however, are performed on the

Introduction

basis of short-term follow-ups and there are very

There are 600,000 to 700,000 patients withfew long-term records of the treatments available.

rheumatoid arthritis (RA) in Japan (0.4–0.5% of theThis is because a follow-up system for the long-term

population, 1% of people aged over 30) with threeprognosis of the disease was not established, such as

times as many women as men afflicted by RA. Onset

whether joint destruction can be prevented or not.

is most frequent between the ages of 30 and 50. The

Koji EBE focused attention on the time within

initial symptoms of the disease are symmetrical

three to four years after onset when it becomes clear

manifestation of pain in finger and toe joints andwhether the disease goes into remission, rapidly

swelling of the joints (in some patients theseworsens, or gradually degenerates. He hypothesised

symptoms start from the knee joints or other joints).

that intervention with Kampo formulations at a

Subsequently,

achieve

very early stage would increase cases of earlyremission within one to two years. On the otherremission and observed the course of treatment inhand, about 5 to 10% of patients exhibit rapid joint

10 cases of primary RA onset. He then provided

degeneration as well as a strong inflammatory

further insights into the results.

about

20%

of

patients

condition in a short period of time. The other 70% of
patients experience alternate improvement andexacerbation in symptoms, progressing to gradualjoint degeneration.
Pharmacological therapy by Western medicine
aims to inhibit inflammation or joint destruction
and non-steroid anti-inflammatory drugs (NSAIDs)
or steroid drugs are used to manage joint swellingand pain caused by inflammation. In recent years,
disease-modifying anti-rheumatic drugs (DMARDS)
have come to be used early in the course of thedisease, and if these are ineffective, TNF blockers

Subjects and prescriptions
The subjects are ten individuals that satisfied the“Rheumatoid Arthritis Criteria” (Table 1) of theAmerican College of Rheumatology (ACR) with aduration of one year or less from the start ofsymptoms. For all subjects, formulae were designed
according to “sho” and decoctions were administered(Table 2).
Table 1: Rheumatoid Arthritis Criteria (American
College of Rheumatology: ACR)
1

Morning stiffness lasts for an hour or more

2

Swelling of three or more joint areas

3

Swelling of the hand joints (wrist joints,
metacarpophalangeal [MCP] joints, proximal
interphalangeal [PIP] joints)

will introduce research that indicates Kampo

4

Symmetrical joint swelling

formulations used in the early stages could inhibit

5

Abnormal hand radiographs

disease progression.

6

Subcutaneous nodules

7

Blood test shows positive for rheumatism
RA is diagnosed if 4 items out of the 7 above aresatisfied (however, items 1 to 4 must last for 6
weeks or more).

are combined with DMARDS.
Is Kampo medicine able to open a new chapter inthe treatment of RA? Although treatment of RA
with Kampo formulations is common in Japan, I

Ebe’s trial
Kampo medicine has long been engaged in RA
treatment. “Jinkui Yaolue,” written in ancient times,

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

11

Volume 2, Number 4 | Winter 2007

Table 2
Date of

DiseaseFirst

Duration

Consultati

Sex・Age2

3Feb. 9,1991

Jul. 9,1985

Apr. 30,
1999

Stage

Male 81

Male 70

Female 51

1.5 months

5 months

6 months

Chinese Medicine)

Treatment

Prescriptions

Diagnosis

Consultationon

1

before FirstTCM (Traditional

1

1

1

Dampness-heat
impediment

Dampness-heat
impedimentWind-damp impediment

Clear heat to transform
into dampness

CombinedDrugsenpito with adjustment

Analgesic

senpito with adjustment

Analgesic

Clear heat to transform
into dampness. Then,reinforce kidney
Dissipate cold to

Kedishikajutsubuto with additiontransform intoof Ephedrae Herba, Asiasari

dampness

Radix and Coicis Semen

Analgesic

Stephaniae Tetrandrae Radix
Coicis Semen, Atractylodis
4

May 22,
1955

Male 50

3 months

1

Damp impedimentTransformed dampness

Lanceae Rhizoma, Atractylodes

to modify statis

Rhizoma, Phaseoli Semen,

Analgesic

Paeoniae Radix Rubra,
Clematidis Radix and others

5

6Mar. 27,
1995

Mar. 11,1987

Dissipate cold toFemale 58

11 months2Wind-damp impedimenttransform into
dampness
Dissipate cold toFemale 43

3 months1

Damp-wind impediemnt

transform into
dampnesskeishikajutsubuto withadjustmentkeishikaryoujutsubuto withadjustment

None

None

Dissipate cold to7

Jan. 12,
1990

Male 70

3 months

1

Wind-damp impedimenttransform intokeishikajutsubuto with

dampness. Convert

adjustment. Later senpito with

damp heat-impedimentadjustment

Analgesic

in mid-course
Stephania tetrandra Radix,

8

Apr. 17,
1992

Female 58

12 months

2Damp-wind impedimentTransformed dampness
to dissipate cold

Armeniacae Semen, Coicis
Semen、Clematidis Radix、None

Aconiti Radix Processa,
Cinnamomi Cortex, and others

9

10

12

Apr. 18,
1997

Jul. 10,1994

Dissipate cold toFemale 45

7 months

1

Wind-damp impedimenttransform into
dampness

Female 41

3 months

1

Dampness-heat
impediment

Clear heat to transform
into dampness

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

Keishikajutsubuto withadjustment

None

senpito with adjustment laterkeishikajutsubuto withadjustment

Analgesic

Volume 2, Number 4 | Winter 2007

Assessment (Evaluation Criteria)
Remission criteria developed by Pinals et al. wasused for the assessment (Arthritis Rheum 1981).
It is essential that 5 or more of the following besatisfied for at least two months.
1.

Morning stiffness does not last for 15
minutes or more

failure occurred concurrently and dialysis
started in June. The patient died in October.
As described above, Ebe reports that remission
was attained in 9 cases out of 10 primary RA caseswith incomplete remission in one case. Excellent
treatment effects are shown.

2.

No fatigue

3.

No joint pain4.

No joint tenderness or no pain on motion

5.

No soft tissue swelling in joints and tendon

However, due to the low number of cases available

sheaths6.

arthritis nodosa was diagnosed. Chronic renal

Erythrocyte sedimentation rate is less than
30 mm/h for males and less than 20 mm/h
for females

for the research, it is too early to conclude whether
these

results

were

producedunderbiasedevaluations or were fortuitous, and that Kampo
medicines are extremely effective for cases ofprimary RA onset. If a number of future primary RA
cases yield good results, Kampo medicines could
become first-line drugs in the treatment of RA.

Results
1． Complete remission was attained in 9 cases outof 10.
2． Case 10 ended in complete remission with 2.5
years of treatment. However, 2 years later inJanuary 1999, the disease recurred. Fourmonths of Kampo treatment starting in April
led to another remission.
3． Case 9 ended in incomplete remission after one
year of Kampo treatment. The case sometimes
satisfied 5 of the 6 remission criteria andsometimes satisfied 3 to 4 criteria. However, 7months after the start of Kampo treatment, thepatient was able to run. About a year later(March 1998), the patient commenced hard
work that required steady walking of 10,000 to
20,000 paces a day. As of March 2000, thepatient was continuing work of a similar
nature.
4． Case 7 ended in complete RA remission after
three years of Kampo treatment. Six years later
in March 1998, however, connective tissue
disease accompanied by vascular inflammation
developed. The disease was controlled byConclusion
This research by Ebe contributes to extending thepossibility of Kampo therapy, resulting in increased
treatment options available for patients with RA. In
assessing the effectiveness of Kampo therapy,
DB-RCTs (double blind-randomized controlled trial)
are difficult to conduct. Thus, to satisfy a similarlevel of EBM requirements, Ebe has suggested thatinvestigations use a definite number of subjects who
have received Kampo treatment from an initialperiod (six months to one year from onset). He alsosuggests that if 10-year follow-up reveals a lower
rate of shifting to polyarticular destruction type andmutilans type compared to Western medicine
research groups, it could be said that Kampo
treatment is efficacious. Later in 2008, he presented
an additional report on the research at the 23rd
Kyoto

Kampo

Academic

Symposium,

contained more cases that referred to the ACR’s“Rheumatoid

Arthritis

Criteria”

and“EarlyDiagnosis of Rheumatoid Arthritis” prepared by thethen Ministry of Health and Welfare of Japan. I willreport on this at a later date.

Kampo medicines and Predonin (6–20 mg). In

Reference

March, the disease worsened and the patient

1) Ebe K.: Φυτο Vol.1 No.4, 4-12,1999

was admitted to a university hospital where

which

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

13

Volume 2, Number 4 | Winter 2007

Clinical Report 1 (Japan)
A Case of Acupuncture Treatment for Left Shoulder Pain
Thought to be Caused by Neuralgic Amyotrophy
Noriko Hori,1),2), Hitoshi Yamashita,3) Hiroshi Tsukayama1)
1) Tsukuba University of Technology
2) University of Tsukuba3) Morinomiya University of Medical Sciences

About Our Clinic
The Center for Integrative Medicine of the
Tsukuba University of Technology (formerly, theTsukuba College of Technology Clinic) is an
outpatient clinic for both conventional medicine andtraditional medicine that was established in April,
1992. It has 2 sections: the Conventional Medical
Clinic and the Acupuncture and Moxibustion Clinic.
In the latter section, we perform acupuncture
treatment for outpatients as well as bedsidelearning for the college students and acupunctureinterns. In the Conventional Medical Clinic, we offer
consultations in 5 specialties, Kampo medicine,orthopedics, neurology, radiology and pediatrical.
Between April 1992 and March 2005, 9665
patients (4086 men and 5579 women) visited the
Acupuncture and Moxibustion Clinic. During thisperiod, 146 acupuncturists (18 instructors and 128
interns) participated in 132359 acupuncture
sessions. The types of acupuncture differed between
acupuncturists and included electroacupuncture,
modern medical acupuncture, meridian therapy,
and moxibustion (direct or indirect). At the
Acupuncture and Moxibustion Clinic we treatedmainly musculoskeletal pain or discomfort (82.4%);
otherhealthproblems
treatedincluded
gynecologicalandobstetrical(2.5%),
otolaryngological(2.4%),
circulatory(1.1%),
respiratory (1.0%), fatigue and tiredness (1.0%),
neurological (0.9%), ophthalmological (0.9%). Thispattern of acupuncture use in our clinic may reflect
the current pattern of acupuncture use in Japan.
However, even in Japan, it is rare that a clinic of anational university corporation provides more thanhalf of its patients with acupuncture treatment.
Keywords: neuralgic amyotrophy, suprascapularnerve disorder, axillary nerve disorder, acupuncture,shoulder pain
14

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

Volume 2, Number 4 | Winter 2007

I.

Introduction

Before onset she had not sustained any external
with

injuries or fever. The only possible cause she could

limitation of motion is caused frozen shoulder,

identify was that 1 week before the onset of thesubacromial bursitis, tendinitis, calcific bursitis anddisease she had spent some time in a very coldso on. These conditions may also cause, depending

air-conditioned room.

on the contracture or affected site, muscle atrophy[Anamnesis] Nothing of particular noteor reduced muscle power. Neurological disorder is[Complications]

Generally,shoulderpain

associatedgenerally not included. Reasons for alleviation of

The patient has diabetes, but it is controlled at aordinarydifferent hospital by diet alone. She has someacupuncture treatment may include (1) natural

hypertension but has not been prescribed any

course of the disease itself, (2) changes due to otherhypotensives. At another clinic, Hachimijiogan andtreatment modalities or variations in lifestyle, (3)Kamishoyosan were prescribed for climactericnonspecificsymptoms.

symptoms

duringeffects

the

based

courseonofexpectationsorassumptions, (4) total sum of effects brought about[Family History] Mother has diabetes.

by[Patient Profile]theacupuncture

treatment,(5)

excessive

evaluation of the effects of the acupuncture

The patient is married and has 2 children. She

treatment during daily practice. Regardless ofengages in volunteer work and goes to Tai Chi andwhether the condition improves or deteriorates,

dancing practice 3 times a week.

most of the diseases for which the influence of the[Present Status]

acupuncture treatment tends to be excessively
evaluated recover spontaneously, such as the

Height: 150 cm; weight: 42 kg; blood pressure:156/96 mmHg; pulse 60 bpm.

well-known example of Bell's palsy. Here, we would

The patient was worried that the pain andlike to report a case in which we observed the entire

chilling of the shoulder might be related and thus

course in a patient treated with acupuncture forrefused to uncover the entire shoulder girdle forshoulder pain thought to be caused by neuralgic

examination.

amyotrophy and in which neural damage-induced

The range of motion (ROM) of the left shoulder

atrophy and loss of muscle power were also

joint was 135° flexion, 30° extension, and 40°

observed.
II. Case

external rotation; during a (posterior) belt-tying

Patient: 55-year old woman; first visit on August 17,

thoracic spinous process (on the right side of the 6th

1992; chief complaint: left shoulder pain

thoracic spinous process), and during a hair-tying

motion the left thumb reached the height of the 8th

motion the left thumb reached the height of the 1st[Present Illness]thoracic spinous process (on the right side of the 3rdThree days before her 1st visit to our clinic andthoracic spinous process). Restriction of the ROM

before going to bed, the patient suddenly fell pain in

was in any position due to pain; contraction was not

the lateral left shoulder. The pain during that nightobserved.

was so severe that it prevented the patient from

The patient denied feeling heat or swelling in thelying down and thus forced her to spend the night inleft shoulder. Tenderness was found at LI15 anda sitting position on a sofa. Whist the pain was

TE14 as well as in the deltoid muscle area but waspresent during both rest and movement, the mostnot very marked. Tenderness was not observed in

comfortable position was with the arm hanging

the intertubercular groove, nor over or around thedown, and the pain subsided slightly during the day.

coracoid process. Palpation revealed an increased

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

15

Volume 2, Number 4 | Winter 2007

tonus of the ascending part of the trapezius muscle.
The ROM of the neck was normal, whilst the
Spurling test (pain radiating to the entire left arm)and the Morley test (numbness radiating to the leftarm) were positive on the left side.
Biceps and triceps brachii muscle reflexes werenormal.
[Auxiliary Diagnosis]
An orthopedist of our center did not detect any
anomalies on X-ray films of the shoulder joint(Figure 1). X-ray films of the cervical vertebrae
showed degeneration of the C5/6/7 intervertebral
discs (Figures 2 and 3). However, according to theorthopedist of our center, the degree of thesechanges was unlikely to be responsible for thesensory disturbances. Furthermore, an evoked
electromyogram(EMG)

obtained

from

the

suprascapular nerve showed a prolongation of theM-wave latency for the left supraspinatus muscle.

Figure 3[Course]Table 1 shows the variations in the pathologicalcondition as well as the main symptoms andfindings.
During the first visit we assumed that thecondition originated from the cervical spine. On thebasis of the findings of pain at rest, during motion,
and at night, and of the pain induced by restriction offlexion and abduction, the lack of any feeling of heat,and the age of the patient, we assumed that the pain
was probably due to a frozen shoulder. Acupuncture
treatment consisted of needling the region of theshoulder joint to a depth of approximately 10 mm
and retaining the needles for a certain period of time.
Stainless steel 50-mm No.18 or 50-mm No.20 needles(K-type：Seirin) were used. Moreover, from August 18
to August 20 diclofenac sodium (proprietary name:Voltaren) was prescribed as additional treatment by

Figure 1

the clinic in our center, with addition of diclofenac
sodium suppositories (25 mg) on August 20, and thisprescription of diclofenac sodium and diclofenac
sodium suppositories was continued until August 27.
At the second (August 20) and third (August
24)

visits,treatment

consistedofretainingneedles and manual needling at GB 22、LI 15、TE
14 and in the axilla. The pain-induced limitationof shoulder motion immediately disappeared, but
the resting pain remained as severe as before.
However, the patient reported that when she woke up
Figure 2
16

on the morning of August 30, the pain had
disappeared and subsequently so had the night pain.
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 2, Number 4 | Winter 2007
Table 1 Changes in symptoms, findings and assumed pathology
Symptoms
First visit (92/8/17)

night pain, pain at rest,

Findings

Assumed pathology

pain during movement： flexion, external rotationso-called frozen shoulder

Spurling test, Morris test (+)

pain during movementorWBC: 3,500/mm3 CRP: (-)

cervical spondylosis

pain during movement: flexion, external rotation
2nd (8/20)

as aboveetc.

inflammation of rotator cuff

Tenderness: LI 15, TE 14orplain x-ray of the shoulder joint: within normal limits

subacromial bursitis

muscle tension: M. trapezius

shoulder stiffness

pain alleviated,
4th visit (9/1)

shoulder stiffness,heaviness of theshouldersmuscle atrophy: left subscapularis

difficulties elevating
6th visit (9/18)

left shoulder,heaviness of thesuprascapular nerve entrapment

muscle weakness: abduction, external rotation

shoulderssensory disturbance: dullness from lateral left upper arm to the region posterior
9th visit (10/9)
11th visit (11/2)
26th visit (93/4/9)

to the shoulder

as abovesuprascapular nerve lesion

plain x-ray of cervical vertebrae: disk degeneration at C5/6/7

orevoked electromyogram: decreased conduction velocity of suprascapular nerve

axillary nerve dysfunction

heaviness of themuscle atrophy: left subscapularis

possibility of neuralgic amyotrophy

shoulderssensation: no differences between left and rightas aboveshe

Because of the patient’s feeling easier after thecomplained of a persistent dull heaviness in theacupuncture treatments and because of her fear ofshoulder.

recurrences, we continued the treatment until June

As

she

continued

treatment

thereafter,

Examination of the area extending from the back

1993, performing approximately 30 treatments,

to the arm on the sixth visit (September 18)

after which slight heaviness in the shoulder still

revealed a marked atrophy of the left infraspinatus

remained.

muscle, loss of power, and difficulties in raising herarm. We suspected that this was due to an

III. Discussion

entrapment neuropathy of the suprascapular nerve,

According to an investigation by Alfen et al.1)

so we targeted our needling at the regions of theneuralgic amyotrophy can be classified as idiopathic

suprascapular notch and the supraspinatus andor hereditary, either of which types involves pain

infraspinatus muscles. Moreover, we also instructed

calledthe patient to exercise the involved muscles athome.
During the ninth visit (October 9), hypesthesia
and hypalgia in the region from the left lateral
upper arm to the posterior region of the shoulder
joint (innervation area of the axillary nerve or thefifth cervical nerve) were observed.
Later, the sensory disturbance disappeared and aNA

attacks(very

severe,relentlessneuropathic ‘NA pain’) that continues for a period ofa few days to several weeks in the early phase of theonset and is particularly frequent during thenight.1) Recurrent attacks may also occuer.1) In mostcases, the pain occurs unilaterally in the upper
extremities but bilateral occurrences have also
occasionallybeenreported.1)

Othersymptoms

recovery of muscle power was observed, but theinclude hyperesthesia and paresthesia, often seen in

feeling of dull heaviness in the shoulder continued

the trapezoid muscle and on the lateral arm.

and the atrophy was present to the same degree as

Following these symptoms, paresis and muscle

that of the sixth visit.

atrophy may develop.

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

Muscles prone

to

the

17

Volume 2, Number 4 | Winter 2007

development of these symptoms include mainly theshoulder to the lateral upper arm, as indicated byinfraspinatus, serratus anterior, supraspinatus, andthe prolonged latency in the M-wave of thethe muscles of the upper trunk and arm.1) Moreover,supraspinatus muscle. We suggested that this was aanomalous findings of EMG in many patients werecasealso observed.1) A combination of NSAIDs andprolonged and persistent to be heaviness in the

opiates has been most effective for the pain, whilst

shoulder remained after the pain had subsided inother drugs are much less effective.1) For many

the long term.

ofneuralgic

amyotrophy.

Moreover,thepatients the prognosis includes residual severe

During the early phase in this patient, the effects

neuropathic stabbing or shooting pain and persistedof needling for the shoulder pain with limitation of

musculoskeletal pain that often continues formotion were immediately reproducible after theseveral years after the NA attacks have subsided.1)

needling at the second and third visits. So we

In Japan, limitation of motion induced by pain

thought needling to be useful for the relief of thehas been treated as a variety of pathologic

pain. However, in this case the night and resting

conditions.

representative

pain suddenly disappeared between the third andclassification2) which is used in Japan for painful

fourth visits. Leading us to conclude that this effectshoulder with limitation of motion.

was unlikely to have been brought about by the

Table

2

shows

a

Table 2 Classification3) of painful shoulder joint arrest in Japan
Coracoiditis
Inflammation of biceps brachii
tendonCalcific inflammation of therotator cuff
So-called frozen shoulder

Subacromial bursitis

Inflammation of the rotator cuff

Rotator cuff tear

Impingement syndrome

acupuncture treatment. Instead, alleviation of theshoulder pain whilst not in except during motion
and recovery of muscle strength and sensation were
probably due to the natural course of the neuralgic
amyotrophy.
Since

the

early

symptomsofneuralgic

amyotrophy generally resemble diseases of theshoulder joint, it is often carelessly treated

In the case described here, a comprehensive

continuouslyasfrozenshoulder,tendinitis,

observation and detailed examination during thecalcific bursitis, and so on. Alleviation of the pain

initial phase of the treatment was not performed

during the natural course may be evaluated as the

because of the patient’s severe pain and refusal toeffect of the acupuncture treatment. In Japan, forexpose the shoulder region based on her fear ofacupuncturists cannot perform diagnostic imaging

chilling. For this reason, the pathology of theor blood tests, so pathological conditions have to

condition could not be correctly identified during thebeearly stage, so that the considerations of the

because we initially did not examine the shoulder

pathology changed again and again. However, on

and upper back in this patient, we missed many

the whole the severe pain of unknown origin andrelevantsudden onset resolved spontaneously after a few

amyotrophy

differs

days without pharmacologic intervention. The

tendinitis

andsymptoms of this case progressed to later atrophy ofacupuncture treatment for patients with shoulder

the infraspinatus muscle and reduced muscle

painshouldsuffice,butstrength for abduction and external rotation, as wellacupuncturists

shouldpromptly

as to hypesthesia extending from the posteriorpatients to a specialist.

18

identifiedbybedsidefindings.

Given
from

runs

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

findings.

thatfrozena

However,neuralgic
shoulderdifferent
whenor

course,indoubt,

refer

these

Volume 2, Number 4 | Winter 2007

IV. Summary

References

1)

1)

2)

We performed acupuncture treatment for leftshoulder pain of sudden onset.

clinical spectrum of neuralgic amyotrophy in

It is highly possible that this was a case of

246 cases. Brain 2006; 129:438-450.

neuralgic amyotrophy.
3)

Nens van Alfen，Baziel G.M. van Engelen. The

2)

In the early stage, the acupuncture treatment

Katsuya Nobuhara: Shoulder – Function andClinics, Sec. Ed., Tokyo 1987

in this patient was effective for the pain duringmotion.
4)

In this case, the acupuncture treatment seemed
to have been effective in alleviating the night
pain and resting pain and in recovering muscle
strength and sensation, but these changes weremore likely due to the natural course of theneuralgic amyotrophy.

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

19

Volume 2, Number 4 | Winter 2007

Clinical Report 2
A Patient Suffering from Rheumatism
Yoichiro Ebe
Takao Hospital, Kyoto

Patient: 28 years, female
First visit: June 29, 2007
Past history: head injury at the age of 14
Family history: nothing warranting special
mentioning
Present illness: At the end of February 2007
development of exanthema over the entire body.
By the end of April with the disappearance of theexanthema a fever (in the range of 37ºC) andarthralgia developed. The patient visited a certain
medical university hospital for consultation.
There she was told that this is not RA, but when
she went to a different clinic in June, she wasdiagnosed with RA. At that time CRP value was
12.3 mg/dl and MMP-3 1053. Chest x-ray films
were said to show no anomalies.
Current status etc.: height: 155 cm, weight: 44 kg
She has a constant low grade fever around 37.1ºC.
Chilliness (+), headache ( － ), cough (+) (sinceJune), dry mouth ( － ), easy fatigability (+),
lassitude (++), restlessness (+), depressive mood(+), insomnia (+), wakes up during the night due
to pain, night sweat (+), chilling of finger- and toetips (+) and due to a marked degree of lassitude,
generalized pain she moved awkwardly.
Pale facial complexion (forehead: bluish-yellow
hue)
Neck pain (+)
Arthralgia PIP of both hands (all), pain (+),
swelling (+), fever (－)
Bilateral shoulders pain (+), flexionand extension of both elbows (↓)
Arthralgia of both hands (+)、swelling(+)、deformities (+)
Pain of right hip joint (+)
Bilateral gonalgia (+)、swelling on
the left (+), fever (+)
Bilateral ankle pain (+), swelling (+),
fever (+)

20

Stiffness of the fingers of both hands; continues
either through morning or even the entire day.
Bowel movements twice/day (soft stools –diarrhea)
Pulse findings:

Left

Right

Thin/rapid uponThin/rapid upon
Inch palpation thin and palpation thin and
weak
weak
Thin/rapid upon
Deep and rapid,Bar
palpation thin and upon palpation thinslightly slipperyand weakDeep and rapid,
Cubit upon palpation
Weakslightly slippery
Tongue findings: slightly red tongue, white – yellow
fur, sublingual veins were engorged.
Abdominal findings

Laboratory data
CRP: 8.75
SAA: 718
RF: 5
Hh: 8.3
Diagnosis: struggle between wind and dampness,
deficiency of both qi and blood.
Prescription 1: Cinnamomi Cortex 12, Paeoniae
Radix 12, Anemarrhenae Rhizoma 9, Ephedrae
Herba 5, Atractylodis Lanceae Rhizoma 12,
Atractylodis Rhizome 12, Coicis Semen 30,
Stephaniae tetrandrae Radix 12, Gentianae
Macrophyllae Radix 10, Clematidis Radix 10,
Bombyx Batryticatus 10, Astragali Radix 30,

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

Volume 2, Number 4 | Winter 2007

Angelicae Radix 9, Zingiberis Rhizoma
Processum 6, Glycyrrhizae Radix 6, Aconiti

September 14
Healthy
Pain 100→10%,
Prescription 1: same as before
Prescription 2: same as before, for 21 days

Radix Processa 6
Prescription 2: Uzugan (one pill contains 0.1 g ofAconiti Kusnezof fii Radix powder), 21 pills,
three times a day, medication for 14 days

Table: Changes in the laboratory data
CRP

SAA

RF

07.6.13

12.3

6.29

8.75

718

5

8. 8

5.67

442

1

9.14

1.05

78.2

1

CourseJuly 13 (second visit)
Pain 100→30% reduction, cough (－), chillinessof the body (+), low grade fever (－).
Prescription 1: same as before
Prescription 2: Tsumura Bushi (Aconiti Radix
Processa) powder 3.0g, three times a day,medication for 14 days
July 27
Prescription 1: same as before, for 14 days
Prescription 2: same as before, for 14 days
August 3
Pain (↓), 100→30%, low grade fever ( － ), easy
fatigability (+)
CRP: 5.07↓ SAA: 442↓
Prescription 1: increased the amount of roasted
aconitum in the above described prescription to
9g and that of Astragali Radix to 40g,
additionally adding 10g of Psoraleae Semen.
Prescription 2: same as before, for 14 days
August 24
The patient had become so healthy, she could hardly
be recognized.
Pain 100→20%, chilling of the body (↓↓), appetite (↑),
skin moisture (±)
Prescription 1: same as before
Prescription 2: same as before, for 21 days

MMP-3

Hb

W

PLT

1053

8.0

5100

50.9

8.3

4800

43.2

8.4

4600

44.2

8.9

4800

27.1

800

Other
他医 clinic

Discussion
This patient was a case, in which a sudden
aggravation occurred a few months after the onsetof the RA. The Kampo medical diagnosis indicatedinvasion by wind cold evil, the resistance to thisinvasion by the protective qi, where the evil partial
transformed into heat creating a situation of"struggle between wind dampness". Yet, since thefundamental nature of the condition was a
deficiency of qi and blood, the basic therapeutic aim
was to dispel wind dampness, simultaneously
clearing the heat that had been generated by thepartial heat transformation of the evil, while thedeficiency of qi and blood required some
supplementation.
The author regularly prescribes for thetreatment of RA Cassia Twig Peony andAnemarrhena Decoction as base formula andbelieves, that minor modifications depending on thepathological condition allow the patient to cope with
it in most cases. This patient is one such example,
where the treatment consisted of heat clearing,
dispelling of dampness and strengthening of
unblocking the collateral vessels.
As can be seen here, after about 2 months oftreatment a remarkable improvement was observed.
This is an effect that will be difficult to obtain withextract preparations. In order to obtain short-term
effects and depending on the disease condition
somewhat larger amounts of crude drugs need to be
combined and administered.

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

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Volume 2, Number 4 | Winter 2007

Clinical Report 3
A Case of Palpitation in which Hangeshashinto had been
Effective
Keigo Nakata
Hosono Clinic

Knotted pulse or palpitations belong to thesymptoms frequently treated with Kampo medicine.

Saikokaryukotsuboreito,

saikokeishikankyoto,teikiin, keishikanzoto, shakanzoto and similarprescriptions may be named as often prescribed
formulas. Yet, in rare cases, like in the present
patient, people visit the clinic seeking relieve fromarrhythmias that have their origin apparently inthe alimentary tract. Below I will describe one suchcase.

dental indentations (+), thick white fur
Pulse diagnosis: between floating and deep, wiry,intermediate, forceful, regular
Abdominal diagnosis: thick abdominal wall, strong,elastic, there was some fullness, tenderness or
discomfort of the hypochondrium and increased
resistance and tenderness of the epigastric region.
Palms reddened and moist
Urinary findings: no anomalies
Electrocardiogram: nothing warranting special
mentioning
Prescription and course
Prescription:The

condition

wasconsidered

to

be

a

saikokaryukotsuboreito pattern and thus thisCase: age 55 years, male, employee
Chief complaint: arrhythmia, palpitation
Present illness:
Two years ago the patient noted that his pulse
was beating irregularly. This occurred particularly
often after meals or when he climbed stairs quickly,
or he noticed the occurrence of a knotted pulse
walking the streets and suddenly emerged onbrightly lit places. He consulted a local physician,
who told him based on his electrocardiogram that
there is nothing to worry, but the taking β-blockers
did not improve the condition. Later he consulted
the department of cardiovascular diseases at a
certain general hospital and underwent detailed
examination, but no anomalies were found, so he
was told there is nothing to worry and wasprescribed the same medication. He continued toconsult that hospital as an outpatient for morethan one year, but because the symptoms did not
improve sought consultation in this clinic.
Present status: height: 162 cm, weight: 64 kg,
slightly obese, blood pressure 120/70

22

Tongue diagnosis: thick tongue body, dark red,

formulaprescribed,

but

after

one

week

of

medication no changes at all were observed. Thus,
I re-assessed the pattern and switched theprescription to hangeshashinto plus Bupleuri
Radix, which then led to gradual improvements.
Discussion
Based on the observation of a wiry and forcefulpulse, a white fur on the tongue and fullness,tenderness or discomfort of the hypochondrium
during the first visit I diagnosed a lesser yangdiseasestage.

BasicallyIusesaikokaryukotsuboreito for excess patterns inpatients

withlesseryang

ofpalpitation

complaining

diseasestage
andsaikokeishikankyoto in cases of deficiency patterns.
Naturally,

in

this

case

I

diagnosedasaikokaryukotsuboreito pattern and prescribed
this formula.
In cases for which saikokaryukotsuboreito is anindication irritability and restlessness arising fromfear are observed, but this patient was calm and did
not show any signs of restlessness arising from fear.
Yet, the reddening and moistness of the palms

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

Volume 2, Number 4 | Winter 2007

suggested a state of excessive heart consumption,intervals of approximately 2 weeks and showed atwhicheach visit gradual improvements of the symptoms.

led

me

to

the

conclusionthatsaikokaryukotsuboreito would be appropriate.

Three months later the knotted pulse attacks had

Yet, contrary to my expectations, on the second

disappeared completely.

visit one week later the symptoms had not improved

Hangeshashinto is frequently use for various

at all. My master taught me: "Once you havediseases of the digestive tract and can be said to beprescribedthat

almost never used for cardiovascular diseases.

prescription without good reason" so that it would

However, while complaining of knotted pulse

probably be in order to continue with that

attacksprescription for a little while longer, but myconsidered to be triggered in this patient by

personal

noabdominal factors. Under these circumstances

improvements at all have been achieved after one

hangeshashinto too can be considered to be a very

week when treating patients with palpitations,useful prescription.

something,experiences

do

not

showed,changethat

ifcontinuing the same treatment usually will not lead

This

and

was

palpitation,

an

these

interesting

attacks

experience

were

that

to improvements. For this reason I reconsidered thenaturally brought the expression: "All five organs

prescription.

and six viscera can cause palpitation. It is not

At that time I focused on the fact that the attacks

limited to Heart.

of knotted pulse occurred after meals. The presenceof increased resistance and tenderness of theepigastric region also led me to the conclusion thatin this patient not stress or mental tension, butrather stimulation of the stomach triggered theknotted pulse attacks. Thus, I judged that unlessthe stomach is treated, the patient's knotted pulse
attacks are unlikely to be cured and therefore
prescribed hangeshashinto plus Bupleuri Radix.
Occasionally I use hangeshashinto with added

Bupleuri Radix. This is an addition based mainlyontheabdominal

pattern.

In

this

way

a

combination of hangeshashinto and shosaikoto isachieved, extending the range of indications forhangeshashinto and enhancing its effects.
One week after switching the prescription tohangeshashinto plus Bupleuri Radix decoction thepatient visited the next time and reported "Thistime I have the feeling the medicine suits me. The
palpitation attacks also have markedly improved."
This gave me the confidence to continue with thatprescription. Later the patient visited my clinic in
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

23

Volume 2, Number 4 | Winter 2007

Introduction of Japanese Acupuncture

The so far described reactions appearing on theConsidering the Therapit’s Hand (8)body surface are each related to some form of

Shuichi Katai, Ph.D., L.Ac., Professor
Dept. of Acupuncture and Moxibustion
Tsukuba University of Technology, Ibaraki, Japan

VII. Correlation between palpation target andtreatment
The reactions found during palpation represent
some form of vital response. Yet, regarding theclassificationofpathologic

conditionsthese

individual responses represent, proposals include:
there is still no unified theory. Some of the meridianandacupoint

theorywithinthescienceofacupuncture and moxibustion, the theory of alarmand back transport points, abdominal diagnosis
according to the Gosei-ha (a school of Kampo
medicine in Japan influenced by the medicine of Li
Dong yuan) or Koho-ha (a school of Kampo medicine
antagonistic to the Gosei-ha school, advocating a
return to the practical type of medicine of the Shang
Han Lun), tender points, trigger points etc. Each ofthese has their relevant theories, but a theory
summarizing palpation in general has not yet been
proposed.
Naturally, the meridian and acupoint theory
represents a theoretical systematic correlation
between the internal organs and the skin, but theactual existence of meridians and acupoints has not
yet been thoroughly substantiated anatomically andphysiologically. Clinically, the effective use of
meridians and acupoints is very important, but fromthe standpoint of a "reaction theory" empiricalevidence is desirable.
For this reason it has been considered necessary
to systematically organize the correlations between
pathological conditions and repeatable physicalfindings on the one hand and using those findings
with effective therapies on the other hand.

24

anomaly within the body and as such have beenorganized as (1) organs/viscera-meridian system, (2)Head's zones, (3) tender points, (4) viscerosomaticreflexes

and(5)

propagatedsensation

along

channels or similar phenomena.
I will try to provide some brief explanations about
these below.
(1) Organs/viscera-meridian system
Meridians are the pathways along which Qi
energy, environmental influences enter the bodyfrom the outside as well as the path between
problems arising from organs that are thenpropagated to and expressed on the body surface.
Accordingly, not only the channels and collaterals of
the body surface, but also the vessels extending
from the body surface to the organs are included in
the relevant examinations. These are associatedwith organs and viscera, or else connected to theseorgans and viscera. Therefore, the concept that "theconnection between acupoints, meridians, organs
and viscera is organized into a system allowing
comprehension of the pathological condition(s) andtheir correlation with the therapy" represents thefundamentals

of

the

organs/viscera-meridian

system. This concept has been described in thesection about environmental qi of the "Su wen"(plain questions) and can be called a fundamental
assumption

not

only

for

acupunctureandmoxibustion, but for oriental medicine in general.
The

designationoforgans/viscera-meridian

system implies that the meridians connect theorgans and viscera with the body surface, i.e., forms
a coordinated connection between the interior andexterior of the body. Katsusuke Serizawa liked touse the above expression in particular because it
can be said to express the point of view of western

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

Volume 2, Number 4 | Winter 2007

medicineandattempts

todefinescientificacupuncture and moxibustion very well. It alsobears some resemblance with the viscerosomaticreflexes concept described below.

These zones have been suggested by Kurakichi
medical facility, and are belt-like zones on the body

The Head's zones have been described by thephysician(4) Twelve Hirata style body surface zones
Hirata, who was a student at the Kyoto University(2) Head's zones
Britishacupoints.

todivided into 12 zones and zones of similar names inhyperalgesic zones apparently associated witheach region are considered to be interconnected.

diseases of internal organs. The underlying nature

Using his "Hirata psychotherapy – hot needlingof this phenomenon is defined as referred pain. The

technique" to develop therapies not relying on

theory holds, that the input of afferent fibers frommoxibustion, he also proposed the "doctor in eachinternal

infamily movement" aiming at universal healthdistributions

coverage under which the entire population would

particularorgansHenry

produces

hyperalgesia

in

Head

and

refer

surface. The head, neck, arms, trunk and legs are

hyperaesthesia,
zonal

corresponding to the innervation of the posterior
spinal roots, so that not only hyperalgesia, but also
reddening and swelling may appear. These zones
are the dermatomes. For this reason it may be said,
as detailed below, the Head has viscerosomaticreflexes.

be able to become healthier.
(5) Viscerosomatic reflexes
Viscerosomatic reflexes are reflexes mediated via
autonomic nerves and theoretically express thestatus of internal organs on the body surface (skin,muscles etc.). The pain appearing on the ulnar side(3) Tender pointsof the left arm in case of heart disease is aThis is a concept that was pointed out in the

representative example. These autonomic nervous

1920s and refers to locations on the body surface

reflexes appear within the dermatomes, and so theythat are painful when pressed. The underlying

are theoretically easy to comprehend.

nature of this phenomenon is mainly a correlation

Again, there are also autonomic nerve reflex

with internal organs in which anomalies may havemediated somatovisceral reflexes, so that the theory

arisen. Most of these points are named after theabout viscerosomatic and somatovisceral reflexes

person who discovered them, for example Boas point

may be considered, from a western medical position,or Onodera's gluteal point.

very important for explaining acupuncture and

It is unclear how the concept of these tendermoxibustion effects.

points has evolved, but they resemble the acupoints

Research into somatovisceral reflexes started inobserved in oriental medicine. However, acupoints

Japan with research into heart rate and later

form groups of points that are related to each otherreports dealing with digestive organs (stomach andvia channels, whereas for all tender points theintestines), gallbladder, kidneys, uterus and the likerelationship is completed between the point and thehave been published.

internal organ. In this regard tender points may besaid to resemble the transport and alarm points
defined within the hypothesis of meridians and(6) Propagated sensation along channels
Reports on the propagated sensation along

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

25

Volume 2, Number 4 | Winter 2007

channels have been published in China [雄渾社].
The quality of the provided images is extremely poorand there may be often signs of modifications madeafter pictures were taken, so that their contents
cannot be considered acceptable but with some ofthese pictures the idea still comes through to acertain degree.
Masao Maruyama et al. performed "research into
Hibiki (needling sensation)" in Japan prior toresearch into the propagated sensation alongchannels phenomenon performed in China. In
Japan Shoji Yoshimoto followed these lines andpresented

later

his

book

illustrated

withphotographs, but subsequent research has not been
affected by it.
There is no doubt that lines are appearing on the
body surface very closely resembling the course of
the meridians, but further investigations in the
future are necessary to determine what pathologicalconditions

they

relate

to

and

what

clinicalsignificance they have. In other words, etiologic
factors and their reflection on the body surface(reactions), as well as the correlations between
these reactions and the treatments performed in
response to their need to be systemized. Since thisline of reasoning represents the fundamental
theoretical system for the training of the hands oftherapists, it needs to be established as soon as
possible.

26

VIII.
Conclusion to this series
The reactions identified during palpation
represent some form of vital physical response. Yet,
unless it is clear to what pathological conditions the
body is reacting, this cannot be applied
therapeutically. And, in the past many different
systems of reactions have been proposed, but there
is still no unified theory.
Naturally, the theory of meridians and acupoints
represents within the system of acupuncture andmoxibustion a systematic theory of the correlation
between internal organs and body surface, but theactual existence of meridians and acupoints has not
yetbeen
substantiatedanatomicallyandphysiologically. Unless there is at least some
empirical evidence, this theory cannot be evenlightheartedly expounded based on the prevailingassumptions.
For this reason the relationship between
pathologic condition and reaction on the one hand
and reaction and therapy on the other hand should
be systematically organized and a suitable theory
established. Once this has been accomplished, theclinicaldevelopmentof
acupunctureandmoxibustion will most probably advance to the nextstage. Future studies dealing with these questions
are desirable.
This being said, at the present moment theconcepts pertaining to meridians and acupoints
offer us an enormous wealth of possibilities.
Although we should not accept the practicalconcepts without question, they definitely serve as avaluable reference and may well be used to achieve
reproducible clinical results.

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

Volume 2, Number 4 | Winter 2007

Medical History in Japan
Todo Yoshimasu and his Medicine (2)CASE 2: Dysphasia

Hiromichi Yasui
Japan Institute of TCM Research

In the last issue, I introduced the biography
and the medical theory of Todo Yoshimasu whoradically changed Japanese Kampo medicine.
His theory replaced the pathophysiological parts
needing elucidation — which is the mostimportant aspect of TCM — with a black box
that quickly spread across the country and hassince become the tradition of Japanese Kampo
medicine. In this issue, I will introduce how headministered treatment using case reports fromhis book, “Kenjyuroku” (1763).

An old man, aged over 90, never believed in
medicine, thinking that it was useless. But hecame to admire our master's medicine recently,
saying to his family members that when he got
ill, the only doctor who could be relied on was
Yoshimasu. A few years later, he began sufferingfrom exogenous febrile disease. He began to feelmalaise and heat in his chest, and to talk indelirium. There was no urination, he lost his
appetite for 6 days. His family members asked
toexamine

him.

There

were

stuffiness in the chest, and his limbs were a little
swollen. Yoshimasu made bukuryoin to give him.
After vomiting much water, the patient was
cured.
Since he was 60, he used to wear thick clothes
even in summer time. Nevertheless he felt chilly.
He thought it was necessary to wear thickclothes because of his age. But after thattreatment, the old man was able to wear thinclothes an when he was younger. So the case was
not due to senility, but disease.

was suffering from dysphagia for 2 years. Every 5
or 10 days, it occurred. He came to feel turgor in
his chest and abdomen and his physical condition
was getting worse. No doctor could cure him.
Hearing of Yoshimasu 's reputation, he decided toask his treatment, saying: life and death aredecided by destiny. If I have to die, I would like todieby

Yoshimasu's

treatment.

Yoshimasu

provided daihangeto, which made him vomit.
Everytime he vomited, there was sputum. After 8
or 9 days, the medicine began to work, letting thebowels loose, and his vomiting stopped. Within 2months, he was cured completely.
CASE 3: Hematemesis

CASE 1: Cold Injury (Shang han)Yoshimasu

A servant to the lord of a clan, 20 years old,A merchant of Karasuma in Kyoto, Ihei
lzumiya was suffering from hematemesis for 20
years Almost every 10 days, he vomited blood. In
autumn of one year he was very sick and almost
unable to breathe. No doctor could do anything to
cure

him.

Familymembers,

crying,were

preparing his funeral. Yoshimasu happened tocome and examine him. The patient was not deadyet, for when our master put a thread in front of
his nose, the thread moved, although themerchant was motionless. When Yoshimasu
touched his abdomen, it moved a little. judging
that Qi was not dead yet, he made san’oshashinto
in haste. Then, after taking the medicine, thepatient began to have loose his bowels and after
10 times, then stopped. Within 20 days, he wascompletely cured. Since then, almost 10 years
passed, and there was no recurrence.
CASE 4: Tuberculosis
A daughter of a merchant, Denbei Masuya of
Kawara-machi in Kyoto got ill, and all the doctors
diagnosed her symptoms as tuberculosis. No

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

27

Volume 2, Number 4 | Winter 2007

treatment worked. She got thinner day by day,

CASE 6: Pain of the heel

and almost died. From the beginning, theA medical student, aged about 20, suffered

merchant was afraid of the treatment of Koho

from pain of the heel. The pain was like being(ancient prescription in “Shang han lun”). He

pierced by an awl or the blade of a sword,

could not bring himself to Yoshimasu to examine

unbearable to the touch. Many doctors tried but

her. Yoshimasu, learning that the merchant did

could not cure him. A surgeon thought that there

not believe in Yoshimasu's intention, just left

was pus, so he cut out that part. But that was notthem alone. A few months later, this girl died.
Two years later, a sister of the girl got ill. The
merchant said: “I have 5 children, and 4 among
them have died due to tuberculosis. In the year
when they turned 17 years old, in spring, they
got ill, and in August, they died. Now the
youngest girl is 17 years old, and infected withtuberculosis. Although I know the efficacy ofKoho, I am afraid that very-strong laxative
medicines

are

used.

But

prescriptionofslow-acting and reinforcement could not work forthis disease, as far as I remember. So please cureher disease. If she would die, I will not regret it.”
Our master examined her. For enervation,
dullness in limbs, alternate spells of fever andchills, and cough, he made shoseiryuto andkontangan, which he used in mixed form. Before
August, she was cured completely.
CASE 5: Edema

effective. Yoshimasu was called to see him.
There was a contracture of the abdominal wall.
There was no softness felt by his hand on
abdominal

palpitation.

He

made

shakuyakukanzoto to give him. With one dosage,
the pains disappeared.
CASE 7 : Soliloquy
An ambitious, poor student studied very hard
and read a lot of books without sleeping for 7 days.
He started to talk to himself in delirium, laughing,rebuking his master. Everybody thought that hehad become insane. Yoshimasu examined him.
There was swelling in the sternocostal, a fast
throbbing of heart and ki went up and could notcome down. He made saikokeishikankyoto to givethis patient, sometimes attacking poison by shien.
Within a few days, the student was completely
cured.
CASE 8 : Eruption on the head

A chief Buddhist monk of the Kosai-Temple in

A merchant in Kyoto, Kichigoro Yamatoya,

Bungo suffered from swelling of his body. He

every spring had a fever in his head and face. On

could not urinate. Stuffiness in his chest made it

his head, he had a sore, which was very itchy. If

almost unable to breathe. His feet became very

he scratched it, it became infected. When autumn

weak. For him, a doctor made eppikajutsubuto

came, the symptoms disappeared, without any

which did not work at all. Yoshimasu examinedtreatment. He wanted to be completely cured

him. As there was unconsolidation in the lower

though. Yoshimasu examined him. There wasabdomen, for which to correspond, he madeslight palpitation, fullness in the chest andhachimijiogan. With one dos-age, the stuffinesshypochondrium, and an abnormal rising of Qi. To

in his chest disappeared. With a second dosage,correspondhe was able to urinate. With less than ten

saikokeishikankyoto and kyuosan . In a month,dosages, he was cured completely

all symptoms disappeared. Since then, there was

to

the

he

prepared

６)

no recurrence.
28

symptoms

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

Volume 2, Number 4 | Winter 2007

CASE 9 : Dumbness and convulsive fit

adorns the first page of “Kenjuroku”, I will add

A soldier of the Yamashiro-yodo clan, named

some explanation from the standing of Modern

Heizaemon Yamashita met Yoshimasu, andTCM. The 5-year-old patient mentioned in thesaid. “I have a 5 year old boy. He cannot speak,book must now be considered to be about 3 years

and he has convulsive fits once or twice a day.

old when various factors relevant at that time are

His body has become very thin, he seems to betaken into account. From the modern medical

very exhausted, and close to death. His agony

point

seems to increase day by day. As his parents,

developmental disorder, although the cause is not

we cannot bear to see him in pain. We would bevery much obliged if you could treat him. If
fortune favors us, and if we will be able to see
him well again, even if it will be only once, wewill never regret it. ”Accepting their wish,
Yoshimasu examined the boy. He recognized an
abdominal symptom of stuffiness in the gastricregion, which was soft when he palpated it. He
made daio’orenshashinto , which he provided
for 100 days. The stuffiness in the gastricregion disappeared, and convu1sive fits also
stopped. Nevertheless, there was still swellingin the sternocostal, fullness is the upper
abdomen, and dumbness. He made shosaikoto,and together with san’ogan, he continued histreatment. Sometimes he provided deikankyogan
to treat those symptoms. In this way, about 6
months passed. One day, his nurse was leaning

of

view,

the

diagnosis

might

be

a

known.
Todo,

however,administereddaio’orenshashinto, targeting a “distressed andsoft epigastrium.” Epigastric distress abated inabout 100 days and rib-side distension, andhypochondrium fullness,” with occasional useof daikankyogan, which achieved the desired
effect.
From the present traditional medical pointof view, what Todo tried to clear out of the bodywas primarily “retained phlegm” accumulated
in the chest, diaphragm, and epigastrium, andsecondarily, retained qi in the epigastrium.
There is no way to tell from the foregoing if he
was

aware

of

pathologicalproducts

andpathological phenomena, and if he thought
they were toxins or a kind of toxin as heasserted. It is conceivable that, depending onthepathologicalcondition,

targeted

andagainst the entrance gate with this child in her

accurate administration of the four foumulaearms. Someone passed in front of them, leading(daioorenshashinto , shosaikoto, san’ogan, anda horse. Suddenly the child uttered “uma.”

daikankyogan)

Being overjoyed to know this, his parents took

non-physical afflictions and improved the flow

the child with them to Yoshimasu to tell himof qi and body fluids.

dispelled

physicalandthis. And when Yoshimasu showed a piece ofThis is a brief study of Yoshimasu's methods ofsweets to the child, he said “uma” again. (Intreatment, citing from his book Kenju-roku. We canJapanese, “uma” means “a horse” and “sweet

see that his methods of treatment were based on his

taste.” It is a homonym.) The parents were very

own medical theory, and at the same time he was a

glad. So he continued with the prescriptions

very efficient clinical doctor with keen insight.

mentioned above. Within a few months, theboy's language ability became normal.
Since the last case is interesting, one thatAnyway, what he said and what he did put the
medical world of that time into great turmoil.

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

29

Volume 2, Number 4 | Winter 2007

Maintaining his motto of relating symptoms to
medication, he denied all theories of traditional
medicine. He insisted upon the administration oftreatments to expel poison, sometimes using very
intense laxatives and mercurial medicine. It willcontinue to be one of our important themes toknow how to grasp the meaning of Yoshimasu,
and how to make the most of his ideas andmethods of treatment in current medicine.

Prescription (Japanese, Chinese Character, Pinyin)bukuryoin 茯苓飲 Fulingyin
daihangeto 大半夏湯 Dabanshatang
san’oshashinto 三黄瀉心湯 Sanhuangxiexintang
shoseiryuto 小青竜湯 xiaoqinglongtan
kontangan 滖痰丸
eppikajutsubuto 越婢加朮附湯hachimijiogan 八味地黄丸 Baweidihuanwan
shakuyakukanzoto 芍薬甘草湯 Shaoyaoganzaotang
saikokeishikankyoto 柴胡桂枝乾姜湯 Chaihuguizhiganjiantang
shien 紫円
kyuosan 芎黄散
daio’orenshashinto 大黄黄連瀉心湯 Dahuanhuanglienxiexintang
daio’orento 大黄黄連湯 Dahuanghuanglientang
shosaikoto 小柴胡湯 Xiaochaihutang
san’ogan 三黄丸 Sanhuantang
daikankyogan 大陥胸丸 Daxianxiongwan

30

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

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Volume 1, Number 3 | Fall 2006

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