Volume 11, Number 2 | Summer 2016

Clinical Report 2 (Kampo Medicine)
Clinical Experiences and Practices of hainosankyuto for
Suppurative Diseases
Takahito Saito1,2, Yoshihiro Furuta2,
Noriaki Ito2, Kazuyoshi Higuchi2, Norimi Fujita
Hiroyuki Akane2, Mitsuiro Kishida3, Atsushi
Nishihara4 and Hiromici Yasui2
1) Department of Internal medicine, Tomidahama Hospital2) Yokkaichi Medical Association, Oriental medicine study
group3) Department of Pharmacy, Tomidahama Hospital4) Department of Orthopedics, Tomidahama Hospitalthathainosankyuto

may

be

beneficial

wererecognized.
Key words: hainosankyuto, suppurative diseases,
antibiotics
Introduction
Hainosankyuto is mixed traditional Japanese
medicine that Todo Yoshimasu devised in Edo period
on Japanese history. According to source book, thatis,

“Kinkiyoryaku”(1), hainosan(mixture of

Kijitsu, Kikyo and Shakuyaku) using at mature

Abstract
Aim: Hainosankyuto is called as an “antibiotics of
traditional Japanese medicine”, but in current
status on development of western antibiotics, its
effect is limited. In this report, clinical experiences
and practices of hainosankyuto for suppurative
diseases in our hospital were reviewed.

stage of inflammation and hainoto (mixture of Kanzo,
Kikyo, Shokyo and Taiso)using at early or post-

drainage end stage of inflammation, were mixed fortreating suppurative diseases during all over thestage of inflammation.
In views of current status on development ofwestern antibiotics, its effect is limited and poorer

Methods: Thirty three patients including sixteen

than that of western antibiotics. Its drug adaptation

men and seventeen women were treated byof the attached documents in Japan are painful

hainosankyuto between July 2012 and August 2014.
These cases were retrospectively researched in viewsof clinical backgrounds, western medical diagnosis,
treatment period, concomitant drugs and clinicaloutcomes.

lesions such suppurative diseases as carbuncle,
furuncle, facial furuncle and other furunclosis with
their reddish and swollen conditions from earlystage to post-drainage end stage.
In this present report, clinical experiences andResults: Most of diseases are cellulitis of extremity,

practices of hainosankyuto for suppurative diseases

colonic diverticulitis, and herpes zoster-induced skinin our hospital were reviewed.

erosion. Mean treatment period was about 30 days.
About

90%

patients

were

also

treatedwith

Patients and Methods

antibiotics, anti-viral drug or anti-fungal drug. In

Thirty three patients including 16 men and 17

clinical outcomes, about 90% were healing or nimble,

women (mean age 75 y.o., 41～93 y.o.) were treated

but remaining about 10% were immutable orby hainosankyuto (Tsumura & Co., Tokyo, 7.5g/day,worsening.

or Kotaro & Co., Tokyo, 7.5g/day) in our hospital

Conclusion: As a target for “penetrating with thebetween July 2012 and August 2014.

open”,

These cases were retrospectively researched inhainosankyuto may be more effective, but not usefulviews of clinical backgrounds, western medical

to cases of poor general conditions and intractablediagnosis,

situations. Several kinds of suppurative diseases

concomitant drugs and clinical outcomes by three-outside-world,

that

is

superficial

andtreatment

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

period,precedingor

15

Volume 11, Number 2 | Summer 2016

step evaluation (healing, nimble and immutable orFig. 2: Case 1 Clinical course of pretibial cellulitis

worsening).

a. On the anterior side of right lower leg,reddishness and swelling with partially skin

Results
Most diseases of western medical diagnosis arecellulitis of extremity, colonic diverticulitis, herpes
zoster-induced skin erosion (Fig. 1). Mean treatment
period was about 30 days (median 14 days, range 3～
180 days).

peeling were observed.
b.

Reddishness

andswelling

werealmostdisappeared leaving the pigmentation
Remarkable adverse effects were not detected.
They belonged to either “Kyo-sho” meaning subjects
who have weak constitutions and low vital energy or

Fig. 1：Hainosankyuto and its
origin“Jitsu-sho” meaning subjects who have strong
constitutions and high vital energy. “Sho” means
universal proof in Oriental medical sense.
Table 3 demonstrated all 33 cases in detail. In
addition,

hainotohainosanhainotomoremeaningful

three

cases

were

presented for clinical significance as following.

Combinationhainosankyuto
Time course of inflammation

Fig. 1: Hainosankyuto and its origin
12.1% of patients were only treated byhainosankyuto. 87.9% of patients precedingly or
simultaneously treated with antibiotics, anti-viral drugor anti-fungal drug. Honestly, 66.6% of patientssimultaneously treated with antibiotics, anti-viral drugor anti-fungal drug.
In clinical outcomes, 84.4% of patients were healingor nimble, but remaining 15.2% were immutable orworsening because of translocation physician, operation
or basic illness-related death (Fig. 2).

Fig. 2：Right pretibial cellulitisaTable 3Age

Sex

Western medical diagnosis

Treatment periods

Clinical outcome

Preceding drug

Concomitant drug

Sh

1

63

Male

Cellulitis of extremity

10

Cure

-

Cefcapene Pivoxil Hydrochloride Hydrate

Jit

2

41

Male

Colonic diverticulitis

7

Cure

-

Levofloxacin Hydrate

Jit

3

71

FemaleSubcutaneous abscess

3

Immutable

Cefazolin Sodium

Jit

4

47

Male

Colonic diverticulitis

7

Cure

-

Levofloxacin Hydrate

Jit

5

88

FemalePharyngitis

49

Cure

Piperacillin Sodium

Ceftriaxone Sodium Hydrate

693FemaleCellulitis of extremity

20

Cure

Levofloxacin Hydrate

-

Ky

7

74

Male

Cellulitis of extremity

7

Cure

-

Cefcapene Pivoxil Hydrochloride Hydrate

Jit

8

87

FemaleInfectious pancreatic cyst

12

Cure

-

Levofloxacin Hydrate

Chu

-

Ky

9

83

Male

Pressure ulcer

180

NimbleCefazolin Sodium

Vancomycin Hydrochloride

実

10

92

Male

Cellulitis of extremity

35

Worsening

Cefcapene Pivoxil Hydrochloride Hydrate

-

Ky

11

82

Male

Cellulitis of extremity

7

Cure

-

Cefcapene Pivoxil Hydrochloride Hydrate

Ky

12

77

FemaleHerpes-zoster induced skin erosion

11

Cure

Valaciclovir Hydrochloride

-

Jit

13

52

FemaleCellulitis of extremity

3

Cure

-

Fosfomycin Sodium

Jit

14

79

Male

Periodontal abscess

14

Cure

-

Cefcapene Pivoxil Hydrochloride Hydrate

Ky

15

80

Male

Herpes-zoster induced skin erosion

4

Cure

Valaciclovir Hydrochloride

-

16

85

FemaleCellulitis of extremity

14

Cure

-

Ceftriaxone Sodium Hydrate

Ky

17

72

FemaleCellulitis of extremity

140

Nimble

-

-

Cu

18

82

Male

Cellulitis of extremity

7

Cure

Levofloxacin Hydrate

-

19

81

FemalePressure ulcer

180

Cure

Pazufloxacin Mesilate

Vancomycin Hydrochloride

Ky

20

77

FemaleLiver Abscess

14

Cure

Meropenem Hydrate

Meropenem Hydrate

Chu

21

52

Male

Colonic diverticulitis

21

Cure

Levofloxacin Hydrate

-

Jit

22

75

Male

Cellulitis of extremity

28

Immutable

Cefcapene Pivoxil Hydrochloride Hydrate

Minocycline Hydrochloride

Jit

23

88

FemaleSkin erosion after hematoma

3

Immutable

-

-

Ky

24

51

Male

Colonic diverticulitis

14

Cure

-

Levofloxacin Hydrate

Jit

24

92

FemaleHerpes-zoster induced skin erosion

27

Cure

Valaciclovir Hydrochloride

Cefcapene Pivoxil Hydrochloride Hydrate

Ky

26

56

FemaleAlveolar pyorrhea

63

Nimble

-

-

Chu

27

80

FemaleCellulitis of extremity21

NimbleLevofloxacin Hydrate

Cefcapene Pivoxil Hydrochloride Hydrate

Jit

28

86

FemalePressure ulcer

7

Immutable

-

-

Ky

29

83

Male

Cellulitis of extremity

7

Cure

Levofloxacin Hydrate

Cefcapene Pivoxil Hydrochloride Hydrate

Jit

30

50

Male

Colonic diverticulitis

7

Cure

-

Levofloxacin Hydrate

Jit

31

82

FemaleCandida flow and Urinary infection

25

Cure

-

32

88

FemaleHerpes-zoster induced skin erosion

14

Cure

Levofloxacin Hydrate

-

Ky

33

80

Male

Infectious atheroma

14

Nimble-Cefcapene Pivoxil Hydrochloride Hydrate

Chu

Fluconazole

Ky

Ky

Ky

Table 3 List of all 33 cases
Case 1 (No.17): 72-year-old woman (Fig. 2)
She was medicated for rheumatoid arthritis. On
June in 201X, she was diagnosed as cellulitis of rightb

lower extremity (right pretibial cellulitis) and was
taken therapy by Dermatologist. Although only
ointment made her not enough to be recovery,hainosankyuto (Tsumura & Co., Tokyo, 7.5g/day)
was started. 140 days later, reddish and swollen
lesions were recovered with leaving only theJun. in 201X
16

Nov. in 201X

pigmentation.

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

Volume 11, Number 2 | Summer 2016

Oriental

medicalfindings:“Chukan-sho”

Fig. 3: Case 2 Clinical course of left heel pressure ulcer(meaning subjects between “Kyo-sho” and “Jitsu-

c. Skin ulcer with purulent change.

sho”, previously described). Pulse finding

d and e. Skin ulcer were shrinkened withwasslightly precipitation. Tongue finding was pink.

approaching epithelialization.

Abdominal finding was moderate.

f. Epithelialization and almost scarring.

Case 2 (No.19): 81 year-old woman (Fig. 3)

Case 3 (No.9): 84-year-old man (Fig. 4)

She was medicated for Hypertension. Years ago,

He was medicated for Hypertension, diabetes andshe was pointed out collagen disease, but had taken

chronic renal failure. On October in 201Z, he wasno therapy. On January in 201Y, she was admitted

taken operation for bone fracture of left femor. Next

to our hospital because of bone fracture of left femor.

month, he was transferred to our hospital for

On admission, pressure ulcer on her left heel was

rehabilitation. At the same time, sacral pressure

detected. Next month, operation was done. One week

ulcer was detected. On February in next year,

later, good clinical course made her remaining

cutaneous flap was constructed. But, MRSA-induced

stitches take off, but serum C-reactive protein (CRP)flap

did not normalized.

unfortunately. Then, other therapies of continuous

After then, culture of pressure

necrosis(woundinfection)

occurredresistantpus aspiration and plastic sheet therapy (so-called,

Staphylococcus aureus (MRSA). Blood culture at

Japanese original technique, Wrap therapy), werehigh fever state also revealed MRSA sepsis. A

started. But, blood culture at high fever statesensitive antibiotic, vancomycin, was used forrevealed MRSA induced bacteremia. A sensitive

therapy. At the same periods, hainosankyuto

antibiotic, vancomycin, was used for therapy. At the(Tsumura & Co., 7.5g/day) was started. 90 days later,same periods, hainosankyuto (Kotaro & Co., Tokyo,

her pressure ulcer was almost healing, and 180 days

7.5g/day) was started. 180 days later, his sacrallater, was almost cured.

pressure ulcer was closed and almost cured.

ulcer

portionrevealed

Methicillin

Oriental medical findings: “Kyo-sho”. Pulse

Oriental medical findings: “Jitsu-sho”. Pulse

finding was precipitation. Tongue finding was

finding was slightly floating. Tongue finding wascrimson. Abdominal finding was mild.

pink. Abdominal finding was moderate.

Fig. 3：Left heel pressure ulcerdceFeb. in 201Y

Mar. 1st in 201Y

f

Fig. 4：Sacral pressure ulcerghOn admission, Nov. in 201Z

i

Mar. in 201Z+1Mar. 15th in 201Yj

May in 201Z+1

Feb. in 201Z+1kAug. in 201Z+1

Apr. in 201Y
Fig. 4: Case 3 Clinical course of sacral pressure ulcer

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

17

Volume 11, Number 2 | Summer 2016g. Pressure ulcer on right buttock.

periodontal abscess, alveolar pyorrhea、candida flow,h. After skin flap procedure.

urinary infection, infectious pancreatic cyst and liveri. Opened state after flap infection

abscess, adapted diseases were trying to become

j. Skin wound was shrinkened and progressing towider. Subsequently, clinical outcome were good.

epithelialization.
k. Skin wound was completely closed and scarring.

Althoughmostantibiotics

or

of

them

anti-viralsimultaneously
drug,

pure

took

effectofhainosankyuto did not be evaluated.
By the way, though the meaningful 3 cases (Case

Discussion
Hainosankyuto is mixed traditional Japanese

1, 2 and 3) had unfortunately inconvenient past

medicine. According to source book, “Kinkiyouryaku”

history and basic illness such as collagen diseases,(1), hainosan and hainoto were mixed. It has a lot of

diabetes and chronic renal failure, significance of its

quality

long-term use is deeply valiable.

indicating“qing

heat-detoxification”,“expectoration-drainage”, “pain-kill” and “stomach

There are many clinical reports as to usefulnesscalm”. Its clinical target is wide for treatingof hainosankyuto. In

suppurative diseases during all over the stage of

perianal abscess is well-known to its effectiveness on

inflammation.

fordecreasing operation(3,4). In area of dermatology,

absorption at early condition under not so highly

there are a few effective reports to palmoplantar

uplifting from skin surface. On the other hand,pustulosis(6,7,8,9）. In area of ophthalmology, there

hainosan was used for drainage at stonely swollen

is an effective report to hordelum, which is sole paper

condition under uplifting hemispherically. It waswith randomized controlled trial that Japaneseoriginated from “Kinkiyoryaku”(1), and was effective

Eastern Medical Society

for suppurative diseases such as carbuncle andEvidence report 2013”. In area of gynecology, there

furuncle. “Kinkiyoryaku”(1) also showed only “Ho”

is an effective report to pyometra(11). In reference tomeaning drug orientation , but not “Sho”. In source

this report, it was used for candida flow and urinary

book of Todo Yoshimasu, “Ruijyuho”(2), it has

infection and resulted in good clinical course.

Namely,hainotowasusedarea of pediatric surgery,certified as ”Kampo

virtuosity in senses of combining “Kikyo” having

In basic research about periodontal diseases,

drainage effect with “Kijitsu” having exclusive effectanti-inflammmatory reaction of hainosankyuto wasof inflammatory mass.

researched in vitro model, indicating that it

In community medicine including our hospital, aincreased amount of interleukin-6 and interleukin-8

lot of suppurative diseases are found if clinicians areby stimulating lipopolysaccharide(12). In reference

consciously careful for them. As hainosankyuto is

to this paper, it was used for two cases trying towell-known to be effective against sinusitis, otitis

therapy

media, mastitis, carbuncle and furuncle, a target for

pyorrhea. In mouse model(13), while Group A-beta“penetrating

streptococcus was infected to

with

the

outside-world,

that

is,

for

periodontal

abscessandalveolarmice, promoting

superficial and open” may be more effective during

interferon-γ

andinterleukin-12

all over the stage of inflammation. But it was not

macrophage

phagocytosis.

useful to the cases of poor general conditions andapproach except using antibiotics may be promising.

intractable ones implicating “kyo-sho”.

It is well-known that Streptococci are inducible to

This

by

enhanced
remarkable

In our clinical experiences and practices, not only

bacterial cellulitis, so cellulitis of extremity was

to many diseases based on classic Bible, but also toentered in our clinical experiences with promisingcolonic diverticulitis, herpes zoster-induced skinstrategy in purpose.

erosion,18

pressure

ulcer(namely

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

Volume 11, Number 2 | Summer 2016

In addition, viral infection such as mumps
virus(14), common wart(14), hand-foot and mouth

long-term prescription were recognized, and wider
indication of it has to be researched further.

disease(15), subacute thyroiditis(16) and others were
sporadically reported indicating hainosankyuto may

References

have a role on interferon induction.

1.

Kinkiyoryaku, ancient classic Chinese book

2.

Todo

According to Nojima’s report(17) about analysis

Ruijuho,ancientclassic

Japanese bookof 68 cases of sacral pressure ulcer, the treatment
period was average 6.2 months. As the cases of them

Yoshimasu,

3.

Kawahara H, Nakai H, Yoneda A, Kubota A.

received an additional therapy after surgery, as theManagement

treatment period was longer. Compared bacteria

hainosankyuto in neonates and young infants.

positive group in culture of pressure ulcer withPediatr Int. 53:892-6, 2011

bacteria negative group, the latter had better clinical

4.

ofperianal

abscess

with

Hanada M, Furuya T, Sugito K, Ohashi K, Ikeda

course. In Case 3 suffered from sacral pressure ulcer,

T, Koshinaga T, Kawashima H, Inoue M, Hosoda

four months later since admission, cutaneous flap

T, Goto H. Evaluation of the efficacy of incision

was performed. After then, more 4 months later,and drainage versus hainosankyuto treatment for

MRSA-infected flap necrosis was detected. Under

perianal abscess in infants: a multicenter study.

suchSurg Today. 2014 Oct 22. 2.

condition,hainosankyuto

after

surgery

considered that intractable sacral pressure ulcer was

5.

Higaki S: Shosekinohosho ni taisuru kampoyaku
no chiryokoka (The therapeutic effect of Kampo

almost cured as significance of combined therapy.
Ishino’s reference(18) highlighted differential

medicine for Palmoplantar Pustulosis. written in

diagnosis from another medication on usage ofJapanese) The Journal of Traditional Sino-

hainosankyuto as following. Senkinnaitakusan isJapanese Medicine (suppl) 12: 264-266, 1991

suitable to the delicate and easily tired person (“kyo-6.

KusakaT:

Chiryoni

nanjyushita

diseases.

Shosekinohosho ni hainosankyuto ga sokoshita 1

Jyumihaidokuto is suitable to the nervous personrei (A case of intractable Palmoplantar Pustulosis

with epigastric discomfort for changing constitutions.

that hainosankyuto treatment was effective.

Hakushusan is mainly fit to be transiently used at

written in Japanese) Science of Kampo Medicine

early

27: 73, 2003

sho”)

with

chronic

pulurent

phase,

Keibohaidokusan

is

but

chronic

notpreferable

acute
to

the

phase.
local

7.

Izumiyama T, Sato K, Kudo N, Yokoyama Y, Tosa

reddishness and swelling together with headache

N: Shosekinohosho ni taisuru kampo chiryo ni

repeatedly. Keigairengyoto is suitable to the person

tsuite (The therapeutic effect of Kampo medicine

whose skin is swarthy with distension of rectus

for Palmoplantar Pustulosis. written in Japanese)abdominis muscle to make better constitution in

Science of Kampo Medicine 26: 137, 2002
8.

middle-aged periods.

Atsuumi T, Rikimaru Y, Suzuki J: A case of
Palmoplantar Pustulosis Successfully Treatedcombined

Conclusion

Hainosankyuto

andMaobushisaishinto. Kampo Med 59: 73-76，2008

As a target for “penetrating with the outsideworld, that is, superficial and open”, hainosankyuto

Formulation

9.

Takama N, Fujiwara T: Naibakuryushu ni taisuru

may be more effective, but not useful to the cases ofhainosankyuto

poor general conditions and intractable ones. In

Hainosankyuto to hordelum. written in Japanese)

community medicine, some suppurative diseases

Japanese Review of Clinical Ophthalmology 100:that hainosankyuto may be beneficial including

9-11, 2006

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

(Efficacyof19Volume 11, Number 2 | Summer 2016

10. Iwabuchi S: Shikyuryunosho no hainosankyuto
niyoruchiken.

Clinical

experienceofhainosankyuto to pyometra. written in Japanese)
Kampo Med 45: 601−607, 1995
11. Nomura N, Matsuda M: Hainosankyuto ga chokoshita munpusu no ichirei (A case of mumps viral
infection effective to hainosankyuto. written in
Japanese) Kampo Med 59 (suppl): 193, 2008
12. Matsuda M: Hainosankyuto no uirusu sei shikkan
he no oyo: Jinjyoseiyuzei, Te-ashi-kuchi byo(Application to viral infection by hainosankyuto:
common wart, hand-foot and mouth disease.
written in Japanese) Kampo Med 59(suppl): 193,
2008
13. TannoY:

Uirusuhainosankyutonokansensho
kokorominitaisuru(Experimental

attempt to viral infection of hainosankyuto.
written in Japanese) Kampo Practice Journal 5:135, 2014
14. Wang P, Masuno K, Sakai D, Okazaki J: Effect ofhainosankyuto on inflammation in periodontal
disease model. Pain and Kampo Medicine 24:
161-164, 2014
15. Minami M, Ichikawa M, Hata N, Hasegawa T:
Protective effect of hainosankyuto, a traditional
Japanese medicine, on Streptococcus pyogenes
infection in murine model. PLoS ONE. 6:e22188,
2011
16. Nojima K: The surgical treatment of sacral
pressure ulcers - analysis of 92 cases - Tokyo
Jikeikai Medical Journal 119: 441-53, 2004
17. Ishino

S:

Jyuyo

hainosankyuto,

Shoho

Kaisetsu

tokikenchuto(103)(Important

medication reference (103). written in Japanese)
Kampo Igaku Koza 49: 54-60, 1990

20

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