Volume 2, Number 1 | Spring 2007

Clinical Report 3 (Japan)

She was introduced to our clinic by an

A Case of Migraine in which Goshuyuto
was effective
Makoto Arai
Department of Oriental Medicine
Tokai University School of Medicine

acquaintance of hers who had been cured ofheadache using Kampo medicine and visited ourKampo ambulance first in January 2007.
[Present status] Height: 159 cm, weight: 65 kg,[Case]

42 years, female, housewife[Chief complaint]

headache associated withblood pressure: 120/78 mmHg, pulse: 68 bpm,regular. The tongue had no coating and showed

nausea, stiffness of neck and shoulders

slight dental impressions (caused by edema of the[Past history]

tongue, so that impressions of the teeth remain on

at the age of 22 whiplash injury

caused by traffic accident

its margin; in Kampo medicine considered to be a

[Family history]

sign of water toxin) were observed. The pulse was

no appreciable disease[Present illness]

deep and weak. The abdomen showed a mild

The patient has been experiencing shoulder

degree of increased resistance and tenderness ofstiffness since her elementary school days, but

thesince the whiplash injury she sustained 20 years

resistance upon palpation of the epigastric region)

earlier during a traffic accident, her neck also

and right-sided fullness, tenderness or discomfort

became stiff and painful. Moreover, about 10 years
ago, headaches limited to the left parietal sidedeveloped, whereupon she was diagnosed withmigraine. The headache had a pulsating characterand developed every morning upon getting up,
being restricted to the left parietal side and theattacks were preceded by an increasing feeling ofheaviness of both shoulders, followed by pain
behind the eyeballs, slight yawning, which wasthen followed by a severe headache feeling as if
her head might split. During these headache
attacks she took a therapeutic agent for migraine(Zomic®) and went to bed, but a slight delay in thetiming of the drug intake resulted in theoccurrence of epigastric discomfort and nausea,
which in severe cases subsequently led to actual
vomiting.
Moreover, the patient

since her youth wasexcessively sensitive to cold and recently started
to feel cold even immediately after a hot bath. Her
sensitivity to cold had grown so much worse that
her abdomen cooled shortly after such a bath andled to diarrhea.
24

epigastricregion(acertaindegreeofof the hypochondrium (a condition of strong
tensionalong

thehypochondrium),andfurthermore tenderness of the left lower abdomen(an abdominal finding indicative of blood stasis).
There was markedly increased muscle tonus
extending from both shoulders to the neck. Therewas edema of both legs which felt cold on touch.
Neurologic anomalies were not observed.
[Course] Targeting headache attacks associatedwith vomiting goshuyuto (Tsumura & Co., Ltd.,Tokyo, Japan, 7.5 g, before every meal) wasadministered.
Three days after the patients started taking

goshuyuto the headache

decreased to half of its

intensity and nausea had been alleviated. The
analgesic (migraine therapeutic agent) the patient
had been using daily became almost unnecessary
and during 1.5 months following treatment begin
she had used only 1 tablet. Since this prescription
has caused such a dramatic improvement, thedose was later reduced, prescribing 5.0 g/day for

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

Volume 2, Number 1 | Spring 2007

anothermonthandthemedication

thenstart of the treatment.

Goshuyuto was originally mentioned in thediscontinued.

section on the "terminal stage of the three yin
diseases" in the "Shang Han Lun": 'goshuyuto[Discussion]
The formula “goshuyuto” isfrequently usedgoverns conditions in patients with headache dry

for the treatment of migraine. In other words, if

vomiting and vomiting foamy sputum'(1). Themigraine has been diagnosed by western medical

formula contains the four drugs: Evodiae Fructus,methods, goshuyuto willoften be effective,

Ginseng Radix, Zizyphi Fructus and Zingeris

making this formula the drug of first choice. From

Rhizoma, where " Evodiae Fructus " is thea Kampo medical point of view it is effective notprincipal agent, that had been described by Todo

only for migraine, but also considered effective for

Yoshimasu in his book "Yaku-cho" as 'this is theheadaches with the following characteristics.

chief treatment for dry vomiting and fullness of1)

Headache with a pulsating character orthe chest'(2). It can be understood from thesemarked by tension, which in each case is both

descriptions, that this formula is used not only forsevere and frequently occurs in attacks.

headache. Dry vomiting also seems to be a main

Associatedpatients

indication. In actual clinical practice I emphasize

complain of epigastric discomfort and nausea,

among the above listed 6 characteristics inwhich are often accompanied by vomiting.

particular "paroxysmal headaches" and "nausea"

As a prodromal symptom for the headache

when prescribing goshuyuto .

2)3)

withtheheadache

patients complain of stiffness from the4)5)

6)

In the past, several reports on clinical researchshoulders to the neck.

about goshuyuto have been published. Maeda et al.

Generally, during attacks the feet are said toconducted a case series study during which they

beadministered goshuyuto to 147 patients withextremely

cold,butthismust

notnecessarily be the case.

chronic headache and found 'better than general

The abdominal pattern often allows one toimprovement' in 55% ,and regarding

observe a feeling of increased epigastrica 'better than useful' rating in 54% of the cases. Atension (uprising epigastric fullness), but

breakdown of the type of headache showed athis is not essential.

tendency

towards

During attacks the pulse seems to be

vascularheadaches

generally deep and slow. (I have never mademanifestations of therapeutic effects appeared ina pulse diagnosis of a patient having an

52% of the patients within 2 weeks(3). However, in

attack in my presence. During the intervals

this study the correlation between headache

between attacks the pulse can also beattacks and nausea was not investigated.

improvement
andusefulness,inreportedcasesofthat

theAs alternative formulas, goreisan should befloating.)

mentioned

first.

In

actualclinicalpractice

Again, in cases in which goshuyuto is effective,

differentiation between the indications for these

the time until the appearance of the effects too is

two formulas is not easy. In cases of associationcomparatively short, so that symptoms generallywith dry mouth, reduced urine volume or edema,often improve within a period of 2 weeks from theor else a tendency of the headache to occur

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

25

Volume 2, Number 1 | Spring 2007

preferentially on days preceding rainfall andother characteristic symptoms clearly indicating
the possibility of water toxin (uneven distributionof water throughout the body), the administrationof goreisan should positively be considered.
I also have seen cases, in which headache andnausea were relieved after administration of

unkeito for menstrual pain or tokishakuyakusan
plusgoshuyutofor

cold

abdominalcolic(abdominal pain induced or aggravated by cold).
Moreover, Keisetsu Otsuka, who contributed tothe establishment of modern Kampo medicine, hasalso reported treating patients with migraine forlong time using ennenhangeto(4). Since all theseformulas contain Evodiae Fructus, it would only
be natural to expect a certain effect; I believe thatcomprehension of formulas like goshuyuto withfew constituent drugs will promote the ability ofskillful clinical application of various Kampo
formulas.
References1) “Songban Shanghan-Lun” published by Zhao
Kaimei of the Ming dynasty, p.275, Ryogen Co.,Ltd., Tokyo 1988
2) Yaku-Cho. By Todo Yoshimasu. Collection ofmedical books on modern Kampo medicine 10,
p.219, Meicho Publishing, Tokyo 1985
3)

Koji

Maeda,

AtsushiMiyagi,Takehito

Sugawara, others: Effects of goshuyuto for thetreatmentofchronicheadache,

Kampo

Medicine 22; 53-57. 1998
4) Collection of Works by Keisetsu Otsuka, Vol. 4,
p.258, Shunyodo Publishing Co., Ltd., Tokyo,
1980

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