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INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 5, Number 1 ･ Spring 2010

Editorial

Acupuncturist Training – Present Situation and Initiatives
Noboru Mitsuhata

Japanese Acupuncture - Current Research

Effects of Electroacupuncture Analgesia on Postoperative Pain after Abdominal Surgery and the Presence of Endogenous
Analgestic Substances
Keisou Ishimaru

Kampo Medicine - Current Research

Effect of Goreisan on Chronic Subdural Hematoma
Mitsusuke Miyagami

Clinical Report 1 (Japan)

A Case Report on Acupuncture Treatment for “Complex Regional Pain Syndrome (CRPS)”
Shigeru Nakajima

Clinical Report 2 (Japan)

One Case that had Effect of Bakumondoto on Post-Herpetic Neualgia caused by Yin Deficiency
Mihoh Koga

Clinical Report 3 (Japan)

One Case that had Effect of Daibofuto on RA with High Level of Maniphalanx Deformation
Hiromichi Yasui

Kampo Formula Development in Japan (1)Otsujito (“B” Character Decoction)

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)
Research on Theory, Practice and Integration

The Journal of
Kampo, Acupuncture and Integrative Medicine
Volume 5, Number 1 ･ Spring 2010

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.

ASSOCIATE EDITORS
Shuichi Katai

TA B L E O F C O N T E N T S
1 Editorial
Acupuncturist Training – Present Situation and Initiatives
Noboru Mitsuhata

2 Japanese Acupuncture - Current Research
Effects of Electroacupuncture Analgesia on Postoperative Pain after Abdominal Surgery and the
Presence of Endogenous Analgesic Substances
Keisou Ishimaru

Ibaraki-ken, Japan

Hiromichi Yasui
Tokyo, JapanEDITORIAL STAFF

Akira Shimaoka
Hiroshi Tsukayama
Hitoshi Yamashita
Naoya Ono
Noboru Mitsuhata
Yoshiro Sahashi

6 Kampo Medicine - Current Research
Effect of Goreisan on Chronic Subdural Hematoma
Mitsusuke Miyagami

12 Clinical Report 1 (Japan)
A Case Report on Acupuncture Treatment for “Complex Regional Pain Syndrome (CRPS)”
Shigeru Nakajima

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)
One Case that had Effect of Bakumondoto on Post-Herpetic Neualgia caused by Yin
Deficiency
Mihoh Koga

22 Clinical Report 3 (Japan)
One Case that had Effect of Daibofuto on RA with High Level of Maniphalanx
Deformation
Hiromichi Yasui

24 Kampo Formula Developed in Japan (1)Otsujito (“B” Character Decoction)
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 1, Number 2 | Summer 2006

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

Volume 5, Number 1 | Spring 2010

Editorial
Acupuncturist Training – Present Situation and Initiatives
The environment for acupuncture and moxibustion training in Japan changed significantly
ten years ago this year. Until 2000, only 26 nationwide universities and vocational schools
provided such training, and every year, around 2,200 applicants from a total of 2,700 passed thenational exam required to practice acupuncture and moxibustion. Following a relaxation ofregulations, thereafter, universities and vocational schools for acupuncturist training increased to
100 schools on a nationwide scale as of April 2010, and as many as 4,000 applicants from a totalof 5,300 passed the national exam held in February 2010. This means that the increase in thenumber of educational institutions that train acupuncturists brought an almost two-fold increasein the number of qualified acupuncturists compared to ten years ago.
However, the change in the environment for acupuncture and moxibustion training
generated a number of issues. One is the issue of employment after graduation, and the other isthe decline in the technical level of practitioners.
Acupuncturists have the choice of going into private practice, but few people actually doso immediately upon graduation. Instead, most choose to receive practical training at an
established clinic to first accumulate experience in treating patients. Under current
circumstances, however, there are not enough clinics in Japan to provide employment to 4,000
acupuncturists per year. At the same time, many of these new acupuncturists need to acquire
practical skills at a clinic and build up confidence to treat patients, because schools that have
newly begun to offer acupuncture training tend to place emphasis on providing knowledge overtechnical skills in preparing students for the national exam, which does not include technicalevaluation.
In response to this situation, the acupuncture and moxibustion industry in Japanestablished the Acupuncture and Moxibustion Medical Promotion Society in 2006 to take on
various initiatives related to awareness raising of acupuncture and moxibustion, the study ofacupuncture and moxibustion, and training of acupuncturists.
Under the theme of “awareness raising,” the society engages in diverse activities topromote understanding of acupuncture and moxibustion in Japan, and under the “study” theme,it collects information about the treatments. For “training,” the society endeavors to establish a
training system for new acupuncturists who have acquired a license but whose skills level is still
low. These activities are not expected to produce immediate results, but are gradually helping totransform the acupuncture and moxibustion industry in Japan.

Noboru Mitsuhata
Goto College of Medical Arts and Sciences
Advanced Course in Clinical Pedagogy
Tokyo Eisei Gakuen College
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 5, Number 1 | Spring 2010

Japanese Acupuncture - Current Research
Effects of Electroacupuncture Analgesia on Postoperative
Pain after Abdominal Surgery and the Presence of Endogenous
Analgesic Substances
Keisou Ishimaru
Faculty of Health Sciences, Ryotokuji University

IntroductionWe
investigatedtheeffects
ofelectroacupuncture through a systematic review
of randomized controlled trials (RCTs) inpostoperative pain. 1)
The results are based on fifteen RCTs
comparing electroacupuncture with sham control
in the management of acute postoperative pain.
The results included one Japanese study(RCTs) by Ishimaru et al (1999). 2-3)
We
have
previously
reported
thatelectroacupuncture decreased the postoperative
pain after abdominal surgery and significantly
reduced the use of analgesic drugs, however, themechanism of electroacupuncture analgesia has
not been completely explained. In this study, The
effects of surgical invasion and electroacupuncture
analgesia
onserum
beta-endorphin,anendogenous opioid peptide that is involved inanalgesic action, and adrenocorticotropic hormone(ACTH) levels were evaluated.
Methods
Continuous frequency 3Hz electroacupuncture
treatment was performed at acupuncture point
LI4 (Hegu) and S36 (Zusanli) for 3 hours from 3
hours after the operation in 11 patients(electroacupuncture group). Another elevenpatients not treated by non-electroacupuncture
served as controls. Peripheral blood (5 ml) wascollected before, during, immediately after
operation and at 3 hour intervals thereafter until
12 hours after the operation, and serumbeta-endorphin and ACTH levels were measured
by radioimmunoassay (RIA).
Results
Surgical procedure and anesthesia time andchanges in serum beta-endorphin and ACTH from2

before operation until 12 hours after operation intheelectroacupuncture
group
and
non-electroacupuncture control group.
During the operations, both beta-endorphin
and ACTH levels increased significantly. Afterthe operations, these levels tended to gradually
decrease to preoperative values, but the levels of
serum beta-endorphin increased significantly
again during the electroacupuncture treatment in
the electroacupuncture group (Table 1.2.).
The degree of the postoperative pain in theelectroacupuncture and non-electroacupuncturegroup and the consumption of the analgesic drugs(Table 3.4.).
Analgesic drugs for postoperative pain wereused in 10 of the 11 cases in the control
non-electroacupuncture group (Table 4.), but wereused only in 1 of the 11 cases in theelectroacupuncture group (Table 3).
These results suggest that the beta-endorphin
levels induced by electroacupuncture reduced the
postoperative pain. The results also suggest that,even under general anesthesia, the surgicalinvasions appear to induce the central nervous toactivate stress-induced analgesia.
DiscussionIn
these
results,
we
found
that
electroacupuncture is effective for postoperative
pain management, as demonstrated by asignificant reduction of postoperative pain scoresandendogenous
opioids
includingbeta-endorphins. From other studies, likewise
electroacupuncture may reduce analgesic drugs
usage in the early postoperative period. 4-9)
Somestudiessuggestedthatelectroacupuncture
mechanisms
includeactivation of the endogenous pain inhibitory
system, release of endogenous opioids including
beta-endorphins, enkephalins, and dynorphins,and non-opioid substances such as serotonin,
norepinephrine, adenosine A1 receptor.10)
Future studies (RCTs) should investigate
electroacupuncture mechanisms given before orafter surgery.

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

Volume 5, Number 1 | Spring 2010

Serum beta-endorphin pg/ml
Serum ACTH pg/ml
patients
No.

age

sex

surgical procedure

duration of anesthesia(minutes)

1

67

F

choledochojejunostomy

220

2

71

M

colectomy

170

3

71

M

total gastrectomy

395

4

57

F

cholecystectomy

160

5

67

M

cholecystectomy

75

6

41

M

subtotal gastrectomy

175

7

57

M

subtotal gastrectomy

210

8

65

F

high anterior resection

166

8

88

M

miles operation anddescending colostomy

225

10

82

F

subtotal gastrectomy

200

11

53

F

subtotal gastrectomy

166

65.3±13.2 years

196.4±77.5

before ope

during ope

after ope

3 hoursEA

6 hours

9 hours

12 hours

3
55
3
19
5
49
2
60
4
15
7
28
3
8
5
45
2
90
6
82
4
20

41
370
38
90
47
170
22
260
30
180
44
350
37
420
66
790
62
580
44
160
64
320

47
150
53
90
25
140
26
370
12
89
32
380
4
60
24
270
46
540
45
130
46
540

10
90
7
71
8
98
8
99
11
89
11
40
20
210
9
19
22
190
40
92
22
90

8
70
6
52
4
80
22
60
15
60
28
30
16
10
15
9
33
60
45
95
33
60

10
50
3
30
4
71
26
70
6
13
18
27
3
16
16
8
46
40
23
80
40
40

10
50
3
13
5
70
8
49
6
13
7
28
3
8
4
10
14
60
10
30
14
60

4.0±1.642.8±27.4

45.0±14.0
335.4±205.7

32.7±15.9
250.8±180.0

15.2±10.0
98.9±56.1

20.4±13.0
53.2±27.0

17.7±14.840.4±24.8

7.6±3.932.0±21.7

Table 1. Surgical procedure and anesthesia time and changes in serum beta-endorphin and ACTH from before operation until 12hours after operation in the electroacupuncture group. Normal value : Serum beta-endorphin 1-10 pg/ml, Serum ACTH 5.5-50 pg/ml.
EA : Electroacupuncture stimulation.
Serum beta-endorphin
Serum ACTH
patients
No.

duration of
age

sex

surgical procedure

anesthesia

before ope

during ope

after ope

3 hours

6 hours

9 hours

12 hours
3(minutes)

1

63

M

subtotal gastrectomy

150

2

68

M

high anterior resection

225

3

70

M

sigmoidectomy

150

4

81

M

cholecystectomy

120

5

74

M

subtotal gastrectomy

215

6

71

M

low anterior resction

210

7

pg/ml

pg/ml

74

M

total gastrectomy

225

8

31

M

subtotal gastrectomy

180

8

80

F

cholecystectomy

50

10

69

M

11

70

F

68.2±13.4 years

subtotal gastrectomy andcholecystectomy
total gastrectomy

290
205

183.6±64.0

3

25

4

3

3

3

52

350

140

60

50

40

-

3

35

9

8

3

3

3

37

190

90

90

63

55

38

7

6

9

8

7

5

7

27

180

98

82

80

59

52

5

14

13

3

13

5

6

16

83

64

5

6

5

5

6

16

20

8

8

8

9

35

110

160

19

14

12

17

4

33

23

28

23

19

20

33

160

82

120

30

18

30

5

44

48

16

15

-

-

24

210

320

54

66

-

-

5

34

33

6

7

6

5

19

640

450

18

24

28

19

3

4

8

3

3

3

3

31

45

75

18

10

16

31

5

36

30

23

10

7

6

60

460

130

60

30

60

53

9

29

22

21

18

14

10

80

180

149

93

80

80

60

5.0±1.825.0±13.2

19.9±13.2

11.5±8.9

10.0±6.6

7.3±5.2

7.2±5.1

37.6±19.2

237.1±178.0

159.8±119.3

56.2±37.6

41.1±27.7

37.3±25.2

33.8±18.5

Table 2. Surgical procedure and anesthesia time and changes in serum beta-endorphin and ACTH from before operation until 12hours after operation in the non-electroacupuncture group. Normal value : Serum beta-endorphin 1-10 pg/ml, Serum ACTH 5.5-50

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

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Volume 5, Number 1 | Spring 2010

Postoperative

pain and the relations of the use pain-killer

patients
No.

after ope

3 hoursEA

6 hours

9 hours

12 hours

1

2

2

1

0

0

2

2

2

1

1

0

3

2

2

0

0

0

4

2

2

0

0

0

5

1

1

1

0

0

6

2

2

1

1

0

1

0

7

2

2

3
Voltaren50mg

8

1

1

1

0

0

9

2

2

1

0

0

10

2

2

0

0

0

11

2

2

1

1

0

Table 3. The degree of the postoperative pain in the electroacupuncture group and the consumption of theanalgesic drugs.
EA: Electroacupuncture stimulation.
The evaluation of the pain. 0:no pain, 1: movement pain, 2:rest pain, 3: use of the analgesic drugs.

Postoperative

pain and the relations of the use pain-killer

patients
No.

after ope

3 hours

6 hours

9 hours

12 hours

1

2

2

3
pentazocin 1A

1

0

2

1

1

1

1

1

3

2

2

1

0

4

2

2

1

0

5

2

2

2

6

2

1

2

7

1

3
pentazocin 1A

8

2

2

9

2

2

10

1

2

11

2

2

3
voltaren 25mg
3
voltaren 25mg
3
voltaren 25mg
3
voltaren 25mg
3
voltaren 50mg

3
voltaren 50mg
3
pentazocin 1A

3
voltaren 25mg
3
voltaren 25mg

1
1

2

2

0

0

0

0

1

0

2

2

Table 4. The degree of the postoperative pain in the non-electroacupuncture group and the consumption of
the analgesic drugs.
The evaluation of the pain. 0:no pain, 1: movement pain, 2:rest pain, 3: use of the analgesic drugs.

4

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

Volume 5, Number 1 | Spring 2010

Conclusion
Electroacupuncture treatment may be a usefulcomplementary and alternative medicine for
acute postoperative pain management.
Acknowledgements
This work was supported by a grant forscientific research from the Ministry of Education
Science and Culture of Japan (0977076),
1998-1999.
References
1)
Sun Y, Gan TJ et al : Acupuncture andrelated techniques for postoperative pain: asystematic review of randomized controlled
trials. Brit J Anaesth. 2008;101:151-160.
2)Ishimaru K : Effects of acupuncture
analgesia on post-operative pain after
abdominal surgery and the relationship ofendogenous analgesic substances. Meiji
Shinkyu Igaku. Bull Meiji Univ Orient Med.
2000;26:11–22.
3)
Ishimaru K, Imai K et al : Effects ofacupuncture analgesia on post-operative
pain after abdominal surgery using serum
β-endorphin and ACTH concentration as
parameters. The Journal of the japan
society of pain clinicians. 1999:1:6:10-16.
4)Wang B, Tang J et al : Effect of the intensityof transcutaneous acupoint electricalstimulation on the postoperative analgesic
requirement.
AnesthAnalg.
1997;85:406-413.
5)Chen L, Tang J : The effect of location oftranscutaneous electrical nerve stimulationon
postoperative
opioidanalgesic
requirement: acupoint versus nonacupoint
stimulation.
AnesthAnalg.
1998;87:1129-1134.
6)
Kotani N, Hashimoto H : Pre-operative
intradermal
acupuncture
reducespostoperative pain, nausea and vomiting,analgesic
requirement,
and

7)

8)

9)

10)

sympathoadrenal responses. Anesthesiology.
2001;95:349-356.
Lin JG, Lo MW : The effect of high and low
frequency electroacupuncture in pain after
lower
abdominal
surgery.
Pain.
2002;99:509-514.
Sim
CK,
Xu
PC
:
Effects
ofelectroacupuncture on intraoperative andpostoperative
analgesic
requirement.
Acupunct Med. 2002; 20:56-65.
Wong RH, Lee TW : Analgesic effect ofelectroacupuncture in postthoracotomy
pain: a prospective randomized trial. Ann
Thorac Surg. 2006; 81:2031-2036.
Goldman N, Chen M et al : Adenosine A1
receptors mediate local anti-nociceptive
effects of acupuncture. Nat Neurosci.
2010;13(7):883-8.

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Volume 5, Number 1 | Spring 2010

Kampo Medicine - Current Research
Effect of Goreisan on Chronic Subdural Hematoma－From the Goreisan Symposium 2010”－
Mitsusuke Miyagami
Department of Neurosurgery and Rehabilitation,
Takenozuka Nohsinkei Rehabilitation Hospital
Sonoda Daiichi Hospital

Introduction
Chronic subdural hematoma (hereafter CSDH)
is a gradual accumulation of blood below the duramater over more than three weeks, generally after
a minor head injury. The hematoma is
encapsulated, in which old liquefied blood is found.
In recent years, increases in the number of theelderly and image analyzing examinations such as
CT/MR images have contributed to an improved
detection of CSDHs, for which surgery is arecognized and established method of treatment.
However, even if CSDH shows up on CT images,some patients do not exhibit the signs andsymptoms indicative of CSDH or merely show
very mild symptoms. There are also patients who
do not desire an operation. Moreover, therecurrence of CSDH after surgery occurs in 10 to20%12,19,23 of patients. Patients who are prone tobleeding or have complications are hesitant toundergo surgery. On the other hand, it must be
kept in mind that CSDHs may heal
spontaneously,3,16 which is said to occur in 2.8 to
21% of patients with mild mass effect who do notshow signs and symptoms or have very mild
symptoms.4,15,17 For this reason, non-operative
treatment may be selected depending on thepatient. In terms of non-operative procedures for
CSDHs, hyperosmolar therapy8,22 with mannitoland steroid hormone therapy1,2,18 have beenreported. Recently, practitioners in the field of
neurosurgery have had another look at Kampo
treatment and treatment of CSDH with Kampo
medicines 9,10,14,21,15 for CSDHs has occasionallybeen seen. However, only a few case reports havebeen published and Kampo treatment has not

6been established for CSDH.
Since January 2006, we have used goreisan forsome patients with CSDH and studied its
efficacy.11 This study reports the efficacy of the
medicine for CSDH obtained through conducting
CTs with long-term follow-up.
Subjects and Methods
As stated above, surgery is an accepted
treatment for CSDH. However, we used goreisan
for CSDH in the following types of patients (withtheir consent and that of their family members):(1) those who did not desire surgery, (2) those who
did not exhibit signs or symptoms, or very mild
symptoms, and (3) those who were prone tobleeding or presented with systemically badhealth conditions. The subjects enrolled in thetrial were 22 patients with CSDH (the number ofhematomas was 27). Their ages ranged from 50 to98, with 18 subjects 70 years old or above. Nine
subjects had right-sided hematomas, 8 had
left-sided, and 5 had bilateral. Fourteen subjects
had experienced trauma. Two subjects developed
recurrent CSDH after surgery as the firsttreatment. At the start of treatment after CSDH
developed, 8 patients presented without any
symptoms, 7 had headaches or dizziness, and 5
had mild motility disorder. In terms ofcomplications, 5 patients had dementia. Eachsubject had one of the following complications:diabetes mellitus, dialysis, cerebral infarction,
cerebral hematoma, terminal colon cancer, or
jaundice.
The CT findings were examined for the
maximum width of the hematomas and their CT
density. Twenty hematomas, the largest number,
had a maximum width of 10 to 19 mm just before
treatment, 4 hematomas had 20 to 25 mm, and 3
had 9 mm or less. The CT density at the start oftreatment with goreisan was evaluated as iso,high, or mixed in 14 hematomas and low in 13
hematomas. The period of follow-up by CT was
4–29 weeks (Table 1).

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

Volume 5, Number 1 | Spring 2010

Table 1. Summary of cases with chronic subdural hematomas treated with goreisan..

TSUMURA Goreisan Extract Granules (Extract of goreisan, 7.5 g divided into 3 doses in three times
a day, basically before meals) was orally administered to all patients with CSDH regardless of thepatients’ pathological conditions from the Kampo perspective. The patients who were able to take themedicine for four weeks or more were assigned to the study. With the disposition of the primary doctor,
hemostatic agents (tranexamic acid and carbazochrome sodium sulfonate) were used in combination for
7 non-selected subjects. The effectiveness of goreisan was assessed based on whether the hematoma
had resolved or decreased in size as determined by a CT. Results (Figure 1, 2)

Figure 1. Change in maximum thickness of hematomas
with iso/high ( ) or mixed ( ) density on a CT afteradministration of goreisan.

Figure 2. Change in maximum thickness ofhematomas with low density on a CT afteradministration of goreisan. ● effective cases〇ineffective cases

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

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Volume 5, Number 1 | Spring 2010

Results
The treatment with goreisan resulted in a highlevel of improvement in 23 (85%) of 27 CSDHs,
including hematomas that had disappeared or
shrunk, whereas treatment was ineffective for 4
CSDHs (15%) since they remained unchanged
after administration of the medicine. In the 23
CSDHs responsive to goreisan, 12 hematomas
disappeared and 11 shrank (Table 1). In 17
CSDHs (74%) out of the 23 CSDHs that showed
improvement, the hematomas began to shrink
within four weeks after administration and thenthey gradually shrank further or disappeared. Of
the 12 CSDHs that disappeared, 10 took less than
14 weeks to disappear. None of the hematomas
grew after administration of goreisan for fourweeks or more, so there were also no CSDH casesthat needed surgery. In the meantime, there wereno adverse effects associated with the medicationin any of the cases.
We studied the time-dependent changes in thedensity level of hematomas after administrationof goreisan. The medicine was effective in all 14
CSDHs with density levels of mixed or high/iso on
a CT before treatment. That is, 14 CSDHs all
improved with 8 resolved hematomas and theother 6 shrank (Figure 1). Of the 13 CSDHs withlower density on a CT, 9 showed an improvementwith the hematoma disappearing or shrinking,while 4 CSDHs remained unchanged andnon-responsive to the administration of goreisan(Figure 2). The results of the study show that
CSDHs with hematoma density levels of iso/highor mixed were more responsive to goreisan. We
consider that further research with many morepatients will be needed.
A representative caseCase: K. H. (Figure 3)
79 years old, female: Bilateral chronic subdural
hematoma (CSDH) (L>R).
On November 19, X year, the patient fell down
and banged her head. On January 10 of thefollowing year, she visited our facility,

8

complaining of a mild gait disorder. CT
examination revealed a bilateral CSDH (right: 8mm, left: 5 mm) with iso density and theadministrationofhemostatic
agents(carbazochrome sodium sulfonate 3 tablets andtranexamic acid 3 tablets a day) was commenced.
A CT scan during a follow-up visit on February 7
indicated enlarged hematomas, having amaximum width of 10 mm on the right and 20 mmon the left, with mixed density on both sides. For
this reason, goreisan 7.5 g (divided into 3 doses)
was commenced with the hemostatic agents. The
hematomas began to decrease in size after sevenweeks: the right hematoma disappeared and theleft one remained unchanged with a maximum
width of 20 mm. However, the extent of thehematoma tended to decrease. On April 20, thedensity decreased to low and shrinkage was
obvious. In the 14th week, the CSDH dissolved
completely (Figure 3). The gait disorder also
disappeared and she recovered her normal gait.

Figure 3. CT scan of case 2 (K.H.) before and afteradministration of goreisan. 06,2,7; before
administration, 06,3,30;, 06,4,20;, and 06,5,25; 7,
10 and 14 weeks after administration of goreisan.
Discussion
A widely-accepted theory13 of the etiology andgrowth mechanism of CSDH is that hematoma
enlargement occurs through blood leakage andconstantorintermittent
bleedingfromneovascular vessels in a false membrane into the

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

Volume 5, Number 1 | Spring 2010

capsule and the cavity of a hematoma in order toenhance local fibrinolytic activity inside thehematoma and its outer membrane. On the other
hand, the old theory of osmosis pressure is stillprevalent, but the cause is not known in detail. As
nonsurgical management of CSDHs, the use ofdiuretics or steroids has been claimed to beeffective. More specifically, effectiveness has beenreported for mannitol 20% osmotherapy by Suzuki,
et al.22 and Kinjyo, et al.;8 the combination
therapy with steroid hormone and 50% glucose by
Ambrosetto, et al.; １ and the steroid-alone
hormone therapy by Glover, et al.２ and Rudiger,
et al.18
In recent years, CSDH has occasionally beentreated using the aquaretic Kampo medicines of“goreisan” and “saireito.” Seki, et al.21 usedgoreisan in 8 cases of CSDH and obtained
improvement in 4 cases. Onuki10 and Ueno, et al.25
reported that hematomas had resolved in all caseswith the combination treatment of goreisan andprednisolone. Muramatsu, et al.14 reported theeffectiveness of goreisan; they used the Kampo
medicine alone in 11 cases and in 10 of the cases,
the hematomas disappeared or shrank. Kitahara9
had favorable results using saireito, which ismade up of two formulae: “goreisan” and“shosaikoto”. Kitahara reported that improvement
could be obtained even if administration of
antithrombogenic agents continued.
Since 2008, a number of reports on thetreatment of initial and recurrent CSDHs withgoreisan have been published and all of thesereports suggest its usefulness.
We treated 22 cases of CSDHs (27 hematomas):goreisan alone was administered in 15 cases, andgoreisanandhemostatic
agentswere
administered in combination in 7 cases, resulting
in effectiveness in 23 hematomas — 12
hematomas were resolved and the other 11 shrank.
We believe this improvement was due to theeffectiveness of goreisan rather than spontaneous

healing. This is based on the following: (1) casesthat had a tendency for the hematomas to growbefore the administration of goreisan, and manycases that did not have a tendency for thehematomas to shrink were included; (2) there
were cases that showed a tendency for thehematomas to shrink from an early stage after theadministration of goreisan; and (3) higher rates ofeffectiveness of the treatment were shown
compared to the frequency of spontaneous
resolution of CSDHs in the past. In general, thehematomas started to shrink three to four weeks
after the start of administration of goreisan, andthey disappeared within 14 weeks afteradministration in most cases. There were only a
few cases in which shrinkage started within 2
weeks. To assess the effect of CSDH treatment
with this Kampo medicine, a continued
administration for at least three to four weeks ormore is required.

Goreisan, which consists of the five crude drugsofarismarhizoma,tuckahoe,
polyporussclerotium, atractylodes lancea rhizoma, andcassia twig, is a typical diuretic Kampo medicine.
This diuretic medicine clinically has anti-edema
action6,20 and is generally prescribed forpathological conditions such as headache, cerebral
edema, ascites, gastroenteritis, ophthalmic
disorders, hangover, and pain. Although themechanism of the effect of the medicine on CSDHs
is unclear, the diuretic actions may be the main
contributing factor as the usefulness of mannitol
osmotic diuretic agents has been reported.8,22
Unlike the diuretic agents used in Western
medicine such as mannitol, this Kampo diuretic
medicine is characterized by the role ofantidiuretic actions in a hydrated state and therole of regulating the actions of water metabolism
in a hyperhydrated state.24 It is said that thediuretic mechanism is involved in the inhibition ofwater channel aquaporins (AQPs), which increasewater permeability in cell membranes, whereas
goreisan inhibits the action of the aquaporins.5,20
According to Isohama,5 the constituent crude

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9Volume 5, Number 1 | Spring 2010

drugs of goreisan, especially atractylodes lancea
rhizoma, polyporus sclerotium, and tuckahoe(poria sclerotium), inhibit cell membrane water
permeability. In particular, AQP4, which is mostabundant in the brain but also distributed in large
numbers in astroglia cells adhered to capillary
endothelial cells, is said to be involved in water
permeability.6 Atractylodes lancea rhizoma, thecrude drug of the atractylodes family contained ingoreisan used for CSDH treatment, has been usedin many medicines as well as the ones used in our
experiment. Ueno, et al.25 have also reported thatgoreisan containing atractylodes ovatae rhizoma
was effective for CSDHs.
Our experiment suggests that goreisan is more
effective if the hematoma density on a CT is iso,high, or mixed, compared to low density. The
reasons, however, are not known in detail.
Meanwhile, in the cases of relatively new
hematomas with iso density or high density,
hematoma capsules often show the sinusoidal
channel layer, which is filled with capillaries. On
the other hand, in the hematomas with low
density, old bleeding to a certain extent canpossibly be found with relatively fewer vessels.
This means that CSDHs with low density have acomparatively long course and the vessels in thehematoma capsule may be relatively scarce. So, it
is possible that AQP4 surrounding the vessels arealso relatively reduced, causing the reduced
inhibition of water permeability.
goreisan is orally administered for treatment,
unlike mannitol or steroid drugs, and it did notcause any adverse effects in the cases in ourstudy11 and in other reported cases.10,14,21,24,25 We
consider goreisan to be an easy-to-use medicine
and useful for the future nonsurgical managementof CSDHs.
Conclusion
1. Goreisan was administered in 22 cases of CSDH
with 27 hematomas for four weeks or more andthe results showed it was effective in 23
hematomas (85%) with the hematomas
disappearing or shrinking.
10

2. Goreisan did not cause any obvious adverse
effects in the cases in our own study and inreported cases to date. It is a safe and useful
drug for nonsurgical therapy of chronic
subdural hematomas.
References
1. AmbrosettoC:
Post-traumatic
subduralhematoma. Further observations on non-surgicaltreatment. Arch Neurol 6: 287–292, 1962
2. Glover D, Labadie EL: Physiopathogenesis of
subdural hematomas. Part 2: Inhibition of
growth of experimental hematomas withdexamethasone. J Neurosurg 45: 393–397, 1976
3. Hirakawa K, Nakamura N, Sano K:
Spontaneous recovery of chronic subdural
hematoma - Resolving subdural hematomathe first edition: clinical pictures and X-ray
pictures, “Brain and Nerve” 19:661–670, 1967
4. Horikoshi T, Naganuma H, Fukasawa I, et al.:Computed
tomography
characteristics
suggestive of spontaneous resolution ofchronic subdural hematoma. Neurol Med Chir
(Tokyo) 38: 527–532, 1998
5. Isohaama Y: Working mechanisms ofaquaretic drug “Goreisan”, Kampo Igaku 29:
213–215, 2005
6. IsohamaY:
Doesgoreisan
impedeaquaporin-4? Is aquaporin a moleculeshowing
diuretic
action?
ISOM/Japan
Goreisan Symposium (October 31, 2010),
Japan Chapter of the International Society ofOriental Medicine, 1st Special Symposium
Abstracts p. 15
7. Keji C: Chronic subdural hematoma(headache due to blood stasis). Traditional
Chinese medicine clinical case studies:
Foreign Language Press and New World press.
Beijing, 1994, pp. 204–207
8. Kinjo T, Sakurai Y, Ogawa A, et al.:Nonsurgical treatment of chronic subdural
hematoma. Neurol Med Chir (Tokyo) 25:
645–653, 1985
9. Kitahara M: Effectiveness of treatment withsaireito for chronic subdural hematoma

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

Volume 5, Number 1 | Spring 2010

continued to take antithrombogenic agents. 19th
Nihon Noshinkeigeka Kampo Igaku-kai
Gakujutsushukai Shorokushu (19 themes)
November 13, 2010
10. Konuki K: Therapeutic trial using goreisan
for chronic subdural hematoma. Kampo Igaku
27: 115-117, 2003
11. Miyagami M, Kagawa Y: Effectiveness of
Kampo medicine goreisan for chronic
subdural hematoma. No Shinkei Geka 37:
765–770, 2009
12. Mori K, Maeda M: Surgical treatment ofchronic
subduralhematomain500
consecutive cases: clinical characteristics,
surgicaloutcome,complication,
andrecurrence rate. Neurol Med Chir (Tokyo) 41:
371–381, 2001
13. Murakami H, Hirose Y, Sagoh M, et al.: Why
do chronic subdural hematomas continue togrow slowly and not coagulate? Role ofthrombomodulin in the mechanism, J
Neurosurg 96: 877–884, 2002
14. Muramatsu M, Yoshikawa T, Hanabusa K:
Effectiveness of Kampo medicine goreisan-ryo
for chronic subdural hematoma in very
elderly patients. No Shinkei Geka 33:
965–969, 2005
15. Naganuma H, Fukamachi A, Kawakami M, etal.: Spontaneous resolution of chronic
subdural hematomas. Neurosurgery 19:
794–798, 1986
16. Nakamura N, Hirakawa K, Sano K:
Spontaneous recovery of chronic subdural
hematoma - Resolving subdural hematoma second edition pathological process andbackground. “Brain and Nerve”19: 1209–1219,
1967
17. Parlato C, Guarracino A, Moraci A:
Spontaneous resolution of chronic subdural
hematoma. Surg Neurol 53: 312–317, 2000
18. Rudiger A, Ronsdorf A, Merlo A, et al.:Dexamethasone treatment of a patient withlarge bilateral chronic subdural haematomata.
Swiss Med Wkly 131: 387, 2001
19. Sambasivan M: An overview of chronic

subdural hematoma: experience with 2300
cases. Surg Neurol 47: 418–422, 1997
20. Sato S, Adachi K, Kanou T, et al.: Brain
edema and aquaporin-4, Shinkei Kenkyu no
Shinpo 50: 183–189, 2006
21. Seki H, Okita N, Takahashi S: Usefullness oftreatment with goreisan for chronic subrural
hematoma. Clinical Neurology 35: 317, 1995
22. Suzuki J, Takaku A: Nonsurgical treatment ofchronic subdural hematoma. J Neurosurg 33:
548–553, 1970
23. Svien HJ, Gelety JE: On the surgicalmanagement of encapsulated subdural
hematoma. A comparison of the results ofmembranectomy and simple evacuation. J
Neurosurg 21: 172–177, 1964
24. Munetetsu TEI: Hozai Yakuri Series,
Goreisan (Part 2), Kampo Igaku 26: 42–46,
2002
25. Ueno S, Ota H, Shimizu I, et al.: Anexperience of treatment with goreisan forchronic subdural hematoma, Journal of Japan
Society for Oriental Medicine 59 (suppl), 205,
2008

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Volume 5, Number 1 | Spring 2010

Clinical Report 1 (Japan)
A Case Report on Acupuncture Treatment for “Complex
Regional Pain Syndrome (CRPS)”
Shigeru Nakajima
Midori no Kaze Acupuncture Clinic,
Morinomiya College of Medical Arts and Sciences

Introduction
Chronic pain, edema, skin temperature
anomalies, sweating and other symptoms areassociated with the refractory and chronic pain ofcomplex regional pain syndrome (CRPS) that may
be triggered with surgeries or injuries. CRPS wasonce called reflex sympathetic dystrophy (RSD) or
causalgia. Its morbidity is approximately 5 in
100,000 people and is therefore a disease ofcomparatively low incidence. We report a case ofacupuncture treatment for a patient who had
been diagnosed of RSD.
[Case Report]
Patient:
Age 52 years, female.
First visit:
March 10, 2008
Chief complaints:#1 dull pain of the left hand
#2 edema of the left hand, stiffness#3 irregular symptoms of feeling of sensations ofheat in the left hand, cold and sweating#4 feeling of weakness of the left upper extremity
Present illness:
The patient underwent surgery for left thumbtendosynovitis in June 2007. Following thesurgery a tingling sensation of the surgical scar
and a feeling of traction gradually developed.
Moreover, symptoms of dull pain, a sensation ofheat in the left hand, edema, stiffness, asensation of cold, irregular sweating and a senseof weakness of the left upper extremity developed.
Based on the results of a detailed examination
performed in a different clinic the physician
diagnosed as RSD. From July 2007 to February
2008 left stellate ganglion blocks (SGBs) were
performed and resulted in a mild improvement of12

the symptoms, but now the injection site on theleft side of the neck became painful. Concerns
about continuous nerve block treatment finallybrought the patient to our clinic.
Past history:
In 2004 temporomandibular arthrosis (treatedwith acupuncture in this acupuncture clinic)
Life style:
Alcohol: moderate amount of beer; tobacco: does
not smoke
Family history: nothing particularly noteworthy.
General symptoms: appetite: normal, bowel
movements: once a day; sleep: normal; stiffness ofthe back of the neck; shoulder stiffness, wearinessofthemusclesaroundthelefttemporomandibular joint.
General physical findings: Height: 155 cm;
weight: 51 kg; blood pressure: 128/80 mmHg;
pulse rate: 56 bpm (regular pulse)
Local physical findings: Jackson and Spurling
test (-), TOS tests (-); deep tendon reflexes (+: noleft-right differences), pathologic reflexes (-)
Left hand: edema (+), feeling of heat (+), redness(+), muscle atrophy (-), sensation (normal: noleft-right differences), nociception (little finger,
digital pad: slightly hypersensitive), tenderness(-).
Right hand: Nothing particularly noteworthy.
Subjective symptoms during the night: nonocturnal pain of the left hand. However, there
is a sensation of edema.
Subjective symptoms in the morning: stiffness of
the left hand.
Comprehension of the pathologic condition:(1) Following
surgery
for
left
thumb
tendovaginitis gradual development of dull pain,
edema, stiffness, a sensation of heat and cold,
irregular sweating and a sense of weakness of theleft upper extremity. (2) Findings during the firstexamination. Based on the above described (1)and (2)the clinical characteristics were considered
to match those of a CRPS.

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Patient impression obtained during the medical
interview: speaks impatiently. Appeared slightly tired.
Informed consent: CRPS is a refractory condition.
The therapist had performed acupuncture andmoxibustion treatment only once about 4 years
ago for a patient with CRPS, but this patient
dropped out when the symptoms had improved toabout 1/2 of their original intensity. The above
described situation was explained to the patient
and the acupuncture and moxibustion treatment
started after obtaining the patient's consent.

 NRS for the acupuncture and moxibustion
treatment after the first examination(1) Edema: NRS 6(2) Pain: NRS 6(3) Redness: NRS 6(4) Irregular symptoms of sensations of heat, coldand sweating: NRS 5(5) Stiffness of the hand: NRS 7(6) Sense of weakness of the upper extremity:
NRS 7(7) Numbness: NRS 0

Acupuncture and moxibustion treatment plan:
Initially the approach was to gradually apply
local stimulation while observing the course.
Moreover,weappliedacupunctureandmoxibustion treatment also for the stiffness fromthe back of the neck to the shoulders and aroundthe left temporomandibular joint.

Acupuncture and moxibustion treatment andcourse (disposable needles, 40 mm, No.1 wereused)

Observation plan (evaluation):
Prior to the performance of the SGB treatment
the severity of the symptoms of the CRPS was
rated on a 10-step Numerical Rating Scale (below
called NRS).
 The NRS10 for the symptoms (1) - (7) prior to
the performance of the SGB treatment:(1) Edema: the edema is so severe that the patientcannot wear M size rubber gloves(2) Pain: dull pain (heaviness + pain)(3) Redness: the entire hand is red(4) Irregular symptoms of sensations of heat in
the left hand, cold and sweating: Depending on
the time the patient experienced hot and cold
sensations and sweating on an irregular basis.
(5) Stiffness of the left hand. Hand and fingers
could not be flexed.
(6) Sense of weakness of the upper extremity:
This sensation covered an area from the upperarm to the tip of the fingers.
(7) Numbness: pulling sensation at the site of thesurgical incision + numbness

 First treatment (March 10, 2008):
Supine position: GV20 (Hyakue, Baihui), left ST6(Kyosha, Jiache), left ST7 (Gekan, Xiaguan), left
GB3 (Jokan, Shangguan), bilateral LI11 (Kyokuchi,
Quchi), bilateral GB34 (Yoryosen, Yanglingquan) retaining the needles for 10 minutes.
Single insertion at interdigital points (distal).
Single needling of interdigital points (proximal) indirect moxibustion, 5 cones.
Prone position: bilateral GB20 (Fuchi, Fengchi),bilateral GB21 (Kensei, Jianjing), bilateral BL43
(Koko, Gaohuang), bilateralSI10 (Jue, Naoshu) retaining the needles for 10 minutes. At the sametime warming moxibustion on the shoulders (boxmoxibustion)
 Second treatment (March 21, 2008):
On the morning following the treatment the
stiffness of the left hand and fingers had
decreased. Alleviation of the sense of weakness of
the left upper extremity. In addition to the firsttreatment pressure applied to the left auricle
resulted in some alleviation of the ipsilateral arm,so that the posterior part of the auricular was
needled. GV20 (Hyakue, Baihui), bilateral LR3(Taisho, Taichong) retaining the needles for 10
minutes. Left carpal tunnel, Tinel sign (-)

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Volume 5, Number 1 | Spring 2010

 Third treatment (March 31, 2008):
Alleviation of the sense of weakness of the left
upper extremity. However, mild pain had
developed around the temporomandibular joint.
Development of stiffness of the MPs of the left
first and fifth fingers. Additional treatment ofright ST6 (Kyosha, Jiache), right ST7 (Gekan,
Xiaguan), right GB3 (Jokan, Shangguan),retaining the needles for 10 minutes.
 Fourth treatment (April 4, 2008):
Following the treatment of pain and stiffness of
the MP of the left first and fifth fingers the
alleviation of the symptoms continued for 1 week,
but after that returned to the original state.
Sensation of heat and swelling in the left thenar
and hypothenar. Single insertion without
retaining the needle into in the left thenar andhypothenar (40 mm, #01). The NRS scores were:(1) edema 6, (2) pain 6, (3) redness 2, (4) irregularsymptoms of a sensation of heat, cold and sweating
4, (5) stiffness of hands and fingers 7, (6) weaknessof the upper extremity 7, (7) numbness 0.
 Sixth treatment (April 25, 2008):
Development
of
pain
near
the
left
sternoclavicular joint, right blepharospasms.
 Seventh treatment (May 2, 2008):
No change of the pain near the left
sternoclavicular joint. Disappearance of the right
blepharospasms.
 Ninth treatment (May 16, 2008):
Sneezing has become impossible because of thepain near the left sternoclavicular joint;development of left blepharospasms. Needle
retaining at bilateral KI26 (Ikuchu, Yuzhong),
CV14(Koketsu,
Juque).
Later
indirectmoxibustion (use of moxibustion paper); 5 conesof half rice grain size.
 Tenth treatment (May 26, 2008):
Disappearance of the left blepharospasms. Relief
14of the pain near the left sternoclavicular joint.
Appearance of sneezing and hiccupping.
 Twelfth treatment (June 11, 2008):
Irritation by weakness of the left upper extremityand stiffness of hands and fingers.
The NRS scores were: (1) edema 5, (2) pain 5, (3)redness 1, (4) irregular symptoms of a sensationof heat, cold and sweating 2, (5) stiffness of hands
and fingers 4, (6) weakness of the upper extremity
5, (7) numbness 0.
 Fourteenth treatment (June 27, 2008):
Relief of left chest pain and stiffness.
 Fifteenth treatment (July 11, 2008):
General relief of the symptoms.
The NRS scores were: (1) edema 2, (2) pain 2, (3)redness 0, (4) irregular symptoms of a sensationof heat, cold and sweating 1, (5) stiffness of hands
and fingers 2, (6) weakness of the upper extremity
5, (7) numbness 0.
 Seventeenth treatment (August 8, 2008):
Due to the general relief of the symptoms I planned
to extend the treatment intervals to 1 month. For
the stiffness of the hands and fingers carpal tunnel
needling (single insertion) was added.
The NRS scores were: (1) edema 0, (2) pain 0, (3)redness 0, (4) irregular symptoms of a sensationof heat, cold and sweating 0, (5) stiffness of hands
and fingers 1, (6) weakness of the upper extremity
2, (7) numbness 0.
 Eighteenth treatment (September 5, 2008):
The previously applied needling of the carpal
tunnel seemed to have been effective, since there
is almost no stiffness of hands and fingers. The
NRS scores were: (1) edema 0, (2) pain 0, (3)redness 0, (4) irregular symptoms of a sensationof heat, cold and sweating 0, (5) stiffness of hands
and fingers 0, (6) weakness of the upper extremity
2, (7) numbness 0.

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Volume 5, Number 1 | Spring 2010

 Twentieth treatment (October 31, 2008):
General improvement of all symptoms.
The NRS scores were: (1) edema 0, (2) pain 0, (3)redness 0, (4) irregular symptoms of a sensationof heat, cold and sweating 0, (5) stiffness of hands
and fingers 0, (6) weakness of the upper extremity
2, (7) numbness 0.

period of approximately 7 months led to thefollowing improvement of the NRS scores: edema
6→0, pain 6→0, redness 6→0, irregularsymptoms of a sensation of heat, cold andsweating 5→0, stiffness of hands and fingers 7→0,
weakness of the upper extremity 7→2.
The improvement was maintained by subsequent
regular treatments.

Numberof treatments and NRS scores
治療回数とNRS10987

NRS scores

N
R
S
値

①②

6

①浮腫

5

(1)
edema
②痛み
(2)
pain
③発赤

4

(3)
redness④熱感・冷感・発汗の不安定症状③(4)irregular symptoms⑤手指のこわばり

3④(5)
stiffness of hands and fingers⑥上肢の脱力感⑥

2(6)
weakness of upper extremity⑦しびれ(7) numbness⑤
1⑦
20th: 10/31/2008

19th: 10/3/2008

18th: 9/5/2008

17th: 8/8/2008

15th: 7/11/2008

12th: 6/11/2008

8th: 5/8/2008

4th: 4/11/2008

1st: 3/10/2008

Pre-SBG: 7/2007

0

治療回数（治療日）
Number oftreatments (treatment date)

Figure 1: Number of treatments and NRS scores

Number of treatments and NRS scores (Figure 1:
Number of treatments and NRS scores)
Shows the improvement of the NRS scores withincreasing number of treatments.
A total of 20 treatments administered over a

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Volume 5, Number 1 | Spring 2010

Discussion
Yoshiki Hamada wrote in his summary of the
CRPS seminar held in February 2007 titled"Early Diagnosis of CRPS and Points toConsider":"The Lankford classification is clinically of
extreme importance and an early initiation oftreatment of the minor type of the condition may
often lead to favorably functional recovery
withoutthedevelopmentofrefractory
symptoms".
Table 1shows the Lankford classification. Thisshows that it classifies the condition into a major
and a minor type.
 Moreover, in Yoshiki Hamada's summary"Early Diagnosis of CRPS and Points to Consider"
it also says:

16"Twenty out of 25 patients (80%) for whom thetreatment was initiated within 6 months of theonset recovered functions so far, that they wereable to return to ordinary daily life within one
year, but in 70% of these cases the condition had
been classified as minor type." The Lankford classification includes theitems "palpation impossible" for the major typeand "palpation possible" for the minor type. The
question whether palpation is possible or not is
considered to be closely related to the possibilityof administering acupuncture treatment.
 In this patient the condition was palpableand it is therefore reasonable to think, that astate of hyperaesthesia was present in the area
treatable by acupuncture.

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Volume 5, Number 1 | Spring 2010

Conclusion(I) In this case the clinical condition of the
CRPS based on NRS evaluations showedalready signs of improvement when thepatient first visited this acupuncture clinic.
The characteristics of the clinical symptomsof CRPS may vary significantly dependingon the disease progression in individual
patients. In this case the acupuncture
treatment for the various symptoms of thispatient with CRPS appeared to have beeneffective.
(II) CRPS is associated with severe physical andmental stress. Acupuncture treatment
seems also to be helpful for secondary
symptoms caused by irritation andconcerns.
(III) Although this was only one case, this one
case gave me the impression, that theconcepts pertaining to indications andcontraindications of acupuncture treatment
for CRPS should be reconsidered.

References
1)
Shibata M., Yoshiya U., Masamo T.: "PainTreatment"; pp 131-135, Kokuseido Co. Ltd.,
2000
2)
Morimoto M.: "Pain Clinic and Oriental
Medicine"; pp 505-512, Shinko Trading Co.
Ltd, Publishing Department of Medical
Books, 2004
3)
Hamada Y.: "Early Diagnosis of CRPS andPoints to Consider"; Summary of the CRPS
Seminar, 2007
4)
Masamo T., Shibata M. editors: "Complex
Regional Pain Syndrome (CRPS)"; Shinko
Trading Co. Ltd, Publishing Department ofMedical Books, 2009

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Volume 5, Number 1 | Spring 2010

< Shigeru Nakajima >
*

*

*

*

-

*

-

Graduated in 1986 fromthe Osaka Vocational
School of Acupunctureand Moxibustion(today: Morinomiya
College of Medical Arts
and Science)
June 2001: employment in the department ofacupuncture and moxibustion of the clinic
affiliated with the Morinomiya College ofMedical Arts and Science (today: Midori no Kaze
Acupuncture Clinic affiliated with theMorinomiya College of Medical Arts and Science)
Member of the Japan Society of Acupunctureand Moxibustion, member of the Japan
Conference of Clinical Acupuncture andMoxibustion
Concurrent lecturer in the Department of
Acupuncture
andMoxibustion oftheMorinomiya College of Medical Arts and Science
In charge of: clinical practice (1st – 3rd gradestudents),
practical
acupunctureandmoxibustion skills I (3rd grade students)
Concurrent lecturer in the department ofhealth services of the Department of
Acupuncture and Moxibustion of theMorinomiya College of Medical Arts andScience
In charge of: acupuncture and moxibustion
diagnostics and therapy I

Midori no Kaze Acupuncture Clinic affiliated with
the Morinomiya College of Medical Arts andScience / Midori no Kaze Acupuncture Clinic
The clinic affiliated with
the Morinomiya College ofMedical Arts and Science andthe affiliated acupuncture andmoxibustion clinic establishedin 1982 were reopened in
January 2010 after moving to
the third floor of a newbuilding under the name
"Midori no Kaze Acupuncture Clinic / Midori no
Kaze Clinic".
The clinic section has the following
departments: orthopedics, rehabilitation, internal
medicine, Kampo medicine and acupuncture andmoxibustion. This facility also focuses on the
training of the next generation of medical
personnel and has the function of providing
opportunities for clinical practice for the studentsof the Morinomiya College of Medical Arts andScience.

< Midori no Kaze Acupuncture Clinic (3rd Floor) >Clinic reception

18

Acupuncture and moxibustion treatment room

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

Volume 5, Number 1 | Spring 2010

Clinic staff

Clinical practice in the department of acupuncture and moxibustion< Midori no Kaze Clinic (1st Floor) >Orthopedics

Internal medicine, Kampo medicine

Physician: Yoshio Miyazaki; physician:Takahiro Shintani
Director of the Midori no Kaze Clinic

Professor of the department of healthservices of the Morinomiya College ofMedical Arts and Science

MRI< Midori no Kaze Clinic (2nd Floor) >Rehabilitation

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

19

Volume 5, Number 1 | Spring 2010

Clinical Report 2 (Japan)
One Case that had Effect of Bakumondoto on Post-Herpetic
Neualgia caused by Yin Deficiency
Mihoh Koga, M.D. – Kampo Specialist
Division of Clinical Pharmacology and Therapeutics,
Division of General Medicine

Jikei University School of Medicine

Different types of individual therapies havebeen attempted to treat post-herpetic neuralgia,
which is one of the conditions for which Kampo
medicines are very frequently used. As we
recently had a successful case that had benefits ofbakumondoto, we will hereunder report it with
our observations and a bit of our views.

the Department of Neurology and Internal
Medicine of a certain university hospital, he hadreceived MRIs due to walking with unsteadysteps and it was found that there were small
cerebellar infarctions x 3 places. He had been toldby the physician that the symptoms would not be
associated with the infarctions and Perkinsonim
was suspected, for which Madopar had been
administered “experimentally to see his reactions
to the medication.” When he visited us, it did notseem that words did not come out easily although
he had the dry tongue that prevented his smooth
speaking. While talking, he incessantly drankwater from a plastic bottle.

[Case]
Male of 85 years old. Small build and thin, aged
person with fair complexion.

[Drugs currently being taken]
Candesartan /Disopyramide / Arotinolol /Magnesium Oxide / Biofermin / Neurotropin /[Chief complaint]

Trimebutine

1. His speech began to slur 2 to 3 years ago.

keishikaogito+Processi

2. 10 years suffering of postherpetic neuralgia

Dipotassium(left lumbar area L3/Level 4).

Brotizolam / Etizolam

3. Habitual constipation.

the left lumbar area L3/Level 4 and then PHS
was induced. The pain was severe and even therubbing of clothing against the skin caused pain.
The patient had been receiving treatment by thepain clinic of a certain university hospital withthe prescription of keishikaogito+Processi Aconiti
2.5

months.

/Aconiti

Clorazepatate→

Levodopa

/

Radix

/

Zolpidem/

He had been living in a care facility for about a

About 10 years ago, herpes zoster developed inforAmitriptyline[Living environment][Origin and course]

Radix

/

He

said

that

year.
[Findings]
Food intake, frequency, and time were well
regulated so that he had a weight loss to 44 kg
from 50 kg. Now he prepared by himself
in-between snacks and eat them. Although hewas sensitive to cold by nature, he claimed thatthethe feet felt warm and burning in this winter.

administration of this medicine brought a pain

There was no itchy sensation in the skin but therelief for a while. Lying down on the bed for a

tongue was dry and red colored. The abdominal

clinical examination produced pain.

strength was reduced with the soft abdominal

He had had the feeling of being unable towall and stools were palpated.

speak articulately and properly for 2-3 years. At

20

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

Volume 5, Number 1 | Spring 2010

[Diagnosis]

The author considered that the root cause of

The dryness of the body was intense and his

the patient’s symptoms was yin deficiency lacking

pattern/syndrome was diagnosed as being caused“the amount of fluids” to enrich yin and that theby yin deficiency.

pain[Treatment]

nourishment.” As the mouth was severely dry and

Neurotropin, Amitriptyline, and famotidine

wascausedbythe“stagnationofthe large intestine of the stomach-intestines wascausing the side effect of dry mouth were

also

discontinued. Likewise, Biofermin and Levodopa

stomach-yin

were discontinued because of the uncertainty of

Bakumondoto which works on the lung, wasthese drugs’ effectiveness. keishikaogito+Processi

effective because the inextricable relationshipAconiti Radix was also discontinued as itexists between the large intestine and the lung.

contributes to dryness.

dry,leadingtodeficiency

constipation,
wasfirstlyapproached.

The pain-relief action of

Aconti tuber, one of the ingredients of this Kampo
medicine may help kill pain temporarily, but its
continued

use

has

a

high

potentialofexacerbating 2 above.
The administration of 3 packs each of TSUMURA

bakumondoto（Tsumura & Co., Ltd., Tokyo, Japan）
and TSUMURA mashiningan（Tsumura & Co., Ltd.,Tokyo, Japan） was started in equal doses threetimes a day.
[Treatment and course]
The amount of saliva increased within 2 weeks
and the patient became aware that he was able tospeak smoothly. However the pain remained as ever.
After 5 weeks, he did not complain of the painin the lumbar region in abdominal examinations.
After 8 weeks, when he was asked about thepain, his reply was “have forgotten about it!”His complexion was good with healthy glow.
He was aware of skin moist. Sleep improved andbowel movements became regular.
Same medication was continued.
In this patient, the symptoms might have
improved only by excluding excessive drugs andan inappropriate Kampo medicine.
This was a case that provoked the author tothink about iatrogenic diseases.
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

21

Volume 5, Number 1 | Spring 2010

Clinical Report 3 (Japan)
One Case that had Effect of Daibofuto on RA with High Level ofManiphalanx Deformation

Hiromichi Yasui

Japan Institute of TCM Research[Case]
Female of 79 years old
Initial visit: November 4, 2009
Chief complaint: With deformed finger joints on
both hands, unable to open them.
Current medical history:
Since the diagnosis of rheumatoid arthritis ofabout 20 years ago, the patient had received
treatment. The daily dose of 5mg of prednisolone
was started six years ago. The deformation ofboth hands began to progress about 5 years ago.
About a year ago, the fingers of both hands
drifted into the ulnar-deviated positions, in which
they (fingers) pointed toward little fingers. All
fingers became bent with pains, and graduallyadvanced to the inability of their extension. The
deformation of toes was prominent. From a week
ago, hand fingers were being unable to open at all,causing her great difficulty in carrying out
normal activities of daily living, such as using
chopsticks at mealtimes and using the toilet. Due
to pains in both shoulders, upper limbs could not
be raised. Toes on both feet were also deformed.
Loxoprofen relieved morning pains, so that it was
routinely used.
Appetite: Ordinary
The patient always had dry mouth. She
frequently drank water.
Sleep: She had difficult in falling asleep, but it
was not a special problem.
Defecation: Once/day
Urination: 10-12 times/day
Present condition: 134cm (as her back washunched, the height was inaccurate.) and 42kg.
Because of the deformed lumbar spines, herback was greatly hunched over.
Pulse: Sunken and thin
22

Tongue: Pale red with no furs. Smooth without
lingual papillae.
Diagnosis: Deficiency of qi and blood and weak
constitution / liver-kidney deficiency / wind-cold
dampness causing accumulation and stagnationof excess fluids.
Method of treatment: To tonify qi and blood/to
dispel wind and disperse swelling
Prescription: daibofuto decoction with adjustment
Angelicae Acutilobae Radix 4g
Paeoniae Radix 4g
Rehmanniae Radix 4g
Astragali Radix 4g
Saposhnikoviae Radix 4g
Eucommiae Cortex 4 g
Atractylodis Lanceae Rhizoma 4g
Zingiberis Rhizoma 1g
Cnidii Rhizoma 3g
Ginseng Radix 2g
Notopterygii Rhizoma 2g
Achyranthis Radix 2g
Glycyrrhizae Radix 2g
Ziziphi Fructus 2g
Aconiti Radix Processa 2g
Course: The pain in the fingers on the hands
improved within 2 weeks and they could be opened
slightly. After 4 weeks, they could be further opened
with the pain in the right shoulder resolved,
allowing the right arm to be elevated. However thepain in the left shoulder still remained. At this point,
non-prepared Aconiti Radix 0.5g was added. The
patient showed CRP0.3 and KL-6 188 on December
17. On January 13 of year X+1, the fingers on both
hands could be opened further wider and the pain in
the left shoulder disappeared and no problems wereleft with both upper limbs. On March 18, the level of
CRP was 0.00 whilst that of RF was 201. In May, thepatient resumed his farm work. In the visit to thehospital of August 18, she showed further recovery
and was more cheerful.

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

Volume 5, Number 1 | Spring 2010

[Discussion]
The patient with the history of RA for 20 years
could not open fingers of both hands, causing thedifficulty in carrying out her daily living.
Furthermore, she had the back hunched andpains in the joints of both shoulders, so that evenmotions gave her excruciating pains and she wasat a complete loss. Thus she visited our clinic.
Unlike in the initial stage of RA development,
disabilities and limits to motions due to thedeformation as well as continuing pains as everthreatened her daily living.
The patient had the long time stagnation ofwind-dampness which obstructed the flows of qi
and blood, resulting in deficiency at the sametime. Because of this, strong medicines for
disorders in the acute stage cannot appropriately
be used. Wind-dampness must be eliminatedwhile qi and blood are being tonified andreplenished to allow for their flows to be
recovered. The patient disease was long-standing,leading to the deficiency of the liver-kidney, whichfurther caused the inability of producing
nutrients for muscles and bones. Therefore, theliver and kidney needed to be replenished.

How could such conditions of the chronic phasebe improved in a short period of time, and even if
possible,

improvements

would

be

limited.

Notwithstanding, only a little improvement could
improvethequalityofthepatient’s

life.

Especially whether or not she could open andclose the hand fingers did matter a lot to her.

Daibofuto has the action of replenishing
deficient

qi

and

blood

and

eliminating

wind-dampness being stagnant in muscles andbones.

Two

weeks

after

the

start

of

administration, the hand fingers became able toopen and close, and then general pains became
gradually improved, making the patient’s dailyliving less difficult. Some functional recovery inother patients with RA that has progressed todevelop deformity over an extended period of time
can be expected to a certain degree, if notcomplete, and the quality of life will be enhancedby means of identifying the etiology to provide
appropriate

procedures.

Daibofutoisarecommendable medication for such cases.

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

23

Volume 5, Number 1 | Spring 2010

Kampo Formula Developed in Japan (1)Otsujito (“B”Character Decoction)
Hiromichi Yasui
Japan Institute of TCM Research

Otsujito(“B”Character

Decoction)

was aformula invented about 200 years ago in Japan by
Nan-yo Hara (1752-1820). He created several new
formulae and four of them have names startingwith Chinese Zodiac, Ko(A), Otsu(B), Hei(C), andTei(D). Otsujito is the most well known formula ofthem all. After this, Sohaku Asada (1815-1894)
modified the otsujito and the modified formula is
now called otsujito.
The formula is now available in the extract
form and often used as a specialized prescription
for hemorrhoids (piles) in clinical sites. The
constituents of the prescription are as follows:
Angelicae Acutilobae Radix 6 g

Bupleuri Radix

5g

Scutellariae Radix

3g

Glycyrrhizae Radix

3g

Cimicifugae Rhizoma
Rhei Rhizoma

1g

1g(In the original prescription made by Nan-yoHara, Japanese angelica Root was not used but
instead Chinese Date and Fresh Ginger were
contained.)[Efficacy] Cooling and activating the blood andelevating qi[Indications] Blood heat, blood stasis, falling qi[Drug actions] Angelicae Acutilobae Radix
activates the blood and its circulation. Bupleuri
Radix frees qi movement in the triple energizers
and Cimicifugae Rhizoma enhances sunken qi.
Combined use of these three kinds of drugs
resolves obstructed network vessels (meridian)caused by qi binding in the lower energizer.
Scutellariae Radix clears heat generated by qi
stagnation and blood stasis. Rhei Rhizoma enters24

the qi system and the blood system, clears theheat and purge the fire and cool the blood andthen expels toxins. Glycyrrhizae Radix has theactions of harmonizing various drugs as well asclearing heat and resolving toxins.
Clinical application
Otsujito is used for various types ofhemorrhoids and its use is especially suitable forthe relatively acute condition in which there areconstipation, pain and small amounts of bleeding.
Otsujito is also used for prolapsed hemorrhoids inthe initial stage.
1. Hemorrhoids
Yoshio, et al. administered otsujito 6.0g to 98
patients with hemorrhoids for 8 weeks to compare
subjective symptoms (pain, bleeding, prolapse)
and objective symptoms (bloating, size ofhemorrhoid) before and after the administration.
They report the results of the overall
improvement rate that markedly improved
accounted for 28.6%, improved 39.6%, andslightly improved 23.5%. For the rate of
usefulness, extremely useful accounted for 22.4%,
quite useful 41.8%, and slightly useful 21.5% withthe recurrence rate of 15.2% after the
discontinuation of administration. The recurrence
timing was after 2.5 to 7 months after the
discontinuation of administration1).
When this prescription is clinically used forhemorrhoids, generally it is not used by itself but
it is often used in combination with otherprescriptions. For example, keishibukuryogan(Cassia Twig and Tuckahoe Pill) is combined if
blood stasis is complicated; hochuekkito(Middle-Reinforcing and Qi-Benefiting Decoction)
if there is distinguished qi deficiency; yokukansan(Liver-Inhibiting Powder) if there is marked liverqi depression; and orengedokuto (Coptis
Detoxificating Decoction) if there is an excess
heat toxin.

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

Volume 5, Number 1 | Spring 2010

Case 1: Hemorrhoid
The patient was a male of 27 years old. He
had been suffering hemorrhoids since his schooldays. Recently, an anal fissure (bleedinghemorrhoid) and internal hemorrhoids of afinger-tip size became inflamed like attacks
several times a year so that the patient was
somewhat neurotic. Although his doctor
recommended a surgery, he could not be awayfrom work for hospitalization for as many as a
week. So he did everything he did but thecondition did not improve at all. He felt likeusing “Kampo Medicine” and visited the clinic.
He was quite healthy except for the affectedarea although there was the sho of blood stasis.
Therefore, the decoction of otsujito wasadministered for continuous two months without
effects. Since there were no reasonableconditions for changing the prescription and thepatient said that it took a lot of trouble toprepare the decoction, I decided to use theextract tablet of otsujito and keishibukuryogan
as a drug for dispelling blood stasis.
Three weeks later, the bleeding stopped andpain was also relieved. After continuous use forsix months, an examination indicated that theinternal hemorrhoids reduced to the size of apiece of soybean and the symptom of blood stasisof the face and the lower abdomen disappeared.
Two years passed without the medication.
However, there has been no recurrence.
(Akira Ishihara, Two Cases in Clinical Trial on
Otsujito, The Association of East-Asia
Medicine Vol.12 3-go p61, 1965)
Case 2: Hemorrhoidal bleeding
Patient: Female of 34 years old
Chief complaint: Bleeding
Current medical history: When constipated, she
had bleeding and the toilet bowl became bright
red, which began to happen several years ago.
Whenever bleeding occurred, the patient used

over-the-counter suppositories. As bleeding
became severe four days ago and did not stopwith suppositories, she visited our clinic.
Findings at the initial visit: There were threeinternal hemorrhoids in the 3 o’clock, 7 o’clock,and 11 o’clock positions. From the internal
hemorrhoid in the 7 o’clock position, rupturesand bleeding were observed. The internal
hemorrhoid was positioned in the 1 o’clock
direction.
Treatment: otsujito (Tsumura & Co., Ltd.,Tokyo, Japan) were used with orengedokuto(Tsumura & Co., Ltd., Tokyo, Japan) Extract
Granules (for ethical use). On the 2nd day of theadministration, the bleeding disappeared. Afterone month of administration, a proctoscopic
examination showed the bleeding stopped andthe internal hemorrhoids changed in color frombright red to dark red.
(Tomonori Kawai, Jishitu ni taisuru Kampo
Seizai Heiyo Ryoho, Kampo Shinryo Vol.7, 2-go,
p50, 1988)
Case 3: Bleeding hemorrhoids and pain
Patient: Female of 59 years old
Chief complaints: Bleeding and pain
The patient had a medium physicalconstitution and no anemia with slightly dark
complexion. Appetite and sleep were normal.
Bowel movements were diarrhea-constipation.
She was sensitive to cold (+) with no dry mouth,and no sweat. The abdominal sho was shown in
Figure 1. There were two hemorrhoids with thesize of a piece of soybean in the 7 o’clock position.
After three months of administration of
otsujito 8.0 + hochuekkito 6.0 (per day), no
bleeding was observed. After five months, thepatient complained pain only sometimes. A cure
was achieved within eight months.
(Shigeru Tanaka, Jishitu to Kampo Chiryo,
Kampo Shinryo Vol.5, 1-go, p42, 1986)

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

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Volume 5, Number 1 | Spring 2010

1. Prolapsed hemorrhoid
Otsujito works to recover the qi movementbound in the lower energizer. So this formula isalso used for prolapsed hemorrhoids. Bupleurum
Root and Cimicifuga Rhizome contained in theprescription enhance stagnant qi movement by
their action of raising qi and drooped organs
caused in conjunction with lowering qi. The
prolapsed hemorrhoids which are the symptom of
deficiency are often accompanied by spleen
deficiency, in which case hochuekkito, forexample, is used in combination.
Case 4: Prolapsed hemorrhoid and pain
Patient: Female of 45 years old
Chief complaints: Prolapsed hemorrhoid andpain
Sometimes hemorrhoid prolapsed during abowel movement, which began to happen several
years ago. Pain was added and became
persistent from two months ago.
The patient face was pale but did not haveanemia. The lower half of her body was cold.
Appetite and sleep were normal. Bowel
movements were once/day with one slightly softstool. The dry mouth condition was (+) withsweat (-). The overall abdomen was weak andsoft without resistance. The affected area: The
hemorrhoid with a size of a finger tip was in thestate of an everted flower and the surrounding
tissues were congested and swollen. Intense pain
was felt intense in palpation. “shiunko” wasapplied and then the hemorrhoid was pushed
back. Shiunko was used as an external
medication.
I judged that an intense sensation of cold withnormal appetite was the symptom of deficiencyof qi and blood. On the basis of this, Prepared
Aconiti Radix Processa 1.5g + shikunshito 8.0g
(per day) were administered for two months.
Then the prolapsed hemorrhoid became able toretract somehow. Therefore, the medications

26

were changed to otsujito 7.0g + hochuekkito 7.0g
(per day). For constipation the patientcomplained of, mashiningan 4.0g (as needed)
was used after dinner. Further two months later,
prolapsing was reduced to only a little during abowel movement. Further three months later,
subjective symptoms relieved. The medications
were suspended again for further two months.
(Shigeru Tanaka, Jishitu to Kampo Chiryo,
Kampo Shinryo, Kampo Shinryo Vol. 5, 1-go, P39,
1986)
1. Itching around the anus
Anal itching is often caused by damp-heat in
the lower energizer. This prescription has theaction of recovering qi movement in the lower
energizer and concurrently dispelling damp-heat,by which the itchy sensation in the anus and theanterior pubic region can be relieved.
Case 5: Bleeding hemorrhoids and itching aroundthe anus
Patient: Male of 38 years old。
Initial visit: July 30, 1983
Present medical history: The patient had been
complaining of bleeding from the anus anditching around the anus for about two years.
Present condition: The patient was of large
build, fatigable, and unable to have sufficient
sleep with pale complexion. The patient was aheavy sweater (whole body). The anus felt no
pain but there were bleeding and an itchy
sensation around the anus. Bowel movements
were once a day with one stool and there was asensation of residual stool. Appetite was good.
The tongue was covered with thin white furs andmoist. Pulse was floating with strength. The
abdomen was generally soft with a slight bloating
feeling in the chest and hypochondrium on rightand left sides, and there was a slight tension over
the abdominal muscles in palpation.

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

Volume 5, Number 1 | Spring 2010

[Treatment and course]
During the administration of otsujito(without
Rei Rhizoma), subjective symptoms gradually
improved. By the end of the 100 day
administration, they become resolved.
(Genpo Ogata, Kampo Chiryo Shorei-Senshu (1)P236, Gendai Shuppan Planning Co., Ltd. 1988）

3)

Akagi K, et al.: Ninshin/Sanjyoku no Komon
Shojyo eno Otsujito no Toyo Koka, Kampo
Shinryo Vol. 15 No. 3, P41-42, 1986

1. Hemorrhoidal disease during puerperium
Pregnancy and child birth delivery haveadverse influences on the development ofhemorrhoids and its worsening. There is adocumentation reporting that otsujito was
successfully applied to these problems.
Honda said that 58% of puerperal women
become affected with hemorrhoids, 30% of thewomen develop hemorrhoids after delivery
although they did not have hemorrhoids during
pregnancy, and 60% of the women who had
hemorrhoids during pregnancy do not have relief
within one month after delivery and rather tend
to have exacerbated symptoms such as bleeding,prolapse, and pain during the period of
one-month-after delivery. He administeredotsujito to 30 patients with hemorrhoids observedon the 1st day of the puerperium, reporting theresults of significant improvements in four
symptoms of “painful bowel movements,”“bleeding,” “prolapse,” and “swelling,” slightly
effective in 11 patients (36.7%), and quite
effective (36.7%) with the overall effectivenessrate of 73.3%2). Akagi, et al. also administeredotsujitofor
anal
symptoms
duringpregnancy/puerperium and obtained mostly
similar results3).
1) Yoshio T, Yanagida K, Sumiyama Y, et al.:Naijikaku ni taisuru Otsujito no Rinsho
Koka, Journal of New Remedies and Clinics
40:2087-2096, 1991
2) Honda T, et al.: Fujin to Ji-shikkan-sono 4 –Kampo (Otsujito) no Koka – Bosei-Eisei, Vol.
31 No. 1, 1990

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

27

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

35

Volume 1, Number 3 | Fall 2006

Kanebo Pharmaceutical, Ltd.
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2

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