Volume 8, Number 4 | Winter 2013

Kampo Medicine - Current Research
Kampo Treatment for Allergic Rhinitis and Hay Fever
Hiromichi Yasui
Japan Institute of TCM Research

general improvement, with 12.0% showing markedimprovement, 32.6% moderate improvement, and39.1% slight improvement, resulting in a usefulnessof 46.2%3).
Furuuchi et al. also conducted a study using

shoseiryuto against year-round allergic rhinitis.

IntroductionMore than 20% of Japan’s entire population are

Rate of efficacy was 45.0%, and reached as high as

said to be affected by allergic rhinitis, with the77.5% when including “somewhat effective” cases.

numbers further increasing yearly.

When looking at overall improvement by degree ofStandard treatment includes drug therapy using

severity, rate of efficacy was 56% among severe cases

anti-allergenic drugs (oral medicine, nasal drops, eyeand 38.9% among mild cases. It was thus reporteddrops, etc.), phylactic remedy (antigen avoidance)that shoseiryuto is highly effective particularly

using

among severe cases4).

gogglesandmasks,

hyposensitization

treatment, and surgical remedy. Most of theseThrough these studies, it has been found thattreatments work well and control the relevant

shoseiryuto is highly effective against roughly 45%

symptoms through the hay fever season withof year-round allergic rhinitis cases, and extremely

continuous use. However, they are ineffective ateffective against another 12%.

times, or produce a strong side effect, and are notTherefore, it is not an exaggeration to say thatexactly without problems. Kampo drugs, on the

shoseiryuto is the foremost selected drug against

other hand, have the power to fill in voids thatallergic rhinitis and hay fever. A typical case isWestern medical treatment cannot address, andpresented below.

offer many advantages, such as imposing minimumA

47-year-oldwoman

suffered

hayfeverphysical damage even with prolonged use. In thesymptoms every spring since ten years ago. In

1970s when allergic rhinitis and hay fever began toaddition to typical symptoms such as sneezing,garner attention, kakkonto and shoseiryuto were
known to be effective. Thereafter, however, thesymptoms have become complex, such that it has
become increasingly difficult to treat the diseases

runny nose and nasal congestion, she also developed
eye irritation. She preferred Kampo, because thedrugs she used previously made her sleepy andimpeded her daily life. She took a shoseiryuto extract

with just a few varieties of Kampo prescriptions.

and soon experienced a mitigation of her symptoms.

Shoseiryuto – Prescription most frequently used for

As the prescription was effective for three to fourwind-cold type allergic rhinitis

Shoseiryuto has been used most frequently
against allergic rhinitis since emergence of thedisease. Many cases have been reported and studies
are being actively pursued.
Accordingtoadouble-blind

randomized

controlled trial conducted by Baba et al. using

shoseiryuto for year-round nasal allergy, the groupthat was prescribed shoseiryuto displayed
significant improvement compared to the placebogroup. They achieved a solid result in terms of
8hours, she took it three times a day. By early May,
her symptoms had disappeared, and she stopped
taking the prescription.
On January 22 of the following year, the patient’s
hay fever symptoms reappeared, so she once again
took shoseiryuto like she did before, this time for twomonths. The patient continues to develop hay fever
every spring, and comes to the hospital every year toreceive a prescription for shoseiryuto. She would
take Olopatadine Hydrochloride on an as-neededbasis when her symptoms were severe, but for many

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

Volume 8, Number 4 | Winter 2013

years until today, her short-term use of shoseiryuto

Symptoms may also vary according to type ofallows her to live each day comfortably without thepollen. Cedar pollen is dispersed into the air in

discomfort of any symptoms.

February and March, hinoki cypress pollen in April,

In this way, shoseiryuto is effective for many
patients, but subsequent studies have begun toreveal that each patient’s condition of allergic
rhinitis is diverse even from the Kampo perspective.
Disease patterns and recent changes in allergic

pollen from orchard grass and other gramineous
plants from May to early summer, and pollen fromhogweed and other asteracea plants in autumn.
Furthermore, the same patient may display different
symptoms for cedar and cypress pollen.
Dr. Imanaka came across patients who showed
symptoms of the wind-cold type of rhinitis but whoserhinitis
In Chinese medicine, allergic rhinitis is classified

nasal mucosa was red and swollen or whose ocular

into wind-cold type, wind-heat type, and weakness

mucous membrane became red. He judged that atype.

wind-cold pathogen invaded the body from outside

In the wind-cold type, a wind-cold pathogen

even though the patient had inner heat, and the(pathogen with cold properties) invades the body

patient experienced a mixture of cold and heat. Thus,from outside. In the wind-heat type, a wind-heat

he added gokoto to shoseiryuto, and observed apathogen (pathogen with properties of heat) invades

dramatic efficacy. He named the prescription

the body from outside. In the weakness type, there is
not enough healthy qi to protect the body against
pathogens from outside.
In Japan, shoseiryuto, kakkontokasenkyushin’iand senkyuchachosan are used for the wind-cold
type of rhinitis. eppikajutsuto and shin’iseihaito areused for the wind-heat type of rhinitis, andhochuekkito and maobushisaishinto are used for theweakness type of rhinitis.
In recent years, however, the symptoms of allergic
rhinitis have changed somewhat from the Kampo
perspective. This has to do with changes in thelifestyle environment (including foods and drinks) ofmodern people.
Even when clear snivel flows, as in the wind-cold
type of rhinitis, if the patient wants something cold
to drink, has a red tongue, or inner heat, the heatmust also be cooled down at the same time.
This is related to the season, to a certain degree.
In February, the outside environment is cold, so r is

koryuto by taking the “ko” (meaning tiger) fromgokoto and the “ryu” (meaning dragon) fromshoseiryuto.
Dr. Imanaka introduced the following patient towhich koryuto was effective.
A 58-year-old man suffered hay fever every springfor 25 years. He experienced severe symptoms ofrunny nose, nasal congestion and eye irritation, but
as he was a golf coach, he spent a lot of his timeoutdoors. He somehow dealt with his symptoms bytaking Fexofenadine Hydrochloride that causes lessdrowsiness than other antihistamines, and also byusing antihistamine eyedrops and steroid nasal
drops, but he would still develop hay fever every year
from February to early May. 2009 was a year of masspollen dispersal, but thanks to the combined use of

shoseiryuto and gokoto from March 11, he was able
to spend the hay fever season comfortably without
taking Fexofenadine Hydrochloride 5).

effective, but when the outside environment becomes

Dr. Imanaka says that in most cases, hewarmer in March and April, some people experience

prescribes shoseiryuto for hay fever around February,stronger inner heat, along with the rise in ambientand adds gokoto around March when inner heattemperature.

occurs. Contrarily, if there is a patient who has the
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

9Volume 8, Number 4 | Winter 2013

wind-cold type of rhinitis but cannot be treatedadequately

withshoseiryuto,

headdsmaobushisaishinto.

patients who do not benefit from such drugs means
different conditions must be assumed.
Allergic rhinitis mostly occurs in spring andActually, there is a certain characteristic to theautumn, as a result of a wind-cold pathogen or wind-abovementioned prescriptions.

heat pathogen invading the body. These are called

shoseiryuto, gokoto, kakkontokasenkyushin’i,eppikajutsuto, and maobushisaishinto all contain
Ephedrae Rhizoma. Ephedrine, the major ingredientof Ephedrae Rhizoma, was found to be contained inEphedrae Rhizoma by a Japanese pharmacologist“outer winds.”

named Nagayoshi Nagai.

Drs. Ebe and Haimoto.

On the other hand, “inner winds” are pathogens
that occur inside the body. The mechanism by whichallergic rhinitis is caused by “inner winds” has been
simultaneously discovered and clinically applied by

In subsequent studies by various other people, it

They thought that inner heat is originally

was found that ephedrine has a sympathomimetic

generated by yin deficiency, and when it rises andeffect similar to adrenaline.

becomes an inner wind, excess water around theFor this reason, it can be said that Kampo drugs

chest rises and suddenly produces snivel. Theirsuch as shoseiryuto that contain Ephedrae Rhizomaprescriptions differ, but they share the same concept.

is effective against allergic rhinitis by the action ofephedrine. Needless to say, these drugs are not madeof a single ingredient, but exerts an effect by thesynergy of many other drugs.
Nevertheless, when looking at short-term efficacy,
Kampo drugs that contain Ephedrae Rhizoma begin
to work after about twenty minutes of taking it,
continues to be effective for about three hours, andDr. Ebe’s prescription6)

Menthae Herba 6 / Chrysanthemi Flos 15 /Rehmanniae Radix 15 / Paeoniae Radix 15 /Haematitum 15 / Fossilia Ossis Mastodi &Ostreae Testa 15 each / Gypsum Fibrosum 30 /Fritillariae Bulbus 10 / Kasseki 15 /Glycyrrhizae Radix 6Dr. Haitani’s prescription7)

thereafter gradually declines in efficacy, in mostRehmanniae

cases. For this reason, it is frequently necessary toRhizoma 15 / Paeoniae Radix Rubra 15 /consider the timing of taking the drug. In some cases,

Glehniae Radix cum Rhizoma 10 /Ophiopogonis Radix 10 / Cnidii Rhizoma 10 /Menthae Herba 3 / Glycyrrhizae Radix 5 /Gypsum Fibrosum 20

another dose needs to be taken at night. From thelong-term perspective, there have been cases wheregeneral symptoms had improved unawares.

Radix

7/Anemarrhenae* Note: Most antihistamine drugs do not contain ephedrine,

These prescriptions cannot be substituted with

but in recent years, a new product (product name: Dillegra)

extracts, but jiinkokato+senkyuchachosan comes

has appeared, which adds ephedrine to fexofenadineclose. What must be noted here, however, is thathydrochloride (product name: Allegra). When taking this

there are cases where yin deficiency may haveproduct in combination with a Kampo drug, it is necessary tooccurred from taking an antihistamine continuously.

pay attention to the concentration of ephedrine.

In this case, the above prescription should be used

A new type, discovered just recently
The use of ephedra agents such as shoseiryuto iseffective for only up to approximately 45% of patientsand no more. The fact that there are around 30% of

10by reducing the amount of antihistamine as much aspossible.
Within this type of rhinitis, there have beenreports of cases where the patient was dramatically
cured by taking a bakumondoto8).

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

Volume 8, Number 4 | Winter 2013

The

Prevention

efficacy

rateofmaoto+eppikajutsuto

In the case of year-round allergic rhinitis, it isprescribed to severe cases (7 patients) was 72%. In

necessary to make up for the lack of qi, also forthe case where shoseiryuto+gokoto were used inprevention.

hochuekkito

commonlyusedandwiththerikkunshito

arecombination to strengthen the anti-inflammatory

additionofaction of Ephedrae Rhizoma and Gypsum Fibrosum

maobushisaishinto.

(16 patients), efficacy rate was 87% and exhibited an

Even if it is seasonal, the above prescription

even better result. Of these patients, there wereshould be prophylactically administered so thenone who needed to use an oral steroid, and only one

symptoms do not appear.

patient who complained of a heavy stomach feeling

Spring hay fever should be treated from autumn

as a side effect.

or winter. hochuekkito should be mainly considered.

Based on the above result, Dr. Imanaka et al. said

Dr. Iwao Yamamoto administered hochuekkito alongthat Western and Kampo drugs could be used inwith tokishakuyakusan as a prophylactic9).

combination as an attempt to increase efficacy.

Other prescriptions for health improvement

It should be noted that even if nasal symptoms areinclude saikokeishito and keigairengyoto. Somealleviated by Kampo treatment, allergy test values

signs for using keigairengyoto are whether the

hardly change, and IgE RAST and IgE RIST values

patient has a sinus problem or heat symptoms thatalso show hardly any changes. However, there is noaccompany tonsil inflammation. People who develop

data on the results of long-term administration.

hay fever symptoms from around January should beWith regard to the combined use of Kampo drugs

administered tokishigyakukagoshuyushokyoto fromwith other standard treatment, there have been no

before they develop the symptoms. In some cases, thereports so far that any inconveniences have occurred.

hay fever season ends without their experiencing
References

any symptoms.
Combined use with Western drugs
Kampo medicines are completely a different typeof drug from antihistamines. There is no problem incombining their uses, in most cases. If the patient’s
symptoms are severe and cannot be effectivelymitigated using Kampo alone, using a drug that goes
well with Kampo is recommended. The same applies
for eyedrops and nasal drops.

1) Committee for Preparation of Nasal Allergy
Treatment Guidelines: Nasal Allergy Treatment

Guidelines —Year-round Rhinitis and Hay
Fever— (2016 edition), Life Science, 2015 (inJapanese).
2) Committee for Preparation of Nasal Allergy
Treatment Guidelines: Nasal Allergy Treatment

Guidelines —Year-round Rhinitis and Hay
Fever— (2016 digest edition), 2015 (in Japanese).

There is a study on the combined use of Kampo3) Baba S, Takasaka T, Inamura N, et al.: “Efficacy ofand Western drugs, by Dr. Imanaka, who developed

shoseiryuto against Year-round Nasal Allergy —shoseeiryuto+gokoto as mentioned above, along with

Double-blindDrs. Mine and Yamazaki10).

Practica Oto-Rhino-Laryngologica 88 (3) 389-405,

According to the study, the efficacy rate ofRandomized

ControlledTrial—,”1995 (in Japanese).

shoseiryuto administered as the foremost selected4) Furuuchi et al.: “Study of the Clinical Efficacy ofdrug against allergic rhinitis (20 patients) was 45%.
The efficacy rate of eppikajutsuto (24 patients) was

shoseiryuto against Year-round Allergic Rhinitis,”
Allergy in Practice 7: 502-513, 1987 (in64% and even better.

Japanese).

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

11

Volume 8, Number 4 | Winter 20135) Imanaka M: “Memorable Cases <1> Tsumura
Medical Today,” Radio NIKKEI, Jan. 5, 2011
broadcast (in Japanese).
6) Ebe Y: “Spring Hay Fever Caused by Yin
Deficiency,” Clinical Journal of Traditional

Chinese Medicine Vol. 29, No. 1, 50-55, 2008 (inJapanese).
7) Haimoto H: “Jibiinkoto for Allergic Rhinitis
Cause by Yin Deficiency,” Φυτο, Vol. 8 No. 2, 410, 2006.
8) Otsuka, Keisetsu, Domei Yakazu, and Totaro
Shimizu: Kampo shinryo iten (dictionary ofKampo medicine, 247-248, Nanzando, 1964 (inJapanese).
9) Bando S: Practice of Kampo Therapy Based on

Disease Names, Medical Yukon, 2002 (inJapanese)10) Imanaka M, Mine H, Yamazaki T: “ClinicalEfficacy of Kampo Combination Therapy against
Cedar Pollen Allergy,” Kampo Medicine, Vol., 60,
No. 6, 611-616, 2009 (in Japanese).

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