Volume 5, Number 3 | Fall 2010

Kampo Medicine - Current Researchwide array of collagen diseases. For otherCollagen Disease

symptoms, Kampo medicine handles individual

Masayuki Kashima

Department of Internal Medicine
Kumamoto Red Cross Hospital

Collagen diseases and the relative diseases are

symptoms as separate clinical conditions and has
not regarded them as a single disease concept forlong. Therefore, the modern Kampo medicine
does not have a unified view of etiology andimmune system disorders and the causes remain

pathogenicmechanisms

thatto be identified. Because of unexplained causes,

accuracy of the pathological conditions that canthe treatment with Western medicine is aimed atexplain the natural history including varieties ofcontrol of further progression of the diseases tosymptoms,

later stages or relief of worsening conditions andprognosis. In our time, most individual symptoms

symptoms. Drugs used for the purposes, such asof a disease are separately approached. Studies tosteroids and immunosuppressant drugs, will

search for etiology and pathogenic mechanisms ofcause various adverse effects, and medicaleach collagen disease are desired in order toresources are consumed at the same time. In theenhance the treatment performance of short-term

situation, the treatment with Kampo medicines,

symptoms and to achieve full-scale improvement

which are relatively cheap with few adverseof the prognosis.

effects, is meaningful. In effect, there are many

Introduced

development

hereunderofcanpinpointdiseases,

arerecentandnotableplay

clinical trials in Japan on typical collagenpositive roles in controlling symptoms of collagendiseases and similar diseases such as rheumatoid

diseases as well as a worsening of the diseases,arthritis, SLE, and Sjogren’s syndrome.

reportssuggestingenablingtoKampo

reducemedicines

thevolumeof

immunosuppressant agents and alleviate theirside effects.
Many of collagen diseases and the relative
disorders often cause pain, swelling, and stiffnessof joints and the musculoskeletal system and forthereason,collagendiseases

areoften

generalized as a group of “rheumatic disorders” a traditional concept of Western medicine after
Greek medicine. Kampo medicine has a similar
concept called “bi pattern or arthritis.” This
concept was established and discussed 2,000years ago in the most old classical book “Yellow
Emperor's

CanonofMedicine/Plain

Conversation”. Even in the present days, collagendiseases and the relative diseases of joints andmusculoskeletal swelling, pain and stiffness areapproached, in principle, with discussions basedon

theancientarthritis

concept.

However,

musculoskeletal symptoms cover only part of a

Rheumatoid arthritis
Rheumatoid arthritis is known as one of themostcommontypesofcollagendiseases.

Western medicine of today has made a major
breakthroughinthetreatment

methodofrheumatoid arthritis. The main stream treatment
is to slow down disease progression with theadministration

ofa

groupofmedications(different types of drugs) known as DMARDs
which mainly use immunodepressant agents suchas Methotrexate (MTX). Especially in recentyears, a new treatment for rheumatoid arthritis
has begun to be performed aiming at a complete
remission

bypowerfullyactivities

withmonoclonal

controlling

diseaseantibody

agents,referred to as biologically derived agents, against
anti

TNF-α

antibodies

and

other

immune/inflammation inducing substances. As
image inspection technologies advance in recent

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

11

Volume 5, Number 3 | Fall 2010years, it has become known that joint destruction

and an appropriate assessment method was used;

starts one to two years after symptoms first

Tanaka administered for six weeks boiogito toappeared, much earlier stages than thought. For

RA32 patients, who met the diagnostic criteria of

this reason, it has begun to be recommended thatdefinite

DMARDs and biological agents be used in asRheumatoid standard criteria; neither changes toearly stages as possible with the objective ofthe drugs they had used nor new drug additions

preventing joint damage. In compliance with this,were made; and changes in Lansbury indexes ofthe diagnostic criteria have been revised in orderindividual patients were monitored. The results

to diagnose rheumatoid arthritis in its early

revealed effective in 14 patients (44%), slightly

stages1). Furthermore, efforts are being made toeffective in 5 (16%), remained unchanged in 5

identify, among unclassifiable joint inflammation(16%), and worsened in 4 (13%). The duration ofdisorders, a group having the high possibilities ofmorning stiffness, the number of painful joints,

RAunderAmerican

CollegeofHowever,and the number of swollen joints significantly

given side effects of DMARDs, high costs ofimproved. Their grip strength and CRP showed abiologicaltendency for improvement. From these results, theprogressing to rheumatoid
drugs,

arthritis2).

andproblems

ofimmnosuppression, wariness persists about thethought of lowering the treatment threshold ofgroup determined boiogito was effective for RA7).
Nagasaka,etaladministeredKampo

rheumatoid arthritis in the early stages that hastreatment to RA54 patients and assessed its

the possibility of spontaneous remission. In view

effectiveness. Their average disease duration wasof reductions in the usages of DMARDs and13 years and mean values of Steinbrocker’s

biological drugs, alleviation of their adverse

functional/stage classification were class2.3 andeffects, and means of treatment for somestage2.5. The 35 patients had been using

refractoy rheumatoid arthritis, relatively low-costWestern-style medicines since before the initial

Kampo treatment with less adverse effects mayvisit. The overall effect was “markedly effective”

mean a great deal as used to be.

in 41% of the patients, “effective” 10%, “slightlyIn

thearthritis

Kampo
intreatmentofrheumatoid“keishikajutsubuto”

Japan,effective” 18%, and “ineffective or exacerbated”

and31%. Twenty-six patients were able to discontinue“eppikajutsuto” are often used in Japan in light of

the Western medicines/reduce the body weight.

the historical use of the formulae described inAmong the prescriptions that yielded the result ofLue”3),4),5).

“slightly effective” or more assessed by theThere are many reports published on the use ofmodified Lansbury Index, boiogito had the“keishakuchimoto”

highest respose rate. Next followed by modified“Shan Han Lun” and “Jin Gui Yao
forrelativelyadvancedadvanced joint deformation. On the other hand, akeishikaryojutsubuto bushito, then modified
keishinieppiichito.
Boiogito
increased
thegroup of practitioners referred to as Gosei School,

response rate with more-than-usual amounts of

who emphasize on the prescriptions of the Ming

Astragali Radix and Sinomeni Caulis et Rhizoma.

Era, recently published a report that jiinkokato

And, Nagasaka, et al. further claimed that if nowas effective for rheumatoid arthritis in its early

effect was obtained from the single use ofstages6). There is a notable report on boiogito. In

keishikaryojutsubuto,
theadministration
combined with boiogito increased the response
rate8). As just described, boiogito is often applied

rheumatoid

arthritisand“daibofuto”

forthis research, relatively a large number ofpatients with rheumatoid arthritis were tested

12The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 5, Number 3 | Fall 2010

to rheumatoid arthritis in Japan - a characteristic
methodologyofJapaneseKampo

Nishizawa, et al. tested bakumondoto in amedicine.

clinical trial of 229 patients suffering from

However, this is not the case in other countries. It

primary Sjogren’s syndrome with six-monthshould be noted that unlike in other countries,administration. They were divided into twothat Sinomenim acutum Rehder et Wilson insteadgroups. A group of 115 patients were givenof Stephania tetrandra S.Moore (Fen fang ji ) isbakumondoto. B group of 114 patients were given

the main ingredient of boiogito in Japan.

a placebo. The results revealed that the amountsof both saliva and tears significantly increased

SLE
SLE in many collagen diseases shows therichest varieties of symptoms and prognoses. It isalso known as a disease that can cause dramatic
symptoms and outcomes both in short and longterms. It is difficult to say that similarly toWestern medicine, Kampo medicine has acquiredcomplete comprehension of the real clinicalconditions.

Therefore,

inmostcases,

SLE

treatment is given only to respond to individual
patients and symptoms from beginning to end, sotrial reports in a comprehensive way are scarce.
Even the same types of SLEs have different
patterns of symptom developments in individual
patients and the disease conditions ranges fromextreme severity to the severity for which only
follow-up is necessary but treatment is not
required and the severity to the extent thattransient worsening is repeated but the condition
spontaneously becomes stable. Here lies theproblem of difficulty to judge the effective degreesof treatment interventions. In such situation,
multiple cases were reported in which clinicalconditions improved by the use of Extract ofninjinto9). The report on the use of ninjinto,
having the efficacy of dissipating cold andwarming yang, for SLEs with fever symptoms isout of common and noteworthy.

increase was negatively correlated with theincreasing rate of the saliva secretion group andtheprogression

destruction

degreeofsalivary

gland

on Lubins & Holt sialographic

intensity classification. Saliva secretion amountscontinuously increased in A group after theadministration and became stable after six weeks
and onward. The amounts of salivary glandsecretion decreased in B group. Subjective
symptoms improved in A group, whereas thosebecame worse in B group.
reactions such as

Inflammatory

CRP and ESR findings

significantly improved in A group with a fewer
adverse effects in terms of the number of episodes
and patients. In A group, pain improved andkeeping

thehealthandQOL

significantlyimproved compared to pre-administration. The
overall rates significantly differed in all items
betweenthetwogroups

with80.9%

of“improvement” or above in A group and 0.9% in B
group and those who desired re-administration
were 92.0% in A group and 6.1% in B group10).
Ohno administered 64 patients with a definite
diagnosis of Sjogren’s syndrome bakumondoto asa medicine with the action of water retention andadditionally given drugs to tonify the kidney(“rokumigan”and“hachimijiogan”)

tothepatients who were diagnosed by Kampo medicine

Sjogren’s syndrome
In recent years, notable reports on randomized
clinical trials of Sjogren’s syndrome have been
published.

more in A group than baseline values. This

as having kidney-deficiency. The results werecompared with the control group of Kampo
treatment (hochuekkito). In the group thatreceived the Kampo medicine having the action of

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

13

Volume 5, Number 3 | Fall 2010

water retention, 2 of 32 patients dropped out. In
the control group, 4 of 32 dropped out. Monitoring
was made with 30 vs. 28. The results showed that“bakumondoto,” “bakumondoto + rokumigan,”and “bakumondoto + hachimijiogan” showedsignificant

differencesafter

fourweeks

ofadministration in the amounts of saliva secretioncompared to “hochuekkito”. Moreover, the groupsof additional administration of “rokumigan” and“hochuekkito” had a significant increase in theamounts of saliva secretion compared to thegroup of bakumondoto only11).
The above results are noteworthy in the sensethat Kampo medicines having the action of water
retention were used for the main symptom ofdryness of Sjogren’s syndrome and effectivenessof the Kampo medicines was verified.
References:1) Aletaha D et al: 2010 rheumatoid arthritis
classification criteria: an American College ofRheumatology/ European League Against
Rheumatism collaborative initiative. Ann
Rheum Dis. 69:1580-1588,20102) van der Helm-van Mil AH,et al: A prediction
rule for disease outcome in patients withrecent-onset undifferentiated arthritis: how
to guide individual treatment decisions.
Arthritis Rheum 56:433-440,2007
3) OTSUKA Yoshinori, et al. Kampo Shinryou-Iten
5th edition, Nanzando P153, 1990
4) MATSUDA Kunio [Ryumachi-sei Shikkan no
Kampo Chiryou Ekisu-zai] keishikajutsubuto,Rheumatology, 27:384-388, 2002
5) KOUTA Kazufumi, et al. [Ryumachi-sei
Shikkan no Kampo Chiryou Senji-yaku]
keishikajutsubuto,
bushizaiSenji-yau,
Rheumatology, 27:488-498, 2002
6) NISHIMORI Fumiko, et al. Syoreikentoukai
＠ touiken Kansetsu Ryumachi no Syorei(Sono 2) Progress in Kampo Medicine ,455:15-18, 2009147)

TANAKA Masahiko: Kansetsu Ryumachi ni
taisuru Boiogito no Syoreishusekikenkyu
Pharma Medica 25:53-55,2007
8) NAGASAKA Kazuhiko, et al. [Role of Kampo
medicine in treating rheumatic diseases,
Boiogito
niokeru
Kansetsu
decoction]
Ryumachi 54 Shorei no Kentou Rheumatology,
27:481-487, 2002
9) ARIMITSU Junsuke, et al. Zenshinsei
Eritematodesu ni taishite Ninjinto ga Yukou
de atta 2 Shourei.
Kampo to Shinryou,
1:124-127, 201010) NISHIZAWA Yoshio, et al. "Forward-looking
ability to salivate for the improvement ofprimary Sjogren's syndrome, multi-center
randomized double- blind study", Journal of
the salivary gland [Japanese] Vol.45, Japan
SalivaryGland Society 66-74, 2004
11) OHNO Shuji [Kampo RCT] Menei Shikkan
no Kampo-yaku RCT, Sjogren Shokougun noDaeki
Bunpitsu
Shogainitaisuru
Kampo-yaku Chiryou no Kouka. Kampo &the Newest Therapy, 15:134-140, 2006

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