KAIM
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Accuuppuunnccttuurree aanndd IInntteeggrraattiivvee M
Meeddiicciinnee
INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 5, Number 3 ･ Fall 2010

Editorial

House of Cards
Hiroshi Tsukayama

Japanese Acupuncture - Current Research
Acupuncture Treatment for Peripheral Paralysis
Hiroyuki Tsuru

Kampo Medicine - Current Research
Collagen Disease
Masayuki Kashima

Clinical Report 1 (Europe)
Shonishin in Europe (1)Thomas Wernicke

Clinical Report 2 (Japan)

A Patient Who Feels Nauseous on Exposure to the Sun
Mihoh Koga

Clinical Report 3 (Japan)

One Case that had Effect of Modified Hochuekkito on Qi Deficiency Headache
Hiromichi Yasui

Front Line of Kampo Medicine

Review 1 of Academic Meeting Concerning Pharmaceutical Sciences (2)Toshiaki Makino

Kampo Formula Developed in Japan (3)Saikoseikannto

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)The Journal of
Kampo, Acupuncture and Integrative Medicine

Research on Theory, Practice and Integration

Volume 5, Number 3 ･ Fall 2010

EXECUTIVE EDITOR

Shuji Goto
Chairman, GOTO College ofMedical Arts & Sciences

TA B L E O F C O N T E N T S

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

1 Editorial
House of Cards

Hiroshi Tsukayama

3 Japanese Acupuncture - Current Research
Acupuncture Treatment for Peripheral Paralysis

Hiroyuki Tsuru

Ibaraki-ken, Japan

Hiromichi Yasui
Tokyo, JapanEDITORIAL STAFF

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

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

PUBLISHER

Shuji Goto
International Institute of Health andHuman Services, Berkeley

11 Kampo Medicine - Current Research
Collagen Disease

Masayuki Kashima

15 Clinical Report 1 (Europe)
Shonishin in Europe (1)Thomas Wernicke

19 Clinical Report 2 (Japan)
A Patient Who Feels Nauseous on Exposure to the Sun

Mihoh Koga

21 Clinical Report 3 (Japan)
One Case that had Effect of Modified Hochuekkito on Qi Deficiency Headache
Hiromichi Yasui

23 Front Line of Kampo Medicine
Review 1 of Academic Meeting Concerning Pharaceutical Sciences (2)Toshiaki Makino

27 Kampo Formula Developed in Japan (3)Saikoseikannto
Hiromichi Yasui

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 1 | Spring 2006

Volume 5, Number 3 | Fall 2010

Editorial
House of Cards
1. Placebo
It was around 1970 that acupuncture and moxibustion treatment began to be recognized as a scientific researchsubject in Western societies. Since then 40 years has been spent to mainly pursue a single proposition. The special
position is “acupuncture and moxibustion treatment is just placebo.”The placebo effect is defined in a medical
dictionary as the phenomenon in which “actions such as pain relief occur after a placebo, pharmacologically inert orineffective, on the patient with the intended disease was administered aiming for its psychological effect.” Although theexistence of the placebo effect is hypothesized from the operational perspective and its mechanism and actual entity are
unknown notions, the effect is widely recognized in the area of medicine. When acupuncture was going to cross theboarder and was to be incorporated into the medical domain, one of the challenges the acupuncture world was asked toaddress from a skeptical standing was to substantiate “acupuncture treatment is not placebo.” Since a mythical literatureexplaining “The powerful placebo” by Beecher in 1955 contributed the placebo effect, which existence is believed basedon a priori assumption, it has become the methodological foundation for scientific assessments in the medical domain
together with various anecdotes. One of the authoritative medical journals, New England Journal of Medicine (NEJM)
carried a journal with aggressive title “Is the placebo powerless?” by Hróbjartsson and Gøtzsche in 2001.
This literature describes the first attempt to objectively identify the quantity of placebo effect by consolidating dataof randomized trials conducted earlier. The results of this study were incredible, showing that compared to
non-treatment, there were none or very few evidences, if any, of the placebo effect that had been believed to be tens ofpercent in all treatments – this is still fresh in my mind.
The editor in chief commented about the results that “as everyone believed that the witches in the Wizard of Oz
had supernatural power, they had power…similarly we had not seen things beyond the curtain, so we thought placebo
was powerful.” Mr. Bailar, the editor in chief of NEJM linked the people related to the medical field including himself tothe inhabitants of the Oz. On the other hand, the keyword of in fact have not sufficiently substantiated is used as an
obvious word, which functions as a high wall set up relentlessly before the persons who are trying to enter the medical
territory.
Placebos have not been well accepted in the medical field, where they have been labeled and categorized as
subjective and empirical things of no value. A factor contributed to the situation is that from a historical standpoint,
physicians and surgeons have been dependent for a long period of time on what patients claimed. Other factor is thatphysicians and surgeons who were exposed to competition with practitioners of other fields have counteracted
discourses of patients on the basis of objective and scientific theories to overwhelm and control patients and persons
involved in other medicines. The emergency of Western medicine may have implications for the paranoid notion forplacebos.
2.

Is the “Sham Acupuncture” assumed placebo equivalent or not?
An intervention with sham acupuncture needles, which are made undistinguishable from real ones, is required
for measuring the placebo effect and a wide variety of procedures have been attempted. The procedures can largely
be grouped into invasive standard stimulation sham acupuncture, which applies needling into points consideredinappropriate; invasive minimal sham acupuncture, which applies shallow needling into a fewer points to give as
least stimulation as possible compared to real acupuncture; and noninvasive sham acupuncture, which seems likeneedles are inserted but they do not penetrate the skin. Although these are regarded as having validity because “those
who have not experienced acupuncture cannot distinguish the differences between real acupuncture and shamacupuncture,” evidence-based studies on the other important factor “ineffective” about placebos has not been made andthe placebo effect is dependent on the unverified hypotheses - (a) “ineffective” when needles are inserted into
non-acupuncture points, and (b) as well as the effect, the amount of stimulation increases or decreases according to thenumber of needles inserted and the needling depths. Proving the placebo effect is now required in general but the situation
seems notions are running up before proving.
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 5, Number 3 | Fall 2010

A result of this was yielded from a large scale project called German Studies carried out in Germany in the first decadeof this century. This project is Phase III clinical trials in which 100 people were engaged for each trial to study whether tocover the effects of acupuncture treatment in the adjuvant setting for chronic pains including low back pain, knee pain, andheadache by the public health insurance. Participants recruitment called for mobilizing clinical practitioners for 100 orders
per trial with these hyper multi centre trials. The result of these trials showed that the real acupuncture group and the control
group of sham acupuncture had equivalent potency. This matter requires analysis on whether the treatment effect in the real
acupuncture group was inadequate, or whether the effects in both groups were equivalent. However, monitoring informationin multi-centers and other quality control information are insufficiently available to plan a process analysis, and althoughtherapeutic protocols are described, the information of the procedures actually performed cannot be collected from thesetrials. About skill of practitioners, factors related to the effect of treatment are not found. Whatever the case, such recognitionis necessary that the beliefs of (a) “needling at non-acupuncture points has no effect”, (b) the amount of stimulation increases
or decreases depending on the number of inserted needles and the insertion depths” are hypotheses.
3. To miss trigger points on purpose
Nonetheless, if you are asked if the parties in the East Asia region concerned with acupuncture and moxibustion are
involved in the runaway of researchers in the United States and European countries, you will not say “they are notresponsible for it.” This is because it is the parties in the East Asia region that have emphasized the differences between theacupuncture points and non-acupuncture points at every opportunity in order to advocate the meridian/acupuncture point
system.
Japanese traditional acupuncturists define concept of acupoint (acupuncture point) as the point where the needle isinserted and manipulated in acupuncture therapy. Acupoint include following points,
・ Meridian point: a point on the fourteen meridians and location had been predefined in classical text books.
・ Extra point: a point that is not located on the fourteen meridians but the position and the property such as
statement of virtues were predefined in the text books.
・ Ashi point: an acupuncture point with no specific name nor definite location, the site of which is determined bytenderness or other pathological responses in palpation. It is hard to differentiate the ashi point on muscle
meridian from the trigger point.
In other words, the locations of all acupoints used in treatment are not determined before starting the session. Somepoints are determined based on the condition of the patient of the day. In treating the musculoskletal system, the existence ofashi point often cannot be ignored. “Non-trigger points” in sham acupuncture or “acupuncture points not used for the related
complaints” should be defined carefully.

Hiroshi Tsukayama, Ph.D., L.Ac., Professor
Department of Acupuncture and Moxibustion
Tsukuba University of Technology, Ibaraki, Japan

2

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

Volume 5, Number 3 | Fall 2010

Japanese Acupuncture - Current Research
Acupuncture Treatment for Peripheral Facial Paralysis
Hiroyuki Tsuru
Department of Clinical Acupuncture and Moxibustion
Meiji University of Integrative Medicine

In

the

"Facial

Guidelines2)

Nerve

Palsy

Treatment

prepared by the Japan Society ofFacial Nerve Research treatment with steroids orantiviral

drugs

or

also

facialnerve

decompression is recommended depending on theseverity of the paralysis during the acute phase of

1. Introduction
The causes of facial nerve palsy may either becentral or peripheral, but in this manuscript I will
focus on the peripheral type of facial nerve palsy,
for which comparatively numerous reports havebeen published in Japan and discuss the effects of
the acupuncture and moxibustion treatment forthis condition.
Bell’s palsy and Ramsay Hunt syndrome are
frequently observed among patients with
peripheral facial nerve palsy, these two
conditions being responsible for about 70% of allcases of facial nerve palsy in Japan1,2).
Accordingly, research reports (or case reports)
about the relevant acupuncture and moxibustion
treatment in Japan also concentrate mostly onthese two diseases3-9). The incidence of Bell's
palsy ranges from 25 to 32 persons per 100,000
population, while that of Hunt syndrome has
been reported2) to be 2-3. Etiologic details for
Bell's palsy remain obscure, but ischemia or virus
infections have been pointed out as possible
causes. In recent years reactivation of herpes
simplex virus type 1 within the geniculate
ganglion has been postulated as an importantfactor. On the other hand, Hunt syndrome is said
to be caused by latent infection within the
geniculate ganglion by varicella-zoster virus(VZV). The inflammation of the facial nerve
results in any case in the development of edema
and a resulting compression within the facial
nerve canal then causes the development ofischemia, which in turn aggravates the edema
and thus leads to a progressive affection of the
facial nerve that then finally leads to thedevelopment of paralysis.

facialnerve

palsy.

recommendation

for

In
oral

particulartheadministrationofsteroids is ranked "A", meaning that it is strongly
recommended and thus represents the mostrecommended

form

of

treatment.

monotherapy

has

been

Steroidclassified

asrecommendability A for the treatment during theacute phase, while the recommendability B was
assigned only to massive dose steroid therapy forsevere Bell's palsy. In this paper2) I "could notverify the effectiveness of at the present moment"of the acupuncture and moxibustion treatment
administeredduring

the

acute

phase

and

therefore judged it to be of recommendability C2(cannot be recommended due to a lack of scientificproof). Low frequency electrical stimulation could
lead in case of ENoG (Electroneuronography)
values of less than 40% to the development ofsynkinesis and as such has been classified asrecommendability D (it is recommend not toadminister this treatment). On the other hand,
there are no treatment forms classified asrecommendability A or B for the chronic phaseand acupuncture and moxibustion treatment forchronic peripheral facial nerve palsy has not been
mentioned. While there have been reports inJapan about the effectiveness of acupuncture andmoxibustion treatment for Bell's palsy or Hunt
syndrome its classification as C2 is truly
regrettable, but this is probably the inevitable
result of the importance in recent years attachedtoresearch

results

obtainedthrough

RCT(randomized control led trials), today considered
to be the mainstream research tool.

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

3

Volume 5, Number 3 | Fall 2010

2.

Reportsonacupunctureandmoxibustion

treatment for peripheral facial nerve palsy in Japan
While there have been no reports in Japan

ENoG value of 0% and in whom the test
instrument

scaledout

duringexcitability test (NET). Thisthetreatise4)

nerve

describes

about the effectiveness of acupuncture andthat the initial treatment administered in themoxibustion treatment for Bell's palsy or Huntdepartment of otolaryngology was basically a

syndrome3,4,6-9)

describing effects promoting thetapered administration of 30 mg of predonine,

recovery from the palsy, there have also been no

ATP preparations, vitamins, antiviral drugs etc.

reports5) about any adverse effects delaying the

The average age of the patients was 44.3±12.8

recovery.

years (mean±S.D.), duration of the morbidity
43.2±23.9 days, paralysis score 10.2±2.7 points,

Ando et al.3) reported about their performancethe acupuncture treatment (Fig. 1) consisted ofof more than 5 acupuncture and moxibustion

retaining the needles (n=17) for 15 minutes ontreatment sessions in 28 patients (20 patientsthe affected site at GB3, GB14, GB2, ST2, ST6,

with Bell’s palsy；8 patients with Ramsay Hunt

ST4, above the angle of the mouth, below thesyndrome), who had received within 6 months

angle of the mouth and LI4 as well as

following the onset of peripheral facial nerve

electroacupuncture applied to the point pairs

palsy

stimulants,

GB3-GB14, GB2-ST2, ST6-ST4, above-below theperipheral vasodilators, stellate blocks or vitaminangle of the mouth for 20 minutes with ancomplexes.

lowintensity that did not cause the patients any

frequency electrical acupuncture was applied to

discomfort (n=12). For the evaluation the 40-point

GB14, Taiyang, ST2, ST3, ST4, ST6, ST7, ST18,

paralysis

TE17 and LI4 on the hand of the affected side

presence of synkinesis or crocodile tears, facialwith maximal intensity that did not cause any

spasm, or else the sequel score for the evaluation

pain (Fig. 1). Once or twice weekly was chosen asof facial stiffness (modified method of sequelfrequency for the acupuncture treatment and theassessment developed by Nishimoto and Murata

severity of the palsy was assessed using theet al.) were used.

steroids,
As

brain

metabolicacupuncture

treatment

score

describedbyYanagihara,

40-point paralysis score described by Japan
Society of Facial Nerve Research. The resultsMoreover, according to the Japan Society ofshowed, that when acupuncture treatment was

Facial Nerve Research a score of less than 10

started later than 30 days after the onset forpoints of the 40-point full score represents

patients in whom recovery after the onset had

incomplete paralysis, while a score of less than 8been slow, led to improvements in the palsy andpoints is a complete paralysis and a score of more

the recovery trend reportedly continued over athan 20 points indicates a mild case, 10-18 points

duration of more than 6 months, while there werea moderately severe and a score of less than 8

no side effects or complications associated withpoints a severe case. Patients reaching a score of

the acupuncture treatment.

more than 36 points and do not have any morethan moderately severe conjugated movements

Ebiko

et

al.4)

of

were judged as cured2) and the paralysis score

acupuncture treatments for a total of 29 patients

described in this paper4) returned within 6

with refractory Bell's palsy (n=14) and Huntmonths to more 36 points, while no apparent after

syndrome (n=15) presenting with a minimal

effects were observed in these cases of complete

4reportedtheresults

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

Volume 5, Number 3 | Fall 2010

recovery. The remaining cases were classified asvalue of over 21% no significant differences

incomplete recovery. In this paper4) the paralysis

between the oral steroid treatment group andscore of the 29 patients at the start of theacupuncture combination therapy group were

acupuncture treatment was 10.2±2.7 points andobserved. Thus, in "between a group of patients

had improved 6 months later to 30.5±4.6 points.

with ENoG values of 1-20% treatment withAmong the 14 patients with Bell's palsy 4

massive steroid doses and a massive steroid dosepatients reportedly recovered within these 6

and acupuncture combination therapy group nomonths so far, that the paralysis score reachedsignificant differences were observed." Thus, nothe normal range of more than 36 points andrecovery promoting effects could be observed inamong the 15 patients with Hunt syndrome 1

the medication monotherapy group and thepatient recovered within these 6 months to

medication and acupuncture combination therapy

achieve a more than 36 points score. The

group, but reportedly no effects delaying recovery

remaining

were

24

patients

wereclassified

asobserved

either.

Moreover,

for

the

presenting incomplete recovery. There were no

acupuncture treatment (Fig. 1) apart from thesignificant differences in the recovery processapplication of electroacupuncture to TE17 on the

between the groups of patients with Bell's palsy

affected side for 15 minutes GB14, ST1, ST2, ST4,

and

above

ST7, BL10, GB20, GB21, SI14 etc. application ofacupuncture treatment for peripheral facial nerve

hot packs to the face for 10 minutes served as anpalsy has been reported to be effective.

additional thermotherapy. Over a period of 1-2

Hunt

syndrome.

As

described

months after the onset the patients were treated
Conversely, Kasuya et al.5) reported the resultsof a retrospective study, where the authors

twice weekly and after that the acupuncture
treatment was administered once per week.

determined the degree of nerve degeneration 2-3
weeks following the onset in a total of 111

Again, in the form of case reports thepatients with peripheral facial nerve palsy andacupuncture treatment of a 70-year old patient6)

used the 40-point paralysis score described bywith Bell's palsy presenting with synkinesis 10

Japan Society of Facial Nerve Research tomonthscompare a group treated with acupuncture (n=61)

treatment of a 29-year old patient with Bell'sand drugs as well as the differences in recovery

palsy 2 years after onset were reported7). In casebetween an acupuncture and pharmacologicof (6) electroacupuncture was applied to the

combination therapy group as compared to aaffected side of the face, resulting in relief of thepharmacologic monotherapy group (n=50). Apartsuffering from synkinesis and facial contracturefrom the steroids used for the pharmacotherapy

as assessed with a VAS (visual analogue scale)

ATP preparations, administration of drugs forand the 40-point paralysis score described by

improving microcirculation, vitamin preparations

Japan Society of Facial Nerve Research as well as

etc. was also described. This paper5) states, that

ENoG.

"the recovery from paralysis was in the group of

performed on the points GB14, ST2, SI18, ST4,

patients with an ENoG value of over 41% andusing two different pulse generators to avoid

treatedsynchronizedwithacupuncture

onlysignificantly

after

onset

and

Electroacupuncturemuscletheacupuncture(Fig.

contractions

1)

from

was

the

inferior to that in the oral steroid treatment

GB14-ST2 and SI18-ST4 pairs. In the lattergroup", while comparison of groups with an ENoG

report7) electroacupuncture was performed on the

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

5

Volume 5, Number 3 | Fall 2010

affected side of the face at TE17, ST7, GB1, ST4,

The first case was a 43-year old patient8)

LI19 and GB14, using also the points Taiyang,diagnosed with Hunt syndrome, who was treated

ST2, ST3 etc. for the treatment (Fig.1). This

18 days after onset with the Koshi method on the

resulted reportedly in improvements of theface using the retaining needle technique for theparalysis score and reduction of the temperature

treatment.

difference between the affected and healthy side

pharmacotherapy with steroids, antiviral drugs,of the face as measured with thermography.

cerebral circulation and metabolism ameliorators,This

patient

received

vitamin preparations and eye drops to prevent
Considering the contents of these reports wedehydration of the eye, but according to theconcluded that a combination therapy establishedpatient "the left side of the face almost does notin cooperation with an otorhinologist rather thanmove and the discomfort is not alleviated".

an acupuncture monotherapy for peripheral facial

Moreover, the attending physician asked thenerve palsy is important. In particular during theauthor "not to perform acupuncture treatment on

acute phase of the peripheral facial nerve palsy

thesteroid

measurescomplaints were impaired movement of theadministered by the otorhinologist should bemuscles and discomfort on the left side of the face,

given

with

simultaneously observing associated symptoms ofacupuncture later considered on the basis of theinability to taste food, shoulder stiffness, dryness

degree of recovery or severity of symptoms.

of the eye, insomnia, constipation etc. At the starttherapypriority

and
and

a

similarcombination

3. Application of the Koshi method of traditional
acupuncture during the acupuncture treatment
for peripheral facial nerve palsy

acupuncture treatment for peripheral facial nerve
palsy in Japan, but since electroacupuncture
treatment can cause synkinesia as describedabove, otolaryngologists currently seem to haveregardingstimulation

on

the

affected side (worries about the development ofconjugated movements8,10).

Thus,

since

the

chief

of the acupuncture treatment (18 days after onsetof the condition) the 40-point paralysis score as
described by Yanagihara was 10 points. The VAS
left side of the face and discomfort were 55 mm
and

56

mm

respectively.

A

total

of

11

acupuncture treatment sessions was given at rateof 1-3 times per week. All needles only pierced theskin to a depth of about 5 mm and were thenretained for 10 minutes (retaining acupuncturetechnique). For the acupuncture of the face thepoints GB14, Taiyang, SI18, ST4, TE17 and SI19
were needled (Fig. 2, upper row). Otherwise,

Regarding case reports in this context theauthor has reported about the application of the
Koshi method of traditional acupuncture to theface integrated in the acupuncture treatment for
peripheral facial nerve palsy (Bell's palsy, Hunt
syndrome). When symptoms are present on theleft side, the Koshi method is applied to the rightside, and for symptoms on the right side theacupuncture treatment is applied to the left side.
6

side".

values representing the difficulties in moving the

So far I have introduced reports about

reservations

affected

based on (1) determination of the treatment
according to pattern identification (bian zheng
lun zhi) needles were inserted and retained at
LR3, KI3, KI7 and SP6, (2) to improve blood
circulation through the muscles of the shoulder
girdle and relief muscle tension needles wereretained in the point GB21 (Fig. 2, upper row).
Acupoints not in the facial region were needled on
both sides. This resulted in an improvement of

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

Volume 5, Number 3 | Fall 2010

the paralysis score to 38 points by the tenth

the neck and shoulder and relief muscle tension

acupuncture treatment (39 days after onset),needles were retained at GB21, SI11, SI13, SI14,

while both the difficulties in moving the muscles

SI15, BL23, BL25, BL52 and EX-B3 (Fig. 2, lower

and the discomfort of the left side of the face had

upper row). Acupoints not in the facial region

been alleviated and the associated symptoms

were needled on both sides. This resulted in anshoulderstiffness,

constipation

and

the

eye,

improvement of the paralysis score to 38 points by

subjectively

been

the 27th acupuncture treatment (242 days after

drynesstasteofimproved.

onset), the difficulties in moving the muscles ofthe face had been alleviated to a VAS score of 2

The second case was 60-year old patient

mm. The VAS score for the associated symptoms

diagnosed with Bell's palsy who I started treatingof shoulder stiffness and low back pain had

using the retaining needle acupuncture technique

improved to 22 mm and 14 mm respectively.

50 days after the onset9). This patient too received

Otherwise the patient commented on the effects

pharmacotherapy including steroids, cerebralof the received acupuncture treatment as "Icirculation and metabolism ameliorators, vitamin

started to sleep well", "the constipation is gone",preparations

prevent"my stomach is feeling just fine", "my tinnitus has

dehydration of the eye, had undergone facialdecreased", "I don't have any palpitations any

nerve decompression and underwent stellatemore" etc.

and

eye

drops

to

blocks once a week, but the "mobility of the right
side

of

the

face

did

not

improvemuch".

Based

on

the

above

described

results

Accordingly, in addition to the chief complaint ofapplication of the Koshi method as an integral

impaired mobility of the right side of the face (atpart of the acupuncture treatment for peripheral

the beginning of the acupuncture treatment the

facial nerve palsy indicates the possibility that it

relevant VAS value was 83 mm) there were also

promotes recovery, but it remains difficult toassociated symptoms including shoulder stiffness

explain the exact mechanism at work during the(VAS of 57 mm), low back pain (VAS of 25 mm)

promotionand the paralysis score was 12 points. The
acupuncture treatment was administered once or
twice a week, where all needles were inserted
only to a depth of about 5 mm and retained for 10
minutes (retaining acupuncture technique). All
needles in the facial region were placed on thehealthy side at GB14, Taiyang, SI18, ST4, TE17,
SI19 and ST7 (Fig. 2, lower row). Otherwise,based on (1) determination of the treatment
according to pattern identification needles wereinserted and retained at LR3, KI3, KI7 and SP6,
and (2) as for a selection of points on the affectedchannel needles were placed and retained in
distinctly tender points at LI4, TE5, LI10, (3) toimprove blood circulation through the muscles of

thisrecovery,includingtheimprovement of associated symptoms. However,mainly animal experiments revealed that theacupuncture

stimulationhas

effectsthatreportedly include reduction of muscle tension11),
improvementofmuscularblood

flow12,13),

improvementofneuronal

blood

flow14,15),

promotion of physical and mental relaxation16),
promotion of peristaltic bowel movements17) andthe like. Moreover, some reports also indicate,that the acupuncture stimulation does not only
increase muscular blood flow at the stimulation
site, but affects muscular blood flow on thecontralateral side also18). This suggests thepossibility that the acupuncture stimulation

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

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Volume 5, Number 3 | Fall 2010

applied to the healthy side in this case somehow
affectedthecontralateral

side

via

higher

Also,

while

complaint(s)improvement

andassociated

of

the

chief

symptoms

isneuronal centers, or else the possibility, as

important regarding the acupuncture treatment

described

thefor facial palsy, inhibition of the development ofacupuncture stimulation improves symptoms insynkinesis is considered to be another importantthe facial region as well as associated symptoms

aspect of the treatment. Thus, treatment forlike shoulder stiffness, low back pain, insomnia,

facialconstipation etc. On the other hand, however, theobservation

administrationacupuncture basically a combination therapy

above,

that

of

the

effects

steroids

or

of

other

palsy

the

shouldandbeinguidedcase

pharmacotherapy, the performance of facial nerve

withtreatment

decompression, stellate ganglion blocks etc. may

otorhinologists is essential.

ofbycarefulperforming

administeredbypossibly have contributed to limiting the facial

Moreover, ENoG measurements made before

nerve conduction disturbances, or else the drugs

and after the acupuncture treatment as well as

may possibly have promoted repair of the facial

RCTs conducted appear to be an important task

nerve, indicating the possibility that combination

for the future in order to objectively assess thetherapy including acupuncture, pharmacotherapy

effects of acupuncture treatment for peripheral

and surgery promotes recovery.

facial nerve paralysis.

Chart with the acupoints used in references 3) through 7)
Acupuncture treatment was performed on the affected side of the face.
8

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

Volume 5, Number 3 | Fall 2010

Chart with the acupoints used in references 8 through 9
Application of the Koshi method during acupuncture treatment performed on the healthy side of the face.

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

9Volume 5, Number 3 | Fall 2010

References
1) Murakami S. (editor): Treatment of facial palsy
update. ENTONI Book 111. Japan Hospital
Press: 1-10, Tokyo; 2010; Japanese only
2) Japan Society of Facial Nerve Research(edition): Facial Nerve Palsy Treatment
Guidelines – Bell's Palsy and Hunt syndrome– KANEHARA & Co., LTD; Tokyo; 2011;
Japanese only
3) Ando F., et al.: Evaluation of acupuncture-combined
therapy for peripheral facial palsy. Facial N Res.
Jpn 8:167-170, 1988.
4) Ebiko K., et al.: Effects of acupuncture on
refractory Bell’s paralysis and Hunt’s
syndrome. Kampo Med 60(3): 347-355, 2009.
5) Kasuya, et al.: Acupuncture treatment for
peripheral facial paralysis. Jpn Society of
Acupuncture and Moxibustion 52(1): 32-42, 2002.
6) Okada T., et al.: Electro-acupuncture for facial
palsy with synkinesis. Jpn Society of Acupunctureand Moxibustion 55(4): 601-607, 2005.
7) Morito A., et al.: Acupuncture treatment in aperipheral facial paralysis with the sequelae.
Jpn Society of Acupuncture and Moxibustion
53(2): 190-194, 2003.
8) Tsuru H., et al.: A case of acupuncture
treatment for facial paralysis. Facial N Res.
Jpn 30: 160-162, 2010.
9) Tsuru H., et al.: A case of acupuncture
treatment for Bell’s palsy. Quarterly
published Oriental Medicine 17(3): 2011.
10) Murakami S. (editor): Treatment of facial palsy
update. ENTONI Book 111. Japan Hospital
Press: 73, Tokyo; 2010; Japanese only
11) Kinoshita H.: Experimental research into theeffects of acupuncture on local pain II: Effects
of retained acupuncture needles on theprocess of posttetanic high level contraction
recovery; Showa Med. J. 41:393-403; 1981;
Japanese only

1012) Tsuru H., et al.: Effect of acupuncture
stimulation on the blood flow of the skeletal
muscle in rabbits. Jpn Society of Acupunctureand Moxibustion 49(1): 6-14, 1999.
13) Shinhara

H.:

Influenceof

acupuncture

stimulation on the induction of variations inskeletalmuscleblood flowandenergymetabolism in ischemia-reperfusion stressed
rats; Meiji University of Integrative Medicine
23:41-54,1998; Japanese only
14) Yamaguchi D., et al.: Effect of acupuncture
stimulation to the low back on blood flow to
the sciatic nerve trunk in rabbits. Jpn SocietyofAcupuncture

andMoxibustion

47(3):

165-172, 1997.
15) Inoue M., et al.: Effects of lumbar acupuncture
stimulation

andsciatic

nerve

electricalstimulation on blood flow to the sciatic nerve
trunk. Jpn Society of Acupuncture andMoxibustion 48(2): 130-14-, 1998.
16) Yano T., et al.: The effects of electro-acupuncture
and TENS on EEG Topogram. The Bulletin of
Meiji University of Oriental Medicine 1: 55-64,
1985.
17) Iwa M., et al.: Electroacupuncture elicits dual
effects,

stimulationofdelayedgastric

emptying and inhibition of accelerated colonictransit induced by restraint stress in rats.
Dig Dis Sci 51: 1493-1500, 200618) Tsuru H., et al.: Acupuncture on the blood
flow

of

variousorgansmeasuredsimultaneously by colored microspheres inrats. Evid Bsed Complement Alterate Med 6:
77-83, 2009

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

Volume 5, Number 3 | Fall 2010

Kampo Medicine - Current Researchwide array of collagen diseases. For other

Collagen 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

pathogenic

mechanisms

thatto be identified. Because of unexplained causes,

accuracy of the pathological conditions that can

the treatment with Western medicine is aimed at

explain 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

hereunderofcanpinpoint

diseases,arerecentandnotableplayclinical 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.

reportssuggestingenabling

to

Kampo

reducemedicines

thevolumeofimmunosuppressant 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

are

often

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 2,000
years ago in the most old classical book “Yellow
Emperor's

Canon

of

Medicine/

Plain

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

arthritis

concept.

However,

musculoskeletal symptoms cover only part of a

Rheumatoid arthritis
Rheumatoid arthritis is known as one of themostcommontypes

ofcollagendiseases.

Western medicine of today has made a major
breakthrough

in

the

treatment

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

of

a

group

of

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

activities

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 2010

years, 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 as

Rheumatoid 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,

RA

under

AmericanCollegeof

However,

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).

andproblemsofimmnosuppression, 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 may

visit. The overall effect was “markedly effective”

mean a great deal as used to be.

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

In

the

arthritis

Kampo
in

treatmentofrheumatoid“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 the

There 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
forrelatively

advancedadvanced 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

arthritis

and“daibofuto”

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

12

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

Volume 5, Number 3 | Fall 2010

to rheumatoid arthritis in Japan - a characteristic
methodologyofJapanese

Kampo

Nishizawa, et al. tested bakumondoto in a

medicine.

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,

in

most

cases,

SLE

treatment is given only to respond to individual
patients and symptoms from beginning to end, so
trial 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 the
problem 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 amounts
continuously 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 andkeepingthehealthandQOLsignificantly

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

with

80.9%

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”)

to

the

patients 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

differences

after

four

weeks

of

administration 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 of
Rheumatology/ 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,
bushizai
Senji-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, 200914

7)

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 no
Daeki
Bunpitsu
Shogaini
taisuru
Kampo-yaku Chiryou no Kouka. Kampo &the Newest Therapy, 15:134-140, 2006

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

Volume 5, Number 3 | Fall 2010

Clinical Report 1 (Europe)
Shonishin in Europe (1)be used field-specifically. Depending on theThomas Wernicke
Therapeuticum rhein-main, Germany

therapist's professional background, as adoctor,alternative

Shiatsu-practitioner,practitioner,

physiotherapist

or

Shonishin is presented in four parts

midwife, the patient collective, and thereby

1. Significance and development

the indications, are different. By way of example,

2. Theoretical basis of Shonishin

approximately 70-80% of all midwifes in Germany

3. Shonishin-study

do have an acupuncture education - and thereby

4. Future prospects

the qualification to absolve a further training in
Shōnishin. For them, Shōnishin offers great

1. Significance and development

opportunities to support newborn babies suffering

Spreading of Shonishinfromsuckingweakness,

abdominalpain,

In the past few years a steadily increasing

developmental retardation or even screaming

interest in Shōnishin has become noticeable alsobabies. In the event of a needle phobia, Shōnishin

outside Japan, especially in the German-speaking

is an alternative for pregnant women whilearea (Germany, Austria, Switzerland) and in the

preparing for birth or as a supporting treatment

English-speaking area (USA, Great Britain).

for women who have recently given birth and

So what makes Shōnishin so popular withsuffer from involutional problems or plugged milk

therapists, parents and children? -Well, there

ducts. Unlike as for the midwives, the area ofare many reasons:application- Therapists reason their increasing interest incompletely different. Their focus is mainly on

it considering the fact that Shōnishin meetschildren with problems related to posture and thethe holistic aspiration and the treatment

musculoskeletal system. On the other hand

successes speak for themselves.

pediatricians preferably apply Shōnishin with- They are appreciative that a theoretical basis

infants suffering from problems of the digestive

has been established which Shōnishin issystem, the respiratory system or developmental

based on (The theory will be focused on at adisorders, whereas allergies and neurodermatitis

later point).

are in the foreground with older children. General- Furthermore it is the simple and effective

practitioners are rather dealing with children or

way of treatment with Shōnishin whichadolescents whose range of topics includes

makes the treatment method very popularconcentration problems in school, ADHS orwith therapists.

enuresis.

- Children love this treatment as it has aof

Shōnishinfororthopedics

isShiatsu-practitioners often apply Shōnishin inpleasant feel to them.

combination with baby-shiatsu or children-shiatsu,- The acceptance of Shōnishin as a treatment

in order to support them in their development.

method is very high with parents as they

Physiotherapists can show better successes in theappreciate

treatment of hemi paretic children, as the usuallythegentle,non-invasive

increased tonicity can be decreased by additional

proceeding very much.
Another

reasonforthespreadingof

Shōnishin is that this treatment method cantreatmentwith

Shōnishin

andtherebythechildren become more treatable.

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

15

Volume 5, Number 3 | Fall 2010

2. Theoretical Basics of Shonishin

Education and Quality Standard
There are no regulated educational criteria so

Energetic Development Modelfar. The offer ranges from one-day courses to

In order to be able to establish a "new"training courses of several days' duration. In thetreatment method in Europe, it needs aninterest of the small and big children, highexplanatory model. During more than 20 years ofquality standards in Shōnishin education should

practical work of the author and his wife, thebe defined.

following development model has evolved and

For that reason the Shōnishin education offeredby the author (Fig. 1) is based on current research

proved its worth as a basis for the therapeutical
approach for treatment with Shōnishin.
This development model unites the knowledgeof the traditional Japanese medicine as well as of
the Western health sciences. A fundamentaloftraining in a meridian therapy (e.g. acupuncture)

psychology and developmental physiology withis the educational requirement. Explaining theknowledge and experience of the traditional

knowledge about children's development from the

Chinese and Japanese medicine. It states that

Western and from the Eastern perspective is anaccording to the motoric and sensory development

important part of the education. Communicatingstages, each energetic stage of development does

the course contents will need a training at least ofbuild

six days' duration and additional further trainings

development.

authorisonneurosciences,apreviously

developmental

gainedstageofEspecially meridians play a super ordinate role

in regular intervals.
The

modernaspiring

toauniversity

certification for the Shōnishin education.

in this respect. They represent a communication
network which connects the child with its outside
world. Via this connection the meridians enable
the integration of reflexes and stimuli. Thereby,
they

are

also

responsible

for

the

child'sdevelopment of posture, movement, patterns of
behavior and personality. This knowledge about
the interpendences between motoric, sensory andenergetics opens new points of view on children's
development,

which

resultsin

specifictherapeutic approaches. It becomes particularly
exciting when the interconnectedness between
meridiansandWesterndevelopmental

physiology- and psychology becomes visible.
Especially then, when it becomes noticeable
which meridian respectively which meridians
control which stage of development and what
happens, if a disorder occurs in that level ofinterconnectedness. This knowledge forms theFig. 1: Practicing with dolls

16

foundation for treatment of children of all ages
with Shōnishin.

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

Volume 5, Number 3 | Fall 2010

Development of the Meridians

Sidewise Circulation (Fig.2) - Most everyday

As well as the locomotor system and the

movements are based on rotation of the body. In

sensory system, the energetic system hasn't

the baby age, turning over from the back to thedifferentiated itself completely at the time of thebelly and the other way around later on are thebirth. According to the motoric and sensorial

first rotation exercises and are originated fromdevelopment, a maturation of the meridians takes

the sidewise circulation. This includes the bodily,place gradually. Therefore stimuli are needed, on

mental and social flexibility.

which the not yet specified meridians react indifferent ways- or even don't react. Only with theachievement of school readiness the meridian
system can be regarded as fully developed.
Three Circulations
On closer inspection this may be summed up as follows:
For a start, during the first year of a child's life,in each case four of later twelve main meridians
are cooperating in community, so that there arethree groups, each consisting of four not yet
differentiated meridians. The three circulations
known from TCM do develop out of the existing,Fig.2: Sidewise Circulation

undifferentiated "meridian pool".
Each of the three circulations has its own

Rear Circulation (Fig.3) - The baby's development

specific development- and life theme:

step from resting on a forearm while lying on its

Front Circulation (Fig. 1) - This one provides the

belly to the quadrupedal posture, or even taking

impetus for finding the own center, regarding

an upright position in order to leave the bed in

motor functions as well as the emotional realm.

the morning as an adult, are qualities of the rear

Feeling the own limits and those of others are

circulation. The impulse for the inner and the

aspects of this circulation, too.

outer erection is originated from this circulation.

Fig. 1: Front circulation

Fig.3: Rear Circulation

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

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Volume 5, Number 3 | Fall 2010

Six Axes (Keiraku)
With ongoing development a readjustment
takes place as well as on the motoric and on theenergetic level - The quadruped turns into a biped.
For that reason a "top" and a "bottom" come into
existence. At the same time a readjustment of themeridians, communicating with each other, takes
place within the corresponding circulations - it
comes

to

a

top-bottom-connection

of

the

corresponding Yin- respectively Yang- meridians,
the so called six axes. These have fully developed
when the child's verticalisation (full ability tobring the pelvis into an upright position) is
completed at the age of about two years.
Five PhasesWith an increasingly differentiated andcontrolled emotional expression and arefinement of the motoric capabilities, another"pairing" of meridians has been enabled whichtakes place when reaching school readiness.

18

Now the child is able to receive stimuli to agreater extent, to get in touch with and to reacton its environment, and to communicate with itusing an individual pattern of action and reaction.
Duringthethreecirculations
aninside-outside-connection of the meridiansdevelops in addition to the already existing
top-bottom-connection- the five phases.
Now the meridian system can be regarded as
being fully developed. So in the time from birth
until reaching school readiness, motoric skills,
sensory, emotion, socialization and enrgetics havedeveloped step by step, whereby each step ofdevelopment is built on the previous one.
The Shōnishin therapist should know and takein consideration these facets and correlations ofdevelopment. For that reason specific diagnostic
methods are required in order to find out in eachcase at which stage of energetical development adisorder or disease occurred for the first time.
Therapeutic treatment will be applied adjusted tothis step of development.

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

Volume 5, Number 3 | Fall 2010

Clinical Report 2 (Japan)
A Patient Who Feels Nauseous on Exposure to the Sun

Mihoh Koga, M.D., Kampo Specialist

Research Assistant of Division of Clinical Pharmacology
and Therapeutics and Division of General Medicine
Jikei University School of Medicine[Case]

Male of 52 year-old, working in thepainting industry.
[Chiefcomplaint]“Becomenauseous

when

exposed to the sun.”[Current medial history]
Since 26 years old, he had suffered a low-grade
fever and nausea. Detailed examinations had notdetected abnormalities and tranquilizing agents
had been administered for 10 years without
improvement.
When he was around 46 years old, he began todevelopadditional

symptoms

ofbecoming

nauseous, light headed and collapsing upon
exposure to the sun. On hot days,
fatigue

in

the

lower

limbs,

hot flashes,
sleeplessness,

nocturnal sweating, and buzzing in the ears
appeared. These symptoms were exacerbatedduring summer and relieved during winter. He
poured water over his head to continue to work.
However, because of the chief complaint, he often
got off work.

Before visiting our hospital, he had received acomplete examination without any findings ofabnormalities.
August 3, he made the initial visit to us.
Findings at initial visit[Inspection] His physique was intermediary withpale complexion. He seemed to have too muchtrouble for sitting on a chair and almost fall down.
He became out of breath and words could not
be spoken continuously, giving the impression ofa negligent air.
His tongue was enlarged and purple coloredwith pale yellow furs.
[Inquiry] He had a dry mouth. His appetite
decreased during summer. Defecation was twotimes a day and normal. He seldom had
perspiration and when sweating occurred, he felt
good. Although he had no difficulty falling asleep,
he woke during the night. He easily got frustrated.
Four limbs were cold. He liked refrigerated air
conditioning and water of a cold spring.
[Palpation] The pulse was deep, thin, andslippery.
Abdominal examinations detected 3/5 of theabdominal strength and a light bloated feeling in
the chest and hypochondrium region andtenderness in the para-umbilical regions.

Analysis of clinical conditions
Spleen Deficiency

Blood Deficiency

Qi Deficiency

Drooping
Viscera

Cold sensation inlimbs
Fatigue in lower
limbs






Feel sickStagnant heat(low-degree fever, hot
flashes)
Like air conditioning
and cold water

Heat evil

Defense Qi
Shortage

Short breath
Reducedperspiration
Nocturnal
sweating

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

Summer symptoms
worsenOn exposure to the
sun …

19

Volume 5, Number 3 | Fall 2010

It can be thought from the low-grade fever andnausea for 20 years that the patient had anunderlying spleen qi deficiency which induced qi
deficiency and blood deficiency. Especially intense
symptoms of progressed spleen qi deficiency withthe drooping of viscera were observed. Because ofqi deficiency, a shortage of defense qi occurred
and thereby the role of sweating that normalizes
the body temperature did not work properly,
resulting in an internal accumulation of heat.
Thus he liked the air conditioning and water fromthe cold spring.
It can also be thought from the long-time low
fever and hot flashes and the general symptoms
including fatigue that there were underlying
deficiency fire and deficiency heat caused by ashortage of source qi. It is possible thatsummer-heat as a pathogenic factor madedeficiency fire and deficiency heat further burnCourseOne

weeklater,

administered.
Three weeks later, his physical condition wasgood. Fatigue in the lower limbs disappeared. The
feeling of heat trapped in the body disappeared
and he was able to do his job.
(Pulse) Deep and thin(Tongue) Enlarged, dark red, covered with thinwhite furs.
The patient had slight constipation.
The patient received the instruction to continue
to take the oral administration with adjustment
in small quantities.

symptom of spleen-qi deficiency with the drooping
viscera may have intensely appeared.
Prescription
LI Dong Yuan says in his book “Pi-wei-lun(Spleen-Stomach Theory)” that “fire and source qi
cannot stand side by side,” “If either one of themis dominant, the other loses,” and “if drugs withsweet taste and body warming characteristics,
such as Astragali Radix, Ginseng Radix, andGlycyrrhizae Radix are used, deficiency heatrecedes voluntarily.” He proposed the treatment
method of using drugs with a warming action toinventedprescriptions

including hochuekkito.
The author selected hochuekkito that nourishes
the stomach-spleen and activates qi to nourish
chest qi.

20

anrelieved. hochuekkito only was continuously

exposure to the sun. In such process, the

and

felt

continued longer. Fatigue in the lower limbs wasupsetting the patient’s health at a burst on

feverspatient

improvement in his physical condition. Sleep

up in conjunction with the internal cause,removethe

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

Volume 5, Number 3 | Fall 2010

Clinical Report 3 (Japan)

her husband’s agreement. It seemed her headache

One Case that had Effect of Modified Hochuekkito on Qi
Deficiency Headache
Hiromichi Yasui
Japan Institute of TCM Research

was agonizing and she looked deeply pained.
Pulse condition: Deep and slippery, 60/min.
Tongue condition: Slightly dark colored with furs(-), swollen sublingual veins (-), moist.

Case: Female of 75 years old

Abdominal condition:

Initial visit: May 15, 2006

Course: At the initial visit, Extract of hochuekkito

Chief complaint: Headache

6.0ｇ＋Extract of chotosan 7.5g were given for 7

Present medical history: Headache developed

day doses. From the day after the start ofafter the patient gave a birth in her 30s. Ever

administration, headache became eased, but theafter headache had continued for long and she

condition was changeable and unstable, becoming

had regularly been using analgesic agents. She

good and then bad during a day. However, heroverused Norshin four years ago and optical

overall condition seemed good. On May 29 (2ndillusions appeared. So she was psychiatrically

visit), she received the above prescription for 28

hospitalized in a nearby general hospital. After

day doses. Subsequently she visited to thethis, she received outpatient treatment at thehospital on June 26 when headache was eased

hospital.

“depressive

but a lassitude sensation still remained. In

She was depressed

compliance with her complaint, the extract form

with severe everyday headache. The pain was a

was changed to decoction - hochuekkito +dull ache type in the entire head and not a

chotosan. A month later, headache further

pulsating type. The onset of headache was not

improved. However, the sensations of lassitude

associated with weather changes. According toand fatigability remained unchanged. At the visit

her husband, she had mild dementia and wasof August 21, headache (pain in the temples) was

receiving treatment.

present. The pain was the type of being

Drugs now being taken: Depas (1.5 g), Risperdal

constricted. She complained of feeling lassitude.

(1), Miradol (150), Marzutene-S (1.5), Tredomin

And a further modification to the prescription(25) 2 times/2 tablets, Gramalil (25) 1 tablet,wasToledomin (25) 2 tablets, Silece (1), Artane (2),formulation, she mostly did not feel headache. In

Kyorinher subsequent visits to the examination room,The

diagnosis

psychosis” and “headache.”

AP2

1.0

was

divided into 2 doses

Past medical history:

No special mention.

Present

Appetite;

insomnia.

symptoms:
Urination;

5

made.

With

the

switch

to

this

new

she conversed with the author in a smiling tone ofgood.

Sleep;

voice and the agonizing symptoms exhibited attimes/day.

Night

the initial visit disappeared.

urination; once. Defecation; once in 2 days.

Diagnosis: Qi Deficiency Headache

Normal stools. Dryness of the mouth. Feeling ofTreatment method: Nourishing qi to activate thesluggish.

flow of qi

Present condition: cm kg. Body temperature 35.6

Course: Resulstingly, following were decocted on

degrees C. Blood pressure 112/76mmHg

August 21 (modified hochuekkito)
Astragali Radix 8, Ginseng Radix 4, Atractylodis
Rhizoma 4, Angelicae Acutilobae Radix 3, Citri
Unshiu Pericarpium 2, Ziziphi Fructus 2,

She had a slightly dark expression on her faceand looked helpless. She did not talk first andwhen answering to questions, she always asked for

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

21

Volume 5, Number 3 | Fall 2010

Bupleuri Radix 2, Cimicifugae Rhizoma 1,
Zingiberis Rhizoma 1, Glycyrrhizae Radix 2
Angelicae Dahuricae Radix 4, Cnidium Rhizome 4,
Chrysanthemi Flos 2 – for 28-day doses
At the visit of September 28, she claimed that
although slightly eased, headache appeared
periodically. So, the same prescription was
administered for further 35 days. On November 7,
headache was relieved – far better than previous
condition. Since then, mostly no headache has
appeared.
Consideration:
The development of this headache was linked
with depression. Headaches associated withdepression are classified by The International
Classification of Headache Disorders 2nd Edition(ICHD-II) into the subcategory of “headaches
attributed to psychiatric disorders” under the
category of secondary headaches. Although
depression headaches are very common in our daily
life, there is no necessity in Kampo medicine to
specifically categorize this type of headache and the
Kampo treatment methods can be patterned to someextent.
In Western medicine, psychiatric disorders
presenting with depression are detailed into
varieties of groups, such as depression, of course,
psychoneurosis, schizophrenia, and organic
mental disorders including dementia. Psychiatricdisorders are usually treated with psychoactive
drugs
includinganti-depressantdrugs.
Meanwhile, there are quite a number of clinicalconditions that have benefits of Kampo drugs. In
the treatment of psychiatric disorders with
Kampo, clinical conditions are divided into a few
types and the most frequently used prescription ishochuekkito that has the action of supplementing
qi and enhancing the flow of qi. Some patientswith depression-associated headaches have had
relief with this prescription. Moreover, there are
published data evidencing the usefulness ofsenkyuchachosan. And there is a case report in22

which chotosan was effective.
Hochuekkito is frequently used for thetreatment of depression. This prescription canalso be applied to depression-associatedheadaches. senkyuchachosan is a potential
candidate for depression-associated headaches.
Thus, for the treatment of depression, following
prescriptions should be taken into account:hochuekkito, or senkyuchachosan, or hochuekkito+ senkyuchachosan, or hochuekkito + chotosan. If
blood deficiency is observed, either kihito or
ninjinyoeito is a good candidate. However, thefirst choice drug will be hochuekkito +senkyuchachosan.
In the case of this report, hochuekkito plus
Angelica Dahurica Radix, Cnidium Rhizoma, andChrysanthemum Flower were decocted andadministered. The final prescription was mostly
settled into this formulation. If the form of extract
is to be used, the Extract of hochuekkito + Extractof senkyuchachosan will produce similar effects.
References:
Isoshima G., Isoshima T.: Seishin-shikkan ni
heihatsu-suru Zutsu eno Senkyuchachosan no
Kouka. Abstracts of 54th Gakujutu Sokai, The
Japan Society for Oriental Medicine, p190 2003
Extract of senkyuchachosan was administeredto 55 patients with the diagnosis of mooddisorders (depressive disorders). The prescription
was effective in 35 and headache disappeared in
20 within two weeks and the medication wassenkyuchachosan was
discontinued.
And,administered to 24 patients with the diagnosis of
schizophrenia; 19 patients were considered tohave had effects with the disappearance ofheadache and the medication was completed.
Most of the patients with schizophrenia
mentioned that “the use of senkyuchachosan
cleared the head,” or “the foggy head became clear
with the prescription.”

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

Volume 5, Number 3 | Fall 2010

Front Line of Kampo Medicine

Visasul

et

al.

of

Niigata

UniversityofReview 1 of Academic Meeting Concerning Pharamaceutical
Sciences (2)Toshiaki Makino, Ph.D.
Associate Professor, Dept. of Pharmacognosy
Graduate School of Pharmaceutical Sciences
Nagoya City University

Pharmacy and Applied Life Sciences reported theThis series introduce latest studies on Kampo

Endo, et al. of Kitasato University reported

medicines presented at the Society’s meetings.

that saireito (Minor Bupleurum Decoction plus

The second installment of the series will provide
the studies presented at The 27th Annual

Poria Powder with five Herbs) and orengedokuto(Coptis Detoxificating Decoction) had the effects

Meeting of Medicinal and Pharmaceutical Society

on ulcerative colitis in mice induced by the oralof WAKAN-YAKU.

administration of dextran sulphate.

Quality preservation of crude drugs, Researcheffectiveness of shomyakusan (Generate thePulse Powder) for memory disturbance induced inmice when scopolamine was intraperitoneallyadministered.

Oka et al. of University of Toyama reported
that they had administered hachimijiogan to thefor identification
Wu et al. of University of Toyama mademodels of chronic renal impairment in 5/6

analysis of diversity of ingredients contained innephrectomized

the products on the peony market and reported

protective effects by the activation of hypoxia

that most of the red peonies produced in China

inducing factor 1α. Kanako, et al. of University ofwere originated from Paeonia lactiflora but someToyama examined renal protective effects ofwere originated from P. veitchii. And they further
clarified that the red peony originated from P.

keishibukuryogan (Cassia Twig and TuckahoePill) using the same models as above and reported

veitchii contains slightly more amounts ofthat this Kampo formula had inhibitory effects on

paeoniflorin

than

the kidney becoming fibrotic - stronger effects

P.lactiflora, but ingredients of both spices are notthat cannot be seen from losartan. And Shibahara,different.

et al. of the same University reported that theyandpentagalloyl

glucoserats

andobservedrenal

had performed gene expression analysis using theStudies on problems arising from preparing

remaining portion of the kidney and found there
were changes in the expression of the genes

Kampo medicines
Himeno et al. of University of Toyama showed

involved in kidney becoming fibrotic, such asthat when a Kampo formula was decocted and thematrix metallopeptidase or kallikrein. Moreover,decoction was heated again after being stored for

Nakatsuka et al of the same University reported

ten hours at room temperature, no changes

that they had administered the single medicinal

occurred in the amounts of the ingredients. And

herb Rhubarb to the same models, observing its

they reported there would be no problem if theinhibitory effects on kidney fibrosis, and it had

amount/formula for a daily use was decocted at athetime and then divided portions were taken.

keishibukuryogan.

Basic pharmacological research for Kampo
medicines

mechanisms

different

from

those

of

Jyou et al. of University of Toyam reported thatgoreisan (Poria Powder with Five Herbs) had
been administered to models of high blood

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

23

Volume 5, Number 3 | Fall 2010

hemi-nephrectomizedrats,

resultinginbofutsushosan(Divaricate
Saposhnikovia
Miraculous Powder) had been continuously

significant

inexpressionsofadministered orally to mice fed a high-fat diet,

Na+/K+-ATPase, beta-1 protein, aquaporin 1 and 2,

showing the inhibitory effects of weight gain andpressure induced by giving saline water toincreases

throughwhichgoreisantheimprovedkidneySakurai, eta al. of University of Toyama
compared inhibitory effects for 50 types of protein
kinase of 10 kinds of crude drug extracts
composing juzentaihoto (Ten Strong Tonic Herbs

Decoction) and suggested the comparison could be
used as an omics research tool.
Kojima et al. of Musashino University reported
that they had administered geniposide, which is aelementofgardenia

fruit,

tospontaneously obese mice (TSOD mice) andobserved the inhibitory effects on body weight
gain, visceral fat accumulation and subcutaneous
fat accumulation.

the effects of lowering the levels of blood sugar
and blood LDL in spontaneously diabetic mouse(db/dbmice)

byadministering

Kangen-karyu(granules),andreported
Kangen-karyu has the effects of improving
diabetes. And, Park et al of the same University
reported that they observed the effects oflowering levels of blood sugar, the effects ofcontrolling

triglyceride

levels,andrenal-protective effects by the administration of
loganin contained in Asiatic Cornelian Cherry
Fruit to the same models.
Kamei et al. of University of Toyama reported
that

of

white

adiposetissues,significant

effects.
Cho et al. of University of Toyama reported
that chotosan improved memory disturbance in
aging

promoted

SAM

mice

and

as

the

mechanisms, the improvement was due to its
actionofpromoting

NMDA-typeglutamate

receptor signals.
Aoki et al of Kitasato University reported thatan increase in anti-virus antibody values wasobserved in influenza virus-infected mice by theadministration of maoto (Ephedra Decoction).
Nagai, et al of the same University reported

Yamabe et al. of University of Toyama observed

modelsincreasesuggesting that bofutsushosan has anti-obesity

impairment.

composingweightdeclines

wasobservedinshoseiryuto (Minor Blue Dragon Decoction)
inhibited antibody value from increasing andshowedanti-inflammatory

effects

andtherecovery of the decreased expression of aquaporin
5 in mouse models of airway inflammationinduced by ovalbumin inhalation.
Nohara, et al of Meijo University produced
frequently sneezing mouse models by nasallyadministering

compound

4/80

to

mice

and

reported the significant inhibitory effects of

shoseiryuto (Minor Blue Dragon Decoction) andmaobushisaishinto (Ephedra, Aconite andManchurian Wildginger Decoction) on frequentsneezing.

increased levels of blood sugar and increased

Sekiya et al of Kitasato University orally

epididymal adipose tissue mass in rat models ofadministered hochuekkito to mice that was givenobese fed a high-fat diet by the administration of

methotrexate intraperitoneally and comparedhachimijiogan.

changes in temperature-controlled expressions of
the immunorelated molecule mRNA and they

Kaminari et al. of Kracie reported that24

clarifiedtheeffects

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

ofhochuekkitoonVolume 5, Number 3 | Fall 2010

immune-enhancement of the intestinal tract.

administered rabbits, blood flow increased in theorbital short posterior ciliary arteries with

Yamamoto et al of University of Toyama

lowered ocular pressure.

reported that they had examined the influence ofHanda et al. of Fukuoka University reported

kakkonto (Pueraria Decoction) in mouse model ofthat the administration of yokukansan to rat

food allergy induced by the oral administration ofmodels of Alzheimer’s induced by treated cerebral

ovalbumin to mice and observed a significant

ischemia-reperfusion

abnormalities+

increase

intracerebroventricularadministrationofinregulatoryTcells,

suggesting

kakkonto has the improving effects on foodamyloid-betaallergy.

effects on memory impairment.

showedthecompleterecovery

Kimura et al of Ehime University reported thatthe oral administration of flavonoid contained in

Ito et al. of Kitasato University reported that

Scutellaria Root improved impairment of thethe antidepressant effects of kososan (Cyperus

dermal layer induced by ultraviolet radiation to

and Perilla Leaf Powder) were observed in the

hairless mice.

models of depression induced by the application ofchronic mild stress to mice.

Kimura et al. of University of Toyama reported
that in the models of pressure ulcers produced by

Hori et al. of Showa University observed that

applying pressure to rats, kigikenchuto (Kigikamishoyosan (Modified Merry Life Powder)

Middle-Strengthening Decoction) showed theshowed the improving effects on the spontaneous

effect of improving pressure ulcers by suppressing

tunnel in menopausal models in ovariectomized

the expression of MCP-1.

mice, suggesting it is effective for unidentifiedcomplaints associated with menopause.

Munekata et al. of Keio University reported
that the administration of juzentaihoto (TenStrong Tonic Herbs Decoction) to mice increased
the expression of interferon-stimulated gene 15 in
the lamina propria mucosae of the large intestine,enhancing the production of interferon.

and Life Sciences reported that in cultured
hepatocytes of healthy rats treated with theofRhizoma

Notopterygium,andenzymesRadix

involved

Forbesindrug

metabolism were induced and detoxication offoreign substances was promoted.

ofyokukansan

Medicine

reported(Liver-Inhibiting

al.

of

The

UniversityofTokushima observed the suppressing effects of

Kujin

Extract(Sophora

Angustifolia

Root

Extract) on cytokine expression induced bystimulating rat basophil leukemia cells (RBL-2H3
it as an active ingredient.
Liu of Hokuriku University reported thatyokukansan (Liver-Inhibiting Powder) showed
the protective effects on apoptosis by treating rat
PC12 cells derived from pheochromocytoma with
Abeta 40.
Clinical research for Kampo drugs

Yamada et al. of St. Marianna University
Schooletcells) with IgE, and isolated maackian to identify

Onuma et al. of Tokyo University of Pharmacy

extract

Kanayama

that

in

the

Powder)Sato et al. of Oita University reported that thelevelsofneuropeptides

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

were

measuredto25Volume 5, Number 3 | Fall 2010

compare those before and after the single
administration(Life-Preserving

goshajinkigan
Extract
Kidney-Qi Pill Extract) inofhealthy males, showing

significant increases

that were caused by the administration in thelevels of vasoactive intestinal polypeptides andcalcitonin gene-related peptides with slightly
increased blood flow rates, blood pressures, andpulse rates.
Ozeki et al. of Osaka University reported that
there was a significant correlation between
stagnant water scores and parameters showing
cardiac muscle function.
Watanabe et al. of Suwa Chuo Byoin reported
on their experience in which they had made thesingle administration of Astragalus Root or

Hedysarum Polybotrys Root to patients withchronic kidney disease with the result of a decline
in serum creatinine levels in either of them.
OthersKashu et al. of Hyogo College of Medicine
conducted a drug lymphocyte stimulation test
(DLST)

bytreating

peripheral

lymphocytes

prepared from the blood withdrawn from healthypeople with crude drug extracts, and clarified
that the reactions were found significantly
positive to “Prepared Aconiti Daughter Tuber”
and “Gardenia Fruit.” They reported that in drug
allergy diagnosis, false-positive reactions to thesetwo drugs are prone to be detected.

26

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

Volume 5, Number 3 | Fall 2010

Kampo Formula Developed in Japan (3)Fructus work to clear heat and expell toxins in

Saikoseikanto
Hiromichi Yasui
Japan Institute of TCM Research
ProfileThe currently used saikoseikanto is a modified
formula of the original saikoseikanto (Bupleuri
Radix,

Scutellariae

Ginseng Radix,
Gardeniae
Fructus,
Platycodi
Radix,

Radix,

Cnidium
Rhizoma,Forsythiae
Fructus,
Glycyrrhizae Radix) described in the “Wàikē

shūyào Pivot of External Medicine”. The formulamodifiedby

DohakuMori(1867-1931)ischaracterized by exercising his ingenuity inadding “shimotsuto” and “orengedokuto” to theoriginal prescription.
The current constituents are as follows:

Bupleuri Radix 2 gScutellariae Radix 1.5 g
Phellodendri Cortex 1.5g
Coptidis Rhizoma 1.5g
Trichosanthis Radix 1.5 g
Glycyrrhizae Radix 1.5 g
Platycodi Radix 1.5 g
Arctii Fructus 1.5 g
Gardeniae Fructus 1.5 g
Rehmanniae Radix 1.5 g
Paeoniae Radix 1.5 g
Cnidii Rhizoma 1.5 g
Angelicae Acutilobae Radix 1.5 g
Menthae Herba 1.5 g
Forsythiae Fructus 1.5 g[Efficacy] Heat-clearing and relieving
toxins/soothing liver and blood activation[Indications] Heat toxin/liver depression/bloodstasis[Drug actions] Coptidis Rhizoma, Scutellariae
Radix,

Phellodendri Cortex, and Gardeniae

orengedokuto, while Angelicae Acutilobae Radix,
Paeoniae
Radix,
CnidiiRhizoma,andRehmanniae Radix work to nourish and cool the
blood and activate blood in shimotsuto. Bupleuri
Radix, Arctii Fructus, Forsythia Capsule,
Platycodi Radix, Trichosanthis Radix, Menthae
Herba, and Glycyrrhizae Radix work to dispel
wind and heat, expell toxins and dispel pus.
Especially Arctii Fructus and Platycodi Radix
repress throat inflammation.
Clinical application
Mori devised this prescription for improving
the scrofulous constitution of children. Scrofulous
is a syndrome caused by allergic reactions
relating to a tuberculosis infection. Scrofulous
was often seen in childhood in those days. The
symptoms include swollen lymph glands of theneck and other places, which were accompaniedbyeczema,keratoconjunctivitis,

blepharitis,

rhinitis or cheilitis, presenting a peculiar sickly
visage. With the decreasing of tuberculosis, suchpatients decreased and are not seen today. Today,with the benefits of the past experience, theprescription

is

used

for

respiratory

tract

infections, atopic dermatitis, other skin disorders,and neurotic diseases that are recurring inchildren. Of course, this formula has indications
for adults.
1.

Recurrent upper respiratory inflammation inchildren (especially tonsillitis)
This formula is often used for tonsillitis andsinusitis that recur in childhood. A long term
administration (more than six months) is needed
for these diseases.
Iwama, et al. have released a document on theirstudy in which saikoseikanto was administered to

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

27

Volume 5, Number 3 | Fall 201012 child patients (age 2-8, 5 males, 7 females)effectiveness and many patients of the groups of

having tonsillitis recurrently, a half of themoderate and serious severity had no effect or

patients had tonsils assessed as grade II of

became worsened) 3).

Mackenzie’s classification with white furs on the

Mikawa, et al. report that they prescribed

cryptae. These patients received the formulasaikoseikanto for children with atopic dermatitis(0.1g/kg/day) for about one year when the disease(15 male and 10 female) who had not obtained

stage

stage.

sufficient effects even though the causes of the

Although eight patients developed a fever after

disease were eliminated or by the use of topicalone month of oral administration, a fever onset

ointments to assess the effects of itching. From

did not appear after two months. Ten patients

one week administration, they obtained theused to suffer from a fever every day during 2-5

impression

months prior to the start of the administration.

improved” in 80% of the children4).

marginallypassed

the

acute

of

“slightly

improved”

to

“very

The onset of fever, however, decreased to only
three times a year. Two patients were not

Ito administered saikoseikanto for 12 weeks to

responsive to the treatment, one of which had a

25 children aged 2-15 with atopic dermatitis who

tonsillectomy1). There is other report published on

had not had adequate effects by the application ofthis formula by Fujii2).

topical creams. The results showed that after 2
weeks and onwards, improvements were observed

This formula containing 15 kinds of crude

withsignificancedifferences

anddrugs is complex in its constitution and has been

more-than-improved were shown in 80% of all

created with the concept different from that ofpatients5).

“Shāng hán lùn.” This suggests that children’s
susceptibility to infections has a variety of aspects,

3. Neurosis

Saikoseikanto contains Bupleuri Radix, which

which elucidation remains to be seen.

is a typical drug for soothing the liver, Wild Mint,
2.

Atopic dermatitis

which has both actions of soothing the liver andAtopic dermatitis is a refractory skin disorderdispersing pathogenic factors, shimotsuto, which

and it is increasing in recent years. Saikoseikanto is

nourishes the liver, and many heat clearing drugs,

often used for this disorder occurring in childhood.

which cure the pathological conditions ofdepressed liver qi transforming into fire.

Horiguchi,

et

al.

report

that

when

this

Therefore, this formula is used for neurosis and itprescription was used together with topical

is often used especially for neurosis in young

steroids to 34 patients in total in the groups ofchildren.

atopic dermatitis with mild to serious severity,
the combination use was effective in 84% of all
patients and it was also effective in each group,
whereas when petroleum jelly was combined
instead of steroids, this combination use was
effective in 64% (this case, many of the patients in
the group of mild severity showed marked
28

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

Volume 5, Number 3 | Fall 2010

References
1) Masafumi IWAMA: Hanpukusei Hentoen ni

Saikoseikanto. Journal of Nippon Shonikai
Kaiho, No. 10 98-99, 1995
2) Kazuyoshi FUJII, Hiroshi SATO, Hirosato
MIYAKE: Clinical Effects of Saikoseikanto on
Habitual Angia (1st report), The Society ofPractical Otolaryngology , 1986, 79, 1343
3) Yuji

HORIGUCHI,

Hiroyuki

NorikoOKAMOTO,HORIGUCHI,

Motoi

OGUCHI,

Motoaki OZAKI: Atopiisei Hifuen ni taisuru

Saikoseikanto no Chiryo Koka, Hifuka Kiyo
78: 145-150, 1983.
4) Haruki

MIKAWA,

Setsuko

ITO:

Shoni

Atopiisei Hifuen ni taisuru Saikoseikanto.
Kampo & Meneki/Allergy 6: 80-86, 1992.
5) Setsuko ITO: Atopiisei Hifuen ni okeru

Saikoseikanto Extract Granule no Shiyo
Keiken, Modern Oriental Medicine 10 Extra
Edition, Nanbyo, Nansho no Kampo Chiryo
No. 2, 202-203, 1989

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

29

Volume 1, Number 1 | Spring 2006

Ominedo is the only professional manufacturer of herbal extracts.

Poria Powder with Five Herbs
Wu-Ling-San
goreisanComposition
Arisma rhizoma
Tuckahoe
Atractylodes ovatae rhizoma
Umbellate pore fungus
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Ominedo Pharmaceutical Industry Co., Ltd.
574, Nenarigaki, Yamatotakada-City, Nara 635-0051, Japan
URL：WWW.ominedo.co.jp
Contact：info@ominedo.co.jp
Phone: (81) 745-22-3601 Fax: (81) 745-23-2540
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 1, Number 3 | Fall 2006

Kanebo Pharmaceutical, Ltd.
Like the cherry trees along Potomac River, Kanebo wishes
to play a role of the bridge for friendship and healthbetween Japan and U.S.A.

History of the Cherry Trees in Washington, D.C.
The plantings of cherry trees originated in 1912 as gift of friendship to the United Statesfrom the people of Japan. In Japan, the flowering cherry tree or “Sakura”, as it is called by
the Japanese people, is one of the most exalted flowering plants. The beauty of the cherry
blossom is a potent symbol equated with evanescence of human life and epitomizes thetransformations Japanese Culture has undergone through the ages.
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Excerpted from National Park Service

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