KAIM
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Meeddiicciinnee
INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 9, Number 1 ･ Spring 2014

Editorial

The Difference Between TCM and Kampo Medicine
Hiromichi Yasui

Japanese Acupuncture - Current Research

Japanese Traditional Medicine Text (11) – Orthopedic Medicine
Masahiro Iwa

Kampo Medicine - Current Research
Clinical Applications of Kakkonto – Part 1
Hiromichi Yasui

Clinical Report 1 (Acupuncture)

A Case Where Press tack Needles at Li4 were Markedly Effective for Should Pain
Genki Shimizu

Clinical Report 2 (Kampo Medicine)

A Case in Which Saikokaryukotsuboreito and Other Kampo Drugs were Effective against Night-crying in a Thirtten-month-old Girl
Hideaki Yamaguchi

ISSN:1559-033X

College Logos
We believe it is necessary to create a new way of thinking
for the total understanding of "Life, Survival, and Health".
We decided to coin the world "Lifence" to express this.
Lifence means the combination of life sceince and medicine
as well as other disciplines such as health science, psychology,
ethics, etc.
Our college logos symbolizes the above.
The ripple effect represents the ocean and the birth of life.
The rainbow colored sphere represents a safe environment
and a barrier to protect us from negative influences.
The picture by Leonardo da Vinch represents a balanced
body and health.
Completing our logos is a ring which represents the unity ofspace fulfilling the total meanings of lifence.

―

The Journal of
Kampo, Acupuncture andIntegrative Medicine(KAIM)
Research on Theory, Practice and Integration

Volume 9, Number 1 ･ Spring 2014

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, JapanASSOCIATE EDITORS
Shuichi Katai

1 Editorial
The Difference Between TCM and Kampo Medicine
Hiromichi Yasui

Ibaraki-ken, Japan

Hiromichi Yasui
Tokyo, JapanEDITORIAL STAFF

Akihiro Souma
Hiromi Sasaki
Hiroshi Tsukayama
Hitoshi Yamashita
Junko Okubo
Kazunari Ozaki
Kengo Nakata
Masayuki Kashima
Naoya Ono
Noboru Mitsuhata
Sayaka Toda
Takao Namiki
Toshiaki Makino
Toshihiro Togo

3 Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (11) – Orthopedic Medicine
Masahiro Iwa

8 Kampo Medicine - Current Research
Clinical Applications of Kakkonto – Part 1
Hiromichi Yasui

13 Clinical Report 1 (Acupuncture)
A Case Where Press Tack Needles at Li4 were Markedly Effective for Shoulder Pain
Genki Shimizu

PUBLISHER

Shuji Goto
International Institute of Health andHuman Services, Berkeley
2550 Shattuck Avenue, Berkeley
California 94704-2724, U.S.A.

14 Clinical Report 2 (Kampo Medicine)
A Case in Which Saikokaryukotsuboreito and Other Kampo Drugs were Effective against
Night-crying in a Thirteen-month-old Girl
Hideaki Yamaguchi

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)KOTARO PHARMACEUTICAL introduced in 1957 the world's first Kampo extract
preparations on the market. Later, in 1967, six of our preparations could be covered in Japanfor the first time by the health insurance and after 1976 more than 100 of our preparations
were used in hospitals and clinics. Now it is half a century since we put our Kampo extract
preparations on the market and believe, we made a major contribution to this industry.
In the future we intend to continue working in accordance with our company motto: "Still better
Kampo for still more people" and provide pharmaceutical products of still higher quality.

Origin of the company's name
The company was named "KOTARO" by its
founder Taro Ueda with reference to his birthplace. Close to the ancient city of Nara. Kotaro
is the name of an enormous sheer cliff, 700 m
wide and about 200 m high. Mr. Ueda felt anaffection rising to the heavens for this cliff andthus made it the company's name.

KOTARO PHARMACEUTICAL CO., LTD.
5-23 Nakatsu 2-Chome, Kita-ku, Osaka 531-0071, JAPANURL: http://www.kotaro.co.jp

Volume 9, Number 1 | Spring 2014

Editorial
The Difference between TCM and Kampo Medicine
Do you know the difference between TCM and Japanese Kampo medicine? Both are traditional medicine of
Eastern Asia originating in ancient Chinese medicine, they use practically the same drugs, and they utilize
prescriptions that have the same names. However, their difference lies in the process from diagnosis to therapy.
TCM is a combination of physiology, anatomy, etiology, pathology, and their therapeutics, based mainly on
the Theory of Yin-Yang and the Five Elements and other ancient Chinese philosophical theories. The therapeutics
is performed by applying pharmacognosy and prescriptionology that stem from the same theories.
Over time, this system developed with the influence of medicine from the West, as well as of Buddhism andTaoism. By the end of the 16th century, it formed a large region of medical culture that included the Korean
Peninsula, Japan and Vietnam.
This situation continued for about a century, when a change occurred—in Japan only. The change wastriggered by the strong influence that the boom in Shang han lun studies in 17th-century China had on Japan.
Furthermore, at around the same time, a movement occurred that claimed that Japan’s world of thought whichmainly centered on Neo-Confucianism should embrace a revival to Confucianism. In response to this movement,a school of medicine emerged, which claimed that medicine should also attach foremost importance on the greatclassic of ancient Chinese medicine, Shang han lun. Yoshimasu Todo, who belonged to this school, invented asystem for using prescriptions written in the Shang han lun according to their written descriptions. The system
did not place weight on assessing pathological patterns (referred to as “patternsTM1” in ICD-11) in TCM, but
aimed solely to determine the best prescription to administer to each patient.
After Yoshimasu announced his system, the medical community in Japan fell largely into confusion, and ahuge debate erupted between pro- and anti-Yoshimasu groups. Ultimately, the supporters won the debate, andother schools were left to merely pass down their lineage. One reason for Yoshimasu’s success was that he focusedon utilizing the basic prescriptions of Shang han lun. Another reason was because the system could directly
determine which prescription was needed by each patient by assessing their signs and symptoms, without
applying TCM theories to therapy.
However, there were many problems in applying the descriptions of the classic work to patients as they are.
New physicians needed to study under a distinguished mentor for a certain duration and, above all, they needed
to gain first-hand experience. Thus, physicians of succeeding generations established categorical classifications
within the system’s structure that directly linked symptoms to prescriptions, and devised an expedient thatwould facilitate the selection of the best prescription for each patient. Today, the Japanese Society of Oriental
Medicine recommends this variation. It uses the three basic elements of qi-blood-fluid, yin/yang,exterior/interior, cold/heat, deficiency/excess, and the six stage patterns as auxiliary classifications for theselection of the best prescription, and does not analyze them for the purpose of analysis.

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

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Volume 9, Number 1 | Spring 2014

The advantage of this Japanese system lies in being able to utilize the accumulation of knowhow for
administering the excellent prescriptions of the Shang han lun by incorporating them into the system.
Furthermore, it is worthy of special mention that it facilitates clinical studies by utilizing extract preparations byprescription units. The standards of extract preparations by pharmaceutical companies in Japan are basically thesame, so the same effect can be obtained from the product of any company.
The greatest reason why integrated medicine that includes Kampo medicine has succeeded without problem
in Japan despite the focus placed on Western medicine practices within a unified health care system, is because
Japan has a system of Kampo medicine that differs from TCM.
This is not a matter of determining whether TCM or Kampo medicine is better than the other. I simply wantto say that integrated medicine can be made even better by using the two systems of traditional medicine (having
the same origin) and Western medicine effectively.

Hiromichi Yasui
Japan Institute of TCM Research

2

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

Volume 9, Number 1 | Spring 2014

Japanese Acupuncture – Current Research
Japanese Traditional Medicine Text (11) –Orthopedic Medicine

point Shiatsu. Additionally, a wide variety of sample
sizes, control group criteria and sham treatment

Masahiro Iwa

group criteria contributes to a wide range of effects

Associate Professor
Faculty of Acupuncture and Moxibustion
Meiji University of Integrative Medicine

and conclusions. P6 tends be used most frequently as

A. Postoperative nausea and vomiting, postoperative
intestinal paralysis
Various symptoms and complications occur after
surgery, for example postoperative nausea andvomiting (PONV) and postoperative ileus (POI).
These seem to be especially adaptable acupuncture
and moxibustion therapy. Of course these are due tovarious factors but anesthetics and analgesic drugs
used after surgery are certainly big factors. Thesenot only reduce patient quality of life, but alsodelayedacupuncture electrical stimulators, acupuncture

recoveryoperatively, there has been a recent trend to use
percutaneous electrical stimulation as opposed toelectro-acupuncture.
To begin with a review of the RCT literature,
Cochranepublished

thelatestreport9).

The

antiemetic effects (POVN) of P6 were verified bycomparing actual needling with sham needling.

It

was found that patients treated with P6 requested
fewer anti-emetic drugs. It was further foundbecause that there was no difference in effectbetween the acupuncture and the antiemetic,

prolong

recentevidencemeans for preventing PONV. Shiao10) et al, used asuggesting acupuncture treatment is useful formeta-analysis and found that both acupuncture andcoping with side effects of drugs such as PONV andanti-emetic medications were equally effective for

POI.

reducing PONV. Notably, it was reported that forWe

surgery

be used pre-operatively, intra-operatively and post-andhospitalization.

after

a treatment area. Because treatment methods may

examinedpatients treated with acupuncture, there were fewer

1. Clinical Studies from Abroad
Studies on the effects of acupuncture point
stimulationfor

postoperativecomplaints

overwhelmingly focus on PONV. A PubMed searchusing

keywords[acupuncture][postoperative

produced

150

nausea]relevantandarticles.

Approximately 30 references were found for clinicalresearch using RCTs in the past 10 years (since2000).
After reviewing more than 25 references, we
extracted 8 reports for examination here.

effects of acupuncture point stimulation for PONV(18). Every year, a number of papers are presented fromcountries.

Targeted

techniquesoracupuncture point stimulation covers a wide rangeoftreatment

options:

acupuncture,

requests for emergency anti-Emetic which is usefulfor POVN patients. Further, the systematic review
by Sun1) et al., they investigated the side effects of
opioids in post-operative PONV patients. It wasreported that the acupuncture group, compared tothe control, had a reduced occurrence of nausea but
there was not significant difference concerning theincidence of vomiting. Dune12) et al, reported in theirsystematic review on pediatric POVN the effects ofacupoint stimulation. Acupuncture and acupuncture
point

Table 7 shows the RCT literature examined

Westernacupuncture stimulation might be reasonable as aelectricalacupuncture, Transcutaneous and percutaneouselectrical stimulation (TENS), laser stimulation,

Shiatsupostoperative

led

to

vomiting

significantlyinchildren.

decreased
Notably,acupuncture and acupuncture point Shiatsu were
found to be more effective than electro acupuncture
for these subjects.z
Allen13) et al. conducted a meta-analysis on theeffects of stimulus at P6 for PONV following
Cesarean surgery under spinal anesthesia. Requests
for Inter-operative, post-operative nausea and

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

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Volume 9, Number 1 | Spring 2014

vomiting and emergency anti-emetic medications

What remains unclear is, to what extent are thesewere reduced however, several inconsistencies in the

protocols being used successfully clinically? On the

protocol may diminish the strength of the analysis

other hand, regarding post-operative ileus (POI), a

and conclusions. Also, the Gynecology Physicians

PubMedAssociation of Canada`s Executive Council has[postoperative ileus] and [acupuncture], 1 RCT

published management guidelines14) recommendingreference was extracted15). Post-operative Colonelectrical stimulation of acupoints as prophylaxis

cancer patients were given electro-acupuncture atand as useful for PONV. Acupoint stimulation

GB34 and SJ6 for 6 days following their surgery.

received a high evaluation and was strongly

However, it was reported that electro-acupuncture

recommended based on evidence based evaluation

was ineffective for preventing POI in these patients.

grades II-1 (I, II-1 through II-3, III of 5 levels).

It

Until recently, most fundamental RCTs on the effects

received a grade A on the A-L 6 level recommendedof acupuncture stimulation for gastrointestinal

degree classification. As the above research suggests

motility have focused in irritable bowel syndrome

acupuncture has been used successfully as a

(IBS) and very little research has been done on thesepreventive therapy for PONV.

effects in POI patients.

word

searchwasconducted

using

Table 7 Major Research Paper on Acupuncture Point Stimulation for Post-Operative Nausea and Vomiting
Researcher

Name of surgery

Teatment area

Treatment method

Sham

TENS
ReliefBand (electro
acupuncture
stimulation device)
ReliefBand (electro
acupuncture
stimulation device)
Auricular
acupuncture

Non-acupoint areas
Not operating theReliefBand

TENSTENS used on/ along
the Ulnar nerve
Stimulate the dorsal
aspect of the wristwith a ReliefBand
Not operating theReliefBand(year)

4

Wang1) (2010)
Frey2) (2009)

Cranial Surgery
Laparoscopiccholecystectomy

Nei Guan (PC6)Nei Guan (PC6)

Frey2) (2009)

Hysterectomy

Nei Guan (PC6)

Sahmeddini4)(2008)

Laparoscopiccholecystectomy

Arnberger5)(2007)
Habib6) (2006)

Laparoscopiccholecystectomy
Caesarean Section

Points on the Sympathetic nervous
system, stomach points, Shen Men(UB23), Occipital point
Nei Guan (PC6) (Median nerve
domain)Nei Guan (PC6)White7) (2005)

Orthopedic Surgery

Nei Guan (PC6)

Gan8) (2004)

Mastectomy, Surgery
for Breast Cancer

Nei Guan (PC6)

ReliefBand (electro
acupuncture
stimulation device)
ReliefBand (electro
acupuncture
stimulation device)TENS

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

Not operating
ReliefBandtheAffixed with tape

Electrode only affixedVolume 9, Number 1 | Spring 2014

2. Current Clinical Studies and Prospects for theparticularly the United States since1999, within the

Future of Japanese Research

NIH, The National Center for Complementary andA web search of online journals for the keywords[postoperative

nausea][postoperativeandintestinal[acupuncture]paralysis]orand

Alternative

Medicine(NCCAM)has

beenestablished. Every year, millions of dollars are
donatedby

National

Research

Foundations,references

Harvard, Johns Hopkins, UCLA, Maryland, Dukehowever, many of these were from minutes atand many other University and medical institutions

meetings, discussions and case study reviews, none

conducting clinical trials on the effects andof which were RCTs. One pilot study for PONV,

usefulness of acupuncture. Additionally, numerous

reported on 11 cases of Gynecologic Surgery whose

medical institutions have incorporated various

subjects were given tack needles at St36, P6, ShencomplimentaryMen (auricular point).

Integrated[acupuncture]

producednumerous

Results suggested that

medical

Medicinemodalities

into

their

Departments.

One

prime

PONV was reduced for these subjects16).

example might be the acupuncture done at Memorial

On the other hand, regarding POI, 12 relevant

Sloan Kettering Cancer Center, one of the world's

reports17,18) were extracted, however these are quite

leading cancer centers. Also, in the United Kingdom

dated. All of these reports set control groups but

inthese did not use sham acupuncture and the sample

acupuncture treatment (published in the British

sizes we between 12 and 15 subjects which was too

Medicalsmall. The acupuncture protocol included either

acupuncture research is being conducted. In contrast,

St36 and LI11 (20 minutes, once a day, 3 days

it must be said that compared the great amount offollowing surgery) or SP13 and SP6 with retention

clinical research from the West, Japan is clearly a(Post-surgery 16 hours).

Positive results were

step or two behind. Not until 2010 did theobtained as the period of post-operative flatulence

Democratic Party Healthcare policy adopt an

was significantly reduced. Further, although notintegrated

primary research, we also conducted acupuncture on“Establishment of integrated health care” andpatients following gastro-intestinal surgery. Tackinauguration of an integrated health project team.

needles were placed at LI4 and ST36. Compared to

However, as of March, 2010, the “Japan Medicalthereported

Association for integrative medicine report released

significantly less post-operative flatulence19). There

their opinion” suggesting that the current flow of theis an especially strong trend for patients following

Japanese Medical Association runs counter to thegastro-intestinal surgery to suffer from extended

trends of integrative medicine.

controlgroups,

the

test

group

periods of flatulence, so in this case acupuncture was

2000,

BritishJournal),medicalmedicalandmodel

doctorsbegan

approved
conducting

promotingtheThese different attitudes to alternative medicine(acupuncture) expressed by the established medical

effective.
ofcommunities in the West and in Japan, reflectacupuncture and moxibustion therapy in surgery, we

differences regarding the fundamental awareness ofattempted to review appropriate RCTs on the effects

and purpose behind alternative medicine. From theof acupuncture administered post-operatively forbackground to the citations we reviewed here,

PONV and POI, however, compared to Western

Western considers acupuncture a useful modality forcountries, far fewer papers have been published incounteracting the side effect of pharmaceuticals.

Japan. The differences between Western andCertainly, the cost effectiveness of acupuncture

Japanese acupuncture and moxibustion research iscannot be overlooked and we may even begin to see

the most important factor. In Western countries,

more evidence based RCTs as a result. However, as

Here,

on

the

subjectclinicalresearch

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

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Volume 9, Number 1 | Spring 2014

is often the case in Japan, the specialists,

prevention of nausea and vomiting during andinstitutions and facilities focused on acupuncture

after cesarean delivery under spinal anesthesia.

research tend to be pursuing evidence based

Anesth Analg 102(2): 581─ 584, 2006

research with the primary purpose of proving the7) White PF, Hamza MA, Recart A, et al.: Optimal

efficacy of acupuncture and moxibustion.

timingofacustimulationfor

antiemetic

In the future, it is considered important that, beyond

prophylaxis as an adjunct to ondansetron in

the narrow scope of orthopedics, high level RCTs on

patients undergoing plastic surgery. Anesth

acupuncture and moxibustion from Japan be

Analg 100(2): 367─ 372, 2005

established8) Gan TJ, Jiao KR, Zenn M, et al.: A randomizedorganizations, medical facilities, doctors and othercontrolled comparison of electro ─ acupoint

researchers, all of which have the financial resources

stimulation or ondansetron versus placebo forto design and carry out specialized research on its

the prevention of postoperative nausea andmany uses and conveniently economical procedures.

vomiting. Anesth Analg 99(4): 1070─ 1075, 2004

organized

andconductedby9) Lee A, Fan LT: Stimulation of the wrist
References

acupuncture1) Wang XQ, Yu JL, Du ZY, et al.: Electroacupoint

postoperative nausea and vomiting. Cochranestimulationfor

postoperative

nauseaandvomiting in patients undergoing supratentorial

P6

for

preventing

Database Syst Rev 2: CD003281, 200910) Shiao

SY,

Dune

LS:

Metaanalysesofcraniotomy. J Neurosurg Anesthesiol 22(2): 128─acustimulations: effects on nausea and vomiting

131, 2010

in postoperative adult patients. Explore (NY)2) Frey UH, Funk M, Lohlein C, et al.: Effect of P6

2(3): 202─ 215, 2006

acustimulation on post ─ operative nausea and11) Sun Y, Gan TJ, Dubose JW, et al : Acupuncture

vomiting in patients undergoing a laparoscopic

and related techniques for postoperative pain: acholecystectomy.

systematic review of randomized controlled

Acta

Anaesthesiol

Scandtrials. Brit J Anaesth 101: 151─ 160, 2008

53(10): 1341 ─ 1347, 2009
3) Frey UH, Scharmann P, Lohlein C, et al.: P6

12) Dune

LS,

Shiao

SY:

Metaanalysis

ofdecreases

acustimulation effects on postoperative nausea

postoperative nausea and vomiting in high ─and vomiting in children. Explore (NY) 2(4):risk patients. Br J Anaesth 102(5): 620─ 625,

314─ 320, 2006

acustimulation

effectively

200913) Allen TK, Habib AS: P6 stimulation for the4) Sahmeddini MA, Fazelzadeh A: Does auricularprevention of nausea and vomiting associatedacupuncture reduce postoperative vomiting afterwithcholecystectomy? J Altern Complement Medanesthesia: a systematic review of randomized

14(10): 1275─1279, 2008

controlled trials. Anesth Analg 107(4): 1308─

5) Arnberger M, Stadelmann K, Alischer P, et al.:cesareandeliveryunderneuraxial

1312, 2008

Monitoring of neuromuscular blockade at the P614) McCracken G, Houston P, Lefebvre G: Guideline

acupuncture point reduces the incidence offor the management of post-operative nausea

postoperativeand vomiting. J Obstet Gynaecol Can 30(7):nauseaandvomiting.

Anesthesiology 107(6): 903─ 908, 2007

600─607, 608─616, 2008

6) Habib AS, Itchon ─ Ramos N, Phillips ─ Bute BG,
et

al.:

Transcutaneous

stimulation

6

point

with

the

acupoint
ReliefBandelectricalfor15) Meng ZQ, Garcia MK, Chiang JS, et al.: Electro─acupuncture

the

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

toprevent

prolonged

Volume 9, Number 1 | Spring 2014

postoperative ileus: a randomized clinical trial.
World J Gastroenterol 16(1): 104─ 111, 201016) Yukie Fukushima, Mahiko Nagase, Michio Tani:
AppliedOriental

postoperative

medicalnauseaandmethods

onvomitingwithdroperidol epidural infusion. Eastern Medicine
17 (3): 31─ 34, 200117) KojiMatsumoto,AtsuroShimizu,

Satoshi

ShimizuTrial of electro acupuncture stimulation
for post abdominal surgery flatulence and pain
relief. Kyoto Minami Hospital Medical Journal
10: 71─ 74, 1991
18) Shin Mastumoto, Takao Sano, Shiji Kokui:
Effects of acupuncture treatment on PostOperative surgical pain relief and stimulation of
peristalsis. Journal of the World of Obstetrical
Medicine 34 (10): 1099─ 1102, 1982
19) Hirofumi Nakanishi, Takashi Tamura Masakazu
Sakutaetal.

Influence

of

Tack

needleacupuncture effects on post-operative intestinal
function. Journal of the National Japan Societyof Acupuncture and Moxibustion 53 (3): 352,
2003

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Volume 9, Number 1 | Spring 2014

Kampo Medicine - Current Research
Clinical Applications of Kakkonto – Part 1

The episode presents two points, at the least. One
is that kakkonto is a famous Kampo drug that isHiromichi Yasui

well-known throughout Japan. The other is that theJapan Institute of TCM Researchprescription is effective for a wide range ofindications. In English, kakkonto is sometimes called Pueraria Decoction, taking the name

Introduction
There are 148 different types of medical Kampo
preparations, each with its own number. Amongthem, the most distinguished number—No. 1—isassigned to kakkonto.
This is because kakkonto is the most popularly
used prescription by the Japanese people.

kakkonto appeared for the first time in the great
Chinese classic Shokanron (treatise on cold damage)and came to be increasingly widely used in Japan
from the latter half of the 19th century. Particularly
since Yodo Odai (1799-1870) introduced various
indications

Ruijuhokogi

for

the

prescription(Interpretations

of

in
the

his

of the principal ingredient, pueraria root. It is also
referred to as Kuz Decoction, taking the Japanesename for pueraria root.

Kakkonto as an extract preparation for medical use
Many

Japanese

pharmaceuticalcompanies

market kakkonto as a Kampo preparation for
medical use. The grams of each ingredient used in
the prescription differ by company, but the JapanesePharmacopoeia, Seventeenth Edition stipulates thefollowing.

work

Ruijuho

Method of preparation
1)

2)

3)

4)

be used widely for a variety of diseases. Moreover,

Puerariae Radix

8g

4g

4g

4g

such clinical applications of kakkonto differed

Ephedrae Herba

4g

4g

3g

3g

completely from those in China.

Ziziphi Fructus
Cinnamonmi

4g

3g

3g

3g

3g

2g

2g

2g

Paeoniae Radix
Glycyrrhizae

3g

2g

2g

2g

2g

2g

2g

2g

1g

1g

1g

2g

(classified assemblage of prescriptions)), it came to

There is a type of traditional performing art inJapan called Rakugo (traditional comic storytelling).
Doctors are frequently mentioned in Rakugo stories,
but the episode of the “Kakkonto Doctor” issometimes introduced at the beginning of a story as
a lead-in.
“Doctor, my head hurts.” “It must be a headache.
Take kakkonto.” “Doctor, my stomach hurts.” “It
must be a stomach ache. Take kakkonto.” “Doctor,
my eye hurts.” “Take kakkonto. And you?” “I justcame to accompany my husband…” “Take kakkonto
anyway.”https://www.youtube.com/watch?v=fcYDwMjTgLIMany who listen to this episode would think that
doctors are totally irresponsible people. However,there also those who say completely the opposite—
they say that doctors who can cure any disease withkakkonto are good doctors.

8

CortexRadix

Zingiber

Rhizoma

Prepare a dry extract or viscous extract as directedunder Extracts, according to the prescription 1) to 4),
using the crude drugs shown above.

Kakkonto as a Kampo preparation for medical use
is made by adding an excipient to the crude extract
obtained by decocting the above ingredients, and adaily dose of 7.5g is divided into two to three portions.
The amounts of each ingredient in the preparationdiffer slightly by pharmaceutical company, as shown
above.
http://www.nikkankyo.org/kampo/info_pi_english/04
8.pdf

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

Volume 9, Number 1 | Spring 2014

Examples of kakkonto extract preparations
Valuation of kakkonto
There

are

two

more

types

of

kakkonto

preparations that contain an addition of otheringredients. They are kakkontokasenkyushin’i andkakkonkajutsubuto. The former is prepared by

http://www.nikkankyo.org/kampo/info_pi_english/04
9.pdf
http://www.nikkankyo.org/kampo/info_pi_english/04
7.pdf

adding 3.0g Senkyu (Cnidium rhizome) and 3.0g
Shin’i (Biond magnolia flower-bud) to kakkonto, andthe latter is prepared by adding 3.0g Sojutsu(Atractylodes lancea rhizome) and 0.5g processed
Bushimatsu (Aconiti daughter tuber) powder tokakkonto.

Examples of kakkontokasenkyushin’i
extract preparations

Kakkonkajutsubuto extract preparation

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

9Volume 9, Number 1 | Spring 2014

would reach my throat and enter my windpipe, such

Clinical applications
In Shokanron, indications for kakkonto are acutethat I would cough for a while, feel a pain in my chest,

infectious diseases. However, from Japan’s moreor had phlegm that would not loosen. At such times,

than 150 years of experience, kakkonto is known to

I used to combine and use shosaikoto andhave an extremely wide range of indications and isbakumondoto. However, perhaps because kakkonto
agrees more with my body, taking kakkonto at thetoday applied to many diseases, as introduced below.

onset of a cold keeps the cold from worsening, and
1. Very early stage of the common cold

Kakkonto is basically classified as an acrid-warm
diaphoretic and is used against common colds thatdevelop as a result of invasion by the wind-cold

more importantly, it prevents the cold from getting
into my body. Owing to this, I have not caught a cold
for more than ten years.
Yakazu Domei, Soukai, Dec. 1975 issue, pp. 93-94

pathogen. However, it is also effective in improving
other types of colds in their very early stage.

2. Wind-cold type of cold

Yanagi et al. report that kakkonto had the effect of

Kakkonto is frequently used in the initial stage ofpreventing the advancement of the common cold in acommon colds and is applied particularly to thestudy where 40 common-cold patients ages 12 and above

wind-cold type of cold one to two days after its onset.

were administered two doses of kakkonto extract

It is one of the most frequently and commonly used

immediately after experiencing symptoms of a cold, suchcold remedy in Japan.

as chills, nasal congestion, runny nose, sore throat, stiff

The wind-cold type of cold basically occurs whenneck, and joint pain. The patients were regularly

the wind-cold pathogen attacks the early yang region

instructed to take kakkonto in the early stage of a cold andand at the same time penetrates the middle yang

were able to take the preparation soon after developing askin, where it fights with the healthy qi. Its

cold. The effective rate was 14/16 (88%) in the group thatsymptoms include chills, fever (this may appear

was administered the preparation within three hours oflater), stiffness in the neck and back, and headache,developing a cold, 12/16 (75%) in the group that was

but no sweat is produced, and the pulse is usuallyadministered the preparation three to six hours after

floating, rapid and tense.

developing a cold, and 2/8 (25%) in the group that was

The shorter the time from developing a cold toadministered the preparation six to twelve hours after

taking kakkonto, the better. If taking kakkonto isdeveloping a cold.1)

delayed, the pattern of the cold may change, and thetiming for taking kakkonto could be missed.

The following is a typical case regarding the onset

Hosono states as follows about the effect ofof a common cold.

kakkonto on colds: “Generally, taking a dose of
kakkonto when you feel you are coming down with aCase: Onset of a common cold

cold and have stiff shoulders, a headache and chills

I make it a habit to take a dose of kakkonto

but no sweating, keeps the fever at bay and cures theextract powder with hot water immediately when I

cold quite easily. If the cold still does not improve,

begin to feel chilly or sneeze even once. This makes

taking another dose after one to two hours does theme feel much better, and the symptoms usuallytrick.”2)

disappear after sleeping soundly for a night, without

Fujihira also states as follows: “When I was in

the cold reaching into my body. Previously, wheneverschool, I used to develop bronchitis whenever I had a

I caught a cold, I used to sneeze profusely for about

cold, and suffered ten days to two weeks of thick

two days, and from around the eighth day, the cold

phlegm before the cold finally abated. However, after

10

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

Volume 9, Number 1 | Spring 2014

I began taking Kampo, my cold would sometimes go

Shiraki applied kakkonto to mouse infected with theaway in about 5 minutes after taking kakkonto.”3)

influenza virus and found that the efficacy of kakkonto

In the case of a decoction, it should always be

could be easily explained when considering that it cuts thetaken while it is warm. Extract preparations should

IL-1 cascade from interferon.5)

also be taken with warm water as a rule, although

A tremendous amount of cases has been presented

there have been reports that tea or cold water was

to date, but from among them, two typical cases are

just as effective.

introduced below.

The original text of Shokanron notes that after
taking kakkonto, the patient should consume hot

Case 1: 20-year-old male student

rice porridge, get under the bedding and gradually

The patient had a slightly heavy head since

induce sweating. The rice porridge is not necessarily

morning but forced himself to attend class. From

relevant, but it is important to keep the body warm.

around 4 p.m., the headache intensified, and he also

Note that kakkonto is suitable for the wind-coldbegan to feel hot.

type of cold. For example, the efficacy of kakkonto as

He made a medical visit at 5 p.m. He had a body

it is would not be apparent in colds that aretemperature of 38.5°C, a pulse that was floating,accompanied by a sore throat. People who have arapid and excessive, but no particular change in his

cold accompanied by a sore throat frequently retain

tongue. No tendency of natural sweating washeat inside their body, because the heat from theobserved, but the spine from the back of his head to

cinnamon bark and dried ginger root contained in

the shoulder blades was extremely stiff. The patient

the preparation further promotes heat. However, byhimself was also aware of the tension at the back ofadding gypsum, it is possible to release thehis head. He was given kakkonto extract and told toaccumulated heat from the body. An Eppito

go to bed immediately after returning home.

prescription may also be added depending on thepathological condition.

The next day, the patient commuted to school ingood health. He said that when he went to bed after

It is difficult to objectively evaluate kakkonto as acold remedy, but there is a report as follows.

taking a dose of kakkonto, his body became warm, he
experienced a good bout of sweat, and soon fell asleep.

Yamaoka made a comparative study of the efficacy of

He woke up this morning feeling thoroughly

kakkonto and PL granules by dividing 26 outpatients who

refreshed and felt like going to school.

made a visit to the respiratory department complaining

Katsutoshi

Terasawa,

Wakan-shinryogaku

chiefly of cold-like symptoms into two groups, group A and(Japanese and Kampo medicine), p. 116, Igaku-shoin,group B. The result was such that the same level of1990

efficacy against coughing and phlegm was seen in bothgroups,butkakkonto wasalsoeffective

againstCase 2: 82-year-old woman

fatigability and stiff shoulders. Thus, on the whole,

Past medical history / Family medical history:

kakkonto was effective against many more symptoms.4)

Nothing in particularThis study, however, was a comparison made after

History of present illness: The patient was admitted

four doses of each preparation (total of 8 days) andto hospital on January 22, 2008 due to lumbar

was not designed to examine the efficacy of kakkonto

spondylosis and chronic heart failure. She began to

one to two days after the onset of symptoms, when it

feel chills in the morning of December 1 of the sameis said to be most suitable.

year and ran a fever of 38°C by noon. She had

Many basic studies have also been made on the

stiffness in the neck and a headache.

antipyretic effect of kakkonto.

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

11

Volume 9, Number 1 | Spring 2014

Present illness: Blood pressure 132/68mmHg; pulse

References

90/min,No1) Kazuo Yanagi et al.: The efficacy of administering

palpating of lymph nodes. No pulmonary sound. No

a double dose of kakkonto in the early stage ofabdominal abnormality.

development of cold-like symptoms. Collection of

Observation from the physical perspective ofsummaries of presentations from the 51st annual

Japanesemeeting of the Japan Society for Oriental

regular.

orientalNopharyngeal

medicine:

redness.

Floating,

slightly

excessive, rapid pulse pattern. Normal tongue
pattern. Intermediate abdominal strength, and noother particular changes in abdominal pattern. No
tendency of natural sweating. The back of the neck

Medicine, p. 243, 2001.
2) Shiro Hosono: Ten Lectures of Kampo Medicine,pp. 82-91, Sogensha, 1982.
3) Talking about kakkonto (round-table discussion).

is tense and stiff.

Clinical study of Kampo, Vol. 11, No. 6, pp. 24-33,

Progress: A half day after developing the cold, the1961.

patient’s pulse pattern indicated the early yang4) Minoru Yamaoka: Study of the clinical efficacy ofstage of the cold. As the patient had no tendency of

kakkonto

natural sweating and had stiffness at the back of hersummaries of presentations from the 45th annual

neck, she was prescribed 7.5g Tsumura kakkonto

meeting of the Japan Society for Oriental

three times a day after each meal. After taking theMedicine, p. 235, 1994.

prescription twice, at noon and night, she produceda large amount of sweat and the stiffness at the backon

colds.

Collectionof5) Kimiyasu Shiraki: History of Medicine, 202:414422, 2002.

of her neck loosened, so she changed her bedclothes
at around 10 p.m. Her fever subsided to 37.5°C.
Thereafter, she went to sleep, and in the morning,
she had a normal temperature of 36.5°C. Her
symptoms, including the stiffness at the back of her
neck and headache, disappeared. She took hermorning dose of kakkonto as her last dose.
Katsutoshi Terasawa, Koreishanotameno wakan-

shinryogaku (Japanese and Kampo medicine for theelderly), p. 127, 2005

12

regular

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

Volume 9, Number 1 | Spring 2014

Clinical Report 1 (Acupuncture)
A Case Where Press Tack Needles at Li4 were Markedly
Effective for Shoulder Pain
Genki Shimizu
Ehime Prefectural Central Hospital[Prescription] Right LI4 press tag needle (Seirinpress tack needle, wire diameter ⌀ 0.2 mm, needle
length 1.2 mm)
Decoction: Chinese angelica root 3 g, Chinese peonyroot 3 g, white atractylodes rhizome 3 g, poria 3 g,bupleuri radix 3 g, paeoniae moutan cortex 2 g,

[Patient] Female, 83 years

gardeniae fructus 2 g, Chinese liquorice root 2 g,

[Chief complaint] Right shoulder pain

fresh ginger root 1 g, mentha arvensis 1 g, cooked[Past history] Gastric ulcer

rehmanniae radix 4 g, cnidii rhizoma 4 g, coptidis[Life history] no smoking, no drinking

rhizoma 1,5 g, phellodendri cortex 1.5 g, scutellariae[Allergies] none
[Present illness] The pain in the right shoulder
started in her sixties. In July 2015 she suffered fromherpes zoster on her right flank (T3,T4 area) and wastreated for it, but currently still has residual pain
and is under ambulant treatment for it. Two days

radix 3 g
[Course] Following her first treatment session thepain was completely alleviated after one night sleep.
She was very grateful that a pain, that almost madeher cry, was gone.

ago her younger brother fell into critical conditionand she traveled from Matsuyama to Kyushu to visit
him, but experienced severe pain in the rightshoulder as if having been struck by lightning.
Requesting acupuncture treatment she was referredfrom her regular physician to our department.
[Oral medication] Neurotropin (4 units) 4 tab,Pregabalin capsules 75 mg ４cap.
[Constitution] Tendency towards constipation; nochilling or hot flushes.
[Current condition]
Height: 148 cm; weight: 46 kg
Tongue: slightly dark purple, thin white coat, novaricose veins, choppy pulse
Abdominal wall tone 3/5, palpitation above theumbilicus,

appearanceoftensioninthe

hypochondrial region, but she herself is notcomplaining

abouthyochondrial

fullnessandtenderness; no lower abdominal cramps; moxa
marks on her back; herpes zoster scars medially of
the right shoulder blade; no incrustation; pruritus.
[Pattern identification] qi stagnation;

stagnationand deficiency of liver blood

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

13

Volume 9, Number 1 | Spring 2014

Clinical Report 2 (Kampo Medicine)
A Case in Which Saikokaryukotsuboreito and Other Kampo
Drugs were Effective against Night-crying in a Thirteenmonth-old Girl
Hideaki Yamaguchi
Tosei General HospitalNight-crying is a symptom that tends to be taken
lightly, as it is a condition with good prognosis, but it
induces child-raising anxiety in some mothers, andcould even lead to abuse if left unattended.

and

cry

every

hour.

Kanbakudaisoto extract was prescribed at a local
hospital, but no changes were observed. Even after
being weaned at age 1, she continued to cry and be
fussy every two hours, thus causing the mother tobecome exhausted from lack of sleep. The childwas quick-tempered and always restless, andwould throw her head back when crying. She waswhat people typically called a “difficult child.”
Diagnosis and prescription: Assuming category 3
and 2 symptoms, yokukansan extract 1/2 packet +shokenchuto 1/2 packet (before sleep) wereprescribed.
Course: After two weeks, the symptom abatedslightly, from level 10 to 8, so shokenchuto was

symptom subsided. The prescription is being
continued.
Observation:
Night-crying is a behavior that is experienced by
60% of children by the time they are one-and-ahalf years old. They wake up in the middle of thenight and cry, seeking their parent’s attention.
Normally, it is transitory, and decreases infrequency from around the age of 1. In Kampo

cases of night-crying. However, as this caseentailedacertaindegreeofseverity,

kanbakudaisoto was ineffective. Judging by othercharacteristics, the night-crying was also thought
to be an early symptom of autism spectrum
disorder.

First,

yokukansankachinpihange in

category 3 and shokenchuto in category 2 wereused in combination, but the effect was insufficient,so Saikokaryukotsuboreito, having the effects of
C1+C2, was used, with the result that its
combined usage with yokukansankachinpihange
improved the symptom. In Kampo treatment ofnight-crying, it is important to administer aslightly larger dose before sleep. Doing so quickens
the effect. When kanbakudaisoto is ineffective, use

yokukansan or saikokaryukotsuboreito.

replaced with saikokaryukotsuboreito extract
granules 1 packet (before sleep). The night-crying
declined from level 8 to around 3, and the child’s
mood at nursery school improved. The prescription
was suspended once when she developed acutegastroenteritis, but the symptom worsened, so theprescription was resumed. As a result, the nightcrying declined, but the child tended to be in a poormood at nursery school, so the prescription waschanged to yokukansan (in the morning) and

14

Her

light to moderate symptoms, it can abate most

History of present illness: From birth, the childupsleep).

first choice since 300 years ago, and in the case ofChief complaint: Night-crying
wake(beforemedicine, kanbakudaisoto has been the drug ofCase: 13-month-old girl in nursery schoolwould

saikokaryukotsuboreito

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

Volume 9, Number 1 | Spring 2014

Reference:
Categories of states of the heart in traditional
medicine and corresponding prescriptions
Category 1 (mainly weakness of the heart, heart
blood deficiency, liver qi deficiency)
Anxiousness, insecurity, sadness, fear (timidity), etc.
In particular, depressive and passive feelings
continue for a prolonged period.

kanbakudaisoto ,keishikaryukotsuboreito , etc.
Prescription:

kamikihito ,Category 2 (mainly liver depression qi stagnation)
Depression, insecurity, anxiousness, hysterics, etc.
Physical tension is strong, and moods tend to readilychange.
Prescription: shigyakusan, saibokuto, etc.
Category 3 (mainly hyperactivity of heart fire,
upward flaming of liver fire, gallbladder stagnation
with disturbance from phlegm)
Anxiousness, short temper, restlessness, impatience,etc.
In particular, agitated symptoms tend to continue fora prolonged period.

yokukansan, yokukansankachinpihange,
orengedokuto, daisaikotokyodaio, etc.
Prescription:

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

15

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Make the most of Kampo in modern medicine

Foundation: 1905
A century of tradition ――――We are a manufacturer consistently controlling the entire process fromthe import of crude herbs to the manufacture of Kampo extracts and assuch have contributed to the development of Japanese Kampo.
We sincerely hope to continue in the future with our contribution tomodern medicine through "Kampo".

OHSUGI Pharmaceutical Co., Ltd.

1-1-2 Tennojicho, Minami, Abeno-Ku, Osaka, Japan
Phone: +81-6-6693-3301

The crude drugs like many other creatures on earth areraised by bountiful NATURE.
Humankind earns as well grace from Mother Natureand is blessed as a member of natural world.
PROFILE of

TOCHIMOTO

Since Tochimoto was appointed as aJapan-China friendship trading firm in
1963, we have expanded our businessoverseas, mainly with China.
We import a variety of quality-controlled
natural resources from all over the world
for maintaining wellness.

TOCHIMOTO TENKAIDO CO., LTD.
3-21 Suehiro-cho, Kita-ku, Osaka 530-0053, JAPANwww.tochimoto.co.jp