Volume 2, Number 1 | Spring 2007

Clinical Report 1 (Japan)
Case Report of Acupuncture: Phallodinia

February of this year, the patient was treatedMasanori Takashi
Tokai University Oiso Hospitralpharmacologically in the department of urology of thisclinic, but because the symptoms did not improve, heunderwent transurethral resection of the prostate(TURP) in July of this year. After that, the dysuria was

Introduction
In recent years the integration of western medicine
and Kampo has come to be called integrative(complementary) medicine. However, within Kampo
the collaboration between Kampo medicine on the one
hand and acupuncture and moxibustion on the other
hand is also very important. Neither treatment with
Kampo medicine nor acupuncture and moxibustion
alone can be called complete. Should not true medicalcare consider the kind of treatment most appropriate
for any given disease from the point of view of thepatient?
The case presented here was treated first withwesternandsubsequently

Kampo
combined

medicine,
with

which

was

acupunctureandmoxibustion treatment. During the course of thetreatment, the cause for the condition could not be
identified from the western medical perspective. In
cases considered to represent an aggravation of theprevailing pattern in a Kampo medical sense,
completing the treatment with acupuncture andmoxibustion can produce good results, as, it did withthis patient.
[Case]

relieved and micturition with a certain force possible,
but from the third month after the surgery heexperienced a sense of coldness of the penis. Moreover,from the beginning of October, pain also developed in
the region and by the end of the same month the senseof coldness

exacerbated.. In the department ofurology no particular anomaly could be identified. It
was decided to keep the patient under observation.
Since the patient began to receive acupuncture andmoxibustion treatment for stiff shoulders in our office
for about one month., I decided to treat the sense ofcoldness and pain of the penis also.
[Present status]Thephallodynia

had

the

characteristics

ofpsychroalgia. There were no diurnal variations and thepenis felt as if immersed in ice-cold water. Even in a
hot bath the patient did not feel any warmth. He
warmed it daily with simple single-use pocket heaters.
Unless these heaters were attached to the affected
region, pain would worsen. There was no micturition
pain. The urine was transparent in color. Frequency of
nocturnal micturition: once. The presurgical dysuria

Age 69 years, height: 164 cm, weight: 59 kg,

self-employed.

and pollakisuria had been alleviated.
Regarding the general condition, there was somestringy shoulder stiffness. The sensation of stiffness
appeared to be stronger around the right shoulder. It[Chief complaint] phallodynia

increased after work or with lack of sleep. It wasalleviated through massage (preference for pressing =[Present illness]
Two years ago, development of dysuria, 1 year ago

xi an). Development of discomfort on the back of thetreatment was initiated with the prescription ofhead and the neck when the shoulder stiffness

Kampo medicine (hachimijiogan) from the department

continues.

of oriental medicine of a hospital affiliated with adifficulty in falling asleep. Chilling of the legs. Low

university.

back pain and dull pain of the right side of the body (inDue to an aggravation of the symptoms since

Appetite

normal.

Shallow

sleep

and

particular of the leg) as well as weariness. The patient

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

13

Volume 2, Number 1 | Spring 2007

tended to sweat profusely over the entire body.

was that of a cold deficiency.

temporarily

Also, I would like to briefly reflect on the shoulder

disappeared after treatment with Kampo medicine.

stiffness which was the reason the patient started

There is also some hardness of hearing. Decrease inacupuncture

visual acuity. Constipation was controlled with drugs,

symptoms of the back of the head and neck followed

but warming the abdomen usually induced bowel

roughly the course of the bladder meridian. This

movements. There was also some decrease in virility.

channel has an interior-exterior correlation with the

Recurrenceoftinnitus

that

had

and

moxibustion

treatment.

Thekidney, so that the bladder channel was considered to
Pulse: deep, wiry, thininfluence the muscles in this region. Moreover, since

Tongue: tongue substance: dark red with white coating

liver and kidney have the same origin, the kidney

Pattern identification: kidney yang deficiency

essence deficiency causes a liver blood deficiency,

The disease was located in the kidneys. The reason
for this conclusion is that the penis is the anterior yin(genital) of the two yin. This location refers to thewhich was considered to be responsible for the
insomnia.
Thus, a kidney yang deficiency was the basis forphysiologic function of the kidneys summarized as

the condition, and in this case,"kidneys control the two yin orifices"(1)(2). The dysuria

treatment with both Kampo medicine and acupunctureand frequency of micturition and similar symptoms

and moxibustion. Yet, the surgery had injured theinduced by prostrate hypertrophy are considered dueyang qi. This led to the manifestation of the kidney

to the failure of the production of vital energy by theyang deficiency pattern and resulted in the sensation

kidneys, i.e., their opening functions. This in turnof cold and pain in the penile region.

improved after

suggests a decrease in the kidneys physiological
function of water regulation.(3) Also, the kidney unites[Point selection]

the bones and controls the bones and generates boneJinyu (BL23), Meimon (DU4), Jiryo (BL32), Kikai

mark(4)(5). Thus, because of the lack of kidney essence(RN6), Kangen (RN4), Chukyoku (RN3), Sokusanri

the bone marrow becomes empty and leads to the(ST36), Saninko (SP6), Taikei (K3); all points wheredevelopment of 'limb and aching lower back and knees'

stimulated using the tonifying twirling method;(dull pain and a feeling of weariness of the lower backKakuyuand limbs). The hearing function of the ears too is

supplementation and drainage method.

(BL19),

stimulated

using

the

neutralrelated to the kidney essence(6). For this reason a lackof kidney essence was considered to be responsible forthe development of tinnitus and the hardness of[Explanation]
Jinyu (BL23) and Taikei (K3) are the transport andsource points of the kidney meridian. In combination

hearing.
Next, regarding the qualitative aspects, thewith Meimon (DU4) they serve to supplement andsensation of cold and pain of the penis were considered

tonify the kidney yang(7). Adding Kangen (DU4)

to be due to a cold pattern. The improvements in thefurther strengthens the warming and supplementation

bowel movements observed after warming and the factof the kidney yang. The effects of this point selectionthat the patient experienced pressing massage of theare similar to those of Ukigan (Kampo medicine)(8).

shoulder region as pleasant indicated a lowered

Moreover, through combination with the source andwarming function for the body. Based on the abovetransport points Chukyoku (RN3), Kikai (RN6) the

findings, I conjectured that the nature of the diseasekidney qi is supplemented and boosted and enables to

14

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

Volume 2, Number 1 | Spring 2007

improve the insecurity of the lower origin and failure

disease in elderly men. Clinically, it can be observed in

Finally, Kakuyu’s

about 10% of men in their 40s and in about 70% of men

and Saninko’s action of supplementing and containing

in their 70s(12). Clinical symptoms include 1) decreased

blood was used for the purpose of supplementing liver

micturition force, 2) the person has to wait a whileblood(10).

until micturition starts, even if there is the intentionof the bladder's retentive

power(9).

By tonifying Jiryo (BL32), an essential point used

to urinate, 3) straining is required at the start and end

for the treatment of diseases of the genital and analof the micturition, 4) micturition requires a longer

regions, the regional flow of yang qi is improved(11).

time and cannot be suddenly interrupted, 5) after the[Course]end of the micturition minimal amounts continue to

I scheduled one to two treatments per week.

trickle, 6) there is a feeling of residual urine, 7)First visit: A VAS for both the cold sensation and pain

urinary retention, 8) pollakisuria, 9) nocturia, 10)

showed a value of 80 mm.

micturition pain, 11) urinary urgency and 12)

Second visit: No changes in the VAS for the cold

incontinence(13). These symptoms correspond to thesensation and pain. The fatigue changed into a mild

above described pathologic functions of the kidney.

discomfort.

The

tinnitus

had

been

alleviated.

In this patient the condition developed following

Treatment using the same point selection.

the TURP. Uchida et al. reported the following

Third visit: Slight reduction of the pain after theincidence of complications for this surgery: perforation

treatment, expressed as a reduction of the VAS valueof the prostate capsule in 4.4%, perforation throughto 50 mm. However, a persistent effect could not yet be

the bladder wall into the abdominal cavity in 0.3%,

observed. The VAS value for the cold sensation

requirement TUR coagulation because of hemorrhage

remained at 80 mm.

in 3.5%, hyponatremia in 0.6%, sepsis in 0.4%, acute

Fourth visit: The VAS value for the pain of the penis

postsurgical

had decreased to 30 mm. No change in the cold

incontinence in 0.8%, urethral stenosis in 0.5% andsensation. The lower limbs started to warm up slightly.

postsurgical sclerosis of the bladder neck in 0.9%(14).

Sixth visit: Tendency towards a decrease in the VAS

Moreover, Tazaki et al. listed hemorrhage induced

value for the cold sensation to 60 mm.

postsurgical

Eighth visit: The patient himself realized a decrease in

impotence and similar conditions(15). Symptoms likethe cold sensation. The VAS value for this symptom

the ones observed in this patient were not recorded.

had decreased to 30 mm and that for the pain to 20

However, Kanbe et al. reported, that nerve blocks

mm.

performed

Tenth visit: Started to work again. Appearance of adeveloping after TURP were effective(16). Phallodynia

certain degree of fatigue and cold sensation.

has also been mentioned in texts about Kampo

Eleventh visit: Mild tendency towards insomnia.

medicine.

Addition of Naikan (PC6) to quiet the heart spirit.

epididymitis

tamponade,forphallodynia

in

0.9%,

urinaryandurinaryincontinence,cold

sensation

In the section about the treatment of blood

Thirteenth visit: The cold sensation and pain of the

impediment and exhaustion diseases of the Jin Kui

penis had been alleviated. The VAS for both symptoms

Yao Lue it says: "loss of virility, tense muscles of thewas 0 mm.

lower abdomen, cold glans, vertigo, loss of hair", sothat Keishi Karyukotsu Borei To is used the dissipate[Discussion]cold and secure essence(17).

Benign prostatic hyperplasia (BPH) is a frequent

In section 67 dealing with the symptoms of

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

15

Volume 2, Number 1 | Spring 2007

diseases of fatigue and exhaustion in the General[References]

Treatise on the Etiology and Symptomology (Zhu bing(1)

Commentary on the Huang Di Nei Jing (Huang

yuan hou lun) it says: "When fatigue and exhaustion

Di Nei Jing Su Wen Shi Wen), last volume,cause the phallus to grow cold, this is due to a

published by [“山東中医学院・河北医学院講校釈”

deficiency of both yin and yang qi. The kidney governs

五 常 政 大 論 篇 ], p.966, People's Medical

the storage of essence, controls bone marrow andopens into the anterior yin. If yin is deficient and yangweakened, it is not possible to nourish blood and qi

Publishing House 1982
(2)

editor: [ 王 琦 主 編 ], P.665, People's Medical

sufficiently, so that it becomes impossible to properly
warm and nourish the anterior yin and as a result thephallus grows cold. If the condition persists for a

Chinese Medical Splanchnology, second edition,
Publishing House 2004

(3)

Commentary on the Huang Di Nei Jing, first
volume, published by [山東中医学院・河北医学院

prolonged period of time, impotence will develop (18)."
In section 69 of the same book it says: "Fatigue and講校釈], [上古天真論篇], p.8, People's Medical

exhaustion will injure the kidney qi, and if there is an

Publishing House, 1982

attack of wind-cold evil, the evil qi will invade the(4)Commentary on the Huang Di Nei Jing, firstkidney meridian and attack the yin qi, resulting in a

volume, published by [山東中医学院・河北医学院

struggle between vital and evil qi, causing pain in the

講校釈, 素問宣明五気篇], p.336, People's Medical

anterior yin. If this is caused solely by the wind-cold

Publishing House, 1982

evil, pain will be the only symptom, but if there is(5)Commentary on the Huang Di Nei Jing, first

additional influence from heat evil, swelling will also

volume, published by [山東中医学院・河北医学院

develop." (19). In this case the condition is not caused

講 校 釈 , 六 節 臓 象 論 篇 ] p.143 － 144 People's

by external evil, but rather internal cold (deficiency

Medical Publishing House, 1982cold) that generates pathogenic cold, suggesting thedevelopment of a condition was just as described in the(6)

Huang Di Nei Jing Su Wen, Hidemi Ishida et al.

above mentioned two classics.

translation supervisors, Section on pulses in the
Ling

SummaryThe

underlying

condition

in

this

case

(7)

treated with Hachimi Jio Gan and by supplementing
kidney yang, but the surgery induced injury of both qi

This in turn decreased the warming action and thus
generated the cold sensation and pain. The patient
was treated with a combination of Kampo medicine
and acupuncture and moxibustion, which resulted in amarked improvement of the kidney yang deficiency
induced cold sensation of the penis and pain. Thispatient was treated successfully with a Kampo andcombination

therapyandrepresents a highly suggestive case report.

as

such

Toyo

Gakujutsu

Clinical Acupoints, translation: Hyodo Akira;(8)

Clinical Acupoints, translation: Hyodo Akira;P.656; Toyo Gakujutsu Shuppansha, 1995

(9)

Clinical Acupoints, translation: Hyodo Akira;P.664; Toyo Gakujutsu Shuppansha, 1995

(10)

Clinical Acupoints, translation: Hyodo Akira;P.361; Toyo Gakujutsu Shuppansha, 1995

(11)

Clinical Acupoints, translation: Hyodo Akira;P.406; Toyo Gakujutsu Shuppansha, 1995

(12)

Urology MOOK, Prostate Hyperplasia – fromthe basics to the newest therapies, Yoshiki
Sugimura et al., p. 8-13, KANEHARA & Co.,
LTD., 199316

p.327-328,

P.743; Toyo Gakujutsu Shuppansha, 1995

and blood led to a blood deficiency and stasis, resulting
in stagnation of the qi flow through the penile region.

Shu,

Shuppansha, 1999

wasconsidered to be a kidney yang deficiency and initiallyacupuncture

Modern translation of the first volume of the

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

Volume 2, Number 1 | Spring 2007(13)

Urology MOOK, Prostate Hyperplasia – from theSituation on Acupuncture & Moxibustion in Tokai

basics to the newest therapies, Hajime Ishida etUniversity

al., p. 32-36, KANEHARA & Co., LTD., 1993
(14)

(15)

(16)

(17)

(18)

Complications and their management in 2266

[History]

patients who underwent TURP before, during

In

Tokai

University,thepracticeofand after surgery, Toyoaki Uchida et al., Journal

acupuncture moxibustion was started in 1984 byof the Japanese Urological Association, pp.

late Dr. Kumio Yamashita at the Department of

897-905, Vol. 84, No.5, 1993

Oriental Medicine of the School of Medicine

Urology MOOK, Prostate Hyperplasia – fromaffiliated Oiso Hospital. Since 2001, treatments

the basics to the newest therapies, Hiroshi

have

Tazaki et al., p.130-139, 1993

Moxibustion Room on a daily basis.

been

providedattheAcupuncture

Therapeutic experiences with the treatment of

In June 2003, the Acupuncture Outpatients

intractable postsurgical penile pain, Hiroshi

started in parallel with the opening of lectures on

Kanbe et al., Journal of the Japan Society ofOriental Medicine. Since April 2005, Associate

Pain Clinicians, p. 224,

Professor Makoto Arai and Instructor Katuhiko

Vol.6, No.3, 1999

Shang Han Za Bin Lun, comprised of the "Shang

Arai, who have assumed full time positions, have

Han Lun" and "Jin Kui Yao Lue", third edition,

been performing the practice at the Specialized

Compilation by the academic chapter of the

OutpatientsJapanese Kampo Society, P.282, Toyo Gakujutsu

Oriental Medicine twice a week, taking turns in

Shuppansha, 2000

half-a-day shifts. Other than Tokai University,

Annotated General Treatise on the Etiology andmedical institutions that have two Outpatients

Symptomology, 4th volume on signs and diseases

are very limited.

annexedtotheDepartmentofof fatigue and exhaustion (second volume), 67
fatigue and exhaustion, translation by KoichiroMuta, P. 77-78, Midori Shobo, 1989
(19)

[Fact of Practice]
In Tokai University, treatments are given to

Annotated General Treatise on the Etiology andthe patients who are referred by their attending

Symptomology, 4th volume on signs and diseases

physicians.

of fatigue and exhaustion (second volume), 69

Patients profiles are compared for the period of

fatigue and exhaustion, translation by Koichiro

June 2003 to March 2006 between the two

Muta, P. 77-78, Midori Shobo, 1989

establishments of the Acupuncture Moxibustion
Outpatients

of

Tokai

University

AffiliatedHospital (hereinafter “Affiliated Hospital”) andthe Acupuncture Moxibustion Treatment Room of
Tokai University School of Medicine AffiliatedOiso Hospital (hereinafter “Oiso Hospital”). The
results are as follows:
Average age of patients was 59 at AffiliatedHospital and 57 at Oiso Hospital. Female patients
accounted for more than 40% at each hospital.
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 2, Number 1 | Spring 2007

In regard to referrals, Affiliated Hospital

specialized in Kampo medicine, which will lead toreceived referred patients at the highest rate of

the improvement of acupuncture moxibustion

58% from the Department of Oriental Medicine,techniques.

followed by 19% from Neurological Internal
Medicine, then 6% from Orthopedics, whereas
Oiso Hospital had them in the descending order of
51% from Orthopedics, followed by 13% from
Neurological Internal Medicine and 13% from
Rehabilitation.
In

regardtochiefcomplaints,

AffiliatedHospital had t requests to treat pain which
accounted for 46%, stiff shoulders 19%, paralysis
6%, and sense of systemic discomfort 6%; whereas
Oiso Hospital had requests to treat pain at 70%,
stiff shoulders 13% and numbness 7%.
The comparison data of these two institutions
were characterized mainly by the fact that
painrepresented 46% of all the chief complaints at
AffiliatedHospitalagainst

70%,

which

is

significantly high, at Oiso Hospital.
This is because 85% of the treatment requests
received by Oiso Hospital were made for the“purpose of pain control” mostly from Orthopedics
while various symptoms other than pain are thesubject of the requested treatment of acupuncture
moxibustion at Affiliated Hospital. For the motivesofhospitalvisits,physician’s

instructions

accounted for 58% at Affiliated Hospital and 32%
at Oiso Hospital. And physician’s instructions fromthe Department of Oriental Medicine accounted for
90%. This is because physicians specialized in
Kampo medicine in the Department of Oriental
Medicine made referrals since they may regard thetreatment by acupuncture moxibustion as being
effective for a broad range of indications.
From the above it may be considered that
acupuncturists and moxibustionists engaged inthepractice

atmedicalinstitutions

haveopportunities to examine patients as physicians

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