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INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 7, Number 1 ･ Spring 2012

Editorial

Clinical Applications and Key Signs
Masayuki Kashima

Japanese Acupuncture - Current Research

Japanese Traditional Medicine Text (3) – Internal Medicine C
Hiroshi Omata

Kampo Medicine - Current Research
Essentials of Pediatric Kampo Medicine (1)Hideaki Yamaguchi

Clinical Report 1 (Acupuncture)

A Case Where Treatment of Heverden’s Nodes Associated DIP Arthralgia with Acupuncture and Moxibustion was Considred Effective- combined Oriental and Western Medical Approaches Souichiro Mine

Clinical Report 2 (Kampo Medicine)

One Case of Ulcerative Colitis Whose Symptoms after Total Colectomy were Successfully Treated with Kampo Drugs
Takao Namiki

Medical History in Japan“Historical Significance of Standardization of Acupoint Locations”, the Second Japanese Acupoint Committee (5)Makoto Mayanagi

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 7, Number 1 ･ Spring 2012EXECUTIVE 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

1 Editorial
Clinical Applications and Key Signs
Masayuki Kashima

CA, U.S.A.

ASSOCIATE EDITORS
Shuichi Katai

3 Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (3) – Internal Medicine C
Hiroshi Omata

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

PUBLISHER

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

9 Kampo Medicine - Current Research
Essentials of Pediatric Kampo Medicine (1)Hideaki Yamaguchi

15 Clinical Report 1 (Acupuncture)
A Case Where Treatment of Heverden’s Nodes Associated DIP Arthralgia withAcupuncture and Moxibustion was Considered Effective- combined Oriental and Western Medical Approaches Souichiro Mine

19 Clinical Report 2 (Kampo Medicine)
One Case of Ulcerative Colitis Whose Symptoms after Total Colectomy were Successfully
Treated with Kampo Drugs
Takao Namiki

22 Medical History in Japan”Historical Significance of Standardization of Acupoint Locations”, the Second Japanese
Acupoint Committee (5)Makoto Mayanagi

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 7, Number 1 | Spring 2012

Editorial
Clinical Applications and Key Signs
A single Kampo medicine may be applicable to various clinical conditions and diseases. For example,
goreisan (Poria Powder with Five Herbs) may be prescribed for a vast range of clinical conditions including
infectious gastroenteritis, edema diseases, and even headaches, hangovers, dizziness and abdominal pain.
The Shokanron (Treatise on Cold Damage) reveals that goreisan was also used for certain dehydration
conditions. It mentions the occurrence of post-perspiration dry mouth as a reaction to taking goreisan, andprovides instructions on drinking plenty of warm water after taking goreisan. In Japan, these conditions
are generally thought to be caused by so-called “water poisoning,” or abnormal water metabolism in the
body. As goreisan is a representative prescription for treating water poisoning, it is thus consideredeffective against the above-mentioned conditions. Most textbooks describe goreisan as being effective
against edema of the extremities, a typical symptom of water poisoning, and headaches and abdominal
pains accompanied by such symptoms as thick tongue plaque or dry mouth.
However, in actual clinical practice, there are many cases where goreisan is ineffective even if such
symptoms are observed, or conversely, cases where goreisan is effective although no signs of water
poisoning are observed. Outstanding studies that aim to solve such issues have begun to appear in recent
years. It has been found that goreisan is effective against migraine headaches that are induced by changes
in atmospheric pressure, but has no significant correlation with other signs.1)It has also been found that
abdominal pains which may be treated with goreisan are practically unrelated to other signs, and thatgoreisan is effective against abdominal pains that are induced by eating or drinking cold foods such as ice
and ice cream during the summer.2) Such findings indicate that even with goreisan alone, the signs for
identifying the responder may differ for each clinical application. It may be said that efforts to deduce thesigns for identifying the responders of actual clinical applications of Kampo prescriptions beyond thebounds of conventional practices and concepts, are necessary for the advancement of future studies ofKampo medicine and enhancement of clinical performance. Moreover, such efforts also increase thepossibility of discovering a clue to solving the essence of clinical conditions that prescriptions aim to treat.
With regard to the examples given in relation to goreisan, there emerges the possibility that headaches
occur when a drop in atmospheric pressure causes a change in pressure inside the skull and ultimately
causes a dilation of the blood vessels in the head and edema in surrounding areas.3) There is also thepossibility that abdominal pains are caused when cold foods stimulate and induce edema of the stomachlining. This writer has in fact also seen goreisan have a complete response to strong upper abdominal pains
from edema of the lining of the stomach and duodenum accompanying advanced portal hypertension.
When considering the above, it seems that goreisan acts against edema in various organizations of thehuman body. It is hoped that such mechanisms will come to be further elucidated.

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

1

Volume 7, Number 1 | Spring 2012

1) Haimoto, H. et al.: Observations pertaining to the correlation between the clinical epidemiology ofchronic headache and migratory cyclones (case-control study of patients for whom the treatment withgoreisan had been effective or ineffective). PHYTO 1:8-15, 1999.
2) Kimura, Y. et al.: Investigation of Clinical Indications of Goreisan in Patients with Epigastralgia in theSummer Season. Kampo Medicine 61:722-726, 2010.
3) Mukamal KJ et al.: Weather and air pollution as triggers of severe headaches Neurology. 2009;72:922-7

Masayuki Kashima
Department of Internal Medicine
Kumamoto Red Cross Hospital

2

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

Volume 7, Number 1 | Spring 2012

Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (3) – Internal Medicine
Hiroshi Omata
Oriental Medical Center
Saitama Medical University

2.

A

reviewofJapaneseandAmericanAcupuncture Treatment Reports Concerning
Maintenance Dialysis Patients and Chronic
Renal Failure
The paper (Advances in Chronic Kidney Disease12(3): 282-291, 2005) written by Garcia and et al. at
National Center for Complementary and Alternative

C Maintenance Dialysis (Chronic Renal Failure)1.

Medicine: NCCAM, a subsidiary organization ofIntroduction

As of 2008, there were more than 290,000 people on
maintenance dialysis in Japan, that is 1 in 438.7
people. There are more than 280,000 people on
Hemodialysis (HD) and between 9,000 and 10,000
people on continuous ambulatory peritoneal dialysis(CAPD). It is estimated that 1,000 people hadreceived kidney transplants, but a new form of
maintenance dialysis allows about 300 people toremain at home. Among these groups of Dialysis
patients, there has been a recent transition
regarding the underlying disease. Until recently, thepredominantdiseasewas

Chronic

Glomerulonephritis (CGN) but since 1998 CGN is
being overshadowed by the prevalence of Diabetic
Nephrology. Generally speaking, people on dialysis
complain of many different symptoms, these are thefactors blocking an improved QOL, however, people
with diabetes have many more disease-related
complications

requiringtreatments.

Perhaps

because of these conditions, following the Japanesepublication of research (2000) about patients who
receive maintenance Dialysis, the authors from thelower branch of the Japan Society of Medical
Dialysis

known

as

“the

Complementary

andAlternative

MedicalResearch

Society

MaintenanceDialysis

Patients(Representative

Suzuki Hiromichi fromofthe Saitama Medical

University`s Department of Nephrology)”, begancollaborating with other institutions to accelerate
the publication of research papers. Authors from the
Saitama Medical University`s Nephrology Center
reported that various Dialysis patients experienced
goodclinicalresults

moxibustion treatments.

with

Acupuncture

andNational

Institutes

ofHealth:NIHofferscommentary on the followings under the title of“acupuncture and chronic kidney disease”
1. acupuncture for kidney pain (腎疝痛の鍼)3),2. acupuncture in hypertension (高血圧症の鍼)4),
3. acupuncture in the treatment of uremic pruritus(尿毒症性瘙痒症の鍼治療)5,6),
4. role of acupressure in improving the quality ofsleep quality of life in patients with end─ stage renal
disease (末期腎疾患患者の睡眠の質/生活の質の改善における経穴圧刺激の役割)7,8) and
5. dose acupressure prevent kidney inflammatory
diseases? ( 経 穴 圧 刺 激 は 腎 炎 症 性 疾 患 を 予 防 す るか？)9), and suggests that acupuncture has potential
in this area. Kimura et al.10) searched the literatures
issued between 1979 and 2008 with keywords:
Dialysis, Kidney, Kidney disease, Acupuncture
treatment, and Acupressure in Japanese from theJapan Medical Abstracts Society site, and in English
from the American National Medical Library Searchsite (PubMed), and as a result, 31 Japanesereferences

and

20

Americanreferenceswereextracted. To summarize, the Japanese Acupuncturereferences included observations on physiologicalresponses within the kidney, complications ofmaintenance dialysis patients, various clinicalreviews of the benefits of acupuncture treatment andfinally, reports of the possible adverse effects ofacupuncture and moxibustion treatments. Amongthe most interesting reports were questionnaire
surveysansweredby

dialysispatients

about

receiving acupuncture treatment. In contrast, theWesternreports

focusedontheefficacyofacupuncture for renal colic and the pruritis (chronic

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

3

Volume 7, Number 1 | Spring 2012

whole body itching) accompanying dialysis, renal

metabolism

sympathetic nerve function, and a recent report fromappropriate points and meridians (Chart 3) toChin et al.,9 on animals with acute Nephritis pre-stimulate the somatic-internal organ reflex. In order

treated with St 36 (Ashi San Li). Of particular noteto provide a thorough method of estimating

was a report from a Taiwan Nurses group reporting

Acupuncture treatment efficacy, we compared pre-on the clinical results of stimulating acupuncture

and post-treatment measurements of local pain

points, they were expecting improved sleep and QOL(lower leg, lower back, shoulder joint, neck stiffness

for dialysis patients. From these accumulatedetc.) and whole body conditions (aches and pains,references,theweariness etc) using a visual analogue scale (VAS);

maintenance dialysis patient was thought to be

indicators of biochemical examinations of blood

influencing the autonomic nervous system, causingchanges were statistically processed and used along

a bloodstream change and possibly influencing

side QOL measures such as the frequently usedhomeostasis; and acupuncture`s protective efficacy“Kidney disease quality of life short form“ (KDQOL-of the kidney and renal function were also suggested.

SF) to provide a comprehensive scale of the patient`s

An important research theme for the future included

internal and clinical condition.

the cost-effectiveness of acupuncture in this type ofChart 3 Leg Shou Yin Kidney Channel (K) / Leg Tai Yang

Acupuncture

analgesia

for

and

elimination,soweselectedpatient.
3.

Acupuncture

andMoxibustion

Treatment

outcomes for Maintenance Dialysis Patients at
the Saitama East Asian Medical Center
A)

Evaluation

methodofAcupuncture

andMoxibustion treatments, protocols, and evaluations
as they relate to maintenance Dialysis Patients
As was mentioned earlier, we are seeking to evaluate
the situation of acupuncture and moxibustion
treatment and clinical research in maintenanceDialysis patients throughout Japan. We used thetreatment system of our former teacher, Serizawa
Katsusuke,

Professor

Emeritus

from

Tsukuba

University on our maintenance Dialysis patients.
While grasping the patient`s disease state thoroughbedside and laboratory findings, we also performeda series of acupuncture treatments 1-2 times a week
using

Acupuncture

ElectroTherapy(AET)stimulating nerves, muscles and joints with the
purpose of clarifying whether or not Acupuncture`s
analgesic effects could help raise the pain thresholdfor patients with (1) whole body aches, pains,
weariness, itchiness etc. (2) Further, from East
Asian Medical Theory we know that Kidney andBladder function are known to influence water

4

Urinary Bladder Channel (UB)

B) Fourteen maintenance dialysis patients (10 males,
4 females, average age 62.5+8.3 years, average timeon dialysis 40.8+38.8 months, (hemodialysis) HD 7,(continuous ambulatory peritoneal dialysis) CAPD7
from the Saitama Medical Hospital of Nephrology
were tracked for local pain, whole body symptoms,
QOL issues and biochemical blood changes, were
given regular acupuncture treatments for one monthafter which they were investigated. Of these patients,
we confirmed 6 patients reported pain and cramping

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

Volume 7, Number 1 | Spring 2012

in the lower leg, low back pain 4; neck stiffness 19,

symptoms (p<0.01), SF-36 scores for [physicalshoulder joint pain, thigh pain and arm pain

function] and [daily life physical functioning] both(average 1.4 complaints per patient); 16 patients

increased (p<0.05, p<0.1). Further, comparing scores

reported whole body complaints including itchingfor [physical and mental wellness] before and after

and weariness (average 1.1 complaints per patient).

the treatments, CAPD subjects reported significant

Given one month of acupuncture treatments, theincreases in levels of physical health (p<0.05). Next,

VAS scores improved (p<0.1, p<0.05) (lower values

scores for KDQOL-SF within the CAPD groupreported) demonstrating a trend toward symptom

increased significantly (p<0.05). Given these results,

improvement. Also, after the one month series, using

the CAPD group enjoyed better results compared toa patient QOL measure, MOS Short-Form 36-Item

the HD group, these results are thought to be related

Health Survey (SF-36), with the exception of

to differences in dialysis type and degree of kidney“vitality” as a response, all other responses showed

dysfunction.

increases, raising the subject QOL levels to nearlyD) Results of Long Term Acupuncture Treatments

National Standard levels, however, a statisticalfor Maintenance Dialysis patientsdifference was not confirmed. Comparing responses

Next, we analyzed changes in dialysis patientsto score items, such as degree of physical and mental

following 1 year of continuous regular Acupuncture

health, before and after acupuncture treatments,

treatments. Eligibility for this study required more

respondents reported a significant increase in theirthan one year of continuous Acupuncture treatment

reported degree of physical health (p>0.05). Further,(subjects included 4 men and 1 woman, average age,

within the KDQOL-SF, scores for “Work situation”

65.2+_ 8.2 years, HD type 1 subject, CAPD type 4

and “Relationships” showed a downward trend

subjects; underlying disease diabetes Mellitis DM 2,(p<0.1, p<0.1),“personal

non DM 3, average dialysis duration 57.2+37.5

condition” showed a significant increase (p<0.05).

months). Once eligibility was confirmed, we collated

These

of

their complaints for local symptoms (total 8

Acupuncture stimulation (that is, the points andcomplaints: 3 lower leg numbness, 1 low back pain,

meridians stimulated) travels along the spinal

1 neck and shoulder stiffness, 1 pain and numbness

column or is a spinal nerve transmission, increasingin the hands and fingers, 1 post herpes related

resistance to pain, possibly inducing a whole bodyneuralgia, 1 lower leg chilliness), and whole body

response.

complaints (4 itching and 2 general malaise).

C) An examination of differences between Dialysis

Significant improvement in whole body aches andtype (HD, CAPD) and the relative effects ofpains VAS scores were confirmed following long term

acupuncture treatment on maintenance dialysis

acupuncture treatments, 6 months to one year

patients.

(p<0.1, p<0.1), the SF-36 life style items such as

We investigated the differences in efficacy between“vitality” improved after one year of treatment

two groups of maintenance Dialysis patients (14(p<0.05), as did the KDQOL-SF item for “Sleep”

subjects, n=7 HD, n=7 CAPD) who received regular(p<0.05). Also, biochemical examination of blood

acupuncture treatments for one month. The results

samples showed significant decreased in BUN

are as follows, within the CAPD group 10 people(Blood Urea Nitrogen) comparing baseline levels,

reported aches and pains, 8 people complained ofwith 1, 3, 6 and 12 month samples (p<0.001, p<0.001,

whole body itchiness and lassitude. Following one

p<0.001,

month of regular acupuncture treatments, the VAS

significant increases with just 3 months of treatment

scores were significantly lower for these whole body

(p<0.1). In addition, we collected a survey of 5

results

especiallysuggest

the

that

item,
the

influencep<0.001),Hb

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

showed5

Volume 7, Number 1 | Spring 2012

andmeasurements in the dorsal area of the foot and at

experience after receiving long term acupuncture

the medial malleolus following one month of AET

treatments. They reported personal improvements(p<0.05,

in actual pain and itchiness, mood, lethargy andsignificantly in all measured areas (p<0.05, p<0.05,

quality of sleep. We also collected comments

p<0.05, p<0.01). Also, one month following thereporting improvements in the excretory function oftreatments, the SF-36 item for “Body Function” rose

the kidney and anemia. As a result of long term

significantly (p<0.05). One possible mechanism for

acupuncture treatments, we can suggest that in

Acupuncture

addition

physical, mechanical stimulation by the needle andpatient`snutritional

impressions

to

of

their

progressvariousmedicaltherapies

support,continuing

andacupuncture

p<0.001),

electricalfurther,treatment

stimulation

SPP

efficacy

increased

could

influencesbedermaltheandtreatments improves the patients QOL by reducing

muscular micro circulation, increasing blood vessel

whole body symptoms and assisting general kidney

reactivity stimulated by the autonomic nervous

function and improving Hemoglobin levels for

system or vessel dilating peptides.

patients with anemia.

F) The possibility of using Acupuncture TreatmentE) Effectiveness of Acupuncture for Maintenancefor maintenance Dialysis Patients with Pruritis

Dialysis Patients with Peripheral Artery Disease

Itchiness is one representative peripheral symptom(PAD)

that includes atopic dermatitis, contact dermatitis,

Peripheral artery Disease is usually divided into

hives,

functional and organic artery disease. Until recently,

dermatological conditions affecting the skin andresearchers have postulated that the efficacy of

mucous membranes, and in particular, there are

Acupuncture for Raynaud`s phenomenon is due to its

many articles presenting supportive evidence for

influence on the autonomic nervous system in

Acupuncture

general and the sympathetic nervous system inmodalities for atopic-dermatitis13. In contrast, theparticular, that is, it might encourage the dilation ofitchiness of the maintenance Dialysis patient is

the capillaries of the affected limb nail bed,

thought to be stimulated or suppressed by the

improving local circulation and thereby alleviating

centralnervouspain11. Therefore, we investigated the effects ofactivationofacupuncture in maintenance dialysis patients who

Hydrochloride has been attracting attention for its

often experience PAD as a complication. The subjects

abilityin this trial were 9 maintenance Dialysis patients

investigations of acupuncture treatment for thewith Arteriosclerosis Obliterans (ASO) (average age

itchiness associated with maintenance Dialysis

65.1+7.3, 7 males, 2 females, 6 DM, 3 non DM, 2suggest acupuncture at LI11( 曲 池 ) appears to be

Fontaine Classification I, 3 Fontaine Classification

effective5,6. These researchers then used the VAS andII, 3 Class III, 1 Class IV). The acupuncture protocol

KDQOL-SF indexes to investigate the effectivenessincluded electro acupuncture at St 36 and Sp6 on theof acupuncture treatments on the whole bodydiseased lower leg; we tracked skin perfusion

itchiness experienced by dialysis patients. The

pressure (SPP) and transdermal oxygen tension

acupuncture protocol included bi-lateral AET of 1Hz(tcPO2). In addition, following a month of once orfor 10 minutes at LI 4 ( 合 谷 ) and LI11 ( 曲 池 ).

twice weekly acupuncture treatments, we compared

Following one month of Acupuncture treatments,pre-patients reported a significant increase in the

and

post-

treatment

tcPO2

with

SPP

drug-related

to

and

skin

Moxibustion

system.
k

suppressindex

evaluations. We found significant increases in SPP

Additionally,following

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

byitchiness.

KDQOL-SF

foras

Recently,

receptors

measurements and conducted VAS and KDQOL-SF

6

eruptions,year

effective

selective

NalfurafineIn

contrast,(p<0.05).

“Symptom”
onevariousofregularVolume 7, Number 1 | Spring 2012

treatments, patient VAS scores showed significant

on the efficacy of Acupuncture for Internal

decreases for “itchiness” (p<0.1). These results

Medicine and treatment. Journal of the All-suggest that acupuncture treatments control βJapan Acupuncture and Moxibustion Society 38

endorphin （μreceptors）through the upper central(3): 288-294, 1988.

nervous stimulation, and stimulation of Dinorphin2)

Garcia GE, Ma SX, Feng L: Acupuncture and(k receptors), these mutually balancing actions arekidney disease. Adv Chronic Kidney Dis 12(3):thought282─291, 2005

toimprove

whole

body

itchingin3)

maintenance dialysis patients.

Lee YH, Lee WC, Chen MT: Acupuncture in thetreatment of renal colic. J Urol 147: 16─18, 1992

4.

The Future Direction of Acupuncture Treatment

4)

Williams T, Mueller K, Cornwall MW: Effect ofacupuncture points stimulation on diastolic

for Maintenance Dialysis Patientsofblood pressure in hypertensive subjects: A

Acupuncturists, Inc. has sponsored 4 Specialist

preliminary study. Phys Ther 71: 523─529, 1991

Since

2007,

Training

the

SystemJapanese
Seminars

Associationon“Acupuncture

5)

Shapiro R, Stockard H: Successful treatment of

Moxibustion Medical Care Risk Management”, to beuremic pruritus. The acupuncture approach

implemented in every prefecture throughout Japan.

revisited. Dial Transplant 32: 257─265, 2003

There is now a pressing need not only for dialysis

6)

Che - Yi C, Wen CY, Min - Tsung K, et al.:patients, but also the medical care providers

Acupuncture in haemodialysis patients at the(Dialysis physicians, engineers and nurses) toQuch(i LI11) acupoint for refractory uraemic

stimulate interest in Acupuncture treatment, and atpruritus.

the same time, to insure the importance of risk

1912─1915, 2005

management in this domain while securing the7)

Nephrol

Dial

Transplant

28:

Tsay SL, Rong JR, Lin PF: Acupoints massage

safety of Acupuncture treatments. Additionally,in improving the quality of sleep and quality ofcurrent research themes for Acupuncture treatment

life in patients with end ─ stage renal disease. J

include improving patient QOL, but accumulated

Adv Nurs 42(2): 134─142, 2003

data also includes research on the treatment of

8)

Tsay SL: Acupressure and fatigue in patients

Fibromyalgia in Dialysis patients, efficacy forwith end ─ stage renal disease ─ a randomized

Kidney function14 and disease in an attempt to delay

controlled trial. Int J Nurs Stud 41: 99─106,

dialysis by preventing disease progression and2004

finallythecost-effectivenessof

acupuncture

9)

Chin LH, Pei ST, Tao YW, et al.: Acupuncture

treatment and reducing the high cost of dialysis

stimulation of ST36（Zusanli）attenuates acutepatient health care. Finally, we are coming into arenalstatus defining time for Acupuncturists, clearly welipopolysaccharide ─ stimulated rats. Anesth

must take up our role and position within theAnalg 104: 646─654, 2007

medical team attending in the Dialysis Room, it is

but

not

hepatic

injulyin10) Hirokichi Kimura, Horoshi Omata, Satoshi

one clear way for the next generation of young

Yamaguchi

et

al.,

A

literature

Acupuncturists to make their appearance in theconsidering

Acupuncture

upcoming medical transition.

Dialysis patients and effective points forfor

surveymaintenance

Moxibustion stimulation. Modern Acupunctureand Moxibustion Studies. 8(1): 27-32, 2008.

References1)

Hiroshi Omata, Satoshi Yamaguchi, Katsusuke

11) Hiroshi Omata, Satoshi Yamaguchi, Teruhiko

Serizawa et al., An article for Dialysis PatientsSuzuki et al.,: An Autonomic Nerve Function

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

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Volume 7, Number 1 | Spring 2012

Index used for Acupuncture Treatment Efficacy
in Autoimmune Disorders (Collagen Disease)14(3): 223─227, 1995
12) Suzuki S, Ichioka S, Omata H, et al : Effects ofacupuncture on lower limb ischemia. J Saitama
Medical University 36: 1─10, 200913) Hiroshi Omata: Acupuncture treatment for
atopicdermatitis.

ModernAcupuncture

Moxibustion Studies 3 (1): 99-105, 2003.
14) Kiyoe Tezuka, Kitakouji Hiroshi, Masato Saito:
Influenceof

Acupuncture

Stimulationon

Kidney circulation changes using the Color
Doppler Imaging method Osaka 19(1): 73─76,
2003

8

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

Volume 7, Number 1 | Spring 2012

Kampo Medicine - Current Research
Essentials of Pediatric Kampo Medicines (1)Hideaki Yamaguchi

The people in ancient China likely chose drugs inorder to survive based on primitive sensation andexperience, thereby compiling a group of natural
products, later combined certain forms of processing
and in this way conceivably created throughIntroduction
Twelve years have passed since Kampo medicine
has officially been integrated into formal medical
education in Japan and by now almost all
universities offer relevant lectures. There seems to
be a gradually increasing interest in Kampo
medicines as applied to the field of pediatrics.
However, apparently many pediatricians still seemto be under the impression, that both Kampo as a
subject and Kampo medicines are difficult tounderstand.
The author has for a long time been trying tosystematize Kampo as applied to pediatrics (forconveniencetermedinthisarticle"pediatricKampo") and thereby facilitate comprehension1-3.
Therefore I would like to arrange in this article theusage of Kampo medicines following modern clinicalpediatric concepts and classified Kampo medicinesfrom the aspect of their beneficial effects. Also, since
I will explain individual Kampo medicines in greater
detail later, in this article the relevant descriptions

enormous, cumulative efforts said Kampo medicines
suitable to treat a variety of pathologic conditions.
This work was done at a time when neither
statistical processing nor analysis of the components
were possible. To accomplish it, the people had torely solely on the elicited body reactions and theirvery keen observation, so that this unimaginable
work rightfully should probably be called a piece ofintellectual property of the human race, somethingthat probably cannot be build a second time.
Multiple therapeutic effects of complex compositions
A characteristic of Kampo medicines as drugs is,that they possess multiple therapeutic effects. Let
me explain using a representative antitussive(bakumondoto). Bakumondoto is composed of the six
crude drugs listed in Table 1 and each individual
crude drug has several pharmacological effects. The
result is, that apart from the antitussive main effectof

Bakumondotoiteffects,

also

has

improvesenrichingandhave been kept to a minimum.

moistening

gastrointestinal

What are Kampo Medicines?

secondary effects. Each of these effects is related tofunction, is emotionally stabilizing and has other

Kampo medicine usually refers to combinations ofseveral crude drugs (roots of plants, stalks, fruits,
minerals, small animal parts subjected to simple
processing) that are used for therapeutic purposes,
thus representing complex compositions containing
many chemical substances. Astonishingly, the basic
compositions of most of the Kampo medicines
currently used in Japan in the form of extracts havethe other effects and helps to augment the main
action. Precisely these multiple therapeutic effects
represent the characteristic of Kampo medicines.
In the human body multiple functional systems
are interrelated. If disturbances of these functional
systems of the human body could be rebalanced
through these Kampo medicinal actions, that mightultimately lead to a harmonization of the entire body.

already been established 2,000 years ago, but nohistorical materials detailing the process of thisestablishment have been left behind.

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

9Volume 7, Number 1 | Spring 2012

Table

Table 1 Bakumondoto Composition & Drug effects

2

shows

the

characteristics

ofpediatric Kampo. In this context it is important

Galenical

ActionOphiopogonisTuberantitussive (strong); enriching and moistening;
mildly emotionally stabilizing

Ginseng Radix

improves digestive functions; mildly enriching
and moistening

whereas in Japan both Western and Kampo

Zizyphi Fructus

improves digestive functions; mildly enriching
and moistening; emotinally stabilizing

The current complementary use of Kampo

Glycyrrhizae
Radix

improves digestive functions; mildly enriching
and moistening

Oryzas Fructs

improves digestive functions; mildly enriching
and moistening

Pinelliae Tuber

antitussive and expectorant; antiemetic

to note, that in the various Asian countries
there are different licenses for the practice ofWestern and traditional Chinese medicine,
medicine are unified in one medical system.
medicines within the Western medical clinicalsetting can be called an outstanding system.
Next, many of the Kampo medicines originatedfrom classic texts like the "Shan Han Lun" of
the Later Han dynasty and almost all of these
preparations are not used as decoctions, butrather as extract preparations. This makes fineadjustments based on individual cases difficult,

Overall action (drug effect): (1) antitussive, (2) enriching andmoistening (retaining water,moistening the body), (3) improving
gastrointestinal functions, (4) mildly emotionally stabilizing

but ensures a high product quality and above
all makes them very convenient, easy to use inclinical practice.
What is pediatric Kampo?

However, as described above, since pediatric

Pediatric Kampo in Japan can be defined as the

Kampo includes a mixture of various different

use of Kampo medicines indicated for characteristic

concepts

pediatric pathologic conditions. The course of its

accumulation of characteristic Japanese experience,

establishment is not necessarily clear, but mostWestern medical evidence etc., it tends to be rather

likely has been transmitted in ancient times from

ill-defined and thus has the disadvantage of being

China to Japan and the accumulated experiencesdifficult to understand.

liketraditional

Chinesemedicine,

pertaining to the use of Kampo medicines for infants
have in recent years be organized by pediatriciansfrom a Western medical point of view. Moreover, inconjunction with the spread of extract preparations,

Table 2 Characteristics of Pediatric Kampo
1)

Before patients may be treated with Kampo, all are firstassessed according to Western medicine (unified
system).

2)

Almost all used preparations are extracts, most ofwhich originate from classics based on the Shang Han
Lun.

3)

Basically, preparations are matched to symptoms(formulation corresponding to a Kampo diagnosis),but they are also often matched to Western medical
diagnoses.

4)

Many experiences with children have been handed
down probably from the Edo period and in recent years
been systematized from a Western medical point of

the results of wide-ranging clinical research havehelped to promote a general compilation of therelevant knowledge. A portion of it includes
statistically proven evidence, but most of thematerial is the accumulation of experience handed
down from the past that is now applied in modern
clinicalpractice.

Based

on

the

described

development of the use of Kampo medicines Chinese
medical pediatrics as the field of pediatrics within
the framework of traditional Chinese medicine
differs slightly from the use of the Kampo medicines
themselves.

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

Volume 7, Number 1 | Spring 2012

What is the reasoning behind the use of Kampo

rename those pathologies and diseases and focused

medicines in pediatrics?

their attention on the correlation with corresponding

Medical practice must necessarily be based on aformulas. In particular, since Kampo medical

solid foundation. Today it is common knowledge, thatextracts are now covered by the insurance, a trend

the concept of evidence-based medicine is graduallythat became more conspicuous after 1976 and in the

being established, where clear standards for thewake of which various results have been reported.

reliability of the practice are shown. However,

These trends signify a reconfirmation of theregarding traditional medicine the evaluation of

tradition.

hundreds,

sometimes

thousands

of

years

of

Opposedtopharmaceuticals

developed

experience still remains subject of debate. As thisintentionally with values for giant markets, Kampo

may be, I would like to concisely organize themedicines have statistically a relatively low chancereasoning behind pediatric Kampo.

of achieving good results, but centering on caseseries studies experiences with their use are steadily
accumulating and attempts are made to reorganize

1. Kampo medical reasoning
Providing bibliographically original proof in

the traditional experiences.

actual practice is very difficult, but mainly from theEdo period until the Showa period various Kampo

Frequently used formulas in pediatric Kampo andphysicians (groups) have used classical pediatrictheir classification according to drug effects

have

Taking these characteristics of pediatric Kampo

meticulously communicated a wealth of accumulated

into account, I will describe Kampo medicines thatclinical experiences to us. Naturally, all thisare convenient to use in children as viewed classified

knowledge relies on the concepts of traditional

according to their drug effects from the point of view

medicine cultivated in China and Japan and has notof both the Kampo medical reasoning as well as

been transmitted based on systematic concepts ofWestern medical results. I am going to present thepediatric Kampo (system). Moreover, that was a

subject after performing a certain degree ofmatching of formulas thought to treat basic

integration of systematized traditional Chinese

symptoms (pattern).

medical theory, will try to avoid Kampo medical

formulasinchildrenandthoughttoOn the other hand, Chinese traditional pediatrics

technical terminology and describe the pediatricfollows the theoretical system of traditional Chinese

Kampo as simple as possible. However, Kampo

medicine

easilycontains a lot of elements that are very difficult tocomprehensible, a treatment essentially based on

explain using Western medical concepts, so that I

the use of individual crude drugs renders its clinicalwould like to ask you to bear with me regarding

application in Japan in certain cases difficult. Thus,

ambiguous theories and feelings of estrangement

I will restrict myself in this article to the partial

regarding technical terms. Also, in this article I

introduction of those concepts.

refrained from citing passages and other detailed

andalthoughits

theoryis

explanations regarding the individual preparations.
2. Western medical reasoning (so-called EBM)

The developing pediatric physiology in ancient

From the above follows (the in Japan handed

China was viewed as characterized by a pure yangdown usage of Kampo medicines) that currently

body constitution, immature yin and yang, twoWestern medical clinicians, mostly pediatricians,

excesses (heart, liver), three deficiencies (lung,rely on Western medical pathology (patterns) as

spleen and kidney) and the like. Among these inviewed from a Western medical point of view toparticular the concept of the two excesses and three

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

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Volume 7, Number 1 | Spring 2012

deficiencies is important. Its modern interpretation→ Kampo medicines with gastrointestinal

would be as follows.

improving functions

1. Easy development of fever, easy occurrence of

4. Immature respiratory function, which may
easily lead to decreased function

convulsions or disturbances of consciousness
2. Easy excitability, mental instability→ Kampo medicines with antitussive actions,

3. Immature gastrointestinal function, which

acting on the nasal cavity and paranasal sini
5. Easy occurrence of impaired growth andmay easily lead to decreased function
4. Immature respiratory function, which may

development, weak vital energy→ Kampo medicines with growth assistingeasily lead to decreased function
5. Insufficient vital energy may easily lead toactions
6. Additional item

impaired growth and development.
These characteristics are even today commonly
observed and can be understood without any feeling→ Kampo medicines acting to regulate water
metabolism

of estrangement from a Western medical point ofview. In East Asia traditional medical systems tried

1. Kampo medicines with actions to regulate

to respond to pathological conditions corresponding

immune functions

to the above listed characteristics. In Japan thisHistorically infections are the most importantsystem was until the Meiji period Kampo. Naturally,

medical topic. There is an outstanding guideline

as compared to modern medicine the therapy was

regarding the treatment of acute infections withextremely limited, but nevertheless a noticeable

Kampo medicines that was written approximatelyamount of therapeutic experiences accumulated and2,000 years ago and even today remains an

this accumulation of experiences today has been

indispensable bedside reference, the "Shang Han

refined and allows to complement areas in pediatrics,

Lun" (later Han dynasty). During the Qing dynasty

where Western medicine is not so strong and in thisa discussion of infections from a different point ofway provides a useful means of maintaining theview (Treatise on febrile disease = Wen Ren Lun) was

health of children. Below I will explain the actions ofalso proposed. These works provide a detailed

Kampo

5

classification of the course and symptoms ofanother

infections associated with fever and used different

important characteristic of Kampo medicines and try

Kampo medicines depending on the stage of theto describe representative formulas matching as far

disease and the presenting symptoms.

medicinescharacteristics

corresponding

listedabove,

toaddingtheas possible the needs of pediatric primary care.

In case of infections [the sum of all involved
biologic activities of infectious agents entering the

1. Easy development of fever, easy occurrence ofbody, the corresponding biologic reaction and the

convulsions or disturbances of consciousness

acquired immunity]4 experimentally administered→ Kampo medicines with immunoregulatory

Kampo medicines may not have much outstanding

actions

direct antiviral or antibacterial actions, but their

2. Easy excitability, mental instability
→

Kampo

medicineswithemotionallystabilizing functions

actions are considered to be mainly directed atregulating

body

responses(anti-inflammatory

action). Almost all pediatric infections are acute with

3. Immature gastrointestinal function, which
may easily lead to decreased functiona fast progress after onset, accordingly requiring aquick and appropriate judgment. Kampo treatment
of infectious diseases is very varied and complex, but

12

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

Volume 7, Number 1 | Spring 2012

here I would like to describe only easily applicable(1) Regarding the acute phasemethods under the current conditions.

* Early stage of influenza: maoto, kakkonto

First, there are various reports about the effects* Low-grade fewer after the acute phase, malaise:of ogito for the treatment of influenza. Primarily, itsaikokeishito

is used as a single dose during the early phase to(2) For recurrent infections (in case of recurrent

lower the fever through sweating and should betonsillitis, middle ear infection, perianal abscesses

stopped once defervescence has been achieved.

etc.）Animal experiments verified that kakkonto, a* During intermissions, when looking for stronger

formula with a purpose similar to that of theanti-inflammatory actions: shosaikoto, saikokeishito

aforementioned formula, has an influence on the* When looking for invigorating actions, expecting

cytokine production5). In this context the correlation

this to prevent secondary recurrences (as detailed

tobelow,

thepreventionofinfluenza-associatedthismethods

resembles

utilizing

function

improving

actions):

encephalopathy as a form of a cytokine storm is ofgastrointestinal

interest, but there are no related reports yet.

juzendaihoto, hochuekkito, ogikenchuto

Next, when the fever in acute infections,* During exacerbations (using something withincluding influenza, is followed by lingering low-strong anti-inflammatory actions)

grade fever and symptoms of malaise etc., shosaikoto

kikyosekkoto: in particular for upper respiratory

should be considered. Although there are no

inflammations

statistical reports, in the classics its use ishainosankyuto:

commonsense and the criteria for its application are

diseasesinparticularfor

suppurative

given in the classics ("Shang Han Lun").
Also, it has long been known that for infections
like recurrent tonsillitis, recurrent middle ear
infections that may recur several times a year either
a combination of shosaikoto and kikyosekkoto or
Saikoseikanto is beneficial. In case of recurrent
tonsillitis their long-term use reportedly led in 5080% of the cases to a marked reduction in theincidence6,7). These cases could possibly include theauto-inflammatory syndrome PFAPA (periodic fever,aphthous

stomatitis,

pharyngitis

andadenitis

syndrome). By the way, the author has useddecoctions for 5 patients with PFAPA and achievedin all cases marked improvements8). Also, perianal
abscesses often recur in short intervals, making
incisions necessary. In these cases juzendaihoto or

hainosankyuto are very effective9,10).
Thus, if local infections and inflammations recur
while no clear immune insufficiency is observed andbecause there is no effective Western medical
pharmacotherapy, Kampo medicines are considered

References
1) Hideaki Yamaguchi: Attempt at a Chinese medical
classification of weak children, Journal of theJapan Pediatric Oriental Medical Society 1995; 11:33-372) Hideaki Yamaguchi: Kampo medicines easily
applicable in children, Pediatric Clinical Guide,
Nakayama Shoten, 2009: 158-164
3) Hideaki Yamaguchi, Basic pediatric Kampo
preparations, Life Science, 20124) Shunpei Yokota: Infections, inflammation andnatural immunity, Pediatric Clinics 2008; 61:
1715-1718
5) Kimiyasu Shiraki: Modes of action of Kampo
medicines used to treat influenza, Progress of
Medicine 2002; 202: 414-418
6) Shigehito Osako: Kampo treatment for habitual
tonsillitis, JOHNS 1990; 6: 71-75
7) Masafumi Iwama: Kampo treatment of weakchildren, Familiar Kampo treatment of pediatricdiseases, 2, Tokyo Medical View, 2002: 53-62

worth using as unique immune modulators.

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

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Volume 7, Number 1 | Spring 2012

Hideaki Yamaguchi: Attempt at treating PFAPA
with decoctions, Journal of The Japan Society for
Oriental Medicine 2012 (Abstract)9) Toshinori Muramatsu et al.: Treatment of perianal
abscesses
andhemorrhoidal
plexi
with
juzendaihoto, The Japanese Society of PediatricSurgeons 2005; 37: 311-315
10) Kawahara et al.: Perianal abscesses andhemorrhoidal plexi; The Japanese Society ofPediatric Surgeons 201l; 43: 878-881
8)(Continue to the next issue)

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

Volume 7, Number 1 | Spring 2012

Clinical Report 1 (Acupuncture)
A Case Where Treatment of Heverden’s Nodes
Associated DIP Arthralgia with Acupuncture andMoxibustion was Considered Effective- combined Oriental and Western Medical Approaches -(orthopedist) for periodic osteoporosis examinations
x-ray findings of the second and third digits of both
hands showed deformities of the joints, but bothdeformities and pain were considered to be due to

Souichiro Mine
Nagoya Medical College

The educational system requires of Japanese
acupuncturists to acquire not only Oriental medical
andskillsfortheassessmentofpathological conditions, but also knowledge andskills for relevant Western medical assessment
during the obligatory education to obtain theirlicenses. This leads to situations, where bothWestern and Eastern perspectives coexist during thetreatment.
This kind of treatment is sometimes criticized for alack of clarity regarding therapeutic concepts andhealing mechanisms, but it may nevertheless lead to
improvements of the patient's symptoms.
In this paper I report a case in which Heberden's
nodes presumably were involved in the development
of joint deformity and arthralgia of DIP joints of both
hands,

after work using the hands and strong pain
occurring, when something comes into contact withthe deformed joints as well as recommendation by

Introduction

knowledge

age and thus not actively treated. Pain developing

where

acupunctureandmoxibustion

treatment using an Oriental medical approachtaking the organs and viscera (zang fu) as well as
local phenomena into account and a Western medical
approach dealing with the local condition was
administered and thought to have led to an
alleviation of the complaints.

her family caused her to seek acupuncture andmoxibustion treatment, which was initiated from
July of the year of the consultation.
< Past history >Viral hepatitis (25 years ago; type of virus unknown;
stationary treatment in a hospital for half a year;
currently in remission);
Diabetes (25 years ago; HbA1c fluctuating around
6.8%; currently regular ambulatory treatment;
maintenancethrough

exerciseanddietary

restrictions);
No history of injury to the hands;< Current condition > Height 151 cm, weight 43 kg;
blood pressure 103/64 mmHg, pulse 71 bpm,
kyphosis;
Good appetite with a tendency towards becoming
excessive; one bowel movement per day; noconstipation or diarrhea; sleep is good, but she
frequently goes to bed past midnight.
< Local findings >The DIP joint of the right second digit on the radial
and ulnar side, the DIP joint of the left third digit on
the radial and ulnar side and the radial side of theleft and right fifth digit showed dorsal swelling like

[Case]

deformities. At the sites of the chief complaint< Chief complaint >Pain of the DIP deformities of the second and third
digit of both hands.

neither reddening nor swelling were observed, but ineither case the joints were slightly warmer than the
PIP joints of the same finger.

< Sex > female< Oriental medical findings >< Age > 80 years

The skin lacked moisture, among the three bilateral< Present illness >Four years before the first consultation she noticed
deformation of the second and third digits and in
January of the year of her consultation started toexperience pain. During visits to a local physician

radial pulses the left chi pulse was somewhat weak.
The pulse was generally floating, surging. The bodyof the tongue was red and dry. The tongue coating
was slightly thick and of a faint yellow color.

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

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Volume 7, Number 1 | Spring 2012

< Aggravating factors >needled using a reducing technique, draining theWork using the fingers. Physical contact with thestagnating heat and eliminating the pain.

DIP joints.

The points were mainly chosen from among< Relieving factors >acupoints showing deficiency reactions on the lesser

Were not observed.

yin channel of the foot and during the treatment[Pathology]

other points added as required for the treatment< Assessment of the condition from an Oriental

purpose based on pulse and tongue findings.

medical point of view >Based on the old age, comparative pulse diagnosis
showing a weak left chi pulse and the bone
deformities kidney deficiency is conceivable. The
lack of skin moisture, floating pulse, red and dry
tongue body, faintly yellow tongue coat indicate thepresence of a mild degree of heat. Surges of appetite
were associated with slight thickening of the tongue
coat, suggesting the presence of internal dampness.
Summarizing these findings makes it conceivable,that the deformities of the fingers caused peripheral
stagnation leading to the pain before a backgroundof kidney deficiency induced deficiency heat and amild degree of internal dampness.
< Assessment of the condition from a modern
medical point of view >Based on the disagreement with the relevant
diagnostic criteria for articular rheumatism and due

A 1-week treatment interval was adopted.
< First treatment >Needling: using stainless steel needles made by
Seirin (applies to other instances below too)
0.14 mm × 30 mm KI3, LU8 (needle twirling after
piercing the skin, retaining the needles for 15 min; if
not stated otherwise, the same technique was used
for the following treatments too);single short insertions into the affected regions of theleft and right 2nd and 3rd digits (insertion depth 1-2
mm, immediate removal).
No changes immediately afterward.
Questioning the patient at the second visit revealed,that there had been no changes in symptoms at all
after the treatment.
Since the patient experienced the symptoms as
intense stress and because I had no prior experiences

to the lack of a history of trauma of the fingers

treating such symptoms, I chose to change theposttraumatic sequelae could be ruled out.

treatment policy and observe the course.

Marked swelling, reddening and dysfunction were

< Second treatment policy > Through application of

not observed, but compared to the PIP joints theheat stimuli to the regions of the chief complaint in

affected regions were slightly warmer, suggestingorder to elicit changes in hemodynamics and thereby

thereducepossibilityofachronic

inflammation.

the

local

influenceof

inflammatory

Accordingly, the base condition was considered to be

substances and promote tissue healing mechanisms

a Heberden's nodes induced chronic inflammation

I tried to achieve relief of the chronic inflammation

causing the pain.

and alleviate the pain (Western medical approach).

[Therapeutic course]

Further, the treatment administered according toTreatment policy 1

the initial treatment policy expected to activate

The treatment was administered based on Oriental

healing mechanisms via its effects on the entire body

medical views. The adopted treatment policy aimed

is continued. If necessary, reducing acupuncture

at supplementing the kidneys in order to improve

techniques are applied regionally in order tothe yin deficiency and thus achieve alleviation of theeliminate heat (Oriental medical approach).

heat. For that purpose the affected regions were16

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

Volume 7, Number 1 | Spring 2012

< Second treatment >Oriental medical view based acupuncture treatment

Pulse: left chi pulse and right guan pulse: weak;

instead.

Tongue: enlarged, dental indentations;

Needling: 0.14 mm × 30 mm left SP3, scattered

The general condition did not change, but a spleen

short pricking around the DIP joints of the left anddeficiency became prominent.

right 2nd digits;

Needling: 0.14 mm × 30 mm right KI7, left SP3

0.16 × 30 mm; left LU6, right ST36.

Heat-sensing moxibustion (using little paper mats

Immediately after the treatment the patient felt

on the skin; applies also to subsequent treatments):

some relief of the pain. Over a period of two days

7 half rice-grain sized cones each, on the finger tips

after the treatment the swelling and pain decreased.

of left and right 2nd digit, left 3rd digit tip, apex of the< Sixteenth treatment >affected DIP joints and dorsal side;

Pulse: on the surface very elastic, deficient in the

No changes immediately afterward. There was no

depth, left chi pulse was choppy;

pain for 2-3 days starting from the next day.

Tongue: thick coating;< Fifth treatment >Liver yin deficiency, internal dampness;

Pulse: left cun mai and chi mai were both weak andAfter the 15th treatment there was pain for two days

slightly choppy;

following the treatment, but relieved later. The

Tongue: somewhat dark and a little red;patient paints pictures as a hobby, but even after

Kidney deficiency, yin deficiency.

holding paintbrushes for a whole day the right 2nd

After the last treatment there was no pain in thedigit did not hurt. The left 2nd digit is a little difficult

third digit on both sides. Unless hit by something,

to bend.

the second digit of both hands too was not painful.

Needling: 0.14 mm × 30 mm

Needling: 0.14 mm × 30 mm KI3, LR3, right SP6;

needling the ulnar and radial sides of left and rightHeat-sensing moxibustion: 7 half rice-grain sized

2nd digit DIP joints (single short insertions,cones each, ulnar and radial sides of the DIP joints

immediate removal);of the left and right 2nd and 3rd digits.

Heat sensing moxibustion: 5 half rice-grain sized

No marked changes immediately afterward. Aftercones each, ulnar, radial and palmar sides of left andthat the pain of the 3rd digit of both hands wasright 2nd digit DIP joints.

completely alleviated for a period of 2 months.

No marked changes immediately after the treatment.

< Eighth treatment >Later after the treatment symptoms of the right 2nd

Pulse: right guan pulse: thin, wiry, slightly choppy;

digit were alleviated and mobility improved.

Tongue: enlarged, tongue in the center of the tongue< 21st treatment >yellow, peeled coating;Pulse: flooding, right guan pulse: choppy;

Spleen deficiency, yin deficiency.

Tongue: slightly dark red;

Swelling, reddening and pain distal of the 2nd right

Tongue coat: slightly greasy, yellow;

digit DIP joint, on the ulnar side of the left 2nd DIP

Spleen deficiency, internal dampness leading to yin

joint. She pinched her right 2nd digit 2-3 days ago in

deficiency.

a door and accidentally hit the left 2nd digit too,

The patient experienced pain on the ulnar side of thecausing pain in both fingers. The affected regions

left 2nd digit DIP joint and on both the ulnar andshowed signs of acute inflammation probably due toradial side of the right 2nd digit, but the pain was

the contusion, so that I refrained from applying

worse on the left.

warming therapy using moxa, administering only

Since last week mildly overeating.

LR3, right KI7

Needling: 0.16 mm × 30 mm, KI7, SP3

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

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Volume 7, Number 1 | Spring 2012

Tip of the right 2nd digit and at the nail base of thethe Oriental medical approach, alleviation of theleft and right 2nd digits (in either case non-symptoms was achieved after the treatment.

penetrating needling);

While in this case the use of moxibustion as thermal

Heat sensing moxibustion: 7 half rice-grain sizedstimulation was related to the Western medical

cones each, apex of left and right 2nd digit DIP joints

approach, the local effects possibly induced direct

deformities and palmar.

tissue healing mechanisms in the affected regions,

Assessing the pain after the treatment using awhereas the Oriental medical approach resulted in

Visual Analog Scale showed, that when the condition

an improvement of the physical condition as aat the first visit was defined as 100 mm, it was bymanifestation of the relevant healing mechanisms,

now 27 mm.

possibly providing the background before which theAfter that the symptoms remained alleviated andchief complaints were alleviated. Again, alleviation

the treatment is currently still continued.

of the chief complaint achieved during the eighth
session indicates the usefulness of scattered short[Discussion]

pricking for the treatment of increased pain due toIn this case the acupuncture and moxibustion

acute inflammation.

treatment was considered to have brought about

Based on the above describe findings it seems

alleviation of the symptoms, because there were no

appropriate to consider a local Oriental medical

changes in lifestyle before and after the intervention

approach based on organ and viscera (zang fu) andand no other treatment was administered.

symptoms combined with a Western medical

However, it is difficult to identify whether theapproach to be effective.

treatment performed from an Oriental medical point

However, in order to perform treatment yieldingof view or the treatment from a Western medical

stable and predictable results further accumulation

point of view had been effective.

and case reports and their investigation is necessary

While the therapeutic effects achieved by the

to clarify the exact role of Oriental and Western

Oriental medical approach adopted during the first

medical approaches for the alleviation of the chief

sessioncomplaint.

could

not

be

confirmed,

thelocallyadministered Western medical thermal stimulation
added from second session led to improvements of[Conclusion]

the chief complaint. These findings suggest that theThis

Western medical assessment based approach of themoxibustion treatment is effective for reducing DIP

condition had played a major role in the alleviation

arthralgia caused by Heberden's nodes. Here aof the chief complaint.

combination of Western and Oriental medical

On the other hand, the Oriental medical assessment

approaches is considered to be therapeuticallyof the physical condition based on pulse and tongue

effective.

findings and the consistent therapeutic approach

Regarding

based on this Oriental medical assessment still

Western medical approaches respectively playcontinues and ignoring its influence would not be

further investigations are required.

casesuggests,

theappropriate.
In particular during the eighth session, when I chose
not to administer moxibustion treatment to prevent
aggravation of the probably contusion induced acuteinflammation of the affected region and used only

18

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

thattherapeutic

acupuncturerole

OrientalandandVolume 7, Number 1 | Spring 2012

Clinical Report 2 (Kampo Medicine)
One Case of Ulcerative Colitis Whose Symptoms after Total
Colectomy were Successfully Treated with Kampo Drugs

Takao Namiki
Department of Japanese-Oriental Kampo Medicine
Graduate School of Medicine and School of Medicine
Chiba University

patient who achieved improvement in QOL withconcomitant use of Kampo formulas.
Case: 44 years of age, male who had complete
removal of large intestine
Chief complaints: Diarrhea, abdominal pain, cold
hands and legs
Past history: At the age of 20, intractable ulcerative

Introduction
Ulcerative colitis is a non-specific inflammatory
disease of the lining (wall) of the large intestinewhere ulcers/erosions are formed in most cases.
What causes the disease is not known. Once thedisease has developed, repeated remissions andrecurrences occur. According to a report by arelevant Japanese authority, 113,306 people areaffected with ulcerative colitis in Japan (equivalent
to the number of Recipient Certificates issued forSpecific Disease Treatment in 2009) with nearly
8,000 new patients every year. Compared to the U.S.
where there are 1 million people affected with thisdisease, Japan has about one-tenth of the patients in
the U.S. １ ） . Ulcerative colitis treatment usually
involves medical therapy with drugs. In severe cases
or cases for which drugs are not effective, surgicalprocedures may become necessary, that is, for thecases of (1) heavy hemorrhage, (2) toxic megacolon(widening (dilation) of the large intestine with toxinstravelling through the body), (3) perforation (of thelarge intestine), (4) canceration or cancer suspect, (5)severe conditions unresponsive to medical therapy,and (6) drugs such as steroids cannot be usedbecause of the side-effects.

colitis, total extraction of the large intestine in year X
Present history: The patient had been having
frequent bowel movements after the removal
surgery of the large intestine in year X. Then,
pouchitis had occurred and antibiotics had been usedand endoscopy had proved disappearance andimprovement in pouchtitis. Diarrhea, however,
persisted (15 times a day). A ELENTAL containing
drug had been administered and even laudanum fordiarrhea had been used. The patient desiring
treatment
Departmentforfrequentofdiarrhea

visitedJapanese-Oriental

our“Kampo”

Medicine of Chiba University with a letter of referral.
The patient had no medical history except ulcerative
colitis and his family members had no history of thisdisease. He did not drink alcohol. His conditions at
the time of hospital admission were height 168cm,
weight 58.2kg, body temperature 36.5 degrees
Celsius, blood pressures 114/73 mmhg, and regularpulse at the rate of 73/min. The presence of anemia
and jaundice was not observed in pulpebral
conjunctivas and lymph nodes were not palpated. No
abnormalities were found in the chest. The abdomen
had an operative scar and lower legs were notswollen. Surface body temperatures were measured:

As of late, the author had a patient who ever had
the entire large intestine removed was sufferingfrom abdominal pains and frequent diarrhea of
unknown causes. For the patient, treatment was
performed using Kampo drugs together with drugs
prescribed by his physician according to thesymptoms (sho) with the results of improved
symptoms. Introduced hereunder is the report of theforehead 34.2 C and lower legs 28 C, lower than theforehead’s . This is the state of upper body heat andlower body cold. The results of blood examination
were WBC 9600/mL, Hb 12.5g/dL, Hct37.9%, Plt
32.5X104 /μl, AST11U/L , ALT 6U/L, LDH 115 U/L,
ALB 4.1 mg/dL, BUN 9 mg/dL, and CRE 0.67 mg/dL.
Findings by Kampo medical diagnosis were thepatient was fatigable, easily felt cold and lied in bed
all day. The number of bowel movements was 15

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

19

Volume 7, Number 1 | Spring 2012

times a day, of which solid stools 5-6 times and

He claimed that the frequency of diarrhea did notwatery diarrhea for the rest of the times. He woke upchange. Further one months later, the third visit was

duringwasmade and at the time stomachache dissipated. A

sometimes accompanied by abdominal pains. He

sense of incomplete evacuation also lessened. Slightclaimed of coldness in the four extremities and therumblings in the intestines were present. The

abdomen. Pulse was slightly sunken and slightly

frequency of diarrhea was 15-13 times a day, still

weak. Tongue diagnosis: pale red colored with slightfrequent, so that changing the formula wasteeth marks, and its dryness was moderate. And it

examined. Pulse diagnosis indicated pulse waswas covered with thin whitish yellow furs withintermediately floating and sunken and the pulse

swollen sublingual veins. The abdomen had strength

size was slightly fine. Tongue diagnosis showed the(5/V). The bloated chest and hypocondrium region

tongue body was pale red and its dryness and moist

showed a strong resistance and the region below theare intermediate. Tongue furs were thick and white.

heart with a feeling of stuffiness and rigidity showed

Abdominal diagnosis showed strength (5/V). Thea slight resistance. Abdominal rectus muscles onchest and hypochondrium region having a bloatedboth sides were tense with a bloated feeling in the

feeling showed a strong resistance and the below-

left chest and hypochondorium. The region besidethe-heart region with a feeling of stuffiness andthe umbilicus felt no pressure pain. The ileocecal

rigidity also showed a slight resistance. Resonant

region felt pressure pain. However, there was no coldsound was heard over the abdomen. Because of

sensation in the abdomen. In short, although pulse

frequent diarrhea, kanzoshashinto was a possible

and systemic conditions exhibited the sho (pattern)

option. However, its extract form was not available.

of yin deficiency, the abdomen had strength, whichSo, first the Extract of orento was changed to

was the state of upper body heat and lower body cold.

hangeshashinto (2.5g) 3 times/day (before meals).

That is, it was considered that the patient was

On the revisit of 1 month later, stomachpain

intrinsically robust and full of vigor with physicaldisappeared. There were no rumblings of thestrength but frequent diarrhea rapidly weakened his

intestines heard and the frequency of diarrhea

physical strength inducing the state of deficiency sho.

decreased to 5 times a day.

Therefore, under the condition that there was theConsideration: According to the records of diagnosis

sho of yang deficiency with a reverse flow of qi andof the department of gastroenterological medicine,

abdominal pains, the Extract of orento (2.5g), which

frequent diarrhea of the patient was the state inis the formula for minor yang diseases, waswhich the function of the small intestine was unableadministered 3 times/day before meals. His revisit toto compensate for a loss in the function of the large

our department was scheduled 3 weeks later. Twointestine. This is considered to be the disease state

weeks after the start of the formula, however, heof a functional disorder and fixing and harmonizing

happenedofdisordered functions is the area of Kampo’s speciality.

gastroenterological medicine that had referred the

Formula selection was dependent on whether topatient to our department. Their medical record

target at frequent diarrhea by using hangeshashinto

about him included the description of “no abdominal

or kanzoshashinto or whether to target at abdominal

pain for these several days and if pain appears, only

pain by using orento. From the past documents thatnear the anus.” Our department confirmed in theabdominal pains in the cases of ulcerative colitis had

second visit as scheduled that a sensation of cold legs

often been successful treated with orento, orento wasand feet dissipated as well as abdominal coldness.

a selective formula and it was administered for

The intensity of stomachache reduced to one-tenth.

abdominal pains of the patient with favorable results.

20

the

night

to

sometimes.

visit

the

Diarrhea

department

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

Volume 7, Number 1 | Spring 2012

The frequency of diarrhea, however, did not

References:

decrease;

1) Japan Intractable Disease Information Center

theformulawaschangedtohangeshashinto, resulting in reduced frequency of

http://www.nanbyou.or.jp/entry/62

diarrhea. There are reports on Kampo treatment

2) Tsuneo MATSUO, et al.: Kaiyosei Daichouen ni(mostly classical formulations) for ulcerative colitis,

taisuru saireito no Koka. Journal of Traditional

illustrating cases of minor yang diseases with yang

Medicines 7(3), 270, 1990

sho for which shosaikoto or saireito2)3) was used, and

3) Tsuneo MATSUO, et al.: Kaiyosei Daichuoen ni

whichokeru Kampo Ryouho,, 2nd Choukan Kinou

hangeshashinto was used. The reports also carried
the description that for yin sho, used were ninjinto4),
bushirichuto, keishikashakuyakuto5), kigikenchuto6)
bushikobeito7).
And
forhemorrhage,
andorengedokuto3) and kyukikyogaito8) were used

Kenkyukai Kirokushu (Geri to Kampo [Diarrhea

cases

of

minor

yang

diseasesforand Kampo], 1998
4) Shuichi MIZUNO: Daichouen no Kampo Ryouho(2nd Report), Journal of Traditional Medicines
7(3), 226,2990
5) Teturo GONOI: Kaiyosei Daichouen, Kaiyosei

concomitantly.

Daichouen no Kampo Chikenrei, Journal of

Orento is the formula that uses cinnamomi cortex inplace of saetellariae Radix contained inhangeshashinto. hangeshashinto is often used for5) Teturo GONOI: Kaiyosei Daichouen, Kaiyosei

targeting at stuffiness and rigidity below the heart

Daichouen no Kampo Chikenrei, Journal of

and rumblings of the intestines. Orento is often used

Traditional

for targeting at abdominal pains9); this formula is

Edition), 12(1), 109, 1991

Traditional

Sino-Japanese

Medicine(ExtraEdition), 12(1), 109, 1991

Sino-Japanese

Medicine(Extrasaid to be good for abdominal pains emerging from6) Makoto FUJIMOTO, et al.: Two Cases of

the region between the epigastric fossa andUlcerative Colitis Successfully Treated with kigi-

umbilicus (the place of acupressure point of the

kenchu-to. Journal of The Japan Society foranterior midline CV12)10) and in many cases, pain on

Oriental MedicineJournal of Kampo Medicine,pressure was felt. In the case of the patient, diarrhea

55(5), 5, 655, 2004

and abdominal pains were co-existed. I thought it7) Kumiko TAKAHASHI, et al.: Bushikobeito ga

better to cure abdominal pains first, for which I used

Yukou de atta Kaiyosei Daichouen no Ichi-Rei,orento resulting in a rapid decrease in the intensity

Journal of Kampo Medicine, 59(2), 319, 2012of abdominal pains. However, diarrhea occurred8) Yoshiko TAKAGI: Kaiyosei Daichouen no Chiken,

frequently as ever, so I changed the formula to

Journal of Kanpo Medicine and Herb, 7(3), 208,

hangeshashinto after confirming the improvement of

2003

abdominal pains. As a result, the frequency of
diarrhea decreased to less than half. If the frequency

9) Tetsuo AKIBA: Katuyo Jizai no Shohou-Kaisetsu,
Life Science, Tokyo, 2009of diarrhea is more than 10 times, kanzoshashinto10) Keisetsu OTSUKA: Shoko ni yoru Kampo Chiryo

which is made by adding Licorice to hangeshashinto

no Jissai (5th edition), Nankodo,Tokyo, 2000

was administered.

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

21

Volume 7, Number 1 | Spring 2012

Medical History in Japan
Historical Significance of the Standardization of Acupoint
Locations”, the Second Japanese Acupoint Committee (5)“Detailed Guide to the Location of Acupoints” from thecalssics to the WHO standardization”, pp411-422, Tokyo,
Ishiyaku Publishing, June 2009 (partially revised)
Makoto Mayanagi
Graduate School of Humanities
Ibaraki University

At this point the theories of that time were organizedthrough the "Hall of Brilliance" (Ming Tang) aroundthe third century, determining as a specialized text
of meridians and acupoints the 12 regular and eight
extraordinary meridians as well as their 349
acupoints. Figure 6 shows a reproduction of the first
volumeofthe"Huangdi

Neijing

Mingtang"

commented by Yang Shangshan during the early
Tang period of the Kamakura period manuscript [8].

(continued from KAIM Joural vol.6 no.1, no.2, no.3
and no.4)

The roots go back to the books brought back by

4. Secondary standardization – unification on the

been handed down only in Japan, but were scatteredtheoretical leveland ultimately lost in China. As can be seen from theAfter the first century and through the spread of

Figure, the text of the original reads "The lungs. The

metal needles the confusion about meridians andlungs have a weight of three jin and three liang, it

acupoints deepened, so that people were forced to

has two parts divided into six lobes ...", showing thatcome to a solution through standardization based on

the individual viscera and bowels were described

the original form of the "Sun Wen" and "Ling Shu".

from the point of view of the visceral manifestation

On the other hand the "Sun Wen" and "Ling Shu"theory, detailing meridians, acupoints and finallydescribe medical basics in general, but are notconcretenecessarily a text specializing in acupuncture andmoxibustion treatment.

Japanese embassies to the Tang court and have later

instructionsforacupuncture

moxibustion.

Figure 6 Huangdi Neijing Mingtang with commentaries by Yang Shangshan
22

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

andVolume 7, Number 1 | Spring 2012

Moreover,Anonymous

personrecompiled

theoriginal "Ming Tang" and "Sun Wen" / "Ling Shu"texts specializing on acupuncture and moxibustion,
but in the latter half of the 4th century in the "Jia Yi
Jing" (Systematic Classic of Acupuncture andMoxibustion) not 365 points, but 356 points arelisted [9]. Also, using quotes from The first volume ofthe"Huangdi

Neijing

Ming

Tang"

with

commentaries by Yang Shangshan transmitted toJapan served and the "Jia Yi Jing" or "Ishinpo", aconsiderably detailed restoration could be completed
through cooperation of China and Japan. Professor
Huan Longxiang of the China Academy of Chinese
Medical Sciences "Collection of lectures on the
Huang Di Ming Tong text" [10] and Hiroshi Kosoto's
compilation of the Japan Nei Jing Medical Society's"Huang Di Ming Tong" [11] are the results. Based on
those we have now been able to obtain an almost
complete view of the second standardization.

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

23

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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".

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1-1-2 Tennojicho, Minami, Abeno-Ku, Osaka, Japan
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PROFILE of

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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