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INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 5, Number 2 ･ Summer 2010

Editorial

Oriental Medicine and Nature
Shuichi Katai

Japanese Acupuncture - Current Research

Japanese Acupuncture for “Hie” Symptoms (excessive sensitivity to cold)
Shunji Sakaguchi

Kampo Medicine - Current Research

Situation on Use of Goreisan in Dialysis Patients
Kazuhiro Muroga

Clinical Report 1 (Japan)

Three Cases of Shonishin (pediatric acupuncture) for Night Cry, Stool Abnormality Nightmare
Shoko Masuyama

Clinical Report 2 (Japan)

A Case that Had More Effect from Less Crude Drugs
Masayuki Kashima

Clinical Report 3 (Japan)

A Case of Eating Disorder Accompanied by Anxiety (Yokukansan for Paroxysmal Vomiting)
Mihoh Koga

Front Line of Kampo Medicine

Review 1 of Academic Meeting Concerning Pharmaceutical Sciences
Toshiaki Makino

Kampo Formula Developed in Japan (2)Jumihaidokuto

Hiromichi Yasui

ISSN:1559-033X

Volume 1, Number 1 | Spring 2006

A good motive creates a selfless devotion.
“I just want my customers to feel better, body and soul. Just to see
their faces light up with hope and happiness, I’d do anything,”
remarks Masao Tsuji, President of Ominedo Pharmaceutical Industry
Company. He visits various sites where raw herbs and substances foruse in their Kampo products are picked. And he believes this is the
tradition Ominedo had maintained for over a century now since thecompany was founded in 1900.
The same philosophy is applied in handling the numerous
high-quality formulas created at their labs where highly advanced
scientific and pharmacological researches are conducted. The
company’s state-of-the-art facilities that comply with GMP standards
turn out various extracts to be incorporated into their pride products.
“Every merchandise is the by-product of our sincere devotion todelivering a lineup of products that not only work for the customers’
body, but also bringing peace of mind as well,” Tsuji concludes,“delivering the right product to customers who appreciate ourknowledge and devotion is our ultimate goal.”

Ominedo Pharmaceutical Industry Co., Ltd.
574, Nenarigaki, Yamatotakada-City, Nara 635-0051, Japan
URL: www.ominedo.co.jp
Contact: info@ominedo.co.jp
FAX (81) 745-23-2540

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

Volume 5, Number 2 ･ Summer 2010

EXECUTIVE EDITOR

Shuji Goto
Chairman, GOTO College ofMedical Arts & Sciences
Tokyo, JapanEDITOR-IN-CHIEF

Donald Lauda, Ph.D.
Dean Emeritus, College of Health &Human Services
California State University-Long Beach
CA, U.S.A.

TA B L E O F C O N T E N T S
1 Editorial
Oriental Medicine and Nature
Shuichi Katai

2 Japanese Acupuncture - Current Research
Japanese Acupuncture for “Hie” Symptoms (excessive sensitivity to cold)
Shunji Sakaguchi

ASSOCIATE EDITORS
Shuichi Katai
Ibaraki-ken, Japan

Hiromichi Yasui
Tokyo, JapanEDITORIAL STAFF

9 Kampo Medicine - Current Research
Situation on Use of Goreisan in Dialysis Patients
Kazuhiro Muroga

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

13 Clinical Report 1 (Japan)
Three Cases of Shonishin (pediatric acupuncture) for Night Cry, Stool Abnormality
Nightmare

EDITORIAL BOARD

17 Clinical Report 2 (Japan)
A Case that Had More Effect from Less Crude Drugs

Denmei Shuto
Hajime Haimoto
Hideaki Yamaguchi
Hidemi Takahashi
Katsutoshi Terasawa
Kazushi Nishijo
Keigo Nakata
Keishi Yoshikawa
Koji Ebe
Shohachi Tanzawa
Tadashi Yano
Takahisa Ushiroyama
Tomomasa Moriyama
Toshihiko Hanawa
Yoichiro Ebe
Yoshiharu Motoo
Yoshiro Yase

PUBLISHER

Shuji Goto
International Institute of Health andHuman Services, Berkeley

Shoko Masuyama

Masayuki Kashima

19 Clinical Report 3 (Japan)
A Case of Eating Disorder Accompanied by Anxiety (Yokukansan for Paroxysmal Vomiting)
Mihoh Koga

21 Front Line of Kampo Medicine
Review 1 of Academic Meeting Concerning Pharmaceutical Sciences
Toshiaki Makino

25 Kampo Formula Developed in Japan (2)Jumihaidokuto
Hiromichi Yasui

2550 Shattuck Avenue, Berkeley
California 94704-2724, U.S.A.

MISSIONTo disseminate peer-reviewed information on the use of acupuncture and herbs, and integration with western
medicine, based on research from an international perspective; thereby stimulating further research, application of
documented therapeutic measures; and facilitating dialogue among health care practitioners worldwide.

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

Volume 1, Number 2 | Summer 2006

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

Volume 5, Number 2 | Summer 2010

Editorial
Oriental Medicine and Nature
Oriental Medicine developed over 2000 years ago when human beings lived their lives under greater
influence from natural surroundings and the environment than we experience in the modern age. It was anage when people were just beginning to construct bigger megalopolises and these social surroundings began tohave significant influences on peoples` minds and bodies; as a result humans began to develop heretofore illness
reflecting their new lifestyles. This illness presented new therapeutic requirements and objectives. In otherwords, considering health and disease, those ancient days were arguably a period when people began to searchbeyond simply making some balance between their lifestyle and nature`s constant change. The newly
developing social environment demanded a larger perspective or vision capable of supporting healthysustainable social development. And then, of course, the scale of urbanization began to accelerate and humanhistory became the story of our alternating struggles between overcoming nature’s challenging forces but also
destroying nature in our efforts to control her (it).
The natural and social environments 2000 years ago provided the basis for Oriental Medicine. The
original classic of Oriental medicine Suwen (Plain Questions) includes descriptions of natural and social changes
and thoughts on how humans might be or live in harmony with those changes. Although written 2000 years
ago, this classic book points out the potential problems humans might encounter in the course of their lives andincludes discourses on how setting a desirable framework for our mind, attitudes as well as lifestyle can help
navigate these constant challenges. Plain Questions further compares people of that period with those of the
distant past. People had already begun to lead their lives largely separated from the natural rhythms theirancestors had adhered to. Patterns of jealousy, unreasonable exertion in efforts to reach “success”, satisfy desires
or ambitions had become increasingly apparent causing mental stress, psychosomatic illness, autonomic
imbalance and various other symptoms. These symptoms could only be relieved by the therapies ofacupuncture, moxibustion, massage or herbal medicine (Kampo). The text warned that people should not try
to satisfy their personal and social desires beyond what is reasonably necessary, avoiding competition. Instead,learning to live their lives by rising above the trivia of life and thus remaining calm and selfless might provide
more social and personal sustainability and satisfaction.
As described above, while the body and mind of an individual and the way society could be are questioned
in this classic text, a more important viewpoint from Oriental medical theory is that the medicine is deeply rooted
in the concept of spontaneous remission or the natural healing ability of the human body. Although thisexpression may be construed to mean cure by acupuncture or moxibustion, instead the understanding was thatthe human body, stimulated by these modalities naturally and easily heal itself. Healing does occur by inserting
the needle or performing the moxa. This critical point is what widens the gap between Oriental and Western
Medicines, their theories, philosophies and practices. When these two medicines are compared, without
considering the origin or construction of both, the opinions tend to be unilateral. In short, from the perspectiveof Oriental medicine, the expression “medical cure” can only be used with a grain of salt, a sense of hesitancy as
oriental medicine is based on the understanding that humans heal themselves. And if medicine does not cure,
medical practitioners might feel a bit more humility toward the human body. They might assume an attitudeof asking or speaking to the body in order to understand what kind of stimulation or treatment best suits thebody` condition. Instead of an attitude of “I will cure you”, it would certainly be good if both the practitioner
developed a mutual attitude about the process of creating a body that can heal itself. It will then be timereconsider the relationships between illness, treatment and healing.

Shuichi Katai, Ph.D., L.Ac., Professor
Department of Acupuncture and Moxibustion
Tsukuba University of Technology, Ibaraki, JapanThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

1

Volume 5, Number 2 | Summer 2010

Japanese Acupuncture - Current Research
Japanese Acupuncture for “Hie” Symptoms(excessive sensitivity to cold)
Shunji Sakaguchi
Research Division of Acupuncture and Moxibustion
Kansai University of Health Sciences

1. Introduction
In Japan excessive sensitivity to cold is a social
1)

common place and definedas "a pathologic

condition where a decrease in environmental

2. Methods
The "Japana Centra Revuo Medicina" (aJapanese searchable database of medicallyrelated documents) served as the data source thatwas searched over the entire period (from 1983 to2010) during which articles pertaining to theacupuncture and moxibustion treatment forexcessive sensitivity to cold had been publishedand as far as possible among these, articles
presenting a high level of evidence credibility wereextracted.

temperature that does not produce any discomfort
to ordinary people elicits an abnormal feeling of

3. Results

cold in regions like the low back, the tips of hands

The extracted articles were summarizedclassified by years to present an outline of theresearch.
1) Fact-finding surveys related to patients withexcessive sensitivity to cold and the effects ofacupuncture and moxibustion treatment Kawana
3-5.
published from 1988 to 1989 three papers

and feet, both legs, or also the entire body, and thisabnormal feeling generally persists for more thana year. In many cases the affected persons
consciously perceive the condition as a disease."
Such a decrease in various physical functions is
considered

to

be

a

generalized

phenotypecharacterized by individual differences in severity

3)

In the first reporthe examined 92 womenand used to be considered a constitutional problem.

(51.1% of whom were in their 40s to 50s) with

However, in recent years fact-finding surveys

excessive sensitivity to cold of the feet regarding

related to this excessive sensitivity to cold

the actual presence of indefinite symptoms, bloodindicated correlations to specific diseases, so thatpressure and the presenting abdominal patterns.

the importance of prevention and treatment of
this condition is beginning to be acknowledged.
Relying on the two pillars of both acupuncture/ moxibustion and Kampo medications Kampo
medicine now uses imbalances related to Qi, Bloodand Water or anomalies in viscera, bowels and

The results showed, that (1) tinnitus, low backpain,

shoulderstiffnessandirregular

menstruations were common complaints and often
appearedtobepartialmanifestationsofgeneralized indefinite complaints. At the root of

meridians as an important indicators for thethe onset of these symptoms existed autonomic

diagnosis of excessive sensitivity to cold and as

dysfunction, (2) blood pressure was in many cases

therapeutic

simultaneously

normal, but tended among the younger patients toattempting to achieve improvements of thebe rather low and conversely in the higher age

associated symptoms.

groups high. (3) Among the abdominal patterns aguidelines,

In this work we discuss Japanese clinicalresearch pertaining to excessive sensitivity to coldand in conjunction with presenting its results
would like to evaluate both the current position
and future tasks.

2

high

incidence

of

Blood

stagnation,

tense

abdominal skin and hard glomus below the heart
were

observed.

For

the

acupunctureandmoxibustion treatment administered to newpatients we used stainless steel needles with a

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

Volume 5, Number 2 | Summer 2010

diameter of 0.2 mm that were usually retained forabout 10 minutes, while for chronic cases thistreatment was combined with low frequency
electro-acupuncture therapy (EAT) and a total of
15 to 20 treatment sessions administered in 1week intervals. Treatment points included thevarious acupoints on the level of the second sacralvertebra along the "S2" line: [Ciliao (BL32),
Pangguangshu (BL28), Baohuang (BL53), Zhongji(CV3)].
For an evaluation of the effects the applicationof a classification using 50% subjective and 50%
objective findings a ratio of symptom alleviation of
more than 80% was defined as highly effective,
more than 60% as effective and more than 40% as
slightly effective. The results showed that thetreatment was highly effective for 4 patients,
effective for 23 patients, slightly effective for 21
patients and thus more than slightly effective fora total of 48 patients (52.1%).
4)
The second report
is a fact-finding
examination related to the correlation between
excessive sensitivity to cold and menstruation,
pelvic circumference and abdominal pattern.
Subjects were 30 women (aged between 19 and 30
years) complaining of constant excessive
sensitivity to cold. The results showed thatpatients with excessive sensitivity to cold had atendency (1) toward low blood pressure, (2) anarrow pelvis and abdominal patterns tended to
be Blood stagnation (70.0%), tense abdominal skin(66.6%) or hard glomus below the heart (63.3%) inthat order. The summary that was also based on
the results of the first report showed, that there
are many common findings between younger
patients with excessive sensitivity to cold andmenopausal patients with excessive sensitivity tocold. Moreover, circulatory disturbances of thepelvic organs apparently have a marked influenceon the excessive sensitivity to cold in women.

5)

The third report is a fact-finding study related
to physical conditions, menstruational status andmental complaints of 105 young women (agedbetween 19 and 30 years). The results showed that
(1) a marked tendency towards presenting aphysical condition classified according to oriental
medicine as Blood deficiency, colic pain fromoverindulgence in cold foods (han shan) or marked
Blood stagnation pattern and the patients would
often be classified according to modern medicine
as asthenic, characterized by a hypersensitive
constitution with a tendency towards low bloodpressure; (2) the menstrual cycle was normal, but
the patients tended to be mentally very tense andbecame easily upset; (3) loneliness, timidity,
impatience and slow reaction to all matters werereported as mental complaints. Basically the same
acupuncture treatment as described for the firstreport was performed and the treatment wasmarkedly effective for 7 patients, effective for 28,
slightly effective for 66 patients, so that it wasmore than slightly effective in 66 patients (62.9%).
2) Effects of the acupuncture and moxibustion
treatment for patients with excessive sensitivity
to cold associated with some underlying disease
6,7)
published two articles in 1998
Nemoto et al.
6)
and 1990. In the first of these reports 21 patients(9 men and 12 women, average age 58.0 years) had
underlying diseases and at the same timecomplained about excessive sensitivity to cold of
the hands and feet. The treatment of the roots aswell as local and symptomatic treatment had the
purpose of activating circulation and inducing
systemically altering effects. Concretely low
frequency electro-acupuncture with a frequency of
1 Hz was applied to PC4 (Ximen), PC6 (Neiguan),
ST36 (Zusanli) and SP6 (Sanyinjiao) for 30
minutes; indirect moxibustion using 2 cones each
was performed on BL23 (Shenshu), ST36 (Zusanli),
KI7 (Fuliu) and KI1 (Yongquan) and thistreatment carried out twice a week for a total of

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

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Volume 5, Number 2 | Summer 2010

10 sessions. The effects were evaluated in thesame manner as described for the Kawana’s report.
The results showed an efficacy ratio of 55.9%
where the associated symptoms were alleviated inconjunction with the improvement of the excessive
sensitivity to cold.
7)
withIn the second report 23 patients
excessive sensitivity to cold and underlying
diseases were grossly divided into 13 patients withhemiplegia (9 men and 4 women, average age 57.2
years) and 10 patients (2 men and 8 women,
average age 55.5 years) with diseases other thancerebral stroke and then the acupuncture andmoxibustion treatment compared. Treatment
method, frequency and evaluation of the results
were the same as described above. The results
showed an efficacy rate of 60.9% where the ratioof improvement classified by diseases was 53.8%
for patients with hemiplegia and 70% for patientswith diseases other than cerebral stroke.
3) Effects of single acupuncture and moxibustion
treatments for excessive sensitivity to cold
8)
Kitamura et al. (1994) administered a single
acupuncture and moxibustion treatment to 7
healthy people (2 men, 5 women, aged 31-52 years)
and 10 people complaining of excessive sensitivity
to cold (3 men, 7 women, aged 29-65 years) andexamined the results using variations in thesubjective findings as well as core and surface
temperature of the sole of the feet. The treatment
used filiform needles that were retained at BL32
(Ciliao), BL23 (Shenshu), BL25 (Dachangshu),
BL52 (Zhishi), KI3 (Taixi), warming needle at SP6(Sanyinjiao) and electro-acupuncture as required.
The results showed therapeutic effects in 70.0% of
the patients with excessive sensitivity to cold.
4) The effects of the acupuncture and moxibustion
treatment when combined with root (general)treatment based on the Akabane method andtreatment targeted at overcoming Blood stagnation

4

9)

As reported in 1995 by the authors , it showedthat the patients presented with subjective
feelings of cold of the feet. Five women (aged 1930 years, average age 23.6 years) responding to
the item "Do you have cold feet even in summer?"in a CMI health check questionnaire covering 37
items received the Akabane style generaladjusting treatment with needles retained at Xuefu, BL32 (Ciliao), BL33 (Zhongliao), irradiation
with far infrared for 15 minutes and additionallyintradermal needles attached to SP6 (Sanyinjiao),
ST36 (Zusanli), CV4 (Guanyuan). A total of 5treatments were administered once a week. The
effects were evaluated after the first and fifth
treatment sessions, using the Terasawa’s Bloodstagnation score and a Visual Analogue Scale(VAS) for evaluating variations among the Bloodstagnation items, associated complaints andsubjective symptoms. The results showed that (1)all of the patients with an excessive sensitivity tocold also had a marked degree of Blood stagnation,(2) the acupuncture and moxibustion treatment
lowered the average Blood stagnation score from71 to 47 points, (3) the acupuncture andmoxibustion
treatment
resultedinanimprovement of the VAS in 3 patients, (4) the
improvement of the VAS induced by theacupunctureandmoxibustion
treatmentsuggested, that among the Blood stagnation items
alleviation of the tenderness and resistance in theileocecal region had contributed to improvementsof the menstrual disorders.
5) Skin temperature distribution over the wholebody as an indicator of the effectiveness ofacupuncture and moxibustion treatment forexcessive sensitivity to cold
10)
(1998) used acupuncture on theMori et al.
abdomen at CV14 (Juque), CV12 (Zhongwan),
ST27 (Daju), CV4 (Guanyuan), CV2 (Qugu), SP12
(Chongmen) and on the back BL20 (Pishu), BL23
(Shenshu), BL25 (Dachangshu), BL32 (Ciliao),

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

Volume 5, Number 2 | Summer 2010

and on the legs SP10 (Xuehai), ST36 (Zusanli) SP6(Sanyinjiao) and KI3 (Taixi) to treat 6 women(aged 20-40, average age 30.2 years) withexcessive sensitivity to cold for a total of 16 times
twice per week. For an evaluation of the effects ofthe treatment the degree of excessive sensitivity
to cold before treatment and 8 weeks later(classified into 4 grades: 3 = very disturbing,cannot be endured; 2 = is bothersome, but can beendured; 1 = somewhat bothersome; 0 = noexcessive sensitivity to cold) and whole body skintemperature distribution were examined. The
results showed that the degree of the excessive
sensitivity to cold improved by more than 2 levels
1 case and by more than 1 level in 5 cases, whilethermography of the legs too showed improvementin 4 cases.
6) Randomized controlled trials regarding theeffects of acupuncture and moxibustion treatment
for excessive sensitivity to cold
11)
(2008) conducted the first
The authors
randomized controlled trials regarding the effectsof acupuncture and moxibustion treatment forexcessive sensitivity to cold in Japan.
The study included 19 female volunteers (aged18-32, average age 20.5 years) with excessive
sensitivity to cold. Following stratification into therelevant numbers based on the questionnaire thesubjects were randomly divided into an"acupuncture and moxibustion treatment group"
and a "control group". In the "acupuncture andmoxibustion treatment group" the subjects weretreated in supine position by needling SP6(Sanyinjiao) and ST36 (Zusanli) on both the left
and right side and then cut pieces of indirectmoxibustion attached to the needle handles andburnt. Moreover, simultaneously with the warm
needling 4 stick-on moxa cylinders attached to alotus-shaped pedestal were placed on CV4(Guanyuan) to perform warming moxibustion.
Later, in prone position far infrared was applied

to the lower back, while applying using the same
lotus-shaped pedestal that was also used on theabdomen, to perform warming moxibustion
centering around BL32 (Ciliao) on both sides. A
comparison showed no significant differences forany of the items observed in both groups prior to
the intervention, with the exception of remnant
lipoprotein cholesterol (RLP-C). Regarding thedegree of suffering before and after theintervention, Blood stagnation score, Ht values,
RLP-C values and 10 RPM values there wasneither any interaction between the two groups
nor any differences.
7) Effects of low frequency electro-acupuncture
applied to the lower extremities for excessive
sensitivity to cold using postural change test
12)
(2010) applied low frequency
The authors
EAT to the lower extremities at SP6 (Sanyinjiao)
for excessive sensitivity to cold and investigatedthe effects.
The effects of low frequency electroacupuncture treatment for excessive sensitivity tocold in young women presenting with posturalchange test induced vasomotor disturbances. The
study included 20 women (aged 18-26 years,
average age 20.6 years), who were aware of theirexcessive sensitivity to cold and in whom the toe
skin temperature increased after lying down
following a 5-minute standing stress or else
showed left-right differences. For the acupuncture
treatment 40 mm long stainless steel needles witha diameter of 0.2 mm were inserted into left andright SP6 to a depth of about 15 mm and then usedas needle electrodes, while on the outside of thetibialtuberosity

on

both

sides

indifferent

electrodes were attached, applying a pulsed
current with a frequency of 1Hz for 20 minutes.
After a total of 5 treatments given once a week thestress test was repeated. Thermograms wereobtained of both lower extremities covering fromthe medial aspect of the foot to the tibial aspect

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

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Volume 5, Number 2 | Summer 2010

with a medical thermography device and then theshowed that ordinary acupuncture treatment andaverage skin temperature was calculated for thelowtoe, metatarsal, ankle and lower extremity areas.

depending on the course and through treatment

A 100 mm wide Visual Analogue Scale (below

along the S2 line improvement of the circulationabbreviated VAS) was used for our originalof the pelvic organs, referring to the intended

evaluation

pursuit of eliminating Blood stagnation, was

of

the

degreeoftheexcessive

sensitivity to cold and the categorical scale of 14
othersymptoms

includingtheexcessive

frequency

EAT

were

used

separately

achieved.
Research

intopatients

withunderlying

sensitivity to cold. A diary was kept starting one

diseases presenting with excessive sensitivity toweek prior to the treatment and continued until

cold receiving both root (general) as well as local

one week after the treatment, noting for all days

(partial) and symptomatic acupuncture treatment

during this period a "chilly score", a total score forpatterns showed, that it is possible to achieve

the 14 symptoms, the VAS values and served

certain effects by using the same indicators ofsubsequently to calculate the average valued.

effects that Kawana used. Moreover, associatedVariations in health related quality of life

with an improvement in the excessive sensitivity

measures due to the acupuncture treatment were

to cold shoulder stiffness, general lassitude,

evaluated using the standard edition of the MOS

constipation and similar associated symptoms

8-Item Short-Form Health Survey(SF-8). The

improved also and notable changes in the

results showed that through the acupuncture

abdominal pattern could be observed. Again, in

treatment the skin temperature of the toes

the second report patients were divided into

following the postural change test did not rise as

hemiplegia and other than cerebral stroke

markedly as it did during adaptation, while 20

patients and a comparative investigation of theminutes after the end of the orthostatic stress test

therapeutic effects reportedly showed, that thethere was a more significant increase in skin

improvement ratio in hemiplegic patients wastemperature on the medial side of the lower

lower. The additional presence of local circulatory

extremity than during adaption. The chilly score,insufficiency due to functional disorders of the

VAS values and the SF-8 heading and summary

central autonomous nervous system was surmised

scores did not show any significant differences

as possible reasons. This conceivably suggested

betweenthat the manifestation of acupuncture treatment

before

and

after

the

acupuncture

treatment, but the total score for the 14 symptoms
decreased significantly.

effects are mediated via central factors.
The research into the effects of single treatments
Kitamura et al. conducted, used retaining filiform

Discussion

needles and warm needling of acupoints in the

A series of articles by Kawana deals with the

lumbar region and on the legs and thereby achieved

pathology of women with excessive sensitivity toa high ratio of improvement. Presumably thecoldfact-finding

mechanism for this improvement involves raising

investigations classified by age indicated incore temperature in the regions affected by themodern medical sense a disorder of autonomic

excessive sensitivity to cold through acupuncture

nervous function and from an oriental medical

and moxibustion treatment of the lumbar region.

point of view a strong correlation to Blood

Moreover, follow-up studies verified that this effectstagnation. Moreover, the accumulation of cases

continued from several hours to several days.

6

and

the

conductionof

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

Volume 5, Number 2 | Summer 2010

For an evaluation of patients with excessive

correlation

to

the

findings

ofhematologic

sensitivity to cold the Cornel Medical Index was

examinations was observed, which suggests thatused and regarding the treatment the authors

the evaluation parameters need to be reconsidered.

conducted research pertaining to the intradermalThe

authors

investigated

among

the

needles originally developed in Japan, that wereaccumulated cases the effects low frequency EAT

used for adjusting the back Shu points within thewith a frequency of 1 Hz applied for 30 minutes had

framework of the Akabane method. A Bloodon toe skin temperature variations induced bystagnation score was used for this evaluation andpostural change tests in persons with excessive

showed, that certain effects had been obtained.

sensitivity to cold. The results showed that AET

Further, there was an apparent correlation to

produced a shift towards normalization of lower

improvements

extremity

in

the

VAS

and

the

Blood

vascular

responsivenessthroughpostural vascular reflexes, so that the excessive

stagnation items.
Mori et al. used thermography as an indicatorsensitivity to cold does not become worse even if theof the effects of acupuncture treatment forambient temperature decreases, suggesting that

excessive sensitivity to cold and found in their

the treatment had improved the general condition.

research using whole body distribution of skin

Stress thermography instead of the so far common

temperature,thesimple thermography as an evaluation index andsubjective symptoms showed a high concordance

the inclusion of an original evaluation chart forwith an increase in the skin temperature of thesubjective symptoms (the chilly diary) can also be
applied to future clinical research.

that

an

improvementoflegs. Regarding the evaluation method the use ofthermography for wide area assessment (wholebody) rather than only the variations in skin andcore temperature of the regions affected by theexcessive

sensitivity

to

cold

is

extremely

Many factors contribute to the onset ofexcessive sensitivity to cold, but among theseautonomic dysfunction from a modern medical

interesting.
In the randomized controlled trial (RCT) the
authors

4. Conclusion

conducted

toinvestigate

excessive

point of view and the pathologic condition of Bloodstagnation from an oriental point of view seem towasbe most deeply involved. Acupuncture andperformed on the sacral region and the lower

moxibustion treatment in the form of warm

abdomen to eliminate Blood stagnation, the effects

needling and intradermal needle, low frequencyof treatment with warm needling applied to the

EAT stimulation etc. applied to acupoints in thelegs was investigated in addition to the common

lumbar, sacral and lower abdominal regions asassessment using subjective symptoms and Blood

well as on the legs to improve autonomic nervous

stagnation score with the new parameter of blood

function and eliminate Blood stagnation is aviscosity. The results showed that acupuncture

treatment form developed in Japan. It causes

and moxibustion treatment led to a reduction ofsubjective variations in the associated symptoms

the suffering and an improvement in the Bloodof excessive sensitivity to cold and additionallystagnation score, but these effects did not exceed

has also been observed using thermography andthose observed among the controls. Although asimilar objective indicators. This verified a clinicalcorrelation between excessive sensitivity to cold

effectiveness among the accumulated cases of as

and Blood stagnation had been verified, no suchhigh as 50-70%. However, there is only little

sensitivity

to

cold,

warm

moxibustion

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

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Volume 5, Number 2 | Summer 2010

research using high evidence level RCTs, so that

7） Nemoto K, Mizukami M, Tanzawa S. A clinicalthese effects have still not sufficiently been

study of acupuncture and moxibustion for thedemonstrated and therefore the conductance ofhypersensitivity to cold (Part 2). Journal of themulti-center clinical studies would be desirable toJapanmake these results publicly known.

Moxibustion. 1990; 40(2): 198-205.

Societyof

Acupunctureand8） Kitamura H. The research on the effect ofReferences:
1） Terasawa K. On the recognition of “Hie-sho”(chillphobia) in the traditional kampoh medicine.
Shoyakugaku Zasshi. 1987; 41(2): 85-96.
2） Hirofumi Kawagoe, Kenji Tahahashi, Akira
Kawashima, Tomoaki Ishikawa: Fact-findings
surveys pertaining excessive sensitivity to cold
– basic data and incidence of excessive
sensitivity to cold classified according todiseases; Diagnostics and Therapy; 2003; 91(12): 139-42 (Japanese only)
3） Kawana R. Acupuncture and moxibustion forthe hypersensitivity to coldness-Studies on thepatients with feeling of leg cold-. Journal of theJapan
Societyof
Acupuncture
andMoxibustion. 1988; 38(3): 249-58.
4） Kawana R. Acupuncture and moxibustion forthe hypersensitivity to coldness (II)-Covelation
with menstruation, pelvic diameters andabdominal symptoms-. Journal of the Japan
Society of Acupuncture and Moxibustion.
1988; 38(3): 259-70.
5） Kawana R. Treatment of a chilly constitution
with acupuncture and moxibustion-Chilly
constitution of young female-. Oriental Medicine
and the Pain Clinic. 1989; 19(4): 131-9.
6） Nemoto K, Mizukami M, Tanzawa S. A clinicalstudy of acupuncture and moxibustion for thehypersensitivity to cold. Journal of the Japan
Society of Acupuncture and Moxibustion.
1988; 38(4): 423-8.

8acupuncture therapy for cold-feeling patients ona deep skin temperature. The Bulletin ofKanazawa Rehabilitation Center. 1993; 20: 33-9.
9） Sakaguchi S, Tani M, Nishiguchi R, Horikawa
T, Noguchi E, Kawamoto M, Fujikawa O. The
effects of acupuncture therapy on cold hands
and feet(“Hiesho”)-The relationship between
cold hands and feet(“Hiesho”) and blood
stagnation“Oketsu”-.

Japanese JournalofOriental Medicine. 1995; 45(4): 919-25.
10）Mori H, Nishijo K. Effects of acupuncture on
pain

and

thermographic

indefinite

complaint,

assessment.

with

BIOMEDICALTHERMOLOGY. 1998; 17(2): 133-42.
11）Shunji Sakaguchi, Shigeyuki Kanai, Shizuo
Toda; Randomized controlled trials regarding
the effects of acupuncture and moxibustion
treatment for excessive sensitivity to cold;
Journal of the KANSAI UNIVERSITY OF
HEALTH SCIENCES; 2007; 1: 82-5 (Japanese
only)12）Sakaguchi S, Kuge H, Kojima Y, Takeda T,
Miyazaki J, Sasaki K, Mori H. Effects ofacupuncture electrotherapy to lower limbs on
hie symptom(vasomotor dysfunction). The
Journal of the Japanese Society of Balneology,
Climatology and Physical Medicine. 2010;
73(4): 231-40.

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

Volume 5, Number 2 | Summer 2010

Kampo Medicine - Current Research
Situation on Use of Goreisan in Dialysis Patients－From the Goreisan Symposium 2010”－

Kazuhiro Muroga
Kurokouchi Hospital

It was in the Korean War’s casualties withacute renal failure that the effectiveness of
dialysis was first recognized. Since then, dialysis
has been applied widely from acute renal failure
to chronic renal failure. At present nearly 300,000
people receive dialysis in Japan1) and Japan has
the world-top level of dialysis technology. The
advanced technology of dialysis membranes has
significantly increased the effectiveness ratio of
dialysis and thanks to the synthesis oferythropoietin by the genetic engineering,
nephrogenic anemia occurring in the dialysis
patients needs for mostly no blood transfusions in
the regular life. However, there are symptoms thatcannot be sufficiently handled or prevented byWestern medicine such as headache, cramps inthe lower limbs, hypotension occurring during a
dialysis session – these symptoms cause to lower
the QOL of the patients in combination with thedialysis three times a week.
Naturally there are no descriptions in classic
books of Chinese medicine about clinicalconditions of patients having the dialysis
treatment of modern medicine, but Kampo
preparations are widely used in everyday dialysis
treatment. A renal failure that has fallen into thecondition that needs dialysis because of Kampo
treatment cannot be improved by Kampo
medicines. However, various implications orunpleasant symptoms that arise during a dialysis
can be relieved by Kampo medicines.
Treatment of various symptoms in dialyzed
patients will be reported below from the viewpointof the method of using goreisan, together with theintroduction of published literatures.

Historical background of Kampo treatment in adialysis patient
The first case report about Kampo treatment of
a dialyzed patient was made in 1977 by Okada.
The patient was a physician with diabetic
nephropathy who was under treatment withdialysis. The author came to know from adocument that the physician suddenly died2) rightafter the conversation was carried out that as his
conditions became improved with the combination
use of Kampo medicines including bunshoto andhochuekkito, the frequency of routine dialysis
might be reduced. The document did not mention
the cause of the death, so details are not known.
However, a cardiac disease or a cerebrovasculardisorder might be the cause. In around ’76, thecost of dialysis was covered by the government
fund and presumably there were no financial
burdens to the patients for paying the medical cost.
Furthermore, as the patient was a physician, I do
not like to think that he received less frequent
dialysis. In these days, practitioners or physiciansin general did not have sufficient understandingof Kampo medicines and information of Kampo
was scarcely available. After that, Kampo
medicines in the form of extract became popularand Kampo preparations began to be used in theeveryday settings of dialysis from 90s onward.
Use status of goreisan in the sites of dialysis
Up until today, the use of goreisan for dialysis
patient has been confined for the following:
1. Prevention of dialysis hypotension
2. Imbalance symptoms such as headache,nausea, cramps in the lower limbs
3. Effect on hyperpotassemia

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

9Volume 5, Number 2 | Summer 2010

no significant differences between the values

1. Prevention of dialysis hypotension
From my experience, hypotension, which may

before and after the intake of the Kampo medicine,possibly be associated with the volume of thefour patients showed an improvement in blood

removed water, often occurs in the patients during

pressure fluctuations during a dialysis session

the latter half of a dialysis session. Especially in theandpatients who badly control their body weight, acorrelation between ΔBV and PRR4). This means

large amount of water is removed and hypotensionthat there should possibly be the patients who had

often occurs in the latter half of a dialysis even if

the water moving, due to the oral administration

they have taken vasopressors beforehand. In theof goreisan, from the outside of the blood vessels

case, to maintain the patient’s blood pressure theinto the inside of the blood vessels.

there

existedasignificant

negative

solution of normal saline is often infused. Thus, theIt may be said that goreisan is a prescription

amount of the water removed with great pains

worth trying for the prevention of hypotension

becomes balanced out by the amount of the infused

during a dialysis treatment.

solution. Kawashima reported in 2000 about a caseof diabetic nephropathy. This female patient of 64

2. Effect of goreisan on headaches, nausea, andyear-old repeatedly developed hypotension during

cramping lower limbs

the latter half of a dialysis and an adequate amount

Headaches and nausea in the introduction stageof fluid could not be removed. Kawashima gave herof dialysis are called disequilibrium syndrome andan oral administration of the Extract 2.5g ofthese symptoms increase pain and suffering of thegoreisan at the start of a dialysis. With thepatient who do not get used to dialysis. Their cause

administration, her blood pressure was controlled

is described as cerebral swelling secondarily

and the volume of the normal saline infusion

developed by changes in the osmotic pressure of thedecreased enabling the planned water volume to be

blood due to the removal of urea nitrogen and otherremoved. In this publication, it was further

elements from the blood. Headaches are often-

reported that changes in the circulating bloodobserved complaints even in maintenance dialysis

volume (ΔBV) were determined by the vascularpatients. And other than migraines, there is a

refilling monitor of

the hematocrit monitor

different type of headache associated with changes

measuring cells (CritLin R

of JMS Co.) for thein the body fluid, similarly in the introduction stage

and

was

of dialysis. Some patients have the type ofconfirmed that the amount of the circulating blood

headache which may be caused by medication

plasma that had not been seen before theoveruse and coping with this type of headache is aadministration of the Kampo medicine wasdifficult task. Cramping lower limbs is also amaintained during the latter half of a dialysis3).

symptom that often occurs in dialysis patients.

The results were further tested and the report

They suffer the cramping during a dialysis andabout this additional testing was presented at thesometimes

2008 Japanese Society for Dialysis Therapy.

Shakuyakukanzoto often has marked effects on

extracorporeal

circulation

that

it

An oral dose of the Extract 2.5g of goreisan wasgiven to 10 patients on non-diabetic maintenanceduring

the

night

time.

cramps as in healthy people, but it cannot beeffective at all times5)6).

dialysis at the start of a dialysis to measure ΔBVs

The author had once conducted a questionnaire

and plasma refilling rates (PRR) before and aftersurvey with 180 maintenance dialysis outpatientsthe administration. Although the result showed

at Tsuchiura Kyodo Hospital, in which they were

10

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

Volume 5, Number 2 | Summer 2010

asked about the presence of headache, nausea, and3. Effect oflower legs cramps and confirmed their willingness

hyperkalemiaof taking a Kampo medicine; and 20 of them weregoreisan on hyperpotassemia /As kidney failure progresses, the levels of bloodadministered goreisan to verify its effectiveness.

potassium

The subjects were aged 41 to 76 with the dialysis

frequency. The author has often experienced cases

history of 7 to 223 months. Primary diseases were

where plasma K did not decline sufficiently

diabetes in 6 patients, chronic glomerulonephritis

sometimes even if the K concentration of thein 9, and connective tissue disease in 2, anddialysis solution was controlled. This is the result

polycystic kidney disease / pregnancy kidney / renal

from the weak ability to remove K in hemodialysis

sclerosis in 1 individually. Headache in 16, nausea

comparedin 2 (nausea and headache overlapping in 1), andinstructions are given to the patients to avoid

cramps in lower limbs in 5 (cramps and headachetaking K from articles of food as much as possible.

overlapping in 2), to all of which goreisan was

However, only a few patients can continue toorally administered twice / morning and night (forstrictly adhere to the die. On the other hand, somepartial cramps in the lower legs, the administration

patients die suddenly due to the blood K levels

was once in the morning of the dialysis day).

elevated by overeating of K-rich foods, especially

Improvements in subjective symptoms after 8

fruit. The patients with high levels of plasma K atweeks were compared against score 10 of before-

ordinary times take the oral administration of

the-administration to see how the scores declined.

potassium absorbing agents, which are hard toThe

drink and have the risk of solidification in the

results

showedheadachedisappeared

completely in 4 patients, 70%-90% improvement in

intestinal

7, 30%-40% improvement in 4, and no change at all

obstruction.

(K)

to

becomeelevated

peritoneal

tract,

dialysis.

leading

to

an

with

high

Therefore,

intestinal

in 1. As for nausea, 90% improvement in 2, and forTajima et al. reported that a patient with highlower limbs cramps, disappeared in 1, 70%

levels of blood K showed an improvement in the

improvement in 1, 50% improvement in 1, andlevels of plasma K after the administration of

20%-30% improvement in 2. Physical conditions

goreisan. According to the report, the femalechanged by the administration were constipation

patient of 50s whose plasma K had once increased

in 5, and soft stools / increased blood pressure /to 7mEq/ml complained of pain in the shoulder

feeling legs light / joint pain relief / relief of cramps

joints and received the administration of thisin 1 individually. In one patient with nausea, theKampo medicine; the levels of K that had not

symptom disappeared but constipation developed,

fallen below 6mEq/ml declined to around 5mEq/ml.

so that the oral administration was discontinued

Later goreisan was replaced with shosaikoto, but

voluntarily but the symptom did not recur7). It has

the K levels were maintained9). Then, Muramatsu

been verified from these results that goreisan ismade a report with Tajima with an addition of one

effective for improving complaints of dialyzed

more patient10).

patients.

And Naito also reported that the level of

There is another document reporting thatplasma K decreased after the administration of

goreisan was used for maintenance dialysis

goreisan in patients with chronic renal failure inpatients who developed cerebrovascular disorderstheduring a dialysis with worsening disordered

comparison was made between the group of highconsciousness during the session8).

levelsmaintenance
of

K

(an

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

period.
average

In
of

the
Cr

report,a4.5mg/dl,11

Volume 5, Number 2 | Summer 2010K≧6mEq/ml) and the group of relatively high

5. Yamashita J.: Touseki Kanjya no Touseki-chu,levels of K (an average of Cr 1.9mg/dl, 5≦K＜

Touseki-go

6mEq/ml). The results showed that in the group of

TSUMURA shakuyakukanzoto no Kouka nihigh levels, an average of 6.6mEq/ml declined to

Tsuite. Pain & Kampo Medicine 2 18 1992anaverageof

5.6mEq/ml

due

to

no

Kin-keiren-tsu

nitaisuruthe

6. Muroga K., et al.: A Clinical Study of the Efficacy

administration of goreisan, whereas in the groupof shakuyakukanzoto for Muscle Cramps inof relatively high level of K, no changes were

Dialysis Patients 46(3) 467-469 1995

observed in effect from an average of 5.2mEq/ml
to5.3mEq/ml.

Moreover,nochangeswereobserved in the amount of potassium in urine
during the administration of this Kampo medicine.

7. Muroga K.: Iji-Touseki Kanjya ni okeru

Goreisan no Shiyou Keiken. Journal of Kampo
Medicine44 (12) 1574－1577 1997
8. Kawamura T., et al.: Jinkou Touseki-chu noThus, it may be possible that although goreisan

Ishikidoes not affect the levels of plasma K in blood K of

Fusegieta Nounai-shukketu no 2-rei. Journal

high levels but not high enough to the life-of Noushinkeigeka to Kampo 3 9-10 2008

threatening extent, the Kampo acts to correct the

9. Tajima K., et al.: Kampo-yaku ni yoru

Shougai

Akka

no

wo

Chiryou

Goreisan nitehigh levels of blood K that exceeds 6mEq/ml11).

Kansetu-shouchuni

Kessei

However, the mechanisms are not known.

Kariumu-chi ga Seijyouka shita Touseki
Kanjya no 1-rei. Kampo & the Newest Therapy

The above is the report on the reality of various

12(4) 367-369

2003

applications of goreisan, together with reports by

10. Muramatsu T., et al.: Kampo-yaku de Kessei

great physicians. I hope that the application of

Kariumu-chi ga Kyusokuni Seijyouka shita

this Kampo medicine will further expand in the

Touseki Kanjya no 2-rei. 22-kai Hinyouki-ka

sites of maintenance dialysis.

Kampo Kenkyu-kai Gakujyutsu-shu 2004
11. Naitou

M.:

Goreisan-ekisu-seizainiyoruReferences

Mansei Jinfuzen Kanjya no Kou-Kariumu-

1. Nakai S., et al.: Current status of chronic

Kesshou Yokusei-kouka (Zokuhou) – Kessei K-

dialysis therapy in Japan (as of December 31,

chi ni oujita Kouka –2008) Journal of The Japanese Society forMed) 57(supple.) 262 2007

Dialysis Therapy 43(1)

1-35

2010

2. Okada M.: Jin-touseki Kanjya ni Kampo wa Ze
ka Hi ka, Journal of Kampo Medicine 24(12)755-758 1977
3. Kawashima A., et al.: Touseki Iryou niokeru
CURRENT TOPICS 2008 Iji-Touseki Kanjya
ni taisuru Kampo-yaku no Ouyou, Journal of
The Japanese Society for Dialysis Therapy 23(2) 195 2008
4. Oshima R., et al.: Goreisan no Touseki-chuu
Jyunkan Doutai ni okeru Kouka no Kentou.
Journal of The Japanese Society for Dialysis
Therapy 41 supple

12739 2008

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

Nittou Ishi (Kampo

Volume 5, Number 2 | Summer 2010

Clinical Report 1 (Japan)
Three Cases of Shonishin (pediatric acupuncture) forNight Cry, Stool Abnormality and Nightmare
Shoko Masuyama
Depatment of Acupuncture
Morinomiya University of Medical Sciences

Introduction
Shonishin (pediatric acupuncture) devices
differ from acupuncture needles which penetrates
the skin for adults. Shonishin therapy is thetechniques of providing painless stimuli involving
rubbing and touching to the skin surface lightly.
For details of treatment techniques, a publishedbook should be referred to1). Shonishin grew
popular mainly in the Kansai area2) and especiallyin Osaka, it has taken root in people’s daily lives.
We introduce three cases of Shonishin thatshowed favorable results at our university clinic.
Case 1
Patient’s name: K. S.
Age and gender: 10 months, male
Family structure: Father, mother and the patient
Chief complaint: Night-time crying
Present history: No symptom appeared until 5months of age. About 7 months of age, night crying
began. The frequency was 2 to 3 times during anight. The patient kept crying for the longest timeof 20 to 30 minutes, sometimes it continued for 5
minutes and stopped. At shortest, crying
continued for 5 minutes and then stopped.
Treatment
Initial visit
He was crying in the waiting room and at thetime of changing the clothes. He disliked hospitals
all the time and got scared when seeing a white
uniform. Treatment was performed with themother holding the patient in her arms. The wholebody was rubbed and touched with Yoneyama
Gingko Leaf Shaped Shonishin.

The 2nd treatment (6th day from the first visit)
On the night of the initial treatment, thepatient fell asleep soon when the mother looked
into him crying face. Although this was repeated 2
to 3 times, he did not keep crying. From thefollowing day, he was in bed at 20:00 as usual but
cried 3 to 4 times and then stopped crying in realtime and fell into a sleep by 24:00 when parents
went to bed. The intensity of night crying
decreased as a whole. During treatment, hereceived acupuncture, lying alone on the bed
without crying.
The 3rd treatment (on the following day of theprevious treatment)
Last night, the patient easily fell asleep 19:30
earlier than usual. Although he woke up crying
twice before 24:00, the mother patted her backgently and then he stopped crying any second. In
the morning he woke up crying
twice and it
continued only for short minutes. Although thefrequency did not decrease, the intensity of crying
became weak and crying time was shortened.
During New Year days, parents were planning tostay at his grand mother’s place and worried if hewould cry violently because of a change in theenvironment. Generally he was not good at taking
the face-up position, but was not reluctant to takethe position during treatment.
The 4th treatment (14th day from the previous
treatment)
Family stayed at his grand mother’s place on
New Year days. Night crying did not occur at all.
He used to dislike being in the baby stroller but
now could have a daytime nap for the first time init. After returning home, night crying occurred
only twice - once by 24:00 and once 5:00 in themorning.
The 5th treatment (6th day from the previous
treatment)
The family stayed at his grand mother’s place

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

13

Volume 5, Number 2 | Summer 2010

again for three days. From the night of returning
home, cough appeared. Before that, the number ofnight crying was about twice. However, he caught
a cold last night and the frequency of night crying
increased due to cough and congested nose. At thetime of vaccination in this morning, he cried out
loudly. Cold drugs were prescribed, and he was ina bad mood. Before visiting the clinic, he cried andcried out but kept quiet at the clinic.
The 6th treatment (7th day from the previous
treatment)
After the previous treatment, a fever of 38 C
degrees developed. On the following day, it
resolved spontaneously without antipyretics.
Appetite and bowel movements were returning tonormal. He was able to sleep from 20:00 at night
through to 4:00 in the following morning without
wakening up. He sometimes woke up at 24:00 but
did not scream and fell asleep.
The 7th treatment (8th day from the previous
treatment)
A cold cured two days ago. Around 12:00 of 2 to
3 days ago, he became fussy but soon fell into asleep at the mother’s breast. This was repeated 5
to 6 times during an hour. After this, he slept
through to the following morning without
wakening up. During treatment, he was in a goodmood and relaxed receiving treatment. As night
crying subsided, a two-week time interval wasallowed before the next treatment.
The 8th treatment (14th from the previous
treatment)
He woke up once before 12:00 but, after this,did not wake up until 5:00. In recent days, night
crying did not occur and he was able to sleep
straight to the following morning. Previously, inthe daytime napping, he had woken up every 30
minutes. However, often times, he was able to nap
for an hour and a half.
Treatment was completed.

14

Case 2
Patient’s name: K. H.
Age and gender: 1 year and 5 months, female
Family structure: Father, mother and the patient
Chief complaint: Diarrhea and constipation
Complication:
Iron-deficiency
anemia.
Hemoglobin was in the vicinity of (Hb) 10 g/dL.
Although syrups were prescribed, she spitted out
the medicine in dislike. So the medication was
suspended for two months. While waiting for the
medical check, Shonishin was requested.
Findings: Skin dryness, red rashes around GV15,
and undereye circles.
Convulsions including nervousness and shorttemperedness seldom occurred.
Treatment
At the time of the initial visit, she was scaredof the acupuncture needle and cried loudly, so that
she received Shonishin in her mother’s arms. The
dorsal region, sacral region, upper limbs, head,and posterior region of neck were lightly rubbed
and touched for about seven minutes.
The frequency of treatment was once or twice aweek. She became able to receive the third
treatment without crying.
Results
Immediately after the treatment, the driedskin felt to be moisturized. According to themother, on the nights of treatment and thefollowing nights, the patient fell into a deep sleep
in a short time and did not wake up till themorning. The patient received 75 times oftreatment during one year and nine months fromthe initial visit, but the patient comes to the clinic
to receive Shonishin for diarrhea or constipation.
Within several hours or on the following day after
treatment, the symptom of constipation or
diarrhea improved. Currently, the patient not in
bad condition comes to the clinic to receive
Shonishin two or three times a month for the

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

Volume 5, Number 2 | Summer 2010

purpose of managing the health. The blood
examination at the start of treatment indicatedHb 9.7 g/dL, Fe 13 µg/dL. One year and eightmonths later, blood levels of hemoglobin and ironincreased to Hb 13.1, Fe 74. The doctor in charge
told that no more blood examination was required
any longer.
Changes in the levels of Hb and Fe
Initial
visit

After
2 months

After
4.5 months

After13.5 months

Hb (g/dL)

9.7

10.0

11.3

13.1

Fe (µg/dL)

13

18

41

74

Case 3
Patient’s name: I. K.
Age and gender: 2 years and 11 months, female
Family structure: Father, mother and the patient
Chief complaints: The patient had great
sensitivity and was full of fears. The patient often
easily got scared and cried out.
Symptoms began to develop 11 months ago.
What she scared of was anything that moved
including insects. She cried by dreaming of a scary
dream at nights. She was the type of person who
acts based on understanding and did not have afear of strangers and was affable.
Special notes: The mother was in the 9th month of
pregnancy (their second baby was expected.)
Findings: Skin temperatures of hands and legs
were high.
On the day of the initial visit, she could notenter the clinic from the door and cried refusing
entering. She was scared of moving toys,
decoration dolls, everything. Her bad moodbecame a little bit better by “Anpanman.”Treatment
As the patient refused to take off the clothes,treatment was made with the clothes on for theforearms, legs, nucha, interscapular region, back,and sacral region while distracting her mind,
using the tinkling bell sounding Spoon Needle. On

the day of the third treatment, she came near theclinic but could not enter. So we met the patient
there and got arm in arm to the treatment bed of
the clinic.
Results
On the 4th visit of 8th day of treatment, themother said that after the treatment of yesterday,
the patient slept well without talking in sleep.
When taking a bath, she usually had become fussy.
However, she promptly took off the clothing andtook a bath with the father. From around this time,
she became able to receive treatment without
crying. After that, although she had night crying,saying “ants are scary,” the frequency gradually
decreased. She had an interest in acupuncture
treatment and prefers to have it, compared toother children. Although she lived apart from themother who was in hospital for eight days before
the delivery of her sister, there was no severenight crying during the days. She had 21 times oftreatment during 7 months. After 11th treatment
onwards, the symptom of the fearful emotion was
relieved. Currently, she receives acupuncture
treatment for the purpose of the healthmanagement including constipation.
Consideration
Case 1 describes about a mother who sufferedfrom night crying, a symptom specific to infants
and selected Shonishin. Immediately after thetreatment, the patient’s condition improved andresponses to the treatment were distinguished.
Night crying appeared intensively by the time ofthe parents going to bed. There was the possibility
that the sleeping environment of the infant was
disturbed by the sound of parents talk and othernoise in life. It is interesting to note that when themother was a child, he was taken to receive
Shonishin by his parent. We felt that he had astronger sense of trust in acupuncture treatmentcompared to other mothers.

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

15

Volume 5, Number 2 | Summer 2010

In Case 2, diarrhea stools changed to a solidstate on the following day without medication,
which happened several times. As regarding
constipation, we consider that the infant was at
the stage of toilet training, during which theinfant was put in the environment that easily
caused constipation. Gathering information about
the environment surrounding the infant, we used
it to make the treatment relaxing and comfortable
to the infant. As well as improvements in diarrhea
and constipation of the chief complaints,
improvements in the levels of iron-deficiency
anemia (a complication) were obtained as shownin the blood examinations. The mother reported ofthese improvements to the pediatrician, who thensaid to continue acupuncture treatment.

peculiar to infants. In many cases many of theparents and grandparents who bring in theirchildren to acupuncture treatment have previous
experience receiving acupuncture treatment andfeeling its effect. We feel that the culture of eachfamily has its “family acupuncturist” to stayhealthy and promote well-being still remains with
Osaka.
References
1.

Birch

S.

Shonishin:

Pediatric

Acupuncture. Thieme. Stuttgart/New York,2011.
2. Noguchi E, Tani M. A survey of the current
status and background of acupuncture for
infants. Jpn J Orient Med. 1996; 46: 581-590.

In Case 3, the symptoms of the patient became
worse when the mother was in 9 months ofpregnancy. From this, the child was acutely awareof physical changes of the mother and this might
possibly have influence on the mind of the child. It
can be predicted that as her mind was in theunstable state, she was overly sensitive to any
sound heard and anything that moved, which was
the condition of kidney deficiency based on thetheory of Oriental Medicine. It is considered that
improvements were connected to the factors that
autonomic nervous system were influenced by theskin stimulation of Shoninshin and the childpatient became fond of visiting the clinic fortreatment, leading to the relief of stress.
We believe from the three cases that children
grow every day and at the same time spend eachday, feeling stresses in learning how to adapt to
new things, which include the change from thebaby food diet to the ordinary food diet, thetraining of diaper withdrawal, a sister’s delivery,and self-presentation to attract the parents’attention. Parents will select Shonishin that does
not use drugs as a means of appeasing symptoms

16Japanese

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

Volume 5, Number 2 | Summer 2010

Clinical Report 2 (Japan)
A Case that Had More Effect from Less Crude Drugs

Masayuki Kashima

Department of Internal Medicine
Kumamoto Red Cross Hospital[Background]
In Kampo treatment with crude drugs,
practitioners apt to add one drug after another in
response to patients’ complaints. On the other
hand, it has often been pointed out that theformulae that have additional crude drugs do notseem to sufficiently yield expected benefits. The
author has modified the original formulation by
giving no major changes to the structure andcharacteristics but rather adjusting the number ofthe crude drugs and drug amounts of the original
formulation, reducing to an essential minimum
structure. Following is the report about theexperience of using this modified preparation:[Case] Female of 22 years old[Chief complaint] Pyrexia and general malaise[Current medical history] Complications of SLE
developed at the age of 17 and Sjogren’s syndrome.
Raynaud’s
symptoms,
fever
onset,
joint
inflammation, depression symptoms, hypocytosis,
and core symptoms of inflamed pleura. The
patient had been receiving treatment withdecoctions to manage the symptoms, but she
became exhausted after unusually hectic and longsummer days. In early October, she began to havethe onset of fever with the body temperature of 3940 degrees Celsius with a loss of appetite, a senseof malaise, and polyarticular pains.
Prescriptions administered up until early October.
According to the text book of Bensho(syndrome/type identification) for spleen-kidney
deficiency, liver qi depression, disquieted heart
spirit, blood stasis, and internal heat, following
had been used.
Astragali Radix 14g, Bupleuri Radix 14g,
Cimicifugae Rhizoma 4g, Ginsing Radix 8g,
Atractylodis Rhizoma 8g, Poria 8g, Fossilia Ossis

Mastodi18g, Oysteae Tespa 18g, thinleaf
milkwort root 6g, Zizyphi Semen 10g,
Rehmanniae Radix 8g, Amomi Semen 5g, Processi
Aconiti Radix 2g, Psoraleae Semen 8g, Cinnamomi
Cortex 8g, Paeoniae Radix 8g, Angelicae Actilobae
Radix 8g, Persicae Semen 8g, Moutan Cortex 8g,
Spatholobi Radix 8g, Salviae Miltiorrhizae Radix
8g, Lycii Fructus 8g, Citrus Unshiu Pericarpium 6g,
Ophiopogonis Tuber 6g, Schisandrae Fructus 6g,
Phellodendri Cortex 4g, Zizyphi Fructus 4g,
Zingiber Rhizoma 4g, Glyzirrhizae Radix 4g.
Prescription after modification:
Astragali Radix 20g, Bupleuri Radix 6g,
Cimicifugae Rhizoma 6g, Cinnamomi Cortex 6g,
Paeoniae Radix 6g, Fossilia Ossis Mastodi 9g,
Oysteae Tespa 9g, platycladus orientalis seed 8g,
Salviae Miltiorrhizae Radix 8g, Ginsing Radix 10g,
Atractylodis Rhizoma 8g, Anemarrhenae Rhizoma
9g, Corneri Fructus 10g, Eucommiae Cortex 8g,
Amomi Semen 4g, Zizyphi Fructus 6g, Zingiber
Rhizoma 3g, Glyzirrhizae Radix 6g.
Only three days from switching to the newprescription, a decline of the fever was attained to
the first half of 37 degrees C. The feeling ofmalaise also improved. Ds-DNA antibodies
returned to the normal vale of 86 from 129.
[Discussion]
Both formulae of before and after themodification are similar to each other in majorparts and there are no major differences between
the two in the properties of the drugs contained. A
marked response was obtained after making
changes to form the structure having an increasein the drugs with the ability of qi tonification but
with a reduction in the drugs for activating bloodstasis and flowing qi downward. It may beconsidered that the improvements in clinicalconditions could be achieved by eliminating the
drugs that were considered to bring only

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

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Volume 5, Number 2 | Summer 2010

ineffectual effects but by matching clinicalconditions with the treatment method. Even if acertain preparation is effective, We often haveobserved the patients who have not responded tosimilar ones containing the same structuralcomponents. This may be due to the samemechanisms. Although we tend to easily increase
the number of crude drugs according to symptoms,
it is suggested in this case that an accurate
diagnostic ability and understanding ofprescriptions that can enable to make simplified
formulations
appropriate
forpathologicalconditions are of clinical significance.

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

Volume 5, Number 2 | Summer 2010

Clinical Report 3 (Japan)
A Case of Eating Disorder Accompanied by Anxiety(Yokukansan for Paroxysmal Vomiting)
Mihoh Koga, M.D. – Kampo Specialist
Division of Clinical Pharmacology and Therapeutics,
Division of General Medicine
Jikei University School of Medicine

3)
Case: K.H. female of 46 years old
Initial visit: June 16, 200X
Chief complaints:
1. Eating disorder
2. Anxiety/sleeplessness
3. Feeling of fatigue
Past medical history:
Bilateral sinusitis (since childhood), irritablebowel syndrome (enteritis), and anxiety neurosisa) As she worried about her husband’ssnoring and apnea, she could not sleep
continuously.
b) She had a fear of being separated from her
husband.
c) She was worried about the disease of theirfirst son.
3) Felt fatigue due to frequent overseas businesstrips.
She had a detailed checking by other hospitaland was told these are symptoms of neurogenic
origin.

Findings at the initial visit:a) 152cm, 50kg. No big changes in the BW.
b) Blood pressure 120/60, pulse count 72/min.
c) Irritation (+)d) Defecation 1-2 times/day, thin stools, a sense
Occupation: Running a jewelry store. As theof incomplete evacuation (+)
volume of business negotiations abroad increasede) Urine – no abnormality
to expand the business, stress increased.
Family environment: Her husband was an artist tof) Menstruation – no problem.

design jewelry. (He likes Kampo.)
Their first son was 21 years old (at age 5, he hadbrain tumor).
Their second son was 19 years old.
Origin and course:
1) The patient often had regurgitated the soupdishes or noodles eaten from the stomach
since around three years of age. Vomiting
after meals began at the age of 24 when she
was pregnant with the first child. She said
that with more than half of the normal foodintake, (1) food was involuntarily spewed out,or (2) she had a stuffy sensation in thestomach and voluntarily vomited. The
symptom got worse at night compared to day
time, and especially it became severe during
the business meeting over a meal.
2) Sleeplessness caused by anxiety, difficulty
falling asleep, and woke in the middle of thenight.

Pulse: Sunken, thin, string-like, and weak wristpulse
Tongue: Slightly dark red (partially purple
colored), moist with pale white furs.
Abdomen: Contracture of the abdominal skin,rumbling of intestine by the intake of cold
drinks/splashing sound (+)
Bensho (pattern identification): Spleen deficiency/ liver-spleen-stomach disharmony / liver qi
depression
Prescription: One day dose of shokenchuto
One day dose of yokukansankachimpihange.
These two prescriptions were divided into 3 doses
and taken 3 times/day between meals.
CourseTwo weeks later, the chief complaints subsided.
Although the patient subsequently made overseas
business trips, the symptoms did not recur. She
did not have vomiting during the negotiations.

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Volume 5, Number 2 | Summer 2010

The prescriptions were continuously administered.
Now she feels fine.
Analysis of clinical conditions:
Vomit

Sinusitis

Deficiency of liver-qi

Stomach qi
ascendingcounterflow

Heart spirit anxiety

Deficiency ofheart blood Sleeplessness
 Anxiety neurosis

Excessive worry

 Regurgitation after eating

Liver qi statis

Spleen deficiency

 Rumbling after drinking cold water Abnormal defecation

 Business responsibility
and full schedule Irritation
 Pulse(sunken, thin, string-like)

Disharmoney ofliver/spleen/stomach

 Worsen during business meeting Irritable bowel syndrome Contracture of the abdominal skin

Yokukansan [Hoeisatuyou]“cures deficiency heat in the liver meridian,development of convulsions, or heat and clenching ofteeth,

orfrightpalpitations/

cold-heatorvomit/thinner saliva / feeling of swollen abdomen by
spleen-deficiency activate liver-qi, small appetite,cannot have a good sleep. Bupleuri Radix /Glyzirrhizae Radix / Cnidii Rhizoma / Angelicae

Actilobae Radix / Atractylodis Rhizoma / Poria /Uncariae Uncis cum Ramulus”

20

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

Volume 5, Number 2 | Summer 2010

Front Line of Kampo Medicine
Review 1 of Academic Meeting Concerning
Pharmaceutical Sciences
Toshiaki Makino
Graduare School of Pharmaceutical Scienses,
Nagota City University

botanical origin of the crude drug “Japaneseangelica root” to be identified from the gene. And
the Kodaira et al. of Kanazawa University
reported on the crude drug "Poria Sclerotium."
They made a comparison between the on-market
product produced in China and the one producedThis series introduce the latest studies on

in Japan and found differences in not only

Kampo medicines presented at the Society’s

production characteristics but also DNA basemeetings.

sequence.

The first installment of the series will provide
the studies presented at The 130th Annual
Meeting of Pharmaceutical Society of Japan heldin Okayama in March, 2010.

Asahina et al. of Ochanomizu University
reported that as a result of their chemotaxonomic
analysis of the original plant of Dendrobium using
LC/MS, it was possible to distinguish the botanical

Kamakura et al. of National Institute of Healthorigin Dendrobium moniliforme from D. tosaense.

Sciences reported that their analysis of heavy

They also reported that the use of chloroplast

metals contained in the products on the crude

genes allowed differentiation between six spices ofdrug market showed high levels of cadmium inthe genus Dendrobium.

coptis rhizome, gardenia fruit, zedoary, and somespecimens of atractylodes lancea rhizom, whereas
low levels of arsenic, mercury, and lead weredetected.

Yamazaki et al of Osaka Prefectural Instituteof Public Health reported that in conducting
HPLC analysis of ginsenoside Rb1 contained in
Kampo preparations, they developed a simple andNakamura et al. of Osaka University reported
that they had made gene analysis, metabolomic
analysis, and elemental analysis using ICP-MS for
50 horticultural varieties of peonies, 16 specimensof peonies as crude drugs distributed in Japan,
and red peonies produced in China, and conducted
multivariate analysis of individual factors; and as
a result of all types of analysis, it is now possible
to classify the various varieties of Chinese peonies
into the group of white peonies or the group of red
peonies and even their production areas.
Kitaoka et al. of Kanazawa University reported

quick analytical method through the use of thepolymer-based HILIC column.
Morinaga et al. of Nagasaki International
University reported that they developed a methodof qualitatively analyzing baicalin in the following
procedure:

Kampo

medicines

containing

scutellaria root baicalensis Georgi are put on thepoluethersulfone (PMS) membrane and thenmembrane chromatography is performed. Or, thespecimen of Scutellariae Radix was pushed onto
the membrane in order to transfer all the
ingredients into the membrane. After that, thethat their DNA analysis of the plants belonging tomembranes

werestainedAngelica genus and the on-market products of thecrude drug "Angelicae Radix" clarified that thebase sequences of three species of Angelica
acutiloba, A. gigas, and A. sinensis in the ITS

antibodies against baicalin.

withmonoclonalStudies on problems arising from preparing
Kampo medicinesregion were different each other, enabling the

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

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Volume 5, Number 2 | Summer 2010

Hakamazuka et al. of National Institute of

purposes on Kampo extract preparations and

Health Sciences reported that they had made areached proper amounts of radiation and exposurecomparison of the total amount of extracts

time.

obtained from separate decoctions of individual
crude drugs composing a Kampo prescription to
the amount of the extract obtained from thedecoction of a mixture of crude drugs. They foundthat in 15 prescriptions and their composing 38
crude drugs, the total amounts of individual
decoctions and the one-time decoction of all crude
drugs were similar, except for the case of

Koyama et al. of Tochimototenkaido reported thatthey had carried out a testing on migration of residual
pesticides remaining on the crude drugs "perilla herb"and "citrus unshiu peel" to decoction liquids, with theresults that there were no migrations except forazoxystrobin at a very low level.
Basic pharmacological study for Kampo medicines

orengedokuto (Coptis Detoxificating Decoction), in

Asahina et al. of Toho University reported thatwhich the total amount of individual decoctions

they administered shigyakusan (Cold Limbs

was 70-80% of that of the one-time decoction.

Powder) or saikokeishito (Bupleurum and Cassia
Twig Decoction) to mice exposed to isolation stress

Hirasawa et al. of Kanazawa University
reported on quality changes of the decocted liquidof kakkonto (Pueraria Decoction). They prepared
the decocted liquid using the automatic Kampo
extract packing machine and stored it at 4, 25, and40 C degrees for 3 weeks to examine changes inquality. At 40 C, the yellow tint was reduced withinduced by individual rearing, with the resultsthat although dose dependent nature of antianxiety effects was observed in the group of
Shigyakusan, no efficacy was observed in thegroup of saikokeishito.
Seshime et al. of National Institute of Healthan increase in redness. As a whole, the color was

Sciencesturning to darkening with an increase inadministered Kampo prescriptions to human

bitterness and a decrease in tart. On the otherintestinal flora and observed the growth situation.

hand, no changes were observed at 4 C and 25 C,

For clostridium welchii that could possibly cause

which suggests that the quality can be preserved

inflammatory

for three weeks if decoctions are stored in a coolorento (Coptis
Decoction), san'oshashinto (Three Huang HeartClearing Decoction with Three yellow color Herbs),
shojokito(MinorPurgative
Decoction),daiokanzoto (Rhubarb and Licorice Decoction),
daiobotampito (Rhubarb and Moutain Bark
Decoction), tokakujokito (Peach Kernel Purgative
Decoction), and mashiningan (Hemp Seed Pill). Of
these, orento, san'oshashinto, daiobotampito, andtokakujokito did not have effects on bifidus

place or at ambient temperature.
Fukuda et al. of Josai University reported thatthey had examined acridity of the steam whenmaoto (Ephedra Decoction) andshoseiryuto (Minor Blue Dragon Decoction) withdecoctingthe results that in Shoseiryuto, the degree of
unpleasantness was high while an improvement
in a sense of blockage in the nose and the eyes
feelingrefreshedweresignificantly

bettercompared to Maoto.
Nakamura et al. of Hokkaido University of
Education reported that they had examined
influence of radiation exposure for sterilization
22

reportedsignificnatly

thatdiseases,

they

the

had

directly

growthinhibitedbyetKitasatowasbacteria.
Nishimotoal.

of

University

reported that they had studied the actions ofhochuekkito and its fractions on the mRNA

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

Volume 5, Number 2 | Summer 2010

expression of immunity-related factors in the cells

performed

derived from the rat duodenum , and that thecompounds migrating into cells, resulting in a

potentiating effects of expression of different

detection of berberin in the cell membrane. They

genes had been observed in various fractions

further reported that migrations to the cytoplasms

having different molecular weights, which meansand vacuoles had not occurred.

hochuekkito

containsawidevarietyofcomponents that are responsible for adjusting theimmune function of intestinal epithelial cells.

Shimadareportednano-MS

et

al

that

analysisofchemicalof Musashino

University

theyexaminedhad

pharmacokinetics in the rats that had orally

Takada et al. of Kitasato University reported

received 6-shogaol contained in dried ginger andthat they had administered shoseiryuto to mousefound higher blood levels of 6-paradol, a metabolicmodels of upper airway inflammation induced bysubstance of 6-shogaol, indicating 6-shogaol has

the inhalation of ovalbumin and observed its

high anti-inflammatory actions.

inhibiting effects on branchial asthma through themechanisms different from those of prednisolone.

Arimune

et

al.

of

Osaka

UniversityofPharmaceutical Sciences reported that the oral

Furumoto et al. of Kitasato University reported

administration of senkyuchachosan (Tea-Blended

kamiuntanto(Modified
GallbladderWarming Decoction) had been found to have

improving effects on sickness behavior induced bySzechwan Lovage Powder) or sokeikakketsuto(Channels-Dredging
andBlood-Activating
Decoction) to rats, together with midazolam at thethe administration of LPS to the abdominal cavity

same time, significantly increased the highestof mice and the effects were caused by theblood levels of midazolam and AUC in both groups,

mechanisms involving the central nervous system,

indicating the inhibition of CYP3A in the digestive

not the immune system.

tract.

that

Ishijima et al. of Hoshi University reported that

Clinical research for Kampo medicines

they had orally administered polysaccharide

Kakikura et al. of Chiba University reported

fractions of kakkonto (Pueraria Decoction) to micethat in the 22 patients with climacteric disorders,and observed the induction of cytokine production

who had received a preliminary examination of

from macrophages and the induction of antibody

polymorphisms of estrogen receptor beta genes

production against the antigens administered atand taken keishibukuryogan (Cassia Twig andthe same time, suggesting that polysaccharides of

Tuckahoe

Kakkonto have immnostimulatory effects.

significantly improved in the group of patients

Iwashita et al. of Showa University reported
that crude drugs showing the anti-inflammatory
action had been selected by screening in vitro
testing using the mouse macrophage-like cells andthe action had been observed in atractylodes
Lancea Rhizome and cinnamon bark.

they

had

incubatedculturedscoresofbloodcongestion

having LL allele compared to the group of patients
havingother

polymorphisms.

Theyfurtherreported that keishibukuryogan had no effect in
the patients having Sallele.
Kue Hisashige et al. of Nihon University
reported that they had conducted a questionnaire
survey with regard to improvements after taking

Oniishi et al. of Hiroshima University reported
thatPill),

human

hepatocytes together with orengedokuto andKampo medicines in female patients visiting
Kampo clinics due to the chief complaint ofinfertility

and

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

thenconducted

category23

Volume 5, Number 2 | Summer 2010classification analysis of main ingredients withthe findings of the relationship between three
categories by-symptom and the corresponding
Kampo prescription groups
OthersNishiki et al. of Tokushima Bunri University
reported that they had analyzed the prescription
sheets received by dispensing pharmacies andfound that there were more patients who wereprescribed Kampo medicines in the orthopedics
and

many

prescriptions

were

for

Western

medicines with Kampo medicines.
Komatsu et al. of Yokohama College of
Pharmacy reported that they had conducted aconsciousness survey in the College students
concerning medical care with acupuncture andmoxibustion and found increases in their interestinacupunctureandmoxibustion

andunderstanding thereof by attending the lecture of“Introduction to Acupuncture and Moxibustion.”

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Volume 5, Number 2 | Summer 2010

Kampo Formula Developed in Japan (2)Jumihaidokuto
Hiromichi Yasui
Japan Institute of TCM Research

ProfileJumihaidokuto is a modified formula of theoriginal Schizonepeta Antiphlogistic Decoction
described in the chapter of “Yoso (malignant skinboils)” of “Manbyo Kaishun.” Seishu Hanaoka(1976-1835) modified the original prescription 200
years ago for the treatment of pyosis of the skin.
Hanaoka was a competent Japanese surgeon andis well known for the excision of breast cancer
under general anesthesia with a Kampo drug.
Today, jumihaidokuto is applied to a wide variety
of skin disorders including purulent skin lecisons,eczema, dermatitis, and hives (urticaria).
This prescription developed for ethical use
consists of the following:
Platycodi Radix 3 g
Bupleuri Radix 3 g
Cnidii Rhizoma 3 g
Poria 3 g
Saposhnikoviae Radix 1.5 g
Glyzirrhizae Radix 1 g
Schizonepetae Spica 1 g
Zingiber Rhizoma 1 g
Quercus Cortex 3g
Araliae Cordatae Rhizoma 1.5 gm.
Note: For the original formula, Notopterygii
Rhizoma was used instead of “Araliae Cordatae
Rhizoma.” For Quercus Cortex, which is a crude
drug often used in Japan, barks of deciduous
broad leaved trees such as oak are used. Somemakers use Pruni Cortex instead of the Quercus
Bark.
[Efficacy] Dispel wind, relieve toxins, and expel
puss/dispel sores and relieve itching[Indications] External contraction of cold / windmoist-heat toxin[Drug actions] Fineleaf Schizomepeta Herb,
Divaricate Saposhnikovia Root, Double-teeth
Pulbescent Angelica Root, and Ginger work todispel wind and cold of the skin surface by theaction of dispelling wind and releasing the exterior.
Bupleurum Root having the action of releasing theexterior with pungent-cool has the ability ofclearing heat produced by skin pyrosis.
Balloonflower Root and Quercus Bark, which has
the action of releasing toxins and dispelling pus,
are also effective for skin suppuration. Cnidium
Rhizome activates blood and frees the collateral
vessels, by which enhances local circulation isenhanced and pure is promoted. Tuckahoe
eliminates internal moist and deals with lesions
caused by moist in collaboration with the drugs
that have the action of eliminating external moist,such as Divaricate Saposhnikovia Root andDouble-teeth Pulbescent Angelica Root. Licorice
Root has the action of clearing heat and releasing
toxins and concurrently works to harmonize
various drugs.
Wild Cherry Bark and Quercus Bark have been
put to civilian use and said to be effective for
furuncles, hives, dermatitis, and athlete’s foot.
The drug actions of these two drugs are not muchdifferent each other. From the past experiences,
however, it is thought that Wild Cherry Bark has
the action of dispelling pus, whereas Quercus
Bark is good for relieving itching. The medical
properties of these two, however, are not clear. It
is thought, however, that they are used in theformula mainly for the purpose of dispelling pus
as they do not have a strong action of clearing heat.
Indications

Jumihaidokuto has effects of dispelling windand cold, moving qi and harmonizing the bloodand it has also the effects of healing throughexpelling pathogenic factors from the exterior of
the skin. From this point of view, indications of
this formula become as follows:

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Volume 5, Number 2 | Summer 2010

First, because of the action of dispelling wind,relieving toxins, and draining pus, it has theindications for pus-related disorders of any kind in
the initial stage. Second, by releasing exterior
pathogens, this formula can remove exteriormoist-heat (eczema, etc.) and water-moist (hives,etc.). However, only few drugs in the formula havethe action to stop itching. Third, because of theaction of dispelling wind, the formula has theindication for common cold in the initial stage.
1. Pyosis of the skinThis formula can be effectively applied from thecondition in which the affected areas turn red andbecome swollen in the early stage of skin disorders
such as folliculitis and furuncle to the condition inwhich inflammation becomes localized andinfiltrations are indurated or hardened. It is often
the case that continued use of the formula
gradually decreases the emergence and over time
the symptoms do not appear.
Moriya Okuma used jumihaidokuto for theprotection of cellulitis observed in lymphatic
edema in a female of 58 years old and reports that
cellulitis that used to appear once a month could
be suppressed1). Ryosaburo Senaga reports that
he used this formula for furunculosis andpyoderma of infant’s heads in the pediatric fieldwith successful results 2).
Case 1: Furuncle
A woman, 36 years old, had furuncles on theface and nape of the neck all through the year.
Soon after one was cured, another one appeared.
Although she used various kinds of antibiotics,
furuncles did not become better. The patient wasof average height and weight. Her complexion
was not very good. No diabetes. Due to the natureof her business, the patient drank alcohol a little
every night.
I used jumihaidokuto for furuncles. After26

about one month of administration, furuncles did
not develop, so the medication was suspended. In
a month, however, they began to appear. The
medication was resumed and continued forfurther about three months and a cure wasachieved.
(Keisetu Ootuka, Shoko ni yoru Kampo Chiryo no
Jissai P499 Nanzando 1963)
2. Eczema/Dermatitis
Kobayashi, et al. report that they administeredjumihaidokuto to17 patients with chronic eczema,with the results of markedly improved in 4
patients, improved in 7, slightly improved in 3,
remained unchanged in 3 with the improving
rates of 64.7% of more than improved and 82.4%
of more than slightly improved. They further
report that the effectiveness levels between theformula and clemastine fumarate used forcomparison were similar with no differences ofstatistical significance. However, the group of
jumihaidokuto showed marginally high levels
with the result of “more than improved3).”
Kimura,etal. report that they usedjumihaidokuto for 18 patients with chroniceczema with the results of markedly effective in 2
patients (11%), effective in 5 (27%), effective in 7(39%) and remained unchanged in 4 (23%). They
also used the formula for four patients withasteatotic eczema with the results of markedly
effective in 1 (25%), effective in 1 (25%), andremained unchanged in 2 (50%)4).
Case 2: Persistent eczema
One day, a well-built plump man in his 40s
who suffered from rashes/eczema visited me for aclinical examination. The size of a lesion was
about the head of a match stick and the eczema
was slightly tinged with red and bumpy. The
areas of hands, legs, and the lower abdomen to
the lower back were severely affected. Tolerating

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

Volume 5, Number 2 | Summer 2010

itching brought him a shivering. He was cautious
not to scratch the affected areas during the night
so that he asked his family to tie both hands tothe bed. He received various injections and usedvariousointments
without
results.
No
abnormalities in urination, bowel movements,
and appetite. I previously had used Pueraria
Decoction for this type of a patient and thismedication had exacerbated the condition.
Therefore, I decided to use jumihaidokuto.
This formula was very effective. Itching
rapidly disappeared and a cure was attained
within about two months. After this, wheneverdrinking beer, he had a recurrence indication.
Therefore, the formula was used for 2 to 3 days
after drinking beer to prevent a recurrence. In
the meantime, the formula was not required atall. This patient visited me after a 10 yearinterval and said that rash-like somethingslightly appeared. This could be recovered by thetwo-week use of the formula.
(Keisetu Ootuka, “Kampo Shinryo 30-nen” p166 167 Sogensha 1959)
3. Seborrheic dermatitis
Yamamoto pointing out that adult seborrheic
dermatitis is one of good indications ofjumihaidokuto says5) as follows: “I use
jumihaidokuto for seborrheic dermatitis in adults.
If it is an extract form, the daily dosage is 10g to
20g or more. It is very effective and a cure can beachieved quickly. However, with the use of only
about 7g/day, it takes many days for treatment or
the skin disorders cannot be cured,” and if theextract formula cannot be modifieda, “I combine
orengedokuto if inflammation is intense, such as a
red flare. Skin rashes in the arm pits and theumbilical region become wet from sweat andswelling becomes intense during the summer
season. In that case, I combine shofusan 5). ”

Case 3: Seborrheic dermatitis[Patient] Male of 60 years[Initial visit] April 28, 1983
[Past medical history] Present condition andcourseHe had an itchy scalp with a lot of dandruff. In
recent days, from 5mm-1cm of the hairline of theforehead towards the hair of the head there were
erythemas with a clear boundary line where, inparticular, there were pityroid scales.
Under the both arm pits, there were also
erythemas having a relatively clear boundary
and there were pityroid scales in the boundaryarea.
And there were keratotic papules (raisedrashes) and erythemas on the dorsal surface.
Diagnosis was seborrheic dermatitis and Extract
Powder of jumihaidokuto 10g/day divided into
equal 3 portions was administered. After one week,rashes on the trunk area disappeared and thoseon the head and armpits also improved. However,the central parts in the armpit areas were difficult
to cure and tended to become exacerbated. So thevolume of Extract Powder of jumihaidokuto wasincreased to 15g/day from May 26. Because a flareup in the central part was intense and it was noteasy to cure, Extract Powder of orengedokuto
5g/day was concomitantly used from June 9. On
June 30, a cure was mostly achieved.
The reason of selecting the prescription is asfollows:
Diagnosis was seborrheic dermatitis. As thepatient’s condition was relatively mild, theextract preparation of jumihaidokuto was used.
From my experiences, seborrheic dermatitis in
adults can be cured with modified jumihaidokuto
regardless of age, sex, being fat or thin, pulsation,
and abdominal conditions.
As the patient’s condition was comparatively
mild, the extract preparation was used. In somecases, 6-7 gm per day yields effects. But with thisdose amount, treatment often becomes prolonged,

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Volume 5, Number 2 | Summer 2010

recurrent, or intractable.
In the case of this patient, the starting dosage
was 10g/day, which was increased as necessary
according to the progress of the condition todetermine the effective dosage. The dosage ofabout 20g/day as a standard would markedly
improve the effectiveness.
(Iwao Yamamoto, Clinical Lecture of Departmentof Dermatology THE KANPO Vol.4, No.2 P13 14 1986)
4. Atopic dermatitis
jumihaidokuto is sometimes applied to atopic
dermatitis but its application is limited to a very
narrow range. Ninomiya says that “the formula isgood for suppurative eruptions in the individuals
having a moderate degree of physical strength.6)”
Kinuko Kobayashi, et al. report that theyadministered jumihaidokuto to18 patients withatopic dermatitis and the results showedmarkedly improved in 2 patients, improved in 7,
slightly improved in 7, and remained unchangedin 2 with the overall improvement rates of 50% of
more than improved and 88.9% of slightly
improved. They further reports that the formula
had similar levels of effectiveness to those of
clemastine fumarate used for comparison4).
Case 4: Atopic dermatitis[Patient] Male of 19 years
The patient had a moderate degree of atopic
dermatitis. There were erythemas and papules
mostly all over the body with mild lichenification,desquamation, and rupture scars. According to
the enveloped method, clemastine fumarate wasgiven orally from August 1992. Eight weeks later,
effectiveness was assessed as mildly improved.
Although the internal administration was
continued for a while, I thought the symptoms of
the patient seemed to be the “sho” ofjumihaidokuto because he tended to become
constipated and has a muscular build. In
28

December of 1992, Tsumura jumihaidokuto wasstarted. After two weeks of administration,itching and skin rashes improved significantly.
After a few months, the skin disorder was nearlyrecovered. Then, the skin condition is wellmanaged only with the internal use of TJ-6.
(Kinuko Kobayashi, et al. , Treatment Effect of
jumihaidokuto for Chronic Eczema and Atopic
Dermatitis, 12th Hifu-ka Toyo Igaku Kenkyu
Kai Kiroku p29-30, 1994)
5. Prurigo
Case 5: Modified jumihaidokuto for urticaria
perstans[Patient] 26 years old, female, company employee[Initial visit] May, 1985
[Past Medical history] Summer rashes developed
when she was a kindergarten child.
[Current medical history] Last summer, thepatient had mosquito bites on both upper
extremities, which became indurated like warts
and felt itchy. That is, urticaria perstans. Bowel
movements were twice a day and normal. No
abnormalities in menstruation.
[Present condition] Height 158cm, weight 54kg.
White furs on the tongue. No special mention
from the abdominal diagnosis..
[Course] jumihaidokuto 6.0g divided into equal
2 portions and Rei Rhizoma powder 0.1g wereadministered.
June 1985, itching was eased.
August of the year, the condition was mostly
good, but there were new traces of mosquito bites.
The overall skin, however, was becoming clear.
By October of the year, the same medications
continued.
In November of the year, the patient claimed
that the number of wort-like indurations
increased. jumihaidokuto 6.g with an addition of
Coix Seed Extract 3.0, both divided into equal

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

Volume 5, Number 2 | Summer 2010

two portions, was administered.
February 1986, a cure was achieved and the
medication was discontinued.
[Comment] Uurticaria perstans is quitepersistent but jumihaidokuto is often effective forthe disorder. It takes time for the treatment. In
the case of this patient, it took nine months.
(Kunio Matsuda, Shorei ni yoru Kampo Chiryo no
Jissai, P331, Sogensha 1992)
6. Urticaria
Nakai, et al. report that they administered
Extract of jumihaidokuto to 26 patients withchronic urticaria and obtained an effective rate of
65% including “slightly effective”7). Maeda, Morita,etal.
reportthat
theyadministeredjumihaidokuto to nine patients with urticaria
from their experience of using Kampo
preparations in the field of dermatology and theresults showed complete cure in 3 patients andrelieved in 3, and no effects in 3 with aneffectiveness rate of 66% (6/9 patients)8). Koga
administered Tsumura jumihaidokuto to 30
patients of over 15 years old with the diagnosis ofchronic urticaria in the departments ofdermatology in eight university hospitals in theregions of Kyushu and Okinawa with the resultsof markedly improved in 6 patients (20%), morethan useful in 19 (63.3%), and slightly more thanuseful in 28 (93%)9). Yamaguchi, et al. used Kampo
preparations for ethical use for various
dermatological diseases. And they report that in
the patients for whom jumihaidokuto was usedaccording to the sho, 42.9% of the group of chronic
urticaria (with an addition of Rhubarb tablets)
showed more than effective and 85.7% of the groupof eczema and dermatitis showed more thaneffective10). Horiguchi, et al. used jumihaidokuto
for 11 patients with urticaria persistent for morethan one month with the results of 91% of slightly
more than effective11).

Case 6 Chronic urticaria
The patient was a female of 19 years old.
According to the patient, in her childhood, she had
repeatedly
hadautotoxication
andherconstitution was fragile. However, over the years,
she was gradually becoming fat. She had ruddy
cheeks and obese. Appetite and bowel movements
are normal, but mouth dryness was intense. Her
main complaint was urticaria, which had been
persistent for about a year since last summer. The
abdomen distended with almost no bloated feelingin the chest and hypochondriac regions.
Menstruation was normal. I administeredjumihaidokuto with an addition of Gypsum
Fibrosum for these symptoms and a cure wasachieved with three weeks administration.
However, in end June of this year, urticaria began
to develop again and the same medication wasgiven. About one month later, full recovery wasachieved.
(Otsuka, Keisetsu, “Kampo Shinryou 30-nen”
P166 Sogensha 1959)
7. AcneJumihaidokuto cannot be used for acne very
extensively. It can, however, be applied if acne has
a strong tendency of becoming prulent.
Makoto Tanaka reports that he administered
this formula together with Minomycin (100mg/day) the subjects of 35 patients with acneand had the result of effectiveness in 23 patients(66%). Subsequently, he added 135 subjects,
making a total of 170, who were assigned to thegroup of jumihaidokuto alone, the group ofminomycin alone, the group of Lurid alone, thegroup of jumihaidokuto + minomycin, and thegroup of shosaikoto + Lurid and obtained theresult that the group of jumihaidokuto +minomycin showed the most excellent result12).
Moriya Okuma performed the treatment of 128
patients with acne vulgaris who were assigned to

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29

Volume 5, Number 2 | Summer 2010

three groups; the group of jumihaidokuto alone,
the group of jumihaidokuto + external medication,and the group of external medication alone. As aresult, the group of jumihaidokuto alone had acomplete disappearance of skin rashes withmarkedly effective in 22 patients, effective in 13,
slightlyeffectivein6
andremained
unchanged/exacerbated in 5. He further says thatjumihaidokuto is adequately effective without theuse of other external medicines (steroids, sulfur
compounds, Clindamycin)13).
Case 7: Modified jumihaidokuto for pimples[Patient] 23 years old female
Initial visit: December 12, 1978.
[Present medical history] Around February 1978,
a large number of pimples developed and weretreated by a dermatologist for three months andrecovered at the time. In around September ofthe year, pimples recurred and treated by thesame dermatologist. However, they were not
cured and rather became reddened, swollen, andmap-like rashes. The patient’s face looked pitful.
She was recommended extract tablets ofshosaikoto and keishibukuryogan by a Kampo
pharmacist and took them with no effect.
[Present condition] The physical frame andnourishment were moderate. The whole bodyseems to contain excessive water. The patient
was fatigable, irritable, and easily became angry.
The face had many rashes that were map-likeand swollen. Other conditions were ringing in theears, congested nose, stiff shoulders, stuffy
stomach, sweater (face), cold hands and legs,
constipation, irregular menstruation (delayed),
good appetite, can eat anything, and eat muchraw vegetable.
The tongue was covered with white furs, moist
and there was an accumulation of saliva in themouth. The pulse was sunken and weak. The
abdomen was soft in general and there was a
bloated feeling in the chest and hypochondrium on

30

both sides. Right and left rectus muscles were
hardened.
[Treatment and course]
When jumihaidokuto plus Forsythiae Fructus,
Coicis Semen and Rei Rhizoma was administered
for about seven days, pimples worsened andbegan to discharge pus.
The patient was told to continue themedication with a sense of security as “this is thesign that the prescription was working.” When
about 40 days passed, pimples mostly
disappeared.
Then, the medication was continued for 90
days, by the time the purulent tendency
completely disappeared. However, as there werescars/spots after pimples treated by the previous
dermatologist, the patient was continuously on
the medication. As of end January, 1980, her faceregained a clear complexion.
(Genpo Ogata, Kampo Chiryo Shorei Senshu I P289290 Gendai Shuppan Planning Co., Ltd. 1988)
8. Rosacea
Nakanishi

reports that he administeredjumihaidokuto to 50 patients with diffuse
erythema (redness) of rosacea and had the resultsof markedly improved in 46 patients (92%),
moderately improved in 1 (2%), slightly improvedin 1 (2%), and no effect in 2 (4%). As for the 42
patients (91%) out of 46 who had marked
improvements, the effects appeared within 7 days
after the start of the administration14). He further
reports that there was no big difference in therates of marked improvement between the
combination group of jumihaidokuto anddoxycycline, which was combined due to thepresence of rosacea-like papules, and the group of
no combination. In the meantime the rate ofmarked improvement in atopic dermatitis with acomplication of rosacea was 90%, a similar rate tothat of the group without the complication15).

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

Volume 5, Number 2 | Summer 2010

9. Palmoplanter pustulosis
Kaneuchi reports that he administeredjumihaidokuto to 38 patients with Palmoplanter
pustulosis and the overall results of the formulafor skin lesions were markedly improved in 3
individuals (7.9%), effective in 7 (18.4%), slightly
effective in 9 (23.7%), remained unchanged in 13(34.2%), and exacerbated in 6 (15.8%), whereas,
relating to subjective symptoms, markedly
improved was in 4 (10.5%), effective in 12 (31.6%),
slightly effective in 12 (31.6%), remained
unchanged in 7 (18.4%), and worsened in 3
(7.9%)16).
Case 11: Jumihaidokuto for palmoplanter
pustulosis
Male, 50 years old. A rash began to develop on thepalms and soles 1.5 years ago. Nails became dirty
colored. It was Palmoplanter pustulosis.
He had a medium build. Abdominal strength
was slightly weak or intermediate. Under theright hypochondrium, weak resistance andoppression when compressed were felt, which wasconsidered as a light bloated feeling (fullness) inthe chest and hypochondriac region.
jumihaidokuto was administered and about one
month later, effects appeared and three months
later, a rash mostly disappeared. So the patient
stopped the medication but a rash recurred after
1.5 months. He hastily visited the clinic andreceived the same medication for four weeks. He
has not visited the clinic since then. He might
possibly have had a cure.
I think that there are a substantial number ofpatients who will have similar effects ofjumihaidokuto as this patient did.
(Koin Yamada, Katsu Vo. 22, No. 12, 1981)
References
1) Okuma M: Limpashu ni Mirareru Hokashikien
no Yobo ni Yakudatu Jumihaidokuto, Takikan
Shogai no Kampo Chiryo

2)

Senaga R: Shonika Ryoiki ni okeru
Kansensho, Arerugi Shikkan ni taisuru
Kampo-Yueki Chiryo Proc. Symp. WAKANYAKU. 11: 36,1978
3) Ninomiya F: Atopi-sei Hifuen no Shinryo
Manyuaru, Gendai Shuppan Planning P*-*
19964) Kobayashi K, et al.: Mansei Shisshin, Atopi-sei
Hifuen ni taisuru Jumihaidokuto no Chiryo
Koka, 12th Hifuka Toyo Igaku Kenkyu-kai
Kiroku p25-34
5) Kimura T, et al.: Kakushu Shisshin ni taisuru
Jumihaidokuto no Chiryo Koka, Juntendo
Medical Journal Vol. 31-4, p584-587
6) Yamamoto I: Hifu-ka Rinsho Koza THE
KANPO Vol.4, No.2 p13-14, 1986
7) Nakia T, et al.: Jinmashin ni taisuru
Jumihaidokuto no Chiryo Koka, Rinsho toKenkyu Vol.59 No.7 p123-125, 1995
8) Maeda M, Shunji MORI: Hifu-ka Ryoiki ni okeru
Kampo Seizai no Shiyo Keiken, Journal of New
Remedies & Clinics Vol.29 p2115-2125, 1980
9) Koga T: Mansei Jinmashin ni taisuru
TSUMURA jumihaidokuto no Koka, JAMA
(Japanese version) Vol.16 No.11 p40-41, 1995
10) Yamaguchi Z, et al.: Kakushu Hifuka Shikkan
ni taisuru Iryou-yo Kampo Seizai no Shiyo
Keiken,JournalofMedicineandPharmaceutical Science Vol.10 No.1 p299-313,
198311) Horiguchi Y, et al.: Mansei oyobi Kyusei
Jinmashin ni taisuru jumihaidokuto toinchingoreisan no Shiyo Keiken, Hifuka Kiyo
Vol.82 No.3 p365-368, 1987
12) Tanaka
M:
Jinjyoseizaso/TSUMURA
jumihaidokuto, shosaikoto to Koseibusshitu
Heiyo no Koka, Hifuka no Kampo Chiryo –Saikin no Wadai p75-80
13) Okuma M: Jinjyosei Zaso ni taisuru
jumihaidokuto (naifuku) Gaiyo-eki Heiyo
Ryoho, Journal of Medical and PharmaceuticalSociety for WAKAN YAKU 5, p346-347, 1988

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

31

Volume 5, Number 2 | Summer 201014) Nakanishi T: Shusa no Biman-sei Kohan ni
taisuru jumihaidokuto no Koka oyobi Atopi-sei
Hifuen to Shusa no Gappei ni tsuite, Hifuka
no Kampo Chiryo p67-88
15) Nakanishi T: Shusa no Chiryo ni okeru
jumihaidokuto no Yuyosei, Kampo Shinryo
Vol.14 No.5 p30-33, 199516) Kaneuchi H: Jinjyosei Kansen to ShosekiNoho-sho ni taisuru unseiin to jumihaidokuto
no Yuyosei, Kampo & Newest Therapy Vol.5
No.1 p69-74, 1996

32

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

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