Volume 4, Number 3 | Fall 2009

Kampo Medicine - Current Research
The Efficacy of Juzentaihoto for Treatment of Perianal
Abscess and Anal
Hiromichi Yasui
Japan Institute of TCM Research

Introduction
Perianal abscess and anal fistula that occur
most often in infancy are relatively common
conditions in daily practices of the Department ofPediatric Surgery. Surgical incision and drainageis the usual treatment. The conditions, however,recur in quite a number of cases. In recent years,
several documents have appeared reporting thatthe use of juzentaihoto for the treatment ofperianal abscess and anal fistula reduced thenecessity of incision and enabled to get thedisease cured in a short time. I will mainly
introduce the study by Muramatsu, et al. whoinvented this method.
Research by Matsumura, et al.
Matsumura, et al. administered juzentaihoto
to 65 patients with perianal abscess and fistula(22 days old – 5 years old) who visited his hospitalduring the period from 1996 to October 2004 andnearly at the same time, treated 28 patients (15days old – 5 years old) of the control group by
incision and drainage alone to conduct a
retrospective study１).
After a definitive diagnosis was made upon thejuzentaihoto 0.2-0.65g/kg/day
initialvisit,(approximately 0.4g/kg /day) was dissolved in asmall volume of lukewarm water andadministered. The incision and drainage wasperformed by the practitioner’s decision. Since 3(4.6%) of 65 patients were unable to orally takethe prescription, the subjects of this researchwere 62 patients.
The patients who received medication without
incision and drainage were 49, of which 13(26.5%) achieved cure within two weeks. On theother hand, 13 patients (26.5%) had prolonged8drainage for the duration of 3 months. One ofthem was shifted to the surgery group. Thus 48(77.4%) of 62 patients were able to avoid theincision and drainage and treated only withjuzentaihoto.
There were 13 patients who received thecombination treatment of juzentaihoto withincision and drainage. In this group, no patients,
however, attained cure within 14 days, whereas 3
patients within 30 days, and 8 within 90 days. It
took 90 days or more for two patients to attaincure and two to three months were required forthe treatment in many patients.
In the control group (treated only with incisionand drainage without the use of juzentaihoto),
many patients needed more than a month before
cure was achieved. There was only one patient
who attained cure within two weeks. In view ofthe short-term treatment performances (curewithin two weeks), the treatment withjuzentaihoto alone is the most beneficial.
In regard to the number of hospital visits, halfof the patients who were treated only withjuzentaihoto had the completion of the treatment
with 5 or less visits since the medication did not
require frequent procedures. And nearly 90% of
these patients attained cure within 10 days. On
the other hand, less than 30% of the patients, whowere treated only by the incision but without
having the administration of juzentaihoto,attained cure with 21 or more visits.
In comparing the rate of recurrence or the rateof prolonged drainage of more than 3 months
between the two groups, the recurrence rate (orprolonged drainage) was reduced to nearly half inthe group of juzentaihoto alone.
Concluding remarks
This is a groundbreaking study that showed
the treatment efficacy of the Kampo medicine onperianal abscess and anal fistula which used to be

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

Volume 4, Number 3 | Fall 2009

generally treated by surgical incision anddraining. When this study was published,
everyone was somewhat doubtful because theformula used in the study was not the medicine totreat pus but was juzentaihoto, which mainly
works to supplement qi and blood. Later on, as
several researchers conducted supplementarystudies and obtained similar results, thetreatment with juzentaihoto for perianal abscessand anal fistula is now treated as beingequivalent to the standard treatment by surgicalincision and drainage.
In addition to the study by Matsumura, et al.,there are other similar studies conducted withmostly same results2), 3), 4), 5).
Why juzentaihoto works well has not beenanswered yet. It is presumed that effects may
appear by improving local immunity in therectum. This, however, has not been verified.
Chiba, et al. used juzentaihoto for not only
perianal abscess but also fistulas in the neck,abdomen, and perineal region of unknown causes
and made reports on nine patients who had reliefof symptoms6), revealing that this formula isuseful for any part of the body. Elucidating its
mechanism remains to be solved.

References1) Muramatsu
T,Te r u iE:Koumon-shuui-nouyou / Jirou ni
juzentaihoto
Chiryou,taisuru
Journal of Pediatric Surgery 37:
3 11 - 3 1 5 , 2 0 0 52) Muramatsu
T,
FuseyaS:
NyuujiKoumon-shuui-nouyou
nitaisuru
juzentaihoto no Shiyou-keiken, Journal of
Pediatric Surgery 32: 1322-1325, 2000
3) Ohtani T, Kadota S, Arai S, et al.: Nyuji
Jirou no Chiryou-hoshin - juzentaihoto wo
Mochiita Atarashii Hozonteki Chiryou –Journal of Japanese Society of PediatricSurgeons: 735-739, 2001
4) Ohya T, Usui Y, Okamoto K, et al :Managementfor
fistula-in-ano
withjuzentaihoto. Pediatrics International 46（1）：72-76、2004
5) Chiba M, Sanada Y, Yoshizawa Y, et al.:Koumon-shuui-nouyou/Jirou,Journalof
Pediatric Surgery 35: 957-960, 2003
6) Chiba T: Shouni-rei niokeru Roukou Heisa wo
Mokuhyou toshita Juzentaihoto no Shiyou
Keiken, Journal of The Japanese Society for
Oriental Medicine 46:427-431, 1995

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