KAIM
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INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 2, Number 1 ･ Spring 2007

Foreword

Introduction of Kampo Medicine and Acupuncture in Japan
Naoya Ono

Japanese Acupuncture - Current Research

Clinical Study of Low Frequency Electroacupuncture Therapy (EAT) for Treatment of Cervical Radiculopathy
Tomomi Sakai and Fumiko Yasuno

Kampo Medicine - Current Research

Use of Kampo Medicine in Treatment of Influenza
Hiromichi Yasui

Clinical Report 1 (Japan)

Case Report of Acupuncture: Phallodinia
Masanori Takashi

Clinical Report 2 (Japan)

A Case in which Goreisan (Wu-Ling-San, 五苓散) was effective for Hypoalbuminemic Edema
Masayuki Kashima

Clinical Report 3 (Japan)

A Case of Migraine in which Goshuyuto (Wu-Zhu-Yu-Tang, 呉茱萸湯) was effective
Makoto Arai

Clinical Report from Europe

Case Report: Full Lumbago u. Diabetes
Ulrich Eberhard

Introduction of Japanese Acupuncture
Considering the Therapist’s Hand (5)Shuichi Katai

Medical History in Japan

Dosan Manase and his Medicine (1)Hiromichi Yasui

Book Review“Introduction to Kampo Japanese Traditional Medicine” written by The Japan Society for Oriental Medicine
Reviewed by Yoshiharu Motoo

ISSN:1559-033X

The Journal of
Kampo, Acupuncture andIntegrative Medicine(KAIM)

T
Thhee JJoouurrnnaall ooff
K
Meeddiicciinnee
Kaammppoo,, A
Accuuppuunnccttuurree aanndd IInntteeggrraattiivvee M

Research on Theory, Practice and Integration

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.

Volume 2, Number 1 ･ Spring 2007

TA B L E O F C O N T E N T S
1 Foreword
Introduction of Kampo Medicine and Acupuncture in Japan

Naoya Ono

2 Japanese Acupuncture - Current Research
Clinical Study of Low Frequency Electroacupuncture Therapy (EAT) for Treatment ofCervical Radiculopathy
Tomomi Sakai and Fumiko Yasuno

ASSOCIATE EDITORS
Shuichi Katai
Ibaraki-ken, Japan

Hiromichi Yasui
Tokyo, JapanEDITORIAL STAFF

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

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

8 Kampo Medicine - Current Research
Use of Kampo Medicine in Treatment of Influenza
13 Clinical Report 1 (Japan)
Case Report of Acupuncture: Phallodinia

Hiromichi Yasui

Masanori Takashi

19 Clinical Report 2 (Japan)
A Case in which Goreisan (Wu-Ling-San, 五苓散) was effective for Hypoalbuminemic
Edema
Masayuki Kashima
24 Clinical Report 3 (Japan)
A Case of Migraine in which Goshuyuto (Wu-Zhu-Yu-Tang, 呉茱萸湯) was effective
Makoto Arai

27 Clinical Report (Europe)
Case Report: Fall Lumbago u. Diabetes
28 Introduction of Japanese Acupuncture
Considering the Therapist’s Hand (5)30 Medical History in Japan
Dosan Manase and his Medicine (1)Ulrich Eberhard

Shuichi Katai

Hiromichi Yasui

34 Book Review“Introduction to Kampo Japanese Traditional Medicine” written by The Japan Society for
Oriental Medicine
Reviewed by Yoshiharu Motoo

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

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

Volume 2, Number 1 | Spring 2007

Foreword

Introduction of Kampo and Acupuncture in Japan
Japan has long-standing historical ties to China and Korea. The traditions of Kampo and acupuncture
originally came to Japan from those two nations. However, once in Japan, these therapeutic modalities andmedical philosophies developed in uniquely Japanese ways, and over the years have become familiar andcomfortable to the Japanese people.
These traditional forms of medical therapy have a long history in Japan, coming originally from China
by way of the Korean peninsula, reaching the Japanese islands together with Buddhism in the 6th century.
Such traditional practices, both Kampo therapy and acupuncture and moxibustion, were a part of standard
medical treatment in Japan until the end of the Edo Period. However, Japan moved toward
westernization/modernization in the second half of the 19th century. A rapid introduction of modern Western
medicine began with the Meiji Restoration (1868) and traditional Japanese medicine fell into decline. Following
World War II, while Japan was under the control of the occupying GHQ, a movement was initiated within the
GHQ to ban acupuncture as an unscientific, superstitious, and barbaric form of treatment. This put Japanesetraditional medicine at an even greater risk of dying out completely. However, since the time of the Showa Era(1925-1989), there has been an ongoing movement to reinstate some forms of traditional medicine in Japan.
Both Kampo medicine and acupuncture therapy have survived and continue to be practiced today.
Because teaching and research in Japanese universities have been based on modern Western medicine
since the beginning of the Meiji Era, medical practitioners who are licensed physicians provide treatment fromthe perspective of modern Western medicine only, and do not generally interact with practitioners of
traditional Japanese medicine such as Kampo doctors and acupuncturists. The two traditions continue to exist
in parallel, but do not touch.
The shortage of EBM-based scientific evidence for Kampo and acupuncture has made it even moredifficult to obtain a fair-minded hearing for Kampo or acupuncture-related research objectives to be added to
the Japanese government's research budget. In fact, from the Meiji Restoration until the present day, Kampo
and acupuncture have continued to receive a cool reception from the Japanese medical establishment withregard to therapeutic services, as well as in terms of physician training and the overall health care system.
What will be required in order to change this status quo?
First, we must accumulate research that demonstrates the scientific rationale for Kampo andacupuncture from an EBM perspective. We will also need to collect and organize case reports substantiatingthat research.
Second, it is essential that these Japanese findings be made available for assessment by the international
medical community. This will be helpful for the domestic status of traditional Japanese medicine, since Japantends to be strongly influenced by overseas opinion, particularly from the United States and Europe. Japanesepeople tend to place more weight on positive evaluations by Europeans and Americans than they do on similarevaluations by other Japanese. This tendency is particularly pronounced in the Japanese academic and medical
communities. It is important to obtain a positive assessment from Europe and America even for beneficial
Japanese traditions of long standing. This is an important step for revitalizing Kampo and acupuncture in
Japan. We hope that this journal will be one means to that end.
Unfortunately the traditions of Kampo and acupuncture, which have been a valuable part of Japanese
health care for so many years, are currently failing to receive either unbiased evaluation or fair treatment by
the Japanese medical establishment. We hope that through this journal we can help to establish Japanese
Kampo and acupuncture as independent from their Chinese and Korean cousins, and that we can contribute insome small way to increasing the understanding of Japanese traditional medicine overseas.

Naoya Ono
Department of Health Informatics, Division of Health Administration
School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, JapanThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

1

Volume 2, Number 1 | Spring 2007

Japanese Acupuncture - Current Research
Clinical Study of Low Frequency Electroacupuncture
Therapy (EAT) for Treatment of Cervical Radiculopathy
Tomomi Sakai1), Fumiko Yasuno2)
1) Department of Health Courses on Acupuncture andMoxibustion, Faculty of Health Sciences
Tsukuba University of Technology, Ibaraki-ken, Japan2) Genki Plaza Medical Center for Health CareKey

words:

cervicalradiculopathy,

acupuncture,muscle EAT, nerve EAT

I. Introduction
Low frequency electroacupuncture, where theinserted needles are used as electrodes, is a treatment
form using low frequency electrical stimulation, and assuch, one variant of acupuncture therapy. Currently,
low frequency electroacupuncture is most frequently
used in clinics for diseases and symptoms in the fieldof orthopedics and here, in particular, nerve pulse
treatment has in recent years found wide
application1,2,3,4,5).
Originally,lowfrequency
electroacupuncture based on muscle pulse therapy,
was used for these diseases and symptoms. For
conditions in which muscle pulse therapy remained
ineffective, the application of electroacupuncture on
the damaged nerves reportedly resulted in
improvements of the symptoms3), so that this nerve
pulse therapy was proposed to be effective and thus
started to come into general use. When low frequency
electroacupuncture is performed in daily clinicalpractice, muscle pulse therapy is usually thetreatment of first choice based on the degree ofdifficulty of the needling. In case the muscle pulse
therapy is ineffective, the method is switched to thenerve pulse therapy. However, this decision is largely
based on experience and it is thus desirable to provide
constant evaluation criteria for the decision.
Yet, there have been no reports examining theclinical aspects of both muscle pulse therapy and nerve
pulse therapy. We have investigated the clinicaleffects of both muscle pulse therapy and nerve pulse
therapy in the treatment of patients with cervical
radiculopathies.

1) Materials
Subjects of the study were 41 patients diagnosed
with cervical radiculopathy based on their subjective
symptoms, positive findings of the physicalexamination as well as x-p and MRI findings. In thepatients with cervical radiculopathies included in thisstudy, head compression tests like the Jackson or
Spurling tests reproduced the pain in the arm.
Patients who had loss of muscle power, weakened
tendon reflexes, dysaesthesias and similar neurologic
anomalies were observed. Those in whom the headcompression test was negative, or who presented only
neck pain, were excluded from the study.
2) Selection criteria for either muscle pulse therapy or
nerve pulse therapy during the application of low
frequency electroacupuncture
The first choice of treatment for all 41 patients wasmuscle pulse therapy. In patients in whom the painscore dropped to less than 5 points after one month ofcontinuous treatment (10-point system),musclepulse therapy was continued (muscle pulse therapy
group). Yet, for patients in whom the pain score
improved only down to 6 points, the therapy was
switched to nerve pulse therapy and then continued(nerve pulse therapy transition group). The consent of
the patients was obtained for the switchover from themuscle pulse therapy to the nerve pulse therapy.
As a result, in the end the muscle pulse therapy
group included 24 and the nerve pulse therapytransition group 17 patients. No significant differences
regarding patient age or duration of morbidity among
the groups were observed. Table 1 shows the profiles
for both groups.
Muscle-EAT n=24

Nerve-EAT n=17

Sexmale 15, female 9

male 11, female 6Age51.6±10.848.3±9.2

Duration (days)

99.9±152.871.5±88.5

Head compression test

24

17

Sensory disturbance87Muscle weakness

50Abnormality in

4

1

deep tendon reflex

II. Materials and Methods

2

Table 1: Profile of the patients

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

Volume 2, Number 1 | Spring 2007

3) Low frequency electroacupuncture for the treatment

confirmation of the induction of mild contractions ofof cervical radiculopathy

the thumb the position of the needle tip was

In order to apply low frequency electroacupuncture

ascertained through CT imaging. Based on the results,

for the treatment of cervical radiculopathy, the level ofEbraheim8) classified three compartments of the sulcus

the responsible lesion was determined based on thefor the spinal nerve root (medial, central and lateralsubjective symptoms as well as the findings of physicalcompartment), according to which the needle tip can

examination and diagnostic imaging. The treatmentbewas then performed with the purpose of achieving acompartment of the exit of the intervertebral foramen.

change inmuscle tension and circulation in the

For the low frequency electrical stimulation used forvicinity of the affected nerve root. Regarding thisthe muscle and nerve pulse therapies, a frequency of 1

therapy, the muscle pulse therapy consisting of

Hz was used and applied over a period of 15 minutes.

needling the spaces between the spinous processes

Treatment frequency was one to two times per week.

confirmed

tobepositioned

in

the

lateraldirectly lateral and superior to the level of the affected
nerve root as well as choosing distal points on theaffected side, using the needles as electrodes for theapplication of a low frequency electrical stimulation,
has also been called the "acupuncture anesthesia
method”6). For example, during application of anelectric current to needles placed immediately lateraland inferior to the 5th cervical spinous process and thepoint Gokoku (Hegu, LI4) between the thumb andindex finger for stimulation of the sixth cervical nerve,mild muscle contractions of the fingers of the handwere observed (Fig. 1-A). For the nerve pulse therapy,
the needles are inserted into close proximity of thenerve root and then used as electrodes for theapplication of a low frequency electrical stimulation(Fig.1-B). Needles with a length of 50 mm and adiameter of 0.2 mm (Japanese-made 1 sun 3 bu, No.3
needles) were used. For the nerve pulse therapy7) the
needles were inserted in the same way as for themuscle pulse therapy into the spaces between thetransverse processes with another needle (needle
serving as an indifferent electrode). After obtainingreferred pain within the region of the innervation of
the particular nerve root, current was applied to theneedle inserted in the neck. The current was applied,
after confirming, that mild contractions of theperipheral muscles innervated by that nerve wereobserved.
Figures 2-A, B show needling of what wasconsidered to be the region of the nerve root C6,
applying a low frequency current of 1 Hz and after

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

3

Volume 2, Number 1 | Spring 2007

4) Evaluation

and after 3 months to 16.9±1.1 points, indicating a

Evaluation of the acupuncture treatment forsignificant improvement between the initial test andradiculopathy follows the evaluation criteria for thethetherapeutic

cervicalexamination of the differences between the groups

radiculopathies9) proposed by Tanaka et al. of Tohoku

showed that while no significant difference was

University, evaluating the condition monthly from theobserved in the test results at the first visit, relevant

first visit until after the third month. The evaluation

significant changes (p<0.05) were observed after one

criteria proposed by Tanaka et al. comprise a totalmonth. However, after 3 months

score of 20 points, including the following four items:changes were observed. In other words, 1 month after

subjective symptoms (0-8 points), ability to work or do

initiation of the treatment in the muscle pulse therapy

household chores (0-3 points), functions of the handgroup and nerve pulse therapy transition group, a(-2-0 points), objective symptoms (0-8 points).

difference in therapeutic results was observed, that

results

Moreover,

since

of

treatment

Tanaka

et

for

al.

test

after

3

months(p<0.05).

Subsequentno significant

considerdisappeared again after 3 months of treatment, so that

improvement of the subjective symptoms in patients

after 3 months the same therapeutic effects werewith radiculopathies to be very important15), theseobtained in both groups.

were also evaluated with a pain score.
2) Variations in the pain score
Statistical processing

Fig. 4 shows the variations in the pain score. In all

The Mann-Whitney U-test was used for the testing

patients the average pain score after 1 month wasof group differences, while the Bonferroni/Dunn

5.2±2.5 points and thus showed a significant (p<0,05)

method was used for the analysis of the values

improvement over the score at the first visit. Yet, if

obtained at the initial stage and at each following

both groups were examined separately, the score in theexamination for a multiple comparison test. Stat View

muscle pulse therapy group was 3.5±1.6 points and in

4.5 was used as the statistical software and the level ofthe nerve pulse therapy transition group 6.8±1.0

significance defined as p<0.05, p<0.01.

points. Improvement in the nerve pulse therapytransition group when compared to the muscle pulse

III. Results

therapy group was not as significant. A significant

1) Evaluation based on the evaluation criteria for thedifference (p<0,05) was observed between the twotherapeuticgroups. Although after one month of continuous

resultsoftreatmentforcervicalradiculopathies

therapy in the nerve pulse therapy transition group,

Fig. 3 shows the results of muscle pulse therapy

an effective improvement had been achieved by theand nerve pulse therapy obtained from the initial visit

muscle pulse therapy as described above. In the groupuntil after the third month based on the evaluation

switched to the nerve pulse therapy the score after one

criteria for the therapeutic results of treatment formonth was naturally higher than in the muscle pulse

cervical radiculopathies. The figure shows, that in thetherapy group. Yet, one month after switching to themuscle pulse therapy group, the score at the first visit

nerve pulse therapy, that means 2 months after thewas 10.7±2.0 points (mean ± standard deviation), after

first visit, the pain score in the muscle pulse therapy

1 month the score improved to 15.0±1.9 points andgroup was 2.6±2.0 points and in the nerve pulse

after 3 months to 16.9±1.1 points (p<0.05). On thetherapy transition group 3.7±2.1 points, indicating aother hand, in the nerve pulse therapy transition

reduction in the difference between the two groups.

group, the score at the first visit was 10.1±1.7 points,

After three months (that is two months after switchingafter 1 month the score improved to 12.3±2.6 points

to the nerve pulse therapy) the score in the muscle

4

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

Volume 2, Number 1 | Spring 2007

pulse therapy group was 2.0±2.1 points and in thethan those observed by Tanaka et al. Moreover,nerve pulse therapy transition group 2.2±1.7 points,

Tanaka et al.10) observed among their cases withindicating that in both groups the same effect had beenradiculopathy,

achieved.

dysaesthesias, loss of muscle power and decreased
tendonIV. Discussionareflexes,

high

ratio

reportingaofpatients

ratio

of

with

86%

of

dysaesthesia, 69% of loss of muscle power and 67%

Tanaka et al.9) used their own evaluation criteria

decreased tendon reflexes respectively among theirfor the therapeutic results to examine the effects of300

conservative therapy in 43 patients with cervicaldysaesthesias were found in as few as 15 (37%) out ofradiculopathies. The results showed a score of 6.0

the 41 cases included in this study, loss of muscle

points at the first visit, that reportedly increased after

power in 5 patients (12%) and decreased tendon

three months of treatment to 11.9 points and after 4

reflexes also only in 5 patients (12%), revealing thatmonths to 13.1 points. Yet, for patients who had 4

the neurologic findings too were of lesser severity thanmonths of treatment and a score of less than 8 points

those reported by Tanaka et al. Based on these

conservative treatment, could

not befindings a comparison with the results of the

expected to result in a subsequent favorable outcome.

conservative treatment implemented by Tanaka et al.

The authors stated that for patients with scores

was considered to show that the results of the low

ranging between 9-13 surgery could also be considered.

frequency electroacupuncture were better.

continued

patients

withradiculopathies.

In

contrast,

Regarding the effects of the muscle pulse therapy
We investigated the therapeutic results obtained

and the nerve pulse therapy, examination of the painwith low frequency electroacupuncture based on thescore revealed that the score after one month ofevaluation criteria of Tanaka et al. and found in thetreatment

muscle pulse therapy group after 3 months an

3.5±2.2 points and in the nerve pulse therapy

improvement of the score to 16.9 points and in thetransition group 6.2±1.8 points. At this point in time anerve pulse therapy transition group to 15.9 points.

significant difference between the two groups was

The condition could be regarded as having improved so

observed, showing a clearly higher score in the nerve

far that surgery was not necessary. Yet, looking at thepulse therapy transition group. In other words, thescore at the first visit showed that Tanaka et al.

score difference between the groups shows that inpatients had a score of 6.0, while the patients of thepatients with higher scores, the treatment wasmuscle pulse therapy group in this study had a score ofswitched from the muscle pulse therapy to the nerve

10.7 points and in the nerve pulse therapy transition

pulse therapy, rendering these results inevitable. Yet,group of 10.1 points. While Tanaka et al. excluded

after 3 months of treatment, significant differences

patients, who underwent treatment at other medical

between the muscle pulse therapy group and the nerve

facilities, and included only those in whom thepulse therapy transition group were no longer

condition had developed within the last 2 months, theobserved. These findings suggest that the condition inpresent study also included patients in whom thepatients who showed resistance towards muscle pulse

condition had lasted longer than 2 months and whotherapy, may be improved by nerve pulse therapy. The

were treated otherwise prior to the treatment with low

same thing may be said about the application of

frequency electroacupuncture. The difference in theevaluation criteria for the therapeutic results.

in the muscle pulse therapy group wasscore at the first visit probably reflects these

Regarding the mechanism of onset of root pain,

circumstances. In either case, the patients included

Hirabayashi11) suggested, that it may be due toin this study were presented with milder conditions

mechanicalstimulation

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)(pressure+friction)→5Volume 2, Number 1 | Spring 2007

circulatory

disturbances(edema)→radiculitis.

one of the mechanisms, namely the improvement ofMoreover, the nerve roots together with the ganglia

the nerve blood flow, is related to the alleviation of theare said to be characterized by their high vascularsymptoms. There are no reports dealing with low

permeability, so that the influence of circulatory

frequency electroacupuncture induced variations in

disturbances on nerve and connective tissues may

nerve

elicit edema induced swelling of the nerve fibers.

experiments the low frequency electroacupuncture

These lesions may then lower the stimulation

stimulation of nerves reportedly led to a significant

threshold so that even minimal stimuli will elicit pain.

improvement of the nerve blood flow16,17). Moreover,Also, Kobayashi et al.12,13) created in animal (dogs)

Kasuya4) and Inoue5) et al. reported that application ofexperiments a model of the pathology of entrapment

low frequency electroacupuncture to the nerves orneuropathy and observed lesions of the nerve roots.

nerve roots to be effective for the improvement of

The results showed a marked decrease in radicularrefractory pain and numbness caused by lumbar spinal

blood flow and conductivity in association withcanal stenosis. Regarding this mechanism, the authors

mechanical compression, making it clear that edema

agree with Inoue et al., who mentioned the increased

develops within the roots. Moreover, stagnation of

nerve blood flow.

blood

flow

in

humans,butinanimalintraaxonal flow and accumulation of SP (substance P)

Concerning the use of muscle pulse therapy andand CGRP in primary afferent fibers were observed

nerve pulse therapy based on the above describedand disturbances of the axoplasmic flow reported. The

results, the application of muscle pulse therapy incapillaries of the nerve root are innervated by nerve

cases

fibers containing SP and various other types of nerve

treatment stage, and if this did not produce certain

activating substances.

clinical effects, switching to nerve pulse therapy was

Since these substances are

involved in radicular blood flow regulation, theofcervicalradiculopathies

was

the

first

considered to be appropriate.

accumulation of SP and CGRP and similar substances
due to decreased axoplasmic flow causes inflammation

V. Conclusions

and thus conceivably promotes the development of1) Comparison of muscle pulse therapy and nerve

intraradicularpulse

edema.

Also,

Takahashi

etal.14)

therapyforthetreatmentofcervicalobserved the blood flow in the lumbar spinal cord andradiculopathies showed in both groups a significant

nerve roots with a temperature gradient tissue blood

improvement between the first visit and after 3

flow meter following stimulation of the sciatic nerve

months of treatment, the improvement being ofusing 20 Hz, 20 V, 0.5msec pulses in animal (dogs)

approximately the same degree in both groups.

experiments. The results revealed a reactive increase2) The nerve pulse therapy transition group refers toin blood flow in this region. Also, based on the results

those patients in whom, in spite of one month ofof these experiments, this research attempted to apply

continuous treatment with the muscle pulse therapy,transdermal electrostimulation of peripheral nerves

no effects were obtained. One month after treatment

for ischemia of the cauda equina and nerve roots asbegan there was a significant difference between theone of the symptomatic manifestations and found thisgroups, but after 3 months approximately the same

treatment to be effective in 56 out of 67 (83%) patientsdegree of improvement had been achieved in bothwith radicular pain15).

groups.

Consideration of the modes of action of the nerve3) This suggests, that in patients in whom treatment

pulse therapy, based on the hypotheses of Hirabayashi

with muscle pulse therapy had been ineffective,

et al. and Kobayashi as well as the experimental

improvements of the symptoms can be achieved byresults from Takahashi et al., allows to assume, thatapplication of nerve pulse therapy.

6

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

Volume 2, Number 1 | Spring 2007

References
1)10) Tanaka K, Kokubu M: Symptom Based Diagnosis

Kitakoji H, Kitamura S, Matsuoka K, et al.:of

Anatomical Studies pertaining to Acupuncture

myelopathy. NEW MOOK, Orthopedics No. 66;

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Sakai T, Sugita M: Acupuncture Therapy for
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Kasuya D, Takeuchi F, Yamamoto K, et al.:Clinical Study on Acupuncture Therapy for
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independent volume, 1990; 18: 99-102
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Sakai T: Treatment of Cervico-omo-brachial Pain

Lumbar Acupuncture Stimulation and Sciatic

withElectroacupuncture.

Nerve Electrical Stimulation on Blood Flow to the

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Sciatic Nerve Trunk. Journal of Japan Society ofVol. 3, Cervico-omo-brachial pain, Ido no Nihon,

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Ebraheim NA, An HS, Xu R, et al.: Quantitative
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cervicalInoue M, Hojo T, Katayama K, et al.: Application

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Phys. M. Baln. Clim. 1979; 43 (1,2): 29-34.
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Radiculopathy

Baln. Clim. 1999; 62 (4): 201-206

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CervicalTanaka Y, Kokubu S, Sato T, et al.: Results ofconservative treatment for cervical radiculopathy
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Society of Acupuncture and Moxibustion; 2000;
50(2): 11-19.

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

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Volume 2, Number 1 | Spring 2007

Kampo Medicine - Current Research
Use of Kampo Medicine in Treatment of Influenza
Hiromichi Yasui
Japan Institute of TCM Research

the vital principle, occurring because of the invasion ofwind-cold with predominance of cold.
The

sore

throat accompaniedby pharyngeal

erythema is the result of heating within the bodycaused by wind-cold. Regardless of whether or not

1. Introduction

internal heat is present, this heating is assumed to be

Influenza is one of the most common conditions

intrinsic within the disease-causing element itself.

encountered in a clinical setting. The disease isWhen there is a cough beginning in the early stages ofwidespread during the winter months, sometimes

illness, that cough is judged to be a manifestation ofreaching pandemic proportions. Vaccination against

the characteristics originally present in this element.

influenza has become commonplace in the developed

That is to say, the element that causes influenza

nations in recent years, which has led to a reduction inshould not be considered as a simple cold element, but

flu epidemics,. With the development of medications

insteadsuch as oseltamivir phosphate (Tamiflu®) that arecharacteristically generates heat as soon as it enters

particularly effective against the influenza virus, thethe body and directly invades the lungs. Although thisperiod required for recovery from influenza infection

element has the intensified characteristics of cold, it

can be considerably shortened. Nevertheless, an

can be considered a type of "epidemic pathogen", aninfluenza infection can be quite serious for the afflicted

element of infectious disease similar to the pestilence.

asaninfluenza-specificelement

thatpatients, frequently requiring several days' absence
It is also possible that a particularly virulent form

3. Are “Cold Damage” and Influenza the same
condition?

of influenza causing a cytokine storm, such as the

Kampo treatment for influenza very commonly

Spanish Flu in 1918, could again reach pandemic

utilizes “Shang Han Lun (Treatise on Cold Damage

proportions and cause worldwide panic. In fact, that

Diseases)” formulations. These formulations areprobability is actually quite high. If we are ever faced

effective in most cases. However, the conditions of "coldwith such a pandemic, Kampo should prove to be

injury" and influenza, although similar, are notparticularly useful because of its long history as an

identical.

effective intervention for the treatment of influenza

associated with sore throat, and is not necessarily

even during major epidemics.

accompanied by coughing. Other symptoms are very

from work or school.

Here we introduce the use of Kampo medicine in
the treatment of ordinary influenza, and discuss
responses to a new and potentially more virulent
influenza epidemic.

"Coldinjury"isnotfundamentally

similar to those for influenza, so "cold injury" ispresumed to be a special form of influenza.
The preface to Shang Han Lun (On Cold Damage)notes, "I had a very large family, over 200 people.
However, within 10 years after the start of the Jian'an

2. The Disease-Causing Elements of Influenza

Era (196 AD), two-thirds of them had died, and seven

The textbook description of influenza symptoms

out of 10 of those deaths were due to 'cold damage'." In

generally includes high fever, accompanying severe

other words, during a ten-year period about 100 people

chills, headache, and joint pain, along with sore throat,in that family died from "cold damage". That would

pharyngeal erythema, and sometimes a severe cough.

mean about 10 deaths per year would be ordinary.

From a Kampo perspective, the symptoms of chills,

However, if there were 50 deaths per year for two

fever, headache, and joint pain are the result of anyears, that would be a pandemic.

intense battle between disease-causing elements and

8

The same virus can manifest with different

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

Volume 2, Number 1 | Spring 2007

symptoms depending on the area and season of

Research by Kawamura [3]contagion. It is also unlikely that antigenicity will be

Kawamura selected 129 patients (0.5 to 14.6 years

absolutely the same in different locations and duringof age) who tested positive with the influenza rapid

different seasons. In Japan in 1918, the "Spanish flu"

diagnosis kit between February 22 and June 13, 2007.

generally started out with "chills and shivering,

These patients were divided into four groups forfollowed quickly by fever, with the simultaneous

treatment: type A-flu oseltamivir group, the type A-flu

developmentasmaoto group, type B-flu oseltamivir group, and typepharyngeal erythema, pain, and cough." [1] At the

B-flu maoto group. Kawamura's results showed maoto

same time, Keegan (JAMA, Vol. 71, No. 8) states thatto be as effective as oseltamivir, and to be particularly

the early-stage pharyngeal symptoms may be omitted,

effective against type B influenza.

with the patient simply showing a fever and general

Research by Kubo and colleagues [4]oflocalized

symptoms

such

symptoms, and that this is considered characteristic of

Kubo and colleagues treated 49 patients fiveinfluenza in the United States [1], indicating thatmonths to 13 years of age (24 boys and 25 girls) who

when viewed on a worldwide scale influenza manifests

had influenza-like symptoms including fever of 38°C orwith a wide diversity of symptoms. The contents ofabove, divided into an oseltamivir monotherapy group

Keegan's report are very similar to descriptions in the(18 patients), a maoto + oseltamivir concomitant use“Shang Han Lun”. As will be discussed later,group (14 patients) and a maoto monotherapy group

formulations that are used for "cold injury" are also

(17 patients), and investigated the effects of treatment

extremely effective against influenza.

in each group. Of these patients, those one year of age

A useful book for reference in this area is Johnor older who had been diagnosed with influenza using

Barry's “The Great Influenza”, which details thea means such as the rapid diagnosis kit, werestories of patients during the Spanish flu epidemic of1918. "Patients cried from joint pain. They sufferedfrom high fever and chills, shaking under theirblankets. They complained of abdominal pain, andvomited repeatedly." (From the Japanese translation,
retranslated into English) [2].
This description is very similar to the “Shang Han

Lun”, which states that "Greater Yang Disease, with orwithout fever, but always with chills, complaints ofpain in areas such as the joints, vomiting, and tense
pulse, is termed 'cold injury'". Given this, it seems
likely that the "cold injury" described by Zhang
Zhong-jing in the preface to the “Shang Han Lun” wasa variation of influenza.

randomly allocated between: (1) the oseltamivir (tradename Tamiflu) group (4 mg/kg/day, divided into twodaily doses), (2) maoto （Tsumura & Co., Ltd., Tokyo,
Japan）0.18g/kg/day, divided into three daily doses) +oseltamivir concomitant use group. Patients less than
1 year old, for whom oseltamivir is not indicated, andpatients who tested negative for influenza with therapiddiagnosis

kit,

were

placedin,(3)maoto

monotherapy group. The parent or other caregiver was
asked to provide information about any medications
being used and records of body temperature, and thetime from the start of treatment until the fever was
resolved (body temperature of 37.2°C or below) was
compared among these groups. There were nodifferences among the groups with regard to patient

4. Research into the Treatment of Influenza with
Kampo Medicine

characteristics such as mean age at the start ofExperientially, influenza responds well to Kampo

first treatment, degree of fever, or history oftherapy, and considerable clinical research is currently

preventative inoculation. Meantime, resolution ofunderway or has been completed. Some typical

fever was 31.9 hours in the oseltamivir monotherapy

examples are described below.

group, 21.9 hours in maoto + oseltamivir group, andtreatment, male/female ratio, duration of fever before

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

9Volume 2, Number 1 | Spring 200717.7 hours in maoto monotherapy group. No adverse

administration of both agents. The research by Kubo

drug reactions or other adverse events were observedand colleagues, which found maoto monotherapy to bein any of the groups treated.

more effective than treatment either with oseltamivir

Research by Kuroki [5]alone or oseltamivir + maoto, also showed that the

Kuroki investigated the effects of concomitant use

effectiveness of such treatment was increased if theof oseltamivir and maoto in the treatment of influenza

agent was administered very early in the course ofduring three influenza seasons from 2003 throughillness. Maoto was used in these studies because the2005. Results showed excellent improvement inmajority of researchers performing the studies wereclinical symptoms in the concomitant therapy group,

pediatricians.

but the change in the amount of time required to

Maoto is more commonly indicated for use inrelieve fever was not as significant.

children than in adults. As can be seen from the

Research by Fukutomi and colleagues [6]research reported here, maoto does not require careful

Fukutomi and colleagues enrolled 24 patients who

selection of patient conditions, and is safe for use as

were diagnosed with influenza based on findings fromlong as it is administered as instructed. Maoto is a

the rapid diagnosis kit. Those patients were divided

typical agent that resolves fever by warming the body.

into two groups and treated as described above. Their

Its primary ingredient is Ephedra Herba, which

results showed a significant reduction in the number

contains ephedrine. maoto is used in the treatment ofof days of persistent headache and general malaise inchills, fever, headache, arthralgia, and myalgia in

the group treated with oseltamivir + maoto incases where the patient shows no spontaneouscomparison to the group treated with oseltamivir only.

sweating and has a floating and tense pulse. The

Research by Kimoto and colleagues [7]method of administration is in accordance with the

From January through March of 2004, Kimoto andchapter on maoto in the “Shang Han Lun”. After

colleagues administered oseltamivir to patients who

administration, the patient should be covered and kept

were diagnosed with influenza on the basis of findings

warm. Treatment is generally repeated every two

from the rapid diagnosis kit, and compared the clinicalhours until sweating begins, but is usually effective

course for those patients receiving concomitanteven if given only every three to four hours. After

treatment with maoto in comparison to patientsadministration there will be a transient rise in bodyreceiving ordinary concomitant therapy in the context

temperature, and the patient should be monitoredofWestern

medicine.

Fever

was

resolvedclosely for the development of febrile seizures and12soonerin

maoto

impaired consciousness. Administration should beconcomitant use group than in the Western medicine

discontinued as soon as the patient begins to sweat.

concomitantThis is because sustained sweating can lead toapproximately

use

hours
group,

andfatigue,thedizziness,lightheadedness, and anorexia also tended to be

dehydration.

improved more rapidly in the maoto group. Elevated

The ordinary course of treatment is as described

CRP was noted in three patients in the Western

above. In most cases, children show the diagnostic

medicine concomitant use group. There were no such

criteria of maoto chapter when they first develop

adverse events in the maoto concomitant use group.

influenza. However, caution is advised because there

These studies show that maoto, although its

are rare instances of lesser yin disease, in which there

mechanism of action is completely different from thatis no chilling, and also influenza can develop withof oseltamivir phosphate, provides a very similar level

manyof clinical effectiveness, and that the effectiveness ofmonotherapy is not always the optimal choice fortreatment is further potentiated by concomitanttreatment.

10

elementsof

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

warm

disease,

so

maoto

Volume 2, Number 1 | Spring 2007

Adults tend to show a wider variety of influenza

with gingyosan or a similar agent to cool fever andtypes than seen in children. Symptoms may be more

eliminate surface elements of disease. gingyosan is notsevere than in children, the condition may beavailable in extract formula of ethical use, but nearlyaccompanied by a sore throat and severe cough, andthe same effects can be obtained by substituting

patients who cannot be cured early may lose appetite

seijobofuto or keigairengyoto.

and waste away. Mori and Miyazaki conducted

According to announcements and releases available

research in adult patients who were allocated into

to date, Japanese influenza tends in most cases to be oftreatment groups depending on Sho diagnosis.

the wind-cold type, and wind-heat variations are rare.
However, there have been some reports of influenza ofResearch by Mori and Miyazaki [8]the warm-disease type.

Mori and Miyazaki enrolled influenza patients whocame for treatment between January and April 2005,
allocated those patients into three groups (Groups I, II,
and III) for treatment, and determined the number ofdays until recovery occurred in each patient. The
results were as follows.
Group I (oseltamivir + Kampo concomitant use
group, 20 patients). Time to recovery: 3.4 days
Group

II

(oseltamivir+

Kampo,

escalated

dose/frequency of administration group, 25 patients).
Time to recovery: 2.0 days

5. Closing Remarks
This article has viewed influenza from a number ofangles based on a Kampo medicine perspective. A
variety of medical procedures are available for theprevention and treatment of influenza, from basic
preventative measures such as wearing face masks
and gargling to vaccination and the administration ofantiviral agents such as oseltamivir. We feel that
Kampo medicine offers unique advantages in thisGroup III (oseltamivir monotherapy + concomitantcontext, and that its inclusion among the medical

Western medical treatment group, 29 patients). Timetreatment options will provide additional security into recovery: 6.3 days

the treatment of influenza, particularly in the event of

In adults, shoseiryuto is generally indicated for thea pandemic.

early stages of influenza. Agents that may beprescribed other than maoto and daiseiryuto include

keishimaoukakuhanto,keishinieppiichito,

keishinimaoichito,

maobushisaishinto.

For

cases

transitioning into lesser yang disease, agents such as

saikokeishito and shosaikoto may be considered. If thecondition transitions to yang brightness disease,

byakkoto chapter may develop. In cases of severe
cough, makyokansekito or chikujountanto should beconsidered. Deficiencies in both qi and yin frequently
develop during the recovery period, so the use of

bakumondoto and shakanzoto, which are beneficial forthe lung, may be useful. Since very few Western
treatment modalities address this stage in therecovery process, these Kampo formulations canprovide a valuable contribution to patient healing. If
warm disease develops, the patient should be treated

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

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Volume 2, Number 1 | Spring 2007

5) Kuroki H: Using maoto in the treatment ofReferences
1) Barry, J (author), Hirasawa M (translator): The
Great Influenza, Kyodo Tsushinsha, 2005
2) Former Bureau of Public Health, Ministry of

influenza. 6th Japan Convocation on Kampo in
Pediatric Applications, 2005
6) Fukutomi O, et al.: Using maoto to effectively
relieve influenza symptoms. Kampo Igaku 29(5):Interior, eds.: Influenza, 1920
3) Kawamura K: Using maoto in the treatment of

28-30, 2005

influenza patients. 39th Annual Meeting of the7) Kimoto H, Kuroki H: Effects of concomitant use ofJapanese Society for Pediatric Infectious Diseases,

oseltamivir phosphate and maoto in treating2007

influenza. Kampo Igaku 29(4): 16-19, 2005

4) Kubo T, Nakata H: Effectiveness of maoto in8) Mori K, Miyazaki Z: Therapeutic effects ofpediatric influenza infection. Proceedings of theconcomitant use of oseltamivir and Kampo in the56th Annual Meeting of the Japan Society fortreatment of influenza. Journal of Kampo Medicine

Oriental Medicine, 204, 2005

53(12), 11-20

12

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

Volume 2, Number 1 | Spring 2007

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

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

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

Kampo
combined

medicine,
with

which

was

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

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

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

had

the

characteristics

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

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

self-employed.

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

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

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

Kampo medicine (hachimijiogan) from the department

continues.

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

university.

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

Appetite

normal.

Shallow

sleep

and

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

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

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Volume 2, Number 1 | Spring 2007

tended to sweat profusely over the entire body.
Recurrenceoftinnitus

that

had

was that of a cold deficiency.

temporarily

Also, I would like to briefly reflect on the shoulder

disappeared after treatment with Kampo medicine.

stiffness which was the reason the patient started

There is also some hardness of hearing. Decrease inacupuncture

visual acuity. Constipation was controlled with drugs,

symptoms of the back of the head and neck followed

but warming the abdomen usually induced bowel

roughly the course of the bladder meridian. This

movements. There was also some decrease in virility.

channel has an interior-exterior correlation with theandmoxibustion

treatment.

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

Tongue: tongue substance: dark red with white coating

liver and kidney have the same origin, the kidney

Pattern identification: kidney yang deficiency

essence deficiency causes a liver blood deficiency,

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

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

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

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

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

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

improved after

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

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

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

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

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

supplementation and drainage method.

(BL19),

stimulated

using

the

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

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

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

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

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

shoulder region as pleasant indicated a lowered

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

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

14

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

Volume 2, Number 1 | Spring 2007

improve the insecurity of the lower origin and failure

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

Finally, Kakuyu’s

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

and Saninko’s action of supplementing and containing

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

blood was used for the purpose of supplementing liver

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

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

power(9).

By tonifying Jiryo (BL32), an essential point used

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

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

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

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

I scheduled one to two treatments per week.

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

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

showed a value of 80 mm.

micturition pain, 11) urinary urgency and 12)

Second visit: No changes in the VAS for the cold

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

above described pathologic functions of the kidney.

discomfort.

The

tinnitus

had

been

alleviated.

In this patient the condition developed following

Treatment using the same point selection.

the TURP. Uchida et al. reported the following

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

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

the bladder wall into the abdominal cavity in 0.3%,

observed. The VAS value for the cold sensation

requirement TUR coagulation because of hemorrhage

remained at 80 mm.

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

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

postsurgical

had decreased to 30 mm. No change in the cold

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

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

Sixth visit: Tendency towards a decrease in the VAS

Moreover, Tazaki et al. listed hemorrhage induced

value for the cold sensation to 60 mm.

postsurgical

Eighth visit: The patient himself realized a decrease in

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

the ones observed in this patient were not recorded.

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

However, Kanbe et al. reported, that nerve blocks

mm.

performed

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

certain degree of fatigue and cold sensation.

has also been mentioned in texts about Kampo

Eleventh visit: Mild tendency towards insomnia.

medicine.

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

epididymitis

tamponade,forphallodynia

in

0.9%,

urinaryandurinaryincontinence,cold

sensation

In the section about the treatment of blood

Thirteenth visit: The cold sensation and pain of the

impediment and exhaustion diseases of the Jin Kui

penis had been alleviated. The VAS for both symptoms

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

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

Benign prostatic hyperplasia (BPH) is a frequent

In section 67 dealing with the symptoms of

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

15

Volume 2, Number 1 | Spring 2007

diseases of fatigue and exhaustion in the General[References]

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

Commentary on the Huang Di Nei Jing (Huang

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

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

published by [“山東中医学院・河北医学院講校釈”

deficiency of both yin and yang qi. The kidney governs

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

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

Publishing House 1982
(2)

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

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

Chinese Medical Splanchnology, second edition,
Publishing House 2004

(3)

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

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

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

Publishing House, 1982

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

volume, published by [山東中医学院・河北医学院

struggle between vital and evil qi, causing pain in the

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

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

Publishing House, 1982

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

additional influence from heat evil, swelling will also

volume, published by [山東中医学院・河北医学院

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

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

by external evil, but rather internal cold (deficiency

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

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

above mentioned two classics.

translation supervisors, Section on pulses in the
Ling

SummaryThe

underlying

condition

in

this

case

(7)

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

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

therapyandrepresents a highly suggestive case report.

as

such

Toyo

Gakujutsu

Clinical Acupoints, translation: Hyodo Akira;(8)

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

(9)

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

(10)

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

(11)

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

(12)

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

p.327-328,

P.743; Toyo Gakujutsu Shuppansha, 1995

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

Shu,

Shuppansha, 1999

wasconsidered to be a kidney yang deficiency and initiallyacupuncture

Modern translation of the first volume of the

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

Volume 2, Number 1 | Spring 2007(13)

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

basics to the newest therapies, Hajime Ishida etUniversity

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

(15)

(16)

(17)

(18)

Complications and their management in 2266

[History]

patients who underwent TURP before, during

In

Tokai

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

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

late Dr. Kumio Yamashita at the Department of

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

Oriental Medicine of the School of Medicine

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

the basics to the newest therapies, Hiroshi

have

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

Moxibustion Room on a daily basis.

been

providedattheAcupuncture

Therapeutic experiences with the treatment of

In June 2003, the Acupuncture Outpatients

intractable postsurgical penile pain, Hiroshi

started in parallel with the opening of lectures on

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

Pain Clinicians, p. 224,

Professor Makoto Arai and Instructor Katuhiko

Vol.6, No.3, 1999

Shang Han Za Bin Lun, comprised of the "Shang

Arai, who have assumed full time positions, have

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

been performing the practice at the Specialized

Compilation by the academic chapter of the

OutpatientsJapanese Kampo Society, P.282, Toyo Gakujutsu

Oriental Medicine twice a week, taking turns in

Shuppansha, 2000

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

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

Symptomology, 4th volume on signs and diseases

are very limited.

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

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

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

Symptomology, 4th volume on signs and diseases

physicians.

of fatigue and exhaustion (second volume), 69

Patients profiles are compared for the period of

fatigue and exhaustion, translation by Koichiro

June 2003 to March 2006 between the two

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

establishments of the Acupuncture Moxibustion
Outpatients

of

Tokai

University

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

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Volume 2, Number 1 | Spring 2007

In regard to referrals, Affiliated Hospital

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

the improvement of acupuncture moxibustion

58% from the Department of Oriental Medicine,techniques.

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

regardtochiefcomplaints,

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

70%,

which

is

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

instructions

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

atmedicalinstitutions

haveopportunities to examine patients as physicians

18

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

Volume 2, Number 1 | Spring 2007

Clinical Report 2 (Japan)< Main text>
Introduction

A Cases in which Goreisan
was effective for Hypoalbuminemic Edema
Masayuki Kashima
Department of Internal Medicine
Kumamoto Red Cross Hospital

Critical conditions like sepsis, multi-organ failure,
major surgeries, chemotherapy etc. are often followedbyhypoalbuminemic

edema.

Western

medicineadministers aldosterone antagonists, loop diuretics, or< Summary >Introduction
Criticala combination of albumin preparations and loop
diuretics to relieve the hypoalbuminemic edema1). Yet,diseases

are

often

followedbyhypoalbuminemic edema. Relief of hypoalbuminemic

some

time

is

required

until

the

aldosterone

antagonists take effect and their effectiveness may beedema is limited to western medical methods, but

insufficient. Albumin preparations are associated withsolutions of various associated problems like efficacy,

the risk of infection via body fluids and because of

economical problems, decrease in renal function,

their extremely high costs, there are many obstacles

variations in electrolytes and the like are often

regarding their use. Again, administration of diuretics

difficult. Here we report our observations indicating

decreasesthat goreisan is effective for the treatment ofdisturbances. A major factor responsible for the

hypoalbuminemic edema.

difficulties

renalfunction

relating

andtocausestheelectrolyte

treatmentofhypoalbuminemic edema is, that although there is an

Patient

accumulation of both fluid and saline matter, theA 57-year old man who had been found collapsed in
his home after not eating during the winter time
because of economical poverty, was transported to a
hospital by ambulance . Upon admission, there wascardiopulmonary arrest. There was also complicating
hypothermia, so that he was connected to an artificial
heart lung apparatus. Later, because of persistent low
blood pressure and urine volume, large amounts ofblood transfusion and fluid therapy were administered.
Because a marked degree of hypoalbuminemia andedema was observed following subnutrition andcriticaldisease,weadministeredgoreisanandjuzentaihoto, after which a swift recovery of the edema
was achieved.

volume within the vessels often decreases, so thatadministration of ordinary diuretics does not result in
sufficient diuresis, but may easily lead to decreased
renal function and electrolyte disturbances. Thus, wereport here a case in which the Kampo medicine

goreisan proved to be effective for the treatment of
hypoalbuminemic edema.
[Chief complaint] cardiopulmonary arrest due toaccidental hypothermia, subnutrition, edema[Anamnesis]
The patient had not eaten for almost a month after
he had been forced to leave his employer. On December
21s, 2004 his daughter found him collapsed in his homeand had him transported to a hospital by ambulance.

Discussion
Defining suitable conditions and indications for theuse of goreisan has been difficult. An examination of
the classics reveal that it is used to treat uneven
distribution of water. Hypoalbuminemic edema canalso be considered to be a form of even water
distribution and therefore an indication for goreisan.

Upon admission there was cardiopulmonary arrest.
Administration
ventilationofcardiacmanagement,

massage,andartificial

cardiopulmonary

resuscitation. Moreover, rectal temperature was 24.5℃,
indicating accidental hypothermia associated withcardiopulmonary arrest, so that he was connected toanartificial

heart

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

lungapparatus

and19Volume 2, Number 1 | Spring 2007

cardiopulmonary

resuscitation

performed.

Later,

following resuscitation he developed shock due tomarkeddehydration

andhemorrhage

fromshowing no signs of renal dysfunction or electrolyte
anomalies.

theconnection sites for extracorporeal circulation, so thatlarge amounts of transfusion fluid were administeredin the form of 30 units of concentrated erythrocytes
and 30 units of frozen fresh blood preparations in orderto maintain blood pressure and urine volume, as wellas an in-out balance + approximately 5 l/day of fluid
therapy. Due to the development of pleural effusion
and ascites, as well as interstitial edema associated
with

the

subnutrition,amarkeddegreeofhypoproteinemia developed, upon which we initiatedtreatment with 7.5 g/day of goreisan and 7.5 g/day of

juzentaihoto.
12/24
TP: 3.7 g/dl, Alb: 2.2 g/dl, BUN: 10.4 mg/dl, Cre: 0.66
mg/dl, Na: 143 mEq/l, Cl: 109 mEq/l, K: 4.2 mEq/l, Ca:
8.4 mg/dl
Contrast CT performed on 12/24 (Picture 1) revealed
bilateral pleural effusion and ascites. A plain x-ray
film taken on 12/26 showed the same degree of
pleural effusion (Picture 2). From 2 hours after
starting

theadministrationofgoreisanandjuzentaihoto a diuretic effect started to set in, leading
to a urine volume of around 4 l/day and a decrease in
the edema (see Figure 1). Plain x-ray films taken on
December 29th showed clearly the disappearance ofthe pleural effusion and the edema too had almost
disappeared. Simultaneously,

urine volume also

decreased. Since a balance had been achieved
between the amount of tube feeding administered via
a nasogastric tube and the urine volume, thePicture 1

administration of goreisan was discontinued. Even

Contrast CT from 12/24

during the diuresis no electrolyte disturbances orShows a large amount of bilateral pleural effusion andanomalies

soft tissue edema.

of

renal

functionswereobserved.

Electrolyte supplementation was performed, but ablood examination performed on 12/29 showed TP: 4.9
g/dl, Alb: 2.6, BUN: 8.8 mg/dl, Cre: 0.58 mg/dl, Na:
142 mEq/l, Cl: 105 mEq/l, K: 4.4 mEq/l, Ca: 8.1 mg/dl,

20

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

Volume 2, Number 1 | Spring 2007

Figure 1 below: Due to the rapid onset of diuresis
starting 1 hour after the administration of goreisan,
the fluid therapy was discontinued. On 12/27 the urine
volume reached a peak of 4,570 ml/day, after which theurine volume gradually decreased. On 12/30 a balance

Picture 2
Plain chest x-ray film from 12/24
Shows a large amount of bilateral pleural effusion

with water administered with tube feeding wasachieved.

<Figure 1>

5000

800

4500

700

4000
600
Amount尿量（ｍｌ）
of Urine (ml)

3500
500

3000
2500

400

2000

300

1500
200
1000
100

500
0
12月24日Dec.
24

12月25日Dec. 25

12月26日Dec. 26

12月27日Dec. 27
Edema
浮腫

12月28日Dec. 28

12月29日Dec. 290
12月30日Dec. 30

Urine
尿量volume: 7.5 g/day of goreisan: 7.5 g/day of juzentaihoto

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

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Volume 2, Number 1 | Spring 2007

Discussion
Previously, various reports have been published
that

dealt

with

the

kind of symptoms andpathologies for which goreisan could be used.
Although goreisan has
applications,thewide actual clinicalprovided

explanations

stillcannot be considered sufficient. Turning one's
attention to classical references pertaining togoreisan , leads first to the Shang Han Lun and Jin
Kui Yao Lue. Both of these classics were written in
the later Han period. An examination of thehistoricalapplications

revealsthat

thedescriptions found in the Shang Han Lun, Jin Kui
Yao Lue and also the [Gedai Hiyou Ho] of the Tang
period are the basis. Examination of the passages
Picture 4
First day of goreisan administered (12/26)
Bilateral pleural effusionreferring to the indications for goreisan among
these classics shows that cases where there is awater surplus in one area of the body and a water
deficitinanothermaldistribution

of

part

is

indicative

water 2-10) .

In

of

case

a
of

hypoalbuminemic edema, there is a surplus ofwater outside the blood vessels, but the amount in
the blood vessels decreases, creating a condition
that can be considered to be a form of water
maldistribution. In this patient, goreisan was used
for the purpose of treating the hypoalbuminemic
edema induced maldistribution of water andproduced a marked effect. This suggests, that
hypoalbuminemic edema could be an indication for
the use of goreisan . Moreover, since the treatmentof hypoalbuminemic edema with western medicine
has the above described disadvantages, goreisan
could possibly become the drug of first choice.
Picture 5
Fourth day of goreisan administered (12/29)
Marked improvement in the pleural effusion wasobserved.

22

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

Volume 2, Number 1 | Spring 2007

[References]1)

Up to date® online 15.1 “Treatment of5) 本以下之故心下痞與瀉心湯。痞不解其人渇而口燥煩
小便不利者五苓散主之。(Shang Han Lun, Line156

refractory edema”
2) 脉浮小便不利微熱消渇者宜利小便発汗五苓散主

Early Yang stage 辨太陽病脉證并治下)之(Jin Gui Yao Lue , Chapter13 Dispersion-6) 脉浮小便不利微熱消渇者與五苓散利小便発汗

Thist, Inhibited Urination, and Strangury）(Shang Han Lun 辨発汗後病脉證并治)3) 渇欲飲水水入則吐者名曰水逆五苓散主之（Jin7) 発 汗 已 脉 浮 煩 渇 者 属 五 苓 散 證 (Shang Han

Gui Yao Lue, Chapter13 Dispersion-Thist,Inhibited Urination, and Strangury）
4) 太陽病発汗後大汗出胃中乾煩躁不得眠欲得飲水
者少少與飲之令胃気和則愈。若脉浮小便不利微
熱 消 渇 者 五 苓 散 主 之 。 (Shang Han Lun,
Line71 傷寒論

辨太陽病脉證并治中)

Lun, Line72

辨発汗後病脉證并治)8) 傷寒汗出而渇者宜五苓散。不渇者属茯苓甘草
湯。(Shang Han Lun, Line73 辨発汗後病脉證并治)9) 五苓散主天行熱病但狂言煩躁不安精釆言語與人
不相主當方。(Wai Tai Bi Yao Vol.3 外台秘要方
巻三天行狂言方)The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

23

Volume 2, Number 1 | Spring 2007

Clinical Report 3 (Japan)

She was introduced to our clinic by an

A Case of Migraine in which Goshuyuto
was effective
Makoto Arai
Department of Oriental Medicine
Tokai University School of Medicine

acquaintance of hers who had been cured ofheadache using Kampo medicine and visited our
Kampo ambulance first in January 2007.
[Present status] Height: 159 cm, weight: 65 kg,[Case]

42 years, female, housewife[Chief complaint]

headache associated withblood pressure: 120/78 mmHg, pulse: 68 bpm,
regular. The tongue had no coating and showed

nausea, stiffness of neck and shoulders

slight dental impressions (caused by edema of the[Past history]

tongue, so that impressions of the teeth remain on

at the age of 22 whiplash injury

caused by traffic accident

its margin; in Kampo medicine considered to be a

[Family history]

sign of water toxin) were observed. The pulse was

no appreciable disease[Present illness]

deep and weak. The abdomen showed a mild

The patient has been experiencing shoulder

degree of increased resistance and tenderness ofstiffness since her elementary school days, but

thesince the whiplash injury she sustained 20 years

resistance upon palpation of the epigastric region)

earlier during a traffic accident, her neck also

and right-sided fullness, tenderness or discomfort

became stiff and painful. Moreover, about 10 years
ago, headaches limited to the left parietal sidedeveloped, whereupon she was diagnosed with
migraine. The headache had a pulsating characterand developed every morning upon getting up,
being restricted to the left parietal side and theattacks were preceded by an increasing feeling ofheaviness of both shoulders, followed by pain
behind the eyeballs, slight yawning, which wasthen followed by a severe headache feeling as if
her head might split. During these headache
attacks she took a therapeutic agent for migraine(Zomic®) and went to bed, but a slight delay in thetiming of the drug intake resulted in theoccurrence of epigastric discomfort and nausea,
which in severe cases subsequently led to actual
vomiting.
Moreover, the patient

since her youth wasexcessively sensitive to cold and recently started
to feel cold even immediately after a hot bath. Her
sensitivity to cold had grown so much worse that
her abdomen cooled shortly after such a bath andled to diarrhea.
24

epigastricregion(acertaindegreeofof the hypochondrium (a condition of strong
tension

along

the

hypochondrium),andfurthermore tenderness of the left lower abdomen(an abdominal finding indicative of blood stasis).
There was markedly increased muscle tonus
extending from both shoulders to the neck. Therewas edema of both legs which felt cold on touch.
Neurologic anomalies were not observed.
[Course] Targeting headache attacks associatedwith vomiting goshuyuto (Tsumura & Co., Ltd.,Tokyo, Japan, 7.5 g, before every meal) was
administered.
Three days after the patients started taking

goshuyuto the headache

decreased to half of its

intensity and nausea had been alleviated. The
analgesic (migraine therapeutic agent) the patient
had been using daily became almost unnecessary
and during 1.5 months following treatment begin
she had used only 1 tablet. Since this prescription
has caused such a dramatic improvement, thedose was later reduced, prescribing 5.0 g/day for

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

Volume 2, Number 1 | Spring 2007

another

month

and

the

medication

thenstart of the treatment.

Goshuyuto was originally mentioned in the

discontinued.

section on the "terminal stage of the three yin
diseases" in the "Shang Han Lun": 'goshuyuto[Discussion]
The formula “goshuyuto” isfrequently usedgoverns conditions in patients with headache dry

for the treatment of migraine. In other words, if

vomiting and vomiting foamy sputum'(1). The

migraine has been diagnosed by western medical

formula contains the four drugs: Evodiae Fructus,

methods, goshuyuto willoften be effective,

Ginseng Radix, Zizyphi Fructus and Zingeris

making this formula the drug of first choice. From

Rhizoma, where " Evodiae Fructus " is thea Kampo medical point of view it is effective notprincipal agent, that had been described by Todo

only for migraine, but also considered effective for

Yoshimasu in his book "Yaku-cho" as 'this is theheadaches with the following characteristics.

chief treatment for dry vomiting and fullness of1)

Headache with a pulsating character orthe chest'(2). It can be understood from thesemarked by tension, which in each case is both

descriptions, that this formula is used not only forsevere and frequently occurs in attacks.

headache. Dry vomiting also seems to be a main

Associatedpatients

indication. In actual clinical practice I emphasize

complain of epigastric discomfort and nausea,

among the above listed 6 characteristics inwhich are often accompanied by vomiting.

particular "paroxysmal headaches" and "nausea"

As a prodromal symptom for the headache

when prescribing goshuyuto .

2)

3)

with

the

headachepatients complain of stiffness from the
4)

5)

6)

In the past, several reports on clinical researchshoulders to the neck.

about goshuyuto have been published. Maeda et al.

Generally, during attacks the feet are said to

conducted a case series study during which theybeadministered goshuyuto to 147 patients withextremely

cold,

but

this

must

not

necessarily be the case.

chronic headache and found 'better than general

The abdominal pattern often allows one toimprovement' in 55% ,and regarding

observe a feeling of increased epigastrica 'better than useful' rating in 54% of the cases. A

tension (uprising epigastric fullness), but

breakdown of the type of headache showed athis is not essential.

tendency

towards

During attacks the pulse seems to be

vascularheadaches

generally deep and slow. (I have never mademanifestations of therapeutic effects appeared ina pulse diagnosis of a patient having an

52% of the patients within 2 weeks(3). However, in

attack in my presence. During the intervals

this study the correlation between headache

between attacks the pulse can also be

attacks and nausea was not investigated.

improvement
andusefulness,inreported

cases

of

that

the

As alternative formulas, goreisan should befloating.)

mentioned

first.

In

actualclinicalpractice

Again, in cases in which goshuyuto is effective,

differentiation between the indications for these

the time until the appearance of the effects too is

two formulas is not easy. In cases of associationcomparatively short, so that symptoms generallywith dry mouth, reduced urine volume or edema,often improve within a period of 2 weeks from theor else a tendency of the headache to occur

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

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Volume 2, Number 1 | Spring 2007

preferentially on days preceding rainfall andother characteristic symptoms clearly indicating
the possibility of water toxin (uneven distributionof water throughout the body), the administrationof goreisan should positively be considered.
I also have seen cases, in which headache andnausea were relieved after administration of

unkeito for menstrual pain or tokishakuyakusan
plusgoshuyuto

for

cold

abdominal

colic(abdominal pain induced or aggravated by cold).
Moreover, Keisetsu Otsuka, who contributed tothe establishment of modern Kampo medicine, hasalso reported treating patients with migraine forlong time using ennenhangeto(4). Since all theseformulas contain Evodiae Fructus, it would only
be natural to expect a certain effect; I believe thatcomprehension of formulas like goshuyuto withfew constituent drugs will promote the ability ofskillful clinical application of various Kampo
formulas.
References
1) “Songban Shanghan-Lun” published by Zhao
Kaimei of the Ming dynasty, p.275, Ryogen Co.,
Ltd., Tokyo 1988
2) Yaku-Cho. By Todo Yoshimasu. Collection of
medical books on modern Kampo medicine 10,
p.219, Meicho Publishing, Tokyo 1985
3)

Koji

Maeda,

AtsushiMiyagi,Takehito

Sugawara, others: Effects of goshuyuto for thetreatmentofchronic

headache,

Kampo

Medicine 22; 53-57. 1998
4) Collection of Works by Keisetsu Otsuka, Vol. 4,
p.258, Shunyodo Publishing Co., Ltd., Tokyo,
1980

26

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

Volume 2, Number 1 | Spring 2007

Clinical Report (Europe)

Case Report: Fall Lumbago u. Diabetes
Ulrich Eberhard
70-year old man
Acute lumbago-ischialgia since 2 weeks.
Diabetes mellitus type II since 15 years
Polyneuropathy
Senile hypertension
Findings:
Right-sided lumbago with myogelosis and inability
to move, pain radiating into the right leg along theposterior aspect of the thigh down to the popliteal
fossa. Numbness of both hands and feet, tinglingparaesthesias of the extremities (in particular duringrest).
Other anamnestic information:• For years weakness of the legs, often dull feeling of
numbness of the feet

• Cold feet, that even in summer do not becomewarm• Nycturia 3x, polyuria during the daytime• Buildup of residual urine due to BPH (benign
prostatic hypertrophy)• Arterial

hypertension,sinceseveralyears

pharmacologically adjusted (Valsartan + diuretic)• Generalized physical weakness, fatigues easily
First examination / Shô identification:• Sturdy statue, lean appearance• Blood pressure 160/60 mmHg
• Relieving posture, mobility of the lumbar vertebral
columnpainfully

restricted(bending

andstretching), nerve stretching pain on the right side
(Lasègue sign positive at 50°), patellar tendon
reflex stronger on the right side, pretibial edema of
the lower legs, cold feet, warm hands.
• No coating, body of the tongue bright red• Pulse deep, without strength
Abdominal examination:“Kidney hollow”
Bar-like tension between navel and symphysis
periumbilical pulsation below the navel
tense Mm. rectus abdominis of the lower abdomen
Therapeutic course
Japanese acupuncture-moxibustion therapy: meridian
school Keiraku Chiryou, every 2 day. Kampo: kidney qi
mixture gosha jinki gan (with Rad. Aconiti praep. 0.5),
initial prescription for 7 days. Rexamination after 7
days: good tolerance, following the third day treatment
induced improvement of the acute symptoms.
Subsequent prescription of the same formulation for
14 days (with Rad. Aconiti praep. 1.0)
This resulted in stabilization, after treatment for
approximately 14 days no more back pain; resorption of
crural edema; subjective reduction of the cold sensation,
but the numbness and the tingling paraesthesias arestill present.
Again repeated prescription of the same formulationfor 28 days (with Rad. Aconiti praep. 1.0).
The patient is pain free after further 3 weeks oftreatment with Kampo and acupuncture, there is an
improvement of the circulation, a blood pressure of
140/70 mmHg is measured, the feet are warm and thetingling and restlessness of the legs have beenmarkedly alleviated, while the numbness in the hands
still remains. Apparently less marked variations inblood sugar levels (easier diabetes adjustment!).
Termination of the acupuncture-moxibustion therapy.
Continuation of the Kampo treatment for another 4months.

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Volume 2, Number 1 | Spring 2007

Introduction of Japanese Acupuncture

palpation of the abdomen, (abdominal palpation)

Considering the Therapist’s Hand (5)palpation of organs (organ examination) based on

Shuichi Katai, Ph.D., L.Ac., Professor

modern medical theory may indicate hypertrophy or

Department of Acupuncture and Moxibustion

sclerosis of the liver, or swelling of the kidneys.

Tsukuba University of Technology, Ibaraki, Japan

However, when adhering to the classical theory, it is
not the organs that are palpated, but oriental medical

IV. How are the hands trained?
Factors influencing the hands of therapists can begrossly divided into two groups. In other words, thekind of hands therapists develop is based on"differences in therapeutic concepts" and "differencesin therapeutic modalities".

comprehension aims rather at understanding thecondition of the abdominal skin, connective tissue or
muscles.

This

can

differences in therapeutic concepts
Based on differences in therapeutic concepts thesites (tissues) from which the gathering of information
is attempted differs, and therefore the requirements of
the hands performing the palpation differs as well. For
example, depending on whether the therapist bases
his/her practice on classical or modern medical theory,the purpose of the palpation will be different.
In case of classical theory the theoretical foundation
will be vitalism and humoral pathology, requiring
comprehension of concepts like stagnation and flow of
Qi and Blood. For this reason the hands have to be
trained to be able to perform pulse and abdominal
diagnosis, palpate the meridians, check the conditionsof the acupoints and the like. The skin, subcutaneous
tissues, muscles etc. will be palpated from the point ofYet, on the other hand, if modern medicine serves
as theoretical basis, solid pathology becomes thefoundation and it will be necessary to comprehend thecondition of tissues (sometimes organs) and perform
palpatory examinations on the basis of a knowledge ofphysiology and anatomy. Palpation will be performed
using concepts like dermatomes, trigger points or
Head's zones etc. This allows us to gain insights into
the position of bones or the course of muscles inand kidneys with regard to the abdominal diagnosis
names are associated with the names of organs andviscera, that do not really indicate those organs itself.
For example, kidney yin deficiency may not bediagnosed as the western “anatomical” kidney. On thecontrary, for the palpation of liver cirrhosis, the liver
will be palpated through the skin, connective tissue
and muscles. The purpose of the palpation is to feel the
liver parenchyme.
2. Differences in palpating hands based on differencesin therapeutic modalities
In cases of differences in therapeutic modalities,
there are specific aspects palpation is used to ascertain,
so that the required palpatory skills differ. In this case,the target tissues vary depending on the therapy
applied during treatment. Table 5 shows a number oftherapies, but here I would like to describe the kind of
palpation required for those therapies (Table 5).

Therapy
Acupoint therapy
Ashi point therapy
Treatment
musclesofTreatment basedon pulse diagnosis
Use of tools

examinations is also required.

28

when

considering the designation of liver, heart, spleen, lung

addition to which an understanding of neurologicalexample,understood

Table 5 How is the hand trained?

view of classical theory.

for

be

according to the Gosei-ha. Or in cases when disease

1. Differences in the palpating hands based onSpecifically,

easilywhen

considering

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

Goal of palpation...
determine
locationandreactivity of acupoints... identify tender or indurated
regions... comprehension of muscles,
tendons and ligament (trigger
point therapy, pulse therapy etc.)... identification of the conditionof the pulse (strength andcondition of the pulse)... identify stimulation sites

Volume 2, Number 1 | Spring 2007

(1) Acupoint therapy

the muscles. This may be due to a trend towards

For therapies with the aim of stimulating acupoints,

deeper needle insertion or using stimuli strong enoughit would suffice to be able to acquire those acupoints

to have the patients realize that the needles areaccording to the descriptions given in the textbooks. In

inserted to a certain depth. Palpation related to thisother words, this requires learning the position of thekind of needle insertion should provide insights into

361 acupoints and practice to be able to locate thosethepositions precisely. Accordingly, it should be sufficient

information pertaining to the skin or connective tissue

to understand and be able to apply the bone-standard

is rather unimportant. Accordingly, modern anatomy

measurement and body inch method.

andconditionofphysiology

muscles

can

be

and

ligaments.

appliedwithout

Here

any

However, an understanding of the location of themodifications. However, during actual needling, theacupoints is a minimal requirement, the location of thequestion where a particular muscle of a given size

acupoints is not simply a question as to how many

should be needled emerges. Therefore, the condition ofinches a certain point is separated from a particular

the muscles must be observed in detail during thebone. Clinical practice therapy will require searching

palpation, and the palpation must help identify

for acupoints mainly in the vicinity of the locations

appropriate points for needling.

given in the text books. Accordingly, acupoint therapy
too, even if performed strictly, requires looking for
detailed local and distal reactions. For this reason it isnecessary to train the hand in order to make themcapable of detecting subtle vital reactions on the bodysurface.

Ashi point therapy treats the sites indicated by thepatient, so that it has been considered a therapy
without theoretical foundation. Since needles areinserted into painful areas, a certain degree oftherapeutic effects can be observed and the patient issatisfied. Therefore, the therapeutic goal can be said tohave been achieved to a certain degree.
However, if ashi point therapy real effects are to beobtained, the therapeutic sites within the areas theiscomplaining

Pulse diagnosis: Since the pulse condition should beunderstood for the treatment, detecting minutevariations in the pulse is required. Yet, if only thepulse was observed among the multitude of reactions
the body shows, and none of those other reactions were

(2) Ashi point therapy

patient(4) Treatment based on pulse diagnosis

about

must

be

firmlyestablished. In other words, determination of the final

considered significant, it would be necessary to firstestablish a system of correlations between those otherreactions and the pulse through comparative studies.
Moreover, if an acupoint has been chosen in responseto the pulse diagnosis (for example one of thecommonly used five element points) and its position
has

been

determined

using

the

bone-standard

measuring, in actual practice an even more exact
determination of its location would depend on thepalpatory skills of the practitioner.
(5) Use of tools to determine treatment sites

needling sites requires, not surprisingly, examination

In case a dermometer or equipment for Ryodoraku

of the relevant reactions, so that it is necessary totherapy is used, a detailed palpatory examination is

perform a detailed palpation in order to comprehend

not necessary, since the results of the measurements

those reactions.

determine point locations. Then the locations of theacupoints can be deducted using the bone-standard(3) Treatment of muscles
Although there are probably no therapists who

measuring. Yet, because this is also a special form ofconsider the lesion to be located exclusively in muscles,

acupoint therapy, practitioners have to face in the end

there may be a substantial number of therapists, who

the same problems already described above in theeventually are able to establish a treatment targeting

section on "Acupoint therapy".

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

29

Volume 2, Number 1 | Spring 2007

Medical History in Japan

Ashikaga school was introduced to the world in 1550

Dosan Manase and his Medicine (1)by Francisco de Xavier as the "largest and mostHiromichi Yasui
Japan Institute of TCM Research

According to one man who contributed greatly tothe revival of Kampo medicine in the current age,
Keisetu Otsuka (1900-1982), "The 'Japanization' of
Chinesemedicine

began

with

Dosan

Manase(1507-1594) and was completed by Yoshimasu Todo
(1702-1773)." [1] This is an accurate summary of what
happened in Japan between the last half of the 16th
Century, when Manase began his work with Chinese
traditional

medicine,

which

had

been

imported

virtually unchanged into Japan, and the mid-18th
Century, when Chinese medicine was modified into asignificantly

different

anduniquelyJapanesetreatment modality by Yoshimasu Todo. In the next
two issues I will introduce the work of Manase, whobuilt the foundation for Kampo medicine in Japan.
Dosan Manase's life story, and the context of his workin Japanese medicine
Chinese medicine first entered Japan in the 5th
century, and after many generations of imitation,
began to evolve into an independent medical traditionin the 15th Century. This was due to the genius of
Dosan Manase. During the first half of the century, theAshikaga Shogunate formally opened trade with Ming
China. Communication flowed freely and trading ships
imported large quantities of goods into Japan. Some of
the most important imports were medical texts andmedicinal ingredients. This was the situation when
Dosan Manase entered the scene.

Koga, located close to this school, was the seatof the Ashikaga Shogunate regional government inEast Japan. In its vicinity lived excellent physicians
together with many intellectuals. Manase studied
first under physicians in charge of important
government officials, as well as priests who had
returned from studying medicine in China and later
the most contemporaneous advanced medicine of
the Ming period. Because he was exceedingly
sagacious he understood almost all of the material.
As a result he acquired a level of medical learningand skills that matched the physicians of the Ming
dynasty.
Following his return to Kyoto in 1545, heapplied this knowledge, referring to a large numberof books, to create his own unique medical system.
The fruit of his labor culminated in his main work,the "Keiteki Shu". The purpose of this compilation
was to unify the process from diagnosis to therapy
based

on

traditional

medicaltheories.

This

structure resembles very closely the current form ofTCM. A school building, the "Keiteki In", waserected in which the medical system he had founded
was taught to students gathering there from all overthe country. This system became the Japanese
medical standard of the day and spread throughout
the country.
Approximately

sixty-fourreferenceswerequoted by Manase in Keiteki-shu which were clearly
influenced by the ideas of Zhu Danxin, one of the

Dosan Manase (1507-1594) was born in Kyoto.
After studying in a Buddhist temple, he headed forthe seat of learning in east Japan, the Ashikaga
Gakko (Ashikaga school) for further studies (the30famous general university in Japan").

four great physicians in the Yuan period in China. A
great many of Manase's references refer to Zhu
Danxin, and this suggests that Manase belonged to
the Danxin school.

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

Volume 2, Number 1 | Spring 2007

Manase's Theoretical Approachexamination(looking,

listeningandsmelling,

1. The Physiological and Pathological Theory

asking, and touching), Manase attaches mostAt the beginning of each chapter of Keiteki-shu,

importance of taking the pulse. This is apparent

the pathological appearance of each disease isfrom how Manase explains the relationship between

described. The theories of yin and yang and the fivepulse patterns and the condition of diseases, andphases are put to full use and the theory of how

devotes a section of a chapter to pulse patterns fordiseases develop through ataxia of the viscera andevery group of diseases, and gives directions forbowels, and an imbalance of Qi, blood, and fluids aretreatment.

fully described. These theories are based on the

Manase divides the pu1se condition into sixclassics Hangdi-Neijing Suwen and Lingshu . In

pulse positions. His diagnoses give a detailed

many cases he also tried to explain symptoms based

account of each of them. In Kirigami he says, “Inon the ideas expressed in this classical text,

order to cure a deficient kidney, I take the pu1se on

althoughboth cubits (a pulse position) and distinguish３)

herefrainsfromdirectquotations.

However, none of Manase's works are limited towhether water or fire should be supplied.”
The causes of a coating on the tongue and its

physiological and pathological theory.

treatment are briefly mentioned in the chapter on
Shanghan in the Keitehi- shu under “Patterns and2. Theory of Disease Causation
Since Sanyinfang(l174) is one of the texts

Treatments of the Coating of the Tongue,” however

quoted by Manase, we can assume that he had athis problem is rarely mentioned in the chapters on

good understanding of its general ideas, including

general disease groups. It seems that Manase paid

postulated internal factors, external factors, andlittle attention to an examination of the tongue“way of life” in disease causation. Moreover, in a

except in cases of Shang Han (Cold Injury). In

compilation of Manase's notes, Kirigami, a collection

contrast to later practice, in Chinese medical textsof his lectures, there is a chapter describing theof that time, only a few descriptions of tongue

three

examination and its significance are mentioned,

elements,

Qi,

blood,

andmucus.

The

importance of these three elements had alreadyalthoughbeen pointed out by his master, Sanki Tashiro, andundoubtedly carried out in some form or another.

it is thought that this later exerted a major

Shanghanshejian by Zhang Deng, written in 1688,

influence upon Nangai Yoshimasu in his work The

first mentions tongue diagnosis in detai1.

chapter on blood, and the chapter on phlegm in

of

the

tonguewere

Abdominal diagnosis, commonly regarded as

Theory of Qi, Blood, and Fluids.
It is fully explained in the chapter on Qi, theexaminations

one of the characteristics of Kampo Medicine, is not
mentioned at all in the writings of Manase

Keiteki-shu how Qi, blood, and fluids can exert aharmful influence and cause disease when they

4. Pharmacological Theory
Manase wrote a book on pharmacology entitled,

become abnormal.

Nodoku (Efficacy and Side Effects). It was heavily
3. Diagnosis

influenced by descriptions in the classical Chinese

Of the four traditional methods of diagnostic

text

entitled

Yixuezhengchuan such

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

as

the
31

Volume 2, Number 1 | Spring 2007

following：“Each medication brings about positive

it is an aid to understanding what is happening

effects and unwanted side effects. If the medicine is

inside the patient. Treatment is based upon theseeffective against a disease, the patient will be cured,observations. The method is almost the same as theif not, it becomes worse.” The original Chinese bookdistinguishing of symptom patterns and treatments

is simply a kind of memo in which the nature andadopted in modern traditional Chinese medicine.

taste of each medicine are itemized and described,

Manase changed his method for distinguishingand only those diseases against which the medicine

symptom patterns depending on the type of disease,is effective are described. In contrast, in Keiteki-shu

and adopted specific measures according to the, Manase puts his great wealth of knowledge ofcircumstances. For example, in the chapter on

medicines to full use. He seems to have developed aedemas, he describes how it is caused by ahuge pharmacological system, though this is not

malfunctioning of the spleen and kidney, and he also

included in Keiteki-shu. However, as a compendium

mentions the influence of the lung. Treatment isfor everyday treatment, Nitiyo Yakusei Nodoku isbased on these observations. In other words,

quite convenient, and the physicians of those days

distinguishing patterns of the viscera and bowels

apparently used it and added various addendum.

are most important. In addition, he made use of the８)

Its wide use is also suggested by the fact that in“analysis of the eight principles”1l) (including the1603 Manase's adopted son, Gensaku９), reissued anconcepts of yin and yang), and he integrated these

en1arged version of the text, referring to the mostprinciples into the ideal case presented in the

recently

Shokan-ron12), where the progression of shokan13)

importedbookonpharmacology,

Bencaogangmu(1578).
In

Nodoku,thethrough six stages is described.
minimum

information

The concepts of Qi and blood are foundnecessary is described in idiomatic phrases, which

throughout his writing and are also made use of inmust have been widely known if we are to assume

the Keiteki-shu. In “Fifty-seven articles” whichthat each concept was readily understood. Manase

appear at the beginning of Kirigami15), Manase

did not mention the medicines by their original

mentions the importance of distinguishing patterns

names, but adopted a method designed to simplify

of Qi and blood, stating, “It is most important firstthe description by creating a single character for

to discern whether Qi and blood are in excess oreach medicine, which he called “a single-character

deficient in diagnosing various symptoms.”

name.” He might have intended to protect his own

At the very beginning of each disease group

school by the adoption of such a method since rival

mentioned in Keiteki-shu, the causes of the diseaseschools would not know exactly what medication

are explained, and the various influences leading towasthe disease are described. Moreover, as mentioned

being

prescribed.

This

is

one

of

the

characteristics of the Dosan Manase school.

above, the idea that Qi, blood, and fluids can exert abad influence once they lose their normal condition

5. Treatment Theory

was well accepted. With Manase's work, the method

It was mentioned above that Keiteki-shu is atext designed to aid in observing symptom patterns
and in making treatment decisions. In other words,
32

of distinguishing symptom patterns and relatingthem to the causes of diseases was perfected.
From the above, and considering the time that

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

Volume 2, Number 1 | Spring 2007

Dosan lived, it seems that he was in almost perfect

However,command of the concepts and theories which we use

contribution,

now in kampo. However, it was impossible for him

created in China to become well known and suitableto know Xue Ji (1488-1558), Zhao Xiankeandfor use in Japan. His contribution due to his own

ideas (Zhang Jingyue disagreed

initiative is remarkable. In addition, he was wellwith the theory of superfluous yang and insufficientable to grasp the differences between Japanese andyin〔which is used by some people today). On the

Chineseother hand, he mentioned a disease which indicates

impossibility of simply adopting Chinese methods of

insufficiency of genuine yang, which is considered totreatment in Japan, stating, “It is desirable to givebe one of the fundamental ideas of present day

different kinds of treatment depending upon the

traditional Chinese medicine. These ideas appearedcountry.” He also made an attempt to establish andafter Xue Ji and the same thing could be said for thewrite a chapter on the subject of gerontology in theepidemic febrile disease

theory which appeared

Keiteki-shu, a topic which had not been consideredmuch later, indicating the foresight of Manase andin China, where he described the pathology of old

his master Tashiro.

people and indicated some methods of treatment.

１)

Zhang Jingyue's

３)

４)

２)

over

and

Manase's

medicalideas.

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

above

his

work

allowedHepointedtheoreticaltheories

out

the

33

Volume 2, Number 1 | Spring 2007

Book Review

Understanding of the actions of each group of“Introduction to Kampo Japanese Traditional
Medicine” written by The Japan Society for
Oriental Medicine

formulations is a key element in clinicalpractice.

Reviewed by Yoshiharu Motoo, MD, FACP
Kanazawa Medical University, Japan

This is an English-written textbook for
beginners

of

Kampo

(Japanese

herbal)Medicine. Thirty-five authors of the Japan
Society for Oriental Medicine (JSOM) wrote
this

book.

It

consistsof6

chapters,

6

appendices, and 8 columns. Chapter I is a
generalintroductionofKampo.

Current

status and history of Kampo, difference
between

Kampo

and

traditional

Chinesemedicine, how to learn Kampo, and how to
improve Kampo skills. This chapter is ofgreat importance because many Japanese
doctors fail to continue the learning of Kampo
due to the obstacles at the beginning. The
obstacles include the Kampo-specific terms
such as “qi”, etc.
of“Sho”, pathophysiology in Kampo diagnosis
treatment,

as

well

as

physicalexamination in Kampo medicine. The term
“Sho” is one of the most difficult terms forbeginners,

but

to use Kampo drugs in each category of
disease such as digestive, cardio-vascular,
respiratory, endocrine and metabolism, renal
and urological, neurological, collagen andautoimmune,
surgical

“Sho”

can

be

naturallyhematological,

anddermatological,

gynecological,

orthopedic

surgical,

oto-rhino-laryngological,

ophthalmological, psychiatric, pediatric, andgeriatric disorders. Usefulness of Kampo incoldness(ofextremities),

asthenic

constitution, and pre-disease state (“Mibyo”)
is also explained in this chapter.
ChapterVdiscusses

acupuncture.

Principles, various kinds of needles andmethods (with many photos), overview ofmoxibustion, indications, contra-indications,andChapter II includes the definition
andChapter IV consists of the description of how

adverseeffectsofacupuncturearedescribed. In the latter part of this chapter
we can see how acupuncture is applied inclinical practice for various diseases. This
chapter

includestheWHOconsensus

statement in 1997 showing the disease names
for which acupuncture may be effective.

determined when we examine patients in the

Chapter VI handles complementary andway of Kampo. It his way, this chapter is also

alternative medicines in Japan, and various

very important.

traditional medicines in the world.
medicalIn summary, this textbook covers the basic

herbs and various formulations. Main actions

aspects of Kampo and further readings are

and adverse reactions are described for eachlisted at the end of each chapter. This book is

herb

the

suitable for beginners as well as co-medical

characteristics of Kampo is the harmonizedstaffs and students. It is also a guide for

combination

foreign researchers to know what Kampo is.

Chapter

34

and

III

discusses

formulation.
of

Kampo

One

multipleofherbs.

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