KAIM
T
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Kaammppoo,, A
Accuuppuunnccttuurree aanndd IInntteeggrraattiivvee M
Meeddiicciinnee
INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 3, Number 3 ･ Fall 2008

Editorial

Risk of Reduced Availability of Raw Drugs and Clinical Treatment with Reduced Amounts
Masayuki Kashima

Japanese Acupuncture - Current Research
Changes in Vessel Puncturing in Japan
Nobuyuki Seki

Kampo Medicine - Current Research

Effect of Kakkontokasenkyushin’i on Sinobronchial Syndrome
Hiromichi Yasui

Clinical Report 1 (Japan)

Acupuncture Treatment for Vertigo
Keizo Ebiko, Makoto Kikkawa, Yoko Kimura and Hiroshi Sato

Clinical Report 2 (Japan)

Severe Pain on the Right Side of the Chest and Hypochondrium – No Abnormalities Found in Tests
Zen’ichiro Watanabe

Clinical Report 3 (Japan)

One Case of Uterine Adenomyosis Responsive to Daiobushito-Based Decoction
Mitsuyuki Takamura and Hiromichi Yasui

Kampo Dermatology – Clinical Studies

Treatment of Rosacea-like Dermatitis with Kampo (3)Treatment of Palmoplanter Pustulosis
Fumino Ninomiya

Medical History in Japan

Origin of Japanese Acupuncture: Waichi Sugiyama and his Text – Sugiyama Shindenryu (3)Jikan Oura

ISSN:1559-033X

Volume 1, Number 1 | Spring 2006

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

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

The Journal of
Kampo, Acupuncture andIntegrative Medicine(KAIM)

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 3, Number 3 ･ Fall 2008

TA B L E O F C O N T E N T S
1 Editorial
Risk of Reduced Availability of Raw Drugs and Clinical Treatment with Reduced Amounts
Masayuki Kashima

2 Japanese Acupuncture - Current Research
Changes in Vessel Puncturing in Japan

Nobuyuki Seki

ASSOCIATE EDITORS
Shuichi Katai
Ibaraki-ken, Japan

Hiromichi Yasui
Tokyo, Japan

7 Kampo Medicine - Current Research
Effect of Kakkontokasenkyushin’i on Sinobronchial Syndrome
Hiromichi Yasui

EDITORIAL STAFF

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

9 Clinical Report 1 (Japan)
Acupuncture Treatment for Vertigo
Keizo Ebiko, Makoto Kikkawa, Yoko Kimura and Hiroshi SatoEDITORIAL 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

13 Clinical Report 2 (Japan)
Severe Pain the Right Side of the Chest and Hypochondrium – No Abnormalities Found in
Tests
Zen’ichiro Watanabe
14 Clinical Report 3 (Japan)
One Case of Uterine Adenomyosis Responsive to Daiobushito-Based Decoction
Mitsuyuki Takamura and Hiromichi Yasui

16 Kampo Dermatology – Clinical Studies
Treatment of Rosacea-like Dermatitis with Kampo (3)Treatment of Palmoplanter Pustulosis

Fumino Ninomiya

PUBLISHER

Shuji Goto
International Institute of Health andHuman Services, Berkeley

18 Medical History in Japan
Origin of Japanese Acupuncture: Waichi Sugiyama and his Text – Sugiyama Shindenryu (3)Jikan Oura

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

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

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

Volume 3, Number 3 | Fall 2008

Editorial
Risk of Reduced Availability of Raw Drugs and Clinical Treatment with Reduced Amounts
In recent years, the reduced availability of crude drugs for Kampo preparations is becoming aserious problem. The resources of many crude drugs largely depend on the production by China. With
China’s economic development, Chinese workers engaged in the production have become decreased
and the places of production or harvest in China have also lessened as a result of the destruction ofenvironment in the country. It is also a big concern that an increased use of crude drugs in China has
been putting a large influence on these problems. Chinese crude drugs supported so far by low rates ofChinese currency yuan had been marketed at relatively moderate prices. Now the exchange rate ofChinese yuan has begun to rise gradually and in the world economic situation of today, the rate will beforced to increase by international pressure from trade frictions. Furthermore, it has been covered bysome news media that money inflows in the crude drug market for speculation purposes, making theprices abnormally high.
Securing the permanent availability of crude drug resources and economizing on consumption
are imminently required. On the other hand, the amounts of crude drugs used in Kampo prescriptions
are saddled with a significant problem For instance, in the prescription of Ephedra Decoction describedin the Song Text of the Shan-han Lun, 4 ryou (old weight unit) of ephedra, equivalent to 50g for a day
dosage of today is used. In modern Chinese medicine, individual schools instruct to use the amountroughly equivalent to 9g, which differs depending on individual schools. There are also increasing anddecreasing in Japanese schools but they use about 4g. The author has often experienced that somepatients had effects from small amounts, while some patients were only responsive to large amounts. It
has often been pointed out that there are crude drugs which use ratios to other components areimportant, whereas there are crude drugs (astragalus root, coix seed, gypsum, ginseng) which use
amounts have an important significance. Japan has historically been reliant on imported crude drugs
over a long period of time, so that treatment has been made using small amounts of crude drugs for along time. For this reason, they are shred more finely than in other countries and their selections arecarefully made, leading to the establishment of the system to strictly differentiate similar prescriptions.
The experiences in the treatment with small amounts as well as the identification system are valuable
for future consideration about determining appropriate measures of crude drugs. These will also
become a base for future discussions. It has often been pointed out that small amounts of powdered
crude drugs often yield effective results. In history, it was the Chinese medicine of North Song thatsystematically performed treatment with powdered crude drugs. In the North Song times, for making
decoctions, crude drugs were mixed and powdered and then a small amount (roughly 3-4 sen for onetime) was brewed for administration. This type of medicine is taken as a powder drug variation in othertimes. Existing various Kampo schools have directly originated from the medicine of the middle Meiji
Era and upward and neither sufficient study nor clinical applications of North Song medicine have notbeen made yet. North Song medicine has neither fully been studied nor clinically applied. Studying the
medicine of these days will be of essential importance in the present days when treatment needs to be
performed with small amounts of crude drugs.

Masayuki Kashima
Japanese Red Cross Hospital – Internal Medicine

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

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Volume 3, Number 3 | Fall 2008

Japanese Acupuncture - Current Research
Changes in Vessel Puncturing in Japan

during the Edo period eclecticism between the Chinese
collateral puncturing method and the Dutch form of

Nobuyuki Seki

phlebotomy. Specifically the method consisted of

Director, Japan Shiraku Gakkai

tightening the cubital or popliteal veins, which arethen punctured with a triangular-bladed needle,

1. Introduction

letting the blood flow for some time before theIt does not need to be particularly mentioned thatbloodletting treatment has been performed sinceconstriction is loosened and the bleeding stopped
during this form of venous puncturing.

ancient times on the East and West of the ocean. In

A number of Chinese texts like the "Sachu

ancient China the meridian theory was integrated into

Gyokuhou" written by Kaku Shitsui during the 14th

this treatment form to establish the "bloodletting"year of the Kangxi period during the Qing dynasty(micropuncture)deals(1675) triggered the flourishing of vessel puncturing

mainly with the currently reported situation in Japan

during the Edo period. Among the books imported toand describes this treatment modality.

Japan this one became a very high ranking bestseller

concept.

Thismanuscript

Since micropuncture is a treatment form whereand since it was brought to Japan by ship in 1681, I

blood is taken, it may not always have been a part ofbelieve it was reprinted at least four times. Sabyou2)

the therapeutic scene, but records indicate, that it has

refers to seasonal diseases occurring from summer

been introduced into medicine from China. In thisthrough autumn and is a common designation forcontext micropuncture survives not as the phlebotomy

acute diseases. The conditions are characterized by

performed as a folk treatment, but rather as theabdominal pain, vomiting, diarrhea, irritation andmicropuncture

beenskin eruptions and may include a variety of diseases

integrated into the medical care based on the meridianvarying from heat stroke to small pox. This specialized

theory. The "I Shitsurei" of the "Taiho Ritsurei",book introduces the reader to the performance ofimitating the regulatory system of the Tang dynasty,

vessel puncturing followed by the administration of

stipulates this treatment form as one of the techniques

Kampo medicine. By the way, the book "Sachu

called "Hanbaku no Ho" anma massage students are

Gyokuhou" was written under the influence of western

supposed to study and the 10-volume commentary

medicine"Ryo no Gige" contains the passage: "Use needles to

Hippocrates or Junani. About 80 years later Tomonjudge presence of blood stagnation in the region of

Yamawaki (1736-1782), who worked together withinjuries, and treat based on this judgment". This may

Yoshio Kōgyū (1724-1800) as an interpreter inbe considered to correspond to the "Byoshiho" called

Nagasaki, studied the Dutch style of bloodletting

collateral puncturing method, that was mentioned intherapy brought from the Netherlands and Gengai

the Ling Shu1).

Ogino (1737-1806) wrote the book "Shiraku Hen"treatment

form

that

has

(traditional

medicine

influencedbyLater too references to vessel puncturing are found(Volume on Puncturing). By arranging a compromisein various texts. There is not enough space here to

between theory and technical skills of both the vessel

discuss all of them, but I would like to expound a little

puncturing and the Dutch bloodletting therapies, thison the form of vessel puncturing of the Edo period, thatform of vessel puncturing reached the zenith of its

has influenced the currently practiced form in Japanprosperity from the middle to the latter Edo period.

most profoundly.

Accidentally, the term "vessel puncturing" (Shiraku) is
not found in texts preceding the Qing dynasty, but

2. Vessel puncturing during the Edo period
Briefly stated was the vessel puncturing practiced2rather called the other way round "Rakushi" =collateralpuncturing.

Theoldestreferencetotraditional medical bloodletting therapy that had been

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

Volume 3, Number 3 | Fall 2008

called vessel puncturing is found in the "Sugiyama

Moreover, a lot of personnel in the prime of their

Shinden Ryu", but it remains obscure, since when thisworking life was drafted into the army and thedeveloped into an established nominal expression forconsensus is, that by the end of World War II skills andthis treatment form3).

schools of the Edo period had discontinued.

Later Kinkei Nakagami (1744-1833), Tousaku
Sanwa (?-1818), Shingen Kakimoto (both birth and
death

dates

are

unknown),

Shukei4. Situation of vessel puncturing in modern times

Suganuma

Regarding the revival of vessel puncturing after the(according to one theory: (1706-1764), Sotetsu Ishizaka

war today mainly two groups can be distinguished in(1770-1841) and similar excellent physicians appeared

Japan, that are involved in the promotion of vessel

and developed such diverse techniques as puncturingpuncturing, including conduction of activities related

the network vessels, three-edged needles with a tip into education and the propagation of this treatment

the shape of Chinese chive leaves, inserting theform. Each of which was initiated by army physicians.

three-edged needle into tubes for the puncturing etc.

The physician Tetsuo Asami established the groupand thus laid the foundation for original Japanesepracticing the "well point puncturing method" he hadvessel puncturing methods4).

proposed, while the two physicians Kunimasa Kudo

Among these and compared to other practitioners,

and Masaaki Maruyama were the central figures at

who used decoctions + vessel puncturing or elsethe base of the academic tradition of the Japanacupuncture & moxibustion + vessel puncturing,

Shiraku Gakkai group.

Tousaku Sanwa employed vessel puncturing for almost
all conceivable diseases and has been regarded as the1) Tetsuo Asami's "well point puncturing method"

greatest vessel puncturist of the Edo period. The

The "well point puncturing method" of Dr. Asami

written records called "Shiraku Bunken Roku" by his

was brought to life by the year 1970, at which time he,disciple Rokuri Itou (Daijo) detail the amount of blood

who

drawn and the clinical course following the treatment(electroacupuncture), obtained hints from books about

and thus are still today an extremely illuminatingoriental medicine regarding vessel puncturing at thereference.

well points for the treatment of shoulder stiffness and3. Vessel puncturing in modern times
In conjunction with the fall of the Edo shogunate
the Meiji government promoted a rapid westernization
both in order to maintain Japan's independence andout of necessity to establish a system enabling Japanto sustain the national militarization. The medical
field was no exception and later not only vessel
puncturing but traditional medicine as a wholedeclined.
According to a proclamation published by the
Cabinet in 1883 and implementation of regulations
related to the licensing of physicians the western
medical system gradually gained in influence and in1895 the Imperial Government rejected a proposedcontinuance of Kampo, which led to a stagnation of
traditional medicine that continued for a century.

alreadypracticed

Ryodoraku

therapythus reportedly later perfectioned his "well point
puncturing method" as a form autonomous nervous
regulation5). After a period of 25 years, based on the
Anpo / Fukuda theory that emerged from 1995
onwards, this technique has become widely and wellknown. Yet, those two treatment forms did not fuseinto one, but rather the establishment of one group
implementing the Anpo / Fukuda theory based on theso-called "ANS Immune therapy" and another grouparound Dr. Asami that called its technique the "wellpoint, scalp vessel puncturing". Many of the membersof these groups are physicians, using injection needles
as the tool for blood sampling, but recently laser
acupuncture, which does not draw blood, is also being
used.
The Anpo / Fukuda theory explains the mechanismof action of the vessel puncturing in terms of

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

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Volume 3, Number 3 | Fall 2008

autonomous

nervousregulatory

effects.

This

the former to choose the path of a doctor. At that timetreatment form employs stimulation of the nerves

he separated himself from the Ikkando school andcorresponding to those that are at that point

independently opened his own Onchido practice,

predominantly active to restore balance in case of

becoming a deciple of the famous Showa period Kampo

various conditions caused by a predominant activity

physician Domei Yakazu. Before he joined the army aseither the sympathetic or parasympathetic nerves.

an army doctor he used vessel puncturing to treat

Formerly glycyrrhizin preparations were used tosprains etc. and thus learned about the extreme

stimulate parasympathetic nerves, but puncturing theeffectiveness of this treatment form. Later, on various

well points is as a method far simpler and reportedly

fronts in Saigon, Hanoi, Laos etc. during his military

has immediate effects.

service too he treated his patients mainly with

Concretely, the sympathetic nerves innervate eachacupuncture & moxibustion as well as by vessel

finger, but the actions of the parasympathetic nerve

puncturing and found through experience, that well

are determined, so that for the stimulation of thepoint puncturing seemed to the be the most effective

parasympathetic nerves the well points of the thumb,treatment for malaria.

index, middle and small finger as well as Hyakue

Maruyama himself had a weak constitution by(GV20, Baihui) are punctured. This induces anature,reduction in granulocytes coupled with an increase inmoxibustion treatment he received from Ken Sawada.

lymphocytes and thus corrects the leukocyte balance.

This motivated him to devote himself to the pursuit ofbutrecoveredcompletely

throughthe

The ring finger may stimulate the sympathetic

acupuncture & moxibustion and after the death ofnerves and therefore has in the past not been used

Sawada he studied under his foremost disciple Ikkaku

except in cases of pediatric asthma and the like, but

Shiro and thus devoted his life not only to vessel

recently it too has come into use.

puncturing, but also to the study of the "Yellow

Moreover, removal of the factors responsible for the
sympathetic

hyperactivity

isimportant

for

the

Emperor's Classic of Internal Medicine" and themeridians.

Consequently,

both

their

patients

treatment of diseases as well as measures to increase

predominantly with acupuncture & moxibustion as

the number of lymphocytes. Vessel puncturing has

well as vessel puncturing and although both werebeen considered to be an assistive treatment for thatphysicians, many members of these groups are

purpose and this line of thought has already been

acupuncturists, using the three-edged needle (fengmentioned in the Yellow Emperor's Classic of Internalzhen) as a tool for the bloodletting.

Medicine. In other words, while the mechanisms of

The two met each other on the inaugural meeting ofaction of the Anpo / Fukuda theory have not yet been

the Japan Society for Oriental Medicine, found eachcompletely clarified in terms of modern medicine, theother to be like-minded and coauthored and publishedability to provide explanations for the effects of vesselin 1957 the book "Vessel Puncturing Therapy". Thispuncturing

drew

makes

this

new

western

medicalinterpretation highly interesting.

close

attention

toandreintroduced

theknowledge about vessel puncturing after a century ofoblivion6,7). Disciples of both physicians with an

2)

Vessel puncturing concepts of the physicians Kudo

interest in vessel puncturing gathered and thus thetheory adopted by the Japan Society for Oriental

and Maruyama
On the other hand, the physicians Kudo andMedicine founded in 1990 represents a tradition of the

Maruyama have a strong connection to traditional

concepts of Kudo and Maruyama and is classified as

medicine. The improvement of the poor health offollows.

Kudo's father achieved by treatment administered by

Vessel puncturing is classified according to sites

Mori Dohaku practicing the Ikkando style motivatedand indications into well point puncturing, skin

4

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

Volume 3, Number 3 | Fall 2008

puncturing and collateral puncturing. Each of thesethat should be promoted throughout the world. Thismethods promotes the flow of qi and Blood through thetechniques employs puncturing superficial microscopic

meridians by drawing a little amount of blood, therebyveins in the skin with a three-edged needle to draw

alleviating symptoms and attempting to heal diseases.

blood. Sankei Nakagami dealt in his book "Seiseido

Well point puncturing is a method where the wellItan" with these microvessels, but the technique haspoints of hands and feet are cut with a three-edged

subsequently been refined based on studies by Kudo

needle to draw blood in order to promote the flow of qi

and Maruyama. The expression microvessel is the only

and Blood through the meridians through theanatomic term used in the "Zhenjiu juying fahuirespective connections of the individual meridians or(Shinkyu Shuei)" and does not appear in the Chinese

else the sites of each meridian, where their qi

classics. Actually, Chinese practitioners practically do

originates. Rephrased in western medical terms thisnot target these microvessels at all. [ Picture 3 ]refers to an improvement of the circulation in theConsidering the state of eruption shown in thewhichpicture as a form of bypass the body sets up in thecirculatory disturbances are likely to occur, thus

most superficial layers of the skin to compensate for a

attempting to modify the microcirculation throughout

deteriorating

the entire body. [ Picture 1 ]microvessels and thus ensure the circulation isregionofarteriovenous

anastomoses,

in

blood

circulation

throughthe

The respective indications correspond to theprobably easily comprehensible. In the venous plexi on

indications for the individual well points, like forthe face or in the vicinity of lesions on the body surface

example "Shoho (LU11, Shaoshang) for the treatment

these microvessels tend to be easily found. For thatof pharyngitis", but in special cases like paroxysmal

reasonhypertension, in case of common cold for the purpose ofpuncturing of the site in question can result in adeferverence or the treatment of shaking chills,

dramatic change in hemodynamics and through theasthma, acute cerebral infarction or its sequelae andappropriate use of suction cups the risk of infection can

the like blood may be drawn from the well points of all

be lowered.

using

this

techniqueevenaminimalten fingers.
Skin puncturing is used for anomalities of the skinor muscles and if no network vessels are found in thevicinity,tenderness,

induration,skin

5. Conclusions
Above I described the history of vessel puncturingchangesin Japan and outlined the techniques currently taught(darkening, dark red coloration, red macular spots andin the relevant courses. Since the foundation of thethe like), tension, itching, swelling, reddening, feelingJapan Shiraku Gakkai in 1996 the "Vessel Puncturingof warmth, blisters etc. may also serve as landmarks,

Manual" has been used as teaching material during

at which the skin (or mucosa) is then punctured with athese courses, but the contents was soon revised andthree-edged needle at several points to draw somerecently the "New Edition: Vessel Puncturing Manual"

blood, or suction cups too are often used to obtain blood.

has been published. I am convinced, that reading thisThe auriculae, nose and tip of the tongue and the likematerial too will certainly contribute to a deepened

are special sites. Skin puncturing has the effect ofunderstanding of the matter.

modifying microcirculation dynamics by puncturing

Regarding the current situation of the medical

specific acupoints or other sites and thus can be usedsystem there are no guarantees, that will be aanywhere on the body. This is what distinguishes it

continuous supply of expensive medications and thatmostly from western phlebotomy. [ Picture 2 ] Efficacy

blackouts

too conforms to the effects of the individual acupoints.

equipment into oversized trash. In this situation vessel

The microvessel puncturing I am going to introduce

puncturing represents a simple method of immediate

here in last place is an original Japanese technique

do

not

renderhighlysophisticatedeffects.

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

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Volume 3, Number 3 | Fall 2008

References
1)

1. Ryuji Shimada: "History of Vessel Puncturing

Acupuncture"; Japan Shiraku Gakkai edition:"VesselPuncturing

Acupuncture

Manual",p.131, Midori Shobo, Tokyo, 1996
2) Hiroshi Kosoto: Japanese Reprinted Edition of a

ChineseBook

PublishingTime

Table","Dictionary of Japanese Kampo Books", pp417-437, TAISHUKAN Publishing Co., Ltd.,Tokyo, 1999
3) Hitoshi Nagano: "Flow of History Regarding Vessel
Puncturing", "Basic lecture text pertaining to vessel
puncturing

needling"(internal

informationmaterial) p.6, 2009
4) My manuscript: "Origin and transitions of vessel
puncturing techniques" in "Vessel Puncturing", Vol.
12, No. 1, pp 39-40, 2009
5) Hirokimi Matsuda: “The challenge of acupuncture”,
pp 120-126, Iwanami Shoten, Tokyo, 2005
6) Susumu Oonuki: "Progenitors of vessel puncturing:
master Kunimasa Kudo"; "Collection of abstracts
from the 15th Academic conference"; pp 5-8, 2006
7. Takashi Shimada: "The achievements of Masaaki
Maruyama"

Japan

Shiraku

Gakkai

edition:Collected works of Masaaki Maruyama, last volume,
pp 161-162, Saitama, 2001

6

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

Volume 3, Number 3 | Fall 2008

Kampo Medicine - Current Research
Effect of Kakkontokasenkyushin’i on Sinobronchial
Syndrome

findings such as CRP levels and pulmonary
functions improved. As a result, improvements wereobtained in cough, phlegm, breathing difficulty,

Hiromichi Yasui
Japan Institute of TCM Researchnasal congestion, nasal discharge, and postnasal
drip. With reduced dosing of the combination drug,
the overall effect was “marked improved” in 4

Sinobronchial syndrome (SBS) is pathologicalpatients, “moderately improved” in 8 and “slightly

changes combined with upper respiratory tract

improved” in 7. In the markedly improved patientschronic

diffusewith DPB, who used Erythromycin concomitantly,

panbronchiolitis (DPB) and bronchiectasis. There

improvements were also clearly manifested in theare various views of the etiology, which, however

symptoms of the upper respiratory tract and x-ray

has not clearly verified. It is conceivable that someCT images of the lung fields. For 7 patients withdecreased immune function and the ability toErythromycin-refractory sinobronchial syndrome,

defend against upper respiratory infections may

kakkontokasenkyushin'i was additionally used,exist. Advanced respiratory inflammation causes

resulting in improvements in not only the symptoms

progressionof sinusitis but also respiratory symptoms, andsinusitis,

of

lower

respiratory

bronchiectasis

andchronic

respiratory impairment. There is Kartagener’s

respiratory functions.

syndrome, which is a special type of clinicalcondition that involves not only sinusitis but alsochronic cough, sputum and shortness of breath. It is

Report by Kato, et al.
Kato, et al. administered the extract, as a

generally treated with a long-term administration of

combined

Erythromycin in small doses (macrolide therapy).

(7.5g/day) for a period of 12 months to the patients

The use of macrolide therapy shows excellent

with symptoms of sinusitis that had not shown

prognoses and reduces severe cases to a few.

improvements with Erythromycin 400-600mg/day

However, some patients do not respond to this typefor 6-12 months (diffuse panbronchiolitis in 3of therapy and quite a number of these patientspatients and chronic bronchitis in 4: male 5, female

desire Kampo use. There are case reports for such2) and observed changes in subjective findings

cases as follows:(nasal congestion, nasal discharge, postnasal drip,

medicine,ofkakkontokasenkyushin’iand smell disorder) and in objective findings (theReport by Egashiraamount of postnasal drip, swelling of the nasal

Egashira, et al. administered a combination
treatmenttosinobronchialand characteristics of nasal secretion). The results

syndrome refractory to conventional treatments

indicated improvements in the subjective symptoms

using

of

of nasal congestion, nasal discharge, postnasal drip,

kakkontokasenkyushin’i (average age 57.8, upperand smell disorder, and in the objective symptoms ofrespiratory tract empema, lower respiratory tractswelling of the nasal mucous membrane, thechronic bronchitis -13 patients, bronchiectasis-2,

amount of nasal discharge, and characteristics ofand diffuse panbronchiolitis - 5).

nasal discharge, and the amount of postnasal drip.

the

20

patients

withmucous membrane, the amount of nasal discharge,

extract(7.5g/day)

In terms of the symptoms of the respiratory tract,
Coughing was reduced in many of the patients.

the degree of breathing difficulty and the amount ofFirstly, nasal discharge and nasal congestion

sputum improved on the Hugh-Jones scale withmarkedly ameliorated and subsequently symptoms

significantly elevated PaO2 levels and significantlyof the lower respiratory tract as well as laboratory

lowered PaCO2 levels. Pulmonary function tests

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

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Volume 3, Number 3 | Fall 2008

indicated a significant increase in FEV 1.0% with a

U.S. and Europe. As the disease is most likely to besignificant decrease in %RV. Blood tests showed

complicated by sinusitis, Kampo is a promising

significant decreases in cold agglutinin titer andtherapy.
There are several formulae that are used for thisserum levels of soluble ICAM-1 and a significant

disease and one of the most effective formulae isincrease in NK-cell activity.

kakkontokasenkyushin’i.
Report by Nakamura, et al.
Theyorallyadministered

Clarithromycin,

Mequitazine, and kakkontokasenkyushin’i to the 9References
1) Yousuke Egashira, Masahito Ushijima: Effects ofa Combination Treatment of the Sinobronchial

patients with a diagnosis of sinobronchial syndrome,

Syndrome

which had not had attained complete remission withnasal douching. And changes in symptoms wereal.: Clinical Effects of a Long-term Combined
Treatment of Sinobronchial Syndrome with
Erythromycinassessed by scoring. As a result, improvements wereAs a whole, symptoms ameliorated, although the3)

HiroshiNakamura,

Yoshifusa

Aizawa:Combination

Discussion

andpresumption that this formula, if used, for thecondition that purulent nasal discharge caused bysinus inflammation flows down to the lower
respiratory tract, which thereby becomes inflamed,
could suppress the inflammation of the paranasal
sinuses, leading to relief of the lower respiratory
above

successfully

substantiated this presumption.
Moreover, on the basis of a similar concept,
studies on keigairengyoto and shin’iseihaito havebeen conducted, and these formulae are known as
being effective.
Diffuse panbronchiolitis mostly accompanied bysinobronchial syndrome is a disease that has often
been reported in Japan whereas a fewer cases in the8

Effects

Treatmen

Medicine 19(8) 1999

The frequent use for sinusitis is based on thestudies

Takashiofkakkontokasenkyushin’i.

used for symptoms of acute and chronic sinusitis.

Thekakkontokasenkyushin’i.
Nakamura,of

Low-dose

Sinobronchial

Syndrome with Clarithromycin, Mequitazine,

Japan in relatively recent years, has often been

symptoms.

andKokyu, 17(8):919-926, 1998

degree of amelioration differs depending on patients.

Kakkontokasenkyushin’i, a formula developed in

Erosive2) Shiro Kato, Izumi Konoshiro, Noboru Ohnuma, etusing questionnaire sheets and the answers were

was also shown in the scoring assessment (p,0.01).

ParticularKampo and Immunoallergy, 4:33-41, 1990

observed once every two weeks for three months

shown in all patients, and a significant improvementin

Panbronchiolitis with kakkontokasenkyushin’i.

the medication for more than six months ofErythromycin and ontological procedures including(SBS),The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

ProgressinVolume 3, Number 3 | Fall 2008

Clinical Report 1 (Japan)
Acupuncture Treatment for Vertigo

acupuncture & moxibustion treatment.

Keizo Ebiko, Makoto Kikkawa, Yoko Kimura, Hiroshi Sato
Institute of Oriental Medicine,Tokyo Women’s Medical University, School of Medicine

2. Methods
The study included 70 patients out of a total of 77
patients,

who

visitedtheacupuncture&

Vertigo case reports1)

moxibustion outpatient department of this facility,

1. Introduction

presenting with either "vertigo" or "dizziness"

The "Tokyo Women’s Medical University Oriental
Medicine Research Active Support System" (below
called TOMRASS), developed by Dr. Fumihiko
Shirota and his group, has been a focus of attention
because the exhaustive and accurate accumulationof clinical facts and analysis of numerous cases
contributes to investigations regarding the efficacy
of both Kampo and acupuncture & moxibustion
treatment modalities as well as the scope theirrespective indications. This system uses a databasebuilt from chief complaints, disease names (namesof prescriptions, sites stimulated using acupuncture& moxibustion and stimulation method), anamnesis,
findings of tongue, abdominal, pulse and similar
diagnostic procedures, oriental medical findings likebody type, blood pressure, body temperature andsimilar general findings as well as hematologic andurinalytic data, that is searchable by setting specificconditions. The above mentioned chief complaints
are classified according to the various symptoms,
incidence and severity into 5 levels, which thepatients are requested to identify themselves during(including

patients

who

were

in

continuous

treatment) and in whom the vertigo symptoms were
evaluated using the TOMRASS more than twicefrom the start of operation of TOMRASS in May
2001 until June 2006. "Vertigo" was found in 14
patients with an age of 65±8 years (mean±SD) and"dizziness" in 56 patients with an age of 54±15 years.
The number of treatments for patients with vertigo
was 8 : 3-74 (median：range) and for patients withdizziness 8 : 2-126 sessions. The symptoms ofvertigo were classified into frequency (none: 0 points,
rarely: 1 point, occasionally: 2 points, often: 3 points,
always: 4 points) and severity (none: 0 points,
minimal: 1 point, slight: 2 points, marked: 3 points,
extreme: 4 points) and the patients requested toevaluate their symptoms themselves using these
five levels respectively.
During the first consultation a questionnaire is used
for this purpose, but from the second visit onwards
it is performed in the form of answering questions
provided on a touch panel before each treatment(picture 1).

consultations. That is, an "evaluation of subjective
symptoms by the patients themselves" allows to
identify sequential fluctuations. The SD method(Semantic

Differential

technique)frequently

employed in the field of psychology served as
reference for the preparation of this scale.
Thus, the TOMRASS is characterized in that itallows to perform cohort research into both the
Kampo as well as acupuncture & moxibustion
modalities. In the present study we used TOMRASS
to conduct a study on outpatients at our oriental
medical department presenting with vertigo as theirchief complaint in order to investigate the effects ofPicture 1 Evaluation of subjective symptoms by thepatients themselves

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9Volume 3, Number 3 | Fall 2008

Acupuncture & moxibustion treatment intervals

Examination of the frequency + severity scorebut

based on the evaluation criteria listed in Table 1

administered basically in 1-week intervals. Mainly

reveals, like shown in Figure 3, that there were 5

and most frequently 40 mm long No. 18 and 50 mm

patients (35.7%) reporting improvement, 5 patients

No. 18 needles were used for inserting and retaining(35.7%) slight improvement and 4 patients (28.6%)

the needles. For the direct moxibustion a set of 3

in whom symptoms remained unchanged, whilehalf-rice

mostaggravation was observed in none of the patientsfrequently. Acupoints in the order of frequency with(this includes among the 4 patients the above

which they were used included in the head and neckmentioned one patient with an initial and final

region Hyakue (GV20; Baihui), Fuchi (GB20;score of 0 points). On the other hand, among theFengchi), Tenchu (BL10; Tianzhu), Shimo Fuchi

patients with "dizziness" 25 patients (44.6%)(*GB20; lower Fengchi), Kami Tenchu (*BL10;

reported improvement, 13 patients (23.2%) slight

upper Tianzhu), in the abdominal region Chukan

improvement, 12 patients (21.4%) no change, 6(CV12; Zhongwan), Kangen (CV4; Guanyuan), on

patients (10.7%) a slight deterioration, while none

the back Kensei (GB21; Jianjing), Kanyu (BL18;(0.0%) reported an aggravation. Three of the 5Ganshu),(BL23;

patients with "vertigo" reporting improvement andShenshu), on the upper and lower extremities

14 among the 25 patients with "dizziness" who

Gokoku (LI4; Hegu), Kyokuchi (LI11; Quchi), Soku

reported improvement achieved a final score of 0

Sanri (ST36; Zusanli) and Shokai (KI6; Zhaohai).

points. Therefore the improvement ratio composed

variedwidely

grain

Hiyu

among

sized

individual

cones(BL20;

were

Pishu),

cases,

used

Jinyu

of the combined ratio of improvement and slight

3. Results

improvement was thus in any case approximately

Examination of the for the 14 patients presenting

70%.

with "vertigo" classified according to the scores forfrequency, severity and frequency + severity shows
for the frequency a score from 3 ： 0-4 points(median：range) to 1：0-3 points, for severity a range
from 2：0-4 points to 1：0-2 points and for the
combination frequency + severity a range from 5：
0-7 points to 2：0-4 points. Thus, for each score asignificant improvement was observed (Figure 1).
For one patient a score of 0 was observed during the

Figure 1 Variations in frequency, severity andfirst examination. This patient visited for thefrequency + severity of vertigo (n=14)

purpose of vertigo prevention and so the final score
too was 0 points.
Examination of the 56 patients presenting with"dizziness" classified according to the scores forfrequency, severity and frequency + severity shows
for the frequency a score from 2 ： 1-4 points(median：range) to 2：0-4 points, for severity a range
from 2：1-4 points to 1：0-4 points and for the
combination frequency + severity a range from 4：
2-8 points to 3：0-8 points. Thus, for each score asignificant improvement was observed (Figure 2).
10

Figure 1 Variations in frequency, severity andfrequency + severity of dizziness (n=56)

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

Volume 3, Number 3 | Fall 2008

Improv ement
Slight improv ement
No change
Slight deterioration
Aggrav ation

Sample with 0 point score or sample with
3 points improv ed score f or f requency +sev erity
Sample with 1 point improv ed scoref or f requency + sev erity
Sample without changed scoref or f requency + sev erity
Sample with 1 point aggrav ated scoref or f requency + sev erity
Sample with 3 points aggrav ated scoref or f requency + sev erity

Table 1 Evaluation criteria

Figure 3 Improvement ratio for vertigo

4. Discussion and conclusion
We examined the effects of acupuncture &moxibustion treatment on vertigo using anevaluation of the subjective symptoms by thepatient themselves as indices and found an
improvement ratio of approximately 70%, indicating
the effectiveness of this treatment modality.
Considering that in particular among acupuncture& moxibustion outpatients in whom thepharmacologic treatment alone may not be very
effective, this was thought to be a fairly highimprovement ratio. The endpoint in thisinvestigation was defined as the resulting score at
the time of the final treatment, but naturally thepathophysiology, number of treatments andtreatment duration also need to be taken into
consideration and examined separately.
“Introduction of our research facility”
The Tokyo Women’s Medical University has
developed out of the Tokyo Women’s Medical School"
established in 1900 as the only medical university
for women in Japan at that time. in 1984 a study
group for Kampo medicine was established within
the university and the 'Institute for Oriental
Medical Research affiliated with Tokyo Women’s
Medical University' established in March 1992
around the founding members of this study group.
Associated with an expansion of the facility it was
moved in December 2007 to its current location in
front of Tabata station and its name changed toTokyo Women's Medical University, Institute ofOriental Medicine (below called 'this institute'). In
this institute physicians and acupuncturists
performs clinical, research and educational
activities.
This institute includes the three sections of aclinic, an acupuncture & moxibustion clinicalfacility and a facility for health promotion. In theacupuncture & moxibustion clinical facility mainly 4
acupuncturists are engaged in clinics, research andeducation. The section has 12 beds for acupuncture& moxibustion treatment that are individually
separated from each other through partitions(Pictures 2, 3). The number of patients visiting thefacility per day varies around 40 persons. Moreover,the facility for health promotion provides the"Kampo health care" programme, integrating
Kampo medical and modern medical examination.
Within this framework acupuncturists perform
Ryodo Raku examinations and offer acupoint
guidance. Regarding research, each individual
acupuncturist pursuits his/her own clinical researchand obtained results are then published via the The
Japan Society for Oriental Medicine.

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Volume 3, Number 3 | Fall 2008

References

Picture 2

Picture 3

Regarding education this university introduced
courses about oriental medicine and practical

1) Ebiko K: Investigation of the effects of acupuncture& moxibustion on vertigo – using evaluation ofsubjective symptoms by the patients themselves as
an index, Ido no Nihon, 756, 42-46, 2006
2) Ebiko K, Kikkawa M, Fujii A, Kimura Y, Arai M,
Sato H: Attitude survey among medical students
pertaining to acupuncture & moxibustion –comprehension and awareness after completion ofacupuncture & moxibustion classes; Journal of The
Japan Society for Oriental Medicine 56 (4), 591-597,
2005

exercises as obligatory subjects in 1992 and among
these 2 credits are assigned to acupuncture &moxibustion practice. This was the first time, that a
medical university had introduced acupuncture &moxibustion into its curriculum. This attempt has
been realized, because the first professor of thedepartment, Dr. Fumihiko Shirota, had placed greatemphasis on acupuncture & moxibustion related
education similar to the education in Kampo
medicine. A questionnaire performed among thestudents of this medical university following
completion of the course showed, that 97.3%
reportedly recognized the necessity for acupuncture& moxibustion courses and 96.1% of the students
reported, they would recommend acupuncture &moxibustion treatments, thus verifying the highlevel of interest in the subject2). Since 2005 a systemof clinical acupuncture & moxibustion practice has
beenestablishedandefforts

pertainingtopostgraduate studies for acupuncturists are made.

12

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

Volume 3, Number 3 | Fall 2008

Clinical Report 2

Severe Pain on the Right Side of the Chest andHypochondrium –No Abnormalities Found in Tests
Zen’ichiro Watanabe
Fuji Nikoniko Clinic

Case: 17 year-old female (2nd year student of juniorhigh school)
Chief complaint: Right side of the chest andhypochondrium regions
Present history: The patient began to have strong painon the right side of the chest and hypochondrium
regions half a year ago and had to take a leave ofabsence from school 3 to 4 days a week. She underwent
blood tests and even CT scan at the internal medicine,surgery, and gynecology of Y municipal hospital.
However, no abnormalities were found. She was told “noappendicitis” and “the cause of the pain was unknown.”
For treatment, Loxoprofen, Timepidium bromide, and
Lac-B were prescribed in case of the onset. She hadstomach medicines prescribed by other clinic. With these
medicines, relief was not attained and she visited ourclinic.
Oriental medical findings
Objective-signs:
Inspection: Dark circles around her eyes. Auscultation
and Olfaction: No special mention. Tongue
diagnosis: Dark red tongue with dark spots and only afew sublingual veins. Pulse diagnosis: Strong-like,slippery, and rapid. Also, when chi-pulse (尺脈) is deeppressed in, will slightly wiry. Abdominal diagnosis:
Oppressive pain along the epigastric region to theright under-arm (the place of the pain complained).
Oppressive pain also in the right lower abdomen (thepoint of blood stasis).
Subjective-symptoms: Stressful (had to juggle bothstudies and activities of the brass band club). Latemenstruation sometimes. Sleep 3:00 to 6:00 without
dreaming. Normal defecation. Normal diet- 3
times/day. No sensations of cold and heat.
Diagnosis: Liver qi stagnation and bad blood
circulation
Therapy: shigyakusan + keishibukuryogan (Tamura
Pharmaceutical Co., Ltd., 7.5 g each 3 times a day)Course: Relief of pain was observed on the second

visit, 14th day from the commencement of theadministration, during which term the patientcommuted to school without a leave of absence. Mild
pain appeared only when she was tired. Pulse
became stable. The tongue still had spots but thecolor became light. The abdominal diagnosis
indicated relief to the extent that the patient felt
only slight oppressive pain in the same regions
when oppressed strongly. The 14 days doses of thesame formula were prescribed and instructions
were given to the patient not to push herself beyond
the point of fatigue. Then the treatment completed
and thereafter no abdominal pain has occurred.
Discussion: The patient is a typical case of thestagnation of liver qi in terms of Kampo medicine.
Usually patients with liver qi stagnation do notpresent such strong pains that prevent them from
commuting to school. The patient was presumed tohave severs pains due to the presence of not only thestagnation of qi but also blood stasis. In sum, thepatient suffered severe stress because she tried totake balance between studies and club activities,
which induced the obstruction of the movement of
diaphragm qi, causing “stagnation-caused pain” –which was then followed by the non-circulation of
the blood, and symptoms such as late menstruation
periods, dark circles around the eyes, and dark
tongue spots appeared.
These conditions that Western medicine isunable to diagnose are often seen in functional
diseases rather than in organic diseases, and often
need a mental approach. For the case of the patient,
it was considered necessary to prioritize pain
procedures before providing counseling. The
prescribed shigyakusan removed the pain withbupleurum root that worked on soothing andregulating liver qi in combination with the added
younger immature bitter orange that worked on
breaking the stagnation of qi to promote the flow of
qi. And peony root and licorice root worked on
removing acute pain. Keishibukuryogan worked on
the circulation of qi and the blood with cassia barkand peony root; and on activating blood andresolving stasis with peach seed and tree peonybark; and on invigorating the spleen and calming
the mind with tuckahoe. The author considers that

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

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Volume 3, Number 3 | Fall 2008

the combination drugs may have enabled thecirculation of qi and blood resulting in the prompt
relief of pain. “As long as circulation is being done,
there is no pain.”

14

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

Volume 3, Number 3 | Fall 2008

Clinical Report 3

to be an accumulation of cold caused by the invasion

One Case of Uterine Adenomyosis Responsive to
Daiobushito-Based Decoctionof cold from outside and yang deficiency. The
present condition was also considered such that thisMitsuyuki Takamuara

cold accumulation caused the stagnation of Qi and

Mie University Occupational Health Research Project

blood stasis, inducing the blockage of the flow of

Hiromichi Yasui
Japan Institute of TCM Researchallow the circulation of stagnant Qi and the removalFirst visit: September 3 of the year X
complaint:

Menstrual

crampsandconstipation
History of present illness: Menstrual cramps began
to become severe about three years ago. Abdominal
pain developed from the first day of her periods andshe could hardly stand it. Although the patient usedanalgesics (loxoprofen) when the onset developed,
she gained no relief of the pain and had to receive apentazocine injection. During the first half of theday, the cramps were so severe that she lost
consciousness sometimes. Bleeding on the first days
was heavy with clots. She had a diagnosis of“uterine adenomyosis” by an OB/GYN doctor andreceived tokishakuyakusan without any effects.

Bowel movement: 3 times/day with the use ofHardpicosulfate,stools.

sennocide)forbofutsushosanwaseffective only when used for the first time.
The body felt cold, especially extremities. No hot
flashes.
Present symptoms: 154cm, 54kg
Pulse: Deep, thready, and wiry
Tongue:Firstly, daiobushito (Rhei Rizhoma-2g, Aconiti
Radix

Processa-2g,

Asiasari

Radix-4g)

was

experimentally administered to get rid of theaccumulation of cold. A ten-day administration of
the formula improved bowel movements and the
body became warm. Two weeks after the start of theadministration, menstruation resumed. However,pain was still severe so that the patient could notendure it without having an injection of pentazocine.
Bleeding still had clots mixed. The blood clots meant
the existence of stagnant blood. As this formula
works to improve the accumulation of cold but does

activating the blood and eliminating the stagnation

Urination: 5 times/day, night urination - once

constipation.

Course:result is logical. So, on September 20, drugs forSleep: Good(sodiumof blood stasis.

not work on Qi stagnation and blood stasis, theAppetite: Ordinary

laxatives

Therefore, the treatment is required to basicallyrelease and eliminate the accumulation of cold to

Case: Female, 28 years old
Chieflarge intestine Qi leading to the accumulation.

Pale colored with white furs and moist.

Abdomen: Strong resistance and oppressive pain
in both paraumbilical areas. Epigastric distress andhardness (+).
Diagnosis: Stagnation of Qi and blood stasis due toaccumulation of cold

were added and the formula was modified asfollows.

Rhei Rhizoma 2g
Aconiti Radix Processa 2g
Asiasari Radix 4g
Persicae Semen 4g
Cinnamomi Cortex 4g
Corydalis Tuber 4g
Angelicae Acutilobae Radix 4g
Cnidii Rhizoma 4g
Paeoniae Radix Rubra 4g
Glycyrrhizae Radix 2g
Poria 4g
Right after the administration of this modified
drug, the pain improved slightly, so the patient was

Therapeutic strategy:
The underlying clinical condition was considered

maintained on the same drug. On November 2, inorder to strengthen the action on Qi stagnation,

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Volume 3, Number 3 | Fall 2008

Ciperi Rhizoma 4g was added. Subsequently,
menstrual cramps gradually became less severe. On
March 30 of year X+1, to further increase the effecton cramps, the amounts of Aconiti Radix Processa,

Ciperi Rhizoma, Corydalis Tuber, and Paeoniae
Radix Rubra were increased.

On the April 17th

visit, the patient claimed that cramps abatedgreatly and felt well every day. During her May
period, an injection of pentazocine was unnecessary.
And then the severity of cramps gradually reduced
to the extent that she could lead a normal life.
Currently (June of year X＋three years) cramps
further abated and the patient lives a life of comfort.
She has become vigorous without cold extremities.
Consideration:
Traditional
Chinesemedicineclassifies
menstrual cramps into five types and has different
approaches and prescriptions prepared that fit toindividual types. The case of the patient falls under
the type of accumulation of cold in the uterus. The
patient’s
constitutional
predispositionisyang-deficiency, upon which cold from outside was
piled up inside the body. This caused theobstruction of the flow of large intestine Qi andthereby the accumulation occurred, leading tosevere constipation. An ideal treatment was todisperse and resolve the accumulation of cold bywarming. The use of a cold type of rhubarb, despite
the presence of the strong internal cold, was aimed
at resolving the accumulation while the use of warm
types of aconite and Asiasarum root was aimed atcounteracting the act of the cold of rhubarb. The
drugs for activating the blood and eliminating thestagnation were used in combination with the drugs
for regulating Qi to respond to the Qi stagnation
and blood stasis which were caused by theaccumulation of cold. These drugs worked incooperation to improve the pathological condition.
The core element of this formula is no lessdaiobushito.

16

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

Volume 3, Number 3 | Fall 2008

Kampo Dermatology – Clinical Studies

the lung, spleen and kidney together with theTreatment of Rosacea-like Dermatitis
with Kampo (3)involvement of lung qi in the stratum corneum.
”Jumihaidokuto” will suffice for treating only

Fumino Ninomiya
Aoki Clinic

pustules. However, if water metabolism is involved

Palmoplanter pustulosis develops pompholyx on

and drugs for inducing dieresis must be used. For

in the problem, its “sho” or symptoms are multiple

the palms and soles. They turn to pustules in time,

instance, “eppikajutsuto” is used for redness caused

become red when dried, and fissured with itch.

by inflammation just before the development of

Although any particular cause is not known,

blisters, and “goreisan” and “choreito” for blisters.

catching a cold or tonsillitis exacerbates thesymptoms. There is a way of viewing that dental

In fact, if pustules are treated and recovered,focal infection and allergy to metal ions may bewhat remained to be treated are pompholyx. And if

involved in this disease. This disease indicates thepompholyx is treated and disappears, what to belink between the interior of the body and the skin astreated is hyperhidrosis. This is an important point.

an internal inflammation causes inflammations at

This dermatitis should be treated based on thethe ends of hands and feet.

notion that it is triggered by hyperhidrosis.

Blisters eczematize and become itchy. Thiscondition is called dyshidrotic eczema, which

Case: Palmoplanter pustulosis

becomes purulent, forming pustules or puss-filled

60-year old female

blisters (pus formation), where no pus-producing

Present illness: In June of a year ago whenbacteria are present. The pustules have no bacteria

menopauseand differ from true pustules in characteristics.

developed. Pustules appeared on both feet and thenThe

blisters

developedinpalmoplanteroccurred,

palmoplanter

pustulosis

on palms.

pustulosis indicate that the five viscerals are

Present symptoms: In addition to palmoplanter

disturbed. From the Kampo perspective, there is apustulosis,

big problem in “water-sweat” and the blisters aresternoclavicular pain, cervical pain, shoulder pain.

deeply related to hyperhidorosis. The treatment

Opacified nail plates and thickened nails on hands

needs to be made by finding where the water-related

and toescauses lie and then removing the pathological water.

Abdominal sho:

joint

pains

including

back

pain,

Fullness in the right chest andhypochondrium
Figure 1 describes the developing flow of
palmoplanter

pustulosis

from

the

Kampo

perspective. Water becomes stagnant mostly by thestagnation of defense qi due to lung qi deficiency.

Examination: Total cholesterol

268mg/dl

Neutralfat 274mg/dl
Treatment and course:
Used

drugs

were

hainosankyuto

5.0g,

fever), which is combined with pompholyx (thebofutsushosan
5.0g,
and
subsequently
jumihaidokuto 5.0g, bofutsushosan 5.0g and biotin

stagnation of water) to form pustules or puss-filled

for 14 days. With thee drugs, nearly recovered

blisters. In a broad sense, these are associated withcondition.

kidney qi in the basal layer and spleen qi in theIn

The retained defense qi causes moist heat (thermal

stratumspinosum,suggesting

that

water

is

stagnant, which is caused by the qi deficiencies ofMarchhyperhidrosis

of

this

was

year,

the

observed.

tendencyofPalmoplanter

pustulosis recurred. For the pains in various joints,
Voltaren suppository was used sometimes.

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Volume 3, Number 3 | Fall 2008

For the relapse, used drugs were shigyakusan
5.0g, bofutsushosan 5.0g, and biotin for 14 days.
Diagnosis of skin (－), opacified nail plates andother disorder were cured with almost no remaining
opacity.

Before treatment

Before treatment

Two weeks later

Four weeks later

Before treatment

18

Two weeks later

Four weeks later

Cured after relapse

Cured after relapse

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

Volume 3, Number 3 | Fall 2008

Medical History in Japan
Origin of Japanese Acupuncture: Waichi Sugiyama and his
Text – Sugiyama Shindenryu (3)to as “appropriate depth of insertion”.
As for range of motion and rhythm of “pecking”, it isadvisable that the movement is small and slow at

Jikan Oura

first, and then gradually becoming larger and faster.

Medical Historical Research Department

Keeping the same rhythm is not effective so there

Kitasato University Oriental Medicine Research Center

should be random variations, pausing and resuming
until there is a comfortable sensation that spreads

3. The techniques of Sugiyama Shindenryu“There are over 100 guide tube acupunctureout from the area.

techniques described in “Sugiyama Shindenryu”.
18 of those are considered the foundation.

The

description of these techniques should make people
understand how Waichi and his students performed
their acupuncture.

From these I will present some

representational techniques below and describe
some important reminder and purpose of eachtechnique.
A. Jakutaku Jutsu“Sparrow Pecking Technique”[Figure: Tonification or sedation technique[Method](Jakutaku Jutsu)]

The needle is inserted perpendicularly to the“appropriate” depth.

This is variable depending on

the practitioner’s sense, the sensitivity of thepatient and the condition.

At that depth, theneedle is moved up and down in a small range with
the image of “a sparrow pecking for food.” This iscontinued for 4-5 breaths of the patient.

Whilepausing for 1-2 breaths the needle is floated up to asuperficial level.

It is then returned to the suitable

depth and a gentle twisting is applied.

This iscontinued until a mild, comfortable sensation isachieved.

The needle is then removed and thepoint closed immediately.

“Following Needle Technique”[Method]
The practitioner pays attention to the patient’s
breathing when inserting a needle. The needle isinserted on the patient’s exhalation and stopped oninhalation until it reaches an appropriate depth.
After reaching appropriate depth there is a pause.
Then gentle twisting is applied and continued for
70-80 breaths of the patient.
gather Qi at the needle tip.

This technique will

This is continued until

both patient and practitioner feel a harmonizing
sensation to gather Qi inside of the patient’s body atthe needle tip just as floating a big stone on water.

[Notes]Jakutaku Jutsu is the basic technique forrelaxing muscle tension and relieving pain.

It canbe either tonifying or sedating.
Depth of insertion varies depending on whether
patient is heavy or thin and the underlying anatomy
at the insertion site.

B. Zuishin Jutsu

Basically, in hot areas

insertion is shallow, cold areas it is deep.

And thegreater the skill of the practitioner, the shallower
the insertion needs to be. Thus, it is often referred

Then the needle is brought to the surface on
inhalation and stopping on exhalation.

The needle

is removed in the pause between inhale and exhale.
Point is closed immediately after removal.
[Notes]Zuishin Jutsu is a basic technique for tonificationand generally used for deficiency of the abdominal
region to activate the function of the internal organs.
Inserting the needle in conjunction with the

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Volume 3, Number 3 | Fall 2008

breathing, twirling the needle in conjunction with

Upon final retraction of the needle pull it out in a

the breathing to gather Qi and then retracting thestraight line by about 10 to 20 mm and again afterneedle in conjunction with the breathing is theapplying the same needle twirling roughly retract

meaning of the name for this technique. The

and reinsert it, retract the needle for the next 10 tobreathing of the practitioner is important to gather

20 mm and again after applying the same needle

Qi beneath the needle. Imagine that the Qi spreads

twirling roughly retract and reinsert it, then finallythroughout the abdomen from the needle tip whileremove the needle completely and slowly close thethe practitioner slowly exhales and with a gentle

needling mark.

push onto the needle tip, slowly twirling the needle,
will cause the Qi to gradually spread throughout theabdomen of the patient.

[Notes]The leaking roof technique is a representative
reducing technique. It is used to achieve relaxationof muscle indurations in a stratified way fromsuperficial to deep layers. It is applied in cases ofexcessive accumulation of the evil Qi in theepigastric region or for severely hardened muscles ofthe lumbar and gluteal regions. For a state of
deficiency in the abdomen a tonification techniquelike the "three tone technique" is used, where thepressing hand applies pressure onto the needle tip
and the needle is twirled for prolonged periods oftime in the different depths of the upper, middle and[Figure: Gathering Qi with the tip of the needle using thelower level.

Following Needle technique (Zuishin Jutsu)]

C.

Okurou Jutsu“Three-step dispersion ofindurations with the Leaking Roof technique"[Method]First insert the needle in a straight line from adepth of 10 mm to 20 mm. Twirl the needle there
over a period of 5-6 breathing cycles and once you[Figure: Three-step dispersion of indurations with thehave explored the Qi of the surface layer proceed

Leaking Roof technique (Okurou Jutsu)]

and roughly retract and reinsert the needle over aduration of 5-6 breathing cycles like dripping rain.
Next, advance the needle straight down deeper for aperiod of about 5 minutes from a depth of 10 mm to
20 mm. Apply here the same twirling of the needle
and once you have obtained the Qi of theintermediate layer apply the same rough retraction
and reinsertion of the needle. Again, insert theneedle still further straight down by 10 mm to 20
mm, twirl the needle similarly and once you haveobtained the Qi of the deep layer apply here too thesame rough retraction and reinsertion of the needle.
20

D. Saishi Jutsu“Finely tapping the needle handle

Fine Finger technique"[Method]
Insert the needle into the tube, place it against
the painful area and tap the needle handle
protruding from the needle tube with the tip of yourfinger finely for 100-200 times. The higher thenumber of taps applied the better. After the tapping
suddenly remove the needle, the tube and thepressing hand all together in one movement and put
them on another painful spot and tap the needle

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

Volume 3, Number 3 | Fall 2008

handle there in a similar fashion. Apply thismovement to several spots and then complete the[Notes]
The three method technique is used when coldevil has led to stagnation of Qi and Blood within atreatment.

somewhat limited region on a slightly deeper level[Note]
The fine finger technique serves to relief
superficial muscle tension spreading over extensive
areas and thus has the purpose of alleviating pain
originating from superficial layers. For example,
application of this fine finger technique at several
sites when a persons is in the initial stages ofcatching cold, where there is marked stiffness andpain in an extensive area from the neck to theshoulder, relieves the skin tension and induces
sweating, thus reducing pain and providing somerelief. The essential point here is the use of thefingers for the fine tapping the needle handle.

and has been causing pain. For example whenchilling caused abdominal pain this technique isapplied to Chukan (CV12, Zhongwan) or Tensei(ST25, Tianshu) or else on the deltoid muscle of theshoulder. According to the "Official Needling"compilation of the "Ling Shu", this method is anapplication of the "Equal needling".
There are many other techniques applying theneedle insertion conversion like the "Four sides ofheaven", the "Four sides of man" and the "Foursides of earth" techniques. Depending on thecondition of the site at which these techniques areapplied the direction of the insertion and thetechniques employed after the insertion may differ.

[Figure: Finely tapping the needle handle Fine Finger
technique (Saishi Jutsu)]

E. Sanpou Jutsu“Three Method technique using

the needle insertion conversion”[Figure: Three method technique,
Four sides of heaven, man and earth technique][Method]
Initially the needle is inserted perpendicularly tothe appropriate depth. Then twisting technique isapplied with the intention of dissolving stagnation
due to cold.

After sensing the stagnation isrelieved, the needle is brought back to the surface.
The needle direction is then changed to the left,
reinserted to the appropriate depth and thetechnique is repeated.

Then back to the surface

and repeated to the right.

After all stagnation iscleared from that point the needle can be removed.

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

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Volume 1, Number 1 | Spring 2006

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35

Volume 1, Number 3 | Fall 2006

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2

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