Volume 11, Number 4 | Winter 2016

Integrating Kampo and Evidence-BasedMedicine (8)The Efficacy of Daiobotanpito against Colon Diverticulitis
Hiromichi Yasui
Japan Institute of TCM Researchtenderness also in the paraumbilical area. No
suspicion of peritonitis, such as rebound tenderness
or muscular defense.
Non-contrast abdominal CT: There is marked
thickening and fecal calculus in the ascending colon

Professor Keiko Ogawa of Kanagawa University

wall and an inflammatory change in the surrounding

Hospital is a pediatric surgeon, but she treats a widetissue. The appendix can be seen away from therange of diseases as a specialist of Kampo medicine

center of the inflammation.

today, and is now an indispensable presence to thehospital. She is a precious friend of mine, and we
often mutually share our experiences.
In a seminar held in 2016, she presented anextremely interesting case1). It was a case in whichcolon diverticulitis was treated with a decoction ofthe Kampo drug daiobotanpito, in addition to anantimicrobial. The case is introduced below.
Case report
Case: 35-year-old woman
Past medical history, family history: None inparticular

Photo 1

History of present illness: After giving birth, thewoman experienced no abnormal progress inparticular, but a condition of poor bowel movement
continued. Around three weeks after giving birth,
her poor bowel movement worsened, and her entire
stomach felt heavy. It did not improve even when she
took a Tokakujokito extract. From a little past noon,
she began to feel sudden pain in the right lower
quadrant.

Thepainintensified,andbecameexacerbated when she walked.
Present condition: Height 166cm, weight 54kg, bloodpressure 110/60mmHg, body temperature 38.7°C
Pulse pattern: Moderately floating and sinking but
excessive, somewhat rapid, string-like, somewhatsmoothTongue pattern: Red, covered with a slight whitecoating
Abdominal

pattern:

Intermediate

abdominal

strength, strong tenderness from the right side of theileocecal
8areatotheright

lower

quadrant,

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

Photo 2Volume 11, Number 4 | Winter 2016

The bold treatment surprised the audience who

Diagnosis: Colon diverticulitis
Treatment:

listened to this report. The standard treatment for1st day: Immediately after diagnosis, a decoction ofcolon diverticulitis, which presents acute symptoms

daiobotanpito(Cortexsuch as abdominal pain and fever, is through fastingMoutan) 4.0g, Tonin (Semen Persicae) 4.0g, Togashi

or intravenous antimicrobial therapy, and requires(Semen Benincasae) 4.0g, Bosho (Natrii Sulfas)

hospitalization in most cases. It therefore drifted

4.0g, Daio (Radix et Rhizoma Rhei) 2.0g).

through the minds of the audience that treatment

At 8 p.m., the patient took a dose of thethat relies on Kampo may be dangerous.

wasprepared(Botanpi

Seeing everyone’s reactions, Dr. Ogawa smiled

daiobotanpito decoction.
Around 11 p.m., she passed a large amount of stool

and said as follows: “Actually, the subject of this casethat she had not passed during the past severalis me.” She had used her own body to monitor thedays. Body temperature of 37.3°C.

efficacy of Kampo medicine. As an outstanding

The pain in the right lower quadrant decreased insurgeon, Dr. Ogawa had monitored her own clinicalfrequency and intensity, such that she rated it a 4/10

condition with conviction, but to those of us in theon the Numeric Rating Scale (NRS).

audience, it was a surprising case presentation.

2nd day: The patient underwent abdominal echo and

The case is highly instructive.

CT inspections. Her appendix was 6.5mm and wasFirst, Dr. Ogawa received an intravenous drip

slightly swollen, but the layer structure wasinfusion of an antimicrobial, the standard treatment,maintained. Body temperature of 37.3°C. WBC 9700,

but without being hospitalized. There was no need

neutrophil 76%. CRP 5.6.

for her to be hospitalized. As a result, her treatment

A 1g intravenous drip of the antimicrobial CEZ wasperiod was able to be shortened compared to thebegun. Daio was increased to 3g/day.

average length of treatment, and she was able to3rd day: Daio was increased to 4g/day. Two bowel

resume breastfeeding quickly. This was possible

movements. Regular stool.

because Dr. Ogawa was thoroughly familiar with the

4th day: Daio was increased to 6g/day. Three bowel

disease, and she knew fully the efficacy of standard

movements. Slightly loose stool.

treatment and the potentials of Kampo medicine.

The jarring pain that accompanied movement

After the above experience, Dr. Ogawa thought

disappeared, but there was a slight tenderness in thethat using daiobotanpito for colon diverticulitis

right lower quadrant.

would be useful to many patients, and thus carried

The antimicrobial was terminated.

out a clinical study with her surgeon colleagues at

6th day: Body temperature of 36.0°C, three bowel

the Japanese Red Cross Kanazawa Hospital. The

movements, loose stool.

study was published in e-CAM under the title,

Only an extremely slight tenderness remained in the“Effectivenessright(Kampo) Medicine, daiobotanpito, in Combination

lowerquadrant.

Thepatient

resumedof TraditionalJapanese

Herbalbreastfeeding.

with Antibiotic Therapy in the Treatment of Acute7th day: Three bowel movements, diarrheal stool.

Diverticulitis: A Preliminary Study”2).

Daio was decreased to 5g/day, and the abdominal

Let me introduce the paper below.

tenderness disappeared.
8th day: The drug was terminated, and treatment
was completed.
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

9Volume 11, Number 4 | Winter 2016

An examination of the progress of treatment

The study by Dr. Ogawa et al.
Dr. Ogawa et al. visited the Japanese Red Cross

among cases in which conservative treatment wasKanazawa Hospital from January 2010 to Marchsuccessful showed that the number of days until the2012, and studied 34 patients who were diagnosed

patient’s fever subsided was 2.3 days in thewith acute colon diverticulitis. The patients were an

daiobotanpito

average age of 45.1 years (ages 22 to 79), andsignificantly shorter than the 3.4 days in the non-consisted of 28 men and 6 women. 28 patientsadministration group. The number of days until thesuffered colon diverticulitis in their right quadrant,patient’s

and 6 in their left quadrant.

disappeared was 4.8 days in the administration

administration

abdominal

paingroupandandtenderness

Diagnosis was based on physical findings andgroup and significantly shorter than the 5.8 days incomputed tomography (CT) images. CT findings ofthe non-administration group. The number of days

colon diverticulitis would show a diverticulum-likeuntil the patient was able to commence meals wasstructure in the region affected by abdominal pain

5.1 days in the administration group and tended toand tenderness, as well as a thickening of thebe shorter compared to the 6.1 days in the non-intestinal wall, an increase in the concentration ofadministration group. The number of days until thepanniculitis, an exteriorization of fascia, andpatient was discharged from the hospital was 7.6

accumulation of exudate. The standard treatmentdays in the administration group and tended to befor acute simple diverticulitis consists of bowel rest

shorter compared to the 9.0 days in the non-(fasting),administration group.

rehydration,

andintravenous

The result of the preliminary study was asadministration of an antibiotic.
The patients who were selected as subjects of thepresented above. As the number of subjects wasstudy were administered an antibiotic until theirsmall, it is difficult to say with certainty, but it

CRP level reached a normal level. Of the 34 patients,

appears that combining daiobotanpito with standard

10treatment has a favorable effect on mitigating

wereadministered

threedays’

worthofdaiobotanpito 7.5g/dayNote 2. The other 24 composed

symptoms and shortening treatment periods.

a non-administration group.
Of

thesepatients,

onepatient

whowasDaiobotanpito and its indications
daiobotanpito is a prescription that is mentioned

administered daiobotanpito had to undergo surgery

Chapter

18ofKinkiyoryaku(11 days of conservative treatment failed to improveinthe patient’s symptoms, and the patient had

Prescriptions from the Golden Cabinet), a Chinese

intestinal stenosis), and three patients in the non-classic written some 1800 years ago, and intestinaladministration group also had to undergo surgery

welling abscess is purulent inflammation in the(one patient’s symptoms worsened after five days ofabdominal cavity. As this is an ancient concept of theconservation treatment, another patient’s symptoms

disease, it is difficult to identify the modern disease

failed to improve after 18 days of conservation

it corresponds to. However, appendicitis was likely

treatment and the patient had stenosis and abscess,the main lesion.

(Essentialand the other patient’s symptoms failed to improve

The prescription has been used in Japanafter 7 days of conservation treatment and thefrequently since 300 years ago, when the studies ofpatient had abscess).

Shokanron (Treatise on Cold Damage Disorders) andthe above-mentioned Kinkiyoryaku became popular.

10

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

Volume 11, Number 4 | Winter 2016

These medical texts contain diverse case reports,
including not only intra-abdominal inflammation,
but also rectovaginal fistula, perianal abscess,hemorrhoid, anal prolapse, and renal calculus.
Dr. Keisetsu Otsuka, a pioneer in the renaissanceof Kampo medicine, states that daiobotanpito
needed to be administered to many appendicitis
patients in the 1930s, but thereafter, the number ofappendicitis cases to which the prescription applieddecreased.

Eventually,

theincidence

itselfofappendicitis declined. As a result, the prescription
applies more to colon diverticulitis today.
It must be noted, however, that the prescription
contains Rhubarb and Magnesium sulfate, which arepurgative, so patients may experience diarrhea.
Nevertheless, as seen in Dr. Ogawa’s personal case,mostly regular stool is passed initially after taking
the prescription, and frequently turns to diarrhea
after the inflammation subsidesNote3). In the above
preliminary study as well, hardly any patients
experienced diarrhea.
ConclusionNote 1) daiobotanpito (Da Huang Mu Dan Pi Tang)
The nominate is daiobotanto (Da Huang Mu Dan Tang). It isa prescription mentioned in Kinkiyoryaku, a medical classic
written some 1800 years ago.
Intestinal welling-abscess manifests with swelling andglomus in the lesser abdomen that is Painful when pressedas with strangury, regular urination, frequent heat effusion,
spontaneous sweating, and aversion to cold. With slow andtight pulses, pus has not yet formed and purgation can beapplied. There should be blood in the stool. With surging andrapid pulses, pus has been formed and purgation isprohibited. Daiobotanpito (Da Huang Mu Dan Tang,
Rhubarb and Moutan Decoction) is indicated.
Da huang (Radix et Rhizoma Rhei) 4 liang
Mu dan pi (Cortex Moutan) 1 liang
Tao ren (Semen Persicae) 50 Pcs
Dong gua zi (Semen Benincasae) 1/2 sheng
Mang xiao (Magnesii Sulfas) 3 ge
Decoct all ingredients except mang xiao (Natrii Sulfas) in 6
sheng water until 1 sheng remains.
Discard the dregs, add mang xiao (Natrii Sulfas) and bringto a boil.
Take warm as one dose.
If pus is present, it will be purged; if there is no pus, blood
will be purged.

Dr. Ogawa’s personal case report, as presented
earlier, and the above study revealed that standard
treatment

forcolon

diverticulitis

progresses

favorably in many cases in combination with theadministration of daiobotanpito, and there havebeen many replication studies of this result. New
clinical studies are also being planned3), so in a few

Note 2) The quantities of each drug contained in Tsumura
daiobotanpito were as follows in the preliminary study:
Radix et Rhizoma Rhei 2.0g
Cortex Moutan 4.0g
Semen Persicae 4.0g
Semen Benincasae 6.0g
Magnesii Sulfas 1.8g

years’ time, the applicability of this prescription forcolon diverticulitis is expected to become evenclearer.
With respect to my classification, this case falls
under Type 2.

Note 3) Diarrhea experienced after taking daiobotanpito
Dr. Kunio Matsuda, who studied under Dr. Otsuka, wrote
about his experience in using daiobotanpito to treat his wife’s
appendicitis, and noted that his wife experienced no diarrhea inthe beginning despite the prescription containing Magnesium
sulfate 10g and Rhubarb 10g. However, she began passing
severe diarrhea after her pain and fever subsided4). This should
be taken into consideration from a clinical perspective.

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

11

Volume 11, Number 4 | Winter 2016

Cited References
1. Keiko Ogawa: “The Effectiveness of daiobotanpito in theTreatment of Colon Diverticulitis,” Kampo Medicine
Seminar for Medical Students, 2016 (in Japanese).
2. Keiko Ogawa, Koji Nishijima, Fumino Futagami, Takashi
Nakamura and Genichi Nishimura: Effectiveness of
Traditional Japanese Herbal (Kampo) Medicine,
Daiobotanpito, in Combination with Antibiotic Therapy inthe Treatment of Acute Diverticulitis: A Preliminary Study,
Evidence-Based Complementary and Alternative Medicine
Volume 2013
3. Hiroshi Koike et al.: “Examination of the Effectiveness ofdaiobotanpito against Colon Diverticulitis: Research Planfor an Open-Label Randomized Controlled Trial,” Kampo
Medicine Vol. 67, Collection of Summaries of Presentations
Given at the 67th General Academic Meeting of the Japan
Society for Oriental Medicine, p. 308, 2016 (in Japanese).
4. Kunio Matsuda: Case Studies of the Reality of Kampo
Treatment, p. 261, Sogensha, 1992 (in Japanese).

12The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)