KAIM
T
Thhee JJoouurrnnaall ooffK
Kaammppoo,, A
Accuuppuunnccttuurree aanndd IInntteeggrraattiivvee M
Meeddiicciinnee
INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 7, Number 4 ･ Winter 2012

Editorial

Key Issues for Quality Control of Natural Medicinal Products
Hiro Sasaki

Japanese Acupuncture - Current Research

Japanese Traditional Medicine Text (6) – Orthopedic Disorders, C Sports
Toshikazu Miyamoto

Kampo Medicine - Current Research

Kampo (Japanese Traditional) Medicine and Gastrointestinal Symptoms in Pediatric Surgery
Keiko Ogawa-Ochiai

Clinical Report 1 (Acupuncture)

A Case Where Blood Letting was Effective for Health Problems Following Multiple Traffic Accidents
Takara Yamami

Clinical Report 2 (Kampo Medicine)

Maobushisaishinto for Non-dipper Hypertension

Narihito Fujii

Medical History in Japan“Historical Significance of Standardization of Acupoint Locations”, the Second Japanese Acupoint Committee (8)Makoto Mayanagi

ISSN:1559-033X

College Logos
We believe it is necessary to create a new way of thinking
for the total understanding of "Life, Survival, and Health".
We decided to coin the world "Lifence" to express this.
Lifence means the combination of life sceince and medicine
as well as other disciplines such as health science, psychology,
ethics, etc.
Our college logos symbolizes the above.
The ripple effect represents the ocean and the birth of life.
The rainbow colored sphere represents a safe environment
and a barrier to protect us from negative influences.
The picture by Leonardo da Vinch represents a balanced
body and health.
Completing our logos is a ring which represents the unity ofspace fulfilling the total meanings of lifence.

―

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

Volume 7, Number 4 ･ Winter 2012EXECUTIVE EDITOR

Shuji Goto
Chairman, GOTO College ofMedical Arts & Sciences

TA B L E O F C O N T E N T S

Tokyo, JapanASSOCIATE EDITORS
Shuichi Katai

1 Editorial
Key Issues for Quality Control of Natural Medicinal Products
Hiro Sasaki

Ibaraki-ken, Japan

Hiromichi Yasui
Tokyo, JapanEDITORIAL STAFF

Akihiro Souma
Hiromi Sasaki
Hiroshi Tsukayama
Hitoshi Yamashita
Junko Okubo
Kazunari Ozaki
Kengo Nakata
Masayuki Kashima
Naoya Ono
Noboru Mitsuhata
Sayaka Toda
Takao Namiki
Toshiaki Makino
Toshihiro Togo

3 Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (6) – Orthopedic Disorders, C Sports
Toshikazu Miyamoto

10 Kampo Medicine - Current Research
Kampo (Japanese Traditional) Medicine and Gastrointestinal Symptoms in Pediatric Surgery
Keiko Ogawa-Ochiai

19 Clinical Report 1 (Acupuncture)
A Case Where Blood Letting was Effective for Health Problems Following Multiple
Traffic Accidents
Takara Yamami

PUBLISHER

Shuji Goto
International Institute of Health andHuman Services, Berkeley
2550 Shattuck Avenue, Berkeley
California 94704-2724, U.S.A.

23 Clinical Report 2 (Kampo Medicine)
Maobushisaishinto for Non-dipper Hypertension
Narihito Fujii

26 Medical History in Japan”Historical Significance of Standardization of Acupoint Locations”, the Second Japanese
Acupoint Committee (8)Makoto Mayanagi

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)KOTARO PHARMACEUTICAL introduced in 1957 the world's first Kampo extract
preparations on the market. Later, in 1967, six of our preparations could be covered in Japanfor the first time by the health insurance and after 1976 more than 100 of our preparations
were used in hospitals and clinics. Now it is half a century since we put our Kampo extract
preparations on the market and believe, we made a major contribution to this industry.
In the future we intend to continue working in accordance with our company motto: "Still better
Kampo for still more people" and provide pharmaceutical products of still higher quality.

Origin of the company's name
The company was named "KOTARO" by its
founder Taro Ueda with reference to his birthplace. Close to the ancient city of Nara. Kotaro
is the name of an enormous sheer cliff, 700 m
wide and about 200 m high. Mr. Ueda felt anaffection rising to the heavens for this cliff andthus made it the company's name.

KOTARO PHARMACEUTICAL CO., LTD.
5-23 Nakatsu 2-Chome, Kita-ku, Osaka 531-0071, JAPANURL: http://www.kotaro.co.jp

Volume 7, Number 4 | Winter 2012

Editorial
Key Issues for Quality Control of Natural Medicinal Products
Traditional medicines have been utilized worldwide. Key issues on using the medicines in a modern
medical care system are described below.
In general, a medicinal product consists of an active principle (active pharmaceutical ingredient: API) andadditives, and quality evaluation is made for them. An API plays a central role in a medicinal product. It
is evaluated from various points of view such as description, identification (e.g. UV, IR and qualitative
tests), pH, melting point, purity (e.g. clarity and color of solution, heavy metals, fingerprinting for related
substances), loss of drying, residue of ignition, and assay in a Western medicine. On the other hand, all ofsuch test items cannot be adopted for traditional medicines because of special circumstances in natural
products. Under these circumstances, there are two premises in using traditional medicines in a modern
medical care system; i.e. (1) equivalency between modernized traditional medicines (e.g. extract products)
and ancient ones (e.g. decoction), and (2) quality evaluated by modern science.
(1) Modernized traditional medicines shall be assured equivalent to ancient ones. Historical facts ofmanufacturing processes from an era to another, adoption of manufacturing processes in classicaltexts, and confirmation of equivalency between modernized traditional medicines and ancient ones
can link the past with the present and can assure efficacy and safety of modernized traditional
medicines. In Japan, extract products, whose quality is equivalent to standard decoctions, have beenmarketed as Kampo extract products.
(2) Contaminants such as heavy metals, residual pesticides, and/or microorganism, and intentional
adulteration of active ingredients cause a number of human sufferings. Safety of traditional
medicines depends on quality of the products. Quality evaluation methods used for Western
medicines cannot directly be applied to modernized traditional medicines; thus, manufacturingcontrols as well as quality controls are absolutely required to obtain high-quality products.
In case of an extract product, what can be considered as an API? Is it a chemical compound, a natural raw
material, or extract? Extract is the answer in the case. Chemical compounds are ingredients of natural raw
materials; natural raw materials are components of traditional formulas; and extract is an API of an extract
product. Quality of medicinal products depends on that of APIs and it is very important to control
manufacturing and quality of APIs; however, situations in natural medicines are complicated as shown
below.
Case A: Mixture of extracts individually obtained from raw botanical/animal/mineral materials
In this case, a finished product is considered a combination product, and “each extract” derived
from a raw botanical/animal/mineral material is an API. Quality assurance of each extract isimportant. An overall pattern of each extract should be strictly controlled.
Case B: Extract obtained from mixture of raw botanical/animal/mineral materials
In this case, a finished product can also be considered a combination product; however, “whole
extract” derived from raw botanical/animal/mineral materials is an API. An overall pattern of whole
extract should be strictly controlled.

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

1

Volume 7, Number 4 | Winter 2012

It is known that constituent profiles of extracts can be different between the above cases if natural materials
contain alkaloids. This is important in considering APIs. For these years, international standardization of
traditional medicines in East Asia including TCM, Kampo medicines and Korean medicines has been
facilitated; however, we have more than one way of thinking on APIs. Difference in manufacturing
processes requires different control items. We should bear in mind different targets in quality assurance oftraditional medicines.

Hiro Sasaki, Ph.D.
Visiting Scholar, Lifence General Institute
Assistant Secretary-General, The Japan Liaison of Oriental Medicine

2

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

Volume 7, Number 4 | Winter 2012

Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (6) – Orthopedic
Disorders C Sports

Toshikazu Miyamoto
Professor,

Graduate School of Comprehensive Human Sciences,

University of Tsukuba

In our current society, the border between healthand disease is often unclear. Health care and its
focus now must aim to cure disease and include
promotion of life style choices that improve qualityof life and increase life expectancy, early detection of
disease and early treatment. In the field of sports
and athletic performance as well, beyond theofsportsinjuries,

treatmentforprevention of injuries or for physical disabilities andconditioning, health maintenance and athletic
performance have become important themes.
Oriental Medicine has characterized itself byaiming to “treat the unseen disease”, that is treating
the tendency to develop disease (root causes) before
the disease has a chance to disrupt essential
physiologicalopinions about Complementary and Alternative
Medicine (CAM); subjects were 309 University of
Hawaii athletes. Results showed that more than 46%
of respondents had received some form of alternative
or complimentary (CAM) treatment within theprevious 12 months, a percentage greater than thegeneral population. Contents of the CAM treatments

1. Introduction

treatment

acupuncture. Nichols et al 3) conducted a survey onprocesses

likeimmunefunction,

respiratory capacity, circulation, digestive processes
etc. In short, Acupuncture treatment starts withinformation about the athletes physical conditionand practice environment/routines and aims toestimate and repair impediments due to past
injuries, help prevent new injuries, fatigue and poor
performance due to over use by teaching the athlete
to maintain their optimally healthy condition.
Akimoto et al1) reported the results of questionnaires
regarding Acupuncture treatment answered byuniversity athletes (577 subjects). The percentage of
respondents who had experienced Acupuncture
treatment was 51.3%. The researchers also reported
that higher level athletes tended to have had moreexperience with acupuncture. Miyamoto et al2),queried 195 athletes (141 men, 54 women) from
Ibaraki prefecture, attending a national sports
event; 31.3% of these athletes had experienced

included 38% massage, 29% chiropractic, 14%
LomiLomi massage (unique to Hawaii) and 12%
acupuncture. Compared to earlier research, Sports
athletes who had tried acupuncture were moreprevalent than in the average population and as theathlete’s level of performance increased, the rate ofexperience with acupuncture increased as well.
Historic references for sports athletes receiving
acupuncture reach back to Homma’s research in1949 and include 6editions of “Ido no Nihon” Journal
as well as numerous international and domestic
reports4). Concerning acupuncture sports medicine,
Homma discussed 1) treatment prior to competition
to improve endurance, maximum strength andpower, dexterity and resistance to impact, 2)
methods for measuring fatigue related to sports andtreatment

methods

for

rapid

recovery,3)

Acupuncture and moxibustion for sports injuries anddysfunction,

4)

sportsmedicine

used

with

acupuncture and moxibustion treatment. Following
Homma’scontributions

toacupuncture

sportsmedicine, research until the mid-1980’s focused
mainly on case studies reported here and there.
In 1990, Miyamoto presented a series of 4 papers
on acupuncture and Physical Therapy for sports
injury5). The topics include research on acupuncture
treatment for sports and exercise, the current
situation of acupuncture treatment for sports
injuries and dysfunction and acupuncture treatment
for muscle fatigue as it relates to sports andmovement. Palham’s 2001 review article introduced
the study of acupuncture treatment on muscle
strength, cardio (aerobic) training, flexibility andsports performance, re-asserting the need for

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

3

Volume 7, Number 4 | Winter 2012

systematic guidelines for acupuncture in the field ofSportssports medicine6).

randomized control trials using embedded needles toSince 1980, the number of papers published

Medicine

Acupuncture

andintroduce

treat sports related injuries.

within the area of sports and acupuncture treatment
in major medical university journals (MEDICINA)(Number of articles)(keywords:

electro-acupuncture,600

embedded needles x sports injuries) has been

500

acupuncture,steadily increasing: 98 reports between 1980-89, 328
reports between 1990-99, 969 reports between 2000-(n=725)

PubMedIgaku Chuo Zasshi (n=1,395)

400

09 (See Figure 4). However, among the 1,395 papers

300

reviewed, most were transcribed minutes from200

meetings and only 332 were original papers.

100

Keywords from these research papers included 1)

0

Acupuncture x Sports (175) 2) Acupuncture x muscle

1980 ～84

1980 ～84

1980 ～84

1980 ～84 1980 ～84 1980 ～84(Year)

fatigue (47) 3) Acupuncture x muscle endurance (1)4) Acupuncture x delayed onset muscle soreness

Figure 4: Number of Published Articles
on Acupuncture for Sports Medicine(DOMS) (10) 5) Acupuncture x Sports injury/
dysfunction (88) 6) Acupuncture x Conditioning (5).
Similarly, of the Sports related acupuncture

2. Clinical Studies Abroad

articles published Internationally in Pub Med

Kleihenzet al.8), performed double blind RCTs on

between 1980 and 2009,there was a similar and52 sports athletes with shoulder tendinitis tomarkedinvestigate the efficacy of Acupuncture treatment.

upwardacupuncturex

trend:
sports(keywords

injury,DOMS,

included:
muscleThe

subjects

weredividedintotwogroups:endurance, muscle fatigue, movement, motion,acupuncture that penetrates the skin layer or shamexercise) between 1980-89, 59 reports, between

acupuncture that does not penetrate the skin layer

1990-99, 140 reports, between 2000-09, 526 reports

completely. The results showed 1)(See Figure 4). The frequency of relevant keywords

acupuncture group pain, function, ROM, muscle

was as follows: acupuncture x sports injury (17strength (as measured by the Constant-Mureley-reports),

reports),score all improved significantly more than the shamacupuncture x muscle endurance (12 reports),

acupuncture group 2) three months following theacupuncture x fatigue muscle (12 reports).

treatment

acupuncture

x

DOMS

(4

sessionsa

tracking

for thequestionnaire

Clearly, despite the overall increase in therevealed that, although at the time the sessions were

number of the internationally and domesticallycomplete there had been no distinction between

published papers, there is a distinctly small number

groups, the sham group reported distinctly differentof original reports from Japan in Japanese.

effects compared to the acupuncture group. Within

Concerning the field of acupuncture research forthe body of research using Acupuncture treatment

sports medicine, of particular interest is the 2010

forissued report on Clinical Sports Medicine, “Special

represents the highest quality research.

Report:forthe

Effectiveness

relatedinjuries,

thisinvestigationofBelow are the research results from Brattberget

Acupuncture Treatment for Sports Medicine”7).

al.9), they compared the effects of steroid injections

Within the field of Sports injury and dysfunction, thewith acupuncture treatment for tennis elbow. Theirresearchers present a picture of current trends infinding are as follows1) Compared to the control

4

Evidence

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

Volume 7, Number 4 | Winter 2012group, the acupuncture group reported significantly

recovery

protocols,

acupuncture

providedmore relief from pain. 2) Seventy percent of thesignificantly greater pain relief but also that,

acupuncture group had received steroid injections incompared to the other test groups, pressure pain was

the past, but had experienced little relief as a result.

not significantly improved in the acupuncture group.

3) Several subjects in the steroid injection groupexperienced a worsening of symptoms, but no such

3. Current Progress and Developments in Japanese

negative result or side effects of the treatment were

Clinical Researchexperienced by the acupuncture group. According to
the NIH and WHO, this research represents grounds

Effectiveness of Acupuncture for Sports Injuries
and Development

for establishing acupuncture as the treatment for

Takazawa et al.15) of the Japan Gymnastics

choice for Tennis Elbow. Further, Trinh et al.

Society presented Sports Medicine Research data on

conducted a systematic review of Acupuncture forthe percentages of athletes with specific injuries who

Tennis Elbow and Epicondylitis. However, many ofhad

the subjects for the study developed tennis elbow

conditions: of the 226 athletes with low back pain,from activities other than tennis. Concerning

13.3%, of the 97 athletes with Spondylolysis 6.2%,

domestic Japanese research, clinical studies ofand of the 140 athletes with disc herniation 15.0％

Tennis Elbow are not uncommon but comparative

were reported to have tried acupuncture. Further, it

studies examining the relative effectiveness of

was reported that at the Tsukuba University Sports

acupuncture have not yet been researched.

Medicine Hospital, low back pain was the mostZhang et al. 10) investigated previous cases ofankle joint sprains treated with acupuncture, andused

acupuncture

treatment

for

their

commonly treated complaint, 40% of all patients
receiving acupuncture.

found tension in the Peroneus and Tibialis Anterior

Miyamoto et al.15) investigated 163 university

muscles, local swelling, pain and feelings of anxiety

level athletes who sought acupuncture for theirwere all lessened.Hahm11) reported that in rats withspecificankle sprains, electro-acupuncture of 2 Hz frequency

compared to the first treatment, following the last

was effective for relieving pain and reducing edema

treatment

and 100Hz electro-acupuncture was effective for

improvements in their ability to practice for low backpain reduction alone. Park et al.12) found that

pain, disc herniation and Spondylolysis, but pain

electro-acupuncture stimulation of 2 Hz frequency

relief was felt most by those athletes complaining of

inhibited inflammation in injured ankle joints. Koo

low back pain and disc herniation. Izumi et al.16) also

et al.13) reported that a combination of 100Hz andcompared the results of 28 athletes following the

2Hz electro-acupuncture stimulation effectively

first and terminal treatment, reporting that training

increased the load bearing capacity in subjects withcondition, JOA score (Japan Orthopedic Society ofsprained ankles.

low back pain Treatment Performance Criteria)

injuries.

Theirathletes

results
reportedshowedthat,significant

Virchota et al.14) divided 48 athletes with plantar

significantly increased but the levels of pain andfasciitis into three groups; acupuncture, shamespecially pain while moving the torso and trunk did

acupuncture and general injury recovery treatments

not improve significantly.

includingstretching,icing,

aspirin-likepain

Ito et al 17) investigated 8 athletes with chronic

relievers and practice restrictions and then assessedlowdegreeacupuncture but had not achieved significantofsatisfaction.

pain,pressure

Researchpain

results

andtraining

showed

back

pain

who

had

been

treated

with

that,

improvement. Treatments were continued for 2

compared to sham acupuncture and general injury

weeks, 9 points on the lower limb were needled until

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

5

Volume 7, Number 4 | Winter 2012

the third session, thereafter, sessions included

research protocol is extremely complicated. However,retention needling at known trigger points for 10

because embedded needles are 1) depending on theminutes. Following the trigger point treatment, astimulation, usually painless so subjects unfamiliar

VAS score was obtained and reported to verify

with acupuncture are more easily “blinded” 2) can be

improvements in experienced pain. The authors

inserted with or without a needle tip so practitioners

reported positive changes in VAS scores but nocan be instructed to insert the needles withoutchanges in JOA scores.

examining the needle tip and to then fix them in the

Miyamoto et al 18) interviewed and investigateddesired location with tape, thereby “blinding” both

43 subjects with pulled hamstrings. These subjects

the subject and the practitioner. For these reasons,received electro-acupuncture treatments for 1-2

embedded needles are very useful for double blind

weeks with an average number of 7.6 treatments and,clinical acupuncture studies in general and, as willcompared to the first treatment, following the final

be discussed below, for sports athletes in particular.

treatment,

significant

Miyamoto et al.21) investigated the effectiveness ofimprovements in levels of pain and training

embedded needles for muscle pain and tension in

condition.

marathon runners using a randomized double blindthesubjects

reported

Yoshida et al. 19) investigated the efficacy of

protocol utilizing placebo needles as the control.

electro-acupuncture stimulation on rats with pulled

Subjects were 15 university students participatingmuscles (injured for the study). Compared with only

in a full marathon for the first time. Data andthe eccentric contraction group, researchers reported

materials were collected and analyzed by individuals

improvement of muscle tension and pain thresholds.

not involved in the needling or the marathon.

Further, Yoshida et al.20)treated model mice with

Subjects were divided into two groups, the firstmuscle injuries to investigate the effect of electro-

group included 8 athletes needled with regularacupuncture on degree and rate of recovery andembedded needles, and the second group included 7

found that, compared to the control group, theathletes needled with well-disguised “placebo”

electro acupuncture accelerated recovery rates.

embedded needles.

Overall, there are few high level evidence based

The embedded needles or the placebo devices

clinical research projects in Japan. However, awere placed bi-laterally on 8 acu-points on the lower

majority of these reports indicated that, regardlesslegs before the start of the scheduled race andof where the injured area is located, acupuncture

removed 5 days later. Data was recorded prior to thetreatments help reduce pain and improve athletic

race and 5 days following the race. Measurements

training condition during treatment. Unfortunately,

included VAS for muscle pain, creatine kinase (CK),

there are almost no double blind comparative tests

lactate dehydrogenase isozyme (LDH), trunk flexion

in the literature. However, within Japan, along withand muscle tension. The results of the research

an increase in clinical research, the response

findings

mechanism of acupuncture using animals for

significantly reduced following the marathon forexperiments is advancing.

those athletes with embedded needles (p>0.01) 2)

are

as

follows:1)

Musclepain

was

CK, LDH isozyme, LDH 4, LDH5 were allb Randomized control trials on Athletes and Sports

significantly elevated following the race (p>0.01) so

Medicine

it was concluded that embedded needles were

The difficulty regarding acupuncture research isineffective in moderating these cellular products. 3)

that, unlike pharmaceutical research, “blinding”

There was no change in trunk flexion between theboth the subjects and the practitioner from thetwo subject groups. 4) Increased muscle tension was

6

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

Volume 7, Number 4 | Winter 2012

andFrom Miyamoto and Kaneko’s research, we have

VastusMedialis muscles (p>0.05) indicating that thetwo comparative research studies demonstratingembedded needles were ineffective in reducingthat embedded needles and carefully crafted tip-lessmuscle tension. 5) Runners with embedded needles

placebo needles can be used to effectively blind thetended to have shorter race times. 6) Athletes were

subjects and the practitioners to the researchunable to determine if they had been needled with

protocol, as evidenced by the inability of the subjects

true needles or the control needles. Based on theseand practitioners to accurately determine which

results, it was concluded that embedded needles

needles had been used. Further, embedded needles

slightly reduced muscle pain following a marathon.

clearly reduced the muscle pain that commonly

observed

in

both

the

VastusLateralis

follows longer strenuous sporting events such as
Kaneko et al.22) investigated whether Triathletes

marathons and triathlons.

experienced less post-race pain following treatment
with embedded needles compared to placebo type

4. Summary

embedded needles. One hundred forty-nine male andWithin the field of acupuncture research forfemale triathletes were recruited and divided into

sports medicine and injuries, there has been a recent

two groups; the embedded needle group had 79

trend toward increased domestic and international

subjects and the placebo needle group had 70. The

research, however there are still few high level

placebo needle was the same item used by Miyamoto

evidence based reports available. The difficulties

et al. discussed above. Both groups were needledassociated with acupuncture treatment during

using the same points, bi-laterally: UB23, UB24,

clinical trials include1) the ethical difficulty of

UB25 and UB32. Needles were placed just before therequesting that serious athletes performing daily

start and removed as the athletes finished. Data wastraining programs participate in comparative trials

collected using a VAS score for 6 muscles in the lower

where the placebo control may offer no particularlimb before and after the race, as well as the day

benefit to them, 2) the reality that an integral partfollowing the race. Results were reported as follows:of acupuncture treatment involves stimulation with1)

needles, it is often difficult to mask these sensations

For

both

significantly

groups,followingmuscle
the

pain

race

increased(p>0.01).

2)during clinical trials.

Excluding the Gluteal muscles, muscle pain for the

For these reasons, a good deal of creativity isembedded needle group decreased significantly thenecessary to develop effective research models thatday following the race compared to immediately

maintain the integrity of acupuncture methods andfollowing

Athletes

techniques but also meet the necessary criteria forreported feeling their condition had returned to pre-double-blind comparative studies. Despite theserace levels. 3) For the placebo group, on the day

challenges, Japan is endeavoring to expand its role

following the race, athletes reported less hamstringin basic research projects that include acupuncture

pain compared to immediately following the race

treatment for sports related conditions such as(p>0.05) 4) Athletes in both groups were unable topromoting early recovery of post-exercise muscle

determine if they had been needled with true needles

weakness and repair, preventing muscle atrophyor the control needles. From these results, theduring injury recovery and speeding muscle repair

researchers
inhibited

the(p>0.01,

suggestedthecharacteristic

race

delayedinexercise in athletes.

p>0.05).

thatembeddedneedlesand development. Compared to foreign countries’

onset

musclesorenessclinical research, Japan has been conducting

following

strenuous

advanced research on fundamental areas of sports

athletes

medicine. However, none of these have been

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

7

Volume 7, Number 4 | Winter 2012published in English Journals, so from now there

Referencesmust be more active transmission of Japanese

1)

Takayuki Akimoto, Toshikazu Miyamoto, Ichiroreports abroad. There is a summary of these results

Kawano: Actual condition of Acupuncture

in Table 5.

Treatment for University Sports Athletes.
Clinical Sports Medicine 15(1): 87-93, 1998

Table 5: Summary of Acupuncture Treatment forSports Performance and Injuries

2) Miyamoto T, Kobayashi T, Meguriya S, et al.:The Actual Condition of acupuncture for1

Year by year we have seen an increase in Acupuncture

Athletes Entered the National Athletic Meet at

research for Sports Medicine, but advanced reports arelbaraki Prefecture. PROCEEDING FISU /still relatively uncommon.

2

CESU Conference The 18th universiade 1995

Concerning the topic of Sports Injury, compared to the

Fukuoka, 316─ 317, 1995

few available foreign research studies, Japanese3

research maintains higher quality methodology.

3) Nichols AW, Harrigan R: Complementary andDomestic (Japanese) research projects often examine

alternative medicine usage by intercollegiatetheathletes. Clin J Sport Med 16(3): 232─237, 2006

treatment

of

low

back

pain

in

athletes.

Acupuncture has often been shown to reduce pain and4)

improve ADL and athletic performance.

4The

responsemechanism

behindof Sports and Acupuncture I. Ido no Nihon 8(7):acupuncture

treatment for sports injuries such as ankle sprains andpulled muscles have been reported in papers both

2-3, 19495)3) : 3-8, 1990

animal research.
Japanese randomized double-blind clinical trials haveToshikazu Miyamoto: Acupuncture Treatment
for Sports Injuries (1). Physical Therapy 20(2・abroad and in Japan using both clinical trials and5

Yoshihiro Homma: An Introduction to the study

6)

Pelham TW, Holt LE, Stalker R : Acupuncture

been used to demonstrate the significant effectivenessin human performance. J Strength Cond Resof embedded needles in reducing post-exertion muscle

15(2): 266─271, 2001

pain for endurance sports such as marathons andtriathlons.

7)

Toshikazu Miyamoto, Akira Wada: Evidence for
Acupuncture Therapy in Sports Medicine.
Clinical Sports Medicine 27(6): 575-586, 2010

8)

Kleinhenz J, Streitberger K, Windeler J, et al :Randomized clinical trial comparing the effectsof acupuncture and a newly designed placebo
needle in rotator cuff tendinitis. Pain 83 : 235─
241, 1999

9)

Brattberg G: Acupuncture therapy for tennis
elbow. Pain 16 : 285─ 288, 1983

10) Zhang QG, Wang J, Gu KB, et al : Effects ofwrist ─ ankle acupuncture of functional statesof the vegetative nerve in the recruit. Zhongguo
Zhen Jiu 26(3): 203─204, 200611) Hahm TS: The effect of 2 Hz and 100 Hz
electrical stimulation of acupoint on ankle
sprain in rats. Journal of Korean Medical
Science 22 : 347─ 351, 2007

8

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

Volume 7, Number 4 | Winter 201212) Park IB, Ahn CB, Choi BT: Effects of20) Yukihiro, Yoshida, Tomoya Hayashi, T. Yanno:electroacupuncture with different frequencies

Effects

on the glycoconjugate alterations in articular

Muscles in in vivo Model Rats. Journal the

cartilage in the ankle joints of complete

Japanese Society of Balneology, Climatology

Freund’s adjuvant ─ injected rats. Am J Chin

and Physical Medicine 73(3): 177-190, 2010

Med 34(3): 417─426, 2006

ofElectro-AcupunctureforPulled21) Toshikazu Miyamoto, Atsushi Hamada, Akira

13) Koo ST, Park YI, Lim KS, et al.: Acupuncture

Wada et al.: Effectiveness of Embedded needles

analgesia in a new rat model of ankle sprain

for Post-Marathon Muscle Pain and Tension—

pain. Pain 99: 423─431, 2002

Investigation using Randomized Double-Blind

14) Virchota D, Belgrade M, Johnson R, et al : True
acupuncture

vs

sham

acupuncture

andconventional sports medicine therapy for

Trials. Japan Oriental Medicine Journal 54(5):939-944, 2003
22) Yasuhisa

Kaneko,Eiji

Furuya,Ayumi

plantar fasciitis. A controlled double ─ blind

Sakamoto: Effectiveness of Embedded Needles

study.

forInternational

JournalofClinicalAcupuncture 2(3): 247─253, 1991
Hosaka et al.: Limits and Responses to
TherapyforMusclePain—Placebo

Controlled Comparative Trial─. Journal of the15) Toshikazu Miyamoto, Ayumi Ishikawa, Riki
Acupuncture

Post-Triathlon

SportsNational

Japanese

Acupuncture

andMoxibustion Society 56(2): 58-165, 2006

Injuries:

Efficacy of Low Frequency Electro-Acupuncture
for Low back pain in University Sports Athletes.
Clinical Sports Medicine 17(9): 1073-1076, 2000
16) Shikegi Izumi, Toshikazu Miyamoto, Koboori
Takahiro, et al.: Low Frequency ElectroAcupuncture for Low back Pain, Training andConditioning, RDQ, JOA Score in Athletes: An
Investigation
Japaneseof

Efficacy.

National

JournalofAcupuncture

the
and

Moxibustion Society 58(5): 775-784, 200817) Kazunori Ito, Tomohiro Inoue, Yusuke Haneda
et al.: Trigger Point Acupuncture for Sports
Injury Induced Chronic Low back Pain: A
Survey Questionnaire for University Sports
AthletesontheEfficacyof

Acupuncture

Treatment. Journal of the National Japanese
Acupuncture and Moxibustion Society 55(2):142-149, 200518) Toshikazu Miyamoto, Kensuke Aoki, Sachiko
Ikemune et al.: Actual Condition of Acupuncture
Treatment for Athletes with Pulled Muscles. Ido
No Nihon 65(8): 44-48, 2006
19) Yoshida N : Muscle injury and acupuncture. Adv
Exerc Sports Physiol 15(4): 135─138, 2010

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

9Volume 7, Number 4 | Winter 2012

Kampo Medicine - Current Research
Kampo (Japanese Traditional) Medicine andGastrointestinal Symptoms in Pediatric Surgery
Keiko Ogawa-Ochiai
Associate Professor
Clinic of Japanese-Oriental (Kampo) Medicine,
Department of Otorhinolaryngology & Head and Neck Surgery
Kanazawa University Hospital

daikenchuto (Da Jian Zhong Tang), shokenchuto (Xiao
Jian Zhong Tang), inchinkoto (Yin Chen Hao Tang),
daiokanzoto (Da Huang Gan Cao Tang), hangekobokuto(Ban Xia Hou Po Tang), yokukansan (Yi Gan San),
juzentaihoto (Shi Quan Da Bu Tang) andhainosankyuto (Pai Nong San Ji Tang) with reference
to clinical trials.
[Overview of pediatric surgical diseases]

Summary
With the dramatic improvements in the prognosis ofpediatric surgical diseases indefinite symptoms related
to the digestive organs associated with prolonged
survival are now also frequently observed. For thesepatients Kampo medicines then become a powerfulchoice. Frequently used prescriptions in the field of

1) Gastroesophageal Reflux Disease (GERD)
Based on the anatomical characteristics a mild refluxfrom the stomach into the esophagus happens in all
infants. It occurs in 50% of newborn under three monthsof age and 67% of the 4-month old, but resolves often
spontaneously when the infants start to assume apediatric surgery for diseases of the digestive system

sitting position. The gastroesophageal reflux in 10% of

rikkunshito, daikenchuto, shokenchuto, inchinkoto,
daiokanzoto, hangekobokuto, yokukansan, juzentaihotoand hainosankyuto are outlined here. In order to meetcomplications.

the enthusiasm of pediatric surgeons, Kampo experts

infants under 1 year of age is said to be associated withThe

symptoms

associatedwithgastroesophageal reflux are called Gastroesophageal
Reflux Disease (GERD). A portion of these symptoms

must cooperate in efforts to search for new indications.

are due to hypoactivity of the sphincter of the lower[Introduction]

lower esophagus. Due to the still immature faculty of

The progress in medicine has dramatically improved theprognosis of pediatric surgical diseases. Associated withthis progress an increase in indefinite symptoms related
to the digestive organs due to the prolonged survival has
been

observed.

Yet,further

improvements

inpostoperative long-term quality of life (QOL) and ADL(Activities of Daily Living) still need to be achieved.
Under these circumstances the value of Kampo
medicines has received attention for their action in
adjusting the general condition of the patients.
Moreover, during daily clinical pediatric surgicalpractice, even if surgery is not required, many patientsare counseled regarding symptoms of the digestiveorgans and Kampo medicines are at that time apowerful choice. In this manuscript we will discuss first
mainly pediatric surgical diseases of the digestiveorgans and later would like to outline the frequently
used prescriptions in the field of pediatric digestivesystem diseases rikkunshito (Liu Jun Zi Tang),

10esophagus. Persistent reflux causes inflammation of the
speech of the infants, they cannot complain of heartburnand the condition may manifest as bad mood, frequentcrying, decreased appetite, abdominal pain, throat pain,
asthma, chronic cough, middle ear infection etc. Thisshows, that once these infant specific characteristics areunderstood, in cases of indefinite complaints of theupper abdomen or a variety of other symptoms, thepossibility of GERD should also be suspected. Also, since
experience has shown, that the use of Kampo medicines
in infants is comparatively safe, their application is
worth a try.
Actually, in addition to the clinically easy developmentof gastroesophageal reflux in infants, aerophagia,
constipation, frequent crying, excessive feeding of milk
and other factors may contribute to the condition.

Rikkunshito is used as the drug of choice for infants
with GERD, but when aerophagia is the main
aggravating

factor,hangekobokuto

andsimilarprescriptions can be effective. Even if the drug of choice

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

Volume 7, Number 4 | Winter 2012

is not effective, Kampo medicines may be advantageous3) Hypertrophic pyloric stenosis

if there is a next therapeutic choice.

Hypertrophic pyloric stenosis is a disease characterizedby continuous vomiting in newborn and hypertrophy of2) Anal atresia (anorectal anomaly)

the pyloric ring. Fiberscopic surgery has developed as

Anal atresia is properly called anorectal anomaly. This

curative surgery for hypertrophic pyloric stenosis andanomaly is caused by incomplete development of thethe number of cases is increasing, but there is still nourorectal septum separating the urogenital sinus andagreement as to whether fiberscopic surgery is actually

the anorectal region, persisting cloacal duct or deficientthe optimal therapy for this condition. The continuous

opening of the anal membrane. There is no sex

vomiting is considered to be due to the hypertrophic

difference in incidence rate. The condition is classified

pyloric ring, but spasms of the pyloric muscles

into a high level type above rectum and coecum, anthemselves are also a conceivable cause for the vomiting

intermediate level and a low level type. Frequently

treated with atropine sulfate. If the treatment of thisfistulas develop between the lower end of the rectum

disease with atropine sulfate is done appropriately,

and urethra on one side and the perineum on the othermost of the cases are cured1). Prior to oral

side. Approximately 70% of anorectal anomalies areadministration 6 times/day, 0.01 mg/kg is administeredcomplicatedanomaly.

intravenously and when the vomiting has stopped, theComplication of anorectal anomaly with spinal

regimen is switched to 0.02 mg/kg per os 6 times/day. A

anomalies, cardiac anomalies, esophageal atresia, renal

gradual increase in the uptake of milk paralleled by amalformation and the like are called VATER (orgradual reduction of the atropine sulfate dose led in 45

VACTER, VACTERL) association.

out of 52 patients (87%) to a cure without complications.

Presentations made on academic conferences regarding

The average duration of the hospitalization was 13 days.

Kampo treatment following surgery for anorectal

In those patients in whom the administration of

anomalies are mainly reports dealing with the use of

atropine sulfate was not effective, rikkunshito was

Daikenchuto.

reportedly effective2). There is a possibility that aManagement of bowel movements following surgery for

combination

anorectal anomalies, in particular maintenance ofimprovement.

by

some

other

form

of

therapy

may

lead

to

an

earliernormal bowel movements and toilet training, isextremely important. Measures like enemas etc. are a4) Hirschsprung's disease

great burden on the guardians and meet at higher age

Hirschsprung's disease is a congenital functionalof the children with greater resistance. It is not an

obstructive disease of the intestines where theoverstatement, that toilet training towards independent

gangliocytes of the intestinal canal are lacking from theevacuation until a time when communal life like school

anal side extending towards the mouth, impairing thestarts, will affect the future of that particular child.

peristaltic movements of the intestinal canal. The range

Examination of the development of the rectal muscleof the aganglionosis varies widely, but the prognosis

group allows to assess, whether the constipation isworsens in proportion with the size of the aganglionic

mainly of organic origin, or whether training will likely

region. The condition is classified as follows.

lead to improvement. In cases of a high probability of(1) short segment aganglionosis: the aganglionic region

improvement through training, Kampo medicines playis restricted to the sigmoid colon, 70-80％

an important role as supportive treatment promoting in(2) long segment aganglionosis: the aganglionic region

particular independent evacuation.

extends past the descending colon towards the mouth,
20％

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

11

Volume 7, Number 4 | Winter 2012(3) total colon aganglionosis: the aganglionic region(MMIHS), Chronic Idiopathic Intestinal Pseudo-Obstruction

affects the entire colon, 1-2％

(CIIP) and hypoganglionosis.

(4) extensive aganglionosis: the aganglionic region

In these diseases the regions affected by the lesions areextends into the small intestines, 2％often very large and the distribution of gangliocytes(5) ultra-short segment aganglionosis: an aganglionicthroughout the intestinal tract is not uniform.

region is observed within the lower third of the anorectal

Prolonged central venous hyperalimentation is required

canal, 4-5％.

and bowel movement management extremely difficult,

Treatment consists of resection of the aganglionic region

rendering the long-term prognosis poor. Causes of deathof the intestines. When the region affected by the

include infection of the central venous catheter and aaganglionosis is limited, the condition often runs atransition towards bacterial translocation from enteritis

favorable course. However, in conditions like (3) and (4)can lead to sepsis. Recently, transplantation of the small

marked by extensive areas of aganglionosis postsurgicalintestine has also been attempted, but the choice of

diarrhea or colonitis may easily develop and progress

donors difficult because of the strong rejection.

into septicemia and shock. Further, due to a reduction

Occasionally relevant case reports describe thatis the absorption intravenous nutrition is required overdaikenchuto was markedly effective for MMIHS ora prolonged period. The general condition and

CIIP3-5). This is highly significant. When the author

parameters including the nutritional state, electrolytes,

administered Shokenchuto to patients with CIIP in his

urinary volume etc. must therefore be carefullycare, septicemia and enteritis due to repeated central

observed.

venous hyperalimentation infections already led to the

In particular in cases of extensive resections destruction

loss of absorption from the intestinal tract and therefore,of the intestinal bacterial flora through the use ofso that the formula did not show any effects at all.

antibiotics is undesirable. However, because infants are

Through the early introduction of Kampo medicine,easily susceptible to infections, the use of antibiotics isprovided bowel movement management is possible, theoften necessary. For common cold or upper respiratory

vicious cycle of enteral infections or intestinal

infections the early use of Kampo medicine can avoid

dysfunction can be broken and there is a sufficient

the administration of antibiotics and is thus extremely

probability of improvement in the long-term prognosis.

important. The authors often use shoseiryuto or

Further investigations in this field are desirable.

kakkonto for sick children. Maoto was mostly
unsuitable following surgery of the gastrointestinal

6) Perianal abscesstract, because the condition is predominantly one ofPerianal abscesses are relatively common in outpatients"spleen deficiency". Usually administration of kenchuto

during infancy and the incidence is higher in boys. This

resembling formulas tends to result in a lower

suggests an immunological immaturity restricted to thesusceptibility to common colds. Although it is difficult toanorectal region that is characteristic of infancy6). Most

provide evidence to substantiate this claim, Kampo

cases heal spontaneously, but there may be repeated

medicine played definitely an important role in therecurrences and treatment periods often extend over

improvement of the individual conditions.

long periods. Ambulatory treatment for pain and care of
the wound etc. pose a great burden on the sick child and

5) Hirschsprung's disease related diseases

its family. In the past incision of the abscess andChronic and continuous intestinal obstruction caused byadministration

deficient or absent of normal peristaltic movements ofmainstream therapy, but the number of reports on thethe intestinal tract are refractory diseases. These include

value of using Juzentaihoto have increased7-10). It is not

Megacystis-Microcolon-Intestinal Hypoperistalsis Syndrome

an exaggeration to state, that it has already been

12of

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

antibiotics

constitutedtheVolume 7, Number 4 | Winter 2012

established as a therapeutic drug for the treatment of[Explanation of the individual formulas]perianal abscess. Juzentaihoto is compounded of

1) Rikkunshito

ginseng, cassia bark, Cnidium rhizome, Rehmanniae

For loss of appetite, early feeling of fullness during

Radix, hoelen, Atractylodes rhizome, Astragali Radix,

meals, gastric discomfort, stomach-upset and similar

glabra.

digestive symptoms found not only in adults, but also in

Examination of the composition reveals, that thisinfants. When in case of infants the food intake

formula is a combination of shimotsuto and shikunshito

continues to be low because of these symptoms, they

with the addition of cassia bark and Astragali Radix. In

may impair growth, making it necessary to achieve

addition of supplementing Qi and Blood it conceivably

improvements earlier than in adults.

also has exterior supplementing effects. In particular

The concept expressed by the general term Functional

Astragali Radix is said to have diuretic and swelling

Dyspepsia (FD), which is characterized by continuing

dispersing, internal expulsion and detoxifying actions,

epigastric digestive symptoms in adults, even if organic

which would explain the effectiveness of Juzentaihoto

diseases have been ruled out, has been proposed andfor perianal abscesses.

here too rikkunshito has received attention as one

Recently published reports describe hainosankyuto as

therapeutic

being effective during the acute phase of perianal

discharging capacity of the stomach and improves theabscesses. Also, while no clinical studies have been

adaptive relaxation of the stomach. This conceivably

published yet, there have been related reports on

results in improvement of the so-called early satiety

academic conferences. Hainosankyuto is comprised ofduring meals. The L-arginine content of this formula,

Zizyphi fructus, orange pease, peony, platycodon,
Glycyrrhiza glabra and ginger. Asada Sohaku too

providing the substrate for the nitric oxide (NO)mentioned that the effect of this formula is "due to theof the stomach, is probably related to this action11).

combination of orange pease and platycodon". By

In the period following pediatric digestive organ surgery

combining hainosan and hainoto the pus discharging

electrogastrography

action is amplified.

effectiveness of rikkunshito for epigastric indefinite

Regarding the combination of orange pease and peony

symptoms in the absence of organic diseases. Following

the "Synopsis of the Golden Chamber" (Jin Kui Yao Lue)administration of Rikkunshito (0.2 g/kg/day (tid)) for analso stipulates in the section for Kijitushakuyakuto: "foraverage of 10 months improvement of the irregularities

abdominal pain after delivery, when a person cannot lie

in gastric myoelectric activity were observed12). For thedownpathologic condition a combination therapy with the H2angelicaroot,

because

peony

of

and

Glycyrrhiza

vexationandfullness,

choice.

Rikkunshito

increasestheinvolved in causing an appropriate adaptive relaxation

reportedly

verifiedthekijitushakuyakuto will control this … and at the same

blockertime controls abscesses". This shows, that it acts to

Rikkunshito (0.2 g/kg/day (tid)) was used and after

dispel some kind of swellings by relieving muscle

disappearance of the clinical symptoms improvements

tension. During the acute phase of perianal abscessesof the irregularities in gastric myoelectric activity weretumors are formed from pus, so that discharge of thisobserved. This suggests, that a combination therapy

pus leads to healing. That is why administration ofusing famotidine and Rikkunshito possibly contributes

Hainosankyuto during the acute phase has adequate

to improvements in gastric myoelectric activities andeffects. Further investigations in this field are desirable.

the coordination of the latter13). Also, according to recent

famotidine(0.8mg/kg/day(bid))

andreports based on improvements in symptoms andesophageal pH monitoring, a decrease in the duration ofesophageal acid exposure and acid clearance time havebeen observed in pediatric patients with GERD. This

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

13

Volume 7, Number 4 | Winter 2012suggests, that treatment of GERD with Rikkunshito

Pharmacologically this formula is said to havealone too seems to be possibly under certain

peristalsis adjusting actions and increases blood flow incircumstances14). Moreover, some reports describe thatthe intestinal tract. It has been clarified, that this action

this formula improved the delay in gastric emptying

is mediated by the calcitonin gene related peptide

time in GERD after cardioplasty in children with severe(CGRP). Daikenchuto promotes the release of CGRP bypsychosomatic disorders15).

peripheral nerves, induces RAMP1, initiates generation

In the field of pediatric surgery there is frequentof large amounts of CGRP1 receptors and thereby

counseling for pediatric patients presenting with upper

increases the blood flow in the intestinal tract17). In thegastrointestinal symptoms, but in whom surgery of the

field of adult surgery it is frequently used fordigestive organs is not indicated. In these cases too

postsurgical intestinal movement disorders (ileus),rikkunshito represents an important therapeutic choice.
Then again, rikkunshito probably promotes appetite by

where it shortens the time until the first postoperative

increasing the secretion of active ghrelin16). Thus, it is

the hospital stay18). The improvement of postsurgicalalso effective for loss appetite, even if there are noileus induced by this formula is presumably due to an

obvious upper gastrointestinal symptoms.

improvement in peristaltic movements of the intestinal

From the long-term perspective, after administering

tract, which in turn is brought about but the increased

rikkunshito some effects like improved appetite,blood flow in the intestines. This formula has been

alleviation of stomach upset and epigastric bloating,reported to be useful in pediatrics for the treatment of

improvement of growth impairment and fatigue are

postsurgical adhesive intestinal obstruction or early

often observed. Prognosis can be assumed to bepostsurgical recovery from dysperistalsis19,20). Thisfavorable, when rikkunshito is continued for several

applies in particular for the use as a conservative

months, in case effects have been observed at this point

treatment for postsurgical ileus infusion of the formulaof time. It is further important to instruct the patients

through an ileus tube19,20). Additionally, it has also been

to use single doses, if symptoms should recur.

reported to improve constipation or evacuation

flatus and thus reportedly contributes to a shortening ofdisorders following surgery for anorectal anomalies in2) Daikenchuto

infants20-24) as well as chronic constipation20,24).

Daikenchuto, first mentioned in the "Synopsis of theFor

Golden Chamber" (Jin Kui Yao Lue), is a formula

Syndrome (MMIHS), a functional anomaly of thecompounded of 2 parts of Zanthoxylum piperitum, 5intestinal tract or Chronic Idiopathic Intestinal Pseudo-parts of Zingiber siccatum and 3 parts of ginseng with

Obstruction (CIIP) the available western medical

added malt extract. The source text states: "severe cold

therapies are currently limited.

pain in chest and heart, vomiting and inability to eat or

Postsurgical constipation is frequent in infants, where

drink, chilling within the abdomen, rising of Qi from thechilling of the intestinal tract is one of the causes for

abdomen to the hypochondrium, it emerges from thedysperistalsis, so that daikenchuto is the drug of firstskin and flows up- and downwards to the head and feet;choice. This does not contradict the Kampo medicalthus daikenchuto cures people suffering from pain thatconcepts pertaining to daikenchuto. Moreover, thecannot be approached or touched." Thus this formula isformula is indicated in healthy infants too, when

considered to be beneficial for conditions abdominal

chilling

pain and vomiting due to chilling and where abnormal

However, in case it should be ineffective, other Kampo

peristaltic movements of the intestines are observed informulas need to be considered.

the abdominal region.

The dose of 6 packages of daikenchuto extract per day

Megacystis-Microcolon-Intestinal

adversely

affects

Hypoperistalsis

intestinal

movements.

for adults is rather large, but this dose serves only as a

14

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

Volume 7, Number 4 | Winter 2012

rough estimate and can be increased or decreased as

the vomiting." Thus, like opening a small window on theappropriate. Since daikenchuto is a warming formula, it

north to let in a southern breeze in order to guide theshould be dissolved in hot water and then allowed to cool

obstruction in the stomach towards the excrements will

beforedifficult,prevent the vomiting caused by upsurging. Regarding

commercially available jelly, wafers or a little honey canthis usage the formula has a wide range of application

also be added.

as a Kampo medicine.

Administered for the treatment of ileus 1 package of

Pharmacologically the sennoside content of the rhubarb

daikenchuto is dissolved in 50 ml of hot water, allowed

is broken down by intestinal bacteria and after

to cool and then infused through an ileus tube. After

reduction

application of an appropriate amount and clamping therheinanthrones stimulating the colonic submucosal

ileus tube for 30 to 60 minutes the contents is released.

neural plexi in the intestinal wall to promote the

Similarly dissolved material can also be applied in form

movements of the smooth muscles. Subsequently theofcolonic

ingesting,enemas.

but

The

above

if

ingestion

described

istreatment

ismetabolized

mucosalintoepithelial

potentcells

laxative

inhibittheadministered as required once to three times a day.

phosphodiesterase activity and thereby inhibit the

Zanthoxylum piperitum, Zingiber siccatum do provide asort of warming stimulus. Since Zanthoxylum
piperitum "disperses cold dampness, but people withlung and stomach heat avert it" daikenchuto may not be

absorption of water, salts, glucose, xylose etc.25-26). The

suited in cases of heat in the intestinal tract. In terms of

movements. Compared to an application of rhubarb

Kampo medical concepts infants are considered to havealone increased tenesmus at the onset of the laxative

a purely yang body, they tend to be hotter than adults

action can be significantly inhibited when using

and therefore daikenchuto is rarely indicated in healthy

daiokanzoto26,27). Moreover, renal function is also

infants. Accordingly, it happens that while daikenchuto

improved and without affecting urinary pH a marked

had been effective during postsurgical recovery, theincrease in urinary output and electrolyte (Na, Cl)

infants suddenly cannot tolerate it any longer. In thisexcretion has been observed. The tanine content ofcase it can be necessary to temporarily discontinue therhubarb increases renal blood flow and the glomerularadministration or switch to a different formula. It must

filtration rate, leading to an improvement in renal

not be forgotten, that the condition of the bodyfunction26-28).

constantly changes.

There are only few reports on the use of daiokanzoto fortransport capacity of the small intestine is not affected,
so that the amount of feces and its water content
increase dose independently and thereby promote bowel

infants, but it has been reported useful for severe
3) Daiokanzoto

constipation in school children29) and reportedly be

In the "Synopsis of the Golden Chamber" it says: "foreffective in 56% of patients with constipation following

people who immediately vomit on eating, daiokanzoto

treatment for Hirschsprung's disease30). As stated above,

controls the condition". It is used for a condition, wherein cases of constipation in infants after surgery or

people vomit immediately after meals due to poor flow

diseases daikenchuto is the drug of first choice. Thisin the intestines. Also, the entry pertaining tohappens often when in healthy infants changes in

Daiokanzoto"Butsugodietary habits led to a febrile syndrome of the viscera,

Yakushitsu Hokan" reads: "when there is no desire fori.e., separation of clear and turbid elements in the colon

the so-called 'southern fume' of this formula, you must

is not processing smoothly. In this case this rhubarb

first open the 'northern lights', meaning that thecontaining formula should be taken into consideration.

stomach content closed up in the stomach must be

Concretely, it is considered useful when patients

guided as stool to prevent it from upsurging and to stop

complain of accumulation of scatomas in the colon,

in

Asada

Sohaku'stext

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

15

Volume 7, Number 4 | Winter 2012

constipation due to hardened feces, abdominal pain due

Also, adult cases of delayed onset hyperbilirubinemia

to the accumulation of feces or vomiting or else

following liver transplantation with small-for-size grafts

decreased appetite. Moreover, even if daikenchuto isalso suggest the possibility, that Inchinkoto will lead touseful, occasionally combination with daiokanzoto

improvements. In the field of pediatric surgery too theallows the treatment form so eloquently described as

number of liver transplants for the treatment of biliary"when there is no desire for the so-called southern fumeatresia is increasing and applicability of this formula inof this formula, you must first open the northern lights".

infants seems conceivable.

4) Inchinkoto

Conclusions

Inchinkoto has first been mentioned in the "Treatise on

Kampo therapy too is about to develop into an

cold-induced diseases" (Shang Han Lun) and "Synopsis

established therapeutic choice in the field of pediatricof the Golden Chamber" and is compounded of threesurgery. This can also be interpreted as a manifestation

crude drugs, namely of 3 parts of Artemisiae capillarisof the enthusiasm with which pediatric surgeons use

flos, 1 part of rhubarb and 4 parts of gardenia.

those choices, as long as they lead to improvements in

Pharmacologically, the gardenia constituents iridoid

their patients. Kampo expert physicians should

glucoside geniposides and the intestinal metabolite

cooperate in order to investigate new indications andGenipin have a non-bile acid dependent cholagogic

thus respond to the aforementioned enthusiasm. Since

action, activate a bilirubin transporter (multidrug

individual differences are particularly marked inresistance-associatedtheinfants, the therapy for each individual patient must be

Artemisiae capillaris flos constituent dimethylesculetin

considered separately. If that is done, still greater

reportedly has a relaxing action for the sphincter ofdevelopments are expected to be accomplished for

Oddi31,32). Also, in rat models of hepatic fibrosis the

Kampo therapy in the field of pediatric surgery.

protein:Mrp2),

while

concentration of liver hydroxyproline, serum hyaluronic
acid increase, the expression and activation in hepatic

Referenceextracellular matrix (type III procollagen mRNA)

1)

Kawahara Hisayoshi, Takama Y, Yoshida H, etincreases while the proliferation of activated Kupfferal.: Medical treatment of infantile hypertrophic

cells is inhibited, thereby allegedly inhibiting thepyloric stenosis: should we always slice thedevelopment of hepatic fibrosis33).

"olive"? J Pediatr Surg 40(12):1848-51,2005

Cases of clinically effective treatment of patients with

2)

Noboru Oyachi, Takano K, Hasuda N, et al.:delayed postsurgical biliary atresia, recurrent icterus,

fects of rikkunshito on infantile hypertrophic

liver function failure with Inchinkoto have been

pyloric stenosis, refractory to atropine. Pediatr

reported34-37). Following administration of Tsumura's

Int: 50, 4, pages 581–583, 2008

Inchinkoto extract for a period of 2 to 4 years after3)

Hirakawa Hiroshi, Ueno S, Matudara H, et al.:surgery for the treatment of pediatric postsurgical

Effect of the herbal medicine daikenchuto on

biliary atresia, improvements in serum GOT, GPT, γ-

gastrointestinal

GTP and hyaluronic acid levels were observed. While

megacystis-microcolon-intestinal

similar improvements of serum GOT and GPT over time

hypoperistalsis syndrome (MMIHS) and chronic

were observed in non-treated patients too, the serum γ-

idiopathic intestinal pseudo-obstruction (CIIP):

GTP and hyaluronic acid levels did not improve overreport of two cases. Tokai J Exp Clin Med.

time. This confirmed liver protective and anti-liver

20;34(1):28-33, 2009

fibrotic effects of Inchinkoto35).

4)

motilityinpatientswith

Tetsu Yamazaki, Masayuki Kuboto, Minoru Yagi:
Attempt at improving intestinal movements with

16

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

Volume 7, Number 4 | Winter 2012

5)

Kampo medicines in patients with CIIPS and

13) Tatsuta Miwa, Ishii H: Effect of treatment withMMIHS. Journal of the Japanese Society of

Liu-Jun-Zi-Tang (TJ-43) on gastric emptying andPediatric Surgeons, Vol. 41, No. 3, 571, 2005

gastrointestinal symptoms in dyspeptic patients.

Hiroki Kakita, Koichi Ito, Wakato Koide et al.: A

Aliment Pharmacol Ther 7: 459-462, 1993

case

6)

daikenchuto

where

was

effectivefor

Effects

Syndrome. Journal of the Japan Society ofsymptoms and esophageal acid exposure in

Perinatal and Neonatal Medicine, 40: 863-867,

children with symptomatic

2006

reflux. Pediatr Surg lnt 23: 1001-1005, 2007

9)

of

on

the

clinicalgastroesophageal

Shiro Sasaki: Research into causative factors for15) Hiroaki Kuroda, Yasuyuki Higashimoto, Jun Iwai:

anal fistulae in infants, centering on clinical

GER and Kampo - Examinations employing RI

immunologic

methods. Pediatric surgery,37: 279-283, 2005

examinations.

Journalofthe16) Takeda Hiroaki, Sadakane C, Hattori T et al.:1115, 1988

Rikkunshito, an herbal medicine, suppresses

Toshiki Ohya, Usui Y, Okamoto K, et al.:cisplatin-induced anorexia in rats via 5-HT2

Management for fistula-in-ano with Ginseng

receptor antagonism. Gastroenterology

and Tang-kuei Ten Combination. Pediatr Int 46;

2004-2013, 2008

1: 72–76, 2004
8)

riltkunshito

Megacystis Microcolon Intestinal Hypoperistalsis

Japanese Society of Pediatric Surgeons, 24;5: 11017)

14) Kawahara H, Kubota A, Hasegawa T et al.:1:17) Kono Toru, Kanematsu T and Kitajima M.:

Toshinori Muramatsu, Elena Terai: Juzentaihoto

Exodusfor perianal abscesses an anal fistulas. Pediatric

medicine,

surgery, 37, 311-315, 2005

alternative medicines: is it time yet? Surgery.

Reiko Oshima, Takashi Sasaki, Shinsuke Hata et2009 Nov;146(5):837-40. Epub 2009 Jul 29.

al.: Examination of the effects of Juzentaihoto for18) Yasuro Kabeshima, Yoko Takahashi, Tetsuaki

perianal abscesses an anal fistulas. Journal of the

Kameyama et al.: Examination of postsurgicalJapanese Society of Pediatric Surgeons, 45:5, 830-

rehabilitation in patients after surgery for

834, 2009

colon

of

Kampo,
fromcancer.

theThe

traditional

Japanesecomplementary

Japanese

Journalandof10) Koji Masumoto, Yoichiro Oka, Akitoshi Nakamura

Gastroenterological Surgery, 38: 592-597, 2005

et al.: Experiences with long-term administration

19) Nobuko Kurosaki, Shuichi Ashizuka, Masayukiof Juzentaihoto for the treatment of pediatricOhata et al.: Experiences with using daikenchuto

perianal abscesses. Clinic and Research, 87:8;

for pediatric postsurgical adhesive ileus. Prog in

1164-1167, 2010

Med 16: 1180-1184, 1996

11) Hayakawa Takamasa, Arakawa T, Kase Y et al.:20) Tomoaki Taguchi, Koji Masumoto, Sachiyo Suita:

Lin-Jun-Tang, a kampo medicine, promotes

Postsurgical evacuation disorders and Kampo –adaptive relaxation in isolated guinea pig

Regarding the usefulness of daikenchuto forstomachs. Drug ExP Clin Res 25: 211-218, 1999

pediatric surgical diseases. Pediatric surgery, 37:

12) Yagi Minoru, Homma S, Kubota M et al.: The

295-299, 2005

herbal medicine rikkunshito stimurates and21) Takanori Nakatsuchi, Junko Akiyoshi, Satoshi

coordinates the gastric myoelectric activity in

Ieiri et al.: Regarding the usefulness of daikenchuto

postoperative

for pediatric postsurgical evacuation disorders.

dyspeptic

childrenafter

gastrointestinal surgery. Pediatr Surg lnt 19:

Pediatric surgery, 40: 195-199, 2008

760-765, 2004

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

17

Volume 7, Number 4 | Winter 201222) lwai Naoya, Kume Y, Kimura O et al.: Effects of31) Shoda Junichi, Miura T, Utsunomiya H, et al.:herbal medicine daikenchuto on anorectal

Genipin enhances Mrp2 (Abcc2)-mediated bilefunction in children with severe constipation.

formation and organic anion transport in rat

Eur Pediatr Surg 17: 115-118, 2007

liver. Hepatology: 39: 167-178, 2004

23) Toshiki Otani, Yoshiko Usui, Hiromi Inoue et al.:32) 0kada Kousuke, Shoda J, Kano M et al.:Effects of daikenchuto for pediatric constipatorylnchinkoto, a herbal

disease. Pediatric surgery, 37: 300-304, 2005

ingredients dually exert Mrp2/MRP2-mediated24) Toshinori Muramatsu, Kenji Kawamura, Yutaka

choleresis and Nrf2-mediated antioxidative

Kuriyama et al.: Therapeutic usefulness ofaction in rat livers. Physiol Gastrointest Liver

Daikenchuto for the treatment of pediatric chronic

Physiol 292: 1450-1463, 2007

medicine, and its

constipation – employing the constipation score for33) Sakaida Isao, Tsuchiya M, Kawaguchi K et al.:the evaluation. Pediatric surgery, 32: 285-290, 2000

Herbal medicine lnchin-ko-to (TJ-135) prevents

25) Tsurumi K, Nozaki M, Fujimura H: Cathartic

liver fibrosis and enzyme-altered lesions in rat

action of sennoside. Jpn J Pharmacol 26: 152,

liver cirrhosis induced by1976

amino acid- defined diet. J Hepatol 38: 762-769,

26) Takeda S, Kase Y, Hayakawa T et al.: Generalpharmacologicaldaiokanzoto.

properties of27) Yagi Teruyo, Yamauchi K: Effects of daiokanzotocolonic

circularmuscle200334) Yamashiki Masayoshi, Nishimura A, Takase K
et al.: Effects of the Japanese herbal medicine

Pharmacometrics 63: 79-91, 2002
on

a choline- deficientmotility

in

conscious rat. Role of glycyrrhiza in theprescription. Trad Med 18: 191-196, 2001

“lnchinko-to”(TJ-135)

on

in

vitro

INF-

reproduction of peripheral blood mononuclear
cells. Gut 35: 49, 199435) Iinuma Yasushi, Kubota M, Yagi M et al: Effects

28) Yokozawa Takako, Fujioka K, Oura H et al.:of the herbal medicine lnchinko-to on the liver

Effects of rhubarb tannins on renal function infunction in post-operative patients with biliaryrats with renal failure. JPn Nephrology 35: 13-

atresia-A pilot study. J Pediatric Surg 38: 1607-

18, 1993

1611, 2003

29) Kishiro Nagata, Jin Seiei: One clinical case of36) Kobayashi Hidefumi, Horikoshi K, Yamataka A

refractory

et al.: Beneficial effect of a traditional herbal

pediatric primary nephrotic syndrome. Journal of

medicine (inchinkoto) in postoperative biliary

The Japan Society for Oriental Medicine, 49: 257-

atresia patients. Pediatr Surg Int. 17:386-9,

271, 1998

2001.

Kampo

30) Shigeo

medicineapplication

Tabayama,

HiroyukiforKanazawa:37) Tamura Tsuyoshi, Kobayashi H, Yamataka A et

Experiences with the use of daiokanzoto for theal.: Inchinkoto prevents medium-term liver

treatment of constipation following surgery forfibrosis in postoperative biliary atresia patients.

Hirschsprung's disease. Journal of the JapanesePediatr Surg Int. 23(4):343-7, 2007

Society of Pediatric Surgeons, 30: 579, 1994

18

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

Volume 7, Number 4 | Winter 2012

Clinical Report 1 (Acupuncture)
A Case Where Blood Letting was Effective for Health
Problems Following Multiple Traffic Accidents
Takara Yamami

induration. Adding edema to those images thefindings of pressure hypersensitive indentation,pressure hypersensitive bulging, congestion, fine
floating vessels, edema are confirmed.

Ehime Prefectural Central Hospital,
Institute of Oriental Medicine
Basic therapeutic concepts

Introduction

Sequential analysis(temporal
recognition)

At the Ehime Prefectural Central Hospital, Instituteof Oriental Medicine we diagnose conditions basedon sequential and point location reaction analyzes.

Point location
reaction analysis(spatial
recognition)

Following the diagnosis we then apply traditional
Oriental medical techniques with reference to the

Traditions frompredecessors(Sawada style,
Fukaya style, Kudo
style, classics)

traditions handed down by our predecessors (mostly
Ken Sawada, Isaburo Fukaya, Kunisei Kudo, Domei
Yakazu) (Figure 1). The sequential analysis allows

Diagnosis / systematic
pattern classification

comprehensive assessment of the patients mainly
based

on

his/herlife

history

andfacilitates

understanding any health disorder related factors
up to the time of the patient's first visit. The analysisof reaction at the point locations confirms findings
obtained through inspection and palpation andcompares these to the signs. Regarding the point
location findings and acupuncture and moxibustion
treatment we refer mainly to the classics centering
around the "Compilation of the Twelve Principles of
the Nine Ancient Needles", emphasizing pressure
hypersensitive indentation, pressure hypersensitive
bulging, congestion, fine floating vessels, edema andsimilar findings and then administered techniques
likemoxibustion,acupuncture

andvesselpuncturing.
For images of the acupoint findings described mainlyin the "Compilation of the Twelve Principles of theNine Ancient Needles", where it says "凡用鍼者、虚則実之、満則泄之、宛陳則除之、邪勝則虚之。"
deficiency states are identified by the character "員=yuan", which here indicates images of depression
and softening. Conditions described as repletenessor fullness are associated with congestion. The term
宛陳 = wan chen refers to fine floating vessels. A
state of prevailing evil is described as " 方 = fang"
and associated with images of bulging, swelling andApplication of traditional
medical techniques

Figure 1

Regarding acupuncture and moxibustion treatment
moxibustion serves as an excess technique. Further,regarding the needling technique the text says: "徐而疾則実": meaning the needles are slowly inserted
and quickly withdrawn, while "呼盡内鍼・候吸引鍼・推闔其門" means that the needles are inserted at
maximum expiration and withdrawn after waiting
for the inspiration, after which the insertion site of
the needles is massaged with the fingers to close theneedling hole; listed as a technique also considered
to be an excess technique (named: excess roundneedling). Next I would like to consider vessel
puncturing at the well points and skin vessel
puncturing as a form of purgative method and fine
floating vessel puncturing as an elimination method.
As a deficiency method "疾而徐則虚" the needle isquickly inserted and slowly withdrawn in case of
deficiency, "吸則内鍼・吸則轉鍼・候呼引鍼・呼盡乃去":describing that the needles are inserted duringinspiration, twirled also during inspiration andwithdrawn after waiting for the expiration so thatthe needle is completely withdrawn when the
expiration has been completed. This too is a
deficiency technique (named deficiency needling).

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

19

Volume 7, Number 4 | Winter 2012

Moreover, in our institute we add as an excess

but the other children are independent and he now

method warming needles and as a deficiency method

lives only with his wife.

skin vessel puncturing.

The diagnosis derived from the sequential analysis

The patient visited out clinic with chief complaints

showed a correlation between the onset of healthof health impairments (neck and shoulder stiffness,

problems and multiple accidents, marriage, wife's

dull headaches, low back pain, numbness of the left

pregnancy and birth, newly-built house and trouble

leg and left arm etc.) following traffic accidents. I

with the neighborhood, inferring a decreased

report this case here, because the treatment

resistance to blood stagnation and mental stresspresumably contributed to an improvement of theinduced health impairments.

QOL.

Regarding the sequential analysis both modern
Western as well as Oriental medical assessments are

Patient: 52 years, male, local public service employee

important and here in particular comprehension of(road and infrastructure maintenance).

the correlation between life events and healthimpairments. It is in this context important to[Sequential analysis]

understand what the patient thought at the time theChief complaints were neck and shoulder stiffness,

events occurred and how he behaved, how hedull headaches, low back pain, numbness of the leftinteracted with family members and society andleg and left arm etc. that occurred following traffic

imagine what happened to the family based on those

accidents. At the age of 51 he was hit by a car in a

results. Also, it must not be forgotten to take thehead-on collision while riding a motorcycle, themental state of the patient into account.

impact rendering him unconscious. The results of CT
and x-ray imaging did not show skull injuries,[Point location reaction analysis]

fractures or ruptures of internal organs and he was

Checking the reactions mainly at the site of the backdiagnosed with "rupture of the left biceps brachii

transport point, abdominal alarm points, sea points,

muscle" and whole body contusions. Starting aboutsource points. It is important to reduce prejudices

one month after the accident neck and shoulder

and confirm the reactions at the point locations

stiffness, dull headaches, low back pain, numbness

open-mindedly.

of the left leg developed. After a period of half a year

Pressure hypersensitive indentation (α) was found at

suddenly numbness of the left arm developed.

GV12, GV11, BL11, SI11 (left), BL45, BL20, BL23,

Currently, when he passes the accident site on his

BL52, BL25, CV4. Pressure hypersensitive bulging

way to work with his car, the dull headache(β) was found at BL10, GV13 (left), from TE15 –increases in intensity and continues until noon. For

BL43, BL17 – BL18, ST19 – LR14, ST36, LI11.

that reason he reported driving to be trying.

Edema (γ) was found at GV20. Fine floating vessels

Also, looking back at the patient's past life showed,(δ) were observed from GV12 – GV11, BL11 (left),that he had met with accidents at the age of 6, 18, 19,

TE15 (right), TE14, SI10 (right), GV6, GV3, from the

37 and 48 years, leading to health impairments. He

greater trochanter down to the vicinity of GB31,

married at 25, between 26 and 31 his children werebehind GB34 (left), anterior chest. Point location

born; at 39 he had a new house built and ran into

reactions like congestion (ω) was confirmed at GV20,

trouble with the neighborhood. Here too healthin posterior region of the neck and similar locations.

problems

theBased on the diagnosis derived from point reaction

mentioned events. The third son is still a student,

location analysis, the extensive development of finedeveloped

simultaneously

withfloating vessels and the mental status the reactions

20

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

Volume 7, Number 4 | Winter 2012

found at GV20, upper governing vessel, BL17-18,

puncturing of deficiency bulging performed both

ST19 – LR14 suggested that the development ofduring the 7th treatment improved the low back pain

blood stagnation and a decreased resistance toand numbness of the leg.

mental stress had probably induced the healthApproximately 2.5 months following the first visit

impairments (Figure 2).

(completion of one treatment set) all chief complaints
were rated as "B". After 8 months (completion of twotreatment sets) the chief complaints were rated aseither "A" or "B". Moreover, symptoms other thanthe chief complaints had also improved (Figure 4).

[Acupuncture and moxibustion treatment]
The diagnosis based on sequential and point location
reaction analyzes coincide so that we treated points
at which blood stagnation and mentally induced
reactions were found. We punctured the fine floating
vessels at BL11 (left), GV12, GV6, GV3, GB31 (left),behind GB34 (left). Puncturing of indurations was
performed at BL17. Tonifying puncturing was
performed at GV12. We instructed the patient totreat himself with moxibustion at home at BL11,
BL13, BL11, SI16 (left), BL20, BL52, BL25, LI11,
ST36. The acupuncture and moxibustion treatment
based mainly on the above described pattern was
performed at a rate of once every 2 to 4 weeks. The
Kampo formula Saibokuto 7.5 g was also prescribed(Figure 3).
[Course][Discussion]

During the 4th treatment we added puncturing of

The sequential and point location reaction analyzes

indurations at BL43, during the 7th treatment also

showed blood stagnation (fine floating vessels) andpuncturing of indurations at TE15, BL17, which led

traumatic injuries from multiple accidents, theto improvements of the neck and shoulder stiffness,pooling of stagnant blood subsequently resulting in

numbness of the left arm and dull headache. Vessel

liver injury which then in turn led to thepuncturing of fine floating vessels at GV3 anddevelopment of the chief complaints associated withThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

21

Volume 7, Number 4 | Winter 2012

psychological symptoms. The sequential and point
locationreactionanalyzes

facilitatedacomprehensive understanding of the patient and theadministration of the acupuncture and moxibustion
treatment, but except for the chief complaints it was
not considered to relate to improvements in the othersymptoms.

Theacupunctureandmoxibustion

treatment corresponding to the findings at the point
locations had presumably been very effective forrelieving the symptoms.
[Conclusions]
The goal of medical care people are seeking is toswitch from therapy towards an improvement in
QOL.

The

improvements

treatment
inofdiseasesfunctional

leads

disorderstoanddisabilities and we believe people are looking for allinclusive improvements of interferences with dailyliving. For that reason the problems should not beapproached using the skills of individuals, but rather
be subject of a team approach (Figure 5).

22

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

Volume 7, Number 4 | Winter 2012

Clinical Report 2 (Kampo Medicine)
Maobushisaishinto for Non-dipper Hypertension

Narihiro Fujii
Tokando Medical Clinic

Other symptoms:

Sensitivity

to

cold

(–),

Sensation of warmth (–)
Present illness:
Height: 169cm; Weight: 72kg; BMI: 25.2
Anemia (–); Edema (–)

Case

69-year-old male

Chief complaint

Non-dipper hypertension

regular

Past medical history

not particular

Stethoscopy and tapping found no particular

Family history

Hypertension (-);

abnormality

Father: prostrate cancer;

Good complexion, light pink tongue with a light,

Mother: gastric cancer

dry coating

Smoking: 10 cigarettes/day

Pulse: On the right, inch-bar-cubit is stable anduntil 2008, thereafter quit.

slightly string-like; on the left, inch-bar is stable

Drinking: Occasionallyand slightly string-like, and cubit is slightly

Social history

History of present illness:

Blood pressure: 130/70mmHg; Pulse: 55/min,sunken.

The patient visited our clinic on 5/25/XXXX after

Abdominal examination: Ventral horn – moderate;

experiencing occasional staggering. He had a blood

Abdominal pressure 3/5; Epigastric fullness (–);

pressure of 185/110mmHg in his right arm andChest side painfulness (left and right 1+);

175/100mmHg in his left. He underwent a complete

Splashing sound in epigastric region (–);

medical

Palpitation (–); Weakness (+)

checkup

every

year,

but

was

never

questioned about blood pressure. He weighs 69kg,
marking an increase of 2kg from the previous year.

Blood biochemical examination: No particular
problem

He underwent an endocrine examination but noProgress: The noctural rise in blood pressure wasparticular problem was detected. He was prescribedseen as poor prognosis, so Maobushisaishinto 5g

an oral medication of valsaltan(80)1T, and was told

was administered on 7/6 to improve nighttime

to record his blood pressure at home. As a result, hisblood pressure.

nighttime blood pressure was found to be high,No subjective complaint from the patient

indicating non-dipper hypertension. In winter, hishimself. A re-examination on 8/6 showed noweight increased to 72kg, his blood pressurechange in the rise and drop in blood pressure,increased at home, and his systolic blood pressure

but blood pressure pattern changed from a non-measured 150-160mmHg. His antihypertensive drug

dipper to a dipper pattern (Fig. 1).

was thus switched to valsaltan + trichlorotiazide

Flow of the defense qi

MD1Tab on 12/24. With a blood pressure of 115 –Physiological condition: The defense qi is produced

135/90-70mmHg, he continued to display non-dipper

from the hydration shell in the lienogastric artery,

hypertension. He continued the oral administration,and flows through the entire body. It flows aroundand returned to the clinic on 7/6/XXXX+1.

the Yang parts of the body during the daytime andAppetite:

Ordinaryaround the Yin parts during the nighttime (Fig. 2),

Bowel movement:

Once a day; no change

and flows through the entire body 50 times in a day.

Bladder movement: 6 – 8 times, once during theThat is, it flows through the Yang parts 25 times

nightduring the daytime and through the Yin parts 25

Goodtimes during the nighttime. It then flows throughSleep:

the five organs.

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

23

Volume 7, Number 4 | Winter 2012

Fig. 1: Non-dipper hypertension changed to dipper hypertension by administering
Maobushisaishinto

Fig. 2: Flow of the Defense Qi – 1 of 2
Fig. 2: Flowof the Defense Qi – 1 of 2

Morning

Liver

Hands & feetFootshaoyin

Kidney &bladder

Middle yang Lateyang Early yangNight

Daytime: Surface of bodyLungs &
large
intestines

Nighttime: Inside ofbody
Cited from Mechanism of the Yellow
Emperor's Inner Classic

Fig. 3: Flow of the Defense Qi – 2 of 2

24

At dawn, the defense qi finishes circulating throughthe Yin parts and is discharged through the eyes as
Yang qi. This makes people open their eyes and wakeup.
This Yang qi flows along the bladder meridian tothe little toes.
The Yang qi that separates from the outside of theeyes flows along the small intestine meridian to thelittle fingers. From the outside of the eyes, it mightalso flow along the gall bladder meridian to the fourth
toe, then up along the triple energizer meridian to thetips of the fingers.
The Yang qi that is discharged from thepreauricular area flows along the stomach meridian
down to the toes. The Yang qi that is discharged fromthe parotid flows along the large intestine meridian to
the fingers.
Of the above, the Yang qi that reaches the feet flows
from the soles to the kidney meridian channel at themedial malleolus. From here, it flows along thekidney meridian to the kidneys, and from the kidneys
to the heart, lungs, liver, spleen, and kidney, where it
completes its round of the Yin part and once again
flows out through the eyes and around the Yang parts.

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

Volume 7, Number 4 | Winter 2012Conclusion
High

blood

pressureduringthenighttime

improved with maobushisaishinto. The exterior
defense qi pattern cannot be evaluated subjectively,
but there are clearly symptoms that can be improved
with maobushisaishinto. If maobushisaishinto could
improve the exterior defense qi pattern, it could also
be used for other diseases.

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

25

Volume 7, Number 4 | Winter 2012

Medical History in Japan
Historical Significance of the Standardization of Acupoint
Locations”, the Second Japanese Acupoint Committee (8)“Detailed Guide to the Location of Acupoints” from the calssics
to the WHO standardization”, pp411-422, Tokyo, Ishiyaku
Publishing, June 2009 (partially revised)

8. Modern spread throughout the world and fourth

Makoto Mayanagi

characters. However, depending on the degree ofGraduate School of Humanities

emphasis on the classics as well as employed

Ibaraki University

techniques and tools, these differences and thestandardization by the WHO
The third standardization by the Song government
had varying degrees of influence on the Yuan, Mingand Qing periods as well as in the individual
countries within the culture sphere using Chinese

accumulationofclinical

experiences

led

in

(continued from KAIM Joural vol.6 no.1, no.2, no.3,

postmodern times to extensive fluctuations between

no.4, vol.7 no.1, vol.7 no.2 and vol.7 no.3)

the individual texts in the various countries, in

7. Yuan, Ming, Qing periods and the influence on andchanges within the Chinese character culture area
The

Jin

editionof[Newlypublishedwithsupplementary notes] Tóng Rén Shù Xué Zhēn Jiǔ
Tú Jīng has been reprinted during the Yuan period
at least once. Further, it is also known that the Ming
government allowed to make rubbed copies of the"NewlyCast

BronzeFigureIllustrationofAcupuncture and Moxibustion" stone relief, butduring the Ming and Qing periods numerous books
entitled "Bronze Figure" were published and became
popular. Thus the bronze figure or the Ming Tong
came

to

be

representative

names

for

books

illustrating meridians and acupoints, but on theother side led to the development of differences
between the various books. The Korean government
reprinted, based on the Jin edition of [Newly
published with supplementary notes] Tóng Rén Shù
Xué Zhēn Jiǔ Tú Jīng, the Chonghua Yuzhi’an
Qinyoushutang edition four times which presumably
continued to exert a considerably influence. On theother hand, in Japan the Ming edition has beenreprinted during the early Edo period only once andthus had not as much influence as the "Elaborationof the Fourteen Meridians" (Shi Ji Jing Fa Hui), thathas been reprinted as many as 17 times [18].
Currently, examination of about 500 Vietnamese
ancient medical texts by the author did not allow todemonstrate any direct influence of the Tóng Rén
Shù Xué Zhēn Jiǔ Tú Jīng.
26

particular regarding acupoint locations.
Today, with the support of the WHO, acupuncture
and moxibustion has developed to the point, where it
plays an important role in the global medical care.
The WHO began around 1980 within the frameworkof a traditional medical program its attempts atstandardization of acupoints. In 1991 the Western
Pacific Office published the "WHO International
Standard Terminologies on Traditional Medicine in
the Western Pacific Region". The Part 1 of this work
is based on the Tensei or Tiansheng bronze figure of
the Song period, while The Chinese Academy of
Sciences uses a picture of a replica of the Ming periodbronze figure manufactured by Professor Ma jixing,
and in Part 2 a picture of the bronze figure in thepossession of the Tokyo National Museum is used.
However, at that point the determination ofstandardized expression of meridians and acupoints
reached a limit. And in 2006, after repeateddiscussions researchers from Japan, China andKorea completed an international standardization of
acupoint locations.
Conclusion
Meridians and acupoints as the framework for
acupuncture and moxibustion medicine have beenstandardized on a conceptual first level. The second
level was standardization on the theoretical level,
the third one a standardization on a national level.
In order to establish logically unified concepts for the

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

Volume 7, Number 4 | Winter 2012a[6] Institute of Archaeology, Chinese Academy ofchanges

Social Sciences, Cultural Relics Institute Hebei

obtained through experiences and the relevant

Province Mancheng Hanmu Fajue Baogao, Vol.2,

deducted concepts can be said to have been

Beijing, Wenwu Chubanshe, 1980

performed within an expanding scope of this history.

[7] Makoto Mayanagi: Acupuncture physician with a

However,hadhuman face and a bird's body － from a second

subjectively been unified logically, still remained

century stone relief, Journal of Kampo Medicine, Vol.

hidden behind a pseudo-scientific veil but was not

41, No. 4, pp 462-464, 1994

yet science. Ultimately, it was inevitable that[8] Kitazato University Oriental Medicine Researchdifferences will emerge later on.

Center, Research Department for Medical History,

discovered

phenomena,

theoreticalunification

this

very

and
to

furthermore

generalize

process,

even

if

it

“Shouhin Hou, or Xiaopin Fang, Koutei Daikei
Yet, through the standardization of the locations on

Meidou, or Huangdi Neijing Mingtang, Koshouhon

this occasion objectivity has been added and led to

Zankan, or Guchaoben Canjuan”, p.23, Tokyo,

the fourth standardization on a global level. It is

Kitazato University Oriental Medicine Researchprecisely the reflection on these first to fourthCenter, 1992

standardizations that shows a typical example of the[9] Author: Chen cunren, translation: Hitotonari

history related to the transmission of traditional

Okanishi: History of Chinese Acupuncture andskills to the present that then further develop,

Moxibustion (1), Journal of Kampo Medicine, Vol. 3,

deepen and spread as a firmly established scientificNo.12, p. 56, 1956

technique.

[10] Huang longxiang “Huangdi Mingtangjing Jijiao”,
Beijing, Zhongguo Yiyao Keji Chubanshe, 1988

References[11] Japan Nei Jing Medical Society, "Huang Di Ming

[1] Mawangtui Hanmu Boshu Zhengli Xiaozu,

Tong Kong, Tokyo, Kitazato University Oriental“Mawangtui Hanmu Boshu (4)”, Rewritten andMedicine Research Center, Research Department forannotated pages 3-4, Beijing / Wenwu Chubanshe、Medical History, 1999

1985

[12] Yasunori Tamba: "Ishinpo", Vol. 22, Gynecology,[2]

MakotoMayanagi,

Book

Review,

Tokyo, Chuzaburo Ogino, 1937

“Mawangtui Hanmu Boshu (4)”, Journal of the

[13]

Cong

chunyu,JAPANESE SOCIETY FOR THE HISTORY OF

Quanshu”,

p200-211,

MEDICINE, Vol. 33, No. 2, pp 272-274, 1987

Chubanshe、1994[3] Li jianmin, “Shengming Shixue － Cong Yiliao[14]

kan Zhongguo Lishi”,

Acupuncture and Moxibustion Classics – Invitation

pp21-97, Taipei / Sanmin

Toshiaki“Dunhuang
Beijing,Maruyama:

Zhongyiyao

ZhongyiGuji"Introduction

toShuju, 2005

to Chinese Traditional Medicine", pp 159-170, Kyoto,[4] Makoto Mayanagi: "Black lacquered wooden doll

Shibunkaku Co., Ltd., 1987

unearthed from a tomb of the early Han period",[15] Hiroshi Kosoto: Manufacturer of the bronze

Journal of Kampo Medicine, Vol. 43, No. 7, pp 1386-

figure in the Tokyo National Museum and its

1388, 1996

manufacturing date – historical facts about the[5] Author: Chen cunren, translation: Hitotonari

shogunate medical officer Yamazaki – " Journal of

Okanishi: History of Chinese Acupuncture and

the JAPANESE SOCIETY FOR THE HISTORY OF

Moxibustion (1), Journal of Kampo Medicine, Vol. 3,

MEDICINE, Vol. 35, pp 140-142, 1989

No. 12. p. 60, 1956

[16] YU ke, “Kaogu”, 6th period, 1972

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

27

Volume 7, Number 4 | Winter 2012[17] Hiroshi Kosoto: (original edition) "Tóng Rén Shù
Xué Zhēn Jiǔ Tú Jīng", Journal of Kampo Medicine,Vol. 41, No. 9, pp 1146-1148, 1994[18] Makoto Mayanagi: "With Japanese printing
blocks reprinted Chinese medical books since theEdo period", Keiji Yamada, Shigehisa Kuriyama:"Disease and Medicine in History", pp 301-340,
Kyoto, Shibunkaku Co., Ltd., 199728

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)Make the most of Kampo in modern medicine

Foundation: 1905
A century of tradition ――――We are a manufacturer consistently controlling the entire process fromthe import of crude herbs to the manufacture of Kampo extracts and assuch have contributed to the development of Japanese Kampo.
We sincerely hope to continue in the future with our contribution tomodern medicine through "Kampo".

OHSUGI Pharmaceutical Co., Ltd.

1-1-2 Tennojicho, Minami, Abeno-Ku, Osaka, Japan
Phone: +81-6-6693-3301

The crude drugs like many other creatures on earth areraised by bountiful NATURE.
Humankind earns as well grace from Mother Natureand is blessed as a member of natural world.
PROFILE of

TOCHIMOTO

Since Tochimoto was appointed as aJapan-China friendship trading firm in
1963, we have expanded our businessoverseas, mainly with China.
We import a variety of quality-controlled
natural resources from all over the world
for maintaining wellness.

TOCHIMOTO TENKAIDO CO., LTD.
3-21 Suehiro-cho, Kita-ku, Osaka 530-0053, JAPANwww.tochimoto.co.jp