KAIM
T
Thhee JJoouurrnnaall ooffK
Kaammppoo,, A
Accuuppuunnccttuurree aanndd IInntteeggrraattiivvee M
Meeddiicciinnee
INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 2, Number 2 ･ Summer 2007

Foreword

My Dream: A National Research Institute for East Asian Medicine in Japan
Hitoshi Yamashita

Japanese Acupuncture - Current Research

Treatment of Tinea Unguium with Heat-sensing Moxibustion
Yuki Menjo

Kampo Medicine - Current Research
Efficacy of Goshuyuto for Migraines
Hiromichi Yasui

Clinical Report 1 (Japan)

Acupuncture for Puerperal Mastitis
Koji Seo, Zhongwei Yang and Yukie Miyamoto

Clinical Report 2 (Japan)

Functional Dyspepsia Gets Worse in Summer
Hiromichi Yasui

Clinical Report 3 (Japan)

Immediate Effects of Maoto in Pediatric Patients with Nasal Obstruction
Mikikazu Yamagiwa

Introduction of Japanese Acupuncture
Considering the Therapist’s Hand (6)Shuichi Katai

Medical History in Japan

Dosan Manase and his Medicine (2)Hiromichi Yasui

Book Review“Finding Effective Acupuncture Points” written by Shudo Denmai, translated by Stephen Brown
Reviewed by Jason Beito

ISSN:1559-033X

Volume 1, Number 1 | Spring 2006

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

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

The Journal of
Kampo, Acupuncture andIntegrative Medicine(KAIM)

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

Research on Theory, Practice and Integration

EXECUTIVE EDITOR

Shuji Goto
Chairman, GOTO College ofMedical Arts & Sciences
Tokyo, JapanEDITOR-IN-CHIEF

Donald Lauda, Ph.D.
Dean Emeritus, College of Health &Human Services
California State University-Long Beach
CA, U.S.A.

ASSOCIATE EDITORS
Shuichi Katai
Ibaraki-ken, Japan

Hiromichi Yasui

Volume 2, Number 2 ･ Summer 2007

TA B L E O F C O N T E N T S
1 Foreword
My Dream: A National Research Institute for East Asian Medicine in Japan
Hitoshi Yamashita

2 Japanese Acupuncture - Current Research
Treatment of Tinea Unguium with Heat-sensing Moxibustion

Yuki Menjo

7 Kampo Medicine - Current Research
Efficacy of Goshuyuto for Migraines
Hiromichi Yasui

Tokyo, JapanEDITORIAL STAFF

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

EDITORIAL BOARD
Denmei Shuto
Hajime Haimoto
Hideaki Yamaguchi
Hidemi Takahashi
Katsutoshi Terasawa
Kazushi Nishijo
Keigo Nakata
Keishi Yoshikawa
Koji Ebe
Shohachi Tanzawa
Tadashi Yano
Takahisa Ushiroyama
Tomomasa Moriyama
Toshihiko Hanawa
Yoichiro Ebe
Yoshiharu Motoo
Yoshiro Yase

PUBLISHER

Shuji Goto
International Institute of Health andHuman Services, Berkeley

15 Clinical Report 1 (Japan)
Acupuncture for Puerperal Mastitis
Koji Seo, Zhongwei Yang and Yukie Miyamoto

21 Clinical Report 2 (Japan)
Functional Dyspepsia Gets Worse in Summer

Hiromichi Yasui

23 Clinical Report 3 (Japan)
Immediate Effects of Maoto in Pediatric Patients with Nasal Obstruction
Mikikazu Yamagiwa

29 Introduction of Japanese Acupuncture
Considering the Therapist’s Hand (6)31 Medical History in Japan
Dosan Manase and his Medicine (2)Shuichi Katai

Hiromichi Yasui

35 Book Review“Finding Effective Acupuncture Points” written by Shudo Denmai, translated by Stephen
Brown
Jason Beito

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

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

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

Volume 2, Number 2 | Summer 2007

Foreword
My Dream: A National Research Institute for East Asian Medicine in Japan
When I attend international conferences held in East Asia on the topic of traditional medicine, I
frequently have the opportunity to meet researchers from countries such as Korea, China, and Viet Nam, who
are affiliated with government-sponsored institutes for the study of traditional medicine. They are employed
as national civil servants to research, teach, and practice traditional East Asian medicine, including
acupuncture and herbal medicine. In Japan we have professors at our national universities who are conducting
research in acupuncture and Kampo, but such research into traditional medicine is not their primary work.
And although a small amount of scientific research is supported by national funding, Japan does not have anational research institute specifically dedicated to traditional medicine. A few prefectural hospitals haveestablished institutes for the study of traditional medicine, and for a time those institutes received significant
levels of support, but this support has dwindled with the recent economic downturn and with changes in theprefectural administration that issued the original proposals.
More than 100 years ago, the Japanese government introduced Western medicine as the mainstream
medical paradigm in Japan. Medical treatment in Japan has certainly made great strides as a result of teaching
and research in Western medicine based on modern science. However, today people are searching for an
integrated approach to medicine that will go beyond the limitations of conventional Western medicine. Japan iscompletely ignoring the important role that traditional East Asian medicine has to play in this integrated
approach. According to our survey on the use of acupuncture by the Japanese populace, only 7% of Japanesepeople currently receive acupuncture therapy in a given year. Today there is little national consciousness ofJapanese traditional medicine or desire to support the traditional medical paradigm, either among the Japanesepeople or in the Japanese government.
One important reason for this lack of awareness of traditional medicine is the legal separation in Japanbetween providers of Western medicine and providers of East Asian medicine (acupuncturists). If more
rigorous research can provide strong evidence of the effectiveness of acupuncture for specific conditions, thenit should be possible to approach those conditions within the context of an integrated medical system,
regardless of whether the treatment provider is utilizing Western or East Asian therapeutic methods. However,
without economic and staffing support from the outset, it will be difficult to either obtain or validate such
evidence.
When I attend international conferences and listen to the presentations of the researchers from nationally
supported institutes of traditional medicine across East Asia, I cannot help but envy them. However, eventhough there are no such national research institutes in Japan at present, traditional medicine is still continuingin this country, thanks to the dedication of individual clinicians and researchers and the support of enthusiastic
fans (patients) and private businesses (Kampo makers and acupuncture equipment manufacturers). We must
maintain our dream of one day having a national Institute of East Asian Medicine that will spur traditional
medical research and practical applications. We also need to provide even stronger encouragement for theactivities of current supporters, and to appeal for more consideration of the needs in this important area.

Hitoshi Yamashita, Ph.D., Lic.Ac.
Professor, Morinomiya University of Medical Sciences
Osaka, Japan
Board Member, The Japan Society of Acupuncture and Moxibustion

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Volume 2, Number 2 | Summer 2007

Japanese Acupuncture - Current Research
Treatment of Tinea Unguium with Heat-sensing Moxibustion
Yuki Menjo
Sukoyaka Acupuncture Clinic

1. Introduction
The removal of warts is a well-known example of
the application of moxibustion for the treatment ofskin diseases, but in actual clinical practice thismodality is widely used for the treatment of atopic
dermatitis, postherpetic neuralgia, alopecia, eruptions,
incision wounds, pruritus and the like. Currently,internal application of antifungal agents is considered
to be an effective treatment for tinea unguium. Tinea
unguium is often refractory to treatment and if left
untreated almost never heals naturally, but it is alsodifficult to achieve improvements with therapy of
topical antifungal medications alone. Under certain
circumstances, pregnant women or people with
impaired liver or kidney function may not tolerate theinternal application of antifungal agents1). For
patients in whom oral administration of antifungal
agents is difficult, we thought about the possibility ofusing moxibustion for skin diseases and thus tried touse moxibustion for the treatment of trichophytosis
unguium.

2. Methods
Duration: from June 2000 to September 2004
Site: Nagoya University, Medical Faculty, ambulanceof the Department of Dermatology
Subjects: The study included 36 patients in whom
direct microscopic examination revealed trichophytia
and who were thus diagnosed with trichophytosis
unguium, presenting with opacities extending overmore than half of the nail area and in whom oral
administration of antifungal agents was difficult
either because of complications or by choice of thepatients. These patients were divided into the A group:comprising 8 patients treated continuously for morethan 24 weeks for trichophytosis with antifungal
agents for external use (3 men, 5 women, average age
62.4±12.9 years, average duration of the morbidity
with trichophytosis 4.5±4.3 years), and the B group: 28
patients who consented to be treated with a2

combination of antifungal agents for external use andmoxibustion (12 men, 16 women, average age
61.1±13.1 years, average duration of the morbidity
with trichophytosis 6.3±4.1 years) (Table 1).
Moxibustion treatment: Moxa ( 長 沙 乙 = Changsha,
Chinese product) was rolled by hand into half ricegrain-sized cones of approximately 2 mg (basediameter approximately 2 mm, height approximately 3mm) and placed on both sides of the posterior nail foldsof the affected toe (hallux) (at sites corresponding towell points) and directly on the opaque areas toperform heat-sensing moxibustion using one cone oneach point once a week. Heat-sensing moxibustion
refers to a technique, where the tip of the moxa cone it
lighted and removed by the practitioner, when thepatient feels the heat.
Study duration: 24 weeks from the first moxa
treatment.
Observation: Once a month pictures were taken fromthe affected nails in both group A and B. In group B in
addition to the pictures sketches of the condition of thenails from the first treatment were made after eachtreatment and the ratio of opacity from the end of thenail (opacity ratio) recorded as figures. Opacity ratio
refers here to the degree of opacity defined as "10",when it extends from the free margin to the posterior
nail fold, a distance divided into 10 equal sections, oras an opacity ratio of 3, when it extends only over three
sections (Figure 1).

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

Figure 1

Volume 2, Number 2 | Summer 2007

Figure 1:
Opacity ratio: The distance from the free margin to theposterior nail fold divided into 10 equal parts is used toexpress the opacity ratio. The figure shows an opacity
ratio of 3. The presence of fungi was evaluated bydirect microscopic examination. The black circles
indicate the sites of the moxibustion treatment
Evaluation of results: The 4-step evaluation defines areduction of the opacity ratio in the 24th week by 5-10,
as compared to the time of the first moxibustion
treatment, as "markedly effective", a reduction by 3-4
as "improvement", a reduction by 1-2 as "slight
improvement" and 0 or a negative value as "no change
and aggravation".

3. Results
Result 1:
In group A only "no change or aggravation" andnothing better than slight improvements wereobserved, but in group B slight improvement or better
results were observed in 86% of the cases (markedly
effective: 6 patients (21%), effective: 6 patients (21%),slight improvement 12 patients (43%) and no changes
or aggravation: 4 patients (14%) (Figure 2)

Figure 2:
B group: (combination therapy of antifungal agents forexternal use and moxibustion therapy: 28 cases)
Variations in the opacity ratio in intervals of 4 weeks.
Solid lines indicate the variations in intervals of 4
weeks for each patient. The dashed line indicates theaverage of the opacity ratio.

Below are the results from group B
1) Marked effectiveness or improvements classified byhands and feet shows improvements in 66% of thefingernails and 36% of toenails.
2) Classification of "no change or aggravation" by
diseases showed for the fingernails one case ofgastritis and for the toenails one case of dermatitis,
one case of diabetes and one case of hypertension.
3) Depending on the number of years of morbidity theratio of improved cases was 67% for patients withmorbidity duration of less than one year, 40% formorbidity duration of 1 to 5 years, 33% for less than
5-10 years and 27% for morbidity duration of morethan 10 years.
Result 2:
On this occasion I add a report of observed
variations in the opacity ratio in all toes of one patient
treated over a period of one year and 8 months withmoxibustion from the first treatment on April 13 (final
treatment on December 6, 2006). The patient was a
75-year old woman, presenting with impaired liverfunction and leukemia. Due to difficulties associatedwith oral administration of the antifungal agents, thetopical application of butenafine hydrochloride wascombined with heat-sensing moxibustion. (Figure 3)

Figure 3
Age 50 years, female, 4th digit of right hand
About 4 months after moxibustion treatment,
improvement in opacity ratio from 5 to 1.
If the weekly interval of the moxibustion treatment
is spaced wider, the opacity ratio tends to deteriorate.
During the wet and hot season from April to August

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Volume 2, Number 2 | Summer 2007

the opacity ratio tends to deteriorate, while it rarely
deteriorates during the dry season from August to
March of the following year. Continued moxibustion
treatment resulted in a tendency towards facilitatedimprovement, even if a temporary aggravation occurs.
The opacity ratio for the 2nd, 3rd and 4th toes of both
feet tends to improve easily.

Figure 4:
Variations in the opacity ratio in intervals of 4 weeks
for a 75-year old woman (combination therapy of
antifungal agents for external use and moxibustion
therapy). The numbers in bracket indicate the numberof moxibustion treatments during that month. The
horizontal line below indicates the actual number ofyears/months (seasons).

4. Discussion
Improvement of the nails here does not refer toimprovements of the deformed or discolored portions of
the nails, but rather a faster growth of new nail at thenail matrix than the invasion of the nails by thefungus, so that the discolored portions are pushed
outwards and thereby end the infection. Nail growthfrom the posterior nail fold to the free margin in thefingers of healthy adults usually takes about 6 months
and in the toes somewhere between 12 and 18 months2).
The experimental observation period was with 6month too short, so that the result "no change"
observed in the 24th week for one affected toe hadchanged by the 48th week to "improved", suggestingthat long-term treatment and extended observation
periods are required. Classified by sites it was found,
not surprisingly, that improvements occurred moreeasily in the fingernails.

4Heat-sensing moxibustion has the advantage, thatit can be performed regardless of the presence ofimpaired liver or kidney function. Yet, with treatment
intervals longer than 1 week the results deteriorate,
indicating that regular moxibustion treatments ofmore than once a week are necessary. In our clinic I
instruct the patients under certain conditions also to
perform the moxibustion treatment at home, using
commercially available simplified moxa products.
However, in cases of sensory disturbances of theaffected finger of toe, poor skin condition or in case of
insufficient comprehension of the explanations, thishome treatment is not recommended.
On this occasion I did not examine the degree of
sensation of coldness of the feet, but after themoxibustion treatment the patients reported "my toes
are now feeling comfortably warm", suggesting thatthe moxibustion stimulation of the nails had promoted
peripheral blood circulation, raised the skintemperature, inhibited the growth of the trichophytia,
promoted the growth of the nails, improved the local
immunocompetence and thereby was considered toinfluence improvements in the onychomycosis.
In case other family members also suffer from
onychomycosis there is a high likelihood of contracting
the disease. Prolonged time spent in highly humid
environments, wearing shoes or similar environmental
factors too have a strong influence. It is therefore
necessary to communicate to the patients, that theyshould try to maintain cleanliness and keep theaffected areas dry during the treatment.
In the control group treated only with antifungal
agents for external use no improvements in theonychomycosis
wereobserved,butthroughcombination
withmoxibustion
treatment
improvements of the onychomycosis were observed
also in cases, in whom oral treatment with antifungal
agents was difficult. There are also clinical cases inwhich improvement of the onychomycosis had beenachieved by moxibustion therapy alone3), but thequestion, whether there are any significant differences
still remains unanswered. Application of antifungal
agents for external use tends to prevent trichophytia
infection of hands and feet and this effect is enhanced
through combination with moxibustion therapy,

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

Volume 2, Number 2 | Summer 2007

suggesting that the latter may have promoted
improvements in the onychomycosis.
Well points lie on both sides of the posterior nailfold. These well points are said to be "the site, wherethe vessel qi emerges, like from a spring, if likened to a
stream of water"4), so that stimulation withacupuncture and moxibustion is not limited to theparticular area, but is considered to influence theentire area of the affiliated meridian.

References
1) Harada T: Dermatomycoses. Shigeo Ikeda, Jiro
Arata, Takeji Nishikawa (editors) ． Standard
Dermatology 5, Tokyo, Igaku Shoin, 1999: 393-418．
2) Hiruma S (Ed.): Tinea unguium treatment manual;
MD Derma, 111, Tokyo, All Japan Hospital
Publishing, 2006．
3) Kojo Y, Hayakawa R, Sugiura M: A patient withtinea unguium improved through moxibustion
treatment. Skin Science, 1(5): 335-337 (2001)

5. Conclusion
Moxibustion therapy may be a possible treatment
choice for cases in whom the oral administration of
antifungal agents proves to be difficult. This indicatesthe role of acupuncture and moxibustion for cases
refractory to pharmacologic therapy.

4) Shirota B: Basics of Acupuncture and Moxibustion
Therapy, 7, Yokosuka, Ido no Nihon Sha, 1983)
Key words: trichophytosis unguium, moxibustion
therapy

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Volume 2, Number 2 | Summer 2007

Table 1

Patient backgroundA group: topical application of antifungal agents for external use only
No.

Sex

Age

Number of years ofAffected

External preparation

Opacity ratio /Opacity ratio / 24

Evaluation / 24 weeks

Complicating conditions

1

M

69

0

Left leg 2

Butenafine hydrochloride

10:10

10:10

No change

At will

2

F

51

0.3

Right leg 1

Butenafine hydrochloride

10:10

10:10

No change

Liver cirrhosis

3

M

63

0.1

Left leg 1

Butenafine hydrochloride

10:10

10:10

No change

Rheumatism

4

M

78

3

Left leg 1

Butenafine hydrochloride

10:10

10:10

No change

Chronic nephritis

5

F

42

5

Left hand 1

Butenafine hydrochloride

10:10

10:10

No change

Dermatitis

6

F

51

8

Right leg 1

Butenafine hydrochloride

10:10

10:10

No change

At will

7

F

73

10

Right leg 1

Croconazole Hydrochloride

10:10

10:10

No change

Hypertension

8

F

72

10

Left leg 1

Butenafine hydrochloride

No change

Diabetes

62.4

4.55

Avg.
M: male

10:10

10:10

10:10

10:10

F: female

B group: combination therapy of antifungal agents for external use and moxibustion
1

F

72

0.5

Right hand 1

Butenafine hydrochloride

10:10

0:10

Markedly effective

Gastritis

2

F

59

1

Right hand 4

Butenafine hydrochloride

7:10

0:10

Markedly effective

Gastritis

3

F

36

1

Right hand 1

Butenafine hydrochloride

10:10

5:10

Effective

Atopy

4

F

75

0.25

Left hand 1

Butenafine hydrochloride

10:10

6:10

Effective

Gastritis

5

M

75

5

Right hand 1

Butenafine hydrochloride

10:10

8:10

Some improvement

Diabetes

6

M

65

20

Left hand 2

Butenafine hydrochloride

9:10

10:10

Aggravation

Gastritis

7

M

50

6

Right leg 2

Butenafine hydrochloride

10:10

0:10

Markedly effective

Dermatitis

8

M

70

3

Left leg 2

Butenafine hydrochloride

10:10

1:10

Markedly effective

Prurigo

9

F

25

1

Left leg 1

Butenafine hydrochloride

7:10

3:10

Effective

Gastritis

10

M

39

10

Right leg 1

Butenafine hydrochloride

10:10

3:10

Markedly effective

Impaired liver function

11

F

52

15

Right leg 1

Butenafine hydrochloride

8:10

4:10

Markedly effective

Gastritis

12

F

72

5

Right leg 1

Butenafine hydrochloride

10:10

7:10

Effective

Diabetes

13

F

63

3

Left leg 1

Butenafine hydrochloride

10:10

4:10

Effective

Diabetes

14

M

72

10

Right leg 1

Butenafine hydrochloride

10:10

7:10

Effective

Impaired liver function

15

M

58

5

Left leg 1

Butenafine hydrochloride

10:10

8:10

Some improvement

Drug eruption

16

F

62

10

Right leg 1

Butenafine hydrochloride

10:10

8:10

Some improvement

Gastritis

17

M

70

1

Left leg 1

Butenafine hydrochloride

10:10

10:10

No change

Dermatitis

18

F

57

11

Right leg 1

Butenafine hydrochloride

10:10

8:10

Some improvement

Cerebral hemorrhage

19

F

52

10

Right leg 1

Butenafine hydrochloride

10:10

8:10

Some improvement

Diabetes

20

M

51

10

Right leg 1

Butenafine hydrochloride

10:10

8:10

Some improvement

Gout

21

M

64

0

Right leg 1

Butenafine hydrochloride

10:10

10:10

No change

Hyperpiesia

22

F

50

10

Left leg 1

Butenafine hydrochloride

10:10

9:10

Some improvement

Eruptions

23

F

54

8

Right leg 1

Butenafine hydrochloride

9:10

8:10

Some improvement

Hyperpiesia

24

F

73

10

Left leg 1

Butenafine hydrochloride

5:10

4:10

Some improvement

Diabetes

25

M

75

10

Right leg 1

Butenafine hydrochloride

10:10

10:10

No change

Diabetes

26

F

79

6

Right leg 1

Butenafine hydrochloride

5:10

4:10

Some improvement

Hyperpiesia

27

M

72

1

Right leg 1

Butenafine hydrochloride

10:10

9:10

Some improvement

Diabetes

28

F

69

4

Left leg 1

Butenafine hydrochloride

10:10

9:10

Some improvement

Diabetes

61.1

6.31

9.29:10

6.11:10Avg.

6

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

Volume 2, Number 2 | Summer 2007

Kampo Medicine - Current Research
Efficacy of Goshuyuto for Migraines
Hiromichi Yasui
Japan Institute of TCM Research

he did not go made such behavior and it was a furious
headache. Yoshimasu hurriedly prepared two doses ofgoshuyuto and administered him. After the use ofthem, the headache disappeared.

Since this reported, the use of goshuyuto has
1. Introduction

become a kind of common sense and many cases

Migraine is a disease that has been around thehave been reported till now. Some clinicians

world dating far back to the ancient times and it

discussed a variety of conditions in which goshuyuto

occurs periodically. The patients with migraine have

was effective and according to the tips gained fromto go through a considerably difficult time coping

the discussions and handed down orally, thewith the severe symptoms it produces: Once aprescription has been applied.

migraine attack takes place, it can almost interferewith patients’ day-to-day life. In recent years,
migraine treatment has greatly been advance andwith the availability of triptan preparations,migraines have become a far better controllable
disease than before. Even then, currently thecomplete and total effect cannot be expected frommodern medications.
On the other hand, migraines are considered to
be a disease easy to care for in Kampo medicine. The
reason is that though migraines, having many types,
are triggered by a variety of factors, Kampo
medicine is the medicine capable of doing rightthings for each of triggers and types with pinpoint
precision. To cure the pains, many prescriptions areready for use. Hereunder, a few experiences inJapan of a typical prescription goshuyuto (goshuyuto,
Wu-Zhu-Yu-Tang, 呉茱萸湯) are introduced.
2. Case Study on Goshuyuto for Migraines
A case report on goshuyuto for a migraine was
first made in Japan about 200 years ago by Nangai
Yoshimasu (1750-1813) as follows:
Patient: An adult male, age unknown, had always
migraines. A heavy headache attack occurred on acertain day with vomiting, disabling him to speak. He
continuously slapped his neck by his hand. It looked
like a puppet, giving a weird impression. People
around him did not know that his behavior was from aheadache and they thought he went out of order.
Nangai Yoshimasu saw the behavior and knew that

Following are the cases of interest:
Case Report 1:
The patient was a 29-year old female. In her highschool days, headache began to develop by the triggers
of stresses and the crowd. Headache always started in
the muscles of the left shoulder, spreading to the backof the entire head from the left back side of the head,leading to a pain behind the eyes and then making her
to feel like vomiting. . An attack occurred especiallybefore the onset of menstruation and persisted forabout a day. The patient had cephalic CT scans but
nothing abnormal was detected. The analgesic drugs
she used to take, although initially effective, graduallybecame less effective and unworkable, so Kampo
treatment was started. With the administration ofgoshuyuto, mild headaches were experienced only 2-3
times before the onset of menstruation and severe
agonizingheadaches
disappeared
completely.
Thereafter, not only has an attack not occurred before
the onset of menstruation, but also menstrual pains
and constipation have been improved.1)
This is a representative case report on goshuyuto.
In case the analgesic drug initially effective becomesineffective, like this case, the treatment by a
medical specialist is required. However, goshuyuto
is effective in many of such cases.
Case Report 2:
The patient was a 49-year old female with amedium build. Since two years before, the patient
sometimes had experienced paroxysmal attacks ofsevere headache. Before and after the attack, thepatient always had a stomach disorder, or distended

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Volume 2, Number 2 | Summer 2007

stomach or pain in the stomach. She felt like vomiting
but did not throw up. The nuchal region and the broadof the back became stiff. Appetite slightly decreased.
The epigastric region was often distended with a heavy
sensation in the region and hands and feet became cold.
There were no significant changes in two-times stools.
Pulse was deep and slow. The tongue had a moderatecoating of white moist furs. The abdominal strength
was slightly flaccid. Mild resistance and tenderness onpressure were felt in the epigastric region andclapotage was demonstrated. These symptoms werediagnosed as the conditions (sho) of goshuyuto, andthus the one-week doses were given. After a week,
discomfort in the epigastric region dissipated. After
three weeks of administration, medication was
discontinued. Although it has passed one year sincethen, a headache attack has not recurred.2)

nausea. While answering, she seemed to have nausea
attacks
andfrequently
threw
up
some
gastric-fluid-like substance into a washbowl. To myquery of whether she felt cold in the hands and feet,she said she felt them considerably cold. On the basisof these findings, I thought goshuyuto might be theapplication targeting cold in the extremities, headache,and vomiting, and gave her on site a dose of the extract
dissolved in half a cup of hot water. I always havesome doses of goshuyuto extract in my bag with me
when I make a patient’s house call. It may beunbelievable but vomiting stopped before me and in
about five minutes, such rampant headache was
reduced to only a fraction of the intensity she felt
originally. And she was able to rise from therecumbent position and sit on the floor.3)

Headaches that have indications for goshuyuto

headache after the administration of goshuyuto on a

are generally associated with underlying internal

potion basis. It is very rare that such a marked

cold caused by a lack of yang Qi, to which external

effect was obtained in day-to-day clinical practice. It

influences are added to develop an attack. This casemay not be extremely rare but it does not mean that

had several symptoms considered indications forany patient shows such an effect. The person who isgoshuyuto, which will be described later in thisas responsive as this patient will not have apaper. It may be a marked improvement that sincemigraine recurrence by taking this medication for athree weeks medication, no headache episode haslong period of time, like several months to one year.

been experienced for a year.

In other words, migraines can be cured.

Case Report 3:
The patient was a 55-year old female. The patient
had the problem of high blood pressure on a daily basis
and made visits to our hospital. Sometimes, she wasplagued by headaches. As seen in many women of
about her age, blood pressure numbers were not stable.
At a certain night of November 1983, I received atelephone call from her family, saying that the patient
had come down with a headache since daytime, atnightfall began to have a severe pain and now was
suffering from vomiting. I made a house call, taking
cerebral vascular disorder into account. Her sensorium
was clear and her response was also clear without
motor paralysis and stiff neck. So I breathed a little
easier. When I asked her the type of the pain, she
replied that at nightfall the pain became a pulsatingtype of throbbing sting with the appearance of violent

Case Report 4:
The patient was a parous female of 27 years old.
Before becoming pregnant, the patient used to haveheadaches. In the 13th week of pregnancy, she had aheadache attack disabling her to do family work. She
did not take analgesics thinking of adverse influencesof the drug on her fetus. She was given goshuyuto on
the moment. On her way home, she fell asleep in the
train. She also had a good night sleep and when she
woke up, she found the headache disappeared.
Attention is called to it that during the period ofpregnancy, the medication should not be administeredwithout careful consideration.4)

8

This is the case that showed a rapid relief ofIn many of women with migraine, a sharp
decrease in the frequency of the attack due topregnancy has generally been observed together
with relief of migraine symptoms. However, this is

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

Volume 2, Number 2 | Summer 2007

Although not many headaches get worse withand remained unchanged 16 (10.9%). Usefulness
consists of: extremely useful 18 cases (12.2%), useful61 (41.5％), slightly useful 53 (36.1％), and not useful
15 (10.2％). The cases that achieved useful and higher
effects for each type of headache are: vascular
headache 61.7％, muscle-contraction headache 47.8％,
and combined headache 48.1％ with many cases ofimprovement in vascular headache. Production ofeffects was seen in 51.7% of cases within two weeks.

pregnancy, they are not scarce. In any event things

The above is a case series using goshuyuto.

are significantly serous to the people who suffer

Despite the low level of evidence, efficacy of thefrom headaches. Kampo medication offers only a

medication is clearly demonstrated. The medication

few choices but they can be expected to yield safe

tends to be more effective for vascular headaches

and high efficacy. One of these choices is goshuyuto,(migraines). However, since headaches that wereon which other cases were reported.

originally migraines must have been included in

not applicable to any woman. Indeed, the researchby Ratinahirana et al. reports that cases offrequency and symptoms became worse in pregnant
woman represented 6.8%.5) Moreover, the researchby Maggioni et al. reports that improvements inwomen experienced pregnancy twice or more were
not as good as in the first time pregnancy.6)

other types of headache, this medication may be
3. Clinical Study on Goshuyuto for headaches

said to be more effective for migraines.

Many clinical experiences similar to the above
have been reported and it has become a kind of2) Study by Odaguchi et al.: Study on thecommon knowledge in Japan that goshuyuto isadministration of goshuyuto in the same dose toeffective for migraines. However, details of thispatients with chronic migraine.8)
The subjects participated in this study were 49
persons who, in principle, took some medicine once amonth for headache attacks due to chronic primaryheadache (male/female=6/43, age 43±14), and scores
were given to improvement in the severity of headache,improvement in the frequency of headache episodes,
improvement in the cold sensation, improvement inmenstrual pains, and improvement in stiff shoulders,which were then divided on the basis of given
standards into two groups – Responder Group(R-Group 36 patients) and Non Responder Group(N-Group 13). And then the patients in the two groups
were equally administered goshuyuto Extract in thesame dose of 7.5g x 3/day for a month and the exact
test of a contingency table was performed.

medication have not been elucidated as to underwhat environments migraines occur in what types of
persons and efficacy percentages. Thus, someresearchers have conducted clinical studies on thesepoints. The studies included tension headaches aswell as migraines. So, though the efficacy of
migraine has not thoroughly been elucidated inthese studies, the data are very useful from aclinical view point. Introduced hereunder are
representative studies.
1) Study by Maeda et al.: Efficacy of Goshuyuto for
Chronic Headache7)
Goshuyuto Extract was administered to 147
patients with chronic headache (Male 46, Female 101)
to assess the overall improvement, general safety, andusefulness. The details of the cases are: vascular
headache 47 cases, muscle-contraction headache 46,
and combined headache 54. Overall improvement
comprises: markedly improved 16 cases (10.9%),
improved 61 (41.5%), slightly improved 54 (36.7%),

The

results

indicated

that

R-Grouphadsignificantly high points in “do not get motion
sickness” (R-Group 34 patients, N-Group 8: P=0.01)
among subjective findings and “have tenderness inthe paraumbilical region” (R-Group 15 patients and
N-Group 1: P=0.04) among objective findings. The
study also indicated that R-Group tended to show

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

9Volume 2, Number 2 | Summer 2007

higher points in the finding of subjective cold

no signs and symptoms associated with goshuyuto.

sensation, finding of discomfort with pain when

The study by Oda et al. was conducted frompressed in the epigastric region (“kyokyo-kuman”),

somewhat Kampo point of view, whereas as thisfacial hot flushing, and non-finding of tenderness instudy excluded unfair views favoring Kampo

the sigmoid region. The findings that exceeded 0,5

medicine when possible, it may be natural that thein both sensitivity and peculiarity were subjective

results differ between the two studies. This is ancold sensation, menstrual pains, hard epigastrium

aspect of goshuyuto. In addition, although the resultwith a sensation of heaviness (“shinka-hikou”), andshowed that efficacy was not related to the type oftenderness in the region between umbilicus andheadache, some of tension headaches and combined

epigastricheadaches may have progressed to migraines.

fossa,

whereasnon-findings

that

exceeded 0,5 in both sensitivity and peculiarity areperspiration, irregular menstruation, weak abdominal
power, and flaccid lower abdomen.

4. Target in the use of goshuyuto for migraine

Goshuyuto first appeared in “Shang han lun”.
The section of “kecchin” disease (power to stay alive

This study investigated to find differences in thealmost extincts) of the prescription text has thesigns and symptoms between the patients group that

description meaning “goshuyuto is applied for theobtained efficacy (Responder Group) of goshuyuto

conditions of feel like vomiting but nothing isand the patients group that had poor efficacy

brought(Non-Responder Group) and is a groundbreaking

headache…”

study as a step forward for clarifying the wholereferring to the description. Traditional Chinese

picture of goshuyuto. The results prominently appear

medicine uses the medication for vomits caused byin subjective symptoms and abdominal diagnostic

excessive fluids in the cold stomach, whereas infindings, offering clues for future applications of theJapan, the medication is an important prescription

medication.

applied for migraines as a first choice medicine.

up,

throw
The

up

liquids,

medication

person

is

now

with

appliedgoshuyuto is beneficial, in theory, for headaches
3) Study by Hayashi et al.: Clinical Study on

caused by cold evil invading into the condition

Goshuyuto for Chronic Headache9)

lacking yang Qi or heat energy, which reversely

Goshuyuto was administered to 32 patients withchronic headache with the result of efficacy at 34.4%.
However, factors associated with the efficacy ofgoshuyuto (level of p<0.05) were not recognized andthe medication may not be said to be specificallyeffective for any one of migraine, tension headache andcombined headache.

flows upward through the liver meridian. It may beThis study investigated more than 100 items of

distinction between responders and non responders

subjective and objective signs and symptoms toto goshuyuto by investigating subjective andelucidate the sho of goshuyuto and multivariableobjective findings in detail. The content of theanalysis was conducted. The methodology was quite

investigation shows that the characteristics ofobjective, eliminating views from the angle ofgoshuyuto appear in the subjective symptoms andKampo medicine to a maximum extent. The result

abdominal sho. Especially abdominal sho confirms

from this methodology was that there were almost

the

10

extremely difficult to grasp signs and symptoms
that can clinically support this theory.
Most recently, the study by Odagukuchi et al. has
madesubstantial

progressinelucidating

indications for goshuyuto and has made a clear

contentof

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

described

inVolume 2, Number 2 | Summer 2007
4. Constitutional
Predisposition

Patients do not have a predisposition tocarsick/motion sickness.
Often feel cold.
The volume of perspiration is not much.
In other words, do not “tend to perspire
a lot”. Patients have menstrual pains.
Menstruation is not irregular.

5. Pulse, Tongue,
and Abdomen

Pulse sho is usually deep and slow.
When a pain attack occurred, pulse rate
decreases from the baseline value and it(pulse) often becomes tense.
Abdominal sho shows that abdominal
strength is not weak; the epigastricregion is hard with a sensation ofheaviness; and tenderness is felt in theregionbetweenumbilicus
andepigastric fossa. Discomfort is often felt
with pain when pressed in theepigastric region (“kyokyo-kuman”). In
short, in many patients, resisting
responses can appear in the upper
abdomen. Tenderness is felt in theparaumbilical region but is not felt inthe sigmoid region. Lower abdomen is
not flaccid. The epigastric region
becomes distended.

6. Others

Some patients have dry mouth andreduced urine output on a daily basis.
In some patients, as soon as theheadache is cured with goshuyuto,
urine output becomes increased.

when attacks occur.

5.

and

Many of the patients complain of severe

differentiation“Fukushokiran”

and“Fukushokiran-yoku”

written in Edo Era.
Given the studies published so far, indications forgoshuyuto for headaches are generally shown as in
Table 1.
Table 1: Indications for goshuyuto
1. Type ofheadache

Most headaches are migraines.
In many of tension headaches andcombined headaches, the medication iseffective. Meanwhile further queries ofdetailed medical history reveals thatmany headaches were originallymigraines.
Aura occurs some time and some time itdoes not.

2. Conditions
that trigger
headache

Attacks are often induced in the cold
environments. Not a few of headaches
develop during or before or after
menstruation.

3. Status in theoccurrence of aheadache attack

The patient feels like vomiting when an
attack occurs and the patient actually
vomits. Vomiting is violent and after
vomiting, the patient does not feel thepain less severe. The epigastric region
becomes distended and a sensation ofsomething

stuck

in

the

stomachdevelops.
Some patients usually complain of stiffshoulders. Indeed, many of the patientssuddenly feel stiffness in the shoulders

cold in hands and feet (They are usuallysensitive to cold.)Some patients complain of hot flushes
on the fact when an attack occurs,
although they do not usually feel

Goshuyuto

Prescriptions

that

need

There are many Kampo prescriptions used for
migraines.

Typicalprescriptions aregoshuyuto,

goreisan, and senkyuchachosan. As a matter ofcourse, many other prescriptions are used forwarmth on the face. Some patients

migraines. However, clinically and frequently usedcomplain of a heat sensation in theare above three prescriptions. Goreisan is used innuchal region.

parallel with goshuyuto as one of first-choiceSome patients writhe in pan during the

medications. Oftentimes, headaches for whichheadache episode.

goreisan may be applied develop with a sudden drop
in atmospheric pressure, so efficacy can be expectedby inquiring the patients of prior occurrence withthe care given to weather and a barometer.

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

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Volume 2, Number 2 | Summer 2007

Senkyuchachosan is the prescription fundamentally
applied to headaches associated with wind-cold,
whereas there are many data showing efficacy of the
medication for chronic headaches in Japan. The
studies conducted so far have made almost noclear

differentiation

betweenheadaches

responsive to senkyuchachosan and headaches
responsive to goshuyuto. It is the current situationthat efficacy cannot be known before use.
Conclusion

Goshuyuto is a very important prescription for
migraines. In Japan, the medication has been used
as a first choice medicine in parallel with goreisan
and has produced good results. The targets in its
use have been elucidated to some extent but not
sufficiently, as mentioned above. Despite of this, it is
not rare that many patients with migraines takethis medication and go to the world with no pains.
Quite a lot of patients showing indications forgoshuyuto get relief from the headache before it
progresses to an attack by taking the medication
when a headache aura appeared. For the pain thathas become violent, immediate effects can rarely beobtained. However, in many patients, some of thesymptoms have become less severe. And also inmany patients, attacks tend not to recur in thecourse of regular use of the medicine. In the case,the duration of the drug exposure cannot be set
categorically, but several months or more than ayear will be necessary depending on the patient.

including 28% (29.7 million) of tension headaches,
about 2% (2.12 million) of migraines with aura (typicalmigraine), 5% (5.09 million) of vascular headaches(this type is classified as migraine) and 0.3% (0.32
million) of cluster headaches. In regard to the
male-to-female ratio, headaches are totally morecommon in female, or two to three times more than in
male. Migraines are common especially in young
women in their 20’s to 50’s.
Reference 2: ICHD-II and Kampo Medication
Headaches are diagnosed according to the criteriaof The International Headache Classification (ICHD-II,
2004). The Classification is comprised of Part 1: The
primary headaches; Part 2: The secondary headaches;
and Part 3: Other headaches, cranial neuralgia,
central or primary facial pain. For the treatment of the
primary headaches, Western medicine mainly uses
medications such as analgesics, triptans, andErgotamines. Treatment with one of these drugs isonly a symptomatic measure and radical treatment
does not exist. On the other hand, great effects cannot
be expected from Kampo medication as abortive
therapy but it exerts excellent effects as preventive or
prophylactic therapy and offers the possibility ofachieving radical cure by its long time use. In thissense, Kampo medicine is not the medicine thatcompetes with Western medicine and but the medicine
that performs treatments by making coordination andcooperation with Western medicine. In addition, for thetreatment of the secondary headaches, Western
medicine that treats the underlying disease isprioritized but in a very few cases there are secondary
headaches for which Kampo medication can be applied.

Although not being effective for everything,goshuyuto is nothing more or less than a dream-like
medication for a fairly good number of the patientswith migraines.
Reference 1: Headache Statistics in JapanThe statistics show that tension headaches are themost common type of headaches and next comemigraines in Japan. According to 1996 research by
Manabu Sakuta of Red Cross Hospital, patients of 15
years old or above with chronic migraines account for
35.7% (37.8 million people) of the population of Japan,
12

Reference 3: Treatment of Headaches by Traditional
Chinese Medicine
Traditional Chinese Medicine classifies headaches
into two groups: headache due to internal injury(internal headaches) and headaches due to external
factors (external headaches). Table 2

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

Volume 2, Number 2 | Summer 2007

Table 2 Classification of Headaches by Traditional Chinese Medicine【Internal Medicine of Traditional Chinese Medicine (7th Edition Text Book): 2003】
External headacheWind-cold headache

Eliminating wind and cold

Adjusted senkyuchachosan 川芎茶調散Wind-heat headache

Eliminating wind and heat

Adjusted kyushisekkoto 芎芷石膏湯Wind-dump headache

Eliminating wind-dampness

Adjusted kyokatushoshituto 羌活勝湿湯

Internal headache
Liver-Yang headache

Checking the Liver, Restraining
the Yang, and Calming the Wind

Blood-Deficiency

Enriching the blood andheadachenourishing the yin

Adjusted tenmakotoin 天麻鈎藤飲Adjusted kamishimotto 加味四物湯Invigorating the spleen,
Phlegm-Damp

resolving phlegm to make theheadacheadvertise-rising qi and relieving

Adjusted hangebyakujututenmato 半夏白朮天麻湯headache
Kidney Deficiency

Replenishing yin and nourishingheadachethe kidney

Adjusted daihogensen 大補元煎Dredging the orifices, activating
Blood Stasis headache

the meridians and resolving

Adjusted tsukyokakketsuto 通竅活血湯blood stasis

External headaches develop by the invasion ofwind-cold, wind-heat, or wind-damp and this type ofheadaches are common in infectious diseases bycommon cold. The treatment method for externalheadaches is fundamentally applied to acute symptoms
but may be applied to chronic headaches. Internalheadaches are under the category of chronic migraines
and are classified into five types: kanyo headache(headaches caused by insufficient liver Qi), kekkyo
headache (headaches caused by insufficient blood
circulation), tandaku headaches (headache caused byinternal fluids stagnation), jinkyo headache (headaches
caused by poor functioning of kidney, and other organs),and oketsu headache (headaches caused by bloodstasis).
The
classification
presented
hereisunderstandable in Japan of today. However, theirformulations greatly differ from those now commonlyused in Japan and clinically corresponding diseasestates can be envisaged but how they are related tothe classification of disease states by Western
medicine, such as migraine and tension headache,from a Western medicine perspective is not clear.

Reference 4: Headaches in children
ICHD-II Classification includes childhood periodic
syndromes as headache in children (periodic vomiting,abdominal

migraine,andchildhoodparoxymalvertigo – these three are included). Children seldomcomplain of headaches. There is the data indicatingthat one fourth of migraines began in childhood(during 4-5 years old). Migraines are common infemales, whereas they are common in male childrenof below 10 years. A migraine often occurs suddenly inthe morning and in 5-10 minutes it is relieved. Caremust be taken as some children say “pain in theabdomen”. For migraines in children, treatments
should be given, referring to the treatment of
migraines in adults with taking the treatment ofconstitutional predisposition peculiar to children into
consideration.

Children

show

many

sho’s

for

yokukansan as well as goshuyuto and goreisan.

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

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Volume 2, Number 2 | Summer 2007

References Cited
1) Arai M, Nakano Y, Mizobe K: Women’s Medical College
Zatsuwa (7)-3 Cases of Headaches － Kampo-no-Rinsho

6) Maggioni F, Alessi C, Maggino T, Zanchin G: Headache
during pregnancy. Cephalalgia 1997; 17: 765－769(Journal of Kampo Medicine), Vol.41-3 45－49，1994

7) Maeda K, Muyagi A, Sugawara T, et al.: Efficacy of2) Fujihira K: Chronic Headaches, Kampo Clinical Notegoshuyuto for Chronic Headaches．Kampo Igaku, 22：53(Edition of Clinical Trial) p356 Sogen-sha 1988
3) Akiba T: Kampo Treatment for Habitual Headache Monthly－57，1998
8) Odaguchi H, Wakasugi A, Shoda H: Mansei-Kanja ni

pregnancy and non-pregnancy. San-Fujinka Kampo

taisuru Goshuyuto-no ichiritsu toyo kenkyu (Study on
the administration of goshuyuto in the same dose topatients with chronic headache), 56th Japan Oriental

Kennkyu-no-Ayumi (Footsteps of Kampo research on

Medicine Academic Conference - Abstracts p169, 2005

Journal of Oriental Medicine Vol.14 No.1 34－39 1986
4) Kyuma M: Efficacy of goshuyuto for headaches during

Obstetric and Gynecologic) (23)104－107，2006
5) Ratinahirana H, Darbois Y, Bousser M-G: Migraine andpregnancy: a prospective study in 703 women after

9) Hayashi Y, Ohno T, Haimoto H: Clinical Study on

goshuyuto for chronic headache Φυτο Vol.4 No.1 p4-10
2002

delivery, Neurology 1990; 40 (Suppl. 1): 437

14

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

Volume 2, Number 2 | Summer 2007

Clinical Report 1 (Japan)
Acupuncture for Puerperal Mastitis

mastitis for patients referred to us from local

Koji Seo, Zhongwei Yang and Yukie Miyamoto
Clinic of Acupuncture and Massage
GOTO College of Medical Arts & Sciences

midwifery centers. In this paper we have analyzed 24
patients with chief complaints of indurations in thebreasts and pain after developing mastitis, then have
performed acupuncture and moxibustion treatment

I. Introduction

based

on

traditional

Chinesemedicalpattern

Mastitis is an inflammatory disease of the breast.

identification and report here some typical cases in

Acute mastitis occurs almost exclusively during thewhich an alleviation of the symptoms has beenlactation period, in particular during the puerperal

achieved.

period1), so that inflammations of the breast observed
during the puerperal period are also called postpartum

II. Analysis of 24 Patients with Mastitis

mastitis. (below the term postpartum mastitis will be[Patient profiles]

abbreviated as mastitis)
Mastitisisclassified

Acupuncture and moxibustion treatment was given
intocongestiveandto 24 patients with chief complaints of indurations or

suppurative mastitis. This then causes obstruction ofpain of the breast during the breast-feeding period.

the milk ducts. Moreover, fatigue, stress, the presence

The patients were first seen between September 2003

of infections within the family, reduction of theand December 2007. All patients had received Oketani

frequency of the breast-feeding, galactostasis, trauma

style breast massage in maternity hospital, after

to the breast, nutritional deficiencies and similar

which

the

maternity

nursesrecommended

thefactors have been indicated as having a significant

combination

therapywithacupuncture

andcorrelation to the development of mastitis2).

moxibustion. (Table 1)

Congestive mastitis is a cause for milk ejection
disorders but not necessarily caused by an infectious

1. Age distribution

agent. Local pain, swelling may be present, but

2. Ranging from 29 to 45 years, average age: 35 years

conservative therapy is considered to be appropriate1).

3. Birth conditions

To improve mild congestion active promotion of

4. Primiparas: 14 women, multiparas (second child): 9

breast-feeding, milking or massage of the breast

women, multiparas (third child): 1 woman

should be performed. In case of swelling of the breast
associatedwithfomentation

is

a

local

generallyheat

sensation,

employed.

mild

Suppurative[Symptoms]
1. Symptoms of the breast

mastitis on the other hand, can develop on the basis of1) Indurations: yes = 24 women / no = 0 womencongestive mastitis, or else result from bacterial

2) Pain: yes = 21 women / no = 3 women

infection of lesions of the nipples3). Mastitis is included

3) Local heat sensation: yes = 16 women / no = 8

among

women

the

indicationsforacupunctureandmoxibustion treatment specified by the WHO, but in

2. Symptoms unrelated to the breasts

Japan there are only very few reports about this1) Fever: (higher that 38℃) yes = 14 women / no = 10

treatment form, which seems currently to be very little

women

known in general.

2) Shoulder/neck stiffness: yes = 24 women / no = 0

In this facility we have used acupuncture andmoxibustion therapy since 2003 for the treatment of

women3) Chilliness: yes = 13 women / no = 11 women

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

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Volume 2, Number 2 | Summer 2007

4) Stress: yes = 15 women / no = 5 women / unclear =

Since

there

was

a

tendency

towards

milk

obstruction from the beginning, she milked the breasts

4 womenonce in the morning and afternoon even during work

3. Tongue and pulse findings
1) Red tongue: yes = 12 women / no = 12 womenand on holydays received breast massage. On June 6 a2) Dark red tongue: yes = 4 women / no = 20 women

39℃ fever developed, leading to the onset of mastitis.

3) Slimy yellow coat: yes = 8 women / no = 16 women

Even after the fever had subsided, the left breast

4) Wiry pulse: yes = 17 women / no = 7 womenremained reddened, felt warm and the pain did not5) Thin pulse: yes = 15 women / no = 9 women

recede. Since the pain grew more intense after June 15,
she was referred to us by the maternity hospital and[Treatment course]

visited our clinic on June 25.

1. Number of treatments: range 1-20, average 7 times[Associated symptoms]
Shoulder and neck stiffness, back pain, eyestrain,

2. Changes in the symptoms of the breast
1) Indurations: In the 21 patients with indurations

intense perception of stressthese disappeared and decreased in size in 3 other[Anamnesis]: N.A.D.

patients.

[Family history]: N.A.D.

2) Pain: The pain was alleviated in all 21 patients,[Current condition]: height: 156 cm, weight: 41 kg,

who had complained of pain.

temperature: 36.6ºC

3)

Local

heat

sensation:

The

heat

sensation

disappeared in all 16 patients, who had complained

Findings during the first examination
The left breast was generally swollen and had
indurations medially and inferior to the nipples. Thereof it.

was reddening, local heat sensation and pain. The

3. Performance of incisions
Incisions were performed in 10, not performed in 14

patient had resting pain that was aggravated by liftingor lowering the left arm or vibrations.

women.

Tongue diagnosis: red tongue body, no furIII. Typical Cases

Pulse diagnosis: wiry and rapid

Patient: 39 years old, female

Traditional Chinese medical pattern identification:[Initial visit]:

Basically yin deficiency, liver Qi congestion resulting

June 25, 2005

[Chief complaint]: Induration and pain in the left

the development of heat, obstruction of milkbreast[Diagnosis]: Mastitis[Treatment][Present illness]:

1. Therapeutic principle: clear heat and drain toxin,

Delivery in December 2004 by Caesarean section.

soothe the liver and rectify qi, resolve congestion andCurrently lives in a family of three with her husband

promote milk flow.

and child. Since Mai 2005 she returned to work 8

2. Point selection: Gokoku (LI4 ＝ Hegu), Kyokuchi

hours per day in an office. She reported the work

(LI11=Quichi), left Shotaku (SI1=Shaoze), Sokusanrirelated stress not to be overly intense, but stated, she(ST36=Zusanli),

could not yet find a comfortable rhythm between work

rinkyu (GB41=Zulinqi), left Kensei (GB21=Jiangjing),

and mothering, but since she could manage to get onlyleft

5 hours of sleep per day, a significant degree of(BL14=Jueyinshu).

exhaustion has developed.

3. Method

16

Tensu

Taisho (LV3=Taichong),(SI11=Tiangzong),

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

left

Ashi noKetsuinyu

Volume 2, Number 2 | Summer 2007

I. Acupuncture treatment: Seirin disposable needles,

pain and local heat sensation before and after the

0.18×40mm, were inserted perpendicularly into thetreatment. All of the 24 patients (100%) had

above mentioned points (except left Shotaku) for about

indurations prior to the treatment, 21 patients (88%)

15～20mm, and at left Shotaku perpendicularly forcomplained of pain and 16 (67%) of local heat

about 1.5～2.0mm.

sensations. The three patients without pain also did

II. Blood letting and cupping: sitting position, network

not report local heat sensations. Based on the above

vessels appearing in the interscapular area, search fordescribed findings the symptoms of mastitis weretender points or eruptions on the back corresponding

considered to progress in the order induration -> pain

to pain of the breast, performance of pricking and-> local heat sensation -> fever.
Regarding general symptoms all of the 24 patients

cupping in these areas.
4. Treatment period: from June 25, 2005 to July 16(100%) complained about shoulder and back stiffness.

(total of 5 treatments)

In particular indurations or tenderness corresponding[Course]to the indurations and tender spots of the breasts

Second treatment on June 30, 2005; pain andappeared on the back. According to some reports

reddening had markedly subsided, indurations were

cupping performed in these areas seems to be

still present, but reduced in size and the local heateffective5).

sensation had disappeared.

Stress has been cited as one of the causes for

Third treatment on July 2, 2005; no pain, reddening,

mastitis2), but only 15 of the patients (63%) complainedor feverish feeling, indurations remained hard.

of a marked degree of stress. The causes of this stress

Fourth treatment on July 9, 2005; no pain, reddening,

included child care, husbands and work. From aor local heat sensation, indurations were reduced in

traditional

size. Additional needling of the vicinity of thedepression of emotions due to mental stress causing

indurations.

stagnation of liver qi, which then results in congestion

Fifth treatment on July 16, 2005; no pain, reddening,of the milk vessels6), can be cited as one of the etiologic

or local heat sensation, indurations were reduced infactors leading to the development of mastitis.

Chinesemedical

point

of

view

the

size, with only a mild degree remaining at the base of

Also, 13 of the patients (54%) complained of an

the breast. After additional needling of the vicinity ofexcessive sensitivity to cold, indicating the necessity totheinvestigate the correlation between this factor andindurations

completion

of

the

acupuncture

treatment.

mastitis.
In a typical case the patient presented with aIV.

Discussion

39-degree

fever,

indurations,reddening,heat

The clinical symptoms of postpartum mastitis aresensation and pain, which were not alleviated byin case of congestive mastitis: tension of the breasts,

breast massage. Judging from the condition of theswelling, reddening, indurations, pain, local heat

fever, the patient was considered to suffer fromsensation. In case of suppurative mastitis: local
findings

characterizedbyamarkeddegreeofcongestion, chills, fever (more than 38 degrees) andgeneral malaise4) are cited.
On this occasion we investigated in the 24 patientswith mastitis the changes in indurations of the breasts,

suppurative

mastitis,treatments,

except

but

for

after

some

5

acupuncture

minimalresidual

indurations, all other symptoms could be alleviated. In
this patient we strongly and clearly perceived thefatigue from child care and work as well as theinfluence of stress, so that treatment intended to

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

17

Volume 2, Number 2 | Summer 2007

soothe the liver and rectify the qi, combined withresolving congestion and promoting milk flow resulted
in marked improvements.

V. Conclusion
Twenty four patients with postpartum mastitis
received a combination therapy of Oketani style

Among the 24 patients incisions were made in 10

breast massage and acupuncture and moxibustion

patients. Again, among the 24 patients generalized

treatment. Among the 14 patients with generalized

fever developed in 14 patients, indicating the presence

fever the condition healed in 4 without incision.

of suppurative mastitis in these cases. Among those

Prognosis was favorable in the 10 patients without

patients in whom an incision appeared to be the only

fever. The adoption of a combination therapy withchoice, a number of patients visited our clinic, wishingacupuncture and moxibustion treatment employed

to cure the conditions without performing an incision.

from an early stage of postpartum mastitis is

And in four of these patients healing could be achieved

considered to be useful.

without incisions. Prognosis was favorable in the 10

VI. References

patients without fever.
The cooperation with the maternity clinics and

1) Medical Dictionary, Nanzando; 2001; 1564

corresponding exchange of opinions led to earlier

2) Perinatal Medicine; Vol.31, 2001:274

considerations of a combination therapy of breast3) Extra Edition, Progress of Medicine; Ishiyaku

massage and acupuncture and moxibustion treatment.

Publisher; 2004; 587

Recently 6 patients have been referred to us by

4) Perinatal Medicine; Vol.26, 1996:260

maternity clinics, even though there was no pain or

5) Zhān gjìng-bō, observation of the treatment of 150

heat sensation yet and the development of indurations

patients with acute mastitis, Jiāngxī zhōng yīyào

had been in the initial stage of formation. Combination

1983; 5:18

therapy with acupuncture and moxibustion treatment

6) Zhang Cong-zheng, Ru-men-shi-qin,1228

from an early stage on is considered to be effective.

18

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

Volume 2, Number 2 | Summer 2007

Age

Day of first visit

Birth history

Indurations

Pain

Local heatsensation

Fever

Incision

Shoulder/backstiffness

Excessive
sensitivity to coldStressSymptoms of 24 patients with mastitis

No

Table 1

1

36

2003/9/10

2

yes

yes

yes

no

no

yes

yes

no

2

34

2004/9/16

1

yes

yes

yes

yes

yes

yes

no

yes

3

33

2004/9/29

2

yes

yes

yes

yes

no

yes

yes

no

4

29

2004/10/23

1

yes

yes

yes

yes

yes

yes

yes

yes

5

37

2004/12/3

3

yes

yes

yes

yes

yes

yes

yes

no

6

32

2005/1/15

1

yes

yes

yes

yes

no

yes

no

no

7

35

2005/2/2

2

yes

yes

yes

yes

yes

yes

yes

no

8

33

2005/3/9

1

yes

yes

yes

yes

no

yes

yes

yes

9

37

2005/6/14

1

yes

yes

yes

yes

yes

yes

yes

yes

10

39

2005/6/25

1

yes

yes

yes

yes

no

yes

no

yes

11

33

2005/6/30

2

yes

yes

yes

yes

yes

yes

no

yes

12

33

2005/7/14

2

yes

yes

yes

yes

yes

yes

no

yes

13

39

2005/7/15

2

yes

yes

no

no

no

yes

no

no

14

35

2005/8/1

2

yes

yes

yes

no

no

yes

no

yes

15

36

2005/9/22

1

yes

yes

yes

yes

yes

yes

yes

yes

16

37

2005/12/6

1

yes

yes

yes

yes

yes

yes

yes

yes

17

43

2006/6/17

2

yes

yes

no

no

no

yes

no

yes

18

39

2006/7/22

1

yes

yes

yes

yes

yes

yes

yes

yes

19

33

2006/10/31

1

yes

yes

no

no

no

yes

no

no

20

37

2007/5/29

2

yes

no

no

no

no

yes

no

yes

21

45

2007/10/20

1

yes

no

no

no

no

yes

yes

no

22

30

2007/10/26

1

yes

no

no

no

no

yes

no

yes

23

35

2007/11/9

1

yes

yes

no

no

no

yes

yes

yes

24

32

2007/12/13

1

yes

yes

no

no

no

yes

yes

no

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

19

Volume 2, Number 2 | Summer 2007

Introduction of Academic Institutions
GOTO COLLEGE OF MEDICAL ARTS AND SCIENCES
TOKYO EISEI GAKUEN COLLEGE

The history of Tokyo Eisei Gakuen College started
in 1953 in Omori of Tokyo with the opening of thecourse for Massage Practitioners and the course for
Assistant Nurses (licensed practical nurse: LPN). Now
the College has expanded to have four medical
departments: Department of General Oriental Medical
Care to train practitioners of Japanese traditional
massage, massage, acupuncture and moxibustion,
Department of Clinical Education to train teachers for
Oriental medical care, Department of Rehabilitation totrain“physical

therapists”,

andDepartmentofPhoto 1
Tokyo Eisei Gakuen College

Nursing (attending school・via communication) to train
nurses. (Photo 1)
The medical facilities adjunct to the College are two
clinics of “Iri Arai Clinic” providing services to Kampo
outpatients and “Treatment Room for Acupunctureand Massage” where medical manual lymph drainage
and acupuncture are practiced for the local residents
and patients with lymphedema.
The medical facilities of the College have visits ofmore than 1,000 patients per month, of which one
thirds receive acupuncture and moxibustion treatments.
The patients who receive these treatments generally
have the chief complaint of mastitis, Parkinson’s
disease, or panic disorder in addition to stiff shoulders
or low back pain. In order to respond to these patients,
treatments for a wide range of conditions are being
given at the clinics. (Photo 2)

20

Photo 2
Room for Acupuncture and Moxibustion

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

Volume 2, Number 2 | Summer 2007

Clinical Report 2

stiffness, low back pain, excessive gas, pain in hands

Functional Dyspepsia Gets Worse in Summer
Hiromichi Yasui
Japan Institute of TCM Research

and feet.
Anamnestic history: Low back pain since March of last year.
Family history: Negative
Present conditions: Height 158.5cm, Weight 50kg

Patient: 55 years old Female

Pulse findings: Tense and smooth

Initial consultation: July 7, 1999
Chief complaint: Discomfort in the stomach andfatigue
Present illness: With the coming of summer the

Tongue findings: Pale but slightly dark, thin white furs,
slightly dry
Abdominal findings: Tenderness in the region between
the epigastrium and umbilicus, gas in the upper

patient always had stomach problems, feeling an

abdomen, and lower abdomen filled as a whole.

extreme heaviness in the region of the stomach andDiagnosis: Dampness blocking spleen

queasiness like going to vomiting. Year before,

Treatment

symptoms were intolerably bad, so the patient had

strengthening the spleen

gastroscopic examination in a nearby hospital withPrescription: Koshaheiisan

findings

of no abnormalities.

The

patient was

method:Dissolving

Magnoliae Cortex 3g

became aggravated on the contrary. This year

Citri Unshiu Pericarpium 3g

symptoms developed in about May. Stomach conditions

Pogostemi Herba 3g

were as bad as those experienced previously. A heavy

Amomi Semen 2g

sensation was felt in the epigastrium. By 10o’clock in

Cyperi Rhizoma 4g

the morning, the patient became exhausted to the

Ziziphi Fructus 2g

extent that she was hardly able to keep herself in a

Zingiberis Rhizoma 1g

10 minutes, the patient recovered. When she became
tired, for instance, during shopping, similar symptoms
appeared.

andAtractylodis Lanceae Rhizoma 4g

administered stomach medicine but the symptoms

standing position. After lying down and resting fordampness

Clinical Course:
2nd Visit on July 14
Queasiness in the stomach mostly disappeared.
Heaviness in the stomach reduced significantly. The

Present status:

patient was hardly bothered by fatigue. The patient

Appetite: The patient had some appetite but felt easily

began to feel fine overall. However, low back pain

full soon after she ate. After meal, the patient felt

remained unchanged.

sleepy.

【Formula】The same formula plus forbes notoptery

Sleep: Insomnia. Difficult to fall into sleep.

gium root 4g

Urination: 4 times/day, Nocturia - once

3rd Visiton July 21
The

Bowel movement: once/day
Menstruation: Menopause at the age of 50

stomach

felt

good

almostcompletely.

Powerlessness in the morning almost disappeared.
Low back pain began to be relieved.

Other symptoms:【Formula】Same as previously.

Heaviness of the head, decreased vision, sneezing, arunning nose, blocked nose, unable to sense smell, drymouth, a bitter taste in the mouth, rough lips, neck

After this, mostly-relieved conditions persisted into
September when medication was discontinued.
At the time of the visit to the hospital due to a cold

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

21

Volume 2, Number 2 | Summer 2007

in November 24, the patient stated that the conditionsof stomach symptoms and fatigue felt good.

The first principle for such pathological condition isto remove dampness, not to heal “deficiency of spleen”.
The treatment is “strengthening the spleen andDiscussion:
characteristic

dissolving damp” and a conceivable formula for this is

symptoms that in summer she has decreased appetite

heiisan. Considering intense severity of the moist stateand heavy stomach and becomes very tired to theof the stomach, I added to this formulaextent that she can’t help but lie down.

Herba,

This

patient

has

extremely

Amomi

Semen,

Cyperi

Pogostemi

Rhizomaand

It should be noted that symptoms develop duringadministered as koshaheiisan. Efficacy appeared in

the period of end June to early July – the rainy season

less than a week and in the third week, symptoms

peculiar to Japan. During the season, temperature

disappeared mostly.

rises with rapidly increasing humidity. This meansthat the body is affected or damaged by atmosphericmoisture. Subjective symptoms of sleepiness after
meal and fatigue are generally observed in many casesof weakened gastrointestines. However, for the subject
patient, given the white furs on the tongue and tenseand smooth pulsation, the author may consider that

There are many patients with symptoms similar to
those of the subject patient in Japan. For the persons
with underlying “deficiency of spleen” who develop
those symptoms in the rainy season, kosharikkunshito
is generally prescribed. For those who always has thedisordered stomach at some level due to dampness,

koshaheiisan is generally prescribed.

her stomach is not in a simple state of “deficiency of
spleen” but its function was disordered by dampness.

22

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

Volume 2, Number 2 | Summer 2007

Clinical Report 3

discharge for eosinophils, tests for total serum IgE

Immediate Effects of Maoto in Pediatric Patientswith Nasal Obstruction

value and specific IgE antibodies were performed

Mikikazu Yamagiwa
Home of the Mizuho, Long-Term Care Health Facility

Maoto (Ma huang tang) is a prescription listed in
the Chinese medical classic Shang Han Lun1), written
in AD 219 by (Zhang) Zhong jing and contains thefollowing galenicals: Ephedrae Herba, Armeniacae
Semen, Cinnamomi Cortex, Glycyrrhizae Radix. The
main ingredient Ephedrae Herba is known as the ideal
plant type for ephedrine. maoto has been used since
times

for

the

treatmentofpatients

complaining of nasal obstruction, sneezing, running
nose, cough, chills, fever, headache, arthralgia etc. as
early symptoms of colds. It has been handed down by
word of mouth, that it provides in particular in infants
with nasal obstruction quick relief, but so far no
objective results supporting this assertion have been
provided.
In the present study the author used acoustic
rhinometry2), allowing non-invasive, highly accurate,
geometric measurements of the nasal cavity almost
without the necessity for cooperation by the examinee
and a visual analogue scale3,4) that can be applied to avariety

of

to

the

"Practicalguidelines

managementofallergic

rhinitis

for

in

the

Japan

<PG-MARJ>" and in this way diagnosed either withperennial or seasonal allergic rhinitis. The purpose of

Introduction

ancient

according

subjective,

sensorymeasurements

toevaluate the immediate effects of maoto on the form of
the nasal cavity and feeling of nasal obstruction inpediatric patients with allergic rhinitis.
Here I am going to report the results of the study,
showing as handed down, that maoto has immediate
effects, relieving nasal obstruction both subjectively aswell as objectively.

the clinical study was sufficiently explained to both thepediatric patients and their guardians and based on
their consent, 25 patients (14 boys, 11 girls, age
distribution 5.6 to 14.9 years, average ± standard
deviation 9.6±2.8 years, duration since onset: 0.7―108
months, average ± standard deviation 45.3±31.6
months) served as subjects.
Nineteen cases were considered to be perennial
allergic rhinitis due to house dust and included 4 cases
complicated by cryptomeria pollinosis. Two patients
suffered from cryptomeria pollinosis and in theremaining 4 patients had antigens that could not be
identified.
Fourteenofthepatientshadahistoryofcomplications of bacterial infection induced nasal andparanasal sinusitis, 6 patients had exudative otitis
media, 6 patients had bronchial asthma and 4 patients
had a history of atopic dermatitis.
The subjects did not receive any treatments thatmight have influenced the evaluation of the effects, atleast not within one week prior to trial begin.
Oriental medical findings:
The diagnosis was made based on the diagnostic
criteria of Terazawa6), taking yin-yang, the physicalconstitution,

deficiency-excess,heat-cold

andqi/blood/water anomalies into account. Regarding
yin-yang balance there were no patients with a clearlyyin or clearly yang dominated condition. As viewed
from the physical constitution too there were no

Subjects and methods
I. Subjects included in the study
The study included patients, who had been visiting
the department of otolaryngology of the Daitai Welfare
Hospital or the Matsuzaka Central Hospital between
March 8, 2006 and March 7, 2007 and in whominterviews, rhinoscopies, examinations of the rhinal

obvious cases of excess, but 4 patients were considered
to have a deficiency condition. Regarding the heat-cold
duality 13 patients were considered to have heatconditions, 4 had cold conditions and 8 had neither.
Regarding qi-blood-water, conditions were somewhat
overlapping, but 6 patients had apparently qi

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

23

Volume 2, Number 2 | Summer 2007

deficiencies, 3 qi reversal, 6 qi depression, 8 blood

AR employs sound reflections to measure thedeficiency and 6 patients had water retention

geometrical form of the nasal cavity. An incident beam

syndromes.

of sounds generated by a sound generator are directed
through a wave tube of suitable size selected according
to the size of the examinees anterior nares and fitted

II. Test drugs and dosages
The test drug Tsumura maoto extract (TJ-27, 2.5 g

to these via a nose piece and thus into the nostrils. A

per package, containing in 7.5 g the amount of 1.75 g

portion of these sound waves alter the acoustic

dry crude drug extract, composed at a ratio of Mao=5.0,

impedance of the various structures in the nasal cavity

Kyonin=4.0, Keihi=3.0, Kanzo=1.5) was used. The size

and are then reflected back into the wave tubes. The

of individual doses (5-7 years = 1/2 package, over 12

temporal and spatial correlation between the incident

years or a body weight of more than 45 kg = 1 package

and reflected waves are recorded with a microphoneeach) were calculated depending on age and bodyinstalled inside the wave tubes. Subsequent computer

weight and each single dose was administeredanalysis then reveals the distances from the anteriordissolved in 100 ml of warm water.

nares to the various structures in the nasal cavity,
which are then used to plot the cross-sectional area in

III. Evaluation of the nasal obstruction

form of a cross-sectional area – distance curve (Figure1)1). Moreover, integration allows to calculate the

A face visual analogue scale (F－VAS) was used

for the subjective evaluation of the feeling of nasal

volume of any arbitrary range of the nasal cavity2).

obstruction
To express the degree of distress in steps, a 100 mm
long horizontal bar with 5 different faces along its
length was used to evaluate the feeling of nasal
obstruction before and after ingestion of TJ-27. The
F-VAS had short vertical lines at both of its ends,
where the left end represented a degree of 0 (no feelingof nasal obstruction at all, capability of breathing
through both nostrils with closed mouth), while its
right end represented a degree of 100 (had to use
mouth breathing, since with closed mouth breathing
through both nostrils was impossible).
The meaning of the F-VAS was explained to the

For the present study I used a device manufactured

affected children, so that they could mark the intensity

at the Aarhus University, Research Laboratory forof the feeling of nasal obstruction before and after

Environmental and Occupational Medicine (most ofingestion of TJ-27 at that point of time. Moreover, thethe parts have been gathered and stored by GJ

distance from the left end to the marked position was

Elektronik、Skanderborg, Denmark, so that I used themeasured. The VAS score was obtained by assigning acomputer program NADAP) and with this objectively

value of 1 to each 1 mm. Accordingly, the VAS-score ofevaluated the nasal obstruction before and after

the feeling of nasal obstruction had a distribution

administration of TJ-27. In the present research I usedrange of 0-100, where higher values indicated apediatric nose pieces with an internal diameter of 7

stronger degree of the feeling of nasal obstruction.

mm for the anterior nares.

2)

Application of acoustic rhinometry (AR) to theobjective evaluation of the form of the nasal cavity
24

The examination was carried out in the order rightnose -> left nose and the base line of the cross-sectional

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

Volume 2, Number 2 | Summer 2007

area – distance curve formed by the nose piece section

VI. Statistical examination

was horizontal, so that abnormal increases were

The computer program StatView 4.0 (productconsidered to be indicative of sound leakage at the"Abacus Concepts") was used and the two groups

nose entrance, or inappropriate angle of insertion ofcompared using a method suited for the examination of

the nose piece, resulting in abnormal decreases. Afterordinal variables, for which a sufficient normality

confirmation that no such anomalies were present andcannot be obtained (Wilcoxon signed rank test,of the reproducibility, data were gathered, stored andSpearman rank correlation) and subsequently theused as material for the analysis.

relevant correlations examined. The results showed a

A calculation program (RHINO) was used tostatistically significant difference of p<0.05.

calculate the minimum cross-sectional area (MCA) forthe left and right nasal cavities as well as their

Results

respective nasal cavity volumes (NCV) as parameters

1)

for the nasal obstruction. During the calculation of the

obstruction (Figure 2)

Variations in VAS score for the feeling of nasal

nasal cavity volume the distance from the front end of

The "Before" value of the VAS score of the feeling of

the nasal cavity to its back end (nasal cavity length)

nasal obstruction had a 0-100 distribution and an

was sought, but for the present study I referred to theaverage ± standard deviation range of 39.6±6.0. The

results of previous investigations and calculated this"After" value decreased to a 0-64 distribution andparameter according to the equation "nasal cavity

22.0±4.1, showing a significant difference between thelength" (mm) = 40.6 + 1.07 x age (years), entering here

two values (p=0.0021).

the age of the pediatric patient.
IV. Objective evaluation of the taste of maoto
The same 100 mm horizontal F-VAS used for theevaluation of the feeling of nasal obstruction was also
used to evaluate the taste of TJ-27 immediately after
the children had taken the drug. Here too the left end
was defined as representing a degree of 0 (best possible
taste), while its right end represented a degree of 100(worst possible taste). Accordingly, the VAS-taste score
too had a distribution range between 0 and 100, where
increasing values indicated increasingly worse taste.

2)

Variations in the MCA before and after ingestionof maoto (Figure 3)
V. Progression of the clinical research
The VAS for the feeling of nasal obstruction, MCA
and NCV were measured between 1 and 13 minutes
prior to the ingestion of TJ-27. The taste-VAS was
measured immediately after the ingestion of TJ-27 andbetween 28 and 60 minutes later the VAS score for the
feeling of nasal obstruction, MCA and NCV values
were remeasured.

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

25

Volume 2, Number 2 | Summer 2007

The "Before" value of the MCA had a 0-0.62 cm2
distribution and an average ± standard deviation

obstruction and objective verification via the form of
the nasal cavity

range of 0.32±0.04 cm2. The "After" value of the MCA

Between the decrease in the subjective VAS scoreincreased to a 0-0.72 cm2 distribution and an average ±for the feeling of nasal obstruction and the increase instandard deviation range of 0.41 ± 0.04 cm2. There was

the objectively measured NCV there was a statisticallya significant difference between the two groups

significant correlation (ρ= -0.266, p=0.1918). Yet,

(p=0.0010).

subtraction of the VAS score for the feeling of nasal

3)

Variations in the NCV before and after ingestionof Mao (Figure 4)

obstruction after the drug administration from the
VAS score for the feeling of nasal obstruction obtained
prior

to

the

medication,

in

other

words,

theThe "Before" value of the NCV had a 0-8.77 cm2

subjectively felt reduction of the nasal obstruction,

distribution and an average ± standard deviationsuggested that there was a correlation to the value ofrange of 4.56±0.51 cm3. The "After" value of the NCV

the NCV prior to the drug administration subtracted

had a 0-9.79 cm3 distribution and the average ±from the NCV value after the medication, in otherstandard deviation range increased to 5.68 ± 0.48 cm3.

words, the objectively measured increase in the NCV

There was a significant difference between the two(ρ=0.327, p=0.1107).

groups (p=0.0002). The increase in NCV being greaterthan 15% was considered to show for 40% of thepatients (10/25) objectively, that maoto had an effectcountering the nasal obstruction.

4)

Taste-VAS score
The taste-VAS score had a 0-100 distribution andan average ± standard deviation range of 52.2±6.5. The
taste of maoto was found to be rather acceptable, since
the ratio of taste-VAS scores below 50 was 52%.
5)

Correlation between the taste-VAS score and theincrease in NCV
There was a significant correlation (ρ= -0.173,
p=0.3962) between the taste-VAS score and theincrease in NCV.
6)

26

Correlation between subjective feeling of nasal

7)

Adverse reaction did not occur during this clinicalresearch.
Discussion
Maoto is one of the prescriptions listed in “Shang
Han Lun” and contains the following galenicals:
Ephedrae Herba, Armeniacae Semen, Cinnamomi
Cortex, Glycyrrhizae Radix.
Among the ingredients extracted from Ephedrae
Herba ephedrine has been most thoroughly researched.
It has an adrenaline like, sympathomimetic action,
causes in small doses dilation of the pupils, in large
doses generalized paralysis, increases blood pressure,promotes sweating and relaxation of the bronchi. Also,in a similar way the pseudoephedrine extracted fromEphedrae Herba dilates the renal blood vessels andhas diuretic actions.
Cinnamomi Cortex has, according to Kampo
medical pharmaceutical principles, body warming,
sudatory and dispersing actions, at the same time it isfortifying the stomach and thus a compound of many
Kampo prescriptions.
Glycyrrhizae Radix has in Kampo medicine arelaxing, mitigating action and is said to be thirstquenching and is compounded in many Kampo
prescriptions to soften and adjust the actions of thevarious component crude drugs. For this reason it isconsidered to be one of the most basic galenicals in

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

Volume 2, Number 2 | Summer 2007

Kampo medicine and is also been called "key retainer".
From a western medical point of view it has
detoxifying,antispasmodic,
expectorant,anti-anaphylactic, anti-inflammatory and similaractions and glycyrrhizin is a well known constituent
widely used in western medical settings as a drug bothfor internal use as well as in preparations for infusion.
Hypokalemia and edema have been indicated as
possible side effects of glycyrrhizin, so that both single
large doses and prolonged use of small doses tooshould be avoided. Armeniacae Semen is in Kampo
prescriptions often combined with Ephedrae Herba
and has antitussive and expectorant effects.
Maoto is used, based on experience, during theearly stages of the common cold for symptoms likeheadache, chills, fever, low back pain, cough, asthma
and the like, and regarding pediatric patients it has
been widely spread by word of mouth, that it isextremely effective in relieving nasal obstruction.
Keiichi Ichimura8) noted in his introduction to thetreatment of nasal obstruction, that maoto would be
the drug of first choice during the treatment of nasal
obstruction in infants. The reasons are (1) maoto
definitely improves the nasal obstruction, (2) the
vasoconstrictive actions of ephedrine hydrochloride ofdrugs for internal use require care and thus should be
used cautiously, (3) the vasoconstrictive actions of
nasal drops are stimulants for α-adrenergic receptors
and thus have powerful actions taking effectimmediately, but the infection induced tissue edema
resulting in the nasal obstruction cannot be completely
relieved through the vasoconstrictive actions. He also
stated,thatininfants
stimulationofcentralα2-receptors is contraindicated because of therespiratory and circulatory depression as well as thedevelopment of lethargy, this could easily induce.
Makoto Arai et al.9) reported one case of a 4-year oldboy, in whom maoto was effective for nasal obstruction
and snoring. The results of a search of the available
literature are described below. The number of reports
describing the treatment of nasal obstruction withmaoto is surprisingly low, but already a long time ago
Yodo Odai wrote in the headnotes for maoto in his
Ruiju-ho-kougi "This prescription gives immediate
relief in cases, when newborn babies develop a fever,development of nasal obstructed blocking the passageof the nose, so that the infant cannot suckle."
In this way maoto, from a modern medical point ofview too, has been recognized as being useful for thetreatment of nasal obstruction, but so far objective
evidence for the effectivity of maoto using western
medical methods has not yet been presented.
The author investigated in the present study withwestern medical methods whether maoto, randomly
administered to infants with nasal obstruction, has
any immediate effects and if it does, the degree ofthese effects. The results definitely showed asignificant relief of the subjective feeling of nasal
obstruction following the administration of maoto(p=0.0021) and a significant increase in the MCA,
which served as a parameter for the intensity of the
feeling of nasal obstruction (p=0.0010). Without
contradicting these results the NCV also increased
significantly following the administration of maoto(p=0.0002) and the observed magnitude of thisincrease of more than 15% revealed, that maoto had in
40% of the cases (10/25) a clear effect opposing thenasal obstruction. These results objectively verify the
Kampo medical tradition handed down by word of
mouth, that "maoto has immediate effects relieving
nasal obstruction in infants".
In general, Kampo medicine tastes bad, but maoto
has been rated as tasting rather good by 52% of thepatients. This gives the Kampo administered toinfants a generally satisfactory taste. Yet, compared towestern medicine Kampo medicine still has the
disadvantage of tasting bad and being difficult toswallow. In Kampo medicine the tradition holds, that if
a patients finds the medicine tasting good, there is ahigh likelihood of that medicine having a good effect in
the particular patient. The affected infants serving as
subjects for this study indicated, that there was no
significant correlation between the taste, as evaluatedusing a VAS and the increase in NCV (ρ= -0.173,
p=0.3962), but when the score of VAS for nasal
obstruction obtained after the administration was
subtracted from the same score obtained prior to the
medication, in other words, the degree of the decreasein the feeling of nasal obstruction tended to correlatewith the NCV value prior to medication subtracted

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

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Volume 2, Number 2 | Summer 2007

from the NCV value obtained after the drug
administration, i.e., the degree of increase in NCV. Yet,this could not yet be called a statistically significant
correlation (ρ=0.327, p=0.1107). A VAS is clearly ascale used for subjective evaluation and thus
characterized by large individual variations. For
example, a score of 40 for the feeling of nasal
obstruction in one affected infant may have a vastlydifferent meaning from the same score of 40 in adifferent pediatric patient. Thus, when the VAS score
for the feeling of nasal obstruction was frequently
measured in a particular affected child, this correlated
well with the simultaneously and with the same
frequency performed measurements of the NCV. Yet, asin the present study, when these measurements weremade only once or twice in a group of several pediatricpatients, there was almost no correlation between thetwo measurements10). Consequently, the results of thepresent study had been anticipated, but it should be
noted, that there is tendency towards a correlation.
Conclusion
A total of 25 pediatric patients (14 boys, 11 girls,
age distribution 5.6 to 14.9 years, average ± standard
deviation range 9.6±2.8 years, duration since onset:
0.7―108 months, average ± standard deviation range
45.3±31.6 months) diagnosed either with perennial orseasonal allergic rhinitis was treated with the usual
dose of maoto extract granules as single doses, using aface visual analogue scale and acoustic rhinometry(AR) between 28 and 60 minutes after the medication
to evaluate its immediate effects. The results showed asignificant, subjective reduction of the feeling of nasal
obstruction (p=0.0021) and a significant increase in
the MCA and NCV, serving as objective parameters of
the nasal obstruction (p=0.0010 and p=0.0002). The
increase in NCV being greater than 15% wasconsidered to objectively verify, that maoto had aneffect countering nasal obstruction in 40% of thepatients (10/25). Adverse reactions did not occur
during this clinical research.
In Kampo medicine maoto is used during the earlystages of the common cold for symptoms like headache,chills, fever, low back pain, arthralgia, cough, asthma
and the like and is said to be extremely effective inparticularly for relieving nasal obstruction in pediatric28

patients. The present study objectively verified, that
this is true and maoto can be ranked even in a modern
medical setting as an extremely useful medication for
the treatment of nasal obstruction in pediatricpatients.
References
1) Otsuka K: Clinical Application, Commentary on
the Shang Han Lun, pp 202-204, Sogen Sha, Osaka,
19802) Hilberg O, Jackson AC, Swift DL et al.: Acoustic
rhinometry: evaluation of nasal cavity geometry byacoustic reflection. J Appl Physiol 66: 295-303, 1989
3) Hayes MH, Patterson DG: Experimental
development of the graphics rating method. Physiol
Bull 18: 98-99, 1921
4) Freyd M: The graphic rating scale. Journal of
Educational Psychology 14: 83-102, 1923
5) Committee for the drafting of allergic rhinitis
treatment guidelines: Guidelines for the Treatmentof Allergic Rhinitis – perennial rhinitis andpollinosis - , pp. 18-30, Life Science, Tokyo, 2005
6) Terazawa K: Skills of Kampo Medical Care
Acquired Through Case Studies, Chapter 2,
Comprehension of diseases based on the concept ofqi-blood-water, pp 15-65; Chapter 4, Recognition ofpathologies based on yin-yang, deficiency-excess,cold-hot and exterior-interior dualities, pp 87-110,
Igaku Shoin, Tokyo, 1990
7) Yamagiwa M: Nasal cavity length in pediatricpatients with otorhinolaryngological diseases.
Rhinology Supplement 15: 63-65, 1999.
8) Keiichi Ichimura: Diagnosis and treatment of
infectious diseases based on observation of symptoms:
nasal obstruction; JOHNS 21: 188-190, 2005
9) Arai M, others: Three pediatric cases. ClinicalKampo, 53: 116-122, 2006
10) Yamagiwa M: Visual analogue rating and acoustic
rhinometry in the evaluation of nasal obstruction
in children. Pediatric Otorhinolaryngology: an
Update (edited by D. Passali), pp. 23-29, Kugler
Publications, 1998

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

Volume 2, Number 2 | Summer 2007

Introduction of Japanese Acupuncture

certain degree of proficiency regarding the sensitivity

Considering the Therapist’s Hand (6)of the pressing hand after about 2 years of practice,

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

but to gain confidence usually requires more than 3

Dept. of Acupuncture and Moxibustion

years. Of course, this is generally based on the

Tsukuba University of Technology, Ibaraki, Japan

assumption, that this achievement is the result ofhighly concentrated efforts made during that period.

V. Basic training of the hands

With less serious efforts and practice the acquisition of

1. Object of the palpation
Below I will describe the basic training of the hands.
(Table 6)2) Examination of skin, connective tissue, muscles,

1) Palpation is performed using the “pressing hand”
The palpating hand, in other words, the “pressing
hand,” is for right-handed persons the left hand. The
necessity of using the “pressing hand,” for thepalpation arises because it must determine thelocation of the acupoints that are subsequently
needled. In current clinical training (practice) this useof the hands is not taught, so invariably the dominant
hand tends to be used for the palpation, which in turnresults in a certain degree of failure to acquire therelevant palpation skills for the pressing hand, i.e., thenon-dominant hand. Most people do have a dominanthand, so that this hand is used to perform the needling,
while the other hand becomes as the “pressing” hand.
Thus, since the dominant hand in many cases is used
to perform various detailed tasks throughout daily life,
it usually has developed a very subtle sensitivity andtherelevant

detection

skills.

For

thisreasonsensitivity of the pressing hand, mostly serving as
support, is relatively dull and many people find it
difficult to concentrate on it.
Accordingly, most people who start studying theskillsthese skills will probably require more than 3 years.

following

theirinitialencounterwith

acupuncture will have to acquire for the first time intheir life, the sensitivity required for palpation.
Naturally, since the skills of palpating the human body
have not been practiced for the needling hand, either,
the conditions pertaining to the acquisition of
palpation skills are essentially for both hands.
Normally, people believe, they could acquire abones (internal organs) through palpation
Palpation has to be performed while being consciousof the four layers skin, connective tissue, muscles orbones (internal organs) being examined. As alreadystated, instructions in current school education oftenemphasizethemusclesastheobjectoftheexamination, so that students tend to think only aboutmuscles. Yet, performing detailed palpation in actual
practice requires also the checking for tension andelasticity of the skin, various reactions of theconnective tissues as well as recognition of thephysical signs originating from sources other than theinformation

obtainedfrommuscles.

Those

are

essential for both examination and treatment andrepresent the basic body of information obtained
through palpation.
On this occasion it should not be forgotten, thatexcept for the skin, none of the mentioned tissues canbe palpated directly. In other words, even though a
palpation of the anterior tibial muscle is performed,
the anterior tibial muscle itself is not directly palpated,but rather through the intervening layers of skin andconnective tissue. Thus, palpation of only the anterior
tibial muscle, regardless of the condition of skin andconnective tissues, is not possible. Keeping this inmind, it should be realized, that the condition of theskin is palpated using the connective tissues asfoundation, connective tissues are palpated throughthe skin using muscles as foundation and the conditionof the muscles is palpated through both skin and

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

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Volume 2, Number 2 | Summer 2007

connective tissues using the bones (or internal organs)

4) Excess and deficiency at the body surface

theJudgment of overall excess or deficiency combines

condition of the individual layers can be comprehended

the results obtained by all four examination methods:

more precisely.

inspection,asfoundation.

Realizingthese

correlations

As a matter of course, however, man has thepalpation.

listening/smelling,Itshouldbequestioning

noted

that

there

and
are

wonderful capability of depicting only the muscles indistinctions pertaining to excess and deficiency among

his mind, eliminating the information pertaining to

the findings gathered through each of the examinationskin and connective tissues. And by mustering

methods.

anatomical knowledge here, the combination of

And in case of palpating the condition of the above

palpation and knowledge will coalesce from a precise

mentioned four different tissue layers, it is alsomap.

necessary to assess the state of excess or deficiency
through palpation.

3) Finding reactions
Differences in tissues produce different reactions(1) Dermal layer

and, based on the differences in these reactions, theFirst, the surface of the skin is examined fortreatment will also differ, so that it is necessary toswellings, indurations, fever, bulging, dryness andclearly distinguish during palpation between the depth

other signs of excess. And conversely, also for signs ofand kind of reactions. Moreover, reactions should be

deficiency like depressions, lack of strength, coldness,

ascertained for each tissue (in other words locationlack of elasticity, lack of moisture etc.

and depth) and treated correspondingly.
Again, as a matter of course, skin, connective(2) Connective tissue layer

tissues, muscles, bones all do feel different during the

Next, is case of excess of the connective tissue layer

palpation. The different structure of the various

tension, swelling, warmth, hardness and similar

tissues gives rise to the difference in feeling uponcharacteristics

palpation and a basic sensitivity for these sensations

comprehended. In case of deficiency a lack of strength,

should be acquired.

noticeable thinness, coldness and dryness etc. can be

And above that, it is also possible to detect the

can

be

felt

and

shouldbefelt.

presence of pathological reactions.
(3) Muscle layer
Table 6 Basic training of the hands- Object 1. Palpation with the pressing handproperties, indurations, swellings and tenderness.
Cases of deficiency present with lack of strength,-> Ultimately improve the ability to determine themuscular grooves, depressions and lack of elasticity

location of acupoints (pressing hand)

can be observed.

2. Requirement of skills to differentiate between skins,connective tissue, muscles, bones (internal organs)during palpation(4) Bone layer
Excess of the bones is associated with swelling,

3. Ascertain reactions-> imagine 3-dimensional structure and be aware ofdepth and the kind of the reactions

30

Muscle excess is associated with tension, sinewy

deformation, tenderness etc., while deficiency gives afeeling of coarseness as in osteoporosis or hardness
lacking moisture and movement.

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

Volume 2, Number 2 | Summer 2007

Medical History in Japan
Dosan Manase and his Medicine (2)definition

yang

minor

channelinthe

Hiromichi Yasui

What is of great interest is that Manase not only

Japan Institute of TCM Researchdetails every symptom and pu1se pattern, but also the

medical theories of Dosan Manase (1507-1594), who
introduced state-of-the-art Chinese medicine to Japanin the 16th Century. In this issue I will discuss theactual therapeutic methods used, based on specificcases described by Dosan in his writings.

a few examples of his clinical work in a book entitled
Shussho Haizai. Among them, however, a considerable
number can be regarded as suitable data from which toanalyze his ideas and actual treatment methods.
Several cases are presented below.

appropriate medicine, instead of first taking a knownprescription and more or less fitting it to the disease.
This method can only be carried out by someone who isconfident of his ability to understand the condition ofprocess of relating symptoms to medication wasestablished:
Pain in chest and side: Scutellariae Radix, Bupleuri
Radix
Deafness:

BupleuriRadix,

Peucedani

Radix,

Glycyrrhizae Radix
Dry tongue: Paeoniae Radix, Scutellariae Radix,

A male, aged 40, suffering from Shang han (Cold
Injury) for four days. A problem of the “yang minor
bywhich he analyzed each symptom, and prescribed an

Bitterness in mouth: Bupleuri Radix

Case 1：Shang han (Cold Injury)

diagnosed

appropriate medicine. That is, he used a method in

the disease. In this particular case, the following

Dosan Manase wrote few case studies. He left only

wasaShokan-ron16).

In the last issue I talked about the writings andchannel”8)

of

the

pu1se

and

accompanying symptoms: pain in the chest and side,
deafness, bitterness in the mouth, a dry tongue, hotand cold sensations, vomiting, a taut and rapid pulse
taken both at the “inch” and “cubit.”
Prescription (Seven herbs):

Glycyrrhizae Radix
Alternating sensations of hot and cold: Bupleuri Radix,

Peucedani Radix
Vomiting: Citri Unshiu Pericarpium, Pinellia Tuber
Taut and rapid pulse at both the inch and cubit:

Scutellariae Radix, Paeoniae Radix, Peucedani
Radix, Bupleuri Radix.
There is no indication from his writings that

Bupleuri Radix

Manase had read the Shang han lun4), but it is likely

Scutellariae Radix

that he knew its outline through reading other books,

Pinelliae Tuberand was aware of its applications. Therefore, he is

Citri Unshiu Pericarpium

likely to have thought of a prescription which includes

Paeoniae Radix

saiko (bupleurum root) as main herb when symptoms

Peucedani Radixof Shang han were apparent for a number of days.

Glycyrrhizae Radix 15)

What is remarkable about Manase is that he could

This case was not cured until four days after the
onset of the disease. In cases of Shang han (Cold
Injury), the fourth day is usually considered to bewhen the syndrome changes from a “yang major
channel” to either a “splendid yang channel” or a “yangminor channel.” In fact Manase mentions that both thepulse and symptoms he describes are in accord with athink of complex prescriptions such as those listed in
the Shang han lun, while he analyzed each symptom
and composed individual prescriptions, taking into
consideration each separate ingredient. This resulted
in selecting a prescription which was similar todaisaikoto6). And this particular case reveals Manase's
knowledge of Shang han very well.

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

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Volume 2, Number 2 | Summer 2007

cases where it affects the bowels, it is necessary to

Case 2: Palsy
A male, aged 50, viscera affected by “wind,” slack

expel the ‘pernicious wind influence’ using diaphoretic

lips, no voice, nasal congestion, blindness, deafness,

recipes such as shozokumeito. This will cure it quite

constipation, has normal urination, and a “forceful”

easily. In cases where it hits the meridians, it is

and “slippery” pulse.

necessary to supply the blood and nourish the muscles

The first four kinds of medicines work to make trappedwith tonifying recipes such as daijingyoto, which canwind circulate:also dispel pathogenic wind from the exterior of the

Notopterygii Rhizoma

body. And in cases where it affects the viscera, we must

Magnoliae Cortex

first get rid of any stagnation with sankato, and thenRhei Rhizoma

adopt additional prescriptions with juzentaihoto andAurantii Fructus Immaturus

shimotsuto, However, cases such as this last one are

The next eleven normalize qi and blood and smooth thevery difficult to cure.”“meridians”:

Angelicae Radix

Palsy caused by wind affecting the viscera indicates

Paeoniae Radix

serious apoplexy, including, at times, bouts of fainting,

Cinnamomi Cortex

hence it is extremely difficult to cure. Although theRehmanniae Radix

name of the prescribed medicine is not described in

Ginseng Radix

this case study, sankato was adopted as a prescription.

Citri Unshiu Pericarpium

It consists of four kinds of medicines which function to

Armeniacae Semen

expel

Notopterygii Rhizoma

Notopterygii Rhizoma

Arecae Semen

dispelled from the exterior of the body, after having a

Astragali Radix

bowel movement with the help of sankato. (At theFour moxibustion points

same

trapped

time,

the

wind.
１ )

Using
,

fainting

shojyokito

pathogenic

would

wind

probably

plus
was

have

Bai-hui(Du20)

subsided.) Manase continued treating the patient thisQu-chi(LI11),

way. The medicines he used served to invigorate blood

Jian-Jing(GB21),

circulation, replenish “vital essence,” dispel pathogenic

Zu-San-li(ST36)

wind from the exterior of the body, and stimulate
circulation in the meridians.

This case is one of Chung-feng, in other words,

Manase also gave detailed advice on his treatment

stroke. Chung-feng means “to be affected by wind”,

methods, including descriptions of palsy such as “oneand is thought to be caused by a harmful windshould not use Aconiti Radix ２ ) and Aconiti Radix

invading the body. In such cases, the patient shows

Processa２) without first smoothing the flow of vital

signs of being upset by a harmful wind influence.

energy and curing phlegm, and one should not depend

Clearly, Manase was well aware of pathogenic factors

only on medicine for dispelling pathogenic wind fromand internal injury. He determined how to drive away

the exterior of the body, and neglect the need tothe pernicious influence, and regulate the internal

invigorate blood circulation.”(Keiteki-shu)

condition in his treatment.
Manase also used moxibustion treatment for
Manase states in the chapter on apoplexy in theapoplexy. The moxibustion points used are exactly the

Keiteki-shu:“Symptoms change depending on whether

same as those used in modern acupuncture andthe wind affects the bowels, meridians, or viscera. In

moxibustion.

32

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

Volume 2, Number 2 | Summer 2007

This suggests Manase's self-confidence in treating

moisturizing the lung” would be expected to be adopted

apoplexy which, in those days when there were noas the treatment.

mannitol, steroids, activation drugs for cerebral

In this case, Manase's thought processes and themetabolism, and no hypotensive drugs, is impressive.

linking of symptoms to medication were as follows:

Case 3: Cough

Cough habitually gets heavier in the afternoon:

When the patient's cough remains uncured and

Bupleuri Radix, Moutan Cortex

usually gets heavier in the afternoon, he has a

Deficiency of yin, slight fever：Chinese angelica root,

deficiency of yin, a slight fever, rushes of blood to theRehmanniae Radix, Paeoniae Radix 18), Moutan

head, a hoarse voice, is thirsty, has bloody phlegm,

Cortexcopious night sweats, weight loss, loss of taste, slight
difficulty with bowel movements and urination, pain in

Rush of blood to the head: Phellodendri Cortex,

Pogostemi Herba

the sides accompanied by a cough, a “taut, fine,

Hoarse voice: Fritillariae Bulbus, Asini Corii Collas

sinking, hesitant pulse,” and “five beats in a breath.

Thirst: Trichosanthis Radix, Ophiopogonis Radix

Sixteen tastes：

Bloody phlegm: Asteris Radix, Fritillariae Bulbus

Asteris Radix

Night sweats: Trichosanthis Radix, Ophiopogonis

Moutan Cortex

Radix, Paeoniae Radix, Cinnamomi Cortex

Bupleuri Radix

Loss of taste: Scrophulariae Radix, Cinnamomi Cortex,

Angelicae Radix

Angelicae Radix

Paeoniae Radix

Slight difficulty with bowel movements and urination:

Phellodendri Cortex

Angelicae Radix, Moutan Cortex, Paeoniae Radix,

Fritillariae Bulbus

Ophiopogonis Radix, Pogostemi Herba

Asini Corii Collas

Chest pain: Bupleuri Radix

Trichosanthis Radix
Ophiopogonis Radix

As shown above, Manase logically chose andCinnamomi Cortex

prescribed medicines which facilitated a supply of yin

Scrophulariae Radixand cooled the extra heat stored in the lung. It is easy

Gentianae Scabrae Radix

to understand Manase's basic method if we consider

Polygoni Tinctorii Folium

this prescription to be removing something from, andPogostemi Herba

then

Rehmanniae Radix

hyakugokokinto.

This case can be regarded as a disease which isCase 4: Sterility

addingsomething

to,

the

prescriptionofsimilar to chronic bronchitis or bronchiectasia. It can

A female in her early thirties. Qi in the liver andbe considered fundamentally to be a deficiency of lunggallbladder is excessive, she is irritable, and therefore

yin, where the cough has stimulated the lung over a

her blood “stagnates,” and is unable to nourish thelong period of time, causing an excess of yang, or heat,

meridians and their collaterals. Because of a uterinein the lung. At the same time, the symptoms of ahypoplasia and a lack of “sex-stimulating essence” indeficiency of kidney and lung yin, such as a slight fever,

the kidney, she is unable to conceive. She has ana rush of blood to the head, night sweats, and thirst

oppressed feeling in the chest, an angry look,were present, and “the method of tonifying yin anddysmenorrhea, tennesmus, and her pulse is slightly

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

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Volume 2, Number 2 | Summer 2007

I have investigated Manase's treatment methods by“taut and hesitant.”
compoundexamining a few cases recorded by him. This has

medicines, with some additions and subtractions

brought to light his own characteristic methods, which

depending upon the symptom variation over time, theformed the roots of the Gosei school13). However,patient was able to become pregnant.

Manase's method disappeared due to the sudden riseAfteradministering

ten

kinds

of

Bupleuri Radixof the Koho school14) in the middle of the Edo period.

Cyperi Rhizoma

Nevertheless, it remains important because it isRehmanniae Radix

remarkably similar to modern traditional Chinese
medicine, and so it is essential that we understand it if

Cnidii Rhizoma

we aspire to a synthesis of Japanese Kampo Medicine

Citri Unshiu Pericarpium

and TCM.

Moutan Cortex
Arecae Semen

Prescriptions: Pinyin - Chinese Character - Japanese

Glycyrrhizae Radix

daisaikoto ・Da-Chai-Hu-Tang・大柴胡湯Angelicae Dahuricae Radix

shozokumeito ・Xiao-Xu-Ming-Tang・小続命湯For this case of sterility, Manase analyzed thesymptoms and prepared a prescription to counteract
the deficiency of liver blood and the stagnant liver qi,
which was the original condition of the patient. The
name of the prescription is not clear, however, it wasprobablyacombinationofkyukichoketuin andshoyosan, with some variations. Even today similarprescriptions are sometimes used.

34

daijingyoto ・Da-Qin-Qiu-Tang・大秦艽湯
shojokito ・Xiao-Cheng-Qi-Tang・小承気湯
sankato ・San-Hua-Tang・三化湯
juzentaihoto ・Shi-Quan-Da-Bu-Tang・十全大補湯shimotsuto・Si-Wu-Tang・四物湯hyakugokokinto・Bai-He-Gu-Jing-Tang・百合固金湯kyukichoketuin・Xiong-Gui-Tao-Xue-yin・芎帰調血飲
shoyosan ・Xiao-Yao-San・逍遥散

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

Volume 2, Number 2 | Summer 2007

Book Review“Finding Effective Acupuncture Points” written by Shudo
Denmai, translated by Stephen Brown

on anatomical landmarks. While this method is great

Jason Beito
MSTCM Lac DNBAO

attention to the deeper messages the patients skin is

AIMC Berkeley

the basic mastery of anatomical landmarks, students

What a treasure! This book provides both the
beginner and the advanced acupuncturist, withvaluable insights on how to correctly identify, locate,
and treat acupuncture points with great results.

in the United States is the limited use of palpation
techniques for diagnostic assessment. Most students in
the US are taught early on that the superior physician
diagnoses by observation and listening, while theinferior assesses primarily through palpation. Thisbias has been truly unfortunate, when so muchinformation can be received and understood, by
developing a sensitive touch. Numerous medical
studies support the fact that developing “listening
hands” will not only benefit a practitioners ability toproperly interpret what is happening within thepatient, but is incredibly therapeutic for the patient’s
touch

providesnumerous

A well-developed

benefits,

notalwaysmeasured, in patients who live alone, have limitedsocial support, or lack frequent day-to-day contacts.
Being

“in

touch”

enhances

bothpatients

become a limiting crutch, when a student fails to pay
telling them through their fingers. All too often, upon
shift their attention away from what is being
experienced to what point prescriptions would best fix
a patients problem, instead of further listening to what
the patient’s skin is telling them based on changes intemperature, texture, & tension. Shudo Sensei’s

One of the most neglected areas of TCM Education

mental & emotional well being.

for developing an awareness of surface anatomy, it can

andpractitioners understanding of one-another, while
giving greater
Insights in to the metaphorical language of TCM.
Shudo Sensei challenges US educated practitioners to
re-evaluate the conventional ways we have beentaught to locate acupuncture points, and provides us
with practical advice on how to enhance our sense of
touch in both diagnosis and treatment
The beginning student always wrestles with how tolocate acupuncture points correctly. Most students
spend their first year in acupuncture school locating
the points according to standardized locations based

approach encourages the western student to view both
locating the acupuncture points and the use of
palpation as an assessment tool in a new way. By
looking at the acupuncture points as organic, living
phenomenon arising in response to a decline in vitality,
students begin to practice their palpation skills with arenewedcuriosity.

As

anorganic

process,anacupuncture points’ size, shape, and location willchange according to the patient’s circumstance. With
this in mind, we are reminded that the anatomical
landmarks serve merely as guides to finding the
precise location, but are not the end and be all. This
attitude of curiosity brings new meaning as every
palpation experience becomes like searching for buriedtreasure. Students are thus better able to “tune in” todiscovering the bodies subtle messages, and interpret
what is present at that given moment. With “listening
hands”, point location takes on a new dimension, as we
begin to discover what is being experienced with aheightened awareness.
Incorporating Shudo Sensei’s attitudes of curiosityand exploration, in addition to his various methods of
palpation assessment, further enforces our direct
experience of the healing power of touch, as wereconnect with our hands as an essential diagnostic
tool as well as an instrument of healing. In an age of
medical practice where the cultivation of palpation
skills are being less emphasized, the methods andideas presented in this book add tremendous value
into interpreting the geographical landscape of the

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

35

Volume 2, Number 2 | Summer 2007

human body. An overview of the additional topics
discussed in this book includes:

In addition to the information on palpation, thesections on point utilization and providing effective
treatment are also worth their weight in gold. On

I. Background on Points

behalf of all practitioners whom struggle to provide-What Are Acupuncture Points

effective relief for those who are suffering, I am truly

-How

to

find

points-ActivePoints,Depths,grateful for the information presented in these sections,Characteristics

as they have tremendous potential for dramatically-Methods of palpation, parts of the fingers to use &shortening

amount of pressure

effectiveness. Shudo Sensei has not only provided us

ourlearning

curvesfortreatmentwith his personal insights and stories into which
II. Specific points for Hyoji Treatment

points have yielded him the greatest results for-Location of specific points

symptomatic relief, but has also given us the methods-How to find the points

and historical commentary for understanding why-Needle Insertion

these points work, and how to reproduce these results-Point Indications

for our patients. Additionally, he introduces us to his-Discussion/Commentary

personal application of various treatment techniques,and gives us keen insight into how to assess ourIII. Providing Effective Treatment

accurate utilization of these methods. With humor and-Needle Gauges, Insertion Methods, Depths

clarity,-Sensing the Arrival of Qi

provides us with the inspiration and encouragement to-Inducing Arrival of Qi

test the wisdom gained from Shudo Sensei’s 50 years of-Needling 5 phase & Regular Points

practice, and is a true gift to acupuncturists the world“Finding

Effective

Acupuncture

over. Thank you, Thank you, Thank you.

36

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

Points”

Volume 1, Number 1 | Spring 2006

Ominedo is the only professional manufacturer of herbal extracts.

Poria Powder with Five Herbs
Wu-Ling-San
goreisanComposition
Arisma rhizoma
Tuckahoe
Atractylodes ovatae rhizoma
Umbellate pore fungus
Cinnamon bark

Ominedo Pharmaceutical Industry Co., Ltd.
574, Nenarigaki, Yamatotakada-City, Nara 635-0051, Japan
URL：WWW.ominedo.co.jp
Contact：info@ominedo.co.jp
Phone: (81) 745-22-3601 Fax: (81) 745-23-2540
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

35

Volume 1, Number 3 | Fall 2006

Kanebo Pharmaceutical, Ltd.
Like the cherry trees along Potomac River, Kanebo wishes
to play a role of the bridge for friendship and healthbetween Japan and U.S.A.

History of the Cherry Trees in Washington, D.C.
The plantings of cherry trees originated in 1912 as gift of friendship to the United Statesfrom the people of Japan. In Japan, the flowering cherry tree or “Sakura”, as it is called by
the Japanese people, is one of the most exalted flowering plants. The beauty of the cherry
blossom is a potent symbol equated with evanescence of human life and epitomizes thetransformations Japanese Culture has undergone through the ages.
2

Excerpted from National Park Service

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