KAIM
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Accuuppuunnccttuurree aanndd IInntteeggrraattiivvee M
Meeddiicciinnee
INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 6, Number 2 ･ Summer 2011

Editorial

What can the East do for the West and What can the West do for the East in Oriental Medicine
Hiromichi Yasui

Japanese Acupuncture - Current Research

Japanese Traditional Medicine Text (1) – Internal Medicine
Kenichi Kimura

Clinical Report 1 (Acupuncture)

Two Cases of Low Back Pain in Pregnant Women Relieved Using Low Acupuncture and Moxibustion Stimulation Dose Evaluated with
VAS and RDQ
Yoshihiko Koido, Keiko Tsujiuchi and Shuichi Katai

Clinical Report 2 (Kampo Medicine)
Headache 2
Mihoh Koga

Clinical Report 3 (Kampo Medicine)

A Case in which Saireito was Effective for Irritable Bowel Syndrome
Masayuki Kashima

Front Line of Kampo Pharmacology

Review of Research Presentations on Kampo Medicines 4
Toshiaki Makino

Medical History in Japan“Historical Significance of the Standardization of Acupoint Locations”, the Second Japanese Acupoint Committee (2)Makoto Mayanagi

ISSN:1559-033X

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

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

Volume 6, Number 2 ･ Summer 2011EXECUTIVE EDITORTA B L E O F C O N T E N T S

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.

1 Editorial
What can the East do for the West and What can the West do for the East in Oriental
Medicine
Hiromichi Yasui

2 Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (1) – Internal Medicine
Kenichi Kimura

ASSOCIATE EDITORS
Shuichi Katai
Ibaraki-ken, Japan

Hiromichi Yasui
Tokyo, Japan

6 Clinical Report 1 (Acupuncture)
Two Cases of Low Back Pain in Pregnant Women Relieved Using Low Acupuncture andMoxibustion Stimulation Dose Evaluated with VAS and RDQ
Yoshihiko Koido, Keiko Tsujiuchi and Shuichi Katai

EDITORIAL STAFF

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

PUBLISHER

Shuji Goto
International Institute of Health andHuman Services, Berkeley

16 Clinical Report 2 (Kampo Medicine)

Headache 2
Mihoh Koga

19 Clinical Report 3 (Kampo Medicine)
A Case in which Saireito was Effective for Irritable Bowel Syndrome
Masayuki Kashima

21 Front Line of Kampo Pharmacology
Review of Research Presentations on Kampo Medicines 4
Toshiaki Makino

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

24 Medical History in Japan"Historical Significance of the Standardization of Acupoint Locations“, the Second Japanese
Acupoint Committee (2)Makoto Mayanagi

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

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

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

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

Volume 6, Number 2 | Summer 2011

Editorial
What can the East do for the West and What can the West do for the East in Oriental Medicine
Joseph Rudyard Kipling, who became the first Englishman in 1907 to earn the Nobel Prize for Literature(1865-1936), wrote a poem that begins “East is East and West is West, never the twain shall meet.” Thisphrase has been cited and discussed in cultural and many other areas.
Similarly, Oriental medicine and Western medicine shall never meet. In fact, as in the other real world,both can be reconciled. Then what is the best way for ideal coexistence between them? The answer is to help
each other. For this, it is necessary for dialogue to take place between representatives of the nations andregions where Oriental medicine or Western medicine is available and the practitioners. I call on the people
concerned to think of “What can the East do for the West and What can the West do for the East in Oriental
Medicine.”Through this process, we will be able to create a path toward a new global world.
Oriental medicine, which was originated in ancient China and developed in China and its surrounding
countries, is a traditional medicine. TCM in China was a versatile medicine embracing various concepts
before the Chinese Revolution. Intrinsically, TCM included and includes a wealth of concepts and theseconcepts served as the driving force for its development. This is true of Japanese Kampo medicine andtraditional Korean medicine in Korea.
Resources of Oriental medicine that the East can provide to the West are varied, ranging widely fromknowledge, techniques, medicinal substances, tools, systems, hardware, and software. The East as recipient
can freely adopt them.
However, the flow of resources should not be in one direction from the East to the West. The West thatreceived varieties of information will be able to fully understand and reshape it that works for or suits tothe West, like the people of Korea, Japan, and Viet Nam have done so for over a thousand years.
In the West, there may be plants similar to Chinese medicinal materials such as American ginseng inNorth America. Moreover, there may still be a lot of plants left unknown to the East, like the ones that werebrought from distant lands of Europe, Persia, and India and came to be used in China.
The day will come when theories, techniques, tools, and medicines introduced into the West from theEast develop into new forms in each land and their modifications are brought back to the East from theWest.
At the time, Oriental medicine will become a truly global medicine.

Hiromichi Yasui
Japan Institute of TCM Research

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

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Volume 6, Number 2 | Summer 2011

Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (1) – Internal Medicine

consumption combined with medical interventions,

Kenichi Kimura

controlling sympathetic nerve blockers (a β acceptor

Department of Health and Medical Careblocker, an alpha-adrenoreceptor blocker), which act on

Kansai University of Health Sciences

1. The present condition of Clinical Research in
Foreign Countries
In this section, on the topic of circulatory organs, wewill be reporting on the current situation andprospects for domestic Japanese clinical research on
Acupuncture and Moxibustion research, especiallywith respect to Hypertension. Hypertension is
known globally as one of several lifestyle relateddiseases, notably in Japan alone has at least 40
million hypertensive patients.

Arteriosclerosis,

which occurs as people age, contributes to theincreased frequency of Hypertension in the elderly
population. Currently, hypertension and its related
complications accounts for 30% of medical costs for
Because of the inevitably highpercentage of elderly patients with hypertension, I
often intend to use clinical acupuncture andmoxibustion for these patients. Widely known as thesilent killer, hypertension has relatively mild or
manageable subjective symptoms but if these are left
untreated, the patient may suffer a stroke, ischemia
or renal insufficiency, life threatening complications
caused by this risk factor. For this reason, thepurpose of treatment for hypertension is not simply
to lower high blood pressure, but also to maintainnormal levels to prevent ischemia or stroke.
Classification of hypertension include Essential
Hypertension and Secondary Hypertension, lifestyle
habits such as high intake of sodium or alcohol,
stress, smoking etc., as well as genetics, constitutefactors that clearly contribute to the disease process.
As for treatment, there is the non-medical aspect oftherapy that includes improving daily habits such as
reducing sodium intake and weight loss, moderate
exercise, prohibition of smoking, and limiting alcohol
2

therenin-angiotensin

system.

Reducing

reninsecretion helps to reduce the heart-oxygen demand by

A Circulatory Organs

people over age 65.

including hypotensive agents such as pharmaceuticals

reducing extracellular fluid volume. The side effects
and complications associated with this type ofpharmacological treatment protocol, not to mention
the costs, means many patients cannot adapt to these
medical treatments 2). For many of these patients,
the low cost and elimination of side effects makes thealternative therapies of Acupuncture and Moxibustion
rather appealing 3). Until now there has been a lackof scientific proof for the effectiveness of acupuncture
treatment for hypertension because there have notbeen enough well designed randomized controlled
studies (RTC) or case studies and long term casereviews 4,5).
However, recently, Europe, America and Korea havebeen performing large scale RCTs demonstrating theefficacy of acupuncture treatments for hypertension68). In 2007, Germany conducted an RCT study on 160
low to middle range hypertension patients and reportthat acupuncture treatments effectively lowers highblood pressure. As a result, when compared to thesham acupuncture group, the acupuncture groupexperienced significantly reduced systolic and diastolicblood pressure during the 24 hour period immediately
following the treatment. This reduction lasted 6 weeks,but, follow-up results, 3 months and 6 months post
treatment, showed the acupuncture group`s bloodpressure had returned to pre-treatment levels 6).
(Figure 1).
Further, Korean researchers performed double-blind
RCTs on 41 patients with High Blood pressure levels
above 120/80mmHg.

Previously, America approved

new guidelines for hypertension, defining systolicblood pressure to be 120-139mmHg and diastolicblood pressure to be 80-89mmHg. The Korean study
showed that 8 weeks of regular acupuncture

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

Volume 6, Number 2 | Summer 2011

treatments significantly contributed to decreases inmoxibustion treatment to two controls, hypertensive

blood pressure when compared to the results of the

medications and no treatment, and found asham acupuncture group 7). The group concluded

significant decrease in patient hypertension levels

that regular acupuncture is beneficial as a remedy

when comparing moxibustion treatment with nofor hypertension.

In contrast, an American RCTtreatment. However, because of the low number ofstudy of 192 hypertension patients was conducted 8).

high quality RCTs, differing results between reports;

This study divided the subjects into three random

and with respect to moxibustion treatment RCTs,

groups: standard acupuncture, sham acupuncture

the difficulty of establishing an appropriate control

and no treatment.

intervention, there is insufficient evidence to suggest

All patients received a Chinese

Medical diagnosis where an individualized set of
acupoints

wasdetermined.

Treatments

conducted regularly for 6-8 weeks.

that moxibustion is effective for hypertension.

were

Compared tobasal readings, all three groups showed reductions
in diastolic and systolic blood pressure 10 weeks
following the trials, however the difference between
groups was not significant. Further, 12 months
following the trials, blood pressure levels showed atrend of returning to pre-trial levels, so both theconclusion that acupuncture treatment is effective
for hypertension andnot long lasting for

hypertension were reported.

In recent years, Lee etal. 9), conducted a systematic review of interventions
using acupuncture therapy to treat Hypertension.
They selected 11 RCT reports that satisfied all thestandard criteria and showed references not only tothe slight efficacy of acupuncture treatments to
reduce hypertension when compared to the control
intervention, but also to equivalent effectivenesswhen

comparedtohypertensive

medications.

Unfortunately, because of small sample size, somequalities of the trial designs and some disagreement
between results the researchers could not reach theconclusionthat

acupunctureissufficiently

effective to treat hypertensive patients. Additionally,

Figure 1 Effects of Acupuncture Treatment on
Changes in Blood Pressure over a 24 Hour Period

Comparing significant drops in blood pressure levels
between acupuncture and sham acupuncture subject
levels immediately following the treatment: Systolic
Blood Pressure (Upper Level), Diastolic Blood
Pressure (Lower Level)(***p<0.0001). Significant
differences between the two groups were notcompared 3months or 6 months following the trials.

concerning moxibustion treatment as well, Kim et al.,conducted a systematic review of 4 RCTs that met
standard criteria. Of the 4 reports, 2 usedhypertensive medications as the only control groupand did not find a significant difference between to
the control and moxibustion treatment for reducing
hypertension.

The

other

2

reports

compared

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Volume 6, Number 2 | Summer 2011

not elicit significant changes, however, using a crosscomparison between day and night time standard
values, known as a hyperbaric index, the researchersreported a significant decrease in blood pressure forthe hypertensive group. Further, with respect toacupuncture treatment efficacy for hypertension,
until now blood pressure readings were taken at
random times before and after the treatments, but
because acupuncture efficacy was not apparent
using this method, it is now being suggested that 24hours ABPM blood pressure recordings provide thepotential for detailed analysis of blood pressure
readings

that

were

undetectable

using

only

occasional readings.
Concerning the mechanism by which acupuncture
can lead to decreases in blood pressure, basic
Figure 2 Changes in Systolic and Diastolic Blood
Pressure due to Acupuncture treatment

research on intrinsic opioids within the brains ofanesthetized rats activates of the inhibitory systemof the sympathetic nervous system, suggesting theTen weeks following the trials, trends in decreased

involvement of serotonin, nociceptin, GABA etc.

systolic and diastolic blood pressure were confirmed,

Further, using an animal as a model with renal

however, significant differences were not confirmed

hypertension, this group treated St 36 (足三里) with

between the three test groups: the individualized

electro-acupuncture causing acceleration of carbon

treatment group, the standardized treatment group

dioxide production, blood vessel dilation and a

and the control group. By 12 months following thereported decrease in blood pressure 13)

trials, blood pressure levels had returned to pre-trial

In the future, the themes of clinical researchlevels in all subject groups.

utilizing acupuncture and moxibustion for thetreatment of Hypertension will necessarily need to2. The current situation and outlook of Japanese

focus not only on effectively lowering blood pressure,but also relieving the numerous complaints andClinical Research
On the one hand, in Japan, most research is collected

symptoms that accompany hypertension. Further, as

in clinical case compilations, and fewer documents,

has been pointed out, hypotensive medications haveincluding RCTs and systematic reviews can beside effects、interactions with other drugs and limits

retrieved.

Kou et al., 11) conducted a 2 monthto their applicability so we consider combining

intervention on 15 elderly women (6 with normal

pharmaceuticals with acupuncture and moxibustion

blood pressure and 9 with hypertension). The

in an effort to create a synergistic effect, reducing the

purpose of these trials was to perform whole bodyamount of medicines required for effectiveness to be

acupuncture treatments. The subjects were asked toan important area of investigation.

perform

24

hour

ambulatory

bloodpressure

monitoring (ABPM). According to cosine similarity,
analyzing blood pressure levels during the day may

4

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

Volume 6, Number 2 | Summer 201112) Li P, Longhurst JC: Neural mechanism ofReferences
1) JapaneseSocietyofHypertension

andHypertensive Treatment Guidelines Committee:
Hypertension Guidelines 2009, Life Scienceelectroacupuncture’s hypotensive effects. Auton
Neurosci 157: 24─ 30, 201013) Kim

DD,

Pica

AM,

Duran

RG,

et

al.:

Acupuncture reduces experimental renovascular

Printing, Tokyo, 20092) Shaw E, Anderson JG, Maloney M, et al.: Factors

hypertension through mechanisms involving

associated withnoncompliance of patients taking

nitric oxide synthases. Microcirculation 13:

antihypertensive medications. Hosp Pharm 30:

577─585, 2006

201─ 203, 206─ 207, 1995
3) Wood MJ, Stewart RL, Merry H, et al : Use ofcomplementary

andalternative

medicaltherapies in patients with cardiovascular disease.
Am Heart J 145: 806─ 812, 2003
4) Huang H, Liang S: Acupuncture at otoacupoint
heart for treatment of vascular hypertension. J
Tradit Chin Med 12: 133─ 136, 1992
5) Chiu YJ, Chi A, Reid IA: Cardiovascular andendocrine effects of acupuncture in hypertensive
patients. Clin Exp Hypertens 19: 1047─1063,
19976) Flachskampf FA, Gallasch J, Gefeller O, et al.:Randomized trial of acupuncture to lower bloodpressure. Circulation 115: 3121─ 3129, 2007
7) Yin C, Seo B, Park HJ, et al.: Acupuncture, apromising adjunctive therapy for essential
hypertension: a double ─ blind, randomized,
controlled trial. Neurol Res 29: 98─103, 2007
8) Macklin EA, Wayne PM, Kalish LA, et al.: Stop
Hypertension with the Acupuncture Reaserach
Program (SHARP): results of a randomized,
controlled clinical trial. Hypertension 48: 838─
845, 2006
9) Lee H, Kim SY, Park J, et al.: Acupuncture forlowering blood pressure: systematic review andmeta-analysis. Am J Hypertens 22: 122─128, 200910) Kim JI, Choi JY, Lee H, et al.: Moxibustion for
hypertension:asystemic

review.

BMC

Cradiovasc Disord 10: 33, 201011) Seiki Kou, Chu Yano: Excerpt from, Ambulatory
Blood

Pressure

Monitoring(AMBM),“The

Efficacy of Acupuncture for Geriatric Blood
Pressure”. Nichiyu Journal of the Specialist of
Climate Physics Society 70: 155-164, 2007
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Volume 6, Number 2 | Summer 2011

Clinical Report 1 (Acupuncture)
Two Cases of Low Back Pain in Pregnant Women Relieved
Using Low Acupuncture and Moxibustion Stimulation Dose
Evaluated with VAS and RDQ

Yoshihiko Koido1), Keiko Tsujiuchi1), Shuichi Katai2)
1) SERIE WOMEN’S HEALTH CARE
2) National University Corporation of Tsukuba University ofTechnology, Faculty of Health Sciences,
Acupuncture and Moxibustion specialist course

acupuncture and moxibustion treatment for low
back pain during pregnancy using only lightstimulation.
[Cases]In this study 2 pregnant women with the chiefcomplaint of low back during the later half of theirpregnancy visited an acupuncture and moxibustion[Introduction]
Katai et al. reported that they used in Japan needles
with a diameter of 0.16 mm for the acupuncture andmoxibustion treatment of low back pain during
pregnancy, inserting and retaining those into
reactive sites verified through palpation to a depthof about 5 mm, thereby achieving definite results1).
On the other hand, multiple RCTs conducted abroadshow a tendency that relevant evidence is about tobe clarified2). However, Lund et al. reported in 2006
that the comparison of the effects obtained in a deep
needling group treated using the common deep
insertion and a shallow needling group, where thinneedles were inserted only superficially showed, thatboth treatment forms led to pain relief and nodifference in the effectiveness could be found3). Afterthat no further reports examining the effectivenessof acupuncture and moxibustion treatment using alighter than the usual stimulation are found.

•
•
•
•
•
•
•
•
•
•
•
•

clinic in a city on the outskirts of Tokyo with apopulation of 3.7 million.
Case No.1 was a multipara 29 weeks and 6 days
pregnant with a single fetus, who complained of painin the left buttock. Her age was 33 years, height 159
cm, weight 51 kg, weight before pregnancy 46 kg,
BMI 18.2, weight increase was 5 kg and she had ahistory of low back pain (Figure 1).
Case No. 2 was a primapara 28 weeks and 2 days
pregnant with a single fetus, who complained of painin the right buttock and the development of pain on
the outside of the right lower leg associated with adiffuse feeling of discomfort upon walking for about
10 minutes. Her age was 33 years, height 154 cm,
weight 56 kg, weight before pregnancy 47 kg, BMI
19.82, weight increase was 9 kg and she had ahistory of low back pain (Figure 2).

•
•
•
•
•
•
•
•
•
•
•
•

Age: 33 years
Height: 159 cm
Weight: 51 kg
Weight before pregnancy: 46 kg
BMI before pregnancy: 18.20
Weight increase: 5 kg
Gestational week: 29th week +6 days
Single fetus
Multipara (1 delivery)
LBP history: yes
Blood pressure: 102/60 mmHg
Blood pressure before pregnancy: 98/58
mmHg○ indicates on a body surface map the painful
Figure 1: Profile of patient No. 1

6

Accordingly, this study investigates the effects ofAge: 33 years
Height: 154 cm
Weight: 56 kg
Weight before pregnancy: 47 kg
BMI before pregnancy: 19.82
Weight increase: 9 kg
Gestational week: 28th week + 2 days
Single fetus
Primapara
LBP history: yes
Blood pressure: 100/60 mmHg
Blood pressure before pregnancy:
100/60 mmHg

○ indicates on a body surface map the painful
Figure 2: Profile of patient No. 2

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

Volume 6, Number 2 | Summer 2011

Table 2: Treatment[Methods]
In both cases the trunk ROM test and sacroiliac
stress test were performed as physical examination.
Since patient No. 2 complained in addition to thepain in the right buttock about right lower leg
symptoms, additionally sensory and muscle tests
and the sciatic nerve stretch test were performed,
deep tendon and pathologic reflexes and Kemp's sign
checked as well as arterial pulses palpated4-6) (Table
1).
Table 1: Physical examination

Acupuncture treatment
Used needles: length = 40 mm x diameter 0.14 mm
Stainless steel needles
Insertion depth: 3-8 mm
Insertion method: singular insertion, needle
retaining (about 10 minutes)
Moxibustion treatment
Used moxa: stick moxa
Heat dose: so that the patient experiences it ascomfortable
Stimulation duration: 2-5 minutes
Other: hot packs, far infrared irradiation

First visit

Lordosis, kyphosis

Trunk range of motion

Anteflexion (finger-floor distance), retroflexion,

Under constant observation about 5 to 10

lateral bending, rotation

acupoints were selected from among Inkokku

Sacroiliac joint stress

Gaenslen test、Patrick test

(KI10,

test

Newton test (compression test, distraction test)

Fukuryu (KI7, Fuliu), Taikei (KI3, Taixi),

Sciatica

Straight leg raising test (SLR test)

SuisenMuscle testing

Quadriceps femoris, anterior tibialis, extensor
hallucis longus, flexor hallucis longus muscles

Deep tendon reflexes

Achilles tendon reflex, patella tendon reflex

Pathologic reflexes

Babinski reflex

Intermittent

Neuronal (Kemp sign）

claudication

Vasal (artery palpation: dorsal artery of the

Yingu),(KI5,

Yongquan),

Chikuhin(KI9,

Shuiquan),

BokushinZhubin),Yusen(BL61,(KI1,

Pushen),Taihaku (SP3, Taibai) and around the regionof the chief complaint, or else into reactive
spots marked by coolness, dampness, lack of
power, muscle tension (Table 3).

foot, posterior tibial artery)
Palpation

Tenderness, percussion pain

For the acupuncture treatment 40 mm stainlesssteel needles with a diameter of 0.14 mm were usedand either singularly inserted to a depth between 3
and 8 mm or else retained for about 10 minutes.
For the moxibustion treatment moxa sticks wereapplied for 2 to 5 minutes to the extend, that patient
experienced the heat as comfortable. Hot packs andfar infrared irradiation were also applied as required(Table 2).

Table 3: Used acupoints
Used acupoints
Inkokku (KI10, Yingu), Chikuhin (KI9, Zhubin),
Fukuryu (KI7, Fuliu), Taikei (KI3, Taixi),
Suisen (KI5, Shuiquan), Yusen (KI1, Yongquan),
Bokushin (BL61, Pushen), Taihaku (SP3,
Taibai), around the region of the chief complaint
Reactive spots marked by coolness, dampness,lack of power, muscle tension.
Selection of a total of 5-10 points.

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Volume 6, Number 2 | Summer 2011

For the evaluation we used a pain scale and a Visual
Analogue Scale (below abbreviated VAS) as well as
the lumbago specific QOL scale Roland-Morris
Disability Questionnaire (below abbreviated RDQ).
The VAS was implemented before each treatment
and the RDQ during the first visit and 5 weeks later
before treatment (Table 4).
Table 4: Evaluation method and measurements

Evaluation method
Pain scale: Visual analogue scale（VAS）100 mm
Lumbago specific QOL scale: Roland-Morris
Disability Questionnaire（RDQ）
Measurement
VAS: before each treatment
RDQ: during first consultation and 5 weeks later
before treatment

The VAS was recorded as a 100-mm long line on thequestionnaire marked "no pain" on one end and"maximal pain" at the other end. The patientsthemselves marked the degree of pain on this line
and this position was then measured from 0 mm,
using the obtained numerical value as pain
evaluation8).
The RDQ is an evaluation method using aquestionnaire inquiring after the presence of low
back pain induced disability through 24 questions
pertaining to daily life activities like "stand", "walk","dress" etc., which the patients answer directly witheither yes or no. It is used widely worldwide andexpected to be employed for studies of therapies andlow back pain related factors9) (Figure 3). For an
evaluation using the RDQ a score between 0 and 24
points is obtained and increasingly higher scores

Figure 3: Main RDQ items[Results]
Multiple sacroiliac joint stress tests showed inpatient No. 1 positive results and in the region of thechief complaint tenderness was also found. In
patient No. 2 the lordosis of the spine was mildly
pronounced and anteflexion slightly restricted.
Although the straight leg raising test was both on
the left and right negative, elevation on the rightside to close to 70° elicited pain on the posterior sideof the thigh. On the right side lateral to theinterspinous spaces L3 to L5 and on the rightbuttock tenderness was found. However, the borderof the region of slightly decreased sensation was
indistinct and no anomalies were found for muscle
strength, deep tendon reflexes, pathologic reflexes
and similar neurologic tests. Moreover, arterial
pulses could be palpated (Table 6).

indicate a more severe impairment of daily life andlow back pain induced reduction in QOL (Table 5).

8

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

Volume 6, Number 2 | Summer 2011

Table 5: All 24 RDQ items and evaluation
1

Spend most of the time at home because of low back pain

13

It hurts almost always

2

Frequently changes body position to alleviate the low back pain

14

Turning over in bed is difficult because of the low back pain

3

Walk slower than usually because of low back pain

15

Has little appetite because of the low back pain4

The usual house chores cannot be done at all because of low back pain

16

Have difficulties wearing socks or stockings because of the
low back pain

5

Uses handrails to climb stairs because of low back pain

17

Take care to walk only short distances because of the lowback pain

6

Spend more time resting by laying down because of the low back pain

18

Does not sleep well because of the low back pain (Please
select "Yes" under "Use sleeping pills because of the pain")

7

Cannot get up from an armchair (a chair supporting the body for
comfortable sitting, sit deeply back in a chair) without holding on tosomething because of the low back pain

19

Ask someone for help with the dressing because of the lowback pain

8

Sometimes ask people for help because of the low back pain

20

Spend most of the day sitting because of the low back pain

9

Dressing takes longer than usual because of the low back pain

21

Take care not to exert oneself when doing the householdchores because of the low back pain

10

Take care to stand only for short periods of time because of the lowback pain22

Get more easily irritated or angry at others because of the
low back pain

11

Take care not bend from the waist or kneel because of the low back
pain

12

Have difficulties of getting up from a chair because of the low back pain

Climb stairs slower than usual because of the low back pain

24

Spend most of the time in bed (futon) because of the lowback pain

Evaluation method: Assigning scores between 0 and 24 points. The higher the score the higher is the degree of daily life impairment,
indicating a decrease in QOL because of the low back pain.

Table 6: Results of the physical examination
Case No. 1

Case No. 2

Lordosisn.p.

mildly pronounced

Trunk ROM
anteflexion (fingerfloor distance)n.p.

n.p.（30 cm）

Gaenslen test

both left and right（－）

both left and right（－）

Newton test (compression test)

left （＋）

both left and right（－）

Newton test (distraction test)

both left and right（－）（－）

both left and right on the left（＋）

both left and right（－）

Patrick testright （－）

Straight leg raising test (SLR test)

Tenderness,

percussion pain（－）at 70° pain is triggered on the posterior side of
the thighTenderness around the left
sacroiliac joint

Tenderness to the right of the spaces between the
spinous processes of L3～L5 and on the right buttock

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

9Volume 6, Number 2 | Summer 2011

1) Case No. 1 (Graph 1)
Gestational weeks are plotted on the abscissa of the graph, while the ordinate shows on the left side theRDQ score and on the right side the VAS value. In patient No. 1 the RDQ score decreased from 12 to 5
points and the VAS of 46 mm also gradually decreased to reach 5 weeks later 20 mm.
Also, the nocturia of once per night reported during the first visit had decreased by the second visit to 0
times. During the daytime the urinary output per micturition increased, the drooping abdomen became
firm, appetite improved, fatigue decreased and the complaints improved.

Graph 1: Course of patient No. 1

1st visit

2nd visit

3rd visit

4th visit

5th visit

6th visit

2) Case No. 2 (Graph 2)
In patient No. 2 the RDQ score of 16 points obtained during the first visit decreased 5 weeks later, at a
gestational age of 33 weeks + 3 days, to 0 points and the VAS of 74 mm gradually decreased to 0 mm. The
straight leg raising test that induced pain during the first visit upon elevation to 70° on the posterior sideof the thigh, but after the third visit this maneuver elicited pain any longer even at an angle of more than
90°.

10

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

Volume 6, Number 2 | Summer 2011

1st visit

2nd visit

3rd visit

Graph 2: Course of patient No. 2

4th visit

5th visit

6th visit

2) Pathology
Low back pain during pregnancy may conceivably

Further, the nocturia of once per night reportedbeduring the first visit decreased to 0 and the patient

lumbodorsal muscles due to the increase in body

could sleep well. The sensation of cold of theweight, influence on posture because the enlarging

abdomen and feet had been replaced by warmth etc.

uterus shifts the center of gravity forward (postural),and otherwise similar improvements of complaints(2) loosening of pelvic ligaments around thelike in patient No. 1 were observed.

sacroiliac joint or the pubic symphysis through thecausedby(1)

increasedburdenontheaction of sex steroid hormones or relaxin may[Discussion]increase their mobility of these joints, resulting in

1) Clinical picture of low back pain during

an instability of the pelvic ring (pelvic ring

pregnancy

instability), (3) pregnancy induced increase in body

A Japanese study showed a prevalence of 50-70% forweight and changes in posture may place severe

low back pain during pregnancy. The pain occurs

stress on latent intervertebral disc degeneration

first either during early gestation or the second

and thus can cause a lumbar intervertebral disc totrimester and reportedly tends to get worse during

prolapse (lumbar intervertebral disk herniation)

the course of the pregnancy. Most cases are(Table 7). As opposed to the non-pregnant statecomparatively mild, but severe cases of low backthere are limits to x-ray, CT or MRI imaging or

pain

restricting

significantly

activities

decreasing

daily

the

QOL

livingandphysical examinations that can be performed during

are

also

pregnancy, so that the differential diagnosis is madeobserved10-14).

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

11

Volume 6, Number 2 | Summer 2011

relying on anamnesis and a minimum of physicalexamination15).
Surmising the pathology from the anamnesis andSocialfactors

physical examination the condition in patient No. 1

psturalwas considered to be due to pelvic ring instability
and that in patient No. 2 a postural lumbago.
However, low back pain treatment in recent years

Psycholo
gicalfactors

Biologicalfactors

Unknown

has shown, that not only biological factors, but alsosocial and psychological factors may be involved16).
causedbythepregnancymanyfactorslmbar
intervertebral
disk herniation

Others

Before the background of physiological changes

plvic ring
instability

areconsidered to contribute to low back pain during
pregnancy, but the details of the condition are not

Figure 4: Factors for low back pain during pregnancy

yet clear (Figure 4).
Table 7: Biological factors for low back pain during
pregnancy
PosturallumbagoPelvic ring
instability

Lumbarintervertebral
disk herniation

Increased burden on the lumbodorsal
muscles due to an increase in bodyweight.
Then enlarging uterus shifts thecenter of gravity forwards and thus
influences posture.
The action of sex steroid hormones orrelaxin loosen pelvic ligaments of thesacroiliac joint and pubic symphysis,
thereby increasing their mobility,
resulting in pelvic ring instability.
The pregnancy induced increase inbody weight and changes in posture
may place severe stress on latentintervertebral disc degeneration andthus can cause a lumbar intervertebral
disc to prolapse.

3) Acupuncture treatment
The acupuncture treatment for low back pain
conceivably uses local treatment of the affected
region, or else distant treatment sites exploiting
channel sinews or channels. Lund compared the useof needles with a diameter of 0.3 mm to needle 3-4
points (on both sides) on the bladder channel with astimulation dose strong enough to obtain theneedling sensation for his treatment of a deep
needling group and needles with a diameter of 0.2
mm inserted only superficially into the same sites tobe retained there for the shallow needling group andfound, that pain was alleviated in both groups andreported he did not find any differences in theeffects3). (Table 8)

Table 8: Comparison of the treatment by Lund et al. and Katai et al.
AuthorPublication year
Lundl et. Al 2006

Shallow needlinggroup

Shuichi Katai et al.
2003

Treatment site
Lumboscral
regionabdomen legs
arms
Diameter
0.2mm

Legs
(lumgosacral
region)Number oftreated acupoints
10-14(calculated)

Therapeutic
tools
Deep needlinggroup

Stimulation
methodDiameter
0.3mm

Insertion into the muscles, twirling,needling sensation

Insertion throughthe skinperpendicularneedling
Diameter
0.16mmRetaining the needles at a depth of about
5mm, until the needle tip is brought incontact with the reation*diameter 0.3 mm (No.8 needle), 0.2mm (No.3), 0.16mm (No.1 needle)
12

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

Volume 6, Number 2 | Summer 2011

Both examined patients had apart from the chief

points. Conversely, in patient No. 2 the nature of thecomplaint

likepelvic pain dealt with by Ando et al. differed, but

abdominal distention, shoulder stiffness, chilling,

here too the RDQ score had decreased after 5 weeks

leg cramps, nocturia, fatigue etc. Thus, regarding

to 0 points and improvements in the QOL were

the acupuncture treatment we palpated withobserved.

reference to the report by Katai et al. relevant

Thus the use of thin needles formerly often treatedchannel sinews and channels and selected mainly

as placebo or sham acupuncture, provides areactive spots along those, using thin needles for

comfortablesingular insertion to a depth of about 3-8 mm or else

elsewhere than locally, it offers a little invasive

needle retaining. For the moxibustion treatment wetreatment and allowed to obtain patient satisfying

used stick moxa, applying it to the region of the chief

therapeutic effects.

many

indefinite

complaints

acupuncture

treatment.

If

used

complaint and the reactive spots on the legsconfirmed through palpation, adjusting the amountIn recent years clinical and physiological studiesof heat so that the patient experienced it aspertaining to the use of press needles tend to clearly

comfortable.

show that minimal stimulation elicits physiologicalactivation19-20).

Forfurtherdevelopmentsof

Watanabe et al. reported that their investigation ofacupuncture and moxibustion medicine in the future

general patients with low back pain showed forinvestigation

lumbago patients consulting medical facilities astimulation are considered to be required andRDQ score of 7.417). Comparing the score for thefurther research in this field anticipated.

intensity of pain due to pelvic pain and the

Likely many factors contribute to the development of

impairment of activity of daily life in the 28th andlow back pain during pregnancy, clinical symptoms

36th gestational week Ando et al. reported, that inare very diverse and there are patients in whom

spite of instructions pertaining to posture during

sufficient effects cannot be achieved. In conjunction

daily life, exercise for the expectant mothers andwith an elucidation of the pathology of low back pain

instructions in the proper use of pelvic belts the pain

during pregnancy the mechanisms of acupuncture

intensity did not vary and there was a high degree ofand moxibustion are also expected to be clarified in

impairment of activity of daily life18).

the future.

The RDQ scores of the investigated patients during

The evidence for acupuncture and moxibustion using

their first visit were 12 and 16 points respectively,

weak stimulation methods must be substantiated ineach of which being higher than the mentioned 7.4

the future through RCTs etc.

of

the

effectsof

low-invasive

points, so that the QOL of these patients had been
decreased by the low back pain.

[Conclusion]
The results of this study examining two patients

The physical examinations performed in this study

suggested, that acupuncture and moxibustion using

on patient No. 1 suggested pelvic pain and from thelow stimulation doses allows to alleviate the degree

start of the acupuncture and moxibustion treatmentof low back pain during pregnancy and possiblyin the 29th gestational week pain and impairment of

improve the QOL.

activity of daily life gradually began to decrease, sothat 5 weeks later the RDQ score had dropped to 5
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

13

Volume 6, Number 2 | Summer 201110) Harumi[References]
1)

2)

3)

Nakamura et al.: Local and distant treatment;

pregnancy; Journal of the Japan Society ofeffects of needling the arms and legs for low backMaternal Health, Vol. 31, No. 1, 77-82, 1990

pain during pregnancy and traumatic cervical11) Yoshiyuki Tashiro, Junichi Kunogi, Mitsuo

syndrome as examples of locomotor diseases;

Hasue, Yuichiro Shinko, Hiroshi Kamata,

Journal of theJapan Society of Acupuncture

Yoshimitsu Hoshikawa: Low back pain inand Moxibustion, Vol. 3, No. 1, pp 21-27,

pregnancy, J. Lumbar Spine Disord., 2(1): 22-

February 2003

26,1996

TakeshiMatsumoto,

Eropean guidelines for the diagnosis and12) Midori Murai, Yuriko Kasumi, Hajime Ito: Fact-

treatment of pelvic girdle pain Eur Spine J

finding survey of low back pain in pregnant and(2008) 17: 794–819

puerperal

Lund I et al.: Decrease of pregnant women's

University of Health Sciences Bulletin, Vol. 10:

pelvic pain after acupuncture; a randomized

47-53, 2005

single-blind

study.

Acta

Obstet13) Masako Momoi: A Descriptive Study of the Daily
Experiencing Low Back Pain, St. Luke’s College

Physical Examination of the Nervous System

of Nursing Bulletin No. 25, pp 1-8, March 1999

16th Edition, 2008, NANZANDO COMPANY,

14) Haruko Shinkawa, Mieko Shimada, Mako

Stanley

Activities

Hoppenfeld,

M.D.:

PHYSICAL

Pregnant

Women

INUI: A survey of the variety, incidence rate,ANDand frequency of minor Symptoms currently

EXTREMITIES 1985, Translation supervisor:

experienced by expectant mothers, J. Jpn. Acad.

Motoo Nozaki; translated by: Takeshi Shudo,

Midwif., Vol.23, No.1, 48-58, 2009

OF

THE

SPINE

15) Mitsuhiro Sugimoto: Low back pain; Obstetrics
and Gynecology, Vol. 70, No. 11; Obstetric andClinicalGynecologic Treatment; Sign-based Diagnosis

Examination: An Evidence-Based Approach for

and Treatment in Obstetrics; Second and third

Physicaltrimester of pregnancy; 1656-1660, 2003

JoshuaCleland:
Therapists

Orthopaedic
2007,

Translation

16) Shinichi

Kikuchi:

Environmental

changesAkasaka, Elsevier Japan Company, Japan

related to low back pain treatment; Low Back

ShuichiPain, Igaku Shoin, Tokyo, pp 6-15, 2003

Katai:

IntroductionofJapanese

Acupuncture Considering the Therapist's Hand,

17) Kazuyuki Watanabe, Shinichi Kikuchi, Koji

The Journal of Kampo, Acupuncture andOtani

Integrative

musculoskeletal disorders: The Minami-Aizu

Medicine(KAIM)

Volume2,

Toshikatsu

Yokota:Pain

Mechanisms

et

al.:

Epidemiologic

study

of

study (part 5), The differences between low backNumber 2, 29-30, Summer 2007
for

pain

patients

withtreatment
by

and

non-

Clinicians, 1990 Nankodo, Tokyo

treatment

evaluated

Roland-Morris Disability Questionnaire (RDQ);

Disability

Questionnaire

Japanese Manual － Lumbago Specific QOL

orthopedic surgery 44(10), 1017-1022, October

Score; author and editor Shunichi Fukuhara;

2009

Iryo Bunka Sha, Tokyo, March 2004

14

ofHayase, Tsubura Inui: HAYASE, Tsubura

supervised by Takeshi Yanagisawa, Kiyokazu

9)Prefectural

Yoshiaki Tazaki, M.D. Yoshio Saito, M.D.:

Publication Inc., Tokyo

8)

Ibaraki

LivingKenji Kariyama, Sumie Tsuneishi; Ishiyaku

7)

women,

Gynecol Scand. 2006; 85(1); 12-9

EXAMINATION

6)

Hamasaki,

Kouichi Shinkoda: Low back pain during

Katai,

LIMITED Tokyo
5)

KunshigeIsaohuichicontrolled
4)

Shinkoda,

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

Roland-Morris(RDQ);

ClinicalVolume 6, Number 2 | Summer 201118) Hukiko Ando, Kazutomo Ohashi: CLINICAL
TRIAL TO IMPROVE DAILY ACTIVITY OF
PREGNANT WOMAN WITH PELVIC PAIN BYPELVIC BELT, Journal of the Osaka University,
Division of Nursing Sciences Vol.15, No.1 (2009)19) Yasuhisa

Kaneko,Eiji

Furuya,Ayumi

Sakamoto: The Effect of Press Tack Needle
Treatment on Muscle Soreness after Triathlon
Race−Placebo-controlled Study, Journal of The
Japan Society of Acupuncture and Moxibustion;
Vol. 56, No. 2, pp 158-165 (2006)20) Kenji Kawakita, Adrian White: Physiologic
basis of sham acupuncture effects during
clinical acupuncture tests, evidence based
acupuncture and moxibustion medicine of low
back pain, The Japan Society of Acupunctureand Moxibustion Edition; June 10, 2010,
Ishiyaku Publication Inc., Tokyo, pp 99-104

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

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Volume 6, Number 2 | Summer 2011

Clinical Report 2 (Kampo Medicine)
Headache 2

I do?" This gave the impression that she had started
to panic because of what was going on with her both

Mihoh Koga, M.D., Kampo Specialist

Research Assistant of Division of Clinical Pharmacology
and Therapeutics and Division of General Medicine
Jikei University School of Medicine

mentally and physically. There was a mild degree ofchilliness of both hands and feet, recently her visualacuity deteriorated and she had nocturnal urinationand dryness of the mouth during the night. One bowel< Tension headache; spleen and stomach deficiency

movement every three days. No feeling of exhaustion.

cold, deficiency of heart and spleen >The pulse was thin and slippery, the tongue had athick white fur and she had a bitter taste in the mouth.

Case (4): age 49, female, visited our clinic in

The abdomen showed chilliness and increased

February XY.

resistance of the epigastric region and a mild degree

Chief complaint: headache, anxiety, discomfort inof

the gastric region, arthralgia of multiple joints

hypochondrium, softness of the lower abdomen,

Present illness:tenderness

At the age of 27, triggered by a pregnancy, the patient

palpitation above the umbilicus were observed.

started to suffer from frequent headaches. She isPattern: deficiency of both heart and spleen,

regularly using commercial analgesics, but since half

deficiency cold (stagnation of liver qi)

a year ago their effects were declining. The headaches

Prescription: kamikihito, keishininjinto

were a sort of pinching pain from the back of the head

Course: The patient expressed strong anxiety regarding

down the back of the neck and at the same time

discontinuation of the saikokaryukotsuboreito she wasassociated with ocular pain, repeating cycles ofusing so far, so that the prescription was first changed

alleviation and aggravation almost daily. The anxiety

to keishikaryukotsuboreito, taking her feelings into

influenced the gastric discomfort, so that she could

account. This helped to overcome her anxiety andeat, but felt nauseated on an empty stomach andsettle down, but still left the symptoms incompletely

therefore constantly ate little portions. She had nocontrolled, with no changes in the incidence ofsense of satiety. Another doctor diagnosed reflux

headaches and gastric discomfort. After persuading

esophagitis and prescribed a protective agent for thethe patient to use a prescription with added

gastric mucosa, but its effect was obscure. Moreover,about 1 year earlier the patient had been diagnosed

keishininjinto the incidence of the headaches
decreased to once per week. Later, using kamikihito

with chronic rheumatoid arthritis and is currently

as the main formula and reducing the dose ofunder treatment. Three months ago development ofkeishikaryukotsuboreito to 1/3 both headaches andfrozen shoulder. Three years ago she worried about

gastric discomfort improved and after three weeks

family matters and this problem now got worse about

were almost completely alleviated. The arthralgia

half a year ago, so that saikokaryukotsuboreito wasand anxiety also improved and the patient now

recommended in a pharmacy, which she is currently

presents with a calm expression.

using.

< Tension headache; liver qi stagnation, transverse

fullness,

tenderness
of

both

or

discomfort

inguinal

regions,ofthemarkedinvasion of the stomach >Findings upon first visit:
The facial complexion was yellowish-white and theCase (5): age 41, female, employee

patient had a leptosomatic habit, she was occupied

Chief

by worries about her symptoms and described theweaknesscircumstances

Present illness:

of

their

development

withdissatisfaction. She repeatedly asked: "What should
16

complaint:

headache,gastrointestinal

From the time she became employed the patient

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

Volume 6, Number 2 | Summer 2011

repeatedly experienced stomach disorders, belching,

Chief complaint: headache

abdominal distention, a bitter taste in the mouth andAnamnesis: At the age of 21 onset of a collagen

reduced appetite, occasionally gastric pain. Afterdisease, that was treated over a period of one year

examination she was diagnosed with neurotic

with steroids and the therapy then terminated.

gastritis and was prescribed western medicine, but

Present illness:later visited our clinic, because the symptoms did not

Onset of repeatedly occurring headaches after the

improve. The headaches developed at the same timepatient started to work in an office at the age of 23.

and were characterized by a slowly progressive and

Her work requires that she uses a computer. The

continuous dull pain.

headaches

Findings upon first visit:

pulsating pain (1) in the occipital region and (2) theIntermediate build, the skin appeared slightly

temporal regions and occasionally she also felt likeyellowish brown and there was some edema. She had

she had be hit or (3) a pain as if a heavy stone weredifficulties waking up in the morning and felt

placed in the center of her head. The incidence

exhausted and headheavy from morning; usually did

fluctuated but was higher on hot days with fair

not have any appetite in the morning. Although she

weather so that summers were difficult for her. A

had one bowel movement a day, there was always aneurosurgeon diagnosed migraine and tension

sense of incomplete evacuation. The menstruation

headache. The use of acetaminophen during periods

was regular, but prior to the onset of theof pain became increasingly frequent. Currently, shemenstruation the headaches grew worse. She

uses analgesics on average 5 times per week.

complained about shoulder stiffness. The pulse wasthin and wiry, the tongue was faintly dark red andhad a thick white fur and teeth marks, the abdomen
showed a marked degree of fullness, tenderness or
discomfort of the hypochondrium.
Pattern: liver qi stagnation, transverse invasion of
the stomach

After about 2 months of treatment, the ease withwhich she could wake up in the morning improvedand both the sense of exhaustion and headheavinessdecreased. Her stomach felt comfortable too, but she
susceptible

tostressatwork.

Improvement of the shoulder stiffness. Since after
about one year of treatment almost all symptoms
had healed, the dose was tapered, but since complete
interruption

of

the

by

throbbing,Findings upon first visit:
Obese physique, muscular, face was flushed red,
there was acne on the mandible, she disliked heatand there was no sense of coldness. She had a good
appetite, but since about one and a half years ago she
experienced almost daily heartburn and gastricdrinking water. There was a tendency toward easy

Course:easilycharacterized

discomfort. She had a dry mouth and preferred cool

Prescription: saikokeishito

was

were

treatment

resultedinadeterioration of her physical condition, she currently

development of edema of the face and extremities.
She had difficulties falling asleep and experienced
night sweats all over her body. She had 1 to 2 bowel
movements per day (in the morning). Her eyestended to tire easily and she was also easily irritated.
Her menstrual cycle ranged between 30 to 35 days,
lasted for 3 days, she had little menstrual flow andthe menstrual blood was dark red. Delayed
menstruation. The pulse was slippery and wiry, thetongue pale and the sublingual veins thin, there wascontinues on a low dose schedule.

distention of the lower abdomen and tenderness on< Migraine; tension headache; blood stasis >Pattern: exterior-interior evil repletion

Case (6): age 24 years, female, employee

Course:the right side next to the naval.
Prescription: bofutsushosan

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

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Volume 6, Number 2 | Summer 2011

Two weeks later she experienced comfortable bowel

use of cathartics. She used a cathartic from a Kampo

movements and lost about 1 kg in body weight. Bothpharmacy (content unknown) and had one bowel

frequency and intensity of the headaches decreased.

movement every 3 to 5 days. There was also cervical

Pulse was wiry and thin, tongue slightly red. Six

spondylosis (C7).

weeks later improvement of the sense of body heat.

Findings upon first visit:

Headaches and dizziness occurring during the

Fair-skinned large-built person, obese, light brownforenoon sometimes were alleviated when she hadcomplexion of the face with many freckles. In her

diarrhea. There was a strong sense of fullness,daily life she is working industriously. She has a big

tenderness or discomfort of the hypochondrium, theappetite, gets up twice for nocturnal urination,

entire lower abdomen was tender and even stroking

dreams a lot, is under stress relating to family

it hurt. Drugs for expelling blood stasis andmatters, her legs are prone to easy development ofrectifying qi were considered necessary and thus aedema, her face flushes and she sweats abnormally on

modified formula of tsudosan used. Ten weeks later

her head and back, dislikes summers, does not

the usage of analgesics had decreased to 1-2 times

complain of chilliness. The pulse was deep and wiry,

per week and without her really realizing since when,

the tongue deep red with a white fur and teeth marks,

she noticed that the gastric symptoms did not longer

engorged sublingual veins, the abdomen showed abother her. She continues to take the formula.

mild degree of fullness, tenderness or discomfort of< Migraine / tension headache; blood stasis >Case (7): age 62 years, female, housewife
Chief complaint: headache, dyshidrosis, constipation
Present illness:
Since 10 years, following her climacteric age, thepatient experienced hot flashes and abnormal
sweating, constipation and was prescribed atanother clinic unseiin + tokakujokito and similar
formulas, which improved these symptoms. Recently,
the same symptoms recurred and the patient visited
our clinic, also because of the headaches she hadsince her youth.
The headaches started at the age of 20, her eyesightdeteriorated and she experienced throbbing pain 2-3
times a month. On these occasions she usedcommercial analgesics and rested for 2-3 days, butsometimes these symptoms were also accompanied
by nausea and vomiting. Also, from her climacteric

the hypochondrium and there was a marked degree oftenderness on both sides of the naval.
Pattern: blood stasis, qi stagnation
Prescription: tsudosan
Course:
The administration of tsudosan led to a quick
alleviation of the headache and 2 months later theuse of analgesics had decreased to half its former
frequency. The frequency of the use of commerciallyavailable cathartic did not change, but upon
combination with daiobotanpito she experienced
from the following month onwards comfortablebowel movements and in association with this theuse of analgesics decreased to the range between one
and two tenth. Since the alleviation of the symptoms
was also associated with improvements in the bloodstasis findings of the tongue and abdomen, she
continued to take this formula and gradually
improved. She stabilized mentally too.

age onward she experienced in the morning upongetting up a sense of headheavyness and felt as if shewore a hat. Formerly, she reported that the use of

kamishoyosan reduced the frequency of analgesic
use. She also had been constipated since her teensand could not have bowel movements without the18

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

Volume 6, Number 2 | Summer 2011

Clinical Report 3 (Kampo Medicine)
A Case in which Saireito was Effective for Irritable Bowel
Syndrome

Masayuki Kashima

Department of Internal Medicine
Kumamoto Red Cross Hospitaland stomach, causing diarrhea. When mainly the
spleen is causing problems, a diarrhea type condition
develops, while with problems caused mainly by thestomach, nausea and vomiting develops. Also, qi
background of liver qi flow anomalies, the influence of[Background]
Daily clinical experience regularly shows that
irritable bowel syndrome is one of the diseases for
Kampo

else the stagnant liver qi excessively flows into spleen

stagnation often causes the abdominal pain. Before a< Summary >whichstomach qi is obstructed, resulting in constipation, or

medicineiseffective.

Variousprescriptions are used, but there are few reports on
the use of saireito, so that I would like to introduce
this one here.

stress and emotions, or a deficiency of liver blood andyin can impede a smooth movement of the liver qi.
Again, if the liver problems are not particularlymarked, the presence of spleen and stomach problems
could appear as a relative uprising of liver qi. 2) In
these conditions marked by liver qi stagnation andliver blood deficiency and associated with diarrhea[Case and course]
Forty-six-year old female. She complained of stressinduced abdominal pain and diarrhea since she was ateenager. Being very busy at work aggravates thesymptoms. The results of detailed examinations inmedical facilities visited in the past led to the diagnosis
of irritable bowel syndrome. She had been treated overa period of about 5 years in another clinic, but visited
our department because lack of improvement of thesymptoms. I administered kamishoyosan, but switchedto saireito because the symptoms did not improve andthereby achieved some relief.

kamishoyosan is used, while daisaikotokyodaio is used
for constipation. If this occurs due to asthenia of spleenand stomach, formulas like keishikashakuyakuto areoften used. Saireito is a combination of shosaikoto +goreisan and frequently used for acute diarrhea or
inflammatory diarrheal diseases, while it is not very
often given for irritable bowel syndrome. Here I reporta case where saireito proved to be effective for thetreatment of irritable bowel syndrome.
[Case] 46-year old female[Chief complaint] chronic diarrhea, abdominal pain

[Discussion]
Generally, saireito is often used for acute diarrhea or
diarrhea caused by inflammatory diseases, but
depending on the pathology and considering othersimultaneously used medications, it is also considered
to be effective for irritable bowel syndrome.

[Anamnesis] migraine[Present illness]
The patient developed diarrhea every time she wastense since she was a teenager. Being very busy atwork aggravates the symptoms. She may have 6-10
bowel movements per day of which the first two aresoft stools, while the remaining movements are< Text body >watery diarrhea. After passing diarrheal stools the[Background]Kampo medicines have also in clinical studies beenshown to be effective for irritable bowel syndrome1) andthis is one of the conditions, for which theireffectiveness can be experienced in daily clinicalpractice. Frequently the correlation to the liver andspleen as well as the stomach has been discussed. The
flow of spleen and stomach qi is controlled by the liver,abdominal pain tends to decrease, but endurance
leads to severe abdominal pain. There is a mild
degree of nausea. Based on the results of detailed
examinations an irritable bowel syndrome wasdiagnosed and the patient was treated by a local
physician, but later visited our clinic, because thesymptoms did not improve.

but if liver qi flow stagnates, the flow of spleen and
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 6, Number 2 | Summer 2011

Height: 155 cm; weight: 45 kg; talkative, has

Lancea Rhizome / Poria and spleen function
improving Zingiberis Rhizoma and Glycyrrhizae

appetite, is easily irritated, has a dry mouth andRadix. This shows that the components of thiswhile complains of chilly hands and feet, her faceformula improve the liver qi stagnation and theneasily flushes.

consequently affect the spleen. On the other hand,

Pulse diagnosis: bilateral wiry and slipperythe combination of shosaikoto and goreisan forms

Tongue diagnosis: thin white coat, tip was slightly red

the framework of saireito (Bupleuri Radix 7,

Abdominal diagnosis: right-sided fullness in the

Alismatis Rhizome 5, Pinelliae Tuber 5, Scutellariae
Radix 3, Atractylodis Lanceae Rhizome 3, Poliporus
3, Poria 3, Ginseng 3, Zizyphi fructus 3, Cinnamomi
Cortex 2, Glycyrrhizae Radix 2, Zingiberis Rhizoma[Current condition]

chest and hypochondrium, epigastric stuffiness[Course]
Initially I administered kamishoyosan. However,after 4 weeks of administration I still could notobserve any changes in the symptoms. The patient
suffered from violent diarrhea and I thought it would
be difficult to achieve improvement of fluid
absorption from the small intestines mediated byspleen function with Atractylodis Lancea Rhizome
and Paria of kamishoyosan alone. Therefore I
switched to goreisan for its powerful strengtheningof fluid absorption combined with the improvementof liver qi flow provided by shosaikoto. After 4 weeks
of administration the frequency of soft stools had
decreased to 3 times per day. Yet, after 8 weeks oftreatment the frequency of watery stools increased
again to 4 times per day, so that I added

tokishakuyakusan. Following the start of the
combination treatment the frequency of soft stools
stabilized at 3 times per day.

to improve the flow of liver qi and contains thepowerful liver heat dissipating Scutellaria Radix,

Bupleuri Radix, the fluid metabolism of the spleenincreasing Atractylodis Lanceae Rhizome, Poria,
Chuling, Alismatis Rhizome, Pinelliae Tuber, spleenfunction improving ginseng, Zizyphi Fructus, ginger
and Glycyrrhizae Radix. Compared to kamishoyosan
it is more powerful in improving liver qi stagnationand dissipating heat and activates the fluid
metabolism of the spleen. That is why I thought thisformula is more effective for treating stress-induced
liver qi stagnation, consequently leading to diarrhea
than kamishoyosan. However, since saireito does notcontain any liver blood tonifying drugs, the liver qi
stagnation developing before a background of liver
blood deficiency could not be improved and therefore
possibly led to the recurrence of the symptoms. The
addition of liver blood supplementing and spleen[Discussion]
The patient presented with stress-induced waterydiarrhea I considered to be an indication for

kamishoyosan, which was, however, ineffective.
Kamishoyosan (Bupleuri Radix3, Paeoniae Radix 3,
Angelicae Radix 3, Atractylodis Lanceae Rhizome 3,
Poria 3, Gardeniae Fructus 2, Moutan Cortex 2,
Menthae Herba 1, Zingiberis Rhizoma 1,
Glycyrrhizae Radix 1) is composed of the liver qi flow
improving Bupleuri Radix, Menthae Herba, liver fireeliminating Gardeniae Fructus, Moutan Cortex /Bupleuri Radix / Menthae Herba, liver blood
supplementing Japanese angelica root, Paeoniae
Radix, spleen metabolism activating Atractylodis
201) in which the amount of Bupleuri radix is increased

fluid metabolism activating tokishakuyakusan isconsidered to have led to an effective treatment.
1) Alan Bensoussan etc. Treatment of Irritable Bowel
Syndrome With Chinese Herbal Medicine A Randomized
Controlled Trial JAMA. 1998; 280:1585-158
2) Hiromichi Yasui: Kampo Medicine for Medical
Students [Basics], Oriental Medical Publishing
Chiba 2008

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

Volume 6, Number 2 | Summer 2011

Front Line of Kampo Pharmacology
Review of Research Presentations on Kampo Medicines 4

Hokkaido reported that they have investigated thecontent amount of liquiritin as a measure forToshiaki Makino, Ph.D.

growing the high quality phyletic line of Glycyrrhiza

Associate Professor, Dept. of Pharmacognosy
Graduate School of Pharmaceutical Sciences
Nagoya City University

found large variations in content volume, which,This series will introduce the recent research andvolume of glucyrrhitic acid used as an indicatorstudies relating to Kampo medicines presented at

ingredient by Japanese Pharmacopoeia.

uralensis that is the plant material of Licorice andthey explained, positively correlate with the content

academic conferences. This installment of the series
provides the presentations planned to be made at

Development of crude drug products

The 131st Annual Meeting of PharmaceuticalSociety of Japan in Shizuoka scheduled on March 28-

Sakai, et al. of Hokkaido College of Pharmacy have31, 2011. Because of the Great East Japandeveloped a w/o cream containing Cnidii Monnieri

Earthquake, the conference was cancelled. However,Fructus and Kochia Fructus, reporting that it is

the contents of the abstracts planned for the Marchsufficiently marketable as a commodity in view of

28 presentation are regarded as having beenstability, impression from use, and moisturizing

published.

effect.

Research of quality evaluation of crude drugs andBasic pharmacological study on crude drugs andtheir discrimination

Kampo foumulas

Yamauchi, et al. of Doshisha Women’s College of

Ohta, et al. of Toho University reported that they

Liberal Arts reported that an HPLC-UV method

have investigated the in vitro action of aldose

with

a

reductase inhibition of varieties of Kampo extract

polyvinylpolypyrrolidone column is effective forand found that sokeikakketsuto (Channels-Dredging

analyzing arecoline contained in Aracea Seed.

and Blood-Activating Decoction) gives the strongest

thepre-treatment

using

inhibition.
Wakana, et al. of National Institute of Health
Sciences reported that they have evaluated the

Yamabe, et al. of University of Toyama reported that

quality of Paeoniae Radix by

1H-NMR–basedhachimijiogan (Kidney-Qi Pill) and bakumijiogan

metabnolom analysis and discriminated individual(Eight-Immortal Pill for Longevity) have the action

cultivars although production sites could not beof complete recovery of renal function in the model ofdifferentiated.

chronic renal failure in 5/6 nephrectomized rats.

Doi, et al. of Kanazawa University have evaluatedYamamoto, et al. of Suzuka University of Medical

the usefulness of a colorimeter for the quality

Science reported that they have investigated theevaluation of Ginger and Processed Ginger andeffect of various Kampo extracts on the in vitro

clarified that the device can determine the intensity

inhibition of parainfluenza type 2 viral proliferationof heating although it cannot differentiate steamed

and found that kakkonto (Pueraria Decoction) andginger rhizomes.

ryokankyomishingeninto (Tuckahoe, Licorice, Dried
Ginger,Schisandra,

Manchurian

wildginger,

Cultivation research of crude drug materials

Pinellia and Apicot Decoction) have a strong

Kojoma, et al. of Health Sciences University of

inhibitory activity.

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

21

Volume 6, Number 2 | Summer 2011

Aoki, et al. of Kitasato University reported on the

Hyuga, et al. and Shiraishi, et al. of Kitasato

activity of maoto (Ephedra Decoction) on influenza

University reported that maoto (Ephedra Decoction)

infection in mice and explained as the mechanism

extract can suppress the ability-to-move of mousethat it is caused by the elevating activity of antibody

osteosarcoma cells stimulated by hepatocellulartiter binding to the virus.

growth factors through the downregulation of theexpression levels of c-Met signal and protein.

Kagioka, et al. of Nagoya City University reported
that they have investigated, using mice, the activity

Matsui, et al. of Fukuyama University reported thatof Processed Aconite Root on improving neuropathic

they have investigated the significance of Ricorice

pain, a side-effect of an anticancer drug oxaliplatin

inclusion in daiokanzoto (Rhubarb and Licoricewith the finding that alkaloids contained are theDecoction) using mice with the finding that liquiritin

active ingredients.

in licorice promotes the purgative activity of

Iizuka, et al. of Yokohama College of Pharmacy
reported

that

they

have

investigatedthevasorelaxant activity of Cyperi Rhizoma in the invitro rat great arterial vessel preparations with thefinding that the methanol extract has the relaxing
effect on vasoconstriction induced by norepinephrineby releasing NO.

reported that they have isolated and identified
maackiain as an anti-allergic active ingredient from
Sophorae Radix with the findings that the ingredienthas the improving effect on a model rat allergic
rhinitis induced by toluene 2,4-diisocyanate.

that they have investigated the action of enhancing
theexpressionofadministration

of

maoto

(Ephedra Decoction) and oseltamivir (OT) elevates
plasma concentrations of OT, these formulas
suppresses the onset of brain inflammation; and it
has the suppressive action of OT and OT beingtransported into the brain.

factorsofhochuekkito (Middle-Reinforcing and Qi-Benefiting
Decoction) in rat digestive tract epitherial cells withwater-soluble

constituents

have

the

immunostimulatory action.
Sekiya, et al. of Kitasato University reported thathochuekkito (Middle-Reinforcing and Qi-Benefiting
Decoction) produces the ameliorating activity in aepithelium

createdbytheintraperitoneal

administration of methotrexate with an increased
level of expressions of Reg III-γ, a member of C-type
lectin.
Nishimura, et al. of RIKEN reported that in orderto evaluate the enhancing action of ghrelinsecretion of rikkunshito (Six Gentlemen Decoction)

Harada, et al. of Saitama Medical University
reported that in rats, food intake decreases andgastrointestinal tract motility weakens following the
cerebral ventricular administration of urcortin andthese conditions can be improved by rikkunshito (SixGentlemen Decoction) through the activity of thisby in vivo testing, (although the action has been
evaluated only by in vitro testing) they havedeveloped a method for verifying the action of

rokkunshito by the synthesis of ghrelin having
complexation with radioactive metal 68Ga, which isthen administered to the rat.

formula to improve the secretion of ghrelin.
22

immune-relatedmouse model of impaired gastric and intestinal

Fukuda, et al. of Josai University reported thatsimultaneous

Nishimoto, et al. of Kitasato University reported

the finding that both lipophilic constituents andNariai, et al. of The University of Tokushima

while

sennoside A present in Rhei Rhizoma.

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

Volume 6, Number 2 | Summer 2011

Nakagawa, et al. of Kyoto University reported that

Pak, et al. of University of Toyama reported thatinmouse,

loganin contained in Corni Fructus has the

yokukansan (Liver-Inhibiting Powder) significantly

improving action of oxidant stress, inflammatory

suppresses withdrawal symptoms produced byresponse, and apoptosis in the spontaneously

naloxone (jumping behavior, weight loss, diarrhea)

diabetic mouse models in db/db mice.

amorphine-dependence

inducedand Uncariae Uncis cum Ramulus and licorice inyokukansan have the action of alpha 2 receptor
antagonist.
Iijima, et al. of Nihon University reported that they
have observed the increased number of endothelial
progenitor cells in the blood and the reduced numberof positive cells of reactive oxygen species inmononuclear cells in spontaneous hypertensive rats
followingtheadministrationofsaikokaryukotsuboreito (Bupleurum plus Dragon's
Bone and Oyster Shell Decoction).
Gan, et al. of Hokuriku University reported thatbofutsushosan(Divaricate

Saposhnikovia

Miraculous Powder) exhibits the antihyperglycemic
action in streptozocin-induced diabetic rats andseveral ingredients are responsible for the activity.
Kato, et al. of Taisho Pharmaceutical Co., Ltd.
reported that Lycii Cortex improves, through theserotonin nervous system, attacking behavior inmice induced by isolation rearing and it gives theanti-stress action.
Nakazawa,

et

al.

of

TohokuPharmaceutical

University reported that hirusutine contained in
Uncariae Uncis cum Ramulus gives the onset of
antipsychotic action mediated by the inhibiting
action of σ1, D2 and 5-HT2A receptors.
Oda, et al. of Keio University reported that they haveevaluated the in vitro anti-inflammatory action ofmagnolol contained in Magnoliae Cortex andmetabolites of magnolol, using macrophages withthe finding that only magnolol is active and thematabolites have no anti-inflammatory action.

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

23

Volume 6, Number 2 | Summer 2011

Medical History in Japan"Historical Significance of the Standardization of Acupoint
Locations“, the Second Japanese Acupoint Committee (2)"Detailed Guide to the Location of Acupoints“ from theclassics to the WHO standardization“, pp 411-422, Tokyo,
Ishiyaku Publishing, June 2009 (partially revised)

Makoto Mayanagi

Graduate School of Humanities
Ibaraki University(continued from KAIM Joural vol.6 no.1)

2. Secondary standardization – unification on thelevel of meridians and acupoints
The meridian concept has developed and been fused
during the above described circumstances, but there
were differences between schools etc., so that the
progressive spread of acupuncture and moxibustion
therapy made a unification of the concepts necessary.
And approximately one century after the forerunnerof the "Su Wen" and "Ling Shu" had been edited, theconcepts pertaining to meridians and acupoints were
unified. The form of the "Su Wen" and "Ling Shu" we
see today is not a document of that time, but rather
the product of extensive modification and from a
considerably later time. However, some of thefoundation. During that process yin and yang were
further divided into three yin and three yangresulting in a concept found only in medicine but notelsewhere in Chinese philosophy or thought. In thisway the concept of the six viscera and six bowels
from the "Su Wen" and "Ling Shu" and thecorresponding

concept

thetwelveregularmeridians were unified and standardized. Moreover,because this was important in order to create a yet
another system also comprising the conception andgovernor vessel explaining the production of theiroffspring, those were placed on the same level as thetwelve regular meridians and now form the basis of
the modern meridian concept.
On the other hand, since the modern form of the "SuWen" and "Ling Shu" refer repeatedly to the number
acupoints as being 365, the forerunners of both texts
from the first century most likely mentioned thesetoo. However, the actual number of points given inboth works does not exceed 132 points [5]. Thisreveals that by the first century only about 130
points had been developed, but based on deductions
from the numbers of heaven the figure 365 wasstandardized into the ideal concept.

contents have unmistakably be transmitted fromentries in the Mawangdui medical texts and thus candefinitely be traced back to before the common era.
Astronomical knowledge was adopted to render theconcepts of meridians and acupoints in the originalform of the "Su Wen" and "Ling Shu" from the first
century absolute. At that time it was accurately
recognized in astronomy that there are 12 cycles ofwaxing and waning of the moon and about 365 daysin a year and these figures accepted as absolute
truth. From those absolute figures of heaven the
figures of man were deducted and thus theunification of the meridians and acupoints planned.
The astronomical concept of the yin-yang theory andthe five element theory were used as the theoreticalbasis for this work. Moreover, the "heaven-earthman" (tian-di-ren) trinity theory was also used andthus the figures 6, 12 and 360 put on a logical

24of

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

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

OHSUGI Pharmaceutical Co., Ltd.

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

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

TOCHIMOTO

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

TOCHIMOTO TENKAIDO CO., LTD.
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