Volume 7, Number 1 | Spring 2012

Kampo Medicine - Current Research
Essentials of Pediatric Kampo Medicines (1)Hideaki Yamaguchi

The people in ancient China likely chose drugs inorder to survive based on primitive sensation andexperience, thereby compiling a group of naturalproducts, later combined certain forms of processing
and in this way conceivably created throughIntroduction
Twelve years have passed since Kampo medicine
has officially been integrated into formal medical
education in Japan and by now almost all
universities offer relevant lectures. There seems tobe a gradually increasing interest in Kampo
medicines as applied to the field of pediatrics.
However, apparently many pediatricians still seemto be under the impression, that both Kampo as asubject and Kampo medicines are difficult tounderstand.
The author has for a long time been trying tosystematize Kampo as applied to pediatrics (forconveniencetermedinthisarticle"pediatricKampo") and thereby facilitate comprehension1-3.
Therefore I would like to arrange in this article theusage of Kampo medicines following modern clinicalpediatric concepts and classified Kampo medicinesfrom the aspect of their beneficial effects. Also, since
I will explain individual Kampo medicines in greater
detail later, in this article the relevant descriptions

enormous, cumulative efforts said Kampo medicines
suitable to treat a variety of pathologic conditions.
This work was done at a time when neither
statistical processing nor analysis of the components
were possible. To accomplish it, the people had torely solely on the elicited body reactions and theirvery keen observation, so that this unimaginable
work rightfully should probably be called a piece ofintellectual property of the human race, somethingthat probably cannot be build a second time.
Multiple therapeutic effects of complex compositions
A characteristic of Kampo medicines as drugs is,that they possess multiple therapeutic effects. Let
me explain using a representative antitussive(bakumondoto). Bakumondoto is composed of the six
crude drugs listed in Table 1 and each individual
crude drug has several pharmacological effects. The
result is, that apart from the antitussive main effectofBakumondoto

iteffects,

alsohasimprovesenrichingand

have been kept to a minimum.

moistening

gastrointestinal

What are Kampo Medicines?

secondary effects. Each of these effects is related tofunction, is emotionally stabilizing and has other

Kampo medicine usually refers to combinations ofseveral crude drugs (roots of plants, stalks, fruits,minerals, small animal parts subjected to simple
processing) that are used for therapeutic purposes,
thus representing complex compositions containing
many chemical substances. Astonishingly, the basic
compositions of most of the Kampo medicines
currently used in Japan in the form of extracts havethe other effects and helps to augment the mainaction. Precisely these multiple therapeutic effects
represent the characteristic of Kampo medicines.
In the human body multiple functional systems
are interrelated. If disturbances of these functional
systems of the human body could be rebalanced
through these Kampo medicinal actions, that mightultimately lead to a harmonization of the entire body.

already been established 2,000 years ago, but nohistorical materials detailing the process of thisestablishment have been left behind.

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

9Volume 7, Number 1 | Spring 2012

Table

Table 1 Bakumondoto Composition & Drug effects

2showsthecharacteristics

ofpediatric Kampo. In this context it is important

GalenicalAction

OphiopogonisTuberantitussive (strong); enriching and moistening;
mildly emotionally stabilizing

Ginseng Radix

improves digestive functions; mildly enriching
and moistening

whereas in Japan both Western and Kampo

Zizyphi Fructus

improves digestive functions; mildly enriching
and moistening; emotinally stabilizing

The current complementary use of Kampo

Glycyrrhizae
Radix

improves digestive functions; mildly enriching
and moistening

Oryzas Fructs

improves digestive functions; mildly enriching
and moistening

Pinelliae Tuber

antitussive and expectorant; antiemetic

to note, that in the various Asian countries
there are different licenses for the practice ofWestern and traditional Chinese medicine,
medicine are unified in one medical system.
medicines within the Western medical clinicalsetting can be called an outstanding system.
Next, many of the Kampo medicines originatedfrom classic texts like the "Shan Han Lun" of
the Later Han dynasty and almost all of these
preparations are not used as decoctions, butrather as extract preparations. This makes fineadjustments based on individual cases difficult,

Overall action (drug effect): (1) antitussive, (2) enriching andmoistening (retaining water,moistening the body), (3) improving
gastrointestinal functions, (4) mildly emotionally stabilizing

but ensures a high product quality and above
all makes them very convenient, easy to use inclinical practice.
What is pediatric Kampo?

However, as described above, since pediatric

Pediatric Kampo in Japan can be defined as theKampo includes a mixture of various different

use of Kampo medicines indicated for characteristic

concepts

pediatric pathologic conditions. The course of its

accumulation of characteristic Japanese experience,

establishment is not necessarily clear, but mostWestern medical evidence etc., it tends to be rather

likely has been transmitted in ancient times from

ill-defined and thus has the disadvantage of being

China to Japan and the accumulated experiencesdifficult to understand.

liketraditional

Chinesemedicine,

pertaining to the use of Kampo medicines for infants
have in recent years be organized by pediatriciansfrom a Western medical point of view. Moreover, inconjunction with the spread of extract preparations,

Table 2 Characteristics of Pediatric Kampo
1)

Before patients may be treated with Kampo, all are firstassessed according to Western medicine (unifiedsystem).

2)

Almost all used preparations are extracts, most ofwhich originate from classics based on the Shang Han
Lun.

3)

Basically, preparations are matched to symptoms(formulation corresponding to a Kampo diagnosis),but they are also often matched to Western medical
diagnoses.

4)

Many experiences with children have been handed
down probably from the Edo period and in recent years
been systematized from a Western medical point of

the results of wide-ranging clinical research havehelped to promote a general compilation of therelevant knowledge. A portion of it includes
statistically proven evidence, but most of thematerial is the accumulation of experience handed
down from the past that is now applied in modern
clinicalpractice.

Basedonthedescribed

development of the use of Kampo medicines Chinese
medical pediatrics as the field of pediatrics within
the framework of traditional Chinese medicine
differs slightly from the use of the Kampo medicines
themselves.

10The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 7, Number 1 | Spring 2012

What is the reasoning behind the use of Kampo

rename those pathologies and diseases and focused

medicines in pediatrics?

their attention on the correlation with corresponding

Medical practice must necessarily be based on aformulas. In particular, since Kampo medical

solid foundation. Today it is common knowledge, thatextracts are now covered by the insurance, a trend

the concept of evidence-based medicine is graduallythat became more conspicuous after 1976 and in the

being established, where clear standards for thewake of which various results have been reported.

reliability of the practice are shown. However,

These trends signify a reconfirmation of theregarding traditional medicine the evaluation oftradition.

hundreds,

sometimes

thousandsofyears

ofOpposedtopharmaceuticals

developed

experience still remains subject of debate. As thisintentionally with values for giant markets, Kampo

may be, I would like to concisely organize themedicines have statistically a relatively low chancereasoning behind pediatric Kampo.

of achieving good results, but centering on caseseries studies experiences with their use are steadily
accumulating and attempts are made to reorganize

1. Kampo medical reasoning
Providing bibliographically original proof in

the traditional experiences.

actual practice is very difficult, but mainly from theEdo period until the Showa period various Kampo

Frequently used formulas in pediatric Kampo andphysicians (groups) have used classical pediatrictheir classification according to drug effects

have

Taking these characteristics of pediatric Kampo

meticulously communicated a wealth of accumulated

into account, I will describe Kampo medicines thatclinical experiences to us. Naturally, all thisare convenient to use in children as viewed classified

knowledge relies on the concepts of traditional

according to their drug effects from the point of view

medicine cultivated in China and Japan and has notof both the Kampo medical reasoning as well as

been transmitted based on systematic concepts ofWestern medical results. I am going to present thepediatric Kampo (system). Moreover, that was a

subject after performing a certain degree ofmatching of formulas thought to treat basic

integration of systematized traditional Chinese

symptoms (pattern).

medical theory, will try to avoid Kampo medical

formulasinchildren

andthoughttoOn the other hand, Chinese traditional pediatrics

technical terminology and describe the pediatricfollows the theoretical system of traditional Chinese

Kampo as simple as possible. However, Kampo

medicine

easilycontains a lot of elements that are very difficult tocomprehensible, a treatment essentially based on

explain using Western medical concepts, so that I

the use of individual crude drugs renders its clinicalwould like to ask you to bear with me regarding

application in Japan in certain cases difficult. Thus,

ambiguous theories and feelings of estrangement

I will restrict myself in this article to the partial

regarding technical terms. Also, in this article I

introduction of those concepts.

refrained from citing passages and other detailedandalthoughitstheoryisexplanations regarding the individual preparations.
2. Western medical reasoning (so-called EBM)

The developing pediatric physiology in ancient

From the above follows (the in Japan handed

China was viewed as characterized by a pure yangdown usage of Kampo medicines) that currently

body constitution, immature yin and yang, twoWestern medical clinicians, mostly pediatricians,excesses (heart, liver), three deficiencies (lung,rely on Western medical pathology (patterns) as

spleen and kidney) and the like. Among these inviewed from a Western medical point of view toparticular the concept of the two excesses and three

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

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Volume 7, Number 1 | Spring 2012

deficiencies is important. Its modern interpretation→ Kampo medicines with gastrointestinal

would be as follows.

improving functions

1. Easy development of fever, easy occurrence of

4. Immature respiratory function, which may
easily lead to decreased function

convulsions or disturbances of consciousness
2. Easy excitability, mental instability→ Kampo medicines with antitussive actions,

3. Immature gastrointestinal function, which

acting on the nasal cavity and paranasal sini
5. Easy occurrence of impaired growth andmay easily lead to decreased function
4. Immature respiratory function, which may

development, weak vital energy→ Kampo medicines with growth assistingeasily lead to decreased function
5. Insufficient vital energy may easily lead toactions
6. Additional item

impaired growth and development.
These characteristics are even today commonly
observed and can be understood without any feeling→ Kampo medicines acting to regulate water
metabolism

of estrangement from a Western medical point ofview. In East Asia traditional medical systems tried

1. Kampo medicines with actions to regulate

to respond to pathological conditions corresponding

immune functions

to the above listed characteristics. In Japan thisHistorically infections are the most importantsystem was until the Meiji period Kampo. Naturally,

medical topic. There is an outstanding guideline

as compared to modern medicine the therapy wasregarding the treatment of acute infections withextremely limited, but nevertheless a noticeable

Kampo medicines that was written approximatelyamount of therapeutic experiences accumulated and2,000 years ago and even today remains an

this accumulation of experiences today has been

indispensable bedside reference, the "Shang Han

refined and allows to complement areas in pediatrics,Lun" (later Han dynasty). During the Qing dynasty

where Western medicine is not so strong and in thisa discussion of infections from a different point ofway provides a useful means of maintaining theview (Treatise on febrile disease = Wen Ren Lun) was

health of children. Below I will explain the actions ofalso proposed. These works provide a detailed

Kampo

5

classification of the course and symptoms ofanother

infections associated with fever and used different

important characteristic of Kampo medicines and try

Kampo medicines depending on the stage of theto describe representative formulas matching as far

disease and the presenting symptoms.

medicinescharacteristics

corresponding

listedabove,

toadding

theas possible the needs of pediatric primary care.

In case of infections [the sum of all involved
biologic activities of infectious agents entering the

1. Easy development of fever, easy occurrence ofbody, the corresponding biologic reaction and theconvulsions or disturbances of consciousness

acquired immunity]4 experimentally administered→ Kampo medicines with immunoregulatory

Kampo medicines may not have much outstanding

actions

direct antiviral or antibacterial actions, but their

2. Easy excitability, mental instability→Kampomedicines

withemotionallystabilizing functions

actions are considered to be mainly directed atregulating

bodyresponses(anti-inflammatoryaction). Almost all pediatric infections are acute with

3. Immature gastrointestinal function, which
may easily lead to decreased functiona fast progress after onset, accordingly requiring aquick and appropriate judgment. Kampo treatment
of infectious diseases is very varied and complex, but12

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

Volume 7, Number 1 | Spring 2012

here I would like to describe only easily applicable(1) Regarding the acute phasemethods under the current conditions.

* Early stage of influenza: maoto, kakkonto

First, there are various reports about the effects* Low-grade fewer after the acute phase, malaise:of ogito for the treatment of influenza. Primarily, itsaikokeishito

is used as a single dose during the early phase to(2) For recurrent infections (in case of recurrent

lower the fever through sweating and should betonsillitis, middle ear infection, perianal abscesses

stopped once defervescence has been achieved.

etc.）Animal experiments verified that kakkonto, a* During intermissions, when looking for stronger

formula with a purpose similar to that of theanti-inflammatory actions: shosaikoto, saikokeishito

aforementioned formula, has an influence on the* When looking for invigorating actions, expecting

cytokine production5). In this context the correlation

this to prevent secondary recurrences (as detailedtobelow,

thepreventionofinfluenza-associatedthismethods

resembles

utilizing

function

improvingactions):

encephalopathy as a form of a cytokine storm is ofgastrointestinal

interest, but there are no related reports yet.

juzendaihoto, hochuekkito, ogikenchuto

Next, when the fever in acute infections,* During exacerbations (using something withincluding influenza, is followed by lingering low-strong anti-inflammatory actions)

grade fever and symptoms of malaise etc., shosaikoto

kikyosekkoto: in particular for upper respiratory

should be considered. Although there are noinflammations

statistical reports, in the classics its use ishainosankyuto:

commonsense and the criteria for its application arediseases

inparticularfor

suppurative

given in the classics ("Shang Han Lun").
Also, it has long been known that for infections
like recurrent tonsillitis, recurrent middle ear
infections that may recur several times a year either
a combination of shosaikoto and kikyosekkoto or
Saikoseikanto is beneficial. In case of recurrent
tonsillitis their long-term use reportedly led in 5080% of the cases to a marked reduction in theincidence6,7). These cases could possibly include theauto-inflammatory syndrome PFAPA (periodic fever,aphthousstomatitis,pharyngitisandadenitissyndrome). By the way, the author has useddecoctions for 5 patients with PFAPA and achievedin all cases marked improvements8). Also, perianal
abscesses often recur in short intervals, making
incisions necessary. In these cases juzendaihoto or

hainosankyuto are very effective9,10).
Thus, if local infections and inflammations recur
while no clear immune insufficiency is observed andbecause there is no effective Western medical
pharmacotherapy, Kampo medicines are considered

References
1) Hideaki Yamaguchi: Attempt at a Chinese medical
classification of weak children, Journal of theJapan Pediatric Oriental Medical Society 1995; 11:33-37
2) Hideaki Yamaguchi: Kampo medicines easily
applicable in children, Pediatric Clinical Guide,
Nakayama Shoten, 2009: 158-164
3) Hideaki Yamaguchi, Basic pediatric Kampo
preparations, Life Science, 20124) Shunpei Yokota: Infections, inflammation andnatural immunity, Pediatric Clinics 2008; 61:
1715-1718
5) Kimiyasu Shiraki: Modes of action of Kampomedicines used to treat influenza, Progress ofMedicine 2002; 202: 414-418
6) Shigehito Osako: Kampo treatment for habitual
tonsillitis, JOHNS 1990; 6: 71-75
7) Masafumi Iwama: Kampo treatment of weakchildren, Familiar Kampo treatment of pediatricdiseases, 2, Tokyo Medical View, 2002: 53-62

worth using as unique immune modulators.

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

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Volume 7, Number 1 | Spring 2012

Hideaki Yamaguchi: Attempt at treating PFAPA
with decoctions, Journal of The Japan Society for
Oriental Medicine 2012 (Abstract)9) Toshinori Muramatsu et al.: Treatment of perianal
abscesses
andhemorrhoidal
plexi
with
juzendaihoto, The Japanese Society of PediatricSurgeons 2005; 37: 311-315
10) Kawahara et al.: Perianal abscesses andhemorrhoidal plexi; The Japanese Society ofPediatric Surgeons 201l; 43: 878-881
8)(Continue to the next issue)

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