KAIM
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INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 4, Number 3 ･ Fall 2009

Foreword

Safer Choice of Needling Methods in Acupuncture Practice
Hitoshi Yamashita

Japanese Acupuncture - Current Research

Acupuncture and Moxibustion Treatment for Patients with Cancer in Modern Japan –A Questionnaire Survey among Practitioners of Acupuncture and Moxibustion
N. Saito, T. Narushima, T. Kurasawa, S. Furukawa and H. Tsukayama

Kampo Medicine - Current Research

The Efficacy of Ten Strong Tonic Herbs Decoction for Treatment of Perianal Abscess and Anal
Hiromichi Yasui

Clinical Report 1 (Japan)

Acupuncture Treatment for Chronic Plantar Pain – One Case Report
Tomoyuki Nabeta

Clinical Report 2 (Japan)
Menopausal Disorder
Yang Cholsong

Clinical Report 3 (Japan)

Poria Powder with Five Herbs + Coptis Detoxificating Decoction for Alcohol-Induced Headache

Mitsuyuki Takamura and Hiromichi Yasui

Kampo Dermatology – Clinical Studies
Solar Irritating dermatitis/Sunburn (7)Fumino Ninomiya

Medical History in Japan

Sotetsu Ishizaka’s “Shinkyu Chiyo Ichigen” (3)Kenji Kobayachi

ISSN:1559-033X

Volume 1, Number 1 | Spring 2006

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

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

Volume 4, Number 3 | Fall 2009

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

Research on Theory, Practice and Integration

Volume 4, Number 3 ･ Fall 2009EXECUTIVE EDITOR

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

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

ASSOCIATE EDITORS
Shuichi Katai
Ibaraki-ken, JapanTA B L E O F C O N T E N T S
1 Editorial
Safer Choice of Needling Methods in Acupuncture Practice
Hitoshi Yamashita

2 Japanese Acupuncture - Current Research
Acupuncture and Moxibustion Treatment for Patients with Cancer in Modern Japan –A Questionnaire Survey among Practitioners of Acupuncture and Moxibustion
N. Saito, T. Narushima, T. Kurasawa, S. Furukawa and H. Tsukayama

Hiromichi Yasui
Tokyo, JapanEDITORIAL STAFF

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

8 Kampo Medicine - Current Research
The Efficacy of Juzentaihoto for Treatment of Perianal Abscess and Anal
Hiromichi Yasui

10 Clinical Report 1 (Japan)
Acupuncture Treatment for Chronic Plantar Pain – One Case Report
Tomoyuki Nabeta

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

PUBLISHER

Shuji Goto
International Institute of Health andHuman Services, Berkeley

15 Clinical Report 2 (Japan)
Menopausal Disorder
Yang Cholsong

16 Clinical Report 3 (Japan)
Goreisan + Orengedokuto for Alcohol-Induced Headache
Mitsuyuki Takamura and Hiromichi Yasui

17 Kampo Dermatology – Clinical Studies
Solar Irritating Dermatitis/Sunburn (7)Fumino Ninomiya

21 Medical History in Japan
Sotetsu Ishizaka’s “Shinkyu Chiyo Ichigen” (3)Kenji Kobayashi

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

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

0

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

Volume 1, Number 2 | Summer 2006

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

Volume 4, Number 3 | Fall 2009

Editorial
Safer Choice of Needling Methods in Acupuncture Practice
Safety of acupuncture practice has been studied by several large-scale prospective surveys,
and the evidence accumulated in the surveys has shown that the incidence of serious adverse
events is very rare. On the other hand, it is a fact that adverse events possibly attributable toacupuncture treatment are still being reported as of today. Particularly, as organ injuries such as
pneumothorax become life-threatening in the worst case, the knowledge of safe depth ofneedling is important to the practitioners of acupuncture-moxibustion.
As a matter of fact, it may be necessary to needle to a certain depth in order to obtainclinical effects. Some randomized controlled trials (RCTs), have reached the conclusion that deep
needling is more effective than shallow needling. At the same time, there are many RCTs
concluding that the clinical effects of both shallow needling and deep needling are not different.
If it is known that the shallow or deep needling is more effective than the no-treatment groupand the usual care group, the next step to take is to select a safer method of needling. Taking an
example of migraine headaches, there are many RCT reports suggesting that shallow needlingand deep needling produce no different effects. If this is the case, treatment with shallow
needling could prevent serious adverse events that have been reported until now, such as injuriesof medulla oblongata or spinal cord.
Japanese acupuncture has a variety of styles in which relatively thinner needles are used ingeneral and relatively shallow insertion is applied. Also it does not necessarily seek Deqi. In the
U.S. and Europe, there are many RCTs that had the conclusion that there are no significant
differences in effects between the group of superficial or minimal needling and the group ofordinary needling with TCM method. Then, performing Japanese style acupuncture would be
sufficient for the conditions in such RCTs. This is because Japanese style acupuncture is safer andbrings equivalent clinical effects.
Let’s think rationally and act accordingly. Patients do not have to wince in pain andwithstand intense needling stimulation and they can often have clinical effects equivalent tothose previously obtained with lower incidence rates of organ injuries. In the U.S. and European
countries there should be many more patients to whom this safer choice can be applied.

Hitoshi Yamashita, Lic.Ac., Ph.D.
Professor, Graduate School of Health Sciences
Morinomiya University of Medical Sciences
Osaka, JapanThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

1

Volume 4, Number 3 | Fall 2009

Japanese Acupuncture - Current Research
Acupuncture and Moxibustion Treatment for Patients with
Cancer in Modern Japan – A Questionnaire Survey among
Practitioners of Acupuncture and Moxibustion
Saito N, Narushima T, Kurasawa T,
Furukawa S, Tsukayama H

2) Objective
The objective of this survey is to investigate thereality of acupuncture and moxibustion treatment

1) Background

According to the results of the nationwide
survey carried out in 2001 by Yamashita, et al
involving the people of Japan, the utilization rateof CAM was 76%. The top 5 of its best utilization
were nutrition supplement drinks (43%), healthappliances (22%), herbs/OTC (over-the-counter)
Kampo medicines (17%), massages and shiatsu(finger pressure) (15%), and Kampo medicinesprescribed by physicians (10%). The use ofacupuncture and moxibustion was 7% [1]. On theother hand, the 2001 questionnaire among
patients with cancer conducted by Hyodo, et al.
showed that the rate of patients utilizing
complementary and alternative medicine (CAM)
was 44.6%. The breakdown was: health foods byan overwhelming majority (89.1%), Kampo
medicines (7.1%), Qigong (3.8%), acupuncture(3.6%), and moxibustion (3.7%) [2]. The results ofthese two surveys cannot simply be compared as
there are small differences in classification
between these two. However, the utilization rateof acupuncture and moxibustion in patients withcancer is 3.7 % to 7.3%, which means that they
use acupuncture and moxibustion more than alittle. Since patients with cancer use CAM mainly
for the reasons of suppressing cancer progression(67.1%) and seeking cure (44.5%), it is easy to
imagine that Japanese people in general use
acupuncture and moxibustion for other reasons
than motor symptoms (79%). In conducting alarge scale survey among patients with cancer
who are receiving acupuncture and moxibustion
treatment, what needs to be done first is theidentification of survey participants. This isunrealistic. Thus, a survey was planned to garner2

information relating to the treatment of cancer
patients with acupuncture directly fromacupuncture practitioners.

now being performed for cancer patients from theperspective of the practitioners and to discusscancer treatment and the application range ofacupuncture and moxibustion.
3) Methods
A survey was conducted through a questionnaire
with

the

authorswho

published

literaturesconcerning acupuncture and moxibustion treatment
for cancer patients during the past five years.
Specifically, in November 2006 “ichushi Web”was
searched for literatures relating to “malignant
tumorsandacupunctureandmoxibustion

treatment” released during the past five years. Then“a questionnaire about roles of acupuncture andmoxibustion in the treatment of cancer” was sent by
post to 83 first authors, who were invited to send
their replies.

Literatures were restricted to thosepresenting human clinical data. Basic studies andanimal studies were excluded. The period of thesurvey was three months from December 2006 to
February 2007.
4) Results
4-1. Profiles of respondents
Replies were received from 46 respondents withthe response rate of 55.4%. The respondents were 36
males and 10 females aged from 29 to 79 (average
51±, standard deviation 12.3).
The length of their clinical experience was 3 to 50
years (average 21.4±, standard deviation 11.3).
In

regardtotheemployment

status,18

respondents were in practice, 20 were employees,

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

Volume 4, Number 3 | Fall 2009

and 3 were in practice concurrently employees. Five

The results were persuasive because the subjects of

respondents made no description for this question.

this survey were literature authors and many of the

The number of experienced cases was 1 to 1300

respondents belonged to medical institutions, such(average 137±, standard deviation 293.2). The mostas university hospitals, where there are necessarily

common 10-49 cases were experienced by 17

many opportunities to write literatures.

respondents, followed by less than 10 cases by 9
respondents. The above 17 and 9 respondents addedby the respondents with less than 50 cases ofexperience made up the majority of the respondents.
On the other hand, 100 cases were experienced by
12 respondents (of which 2 had 1,000 cases or more).
The respondents having 1,000 or more cases ofexperience (8 out of 10 had 100 or more cases) all
answered that their sites of practice were in medical
institutions. This means that in the settings where
acupuncture and moxibustion were adopted to carefor cancer patients, there were many potential
scenes to utilize acupuncture and moxibustion.

4-3. Motives for performing acupuncture
A multi-choice question was asked as to whaturged the subject to perform acupuncture. To thisquestion,

multipleanswers

were

accepted.

“Patient’s own decision” accounted for the highest
rate of 78.2%, followed by “request by the doctor in
charge” which accounted for 41.3%.

And then“recommended by the patient’s family and/or close
relatives” accounted for 39.1%.
Analysis of the data by practice site showed that“patient’s own decision” had the great majority in allsites. Second motives were “request by the doctor in
charge” in medical institutions, “recommended by
the patient’s family and/or close relatives” in

4-2. Practice sites

practitioner’s

owntreatmentrooms,

andIn terms of the sites where practice was“recommended by a co-medical” in the patient’s

performed, “in a medical institution” accounted forhomes. The results suggested that factors having

50%, “in the practitioner’s own treatment room”

influences

accounted for 41.3% and “in patient’s home”13.0%.

dependent on the site of practice (Fig. 1).

on

the

treatmentofcancerwere

In institution

In practitioner’s
own room

In patient’s home

Others■Patient’s own decision ■Request by doctor ■Suggested by co-medical ■Suggested by family

Fig. 1 Motives to come to perform acpuncture (by practice site)
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

3

Volume 4, Number 3 | Fall 20094-4. Purposes of performing acupuncture andmoxibustion for cancer patientsTo the question as to the purposes of performing
acupuncture, the answer of “as a means to relieve
symptoms caused by cancer” had the vast majorityof 69.5%, followed by 60.8% each for “as a means torelieve adverse effects associated with cancer” and“as a means to improve cancer and complaints
unrelated to cancer and to enhance QOL.”
Analysis of the purposes by site of practice
showed no major differences from the above results.
Relatively many of the respondents, however, whoanswered that the purpose was “a means to shrink
cancer and to retard cancer progression” performthe treatment in their own treatment rooms.
4-5.Reasons to determine use of acupuncture andmoxibustion for cancer patients
A multiple-choice question was asked as to thereasons to determine the use of acupuncture
treatment. “Can obtain patient’s satisfaction”
accounted for the majority 69.5%, followed by “lessside effects and less damages” at the rate of 56.5%,
and then “expect resistance to cancer to improve by
getting the patient in shape” was 54.3%.

On the other hand, few respondents answered“connect to revenues and profits” and “there were
evidences.”
In the results by site of practice, there were
noticeable answers of “good ways/methods
unavailable” from the respondents practicing inmedical institutions. The reason mentioned by thelargest number of respondents was “expect
resistance to cancer to improve by getting thepatient in shape.”
4-6.Cooperation with the doctor in chargeAquestion
was
asked
about
cooperation/partnership with the doctor in charge ofthe patient, to which “yes” cooperating had 47% of
the total, whereas “no” had 36%. “Others” had 17%.
The results by site of practice showed respective
70% of the respondents performing treatment inmedical institutions and those performing
treatment in the patient’s homes were cooperating
or developed a partnership with the doctor in charge.
On the other hand, respondents performing
treatment in their own treatment rooms who werecooperating or developed a partnership were shortof 30% (Fig. 2).

Cooperating

Not
cooperating

Others■In institution ■In practitioner’s own room ■In patient’s home

■OtherFig. 2 Cooperating or not cooperating with doctor in charge (by site of practice)4

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

Volume 4, Number 3 | Fall 2009

Since the method of cooperation/developing apartnership was asked for free descriptions, there
was variability among answers. In regard to themethod of contact with the doctor in charge, many
replies were received for verbal contacts or contacts
by writing. There were answers describing that
instructions were received from the doctor in charge
and reports were made to the doctor in charge. Fromthese results, it seemed that in performing
acupuncture in medical institutions, suitable
methods of cooperation/developing a partnershipwere adopted in the doctor-centered environment.
To the question whether or not difficulties inhaving contacts with the doctor in charge or
difficulties in reporting the doctor in charge about thepatient were felt, 21.7% of the total answered “yes”
whereas 26.1% answered “no.”And “others” accounted
for 10.9% and “no answer” accounted for 10.9%.
Among the respondents who answered that they were
having contacts, half of them performing treatment inmedical institutions felt no difficulties whereas 30%
felt the difficulties. In regard to the treatment in thepatient’s homes, 70% or more felt the difficulties. Thismay have been resulted from it that the site ofpractice was not shared between the practitioner andthe doctor in charge as in medical institutions.
4-7. Issues arising from the participation of an
acupuncture and moxibustion practitioner in team
medicine for cancer

To the question as to what issues would arise if
an acupuncture and moxibustion practitioner joinedin the members of team medicine, 30.4% mentioned
the points relating to “building confidence with
other
staff
members,”
23.9%
mentioned“understanding of acupuncture and moxibustion,”and 19.6% pointed out “insufficient medical
knowledge.” Many answers received were lack ofcooperation and understanding with each other.
There were requirements for building up evidences.
The results by site of practice showed that many
respondents performing practice in medical
institutions
mentioned“insufficient
medicalknowledge” and “understanding of acupuncture andmoxibustion.”Although the respondents performing
practice in their own practice rooms had different
opinions, the most common answer was tounderstand acupuncture and moxibustion.”Unlike
in medical institutions and in the patient’s homes,
the respondents performing in their own practicerooms expressed opinions concerning “techniques ofpractitioners of acupuncture and moxibustion.”The
respondents performing practice in the patient’s
home expressed eye-catching opinions about“medical treatment fees and health insurance
system” as well as “insufficient medical knowledge”
and “cooperation” and the voices requiringunderstanding of acupuncture and moxibustion
were undistinguished (Fig. 3).

In institution

In practitioner’s
own room

In patient’s home

Others■Insufficient knowledge ■Cooperation ■Understanding ■Evidence ■Fee/insuranceof acupuncture
system■Technique of ■Others
acupuncturist

Fig. 3 Issues arising from the participation of an acupuncture and moxibustion practitioner in team medicine(by site of practice)
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

5

Volume 4, Number 3 | Fall 2009

4-8. Symptoms difficult to have effect in thetreatment of cancer patients with acupuncture and5)

Summary
The subjects of this survey were literatureauthors, so many replies were received from thosemoxibustion
A question was asked about symptoms difficult tobelonging to medical institutions, such as university

have effect on cancer patients. Answers were varied

hospitals. Although there was a respondent’s bias, it

and it was not easy to categorize them all. In thewas suggested that the environmental conditions

answers that could be categorized, the mostsurrounding patients differed in each site ofcommon answer was “pain” (especially, sharp pain

practice.

and neuropathic pain) which accounted for 28.5%,

In the sites of medical practice, the trend offollowed by “aggravation of general conditions”

feeling difficulties in cooperating with physicians

which accounted for 19.5%.

was weak. And as issues arising from thepractitioner’s participation in team medicine,

4-9. Symptoms that could be indications for

insufficient medical knowledge and understanding

acupuncture and moxibustion treatment in cancerof acupuncture and moxibustion, which could bepatients (Table 1)translated as understanding of acupuncture andTable 1. Acupuncture treatment applicable symptoms
symptoms

No.

pointed out. In the settings where both medical

Percentage

practice and acupuncture and moxibustion practice

Cancer pain

23

50.0%

were performed, certain levels of cooperation were

Nausea, vomit, poor appetite

14

30.4%

functioning and seemed to be at the stage which

Non-cancer pain

8

17.4%

required better mutual understanding.

8

17.4%

Edema

7

15.2%

answered that they were cooperating as similarly as

Sleep disorder

5

10.9%

in the sites of medical practice, 70% felt difficulties

Post-surgery health management

3

6.5%

in cooperating or having a partnership with the

Defecation

3

6.5%

doctor in charge. As issues in the participation in

Recurrence prevention

3

6.5%

Urination disorder

2

4.3%

Unidentified complaints

2

4.3%

Peritoneal fluid

2

4.3%

Others24

52.2%

Side-effects of chemotherapy(except for nausea and vomit)

A question was asked about symptoms for which
acupuncturewasapplicable.

“Cancerpain”

accounted for the highest rate of 50.0%, followed by“nausea, vomit, poor appetite” representing 50.0%,
and then “pains other than cancer pain” and“thermotherapy side effects (except for nausea andvomit) representing 17.4% respectively.

6

moxibustion and mutual understanding, wereOn the other hands, although the respondents
performing acupuncture in the patient’s homes

team medicine, medical fees and medical insurance
were mentioned, from which it seemed practitioners
were facing problems with systems revolving
aroundcancerpatients,

physicians,andpractitioners of acupuncture and moxibustion.
Out of the respondents performing acupuncture
and moxibustion treatment in their own practicerooms, those who were able to have cooperation
were short of 30%. The first reason for those
respondents to apply acupuncture and moxibustion
for the treatment of cancer patients was the“expectation to increase resistance to cancer bykeeping the patient fit” whereas “for the patient’s
satisfaction” was the first reason in other sites of

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

Volume 4, Number 3 | Fall 2009

practice. From these responses, it was known that
responding

surveysubjects

wereperforming

acupuncture and moxibustion treatment rather on
their

own

experienced

judgment

thanbyinstructions from physicians.
The efficacy of acupuncture and moxibustion forsick feeling, vomit, and loss of appetite in cancer
treatment

is

now

being

discussed

[3].

And

acupuncture and moxibustion are also attracting
attention for the treatment of side-effects This is
supported by the symptoms that were mentioned by
the respondents of this questionnaire survey [4]. In
the meantime, pain was cited as a symptom difficult
to have effects and it was also included in theindicationsforacupunctureandmoxibustion.

Further studies are necessary on usefulness ofacupuncture and moxibustion in cancer patients.

References[1] Yamashita H, Tsukayama H, Sugishita C: Popularity
of complementary and alternative medicine in Japan:
a telephone survey. Complementary Therapies in
Medicine 10: 84-93, 2002.
[2] Hyodo I, Amano N, et al,: Nationwide Survey onComplementary and Alternative Medicine inCancer Patients in Japan. J Clin Oncol. 23 (12):2645-2654, 2005
[3] Ezzo J, Streitberger K, Schneider A: Cochranesystematic
reviews
examineP6
acupuncture-point stimulation for nausea andvomiting. J Altern Complement Med. 12(5):489-95, 2006
[4] Shimoyama N, Kitsutani H, et al.: Gan-Chiryouniokeru
Fukusayou
Taisakutoshiteno
Tougou-Iryou no Yakuwari (Countermeasures ofside effects and roles of integrative medicine incancer treatment): Byouin 68(11): 904-907, 2009.

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

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Volume 4, Number 3 | Fall 2009

Kampo Medicine - Current Research
The Efficacy of Juzentaihoto for Treatment of Perianal
Abscess and Anal
Hiromichi Yasui
Japan Institute of TCM Research

Introduction
Perianal abscess and anal fistula that occur
most often in infancy are relatively common
conditions in daily practices of the Department ofPediatric Surgery. Surgical incision and drainageis the usual treatment. The conditions, however,recur in quite a number of cases. In recent years,
several documents have appeared reporting thatthe use of juzentaihoto for the treatment of
perianal abscess and anal fistula reduced thenecessity of incision and enabled to get thedisease cured in a short time. I will mainly
introduce the study by Muramatsu, et al. whoinvented this method.
Research by Matsumura, et al.
Matsumura, et al. administered juzentaihoto
to 65 patients with perianal abscess and fistula(22 days old – 5 years old) who visited his hospitalduring the period from 1996 to October 2004 andnearly at the same time, treated 28 patients (15days old – 5 years old) of the control group by
incision and drainage alone to conduct a
retrospective study１).
After a definitive diagnosis was made upon the
juzentaihoto 0.2-0.65g/kg/day
initialvisit,(approximately 0.4g/kg /day) was dissolved in asmall volume of lukewarm water andadministered. The incision and drainage was
performed by the practitioner’s decision. Since 3(4.6%) of 65 patients were unable to orally takethe prescription, the subjects of this researchwere 62 patients.
The patients who received medication without
incision and drainage were 49, of which 13(26.5%) achieved cure within two weeks. On theother hand, 13 patients (26.5%) had prolonged
8

drainage for the duration of 3 months. One ofthem was shifted to the surgery group. Thus 48(77.4%) of 62 patients were able to avoid theincision and drainage and treated only withjuzentaihoto.
There were 13 patients who received the
combination treatment of juzentaihoto withincision and drainage. In this group, no patients,
however, attained cure within 14 days, whereas 3
patients within 30 days, and 8 within 90 days. It
took 90 days or more for two patients to attaincure and two to three months were required forthe treatment in many patients.
In the control group (treated only with incisionand drainage without the use of juzentaihoto),
many patients needed more than a month before
cure was achieved. There was only one patient
who attained cure within two weeks. In view ofthe short-term treatment performances (curewithin two weeks), the treatment withjuzentaihoto alone is the most beneficial.
In regard to the number of hospital visits, halfof the patients who were treated only withjuzentaihoto had the completion of the treatment
with 5 or less visits since the medication did not
require frequent procedures. And nearly 90% of
these patients attained cure within 10 days. On
the other hand, less than 30% of the patients, whowere treated only by the incision but without
having the administration of juzentaihoto,attained cure with 21 or more visits.
In comparing the rate of recurrence or the rateof prolonged drainage of more than 3 months
between the two groups, the recurrence rate (orprolonged drainage) was reduced to nearly half inthe group of juzentaihoto alone.
Concluding remarks
This is a groundbreaking study that showed
the treatment efficacy of the Kampo medicine on
perianal abscess and anal fistula which used to be

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

Volume 4, Number 3 | Fall 2009

generally treated by surgical incision anddraining. When this study was published,
everyone was somewhat doubtful because theformula used in the study was not the medicine totreat pus but was juzentaihoto, which mainly
works to supplement qi and blood. Later on, as
several researchers conducted supplementarystudies and obtained similar results, thetreatment with juzentaihoto for perianal abscessand anal fistula is now treated as being
equivalent to the standard treatment by surgicalincision and drainage.
In addition to the study by Matsumura, et al.,there are other similar studies conducted withmostly same results2), 3), 4), 5).
Why juzentaihoto works well has not beenanswered yet. It is presumed that effects may
appear by improving local immunity in therectum. This, however, has not been verified.
Chiba, et al. used juzentaihoto for not only
perianal abscess but also fistulas in the neck,abdomen, and perineal region of unknown causes
and made reports on nine patients who had reliefof symptoms6), revealing that this formula isuseful for any part of the body. Elucidating its
mechanism remains to be solved.

References
1) MuramatsuT,
Te r u iE:
Koumon-shuui-nouyou / Jirou ni
juzentaihoto
Chiryou,
taisuru
Journal of Pediatric Surgery 37:
3 11 - 3 1 5 , 2 0 0 52) Muramatsu
T,
FuseyaS:
NyuujiKoumon-shuui-nouyou
nitaisuru
juzentaihoto no Shiyou-keiken, Journal of
Pediatric Surgery 32: 1322-1325, 2000
3) Ohtani T, Kadota S, Arai S, et al.: Nyuji
Jirou no Chiryou-hoshin - juzentaihoto wo
Mochiita Atarashii Hozonteki Chiryou –Journal of Japanese Society of PediatricSurgeons: 735-739, 2001
4) Ohya T, Usui Y, Okamoto K, et al :Managementfor
fistula-in-ano
withjuzentaihoto. Pediatrics International 46（1）：72-76、2004
5) Chiba M, Sanada Y, Yoshizawa Y, et al.:Koumon-shuui-nouyou/Jirou,
Journalof
Pediatric Surgery 35: 957-960, 2003
6) Chiba T: Shouni-rei niokeru Roukou Heisa wo
Mokuhyou toshita Juzentaihoto no Shiyou
Keiken, Journal of The Japanese Society for
Oriental Medicine 46:427-431, 1995

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

9Volume 4, Number 3 | Fall 2009

Clinical Report 1 (Japan)
Acupuncture Treatment for Chronic Plantar Pain –One Case Report
Tomoyuki Nabeta
Health Faculty, Dept. of Acupuncture & Mosibustion
Morinomiya University of Medical Sciences

1. Introduction
Pain associated with numbness of the extremities isindicative of constriction of central nerves or nerveroots and diagnostic imaging is often performed in
medical facilities for the lumbar and cervical regions.
However, frequently any clear organic diseases areabsent and causes remain unknown, so that local
symptomatic treatment is performed. Many of thepatients receiving acupuncture treatment in Japan
underwent treatment in medical facilities but
without resulting in any improvement and came ourclinic in the hope for some relief. This article
presents one case report, where acupuncture
treatment was markedly effective.
2. First visit
Born in July 1936, aged 74 years, female, housewife
First visit: November 1, 2010 (Monday)
Chief complaint: plantar pain
1) Anamnesis
Three months earlier without any causes the patient
can think of the left heel became swollen upon risingin the morning, subsequently developing severe pain
and resulting in the disability to walk. An
orthopedist took an x-ray picture of the foot but
could not identify any anomalies and therefore gave
the patient cold compresses. Yet, the pain was notalleviated and starting one month ago she ceased
seeing the orthopedist and started instead to visit anosteopathic clinic. The treatment there resulted insome improvement of the symptoms, but she still
had to walk on the toes because of the pain during
walking. The pain was of a tingling nature and grewworse when walking. During rest she felt somediscomfort, but not strong pain. As concurrent
symptoms she complained about marked shoulder
10

stiffness and occasional headaches. The headacheoccurred frequently in the right parietal area andwas a continuously squeezing pain. She was easily
susceptible to stress and irritation during daily life.
2) Acupuncture treatment experienceShe had no previous acupuncture treatment
experience and since this was her first visit, she felt
somewhat frightened. A friend of hers wascommuting to this clinic and because this friend took
the patient by car, she could visit our clinic, although
she lived rather faraway.
3) Past history
Surgery for varices near the 4th digit of the left foot.
Surgery of the left eye, resulting in a recovery of left
visual acuity to 1.2. (right: 0.3)
The timing of the surgeries for both symptoms is
unclear.
4) Examination findings(1) Observation upon entering the room
The upper half of the body leaned forward and apainful gait protecting the left foot could beobserved.
(2) Observing the patient in a sitting position
I Static observation
I instructed the patient to sit at rest in the most
comfortable position with eyes closed, facing straightforward and observed this posture. This showed thatthe right shoulder was elevated, the neck tilted to
the right and slightly rotated to the left.
II Dynamic observation
I instructed the patient to bend the neck for-,backward, sideways and rotate it. Retroflexion of theneck caused a sensation of dull pain extending fromthe cervical to the back region, while upon
anteflexion the patient reported a feeling of tractionin the posterior region of the neck, bending to the leftcaused a feeling of traction in the right shoulder
region, while rotation to the right was restricted.

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

Volume 4, Number 3 | Fall 2009(4) Observation in face-down position
I Observation
Protuberances on both sides of the erector spinae
muscle region between Th4 and Th7 could beobserved.
II Palpation
I observed a very strong tension from the cervicalregion towards both shoulders, in particular within
the right trapezius muscle in the vicinity of GB 21(Kensei, Jianjing) a string-like induration andtenderness was observed. In the same locationpressure induced ischemia triggered in the rightposterior cervical region a dull pain, so that I
considered this area to be a trigger point.
The triceps surae muscles were overall very tense
and a slight swelling and reddening of the heel
region could be observed. Lightly touching the same
region or compression causes the patient to complainof a numbening pain.
(4) Observation in face-up position
II Palpation
On the outside of both lower legs an increased
tension of the long peroneal muscle and theperoneus brevis muscle was observed andparticularly marked on the left. Moreover, on the
medial side of the left lower leg, the muscle along themedial marginal region of the tibial bone was flaccid.
Passive movement of the ankle joint showed that the
restriction of the mobility (resistance) was moremarked on the left side. A mild degree of edema wasalso noted for the left lower leg, so that pressure
against the tibia left a finger impression. In thecenter of the right sternocleidomastoid muscle belly
a strong tension could be observed and the patientcomplained about tenderness of the same site andparietal discomfort upon compression, so that thissite too was identified as a trigger point.
5) Comprehension of the pathologic condition
Excessive tone of the muscle groups stabilizing theankle joint could conceivably be a factor for the

restricted joint movement. Since the patient could
not recall any contusion of the left heel possibly
responsible for the symptoms, the condition wasprobably not caused by a trauma. For some reason
circulatory problems in the left heel region developed
and the resulting swelling caused a local
compression neuropathy, so that during walking thecompression conceivably led to the manifestation ofpain.
The author thought, that the excessive tension of themuscle groups located around the ankle joint andthe tension of the erector spinae muscles caused by
the patient's stooped posture were related to themuscle tone of the neck and shoulder region andthus possibly contributed to the headache. Because
the disturbance of the trunk balance shifted thecenter of gravity and thus put an increased stress on
the antigravity muscles, the patient shifted hercenter of gravity forward, so that the muscle tension
in the posterior crural muscles increased and thetone of the triceps surae muscles responsible forplantar flexion of the ankle joint led to a tensing of
the long peroneal muscle, peroneus brevis muscle,posterior tibial muscle and this in the end probably
led the development of an increased tonus of theflexor hallucis longus muscle. While these muscle
groups caused a shortening of the ankle joint andthus a limitation of the mobility, at the same timethey probably also adversely affected the flexibilityof the plantar arch. Accordingly, the increased
muscle tension in the lower legs conceivably
developed in this patient because of the abnormal
posture assumed during daily living, resulting in an
abnormal center of gravity.
6) Treatment plan
Purpose of the treatment was to achieve relaxationof the structural muscles of the ankle joint topromote mobility of the ankle joint and relaxation ofneck and shoulder region muscles. Tension of thelumbar and back muscles too should have beenadjusted to improve the posture, but because this

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

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Volume 4, Number 3 | Fall 2009

was the patient’s first acupuncture treatment, thiswas omitted in order to reduce the stimulus dose.
Further, from a point of view of meridians thecondition was considered to be a lesser yang disease,
where an increased tension was observed along the
gallbladder meridian, while on the medial side of thelower leg along the reverting yin liver meridian someedema could be noted, allowing the conclusion thatthe greater yin spleen meridian is weakened andthus relevant therapeutic points were selected on
the various muscles. For the acupuncture treatment
40 mm No.18 needles manufactured by Seirin wereused. Since the patient underwent acupuncture
treatment for the first time, obtaining de qi waseither not necessary or kept to a mild degree.
7) Treatment
I Treatment for the heel pain
Left GB34
Purpose: Reduction of the long peroneal muscle
tension, stimulation of the common fibular nerve,
adjustment of the lesser yang gallbladder meridian.
Method: Perpendicular insertion, 1 cm insertion
depth, obtaining de qi is not necessary after
thrusting and lifting with little stroke.
Left BL60
Purpose: Stimulation of the fibular nerve,
adjustment of the greater yang bladder meridian.
Method: BL60 was needled perpendicularly in a
fashion of "penetrating insertion" towards KI3,
where the movement of the tip of the needle could befelt underneath the skin, meaning that the needle
had passed beneath the Achilles tendon. Obtaining
de qi is not necessary.
BL57 (bilateral)
Purpose: Reduction of the triceps surae muscle
tension, adjustment of the greater yang bladdermeridian.
Method: Perpendicular insertion in the region ofmuscle-tendon
transfer
region
from
the

12

gastrocnemius to the Achilles tendon, insertion todepth of more than 2 cm until the needle reached thetransitional region of the soleus muscle. Otaining de
qi is not necessary.
Left SP6
Purpose: Relaxation of the posterior tibial muscle
and freeing the three leg yin meridians.
Method: Perpendicular insertion, insertion for morethan 2 cm. Otaining de qi is not necessary.
LR3 (bilateral）
Purpose: Relaxation of plantar muscles, adjustmentof the liver meridian.
Method: Slightly oblique insertion towards the baseof the first and second metatarsal bones. Insertion toa depth of more than 1 cm and obtaining de qi.
II Treatment of the neck and shoulder region
symptoms
Induration in the center of the rightsternocleidomastoid muscle belly.
Purpose: Calming the trigger point
Method: Presence of strong tenderness, bycompressing the area of blood deficiency for 5
seconds a perpendicular vertical insertion was madein the area of the discomfort reported in the parietal
region, and after thrusting and lifting several times
de qi was obtained.
GB20 (bilateral）
Purpose: Relaxation of the semispinal muscle of thehead and the greater posterior rectus capitis muscle,
freeing of the lesser yang gallbladder meridian.
Method: Markedly oblique insertion toward theoccipital bone, after confirmation that the needle tip
touched the bone the needle was slightly retracted
and thrusting and lifting performed. Obtain only amild degree of de qi.
Hyakuro (bilateral)
Purpose: Reduction of the tension of the erector

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

Volume 4, Number 3 | Fall 2009spinae muscles in the center of the border between
the semispinal muscle of neck and the semispinal
muscle of thorax to alleviate the dull pain triggeredby retroflexion of the neck.
Method: Perpendicular insertion, insertion for morethan 2 cm until resistance is felt.
GB21 (bilateral）
Purpose: Relaxation of the trapezius muscle,
calming the trigger point and freeing of the lesser
yang gallbladder meridian.
Method: Grip the trapezius muscle as thinly as
possible and twist it forward, after confirmation of astrong pain and referred pain extending towards theocciput, directly prepare the pressing hand andinsert the needle. Obtain a mild degree of de qi.
III Stretch exercises and joint mobilization
techniques
Mobilization techniques for the ankle joint
Passive performance of dorsal flexion, plantar
flexion, plantar flexion and inversion, plantar flexionand eversion. At this time the techniques are
performed consciously imagining the sliding
direction of the joint. Finally perform traction
towards the heel in a dorsiflexed position.
Mobilization techniques for the neck and shoulder
regionThe head and neck were bend to the left, while thejaw was moved in three directions to the right, front
and left side, the muscle groups of the neck werestretched in general, on the sides and in the back.
After performing the same procedure for the rightside, a passive traction of the cervical vertebrae isperformed.
IV Other
The patient was instructed to rotate both ankles athome and assume a proper erect posture.
8) Immediate effects

The stiffness of the neck and shoulder region wasmarkedly alleviated and movement of head and neckeasier. The patient felt the pain in the left heel while
walking, but she reported it being less than whenshe visited the clinic. I told the patient: "Since themuscles stabilizing the ankle joint are now softer,
the overall circulation has improved and if theswelling decreases with time, I think the pain will godown too." and instructed her to go home andobserve the course.
3. Second treatment session
Day of visit: November 8, 2010, 1 week after the firstvisit1) Course
The pain of the foot had disappeared completely by
the day following the treatment. It has not recurred
until now. The condition of the neck and shoulder
regions too is good.
2) Examination
Swelling and reddening of the left heel had
disappeared. Tension of lower leg muscle groups had
decreased. The tension of the right trapezius muscle
had decreased too. In the neck and shoulder region
on the left side externally from C7 a dull pain
remained, that grew worse upon rotating the neck.
Treatment
The pathologic condition anticipated during the first
visit was thought to have improved, but the patient
treated to alleviate the remaining mild degree ofmuscle tension and free the meridians. I added somemore acupoints for the purpose of systemic
regulation.
Points removed from the first visit regimen.
GB20, Hyakuro, BL57
Newly added treatment points
SP9, induration at BL20, induration at BL21, left
BL10
4. Subsequent course
Since the patient lived at a considerable distance

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

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Volume 4, Number 3 | Fall 2009

from the clinic another patient commuting to ourclinic suggested giving the patient a ride, but for
certain reasons that other patient stopped visiting
our clinic, so that the appointment made for 2 weeks
later was canceled. At that point I inquired by
telephone and was told that there were norecurrences and she felt fine. I instructed the patient
to visit my clinic again, if the symptoms should recuror other symptoms develop and initiated myfollow-up.
5. Discussion
This patient had consulted medical facilities over a
period of 3 months without experiencing any
improvements, while the pain was markedly
relieved by a single acupuncture treatment, whichclearly shows the effectiveness of the acupuncture
treatment. I discussed that the treatment included
meridian therapeutic elements, but it wasconsidered mainly as an attempt at correcting the
body's balance anomalies thought to cause local
stress and thus led to the development of thesymptoms. While the patient presented with thechief complaint of left heel pain during walking, theauthor considered the usually poor posture and theunbalanced tension of the antigravity muscles as the
etiologic factors. These caused heavy strain on one
leg, where the muscles groups stabilizing the ankle
joint developed an abnormally high tone, so that theshock absorbing properties of the plantar archdecreased, increasing the load on the heel and thus
resulted in the development of inflammation. The
influence on the nervous innervation and circulationof the heel is not clear, but since the inflammation of
the heel became chronic, it therefore probably led tothe development of hyperalgesia and at the sametime caused the swelling conceivably somecompression of the peripheral nerves. Accordingly,
improvement of the local muscle tension also
improved the mobility of the ankle joint and in
conjunction with ensuring the circulation treatmentof the neck and shoulder symptoms helped to reduce14

the load on the left lower leg. If the patient would
have had experience with acupuncture treatment,
some additional treatment of the back and lumbar
regions to improve the tension of the antigravity
muscles in general. In case an imbalance in muscle
power were observed, additional treatment toincrease muscle power should be considered.
Concepts applicable to this patient showed, that
local symptoms apparently relate to the entire bodyand a generalized unbalance in turn may lead to
local manifestations. Moreover, regional symptoms
or generalized unbalance may sometimes be
triggered by anomalies of internal organs caused byviscero-somatic reflexes. Otherwise stress or otherpsychologic factors can possibly result in anomaliesof the autonomic nervous or endocrine systems. I
believe, these concepts do not represent the oriental
traditional medical views on pathophysiology, butrather discuss acupuncture treatment as theconnection between oriental and western medicine.

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

Volume 4, Number 3 | Fall 2009

Clinical Report 2 (Japan)
Menopausal Disorder

Sho:

Yang Cholsong
Yang Herb Clinic

Liverdepression

transformed

intoheat/internal depression
Method of treatment: Sooth the liver andpurge fire/unblock yang and activate blood

Case: Female of 44 years old

Formula: Extract of kamishoyosan 9ｇ/3＋

Chief complaint: Hot flashes

Extract of keishibukuryogan 7.5g/3

History of present illness: The patient’s

Course:menstrual cycle became irregular about four

disappeared after two week and hot flashes

to five years ago and her period also becameand sweating were markedly relieved.

Chest

and

back

symptoms

once every three months three years ago. She
had

been

experiencingafeelingofComment

paroxysmal tight chest, a heat sensation on

Qi that has become stagnant by depression of

the back, hot flashes and sweating. She also

the liver transforms into heat, which thenhad prolonged heaviness in the head andbecomes stagnant internally. This internal

coldness of the four extremities. There washeat causes a heat sensation on the back,also eyestrain. At one time, she had received

which then goes up, like opening a flood gate,

hormone therapy but she had a fear of its sideinducing hot flashes of the face. And/or theeffects and quit the therapy. She was on theheat is discharged to the outside of the bodyslim side with red cheeks. She was loquaciouswith sweat. Heat stagnation can be resolved

and restless. I administered Extract ofonce but the same things are repeated overkamishoyosan

9g/2

for

2

weeks

and

kamishoyosan 9g/2 + rokumigan 7.5g/2 for 4

and over gain. In the case of the patient, theinternal heat stagnation was prevented

weeks, with the result of a slight relief of hot

efficiently by not only soothing the liver for

flashes and sweating.

purging fire with kamishoyosan and but also

Present condition:

unblocking yang for activating blood with

Medium built, thinnish.

Pulse: String-like. Tongue: Deep red withkeishibukuryogan.

thin yellow furs.

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

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Volume 4, Number 3 | Fall 2009

Clinical Report 3 (Japan)

He received the administration of the foregoing

Goreisan + Orengedokuto for Alcohol-Induced Headache

medicines for 7 days. Further a week later, aMitsuyuki Takamura

Mie University Occupational Health Research Project

Hiromichi Yasui
Japan Institute of TCM Researchheadache developed when he used hot shower
water on the head. He said that sudden
temperature changes might have affected on theoccurrence of the headache. Same medicines were

Case: Male of 49 years old

administered for 7 day. Further a week later, heInitial Visit:

made a visit to us. Headache appeared only once

June 10 of year X

Chief complaint:

Occurrence of headache after

when he drank beer. However he felt the intensity

drinking alcohol.

became less severe. Same medications were

History of present illness: The patient had been

continued. After this, there were no incidences ofsuffering from migraines which started five to six

headache. Even after drinking beer, no headache

years ago. Before a migraine attack, he got an

occurred. On September of the year, he drankaura or visual warning of flickering points of lightalcohol but experienced no pain at all.

around the right eye. The right side of the headand behind the right eye had a dull pain. The
aching is localized. When the pain got worse,
nausea, vomit, and the urge to defecate developed,
which persisted for two to three hours. A
headache occurred 1-1.5 hours after drinking
alcohol.

Subsequently, he continued the use of the
medicines and discontinued in March of year X
because of non-occurrence of headaches. Although
it recurred after a year, it resolved with theadministration of the same medicines for a while.
So, he uses the medicines on occasion.

Appetite: Ordinary.

Consideration: There is a type of headache that

Sleep: Good

can

Defecation: Once a day. Ordinary stools.

ICHD-ⅡAlcohol-induced headache). The type ofUrination: 5 times/day

headaches in the patient is migraine. For typical

Leg coldness (＋).

headaches, prescriptions vary according to theExperienced body flushing.

conditions. If alcohol use is strongly associatedDry mouth (－）

with headaches, the combination of orengedokuto

Present conditions:＋goreisan is appropriate for such headaches. If

beprovokedbyalcohol(8.1.4ofPulse: String-like and slippery

drinking alcohol is unavoidable for some reason,

Tongue: Pale colored with white furs. Moist.

the use of these formulae ahead of time is

Diagnosis: Internal stasis of water-dampness andbeneficial. It will, however, take a little bit more

dampness and heat in the triple energizer

time to feel the alcohol.

Formulae: Extract of goreisan 6.0g＋Extract oforengedokuto

4.0g,

divided

into

3

equal

And, the use of orengedokuto before an
ordinary drinking will help to prevent a hangover.

dosages/day

Goreisan is also used for hangovers. This is an

Course: The patient made a re-visit a week later.

example of a combined medication, but it works

He had a headache once. The next week, he waswell.

awakened with a headache from his sleep (about
2 o’clock in the morning). The intensity was mild.
16

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

Volume 4, Number 3 | Fall 2009

Kampo Dermatology – Clinical Studies
Solar Irritating Dermatitis/Sunburn (7)Fumino Ninomiya

circulatory system in the dermis, and connective

Aoki Clinic

To reduce inflammation, maobushisaishinto is

Ultraviolet radiation is made up of different
wavelengths which are classified into UVA (longwavelength), UVB (middle wavelength), and UVC(short wavelength). The radiation levels of UVA
are at their highest from May through to the endof August, whereas UVB levels are at theirhighest from July to the end of August. Solar
irritating dermatitis frequently happens from
April to October.

into the skin, causes wrinkles and slack, andaccelerates skin ageing. UVB rays are absorbedby the surface layers of the skin, causing skininflammation. The skin surface becomes red
which then turns to black. If this is repeated over
and over gain, the production of keratin increases
theincreased

productionofmelanin, which is the source of spots and freckles.
The skin exposed to direct rays of the sun forhours becomes like being burned, which isreferred to as sunburn. The skin complexions ofpeople are various, some have fair skin by nature,some have dark skin, and some have medium
complexions. The sensitivity and response to thesunlight differ among people. Just walking in thesunshine causes inflammation in the exposed
region of the skin – this condition is specificallycalled as solar irritating dermatitis.
In a skin inflammation induced by ultraviolet
radiation, symptoms are generally swollen red
face

with

keratoma.
used. If coldness exists, this formula is more
effective because aconite daughter tuber andAsiasarum root work on the kidney together withthe action of keeping the kidney warm. By
warming the kidney, the legs and feet also getwarmed, which improves the predisposition sothat the skin does not get burned easily.
And, in the extremely hot season, systemic
flushes and dryness become intense.

Sometimes

hyperthermia-like symptoms appear. A skin

UVA plays a role in carcinogenesis, penetrates

accompanying

tissues, leading to wrinkles, spots/blemishes, andblisters.

Repeated

exposures

toultraviolet radiation often result in chronic
disorders. Ultraviolet radiation causes damages
to such as epidermal cells, pigment cells, theinflammation that exhibits hyperthermia-like
symptoms

iscalledsolardermatitis.

Erythroderma developed as a result of solar
dermatitis

needsprescriptions

that

have

heat-clearing and diuretic actions. For this,byakkokaninjinto, shofusan, and eppikajutsuto
are used. If enriching yin and clearing heat are
expected, shishihakuhito is used. This formula isgood for red spots (erythema) around the eyes andconjunctival injection.
Once these inflammations have developed,
mostly kidney yang becomes deficient and legs
become cold. So sun care and a warming type ofprescriptions are required. It is needless to addthat Kampo medicines for oral administrationdiffer depending on the condition.
In any event, avoiding ultraviolet rays isimportant.

Beachsunbathingandartificial

tanning are out of the question. Even with a hat
on for protection, there are negative influencesfrom the reflection of ultraviolet radiation, so
caution is necessary. In other periods than
May-August, needless to say, care needs to betaken for winter snow-surfaces. Light reflections
from water surfaces, sand hills, and asphalt have

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

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Volume 4, Number 3 | Fall 2009

also adverse affects, which needs to be taken intowith white furs

account. Even on a cloudy day, up to 80 percent ofTreatment and course

the sun's ultraviolet rays can pass through theInitialclouds and reach the earth.

eppikajutsuto 5.0g were administered for 7 days.

Since UVA has the action of carcinogenesis asshishihakuhito

visit.

Together

with

4.0g

these

and

medicines,

mentioned above, protecting ultraviolet rays ismaobushisaishinto was also prescribed. The

connected to preventing cancer. Especially inpatient received the instructions that it be taken

women, the use of cosmetics, for example, with30 minutes before going out and need not belight blocking effects will help prevent skintaken on rainy days.

damages and diseases or stop inflammation from

Re-visit:

becoming exacerbated.

Constipation. Sweating around the jaw.

History of present illness: More than 40 years ago(around at the age of 20) solar irritating
dermatitis developed and every year it occurred.
This year, it was in May (two months ago).
Present condition: There were swellings and red
pots (solar irritating dermatitis) from the face tothe hands. Hives, drug eruptions, and thyroid
hypofunction developed. Legs were cold. The
patient was using many internal anti-allergic and
and

was

mostlytreated.

were administered for 14 days.

64 year- old, female

agentsface

Daiobotampito 5.0g and sammmotsuogonto 5.0g

Case 1: Solar irritating dermatitis

antihistaminic

The

external

betamethasone and other two agents that were

Maobushisaishinto 5.0g was also prescribed as in
the initial visit.
Fourdiagnoses.

daiobotampito

5.0g

and

sammmotsuogonto 5.0g were administered for 14
days.

Maobushisaishinto 5.0g was also prescribed. Curewas attained.
Case 2: Solar irritating dermatitis ＋ atopic
dermatitis
25-year old, female

prescribed by her previous physician.

Before treatment

After 1 week

UV test up to 10 seconds（―）
Abdominal condition: Tenderness in para-umbilican
regions on both sides
Tongue condition: Tongue body - purple-red colored18

After 2 weeks

Present condition: Solar irritating dermatitis andatopic dermatitis became aggravated six months
ago. The conditions became further aggravated by
the steroids administered by a previous physician.

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

Volume 4, Number 3 | Fall 2009

After this, maobushisaishinto alone was used.

UV test up to 30 seconds (-)

Good conditions were maintained.
Treatment and course

Sammmotsuogonto 5.0g and maobushisaishinto
5.0g were administered for 7 days.

Before treatment

Before treatment

After 2 weeks

After 2 weeks

Shishihakuhito 5.0g and maobushisaishinto 5.0g
were also administered for 7 days.
The condition of solar dermatitis improved.
However, red spots on the face, forehead, andupper body appeared due to sweat.

eppikajutsuto 5.0g and maobushisaishinto 5.0g
were administered for 7 days. The overall
condition including atopic dermatitis became
good.

Before treatment

Case 25: Solar dermatitis ＋Erythroderma
Female of 53 years old
Current medical history: Erythroderma. Allergic
dermatitis was transferred to solar dermatitis,which then progressed to erythroderma. Facial
ertythroderma developed three years ago andgradually expanded to the present condition.
She had various examinations at the Departmentof Dermatology of a certain University Hospital

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

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Volume 4, Number 3 | Fall 2009

with the findings of no abnormalities.
She also visited the Departments of Gynecology
and Ophthalmology of the University Hospitaland was told that she had uterine myoma and eye
floaters.
Present condition: Marked erythroderma which
was caused by solar dermatitis.
Abdominal condition: Stuffiness in the epigastricregionTongue condition: White moss, veins (+).
Examinations: UV test 10 seconds and more (+).

Treament and course
Inchingoreisan 5.0g, tsudosan 5.0g, andbyakkokaninjinto 6.0g were administered for 14 days.
The patient had a favorable course withremaining hot flashes and dry mouth (+). In two
weeks, they were mostly recovered.
Inchingoreisan 5.0g, tsudosan 5.0g, andkeigairengyoto 5.0g were administered for 14
days.
A cure was achieved.

After 2 weeks

Before treatment

The SDS 42 (training on autonomic nervous
functions) was conducted. Total cholesterol
239mg/dl↑ LDL cholesterol 169↑ β globulin
l0.6↑

20

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

Volume 4, Number 3 | Fall 2009

Medical History in Japan
Sotetsu Ishizaka’s “Shinkyu Chiyo Ichigen (3)Kenji Kobayashi
Guest researcher of Medical History Research Dept.
Kitazato University Oriental Medicine Research Center[Part 3 of this series]- Moxibustion, again according to the Chineseclassics is a treatment form applied first when thesites of the body’s arteries that are supposed tomove have stopped moving, or else when the
movement of sites that should move strongly is
only very light.
The number of moxibustion cones ranges fromthree to seven.
It is used for all skin diseases, obstruction,
entanglement, blockage, closure or weakening of
the essence and spirit as well as the Eie nutritiveand protective qi network vessels (luo mai) /Senraku ( 纖 絡 fine vessels, xian luo). Oftenmarked effects can be achieved.
For these reasons it should be used forsuperficial pain in any location.
In China 365 points have be determined on thehuman body and are used as a guide for theacupuncture and moxibustion treatment.
For all ancient people these were sites at which
the essence and spirit as well as the nutritive andprotective qi accumulated and were given
corresponding indicative names. Yet, during theirhanding down over the generations the number of
mistakes has increased.
In today’s China, simplistic concepts like "thispoint cures this disease" are used and both theacupuncture technique as well as the moxibustion
method seem to have fallen into misuse.
Now, the sites at which essence and spirit aswell as the nutritive and protective qi accumulate
are also the portals through which the pathogenic
qi enters. At the locations of this pathogenic qi

warmth/cold of the skin, smoothness/roughness
have to be carefully observed and moxibustion
performed at sites where that person suffers. It is
important to understand that fomenting lotions
should be used and cauterized with strong directheat.
Red-hot needling or fire needling heals themuscles. Moxibustion is a method to heal the skinand interstices.
The size of the moxa cone should be prepareddepending on whether one treats an adult, elder
or child, exuberance or debilitation.
- The old names of "Banshin, Shoshin andKashin" (all meaning fire needles) are made ofiron in the shape of modern thin tongs that are
baked until they are red-hot and then inserted
into the ailing muscles, as a treatment for
numbness and pain.
Prior to their application it must be carefully
discerned whether the affected site is superficial
or deep, and accordingly also pierced either
superficially or deep. This technique does appear
in the Chinese classics, but has declined and is nolonger used.
Previously, in my days as an acupuncture
instructor in Koshu, I heard a story from a certain
person in the town Kajicho in Fucho in the regionof Suruga, describing how a certain blacksmith
suffered for a long time from abdominal pain andtried various treatments. Yet, because it did not
improve at all he started to think about suicide
and thus heated tongs until they were red-hot
and thrust them into the painful site. Thereupon
the long-standing pain was cured immediately.
That is a story showing that this act had a similareffect as the ancient "Banshin" (red-hot needling).
The above is an outline of the acupuncture andmoxibustion techniques.

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Volume 4, Number 3 | Fall 2009

One phrase in the classic "Shinkei" (zhen jing)says: "Those who know the essence, can express it
in one word. Those who don't know the essenceloose themselves in pointless chatter."That is why I have named it with the short
title "Essentials in a word" (Chiyo Ichigen).
If this method and its techniques werepracticed in the West, I am convinced that it willachieve good results.
Since the reducing technique of acupuncture
has already be performed in the West for sometime, acquisition of the skill for tonification withfine needles, directional reducing-reinforcing andthe essentials of deficiency and excess and theirperformance in the various western countries will
doubtlessly lead to a further development ofacupuncture and moxibustion.
[Author's note: The above is a summary of theessentials of acupuncture and moxibustion.]
On New Year of the year Bunsei 7 (1824) I
received a letter from the interpreter Sakusaburo
Nakayama from the Nagasaki trade post. The
following is a brief summary of its contents.

"Last year (1823) the surgeon Dr. Siebold cameto Japan. He enthusiastically studies all sorts ofsubjects, since last autumn he started to collectmedicinal plants and even started to prepare
medicines and has gathered specimens I havenever even seen before, corrected theirindications and is a person of very high ideals. Dr.
Siebold has already read a textbook about
acupuncture written by Kaempfer2) and therefore
knows about acupuncture and moxibustion, butthat particular book apparently was not very
detailed, so that he aspires to see it with his own
eyes and wants to know more about the technique.
When I showed him a copy of "Chiyo Ichigen" hewanted to study the subject in greater detail, sothat upon my explanations of the contents, hesaid: "This is truly the essence of acupuncture
and moxibustion."[Illustration 9] An acupuncture point chartaccording to Kaempfer's "Kyu Sho Kagami"(Examples of moxibustion sites)[Illustration 10] Kaempfer "Tools for Japanese
Acupuncture"[Illustration 9]

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

Volume 4, Number 3 | Fall 2009http://record.museum.kyushu-u.ac.jp/
http://record.museum.kyushu-u.ac.jp/kaempfer/index.html* [Japanese acupuncture tools]
http://record.museum.kyushu-u.ac.jp/kaempfer/eng44.html* [Acupoint chart according to the [Kyu Sho
Kagami]
http://record.museum.kyushu-u.ac.jp/kaempfer/eng45.html**********************************************
Dr. Siebold wanted to have this text translated
into Dutch and therefore asked the student Junzo
Mima in Tokushima prefecture, who has
zealously devoted himself to the study of Westernsciences, whether he would like to work on thismanuscript for his own study. He prepared a draft
and when he showed it to Dr. Siebold, he literally
leaped up with joy.

[Illustration 10]*********************************************
2) German physician Engelbert Kaempfer (1651 –
1716). Written in Chinese characters as: "検夫爾"。During the Genroku era had an audience
as a Dutch factory member with Tsuneyoshi.
Wrote the book『日本誌』("Nihonshi" = The
History of Japan). In his book 『廻国奇観』("Gaikoku Kiran" = Amoenitates Exoticae) heintroduced moxibustion therapy and included
the illustration "Kyu Sho Kagami". Details
about acupuncture therapy were unknown.
Kaempfer's『日本誌』("Nihonshi" = The Historyof Japan) is currently on display on the digitalarchive website of Kyushu University.

Thus Siebold was able to grasp the intricacies
of acupuncture and moxibustion and plans to go
to Edo in spring of next year with the head of the
Dejima trading post in Nagasaki. At that time hewould really like to meet with master Sotetsu. He
mentioned that he would like to ask somequestions about still unclear passages. Pleaseconsider meeting him on that occasion.
The end."This letter was translated by the official
interpreter Sakusaburo Nakayama and presented
to my father master Sotetsu. When my father
Sotetsu saw the letter, he said:"I am under the impression that this Dutch
physician Dr. Siebold is a person with such asagacious comprehensive faculty that "a word will
be enough to this wise man". If that is so, I will
look for an opportunity and later actually teachhim acupuncture and moxibustion in detail."

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

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Volume 4, Number 3 | Fall 2009

Occasionally, I, Soka, was observing master
Sotetsu quietly by his side commented as follows
while retreating.
"Regarding treatment techniques the Dutch
physician has as a matter of course from the
beginning a more detailed knowledge of anatomy,
but also physiology and pathology than Kampo
medicine. Unfortunately, however, he is not
skilled with the filiform needles. That is a pity.
If Dr. Siebold could acquire these skills,
acupuncture and moxibustion would spreadwidely throughout Europe. On that occasion thebook "Chiyo Ichigen" will become a representative
introduction to this field.
If that would happen to pass, it would become
for future generations a precious testimony of thevalue of this single letter. That is why I write thisdown and pass it on.
Bunsei year 7 (1824), April 15
Signed: Soka Ishizaka3)**********************************************
3) Husband of Sotetsu Ishizaka's daughter. The
name is Soka, characters are "Koki, or
Rekien" (公琦、檪園) and his artist name aswell as alias is Sogen. As an heir to Sotetsu
Ishizaka he served the eleventh shogun Ienari
Tokugawa and the twelfth shogun Ieyoshi. He
died in February of the year 3 of era Bunkyu(1863).
**********************************************

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

Volume 1, Number 1 | Spring 2006

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

35

Volume 1, Number 3 | Fall 2006

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

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

Excerpted from National Park Service

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