Volume 9, Number 1 | Spring 2014

Kampo Medicine - Current Research
Clinical Applications of Kakkonto – Part 1

The episode presents two points, at the least. Oneis that kakkonto is a famous Kampo drug that isHiromichi Yasui

well-known throughout Japan. The other is that theJapan Institute of TCM Researchprescription is effective for a wide range ofindications. In English, kakkonto is sometimes called Pueraria Decoction, taking the nameIntroduction
There are 148 different types of medical Kampo
preparations, each with its own number. Amongthem, the most distinguished number—No. 1—isassigned to kakkonto.
This is because kakkonto is the most popularly
used prescription by the Japanese people.

kakkonto appeared for the first time in the great
Chinese classic Shokanron (treatise on cold damage)and came to be increasingly widely used in Japan
from the latter half of the 19th century. Particularly
since Yodo Odai (1799-1870) introduced variousindications

Ruijuhokogifor

theprescription(Interpretationsofin
thehisof the principal ingredient, pueraria root. It is also
referred to as Kuz Decoction, taking the Japanesename for pueraria root.

Kakkonto as an extract preparation for medical use
ManyJapanesepharmaceuticalcompanies

market kakkonto as a Kampo preparation for
medical use. The grams of each ingredient used inthe prescription differ by company, but the JapanesePharmacopoeia, Seventeenth Edition stipulates thefollowing.

work

Ruijuho

Method of preparation
1)

2)

3)

4)

be used widely for a variety of diseases. Moreover,

Puerariae Radix

8g

4g

4g

4g

such clinical applications of kakkonto differed

Ephedrae Herba

4g

4g

3g

3g

completely from those in China.

Ziziphi Fructus
Cinnamonmi

4g

3g3g

3g

3g

2g

2g

2g

Paeoniae Radix
Glycyrrhizae

3g2g

2g

2g

2g

2g

2g

2g

1g

1g

1g2g

(classified assemblage of prescriptions)), it came toThere is a type of traditional performing art inJapan called Rakugo (traditional comic storytelling).
Doctors are frequently mentioned in Rakugo stories,
but the episode of the “Kakkonto Doctor” issometimes introduced at the beginning of a story asa lead-in.
“Doctor, my head hurts.” “It must be a headache.
Take kakkonto.” “Doctor, my stomach hurts.” “Itmust be a stomach ache. Take kakkonto.” “Doctor,my eye hurts.” “Take kakkonto. And you?” “I justcame to accompany my husband…” “Take kakkontoanyway.”
https://www.youtube.com/watch?v=fcYDwMjTgLIMany who listen to this episode would think that
doctors are totally irresponsible people. However,there also those who say completely the opposite—
they say that doctors who can cure any disease withkakkonto are good doctors.

8Cortex

Radix

Zingiber

Rhizoma

Prepare a dry extract or viscous extract as directedunder Extracts, according to the prescription 1) to 4),
using the crude drugs shown above.

Kakkonto as a Kampo preparation for medical use
is made by adding an excipient to the crude extract
obtained by decocting the above ingredients, and adaily dose of 7.5g is divided into two to three portions.
The amounts of each ingredient in the preparationdiffer slightly by pharmaceutical company, as shownabove.
http://www.nikkankyo.org/kampo/info_pi_english/04
8.pdf

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

Volume 9, Number 1 | Spring 2014Examples of kakkonto extract preparations
Valuation of kakkonto
Therearetwomoretypesofkakkonto

preparations that contain an addition of otheringredients. They are kakkontokasenkyushin’i andkakkonkajutsubuto. The former is prepared by

http://www.nikkankyo.org/kampo/info_pi_english/04
9.pdf
http://www.nikkankyo.org/kampo/info_pi_english/04
7.pdf

adding 3.0g Senkyu (Cnidium rhizome) and 3.0g
Shin’i (Biond magnolia flower-bud) to kakkonto, andthe latter is prepared by adding 3.0g Sojutsu(Atractylodes lancea rhizome) and 0.5g processed
Bushimatsu (Aconiti daughter tuber) powder tokakkonto.

Examples of kakkontokasenkyushin’i
extract preparations

Kakkonkajutsubuto extract preparation

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

9Volume 9, Number 1 | Spring 2014

would reach my throat and enter my windpipe, such

Clinical applications
In Shokanron, indications for kakkonto are acutethat I would cough for a while, feel a pain in my chest,

infectious diseases. However, from Japan’s moreor had phlegm that would not loosen. At such times,than 150 years of experience, kakkonto is known to

I used to combine and use shosaikoto andhave an extremely wide range of indications and isbakumondoto. However, perhaps because kakkonto
agrees more with my body, taking kakkonto at thetoday applied to many diseases, as introduced below.

onset of a cold keeps the cold from worsening, and1. Very early stage of the common cold

Kakkonto is basically classified as an acrid-warm
diaphoretic and is used against common colds thatdevelop as a result of invasion by the wind-cold

more importantly, it prevents the cold from getting
into my body. Owing to this, I have not caught a cold
for more than ten years.
Yakazu Domei, Soukai, Dec. 1975 issue, pp. 93-94

pathogen. However, it is also effective in improving
other types of colds in their very early stage.

2. Wind-cold type of cold

Yanagi et al. report that kakkonto had the effect ofKakkonto is frequently used in the initial stage ofpreventing the advancement of the common cold in acommon colds and is applied particularly to thestudy where 40 common-cold patients ages 12 and above

wind-cold type of cold one to two days after its onset.

were administered two doses of kakkonto extract

It is one of the most frequently and commonly used

immediately after experiencing symptoms of a cold, suchcold remedy in Japan.

as chills, nasal congestion, runny nose, sore throat, stiff

The wind-cold type of cold basically occurs whenneck, and joint pain. The patients were regularly

the wind-cold pathogen attacks the early yang region

instructed to take kakkonto in the early stage of a cold andand at the same time penetrates the middle yang

were able to take the preparation soon after developing askin, where it fights with the healthy qi. Its

cold. The effective rate was 14/16 (88%) in the group thatsymptoms include chills, fever (this may appear

was administered the preparation within three hours oflater), stiffness in the neck and back, and headache,developing a cold, 12/16 (75%) in the group that was

but no sweat is produced, and the pulse is usuallyadministered the preparation three to six hours after

floating, rapid and tense.

developing a cold, and 2/8 (25%) in the group that was

The shorter the time from developing a cold toadministered the preparation six to twelve hours after

taking kakkonto, the better. If taking kakkonto isdeveloping a cold.1)

delayed, the pattern of the cold may change, and thetiming for taking kakkonto could be missed.

The following is a typical case regarding the onset

Hosono states as follows about the effect ofof a common cold.

kakkonto on colds: “Generally, taking a dose of
kakkonto when you feel you are coming down with aCase: Onset of a common cold

cold and have stiff shoulders, a headache and chills

I make it a habit to take a dose of kakkonto

but no sweating, keeps the fever at bay and cures theextract powder with hot water immediately when I

cold quite easily. If the cold still does not improve,

begin to feel chilly or sneeze even once. This makes

taking another dose after one to two hours does theme feel much better, and the symptoms usuallytrick.”2)

disappear after sleeping soundly for a night, without

Fujihira also states as follows: “When I was in

the cold reaching into my body. Previously, wheneverschool, I used to develop bronchitis whenever I had aI caught a cold, I used to sneeze profusely for about

cold, and suffered ten days to two weeks of thick

two days, and from around the eighth day, the cold

phlegm before the cold finally abated. However, after

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

Volume 9, Number 1 | Spring 2014

I began taking Kampo, my cold would sometimes go

Shiraki applied kakkonto to mouse infected with theaway in about 5 minutes after taking kakkonto.”3)

influenza virus and found that the efficacy of kakkonto

In the case of a decoction, it should always be

could be easily explained when considering that it cuts thetaken while it is warm. Extract preparations should

IL-1 cascade from interferon.5)

also be taken with warm water as a rule, although

A tremendous amount of cases has been presented

there have been reports that tea or cold water was

to date, but from among them, two typical cases are

just as effective.

introduced below.

The original text of Shokanron notes that after
taking kakkonto, the patient should consume hot

Case 1: 20-year-old male student

rice porridge, get under the bedding and gradually

The patient had a slightly heavy head since

induce sweating. The rice porridge is not necessarily

morning but forced himself to attend class. From

relevant, but it is important to keep the body warm.

around 4 p.m., the headache intensified, and he also

Note that kakkonto is suitable for the wind-coldbegan to feel hot.

type of cold. For example, the efficacy of kakkonto as

He made a medical visit at 5 p.m. He had a body

it is would not be apparent in colds that aretemperature of 38.5°C, a pulse that was floating,accompanied by a sore throat. People who have arapid and excessive, but no particular change in hiscold accompanied by a sore throat frequently retain

tongue. No tendency of natural sweating washeat inside their body, because the heat from theobserved, but the spine from the back of his head to

cinnamon bark and dried ginger root contained in

the shoulder blades was extremely stiff. The patient

the preparation further promotes heat. However, byhimself was also aware of the tension at the back ofadding gypsum, it is possible to release thehis head. He was given kakkonto extract and told toaccumulated heat from the body. An Eppito

go to bed immediately after returning home.

prescription may also be added depending on thepathological condition.

The next day, the patient commuted to school ingood health. He said that when he went to bed after

It is difficult to objectively evaluate kakkonto as acold remedy, but there is a report as follows.

taking a dose of kakkonto, his body became warm, he
experienced a good bout of sweat, and soon fell asleep.

Yamaoka made a comparative study of the efficacy of

He woke up this morning feeling thoroughly

kakkonto and PL granules by dividing 26 outpatients who

refreshed and felt like going to school.

made a visit to the respiratory department complaining

Katsutoshi

Terasawa,

Wakan-shinryogaku

chiefly of cold-like symptoms into two groups, group A and(Japanese and Kampo medicine), p. 116, Igaku-shoin,group B. The result was such that the same level of1990

efficacy against coughing and phlegm was seen in bothgroups,

butkakkonto wasalsoeffectiveagainst

Case 2: 82-year-old woman

fatigability and stiff shoulders. Thus, on the whole,

Past medical history / Family medical history:

kakkonto was effective against many more symptoms.4)

Nothing in particularThis study, however, was a comparison made after

History of present illness: The patient was admitted

four doses of each preparation (total of 8 days) andto hospital on January 22, 2008 due to lumbar

was not designed to examine the efficacy of kakkonto

spondylosis and chronic heart failure. She began toone to two days after the onset of symptoms, when it

feel chills in the morning of December 1 of the sameis said to be most suitable.

year and ran a fever of 38°C by noon. She had

Many basic studies have also been made on thestiffness in the neck and a headache.

antipyretic effect of kakkonto.

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

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Volume 9, Number 1 | Spring 2014

Present illness: Blood pressure 132/68mmHg; pulse

References

90/min,No1) Kazuo Yanagi et al.: The efficacy of administering

palpating of lymph nodes. No pulmonary sound. No

a double dose of kakkonto in the early stage ofabdominal abnormality.

development of cold-like symptoms. Collection of

Observation from the physical perspective ofsummaries of presentations from the 51st annualJapanesemeeting of the Japan Society for Oriental

regular.

orientalNopharyngeal

medicine:redness.

Floating,slightlyexcessive, rapid pulse pattern. Normal tongue
pattern. Intermediate abdominal strength, and noother particular changes in abdominal pattern. No
tendency of natural sweating. The back of the neck

Medicine, p. 243, 2001.
2) Shiro Hosono: Ten Lectures of Kampo Medicine,pp. 82-91, Sogensha, 1982.
3) Talking about kakkonto (round-table discussion).

is tense and stiff.

Clinical study of Kampo, Vol. 11, No. 6, pp. 24-33,

Progress: A half day after developing the cold, the1961.

patient’s pulse pattern indicated the early yang4) Minoru Yamaoka: Study of the clinical efficacy ofstage of the cold. As the patient had no tendency of

kakkonto

natural sweating and had stiffness at the back of hersummaries of presentations from the 45th annualneck, she was prescribed 7.5g Tsumura kakkonto

meeting of the Japan Society for Oriental

three times a day after each meal. After taking theMedicine, p. 235, 1994.

prescription twice, at noon and night, she produceda large amount of sweat and the stiffness at the backoncolds.

Collectionof5) Kimiyasu Shiraki: History of Medicine, 202:414422, 2002.

of her neck loosened, so she changed her bedclothes
at around 10 p.m. Her fever subsided to 37.5°C.
Thereafter, she went to sleep, and in the morning,
she had a normal temperature of 36.5°C. Her
symptoms, including the stiffness at the back of her
neck and headache, disappeared. She took hermorning dose of kakkonto as her last dose.
Katsutoshi Terasawa, Koreishanotameno wakan-shinryogaku (Japanese and Kampo medicine for theelderly), p. 127, 2005

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regular

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