Special Edition

KAIM
C URR ENT KAMP O MED IC IN E
INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 1, Special Edition ･ November 2005

ISSN: 1559-033X

Foreword – What is Kampo Medicine
Shuji Goto

History of Kampo Medicine

Features of each period, prominent persons, individual theories, celebrated books
Hiromichi Yasui

Distinctive Features of Kampo Medicine

Theory, clinical style, research, application in the modern medical system

148 Prescriptions of Kampo Medicine in Medical Insurance

Explaining the contents and indications of the 148 prescriptions of Kampo Medicine approved for medical insurance

Clinical Applications of Kampo Medicine

Hiromichi Yasui, Committee Chairman, Annual Report Committee of Kampo Medicine

Manufacturing Process for the Prescriptions of Kampo Medicine

Introduction of the production process of Kampo prescriptions illustrated with photographs

Quality Evaluation of Kampo Medical Extracts

Analytical evaluation of crude drugs, residual agricultural chemical examinations, extract quality evaluation

Herbs Covered by Health Insurance in Japan

Tables, explanation of 160 different herbs, common name/botanical name/Chinese name(Chinese characters)/Japanese nameYoshiro Sahashi

Societies for Kampo Medicine

Japanese Society for Oriental Medicine, Medical and Pharmaceutical Society for WAKAN-YAKU, The Association of East-Asian
Medicine, Japanese Society of Pharmacognosy, The Japan Society of Medical History

Education for Kampo Medicine

Education for Kampo Medicine in medical schools, seminars, educational lectures of the Japan Society for Oriental Medicine

Journals of Kampo Medicine

Kampo Medicine, Journal of Traditional Medicine, Journal of Kampo Medicine, Journal of the Japan Society of Medical History,
Clinical Journal of Traditional Chinese Medicine, Φυτο, The Kampo Medicine, Phil Kampo, and others

Medical Insurance in Japan

History and the present state of medical insurance in Japan
Naoya Ono

Appendix – Composition and Indications of 148 Prescriptions
www.kaim.us

US$30.00 per copyVolume 1, Special Edition | Current Kampo Medicine 2005

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 1, Special Edition | Current Kampo Medicine 2005

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

EXECUTIVE EDITOR

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

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

ASSOCIATE EDITORS
Shuichi Katai
Ibaragi-ken, Japan

Hiromichi Yasui
Tokyo, JapanEDITORIAL STAFF

Akihiro Soma
Akinori Suzuki
Hiroshi Tsukayama
Hitoshi Yamashita
Naoya Ono
Noboru Mitsuhata
Shigeru Tajima
Yoshiro Sahashi

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

PUBLISHER

Shuji Goto
International Institute of Health andHuman Services, Berkeley
2550 Shattuck Avenue, Berkeley
California 94704-2724, U.S.A.
Website: www.kaim.us
E-mail: info@kaim.us

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Volume 1, Special Edition ･ November 2005
TABLE OF CONTENTS
2 What is Kampo Medicine

Shuji Goto, Exective Editor

3 History of Kampo Medicine
Hiromichi Yasui, Japan Institute of TCM
Features of each period, prominent persons, individual theories, celebrated books

10 Distinctive Features of Kampo Medicine
Theory, clinical style, research, application in the modern medical system
14 148 Prescriptions of Kampo Medicine in Medical Insurance
Explaining the contents and indications of the 148 prescriptions of Kampo Medicine
approved for medical insurance
15 Clinical Applications of Kampo Medicine
Hiromichi Yasui, Committee Chairman, Annual Report Committee of Kampo Medicine

51 Manufacturing Process for the Prescriptions of Kampo Medicine
Introduction of the production process of Kampo prescriptions illustrated with photographs
56 Quality Evaluation of Kampo Medical Extracts
Analytical evaluation of crude drugs, residual agricultural chemical examinations, extract
quality evaluation
58 Herbs Covered by Health Insurance in Japan
Yoshiro Sahashi
Tables, explanation of 160 different herbs, common name/botanical name/Chinese name(Chinesecharacter)/Japanese name
63 Societies for Kampo Medicine
Japanese Society for Oriental Medicine, Medical and Pharmaceutical Society for
WAKAN-YAKU, The Association of East-Asian Medicine, Japanese Society of
Pharmacognosy, Japan Society for Medical History
65 Education for Kampo Medicine
Education for Kampo Medicine in medical schools, seminars, educational lectures of theJapanese Society for Oriental Medicine
68 Journals of Kampo Medicine
Kampo Medicine, Journal of Traditional Medicine, Journal of Kampo Medicine, Journal of
the Japan Society of Medical History, Clinical Journal of Traditional Chinese Medicine,Φυτο, The KampoMedicine, Phil Kampo, and others
70 Medical Insurance in Japan
Naoya Ono, Kyoto University
History and the present state of medical insurance in Japan
85 Appendix – Composition and Indications of 148 Prescriptions

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

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

Volume 1, Special Edition | Current Kampo Medicine 2005

Foreword
What is Kampo Medicine
Kampo medicine, practiced in Japan, is TCM which has been modified incorporating Japanese culture andproven scientific and medical knowledge. At first, Kampo medicine, which began as an imitation of China’s
TCM, was organized as a system in the 16th century. At this time, medicine of Ming-China was introduced andwidely spread. After that, in the 17th to 18th centuries, the basic concept of TCM was already articulated in“Shang han lun” and “Chin gui yao liu”. Individuals in Japan applied these treatments based on these classicalprescriptions. This became a major force and helped establish a Japanese tradition. This tradition which
experienced a decline due to political causes after 1868, remains today, even after the reconstruction period
in the 1930’s.
Kampo medicine, compared to Chinese TCM, does not differ only in theoretical interpretation, or use ofprescriptions; but it also differs in the way it is incorporated within the medical system. First of all, thismedicine is dealt with in the unitary medical system based on European Medicine. The second, is the fact that148 kinds of traditional prescriptions processed in extraction are approved for medical insurance. This large
number is due to the scientific study of Kampo medicine which helped develop new prescriptions.
In countries other than East Asia, TCM and its family are treated as complementary and alternate medicine(CAM). However in Japan, the idea is heterodox. While the Japanese medical system used today is based on
European Medicine, Kampo Medicine, which supported Japanese health for over 1500 years, is neither
European Medicine nor CAM. It is recognized as an independent form of medicine, unique to Japan.
As mentioned above, this issue refers to the current form of Japanese traditional medicine which has
Chinese origins. Therefore we named this issue "Current Kampo Medicine". Kampo medicine differs fromtraditional Chinese medicine in other countries practicing this form of medicine. Kampo medicine has
antecedents with Chinese history since the 18th century and now has begun to demonstrate its own
configuration which is unique to Japan.
In a word, we use a few excellent prescriptions (in particular, prescriptions of "Shang han lun" and "Qin qui
yao liu" ) for various disorders. It will be demonstrated that the accumulated experience of Kampo in Japanis different than TCM in other countries.
Our intent is to provide knowledge so that readers may understand the special role that Kampo medicine
holds in the Japanese medical system. We hope the contents in this issue are useful for the understanding ofJapanese Traditional Medicine and will promote its use in other countries.

Shuji Goto, Ph.D.
Executive Editor＊Kampo Medicine

Chairman, Acupuncture and Integrative Medicine
College, Berkeley, U.S.A.
Chairman, International Institute of Health andHuman Services, Berkeley, U.S.A.
Chairman, GOTO College of Medical Arts & Sciences,
Tokyo, Japan2

Kampo’s “kan (han)” means “Ancient China”,
and “po (fang)” means “technique”.
Translated in English, this means “Techniqueof Ancient China”. This name was establishedin the 18th century when Dutch Medicine(called Rampo=Technique of Holland) was
introduced in order to distinguish it from
Kampo Medicine, and spread for general use.

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Volume 1, Special Edition | Current Kampo Medicine 2005

History of Kampo Medicine
Hiromichi Yasui, Japan Institute of TCM
Kampo medicine is the descriptive term used inJapan for TCM (in a broad sense Kampo medicine refers
to the entirety of traditional Chinese medicine practiced
in Japan, and in a narrow sense specifically to herbal
medicine). This form of medicine differs from the Chinese
form of TCM and is characterized by many uniquetheories and therapies. It is necessary to review the1500-year history since the introduction of this system
into Japan and thereby illuminate the characteristics ofKampo medicine.
Introduction and imitation of Chinese medicine
Traditional Chinese medicine was brought to Japanin the 5th century via the Korean peninsula. At that time
Japan maintained an extensive exchange with the
Korean peninsula and immigrants from the peninsula(some Korean physicians had been invited to Japan) had
provided the people of the ruling class in Japan with acertain degree of insight into Chinese medicine. From theend of the 6th century direct exchange with China started
and by the 7th century the Japanese government sentscholars for foreign studies with their ambassadors to
China in the Sui and Tang periods. Some studied theChinese medicine before their return to Japan.
In 701 the government enacted laws (including items
related to the medical system) modeled according to theChinese system used in the Tang period. For the purposeof medical education a curriculum was established, where
the textbooks included classics like the "Huang-Di
Nei-Jing" (Yellow Emperors Classic of Internal Medicine),
medical encyclopedias, textbooks of pharmacology, pulse
diagnosis and the like. The duration required for the
study of medicine was set at 6 years. This was a period ofimitation during which almost no original contributions
introduced by Japanese were observed, but in 984 theoldest Japanese medical encyclopedia, the "Ishinpo" wascompiled (the contents of which are, however, mostly
citations from Chinese medical textbooks).
This system of medical affairs served the ruling classof the government and functioned as long as thearistocracy controlled the government until the end of the
12th century. After the warrior class seized politicalpower and moved the capital from Kyoto to Kamakura
the system was perfunctorily handed down (thisgovernment is called the Kamakura Shogunate).
Medicine was handed down in specialized families and in
extremely confined conditions. Yet, during this period,
Buddhism, concentrating on salvatational activities,
suddenly flourished and people involved were looking for
a new medicine, breaking free of the Kyoto medical
community. The representative priest and physician of
the time was Shozen Kajiwara (1266-1337), who wrote

two large medical encyclopedias between 1302 and 1327.
In these works an enormous amount of Chinese medical
books are cited as references.
Early development
In the 15th century the second government of thewarrior class, the Ashikaga Shogunate, placed great
importance on trade with China of the Ming period anddispatched many trading vessels. Beside these there wasa significant number of private vessels scuttling between
China and Japan. While this led to the import of many
Chinese articles, it simultaneously also increased thenumber of people visiting Japan. Moreover, since
Buddhist priests and intellectuals had found an interestin medicine, the merchant vessels imported large
quantities of medical references and drugs. Yet, duringthat time the trade partners of the Japanese were
Chinese merchants and information pertaining to thecapital, Beijing, was scarce. The imported medical books
tended to be slightly biased. They did not represent themost advanced medicine of the Ming period, but the
majority of the books were rather of the preceding Sung
period. For this reason Japanese medicine adapted itself
to that period.
This situation was changed by Dosan Manase(1507-1594) who was born in Kyoto. After studying in a
Buddhist temple, he headed for the seat of learning ineast Japan, the Ashikaga Gakko (Ashikaga school) for
further studies (the Ashikaga school was introduced to
the world in 1550 by Francisco de Xavier as the "largest
and most famous general university in Japan").
Koga, located close to this school, was the seat of the
Ashikaga Shogunate regional government in East Japan.
In its vicinity lived excellent physicians together withmany intellectuals. Manase studied first underphysicians in charge of important government officials aswell as priests who had returned from studying medicine
in China and later the contemporarily most advanced
medicine of the Ming period. Because he was exceedingly
sagacious he understood almost all of the material. As aresult he acquired a level of medical learning and skills
that matched the physicians of the Ming dynasty.
Following his return to Kyoto in 1545 he applied thisknowledge, referring to a large number of books, to create
his own unique medical system. The fruit of his labor
culminated in his main work, the "Keiteki Shu". The
purpose of this compilation was to unify the process fromdiagnosis to therapy based on traditional medical
theories. This structure resembles very closely thecurrent form of TCM. A school building, the "Keiteki In",
was erected in which the medical system he had founded
was taught to students gathering there from all over thecountry. This system became the Japanese medical
standard of the day and spread throughout the country.
During the latter half of the 16th century the powerof the Ashikaga Shogunate declined, and in the course of

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multiple civil wars over a period of several decades, theTokugawa Shogunate was established in 1603. This
government transferred the capital to Edo (present day
Tokyo) in order to govern the country, divided the country
into more than 200 small feudal domains and appointed
feudal lords (daimyo) to rule those particular domains,while the shogun maintained a central authorative
government. The government of the Emperor in Kyoto
continued to exist as a government without any real
powers to which perfunctory government officials wereappointed. The same situation applied to medicine.
Each feudal domain had an administrative
organization resembling that of the central government.
Initially the medical system was not exceptional. Duringthat period there had not yet been any attempts at state
regulated educational systems, so that people who
studied in private medical schools were free to open
offices in the cities and establish their practice there. The
leaders of the private schools had studied in Manase's
school and most were excellent physicians.
Many of the private schools were found in Kyoto andEdo (present day Tokyo), so that students intending tostudy medicine gathered in these two cities. The
publication of medical books gradually increased, and in
addition, the classics and books of the Ming period,
reprints and commentaries trying to render difficult
medical issues easier to understand circulated. Thesevarious commentaries became very important for the
tradition of Japanese Kampo medicine.
Following the late 16th century new situations arose
between Japan and the continent. One of those eventswas the attempt of Hideyoshi Toyotomi, for a short period
the supreme ruler of Japan, to invade the Korean
peninsula. The invaders plundered cultural artifacts
including medical books and technical experts (including
physicians) throughout the various parts of the peninsulaand brought them back to Japan. In particular, theexperts on wood block printing made important
contributions to the Japanese publishing business.
Publication of medical books relied largely on thetechnical expertise of these people.
Another event occurring a little later was thedownfall of the Ming dynasty. People being attacked by
the Manchurians (of the later Qing period) fled to thesouth and a small minority of these people(approximately 20-30,000) sought refuge in Japan. Herethey were accepted by the Tokugawa Shogunate newly
formed in 1603. Among these people were excellent
physicians who taught the Japanese the newest level ofChinese medicine of the day.
These two events greatly promoted during the 17th
century the introduction and spread of the latest medical
knowledge from China and the Korean peninsula to
Japan.
As stated above, the conceptual world of Japan at thetime regarded Confucian studies to be of highest priority
4and studies of Neo-Confucianism, as the conceptual basisof the Tokugawa Shogunate, were promoted (serious
introduction of Neo-Confucianism to Japan occurred
during the latter half of the 16th century). Yet, by thelatter half of the 17th century, new trends were observedin this branch of learning. Some of the progressive
scholars denied Neo-Confucianism and attempted toreturn to the original Confucian views. Thus, the classicsof the Confucian area were no longer interpreted along
the Neo-Confucian lines of thought, but the trend among
these scholars was to interpret the classics according totheir own views. This also influenced the practice of
medicine, which always stood under the strong influenceof conceptual Confucianism. That is why the medical
original classic "Sho Kan Ron" (Shang han lun) wasinterpreted according to the views of the medical scholars
and not according to the interpretations prevailing during
the Ming period in the same way that the Confucianists
emphasized Confucius's original texts. This led to the
spread of a movement, placing the utmost importance on
clinical applications.
One cannot disregard the extensive studies of theChinese "Shang han lun". In China the "Zhung-Jing's
Encyclopedia" of 1599 (this included the "Shang han lun"and "Jin gui yao liu") was published. Around this time
research on the "Shang han lun" started. This boom sooncaught fire in Japan and in 1659 the Japanese re-print of"Zhung-Jing's Encyclopedia" and a number of otherclassic texts were published. Moreover, during this period
research scriptures dealing with the Chinese "Shang hanlun" were brought to Japan, immediately receiving muchattention and motivated many people to study this world.
The second trend motivated the Japanese physicians
to emphasize the original medical text of the "Shang hanlun". This was a characteristic Japanese event and thisschool of thought later was designated the "classic school"(Koho Ha). The origin of the classic school was the revivalof ancient medical saints (medical arts) in modern times,
but the actual manifestation varied with each individual
and through the different periods.
Creative Period
While the physicians of the classic school studied the"Shang han lun", they criticized at the same time
traditional medical theories. Later, these concepts formed
the characteristics of this school. During the early period
there were influential people among the members of thisschool, their problem awareness was based on the "Riki
Nigen
Ron"
(Two
Principle
theory)ofthe
Neo-Confucianism. They considered "qi" (spirit) to be
more important than "li" (reason) and thus establishedtheories emphasizing "yang qi" or the "movement of qi".
These concepts received much attention as new
hypotheses of physiology and pathology, but did not
develop beyond that, so that there was little hope, as will
be stated later, for the appearance of new theories.

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Volume 1, Special Edition | Current Kampo Medicine 2005

The "Shang han lun" may have been considered bythis school of thought as the one and only classic and gave
rise to an enormous number of research books. The mostoutstanding methodologic characteristic of their study
was that they tried to explain this classic through therules it provided itself. Todo Yoshimasu (1702-1773) was
the one person who promoted this methodology to its
extreme limits. His appearance on the scene abruptly
changed the form of Japanese Kampo medicine.
Yoshimasu gave his own experiences and the entries
in the classic a lot of thought and came up with theconcept that "all diseases arise from a single toxin"(Manbyo Ichidoku Setsu = single toxin hypothesis of
diseases) and thus arrived at a view of pathology entirely
new and different from the common one. Drugs were
supposed to expel this toxin and he set forth that theprescriptions listed in "Shang han lun" and "Jin gui yao
liu" were highly effective for this purpose. Although there
was only one toxin, it could reach various different places,
causing a multitude of different symptoms. Abdominal
examination was given great importance as the one
diagnostic method of choice to determine the location of
the toxin. Abdominal examination is a uniquely Japaneseexamination procedure. Its origin reaches back to the16th century and Todo Yoshimasu inheriting its
tradition, relied for his use available prescriptions.
Moreover, he insisted that "prescriptions were the mostimportant thing in medicine" and studied how individual
prescriptions could be used for the expulsion of the toxin.
For this purpose he temporarily broke up the "Shang
han lun" and "Jin gui yao liu", reassembled themclassified by drugs and termed this work "Ruiju Ho" or"Lei Shu Fang" (in Chinese). In this book the individual
paragraphs are arranged according to prescriptions,which served to facilitate clear comprehension of theindications for each drug. This arrangement does notdepend on traditional theories, but allowed one toadminister appropriate treatment provided a set ofsymptoms could be identified. This "treatment system of
specific prescriptions for specific symptom complexes" iscalled "prescription-symptom relation". Later this system
continued to play an important role in the Japanese
Kampo medical system.
Yoshimasu also tried to deduce a posteriori the actionof the individual drugs from the entry text in the "Shang
han lun". When regarding prescriptions containing
several crude drugs he searched for shared meanings in
the text pertaining to the indications, identified theactions of the individual drugs and detailed them in his
book "Yakuchou" or "Yao Chang" (in Chinese). In this way
he supported his theories with pharmacology.
The "single toxin hypothesis of diseases" hypothesis
did not worry about the right qi, but concentrated solely
on the presence of evil forces and his treatment wascharacterized by dispelling this evil. Yoshimasu's

concepts gave rise to extensive discussion and quickly
spread throughout Japan. This resulted after a shortwhile in the collapse of the Manase school of medicine.
However, while the single toxin hypothesis was one of thedefining characteristics of Yoshimasu's medicine, it too
gradually fell into disuse after his death and only the"prescription-symptom relation" was passed down tofuture generations.
The classic school of medicine was, as stated above,
not uniform, but had several other special characteristics
such as emphasizing the "Shang han lun", rejecting the
traditional medical theories, and attempt to findtreatment principles out of the "Shang han lun".
Eclectic Period
Until the early 18th century the theories of
traditional medicine formed the roots of medicine,including the Manase school of basic theories, but were
rejected by the advocates of the classic school. Instead
speculation was given up and therapies that could bebased entirely on directly verifiable things became themainstream. Symptoms were minutely examined,
symptompatterns
identified
andtreatments
administered matching those patterns. The physicians of
the time founded their practices under thesecircumstances on their own personal experiences,
experience based personal hypotheses and the integrationof therapeutic methods from other fields (like folk
medicines and blood letting) and practiced their own
individual eclectic styles. The result was that from thelater half of the 18th century until the early 19th century
an abundance of experiences was accumulated using thismethod. These people were called eclectics.
During this time the completely rejected traditional
medical concepts by Todo Yoshimasu again came into use
because of their clinical necessity. The eight principles of
yin-yang, exterior-interior, cold-heat, deficiency-excess, orgreater yang disease, brighter yang disease and similarterms revived the six channel concepts of the "Shang hanlun". Also, a child of Todo Yoshimasu, Nangai Yoshimasu,
proposed the hypothesis that although there is only one
toxin, this may superimpose on qi, blood or water andthereby cause the symptoms of disease. These technicalterms appear on first sight to be the traditional medical
terms used previously, but actually refer to completely
different things. They possess almost no meaning related
to physiology or pathology, but are instead characterized
in that they are used simply as indices of classifications.
Also, during this period academic conflicts arose
between Kyoto and the capital Edo (present day Tokyo).
The physicians of Kyoto placed their greatestemphasis on the epoch of the "Shang han lun" andfrequently used prescriptions listed in this classic. A
representative figure of the contemporary eclectics was
Tokaku Wada (1742-1803) from Kyoto. He acquired the

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skill to use a relatively small number of prescriptions (afew dozen) for their respective indications throughexperience and was very skillful in applying theseprescriptions to various different pathologic conditions.
Kinkei Nakagami (1744-1833) also came from Kyoto andclassified therapies most suitable for individual diseases,
not restricting himself to Chinese herbal medicine, butalso successfully used folk medicines, acupuncture andmoxibustion, blood letting, affusions, and the like, for thetreatment of diseases.
Conversely, Kakuryo Katakura (1751-1822) from Edo
had referred to Chinese medicine up to the Sung dynasty,
fitting specific prescriptions to the various conditions,thus achieving excellent results. He is known to have
performed in 1794 the world's first resection of a nasal
polyp with a snare.
In the latter half of the 18th century new trends
appeared in Confuscianism and the study of historicalartifacts flourishing in China of the Qing period wasintroduced to Japan. Medicine too came under the
influence of this trend and the study of historical artifacts
began to flourish in Japan. Classic texts like the"Huang-Di Nei-Jing" and "Shang han lun" were subject tostrict criticism, which led to the preparation andpublication of the correct texts. These movements were
initially propagated by individual persons, but later also
acknowledged by the Tokugawa Shogunate that
established a national medical research institute (EdoMedical House). Here research and education were
performed simultaneously. The third director of theinstitute, Genkan Taki (1754-1810), has left the world
many great achievements. Among these his comments on
the most important classic texts of traditional Chinese
medicine "Huang-Di Nei-Jing", "Shang han lun" and "Jingui yao liu" are of particular excellence. Later, while theinstitute was responsible for a portion of medical
administration, the Taki family made remarkableachievements in the study of historical artifacts. The
result was that the study of historical artifacts became
the mainstream academic trend in Edo.
The serious introduction of western scientificmedicine presented in Dutch to Japan began in the 19th
century. In the middle part of the 18th century, during
the period of Yoshimasu's activity, the gradualintroduction of western medicine had already begun.
While few in number, some medical books of highly
advanced content had been imported and progressively
minded physicians studied and translated these. The firsttranslation of such a book was the "Ontleedkundige
Tafelen" by the German Johan Adam Kulmus. This
edition expanded the view of the Japanese, who had
previously known only traditional Chinese medicine. Allof a sudden a view of European trends was available.
Initially only anatomy and surgery in western
medicine were introduced and started to gain ground, but
6soon internal medicine and other clinical applications
started to spread. In particular a form of integrative
medicine was practiced in the field of surgery. The
representative person of this era, Hanaoka Seishu,
resected in 1805 a breast cancer under the world's first
general anaesthesia. Moreover, nearing the end of the
Shogunate, western scientific medicine gained a lot more
momentum, so that a western medical doctor was
assigned as the physician responsible for the Shogun. A
demonstration of this medicine's effectiveness in form ofsmallpox vaccinations made clear that Kampo medicine
was not necessarily any longer the only form of medicine.
The Meiji government later succeeded in adopting
German medicine, because Japan had shown that it had
been able to assimilate and apply western medicine of thehighest level worldwide.
The ranks of Kampo physicians working in the fieldof internal medicine having difficulties in integrating
both medical systems according to Hanaoka's approach,assumed a hostile attitude toward western medicine andtried to reject it. But their attempt at opposing the trendsof the time failed and western medicine spread still
further, leading to the feared decline of Kampo medicine.
Under these circumstances, many physiciansbelieving in the superiority of Kampo medicine, appeared
and tried to develop it further. At that time many
physicians conducted their clinical practice along thelines of Yoshimasu's concepts and among these Yodo Odai
(1799-1870) practiced a consequent Yoshimasu style
medicine and became renowned for his excellent
treatment. He added his personal experiences in the formof comments to Yoshimasu's "Ruiju Ho" and published his
own book "Ruiju Ho Kogi". His book detailed explicitly
how the prescriptions of the "Shang han lun" should beapplied to the various pathologic conditions (The "Ruiju
Ho Kogi" was a popular piece of reading during therenaissance of Kampo medicine in the 1930s anddeveloped into a clinical guide. Its influence continues tothe present day).
Gyoko Yamada (1808-1881) was one of the clinicians
contributing to actual clinical practice. He was an
outstanding personality who also had an academic sidethat led to his assignment as a teacher at the Edo medical
research institute. He integrated the study of historicalartifacts in clinical practice and applied past clinicaldescriptions and case reports into present clinicalpractice.
Another remarkable person was Sohaku Asada(1815-1894). He established a unique system based
mainly on the "Shang han lun" and the medical theoriesof the Sung period. He was entrusted with important
posts by the Tokugawa Shogunate and the new Meiji
government. He is also known for having treated many
important government officials and ministers of many
foreign countries. His medical system was a broad-based

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system combining the Kyoto and Edo schools and he isalso well known for episodes describing his dealing with asciatica attack in the French envoy, Leon Roche; or
inducing recovery in the Taisho Emperor during a critical
illness in his infancy.
While Kampo medicine developed, it divided into
various coexisting schools by the middle of the 19th
century. The study of historical documents achieved an
unprecedented development. Before this backgroundclinical experiences were accumulated in a preparatory
step for further development. Yet, these trends came to asudden standstill, as outlined in further detail below,
because of changes in the political environment.
Decline and Revival
Until the middle of the 19th century Kampo medicine
made enormous contributions to the health of ordinary
people. During this time there was both technicalprogress and academic development. Yet, when the new
Meiji government (where the emperor again assumed thehighest position in a constitutional monarchy) replaced
the Tokugawa Shogunate in 1868, the circumstances
relevant to medicine changed completely.
The new government was modeled after the politicalsystems of America and various other countries,
establishing guidelines that westernized politics,
economy, education, military and various otherinstitutions. While it suffered from unequal treaties with
America and various other countries, it initiated abuild-up of national strength according to the motto“national prosperity and defense”.
Regarding medicine, there was a need for military
medicine and for that purpose it was decided to adopt themost advanced German medical system. German medical
educators were invited and highly advanced, specialized
education started at the universities. All medical
facilities of the former government were requisitioned by
the new government or else abolished. After that, allpracticing Kampo physicians had to terminate theirprofession in one generation (the profession of a physician
was often hereditary) and regardless of how zealously
their children or disciples practiced, they were not able tobecome physicians any longer.
People aspiring to become physicians were obliged to
study western medicine at universities or specializedorganizations and then pass an examination forpracticing physicians. Although the curriculum did notinclude Kampo medicine, the people in charge of therelevant department at that time, did not reject Kampo
medicine in itself. There was still room left to study
traditional medicine after formally becoming a physician.
This measure later led to the revival of Kampo medicine.
Kampo medicine was considered not to be proper
medicine and as such banished from any official capacity.
Social survival was permitted only for acupuncture andmoxibustion with permission of the regional government(refer to the special edition of "Japanese Acupuncture" forfurther details). The research of the constituent crude
drugs of Kampo prescriptions (pharmacognosy) was at
the time the most advanced academic subject andenthusiastically conducted in pharmacologic faculties ofuniversities. The isolation of ephedrine from the ephedra
herb by Nagayoshi Nagai is just one such example. In thisway the traditional Japanese pharmacology wasinherited and led to modern scientific research in Kampo
medicine.
Having received a major blow from the government,
Kampo medicine was now completely removed from themainstream of medicine. In spite of the opposing
movement of actual Kampo medicine practitioners (thismovement is in terms of medical history very intriguing),
there was almost no reflection on this situation at all
during the 1900s. However, the small number ofphysicians who studied by the end of the Tokugawa
Shogunate under the few remaining Kampo physicians(most of which had degrees in western medicine) started
new research into Kampo medicine and applied thisclinically.
During this period the Kampo physicians could
grossly be divided into three different groups.
The first group was the successors of Shuhaku Asada,
who practiced by the end of the preceding century. They
handed the medical teaching of their master down while
practicing in Tokyo, Osaka, and Kyoto and these disciples
in turn trained their own students in their devotion forfurther development. This school belonged to the so-called
eclectics.
The second group were followers of Wada Keijuro,
who himself still being a young boy, saw his sisterradically improve through Kampo medicine and thus
decided to become a Kampo physician himself, later
making great efforts in his attempt at facilitating thedevelopment in this field of learning. In 1910 hepublished the book "Ikai no Tettsui" (The Iron Hammer ofthe Medical World) wherein he used western medicine as
academic background. The book provides an outstanding
description of Kampo medicine as a form of clinicalmedicine and by which he pioneered the social revival of
Kampo medicine. The basic style of the book was thesame as that of Todo Yoshimasu and based mainly on the"Shang han lun" and "Jin gui yao liu". He and his
successors formed a group of people belonging to theclassic school.
Third, was the group of followers of Dohaku Mori,
who was also a religious figure with his disciples. Mori
entered into an apprenticeship with a not famous, but avery capable Kampo physician, where he acquired his
medical skills. Adding his own personal ideas he createda unique classification of physical constitutions and later
instructed younger generations. His treatment was

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outstanding and in 1918, during the so-called Spain
influenza epidemic, he classified this disease into three
types, assigned different prescriptions to these types andthereby achieved great therapeutic success. His school
belonged to the Gosei Ha (new world school).
Second generation followers of these schools
cooperated later in the 1930s to establish the Japanese
Kampo medical system. The results of these efforts foundtheir common expression in the book "Practice of ClinicalKampo Medicine" (1941). This book was prepared for the
purpose of offering the "busy clinician the possibility ofacquiring Kampo medical skills without any backgroundknowledge". It later became the archetype of literature on
Japanese Kampo medicine.
The methodology outlined in this book closely
resembles that put forward by Todo Yoshimasu. Specificprescriptions were assigned for specific symptom
complexes and the concept therefore followed the
tradition of the "prescription-symptom relation" (fangzheng xiang dui) where the prescription matches the
Kampo diagnosis. It may be said to have developed basedon the hypothesis that "prescriptions are the mostimportant thing in medicine".
The revived Kampo medicine followed the lines of
medicine as it had been practiced during the Edo period.
It promoted a form of treatment that put little emphasison the pathologic factors and mechanisms at work in thepatients and therefore facilitated its application within
the framework of western medicine. Later thiscontributed both positively and negatively to the future
development of Kampo medicine. Put in another way, thisform of medicine could be put to practical use from thattime onward, provided there was a basic backgroundknowledge in western medicine. Doubtlessly this wasvery convenient for physicians who had received only awestern medical education but would like to give the useof Kampo medicine a try.
Actually, the application of health insurance to theprescription of Kampo medical formulas was introduced
in 1976 on this basis and later saw a surprising growth,thus supporting this methodology. Conversely, the loss of
traditional ways of thinking obstructed theoreticaldevelopments. This became a major obstacle in academic
exchanges with China and Korea and various othercountries with the similar traditional medical systems(and theoretical systems) by creating major systematicdifferences.
Application of medical insurance to specific Kampo
medical extracts
Currently, even though Kampo medicine is nottaught in medical school, herbal medicines are sold in
pharmacies and traditional prescriptions in use (many ofwhich are manufactured by small scale, by family

8business type companies) are in use. Their constituentsare actively studied as materials for new drugs.
Furthermore, since the establishment of the Japanese
health insurance system, health insurance currently
covers more than 160 herbal formulas. While the policy of
the Meiji government superficially had abolished Kampo
medicine, it had survived among the people.
In 1976 the Ministry of Health and Welfare adapted
the opinions from the chairman of the Japanese Medical
Association, Taro Takemi who had a deep understandingof Kampo medicine, demonstrated strong politicalleadership, and made remarkable contributions to the
medical administrative management of the Japanese
government, which led to the approval of healthinsurance for Kampo medical prescriptions.
A number of pharmaceutical companies have started
to manufacture these formulas. The sales strategies forthese companies at the time were to use Kampo
medicines based on names of diseases. Thus, while
yin-yan, deficiency-excess and similar pathologic factors
and mechanisms were largely neglected, identification of
the symptom patterns called "Sho" was the only concept
barely being accepted and used. This resulted in the useor large quantities of Chinese herbal extracts covered byhealth insurance in the clinical setting and a quick
spread of these in the medical world.
These circumstances led to the appearance of a small
number of physicians using Kampo medicine in adisorderly manner, yet did not entirely drive thedevelopment of Kampo medicine into an undesirable
direction. A substantial amount of clinical research(including
DB-RCT
cumulative
research)
andpharmacologic research was conducted, also developing
new applications and indications like relief of side effectsof radiation therapy or chemotherapy. In this way a
number of applications for a number of fields have beendeveloped.
At the same time, limitations of this kind of
application became evident. Already in the 1980s anumber of problems had emerged. The first of which was
the efficacy of Kampo medicine (extracts) for medical use.
While the dose of Japanese Kampo prescriptions is quite
small, the amount of extract contained in the extracts iseven smaller. Regarding efficacy, this was reason why
these formulas were thought of as possibly not being
sufficiently effective. Following communication of thisfact to the Ministry of Health and Welfare in 1985, thesituation improved. However, the fact that the used doses
were small, remained unchanged.
The second problem was that ready-made formulas
could not be individually adjusted, preventing theprescriptions made to order for individual patients. To
circumvent this problem a number of extracts werecombined to provide a limited amount of freedom, yet thisdid not constitute a fundamental solution.

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For the solution of this second problem a significant
number of physicians adopted the original application
form of these drugs, namely decoctions.
Thirdly, and this is the most important problem,
limitations became clear, when Kampo medicines wereprescribed according to western medical diagnoses anddisease names instead of the original Kampo medical
concepts.
A number of solutions to these problems haveemerged.
The first of which was the reintroduction of a system
similar to that used by the Japanese 400 years ago inmodern traditional Chinese medicine (TCM). Because thetraditional body concepts (anatomy, physiology, etc.)
similar to those originally adopted by the Chinese andlater used by the Japanese, had been replaced in a little
over a century by western medical body concepts,
comprehension of traditional TCM theories based on said
traditional body concepts became almost impossible. This
resulted in the necessity for physicians to relearn the
TCM theories. A rather difficult undertaking. Even
though identical Chinese characters are used in both
systems, correct comprehension is currently quitedifficult. A large number of relevant textbooks andreferences have been published.
Even though TCM has again become a subject of
research among Japanese physicians, the Japanese havedifficulties in grasping the abstract TCM theories, whichmakes a complete mastering of the subject difficult.
Recently, Yoichiro Ebe developed a theory integratingthese abstract theories with practical elements tofacilitate their explanation. This theory is called "Keiho
Igaku" (Classical formulation (jing fang) medicine) andassigns particular importance to the attempt at obtaining
a detailed and concrete understanding of the functions of"qi" within the body.
Another problem is the adoption of modern medical
research methods. In order to enable various practicalclinical applications of Kampo medical extracts coveredby the health insurance, cumulative research, including
DB-RCT, have been performed and the formulations
applied clinically based on these studies.
In this field the research into clinical epidemiology isparticularly noteworthy. The research group of Hajime
Haimoto examined more than 100 conditions for which
patients received Kampo medicines, analyzed this datawith a computer and calculated the odds ratio. One of thefindings of their research particularly well known is thatthe use of Poria Powder with Five Herbs for headaches
associated with a drop in atmospheric pressure carries aprobability of being effective of more than 90% (see thisjournal, Vol. 1, No. 1).
In Japan, the study of galenicals has been a family
tradition for more than 100 years. Application of modern
methods in this field has led to further developments andnow similar studies performed for Kampo medicines haveyielded corresponding results. Studies trying to identify
the components of crude drugs or formulas are in thelimelight of recent attention. However, the newtechniques trying to identify "compounds in serum",following the intake of Kampo herbal formulas, are themost significant with application of this so-called serum,
Kampo pharmacology attempts to clarify thepharmacodynamics of the crude drug components in the
body. It gradually becomes clear that the enteric bacterial
flora apparently plays an important role in the absorptionof these components.
In Japan, there is another research area that thecountry can pride itself with before the world, and this isresearch into medical history, classical texts andbibliography. In the first half of the 19th century the Edo
Gakko (Edo Medical House) led research efforts in thisarea to a culmination point, but after the adoption ofGerman medicine, it lost its necessity and rapidly
declined. Yet, this area of research has in recent years
seen a renaissance and Hiroshi Kosoto, et al. of the
Department of Medical History Research at the Oriental
Medicine Research Center of the Kitasato Institute havepublished a series of new research results. The research
into medical history on first view does not appear to haveany direct bearing on clinical practice, but it plays animportant role in the establishment of the foundation of
Kampo medicine. Also, critical text analysis often
provides hints for new clinical applications.
From a clinical point of view, the most importantfeature of Japanese Kampo medicine is the extensive
accumulation of experiences in the use of "Shang han lun"prescriptions (including the "Jin gui yao liu"). In the past,
Japanese physicians have been using these for conditions
that are basically indications for different prescriptions.
This successfully contributed to the demonstration of theinherently great potential of these drugs, indicated newforms of clinical applications and has thus also provided
material for further studies. Researchers of Japanese
Kampo medicine work with the above described various
different research methods and clinical applications, but
agree with each other regarding the importance placed onthe "Shang han lun" prescriptions. The achievements
associated with this accumulation of experiences are both
Japan's pride and asset.
In modern Japan, highly diverse forms of Kampo
medicine coexist and their presence has a historicalbackground.
Yet, this diversity represents the real nature ofJapanese Kampo medicine and comprises new researchmethodologies and applications found only in Japan.
Even though the future worldwide development of TCM islargely influenced by the prevailing trends in its birthplace, China; Japanese Kampo medicine will contributesignificantly to that development.

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Distinctive Features of Kampo Medicine
There are varying styles of Japanese Kampo Medicine.
Each derives its inherent characteristics from the Japanese,
their culture, climate and history.
Japan began accepting Chinese Medicine in the 5th
century. It utilized Ming-China’s therapeutical system in the
16th century, but constructed a new system based on the“Shang han lun” from the late 17th century to the early 18th
century. At this time a school providing treatment that was
not based on the theory of traditional Medicine appeared.
This school sought a principle of medicine in “Shang han lun”
and did not utilize the Ming-China’s system. From then on
there was academic controversy between the grouppracticing Ming-China’s Medicine and the group based on“Shang han lun”. In addition, a group compromising both
systems arose. Groups correcting and annotating medical
textbooks arose, and as a result, Japan developed its own
medical environment in which various views coexisted.
After the Meiji Restoration in 1868, Kampo Medicine,once ostracized politically during the reconstruction period
starting in the 1930’s, developed successfully in thisenvironment. Medicine can be divided into “study” and“skill”. One of the features of Japanese Kampo Medicine isthat it has a strong tendency to be considered as “skill” andnot “study”. This tendency is especially remarkable in viewof the compromising party which arose in the 18th century.
Medicine is, of course, knowledge. The highest level to beachieved is mastering the skill followed by continued
improvement gained through new knowledge and experience.
It has something in common with the world of art or ‘Zen’.
Having these aspects, Kampo Medicine is applied fairly
pragmatically at bedside. For instance, Kampo medicine is
specifically prescribed for specific diseases. That is, as toapply “Minor blue dragon decoction”, of which its validness ischecked by DB-RCT, for allergic rhinitis, or the use of “TenStrong Tonic Herbs Decoction” in order to increase theimmunity, reduce the side effects, and improve the QOL for
patients who take chemotherapy, radiotherapy, or malignant
tumor surgery. These are only some of the many uses ofKampo medicine.
Even in these pragmatic methods, Kampo medicine exists
with its own unique styles of logic. These styles are various,
such as the traditions from the Edo period, the recent TCM
theory, or the utilization of clinical epidemiology.
1. Theory of Usage
Logic adopted in Kampo Medicine is varied as seen
above. While one adopts the same logic as present day
Chinese TCM, another may use prescriptions applying theresults of an experimental study in modern medicine.
Yet, the most frequently employed method is theso-called "pattern corresponding prescription" system. Thissystem was established approximately 200 years ago by Todo

10

Yoshimasu and is based on the concept: "Regardless of what
pathologic factors are at work, the form of body response
constitutes the real nature of the disease". Basically, thissystem assumes that reliance on minute clinical observation
allows to identify the relevant symptom complexes andthereby leads to the deduction of the required medication foreach individual patient. The most important aspect of a TCM
diagnosis, namely the disease stage (disease mechanism) is
at that time treated as a sort of black box. This is one of themost distinguishing features of Japanese Kampo medicine.
Since this system easily allows the integration of modern
medical research results, it is extremely helpful for the
spread of this medicine in Japan, where medicine is unified
according to the western medical system.
Currently, in contrast to Yoshimasu's time, theimplementationof
thismethodemploys
severalsupplementary
traditional
medicalconcepts.
Theterminology of these concepts itself is almost identical withthe relevant terms used in TCM. Yet, there are essential
differences in their application. The terms are not used to
identify the aforementioned pathologic mechanisms, butrather to classify the various diseases. This classification of
diseases in turn decisively determines the most suitableprescription for the patients. The concepts used in thisconnection include the eight principles (yin-yang,interior-exterior,cold-heatanddeficiency-excess),"Qi-Blood-Water" triad, the six channels according to the"Shang han lun" and the internal organ concept etc.
Although the same terms are used in TCM, theirrespective meaning is not necessarily the same.
Terms from the Kampo medical point of view arepresented below.
(1) Eight principles
The eight principles indicate the eight fundamental
concepts of yin-yang, interior-exterior, cold-heat anddeficiency-excess.
The terms yin and yang are used in daily life speech inJapan and thus do not have to be remembered, but some
aspects of their usage differ from that in China. Medically,
they have two different meanings. One expresses the generallevel of activity of the patient(s). Here there is no majordifference to their meaning as it is used in TCM. The otheraspect is a characteristic of Kampo medicine and serves toindicate the location of diseases based on the six channels
according to the Shang han lun, where they are divided into
greater yang, brighter yang, lesser yang disease stages orgreater yin, lesser yin or reverting yin. The former are called"yang pattern" and the latter "yin pattern". The frequent useof prescriptions from the Shang han lun has a significant
meaning. It is not necessarily common that the use yang
implies yang Qi and yin be a representative for yin fluid as it
is in TCM. Usually, a yin deficiency pattern represents a yin
pattern combined with a deficiency pattern, whereas a yangdeficiency pattern means a yang combined with a deficiency
pattern.

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The concept of interior-exterior expresses the depth ofthe disease and here there are no major differences with its
use in TCM.
Cold-heat is a scale pertaining to temperature andexpresses the true nature of the body as well as
characteristics of diseases and crude drugs or prescriptions.
Yoshimasu did not use this concept for his treatment, but
expressions like shivering or fever are cold-heat related
symptoms frequently encountered in daily clinical practice,so that in spite of Yoshimasu's intentions, they have beenused comparatively frequently and are currently still in use.
Regarding deficiency-excess, there are several aspects
and not just one concept. Usually, the terms are used to referto the conditions of true and evil Qi within the body based on
the reference in the first section of the classic "The Yellow
Emperor's Classic of Internal Medicine" given as "when theevil Qi is flourishing, the essential Qi is lost and deficiency
results". Following the introduction of TCM, the concept of
deficiency-excess has remained bound to its traditional
forms.
However, during the revival of Kampo medicine in the
1930s, researchers of the time proposed one more
deficiency-excess concept. According to this concept, there is"deficiency, the weakening of physical resistance to disease
with an excess, representing a condition of abundant
physical resistance to disease. Generally, people of strong
physical build present a state of excess, while asthenic
people of frail body build present a state of deficiency." Thatmeans that deficiency and excess indicate a state of excess of
deficiency of a certain vector and thus can be considered torepresent the difference in physical constitution andstrength. The background for this new interpretation in
Japan lies with the two different elements ascribed to thecharacteristics of right and evil Qi respectively. When
discussing the one index, "deficiency-excess", this seemed tobe paradox and may partly be explained by the logicalstructures the Japanese used in general. Currently, this is
accepted as the representative concept of deficiency-excess.
Later, Terasawa combined these two concepts in 1990 topropose a new concept of deficiency-excess. He suggested
that "deficiency pathologic conditions (deficiency patterns)
represent pathologic conditions for which only weakened Qi
and blood forces can be mobilized against any possible
distortions caused by external disruptive factors. Generally
this occurs before a background of lowered whole body levelsof Qi and blood. In excessive pathologic conditions (excess
patterns) the external disruptive factors are very strong and
the Qi and blood forces mobilized against these factors arealso very vigorous. This condition generally develops before abackground of heightened whole body levels of Qi and Blood."
In this form the concept resembles the prevailing ideas usedin TCM.

(2) Qi-Blood-Water
The concept of Qi (in Japanese Ki) is one of thefoundations of traditional Chinese medicine. In Japan thisconcept is very important. There is a large number of
expressions in everyday language pertaining to Qi.
Yet, about 250 years ago in Japan, Todo Yoshimasu
discarded it based on the concept that it cannot be seen andthere is no way of objectively proving its real existence. Since
then a considerable number of physicians have forsaken theapplication of this concept in medicine. This trend became a
new tradition in Kampo medicine and has been handed down
to the present, but there are also schools that recognize therelevant concepts of those days and in recent times almost all
modern physicians understand the concept of Qi.
Pathologic Qi conditions include Qi deficiency, Qi stasis,Qi reversal etc. and Terasawa has assigned scoring systems
to these pathologic conditions.
Diagnostic criteria for Qi deficiency (Terasawa)

Qi deficiency score
Body feels heavy

10

Dull eyes and toneless voice

No energy

10

Tongue with pale white or red fur,

Tire easily

10

Drowsiness during the day

6

Weak pulse

8

Loss of appetite

4

Weak and soft abdominal wall

8

Catch cold easily

8

Symptoms of internal organ atonia１） 10

Be easily startled

4

Subumbilical insensitivity2）

6

Tendency toward diarrhea

4

hypertrophied

68

Diagnostic criteria: A score of more than 30 points indicates Qi
deficiency. Any clear manifestations of the parameters receives a fullscore, while half the score is given to mild cases.
Note 1: Symptoms of internal organ atonia refers to gastric atonia,
kidney ptosis, uterine prolapse and anal prolapse.
Note 2: Subumbilical insensitivity refers to decreased muscle tonein the lower abdominal region.
Diagnostic criteria for Qi stasis (Terasawa)◆

Qi stasis score
Tendency toward stasis１）

18

Symptoms periodically get worse2） 8Dull headache, sense of developing

Difficulties getting up in the morning 8

8

A lot of flatulence

6

Feeling of throat congestion

12

Belching

4

Feeling of thoraci oppression

8

Sensation of residual urine

4

Abdominal tympanicity

8

a coldFeeling of stasis in the
hypochondrium

8

Abdominal distention

8

Diagnostic criteria: Any clear manifestations of the parameters
receives a full score, while half the score is given to mild cases. A
score of more than 30 points indicates Qi stasis.
Note 1: The severity of various symptoms, like a tendency towardstasis, refers to depressive moods, lack of interest, loss of appetite,food tasting unpleasantly like sand, is used for the evaluation.
Note 2: "Symptoms get worse over time" means that the chiefcomplaint fluctuates.

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

Diagnostic criteria for Qi reversal (Terasawa)

Diagnostic criteria for blood stasis (Terasawa)

Qi reversal score
Feeling hot in the upper half of the
body and cold in the lower half 14
１）

Blood stasis score

Easily startled

6

Attacks of restlessness

8

Palpitation attacks

8

Facial flushes

10

Paroxysmal headaches

8

Epiumbilical palpitation2）

14

Vomitting（with little nausea）

8

Feeling of cold in the lower or all four

Cough associated with anger

10

Attacks of abdominal pain

6

extremities
Palmar and plantar sweating

4
4

Diagnostic criteria: Any clear manifestations of the parameters
receives a full score, while half the score is given to mild cases. A
score of more than 30 points indicates Qi reversal.
Note 1: This refers to a condition where the patient experiences
heat in the upper half of the body and feels cold in the lower half ofthe body at the same time. The condition is triggered by entering awell air-conditioned room. This also receives 14 points.
Note 2: Epiumbilical palpitation refers to an increased pulsation of
the abdominal aorta that is felt when touching the medianabdominal wall lightly with the palm of the hand.

Pathologic conditions of blood include blood deficiency,
Oketsu syndrome (which has the same meaning as"stagnation of blood") blood heat, blood cold, hemorrhage etc.
The most important of these conditions in Japan is the
Oketsu syndrome. These pathologic conditions can beobserved in most chronic diseases and have been given
particular importance in many gynecologic diseases. For
Japanese trying to grasp all phenomena in concrete form thisconcept is extremely important, because the abdominal
examination provides comparatively easily assessable
information. Extensive basic and clinical research has been
conducted regarding the Oketsu syndrome and even an"Oketsu Academic Society" has been established. Terasawa
has created a scoring system for blood deficiency and Oketsu.
Diagnostic criteria for blood deficiency (Terasawa)
Blood deficiency score

Decreasing concentration ability

6

Poor complexion

10

Insomnia, sleep disorders

6

Head hair easily falling out１）

8

Eyestrain

12

Dry skin, getting rough andDizzyness

8

Calf cramps

10

Oligomenorrhea, irregularmenstruation

6

chapped

14

FemalePigmentation of
the eyelids
Pigmentation of
the face
Dermal roughness
and chapping１）
Darkening of the
lips

10

10

2

2

2

5

2

2

Darkening of thegingivae

10

5Tounge turning
dark red or
purpleFine arteries2）
Subcutaneous
extravastion
Palmar erythema

10

10

5
2

5
10

2

5

Male

Female

5

5

10

10

5

5

5

2

5

5

5

5

10

5

Periumbilicaltenderness, left
Periumbilicaltenderness, right
Periumbilicaltenderness, center
Tenderness,
resistance of theileocecal region
Tenderness,
resistance of thesigmoid region
Tenderness,
resistance of the
hypochondrium
Hemorrhoids
Menstrual
disorders

10

Diagnostic criteria: A score of less than 20 points indicates apathology unrelated to blood stasis, a score of more than 21 points
an blood stasis pathology, more than 40 points a severe blood stasis
pathology. Any clear manifestations of the parameters receives a fullscore, while half the score is given to mild cases.
Note 1: Chapping skin, roughening, fissure formation.
Note 2:Dilatation of capillaries, arterial spiders etc.

Pathologic conditions of fluids include besides a lackthereof, an excess, asymmetrical distribution etc. also rheum
produced by excessive metabolism, dampness, phlegm andsimilar pathologic substances. In Japan, pathologic
conditions caused by excessive fluids, have theirasymmetrical distribution or pathologic substancescollectively called "water toxin (disorders of the body's fluid
metabolism)" or "water stagnation". This term implies thatstagnation of the flow of water has adverse effects on the
body through individual metabolites of water or its entirety
and as such as a very broad range of application. Terasawa
has created a scoring system for water stagnation.
Diagnostic criteria for water retention (Terasawa)
Water retention score

Body feels heavy

3

Nausea, vomitting

3

Pulsating headache

6

Increased gurgling3

Dull headache

3

Morning stiffness7

Getting motion sickness easily

5

Tendency toward edema, gastricAnomalies of the nails2）

8Disturbances of perception3）

6

Lightheadedness, dizziness

5

Stiffness of abdominal muscles

6

Syncope5

Watery nasal discharge

3Hypersialosis

3

Epiumbilical palpitation１）

Foamy sputum

4

Watery diarrhea

5Decrease urinary volume

7

Diuresis

5

Diagnostic criteria: Any clear manifestations of the parameters
receives a full score, while half the score is given to mild cases.
A score of more than 30 points indicates blood deficiency.
Note 1: An abundance of dandruff would have the same meaning.
This too receives 14 points.
Note 2: This refers to symptoms like brittle, easily splitting nails,roughening of the skin around the nail beds and the development of
hangnails.
Note 3: Tingling or ticklish sensations resembling numbness,feeling like the presence of an added skin layer, loss of sensation etc.

12

Male

clapotage

15

Pleural effusion, cardiac water
retention, ascites

15
5

Diagnostic criteria: A score of more than 13 points indicates water
retention.
Note 1: Epiumbilical palpitation refers to an increased pulsation of
the abdominal aorta that is felt during light massage of theumbilical area.

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(3) Six channel classification of the "Shang han lun"
The "Shang han lun" has been recognized since the 18th
century as an extremely important classic of Kampo
medicine and many Japanese physicians believe that thisbook contains important treatment rules. The classification
into six channels (greater yang, brighter yang, lesser yang,greater yin, lesser yin or reverting yin disease) represents a
basic classification of disease stages, but each of the diseasestages according to the Shang Han also indicates diseases in
specific locations, so that it can also be called a classification
into disease locations. Its acknowledgment in Kampo
medicine is used to classify all diseases into disease locations
for which suitable Kampo medicines are applied from among
the prescriptions listed in the "Shang han lun". Not
restricted to acute diseases these may also be applied tochronic diseases. For example, a condition like rheumatoid
arthritis is classified as a greater yang disease location andis treated with Two-parts Cinnamon Twig Decoction and
One-part Maidservant from Yue Decoction, whereas a
disease like chronic hepatitis is classified as lesser yanglocation and thus treated with Minor Bupleurum Decoction.
(4) Concept of bowels and viscera
As with the other concepts, the concept of bowels andviscera is essential to Kampo medicine. However, Yoshimasu
maintained the point of view that he "will not discuss things
invisible". Later, discussions of pathologic conditions of thebowels and viscera ceased in Japan. Due to the influence ofthe reintroduction of TCM in recent years there has been atrend towards a revival.
2. The Clinical Practice
The medical treatment of Kampo Medicine is based on
the tradition of TCM, and begins with the comprehension of
the patients’ conditions using four diagnostic methods. Whatdiffers most from the Chinese system is that it values
abdominal diagnosis among four diagnosis methods. Thisclinical system developed gradually from the 16th century,and nearly established its present prototype in the early 18th
century, and from then formed its present prototype by
gaining experience. Currently, this is an examination form
indispensable for the proper application of prescriptions.
Another considerable difference of Japanese Kampo
Medicine from other countries possessing various types of
TCM, is that it enables the use of medical insurance in theEuropean medicine system, and for that it uses
approximately 160 herbal materials and 148 Kampo
prescriptions for medical use. Since Kampo medicine for
medical use was approved by the Ministry of Health andWelfare in the 1976, the significance of Kampo Medicine isremarkable when considering that 90% of doctors practicing
European medicine, which once became irrelevant totraditional medicine, now include it in their practice.
Reflecting Japanese tradition, some 50% of the prescriptions
are based on “Shang han lun” and “Jin gui Yao lue”. These
two classics represent basic contributions to Kampo
medicine. The prescriptions given therein form the basis of
TCM dosimetry. In Japan these have been historically highly
valued.

In spite of the large number of opinions, the mostmarked characteristic of Japanese Kampo medicine is theapplication of prescriptions from the "Shang han lun" and"Jin gui Yao lue" to a variety of diseases and an extremely
large body of related experiences.
For example, the ethical Kampo drug designated as No.
1, Pueraria Decoction, is used for many different diseases.
Table 7 lists the diseases for which it has been used so far. It
goes without saying that physicians do not prescribe theindividual formulas indiscriminately to the various diseases,
but first identify the relevant pattern (Sho) for the particularprescription to be used.
In the past several hundred years, physicians havecontinued to ponder about indications for individual
prescriptions. This led to the accumulation of an enormous
body of information and is reflected in current clinicalpractice.
3. Research
Research on Kampo Medicine is actively pursued, bothbasic research and clinical trials. In the clinical field, themost significant research effort is the clinical application of
Kampo Medicine in modern medicine. Numerous researchstudies are published at many professional medical
congresses every year including the Japanese Society ofOriental Medicine. It should be noted that research resultsin some areas exceed the latest European medical research.
It is important to note that in clinical research, otherthan modern medical research, there are studies of
traditional logic. Studies are done on the treatment andcomprehension of patient conditions based on traditional
logic, the logic of present TCM, and medical treatment
methods as abdominal diagnosis. Conversely, in the field of
research, many outstanding, typical Japanese items can befound. These appear in publications of such groups as theJapanese Society of Oriental Medicine and the Association of
East-Asian Medicine.
Table 7

Indications for Pueraria Decoction

Infections: influenza, measles, scarlet fever, encephalitis,
meningitis
Respiratory tract: common cold, bronchial asthma, bronchitis,
pneumonia
Circulatory system: hypertension
Alimentary tract: infectious enterocolitis
Locomotorium: stiff shoulders, neck pain, frozen shoulder
Nervous system: headache, tetanus, trigeminal neuralgia,
myasthenia gravis, facial palsy
Otolaryngology: otitis media, otitis externa, parasinusitis,
allergic rhinitis, hypertrophic rhinitis, nasal polyps,
tonsillitis, pharyngolaryngitis, epidemic parotitis
Ophthalmology: conjunctivitis
Dermatology: urticaria, purulent dermatitis, eczema, herpes
zosterStomatology and dentistry: temporomandibular arthrosis,
dental pain
Breast: hypogalactia, mastitis
Psychiatry: narcolepsy, depressed mood
Other: common cold prevention, health maintenance, nocturnal
enuresis

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148 Prescriptions of Kampo Medicine in
Medical Insurance
Kampo or Chinese herbal medicinal preparations for ethicaluse are pharmaceutical Kampo products including classicalprescriptions of Chinese herbal extracts, pills, powders etc.
These are made through manufacturing processes involving theextraction of essences by boiling them down in water, recovery inpowder form, and the addition of excipients before theirconversion to pharmaceutical preparations. The term “ethicaluse” implies that these pharmaceutical preparations areregistered in the Drug Price List for National Health
Insurance(NHI). They can, therefore, be prescribed by Japanesephysicians at their discretion for daily medical use under thehealth insurance system. Kampo preparations have a long
historical background in Japan where traditional Chinese
herbal medicines have been used for more than ten centuries.
Today there is a heavy demand among the Japanese for theseprescriptions and the benefits they can offer, all covered under
the national health insurance system for ordinary medical use.
In 1976 the use of Chinese herbal preparations under thenational health insurance system was approved for the first time,
except for 6 formulations which were approved in 1967. Today,
148 registered formulations of Kampo prescriptions areavailable.

History of Chinese herbal preparations for ethical use
The development of ethical Kampo preparations was
possible because Chinese herbal medicines had already beencommercially available as extracts in the generalpharmaceutical market.
Research to develop extracts of Chinese medicinal herbs
was first initiated with 4 formulations of Minor Bupleurum
Decoction (xiao chai hu tang) etc. These were prepared forclinical trials by Takeshi Itakura in the 1940s. After World War
II, Hosono, Sakaguchi et al. of the Seikoen Hosono Clinic,
conducted further studies aimed at developing commercial
products from them in the 1950’s. Although the resulting
products attracted a highly favorable clinical evaluation they
were not actually marketed.
In the 1950’s, pharmaceutical scientists and manufacturers
began further research for the development of extract
preparations. A number of extract preparations made by certain
pharmaceutical companies made their way into the OTC market
around 1957, and were commercially promoted at drug stores.
Around that time, Chinese herbal medicines achieved a highdegree of popularity, with many people buying and taking these
old remedies in the guise of new drugs at pharmacies.
However, general practitioners did not accept these Kampo
preparations for prescription because they were not yet
approved for use under the national medical insurance scheme.
In 1967, 6 products supplied by Kotaro Kampo Pharmaceuticals
were accepted for registration in the NHI Drug Price List, butwere less successful in gaining widespread acceptance by the
public. This was partly because they were not generally known
and partly because they had not been used within the Chinese
medicine establishment.

14

Chinese herbal preparations began to be available within thenational health insurance system in 1975, and 43 formulations
were approved for registration. Since then, thanks to the efforts of
the Japan Society for Oriental Medicine and of thepharmaceutical companies, they have gradually come to be widely
accepted among general clinicians.
Many other Kampo
formulations were newly registered in the NHI Price List, so thatthe total of currently registered Kampo products is now 148.

Manufacturing Methods and Product Forms
Traditional Chinese herbal medicines are sold in various
product forms. Decoction is the most common, followed by pills
and powders. In Japan, Chinese herbal preparations are
manufactured by extracting them from a crude drug mixture
containing the relevant ingredients with hot water. The extract
is then isolated using spray dryers for ultimate conversion to thepharmaceutical preparations. The most commonly employed
excipient is lactose. Starch is also used, but less frequently.
The preparations are marketed in various forms:
Powders
Fine granules
CapsulesPill

GranulesTablets
Ointment

Of these forms, the first three are the most common on themarket. Pharmaceutical companies tend to prefer certain forms
for their proprietary products. For instance, Tsumura offers
granule preparations, and Kanebo fine granules. Somecompanies are presenting some of their products in tablets. Only
Kotaro employs the capsule form on a limited scale for its Coptis
Detoxification Decoction, Ephara, Aconite and Manchurian
Wildginger Decoction, etc.
These Kampo preparations are produced according to
manufacturing methods approved by the Ministry of Health,
Labor and Welfare; and are subject to strict regulatory control interms of concentration, composition and other quality
requirements.
Among the classical preparations preparations, for example
Angelica and Peony Powder or Cassia Twig and Tuckahoe Pill
were developed as powders or pills. Ethical Kampo preparations,even if their original form was a powder or pill, are without
exception preparations obtained as extracts from hot water. The
reason for this procedure is, that it eliminates bacteria or fungicontained in the crude drugs and markedly decreases theconcentration of heavy metals and pesticides. Microorganisms
and fungi are killed and the concentration of heavy metals andpesticides decreased during extraction to one tenth of theirinitial concentration.
The additional combination of chemical substances withextracted Chinese herbal essences is not performed, because it isrequired to maintain the purity of the contained essences. Inview of the need to ensure the purity of the essences contained in
the preparations, no crude powder admixture to the product is
admissible.

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Clinical Applications of Kampo Medicine

Hiromichi Yasui, Committee Chairman
Annual Report Committee of Kampo Medicine

Table of Contents
1. Geriatric Medicine
2. Skin, Hair and Nails
3. Eye4. Ear, Nose and Throat
5. Lung
6. Heart
7. Systemic Hypertension
8. Blood Vessels and Lymphatics
9. Blood
10. Alimentary Tract
11. Liver, Biliary Tract and Pancreas
12. Gynecology
13. Obstetrics
14. Arthritis and Musculoskeletal Disorders
15. Kidney
16. Urology
17. Nervous System
18. Psychiatric Disorders
19. Endocrinology
20. Diabetes Mellitus
21. Lipid Abnomalies
22. Nutrition
23. Infectious Diseases
24. Cancer
25. Pediatrics
Introduction
Legitimate Japanese medicine until about 140
years ago was Kampo Medicine. Naturally, the Dutch
medicine, representing the legitimate European
medicine of the day, was at the time of its introduction
to Japan a non-mainstream medicine. Yet, its contents
gradually became known and thus started to spread,so that in 1804 a mastectomy was performed by Seishu
Hanaoka under general anaesthesia in a patient withbreast cancer. This showed the emergence ofphysicians highly skilled in both forms of medicine andrepresents a successful example of integrative
medicine that occurred 200 years ago. Trends in the
medical world attempting the integration of westernand Kampo forms of medicine in Japan actually were
not modern efforts, but have been an important topic
for several hundred years.
Kampo medicine is widely used in daily medical
practice. This form of medicine originally was atherapeutically oriented medicine with outstanding
characteristics. The excitement during its revival
movement in the 1930s frequently showed it to besuperior to the western medical approach. However,later the developments in western medicine andrelated sciences, greatly expanded therapeutic
possibilities. Correspondingly, the scope of applicationof Kampo medicine has declined in proportion to the
expansion of western medicine. However, currently it
is still frequently applied for the treatment of many
diseases for which western medicine is unable toprovide satisfactory solutions.
In Japan, only a few physicians are specializing
solely in Kampo medicine. Except for such extreme
exceptions (that means almost always) physiciansassume a western medical stance and add Kampo
medical treatment as required. In other words,
integrative medicine is practiced on a private level.
Described below is the generally practiced form of
Kampo medicine in daily clinical routine. The
descriptions are based on the experiences of the author
and refer to the references 1 to 6 (either of which
describes the general treatment of diseases). Citationof references from related research are indicated bynumbers and are introduced in the order of theirappearance.
References:
1. Otsuka K., Yakazu D., Shimizu T.: encyclopedia of Kampo Diagnosis,
Manzando 1963
2. Terasawa K.: KAMPO Japanese-Oriental Medicine Insight from ClinicalCases, Standard Macintyre Tokyo ISBN915719-05-7 C3047
3. Hanawa T.: Lessons of Kampo Diagnosis, Kanehara Publishing 1995
4. Bando S.: Medical Practice with Kampo for Disease, Medical Yukon 2003
5. Otsuka K.: Medical Practice with Kampo for Symptom, Nanzando 1963
6. Matsuda K.: Medical Practice with Kampo for Symptom, Sogensha 1992
7. The Guideline of Medical Insurance for Kampo Medicine, edited by theJapanese Society for Oriental Medicine; revised edition, 1993

1. Geriatric Medicine
Among Japanese medical books, the "Kei Teki
Shu" (1574) by Dosan Manase was the first to separate
geriatric medicine from other clinical disciplines. Thus,
Kampo medicine has a very long tradition of geriatric
medicine, but with the addition of modern medical
approaches in recent years, there are still more newdevelopments. In particular the "Japanese Kampo
Medical Care for the Elderly", edited by Katsutoshi
Terasawa, is a very valuable book describing the
Kampo medical treatment for senile diseases in great
detail1).
Problems of particular importance in the elderly
are aging induced changes in the central nervous
system, the so-called cerebrovascular dementia and
Alzheimer's disease, which are associated withdementia, depressive states, delirium and similar
mental symptoms. Currently these symptoms are thesubjectofmulti-center
cumulative
research.
Particularly, research into the efficacy of Uncaria
Powder for the treatment of cerebrovascular dementia
and Angelica and Peony Powder for Alzheimer's
disease appear promising2,3,4,5). Recent research into theclinical effects of Liver-Inhibiting Powder on 'Behavioral
and Psychological Symptoms of Dementia (BPSD) has
been performed, and the results were published in "J. Clin.
Psychiatry" and similar organs6).
In Kampo medicine, aging is closely related to thekidneys. Age related changes in bones and joints too

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are often related to a weakening of the kidneys. For
low back pain due to osteoarthrosis, gonalgia andsimilar typical diseases of bones and joints in theelderly, the application of kidney tonifying
preparations should be considered. The available datasuggest that Kidney Qi Pill is effective for the treatmentof postmenopausal osteoporosis.
There are several problems pertaining to diet also
requiring careful attention, since aspiration for
example may even be fatal. Certain reports and someresearch indicate that the use of Pinellia and Magnolia
Decoction or Lung-Clearing Decoction for patients
suffering from repeated aspiration pneumonitis
produces favorable results7,8).
Among the diseases of the urinary tract, Kampo
medicines are frequently used for dysuria. Kidney Qi
Pill9) for the treatment of impending incontinence andMiddle-Reinforcing and Qi-Benefiting Decoction or
Pueraria Decoction10,11) for abdominal pressureincontinence have been found to be effective in somestudies. Kampo treatment also appears to be
therapeutically useful during the early stages ofhypertrophy of the prostate12).
In the elderly, even simple infections like colds
should not be taken lightly. The reason for this is thatthey may be complicated by bronchitis, causing loss ofappetite and thus may easily lead to debility. The useof Kampo preparations during the early stages ofinfections in the elderly reportedly can lead to an earlyrecovery at low costs. Akiba treated stationary
patients
suffering
from
upper
respiratory
inflammation or bronchitis and found a shorter
duration of the morbidity and lower treatment costs
than in patients treated only with western
medications13). Moreover, Kampo also appears to be
useful for the treatment of refractory infections likethose caused by MRSA (see section on infections)14).
1) Terasawa K.: "Japanese Kampo Medical Care for the Elderly", Igaku-Shoin 2005
2) Shimada Y., Terasawa K., Yamamoto T. et al: A well-controlled study ofUncaria Powder and placebo in the treatment of vascular dementia, J. Trad.
Med. 11: 246-255, 1994
3) Terasawa K, Shimada Y, Kita T, et al: Uncaria Powder in the treatmentnt
of vascular dementia a double-blind, placebo controlled study,
Phytomedicine 4: 1522, 1997
4) Inanaga K., Dainoson K., Ninomiya Y. et al.: Multi-center joint research into
the therapeutic effects of Angelica and Peony Powder on cognitive disorders
in the elderly, Prog. Medicine 16: 293-300, 1996
5) Yamamoto T.: Kampo and modern medical treatment of Alzheimer's disease,
Current Medicine 5: 96-102, 1989
6) Arai H., Iwasaki K.: Effects of Liver-Inhibiting Powder on AssociatedSymptoms Cognitive Disorders, Kampo Igaku 29(4): 13-15, 2005
7) Mantani, N. et al: Effect of Lung-Clearing Decoction, a Kampo medicine, in
relapsing aspiration pneumonia an open-label pilot study, Phytomedicine, 9:195-201, 2002
8) Iwasaki, K. et al.: The traditional Chinese medicine banxia houpo tang
improves swallowing reflex. Phytomedicine, 6: 103-106, 1999
9) Yamanaka H., Suzuki T., Tokunaga S. et al.: Kampo Therapy for
Incontinence, Kampo Igaku 21(8): 2-10, 1997
10) Kase H., Akashi M., Satou T.: Effects of Middle-Reinforcing and
Qi-Benefiting Decoction on Pressure Incontinence, Kampo Igaku 29(3):19-21, 200511) Shin S., et al.: Usefulness of Pueraria Decoction for Pressure Incontinence,
Summary collection of the 47th General Academic Conference of the Japan
Society of Oriental Medicine, P126, 1996

1612) Harada K.: Japanese & Chinese Pharmacotherapy for Urologic Disorders,Japanese Journal of Clinical Urology 45: 295-300, 1991
13) Akiba T.: Effects and possibility of reducing medical costs by local andsystemic application of Kampo preparations, Progress in Medicine, 21(8):1863-1865, 2001
14) Kitahara M., Ishikawa S., Hara K.: Protective effect of Ten Strong Tonic
Herbs Decoction against infection after acute ischemic stroke in elderly
patients. Biotherapy 17(3): 287-298, 2003

2. Skin, Hair and Nails
Skin diseases used to belong in the realm ofsurgery. That is due to the fact that there were somany infections of the skin that required surgery.
Many preparations have been developed for thetreatment of skin infections, but can also be applied toskin diseases other than infections and currently arein fact widely used. Seishu Hanaoka, who did theworld's first surgery for breast cancer under generalanaesthesia, invented the representative preparations
for the treatment of skin disease Antiphlogictic
Decoction with Ten Herbs and Purple Cloud Ointment.
His experiences are still useful today.
For diseases in this field there are excellent modern
medical treatments, leaving fewer pathologic
conditions that would require the use of Kampo
preparations. There was not a significant reference tothe use of Kampo therapy, but nevertheless a
combination with Kampo medicine frequently provides
additional benefits1). Among these conditions, Kampo
is used most frequently for the treatment of atopic
dermatitis. Regarding this disease, the combination of
appropriate skin care and Kampo medicine is effective.
Experienced dermatologists achieve good results bycombining various preparations2). Here the effects ofMiddle-Reinforcing

andQi-Benefiting

Decoction

during infancy are particularly well known. The
situation changes during childhood, adolescence andadulthood, where Wind Dispersing Powder, For
Eczema Decoction, Coptis Detoxificating Decoction,
Bupleurum Liver-Clearing Decoction, White Tiger plus
Ginseng Decoction, Yue Bi Decoction for Relieving
Edema plus Atractylodes, Warming and Clearing
Decoction, Head-Clearing Divaricate Saposhnikovia
Decoction, Schizonepeta and Forsythia Decoction andsimilar preparations are used. Still other effective
preparations are available as decoctions. A significant
number of physicians prescribe specially modified
decoctions for refractory cases. Using a combination of
topical steroids and Kampo preparations generally
allows the physician to taper the dose of the topicaldrug application. The Kampo formulas are then useduntil patients are capable of managing self medication.
These diseases are characterized clinically by their
psychological aspects and some physicians also seek
the cooperation of clinical psychologists for thetherapy.
1) Morohashi M.: Current Situation and Use of Kampo Medicine in the Field ofDermatology, 27-46, Kampo Report of Dermatology, 1990
2) Ninomiya F.: Treatment of atopic dermatitis with extract preparations, The
Kampo 13(1): 13-17, 1995

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Steroid ointments or topical retinoids and similar
western medical preparations are given priority for thetreatment or psoriasis. Kuboki et al. reportedly foundthat a combination therapy with Minor Bupleurum
Decoction, Poria Powder with Five Herbs had significantly
improved effects on pruritus, erythema, scaling,
infiltration, hyperplasia etc3).
Topical steroid ointments alleviate the symptomsof seborrheic dermatitis, but the condition tends to berecurrent throughout life and therefore warrants a
trial with Kampo therapy. Antiphlogictic Decoction
with Ten Herbs or Wind Dispersing Powder are widelyused for this purpose. Tsutsui et al. treated 30 patientswith seborrheic dermatitis with Wind Dispersing
Powder and reportedly found in their study ausefulness of 81.5%4).
It has been recommended that Yue Bi Decoction for
Relieving Edema plus Atractylodes or Gentian
Liver-Purging Decoction are used in conjunction withwestern medical treatment during the acute phase ofherpes zoster. For the treatment of postherpetic
neuralgia as a late effect of this condition, Ephdra,
Aconite and Manchurian Wildginger Decoction, Cassia
Twig Decoction plus Atractylodes and Aconite, Evodia,

Fresh Ginger plus Chinese Angelica Cold Limbs
Decoction and similar preparations are used.
Formulas like Schizonepeta and Forsythia
Decoction, Cassia Twig and Tuckahoe Pill Plus Coix
Seed, Antiphlogictic Decoction with Ten Herbs etc. are

generally used for the treatment of acne. A number ofstudies investigating this condition have also been
performed. Okuma et al. performed a RCT using
Antiphlogictic Decoction with Ten Herbs and Coptis
Detoxificating Decoction in a combination with theusual topical applications and found for Antiphlogictic
Decoction with Ten Herbs an efficacy of more than 75%
and for Coptis Detoxificating Decoction of more than40%5). Hashimoto et al. used in a RCT Schizonepeta
and Forsythia Decoction and tetracycline antibiotics
and found for Schizonepeta and Forsythia Decoction
an equivalent usefulness of 60.6%. A combination ofboth preparations reportedly resulted in a usefulnessof 78.6%6).
Research has also been done on palmoplantar
pustulosis. Hashimoto et al. treated 97 patients withpalmoplantar pustulosis with Warming and Clearing
Decoction extract and reportedly found in the fourthweek a usefulness of 59.8% and by the eighth week
69.8%7). The research of Watanabe et al. using Coptis
Detoxificating Decoction led to similar results8).
Antiphlogictic Decoction with Ten Herbs is also widelyused.
Regarding rosacea, numerous studies haveinvestigated Antiphlogictic Decoction with Ten Herbs.
Nakanishi administered Antiphlogictic Decoction withTen Herbs to 50 patients with rosacea and reportedly
found in 46 of these patients a marked improvement in
the diffuse erythemata9).

3) Kuboki J., Harada S. Fujisawa R., et al.: Investigation of the Effects of
TJ-114 (Minor Bupleurum Decoction, Poria Powder with Five Herbs)
Combined with Topical Steroids for the Treatment of Psoriasis, Journal of
Clinical Therapeutics & Medicine 17: 927-937, 1991
4) Tsutsui K., Hirone T., Tanaka T. et al.: Clinical Effects of Wind Dispersing
Powder on Atopic Dermatitis, Seborrheic Dermatitis, Nummular Eczema
and Chronic Eczema, Kampo Igaku, 118: 309-312, 1994
5) Okuma M.: Combination Therapy of Orally Applied Kampo Medicine andTopical Preparations, Journal of Traditional Medicine 10: 131-134, 1993
6) Hashimoto Y., Matsuo S., Iizuka H.: Experiences with Schizonepeta andForsythia Decoction in the Treatment of Acne, Records of the 12th Meetingof the Research Group for Oriental Medicine in Dermatology, 46-53, 1994
7) Hashimoto Y., Matsumoto M.: Experiences with Warming and Clearing
Decoction in the Treatment of Palmoplantar Pustulosis, "Kampo Therapy"
Helpful for Daily Practice, 10: 51-155, 1991
8) Watanabe M., Ohkuma N.: Experiences with Coptis Detoxificating
Decoction in the Treatment of Palmoplantar Pustulosis, Kampo Igaku,
10:21-24, 1986
9) Nakanishi T.: Effects of Antiphlogictic Decoction with Ten Herbs on the
Diffuse Erythemata of Rosacea and a Combination of Atopic Dermatitis andRosacea, Current Situation of Kampo Therapy in Dermatology, 8: 67-83,
1997

Urticaria is occasionally an indication for Kampo
therapy. For acute urticaria, suitable western medical
treatment has been established, so that circumstances
specifically calling for the application of Kampo
therapy are few. Chronic forms of urticaria also include
refractory cases for which attempts at using Kampo
therapy have been made. Yano used a Kampo medicine
combination therapy on 19 patients with refractorychronic urticaria continuing the original treatment
and found a usefulness in 10 of the patients,
ineffectiveness in 7 and aggravation in 2 patients10).
The most frequently used preparation was Bupleurum
Liver-Clearing Decoction, followed by Wind Dispersing
Powder and Minor Bupleurum Decoction, Poria
Powder with Five Herbs in that order. Horiguchi et al.
treated 13 patients with chronic urticaria with

Capillary Wormwood Poria Powder with Five Herbs

and reported finding a slight usefulness in 85% of thecases11).
For warts, there used to be two traditional
treatment forms in Japan. One was the direct
application of moxibustion on the warts, something all
acupuncturists would do. This is extremely effective.
The other is the preparation of a Yokuinin decoction
and drinking this infusion. This latter treatment has
frequently led to very good results, so thatdermatologists now are using the extract. Among the
Kampo formulas, Ephedra, Apricot, Coiw and Licorice
Decoction is widely used.
When the cause of pruritus is determined,
treatment should be directed at the etiology, otherwise
this condition becomes an indication for Kampo therapy.
For the treatment of senile dermal pruritus, Kidney Qi
Pill, Life-preserving Kidney-Qi Pill, Angerica Decoction,
Antipruritus, Coptis Detoxificating Decoction andsimilar preparations are used. RCTs have shown thatthe effects of Kidney Qi Pill or Coptis Detoxificating
Decoction are comparable to antihistaminic drugs,
achieving an improvement of approximately 70%12,13,14).
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Volume 1, Special Edition | Current Kampo Medicine 2005

chronic renal failure requiring dialysis is frequent andAngerica Decoction, Antipruritus has, in some cases,
reportedly proven to be effective15). Gentian
Liver-Purging Decoction or ”B”Character Decoction
are used for anal or genital pruritus.
10) Yanot T.: Kampo Therapy for Refractory Chronic Urticaria and Atopic
Dermatitis, Kampo Igaku 19(7): 17-20, 1995
11) Horiguchi Y., Furukawa F. Mitani T. et al.: Clinical Experiences with
Antiphlogictic Decoction with Ten Herbs and Capillary Wormwood Poria
Powder with Five Herbs for the Treatment of Chronic and Acute Urticaria,
Proceedings of Dermatology, 82: 365-368, 1987
12) Five Universities Joint Research Group: Experiences with the use of TJ-15,
TJ-107 for the Treatment of Patients with Senile Pruritus, Dermatology inWestern Japan, 53: 1234-1241, 1991
13) Fujita M., Ohno S., Miyaji Y. et al.: Therapeutic Effects of Kidney Qi Pill
(Tsumura) on Refractory Senile Pruritus, Proceedings of Dermatology, 88:
175-179, 1993
14) Hori Y., Saida T., Torii Y. et al.: Clinical Experiences with Angerica
Decoction, Antipruritus (Tsumura) for the Treatment of Senile Pruritus,
Proceedings of Dermatology, 79: 209-214, 1984
15) Sakaizawa I.: One Case in which Angerica Decoction, Antipruritus for theTreatment of Refractory Erythema and Pruritus in a Patient on Dialysis
due to Chronic Renal Failure, Kampo Igaku, 29(3): 38, 2005

Decubitus ulcers are treated following a fixed
protocol, but combination with Kampo preparations
may result in an even better prognosis. Nagasaka useda decoction of Kigi Kenchu To Ka Bushi (that is
Astragalus Middle-Strengthening Decoctoin withadded Toki (Japanese angelica root) and Bushi (aconiteroot)) and observed many favorable outcomes16).
Middle-Reinforcing and Qi-Benefiting Decoction and
Ten Strong Tonic Herbs Decoction are also widely used.
Dermal affections caused by cold include frost bitefor which Evodia, Fresh Ginger plus Chinese Angelica
Cold Limbs Decoction is effective and frequently
administered17). According to Mori, RCTs have also
been performed. Burns among heat induced affections
is principally treated by western medical therapy, but
occasionally topical Kampo medications like Purple
Cloud Ointment are also applied. There are casereports about the treatment of burn scars in patientsfor whom surgical treatment could not be performed18).
Nagasaka K. et al.: Therapeutic Experiences with Astragalus
Middle-Strengthening Decoctoin for the Treatment of Decubitus Ulcers,

16)

Kampo Medicine (Jap. Journal of Oriental Medicine), 49: 273-280, 199817) Mori S.: Clinical Experiences with Evodia, Fresh Ginger plus ChineseAngelica Cold Limbs Decoction for the Treatment of Frost Bite, Kampo
Shinryo 3(1): 46-51, 1984
18) Shimizu J.: A Patient with Burn Ulcers Successfully Treated with Shiun K,
Kampo Igaku, 20(4): 122-123 1996

3. EyeTechnical books about ophthalmology existed in
the Tang period in China. In Japan, the first
specialized physicians appeared in the 13th century.
Yet, their experiences were not handed down to us, sothat the treatment in this field was developed only inrecent years. Among the diseases and conditions
Kuroki wanted to treat with Kampo medicine were eyestrain, dry eye, central retinitis, some forms ofpigmentary degeneration of the retina, some forms ofglaucoma, some forms of cataracts, prevention of therecurrence of uveitis, conjunctival injection (cause
18

unknown), pterygium, ticks, bulbar contusion, bulbar
postsurgical care, neovascularization of the maculaand similar conditions1).
1) Kuroki S.: The Use of Kampo in These Cases - Eye Diseases; The Kampo for
the Practical Physician No.3: 2-7, 1999

Regardless of whether conjunctivitis is of bacterial
or viral origin, western medical treatment has priority.
However, Yamamoto described patients he treated for
keratomycosis or corneal herpes and obtained
excellent results, stating that great expectations may
be placed on Kampo therapy for infections of the eyes2).
Application of steroid or antiallergic eye lotions as wellas orally applied medications for the treatment ofallergic conjunctivitis are standard therapy, but
Kampo medications used for allergic rhinitis appear tobe effective for conjunctivitis as well. Minor Blue
Dragon Decoction, Yue Bi Decoction for Relieving
Edema plus Atractylodes, Ephdra, Aconite andManchurian Wildginger Decoction and similar
preparations are widely used. Dwarf Lilyturf Decoction,
Bupleurum Cassia Twig and Dried Ginger Decoction,
Liver-Inhibiting Powder, Modified Merry Life Powder,
Kidney Qi Pill, Ginseng Decoction and similar
preparations are used for the treatment of dry eye3).
There is also cumulative research into the use ofGinseng Nutrition Decoction. Fukuda et al. divided agroup of 60 patients with dry eye of unknown origin ina group of 30 patients treated with Ginseng Nutrition
Decoction and a placebo for 30 patients. Both groups
used the same eye lotions and were evaluated after 12
weeks. At this point, a slight improvement of thesubjective symptoms was reportedly found in 63.3% of
the patients in the treatment group as compared to 50%
in the placebo group4).
2) Yamamoto S.: Kampo Therapy in Ophthalmology, Journal of Kampo
Medicine 47(11): 10-18, 2000
3) Yamamoto S.: Kampo Treatment for Sjörgren’s Syndrome, The Journal of
Traditional Sino-Japanese Medicine 14(3): 23-36, 1993
4) Fukuda Y., Narita Y., Miwa M. et al.: Effects of Ginseng Nutrition Decoction
for Dry Eye - New Ophthalmology 12: 1427-1430, 1995

Some forms of glaucoma are indications for Kampo
therapy. Yue Bi Decoction for Relieving Edema plus
Atractylodes, Minor Bupleurum Decoction, Poria
Powder with Five Herbs, Uncaria Powder and similar
preparations are used to lower ocular pressure.
Toshihiko Ueda treated glaucoma patients (22 patientswith primary open angle glaucoma, 5 patients withclosed angle glaucoma, 1 patient with secondary
glaucoma, 1 patient with normal pressure glaucoma
and 2 patients with ocular hypertension), in whom
control with eye lotions alone had been foundinsufficient. Over a period of 24 weeks with Minor
Bupleurum Decoction, Poria Powder with Five Herbs,
he reportedly found a significant reduction in ocularpressure5). Kinugawa et al. analyzed 7 patients
suffering from open angle glaucoma treated with Yue
Bi Decoction for Relieving Edema plus Atractylodes,
which resulted in a reduction in ocular pressure. He

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

Volume 1, Special Edition | Current Kampo Medicine 2005

reported that the ocular pressure reducing effects
started to appear at the earliest a few hours following
administration. These effects apparently continued,
and even after a treatment period of 2 years, no side
effects had been observed. Clinically, carbonic
anhydrase inhibitors are the drugs of first choice used
to achieve a reduction in ocular pressure, while Yue Bi
Decoction for Relieving Edema plus Atractylodes may
be administered as a maintenance drug6). There are alarge number of case reports pertaining to this disease.
5) Ueda T.: Effects of Minor Bupleurum Decoction, Poria Powder with Five
Herbs on Glaucoma and Ocular Hypertension, Kampo Medicine (Jap.
Journal of Oriental Medicine), 46(6): 154, 1996
6) Kinugawa K., Sato K.: A Case Where Yue Bi Decoction for Relieving Edema
plus Atractylodes was Effective in Reducing Ocular pressure in Glaucoma,
Kampo Igaku 21(10): 19-21, 1997

Uveitis is treated with steroids, but heat clearing
Kampo preparations like Gentian Liver-Purging
Decoction or Coptis Detoxificating Decoction can also
be used. Yamamoto used Coptis Detoxificating
Decoction (heat clearing formula) and blood stasis
expelling formulas (blood activating and stasis
resolving formulas) in the treatment of 23 patientswith uveitis in whom treatment in university hospitals
or similar institutions had not led to any
improvements. He sought Kampo therapy andobserved a favorable course. This author states thatthe addition of aconite root was occasionally required
for elderly patients. Kuroki et al. modified the Yang
tonifying formula Jio Inshi for the treatment ofpatients with uveitis in whom treatment with heatclearing formulas like Gentian Liver-Purging Decoction
alone did not lead to improvements. He observed an
alleviation of the ocular symptoms in three patients7).
7) Kuroki S., Son K.: There Cases in Which the Application of Yang Tonifying
Preparations was Effective for Uveitis, Kampo Medicine (Jap. Journal of
Oriental Medicine) 54: Separate Volume 248, 2003

Kampo preparations are also used for some formsof cataracts and in some cases have led to an
improvement in visual acuity. Fujihira treated 284
patients (568 eyes) with senile cataracts with Kidney
Qi Pill and reported an improvement in visual acuityin 54.6% of the patients8). Kubota treated both eyes of
6 patients with senile cataracts over a period of 3 years
with Kidney Qi Pill and reported that further progressof the cataract could be prevented9). Kidney Qi Pill,
Ginseng Decoction and Ten Strong Tonic Herbs
Decoction are also used. However, even if an
improvement in visual acuity is observed, there are nodata that would suggest any changes in theophthamologically observed degeneration of thevitreous body with a few exceptions10).
8) Fujihira K.: Treatment of Senile Cataracts with Kidney Qi Pill, Kampo
Medicine (Jap. Journal of Oriental Medicine), 24(4): 465-479, 1973
9) Kubota Y.: Treatment Results of Senile Cataracts with Kidney Qi Pill Basics and Clinics, 23(6): 2359-2540, 1989
10) Yamamoto S.: Kampo Therapy of Senile Cataracts, Current Kampo
Therapy, Journal of Kampo Medicine & Herb, 1985

For age-related macular degeneration there areexcellent western medical treatments, but occasionallyKampo therapy is also very effective. Shizuka et al.
reported cases in which treatment with Kidney Qi Pill
improved visual acuity11). However, in most cases ofthis disease an efficacy cannot be anticipated unlessdecoctions are used. Kuroki et al. prepared formulas
based on TCM theories and later published two casereports in which improvements in ocular findings wereobserved12). Various studies have been performed
dealing with macular edema (cause: branch retinal
vein occlusion = BRVO, diabetic retinopathy = DR,central serous choroidopathy = CSC etc.). Generally,
diuretic preparations like Yue Bi Decoction for
Relieving Edema plus Atractylodes or Minor

Bupleurum Decoction, Poria Powder with Five Herbs

are used for these conditions. There is cumulative
research into the use of Minor Bupleurum Decoction,
Poria Powder with Five Herbs13,14).
11) Shizuka T., Arai M. Sato H.: One Case with Age-Related Macular
Degeneration in Kidney Qi Pill induced Improvement in Visual Acuity,
Kampo Medicine (Jap. Journal of Oriental Medicine) 56: Separate Volume249, 2005
12) Kuroki S., Son K.: Two Cases of Age-Related Macular Degeneration (AMD),
Kampo Medicine (Jap. Journal of Oriental Medicine) 56: Separate Volume248, 2005
13) Iwashita K., Yamagishi K., Yuge K. et al.: Effects of Minor Bupleurum
Decoction, Poria Powder with Five Herbs on the Macular Edema of BranchRetinal Vein Occlusion, Clinical Ophthalmology, 54: 1247-1251, 2000
14) Isobe Y., Inamura M., Okada K. et al.: Clinical Effects of Minor Bupleurum
Decoction, Poria Powder with Five Herbs on Eye Diseases Associated with
Macular Edema, Pharmacology and Clinics, 3: 165-179, 1993

Retinic pigment degeneration is a hereditarydisease, but early initiation and continuous treatment
with Kampo preparations reportedly allows its
progression to slow down. Yamamoto observed atemporary normalization of the visual field and theappearance of peripheral visual field, but also statedthat the nature of the disease requires an observation
period of 20-30 years15). Fujihira published one highlyinteresting case report where Kampo therapy induced
a marked improvement in visual acuity.
15) Fujihira K.: A Case of Marked Improvement in Retinal Pigmentary
Degeneration, Journal of Traditional Sino-Japanese Medicine, SelectedCase Reports 188-189, Igaku Shuppan Center, 1984

4. Ear, Nose and Throat
Diseases in this field are indications for Kampo
therapy, frequently for chronic inflammatory andallergic diseases, but it is also used for a number ofother diseases that are often difficult to cure withwestern medicine.

Minor Bupleurum Decoction, Poria Powder with
Five Herbs is frequently used for the treatment ofstasis of the auditory tube or exudative otitis media
among the forms of otitis media and there are many
cumulative studies1,2,3). Minor Blue Dragon Decoction
and Yue Bi Decoction for Relieving Edema plus
Atractylodes are reportedly effective for the treatment

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19

Volume 1, Special Edition | Current Kampo Medicine 2005of adult diseases4). When an edema of the external
meatus of the auditory tube develops due to a common
cold, Pueraria Decoction or Minor Bupleurum
Decoction plus Cyperus and Perilla Leaf Powder canbe employed. Specialized treatment for both the acuteas well as chronic phase of purulent otitis media
should be given priority, but if required, a Kampo
combination therapy can also be used. In particular, inchronic cases that prove to be almost refractory to theordinary therapies, the application of Kampo medicine
should beattempted. Here Pueraria Decoction, Minor
Bupleurum Decoction, Major Bupleurum Decoction,
Schizonepeta and Forsythia Decoction, Cassia Twig
plus Astrgalus Decoction and similar preparations areused.
1) Nakajima T., Yanagida N., Niwa H., et al.: Therapeutic Effects of Minor
Bupleurum Decoction, Poria Powder with Five Herbs for Exudative Otitis
Media; Clinical Otorhinopharyngology 82(7): 1025-1030, 1989
2) Ito S., Hayashi N.: Clinical Experiences with Minor Bupleurum Decoction,
Poria Powder with Five Herbs for The Treatment of Exudative Otitis
Media; Prog. Med. 11: 3087-3091, 1991
3) Tanaka H.: Usefulness of Minor Bupleurum Decoction, Poria Powder with
Five Herbs for Exudative Otitis Media; Prog. Med. 15: 1451-1452, 1995
4) Inoue H.: Immediate Effectiveness of a Combination Therapy with Minor
Blue Dragon Decoction and Yue Bi Decoction for Relieving Edema plus
Atractylodes in Adult Patients With Acute Exudative Otitis Media; ClinicalOtorhinology 47(5): 361-366, 2001

Vertigo is a comparatively frequent indication for
Kampo medicines among the diseases of the inner ear.
This symptom may be the subject of a Kampo therapy
whether the symptom is central or peripheral, andpreparations are chosen depending on which of thesymptoms are to be treated. For the treatment of
Ménière's syndrome Pinellia, Largehead Atractylodes
and Tall Gastordia Decoction, Bupleurum plus
Dragon’s Bone and Oyster Shell Decoction, Tuckahoe,

Cassia Twig, Largehead Atractylodes and Licorice
Decoction and similar preparations are used.
Otherwise Uncaria Powder is used for vertigo due toinsufficient cerebral circulation; Tuckahoe, Cassia
Twig, Largehead Atractylodes and Licorice Decoction
for the treatment of orthostatic syncopes. For dizzinessin the elderly during walking North Water God
Decoction finds frequent application. There iscumulative research into the effects of Pinellia,

Largehead Atractylodes and Tall Gastordia Decoction5).
In cases of tinnitus, depending on its cause, there aremany refractory forms rendering treatment difficult.
For chronic forms of tinnitus there are cumulative
studies regarding Life-preserving Kidney-Qi Pill,
Bupleurum and Cassia Twig Decoction, Uncaria
Powder, Bupleurum plus Dragon’s Bone and Oyster
Shell Decoction and similar preparations6,7,8,9,10).

5) Kimura T., Yamanaka N., Kuki K.: Clinical Effects of Pinellia, Largehead
Atractylodes and Tall Gastordia Decoction for the Treatment of Tinnitus,
Clinics of Ear and Nose 45 (5) 443-449, 1999
6) Onishi S., Sawaki S., Tsuchiya K. et al.: Multi-center Joint Clinical Trial
Regarding the Effects of Tsumura Life-preserving Kidney-Qi Pill on
Tinnitus, Developments in Otorhinopharyngology 37(3): 371-379, 1994

207) Kida K., Ito Y., Akita S. et al.: Effects of Bupleurum and Cassia Twig
Decoction on Chronic Tinnitus, Clinics of Otorhinopharyngology,
Supplement 98: 31-34, 2001
8) Iwasaki N., Sakamoto M.: Clinical Evaluation of Uncaria Powder in theTreatment of Tinnitus, Medical Journal of the National Noborito Hospital
12: 20-23, 2001
9) Saito A.: Evaluation of the Effects of Uncaria Powder on Tinnitus Using
Headache and Hypertension as Indices, Clinics of Otorhinopharyngology,
Supplement 98: 20-30, 1998
10) Takei S., Masuno H., Ando M. et al.: 9th Kanto Conference on Kampo
Research in Otorhinolaryngology, clinical reports; clinical effects of
Bupleurum plus Dragon’s Bone and Oyster Shell Decoction on hypertension
associated with tinnitus, Prog. Med. 16(9): 2242-2245, 1996

Application of Kampo medicine appears to be ofparticular importance for viral rhinitis (common cold)
among the diseases of the nasal cavity and accessory
nasal sini. In Japan, preparations listed in the "Shang
han lun" are most frequently used. For further detailplease refer to the section on infections. The treatmentof acute inflammation of the paranasal sini follows theguidelines for the treatment of common cold. Yet,
Kampo medicine is used more often for the treatmentof chronic inflammation of the paranasal sini. Herepreparations like Pueraria Decoction, Pueraria
Decoction plus Szeshwan Lovage and Magnolia Flower,
Magnolia Flower, Lung-Clearing Decoction findapplication11,12), but when the underlying pathology
has been identified as phlegm-fluid retention,

Pinellia, Largehead Atractylodes and Tall Gastordia
Decoction or Two Vintage Herbs Decoction are also

administered.

11) Shibuya K.: Experiences with Magnolia and Lung-Clearing Decoction for
the Treatment of Refractory Chronic Inflammation of the Paranasal Sini inChildren, Prog. Med. 15: 1479-1481, 1995
12) Ito H.: Kampo Treatment of Chronic Inflammation of the Paranasal Sini.
Clinical effects of long-term administration of Pueraria Decoction plus
Szeshwan Lovage and Magnolia Flower for the treatment of chronic
inflammation of the paranasal sini in children, Prog. Med. 12: 2578-2585,
1992

Allergic rhinitis is widely treated with Minor Blue
Dragon Decoction or Ephdra, Aconite and Manchurian
Wildginger Decoction either alone or else incombination with antiallergic drugs. For year-roundtreatment of allergic rhinitis with Minor Blue Dragon
Decoction, double-blinded randomized controlled
studies (DB-RCT) showed significantly better effects
than in the control groups. Examination of the general
improvement shows a marked improvement in 12.0%of the cases, an intermediate degree of improvement in
32.6% and mild improvements in 39.1% and thus withoverall favorable results. The usefulness has received
an acceptable rating of 46.2%13). Regarding Ephdra,
Aconite and Manchurian Wildginger Decoction there issome cumulative research14). Besides the above mentioned
drugs Pueraria Decoction, Pueraria Decoction plus
Szeshwan Lovage and Magnolia Flower, Yue Bi Decoction
for Relieving Edema plus Atractylodes, Tea-Blended
Szechwan Lovage Powder, Bupleurum Cassia Twig andDried Ginger Decoction, Tuckahoe, Licorice, Dried ginger,

Magnoliavine, Manchurian wildginger herb, Pinellia
rhizoma and Apicot kernel Decoction and similar

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Volume 1, Special Edition | Current Kampo Medicine 2005

preparations are also used.
Seasonal allergic rhinitis is also treated inapproximately the same manner, but during
asymptomatic periods it is recommended to administera combination of Middle-Reinforcing and Qi-Benefiting
Decoction and Angelica and Peony Powder as apreventive medication.
13) Baba J., Takasaka T., Inamura N. et al.: Effects of Year-around Treatment
with Minor Blue Dragon Decoction on Allergic Rhinitis, single anddouble-blinded comparative studies, Clinical Otorhinopharyngology 88(3):389-405, 1995
14) Ito H., Baba J., Tkagi I. et al.: Evaluation of the Pharmacologic Effects of
Ephdra, Aconite and Manchurian Wildginger Decoction on Allergic Rhinitis
Clinical effects on nasal obstruction, Clinical Otorhinopharyngology 52:
107-118, 1991

Pharyngitis and tonsillitis are usually considered
to be caused by the intrusion of wind heat, so thatduring the early stages, Shinryo Kaihyo (xin liang jie
biao = releasing the exterior with pungent-cool)treatment principle is applied. Since most of these
diseases are bacterial infections, they are indications
for antibacterial therapy, but Kampo medicine is also
useful. For further detail please refer to the section on
infections. Regarding pharyngitis there are case series
studied using Balloon Flower Root Decoction15).
15) Tsujihisa S., Maeda S.: Experiences with the Use of Tsumura Balloon
Flower Root Decoction extract for the Treatment of Patients with Acute
Upper Respiratory Infections Complaining About Pharyngitis, Basics andClinics, 19(5): 481-485, 1985

Anomalies of the pharyngolarynx are considered to
be a form of psychosomatic disease treated in western
medicine with tranquilizers, but in refractory cases,

Combind Minor Bupleurum Decoction and Pinellia andMagnolia Decoction, Cyperus and Perilla Leaf Powder,
Pinellia and Magnolia Decoction and similar

preparations may also be used16,17). For dryness of themouth Dwarf Lilyturf Decoction, Ginseng Nutrition
Decoction, White Tiger and Ginseng Decoction etc areused18,19). These preparations are also effective forptyalolithiasis.
16) Tanino T., Takeda Y., Harada K. et al.: Experiences with Tsumura

Combind Minor Bupleurum Decoction and Pinellia and Magnolia Decoctionin Treating Abnormal Feelings of the Pharyngolarynx (from a multi-center
joint study), Prog. Med. 11: 3111-3114, 199117) Motoo Y., Taga H.: Effects of Cyperus and Perilla Leaf Powder on
Abnormal Sensations in the Pharyngolarynx Associated with Depressive
Moods, Kampo and Modern Therapy 7(3): 249-251, 1998
18) Okawa S., Shindoi N., Akagawa Y.: Clinical Effects of Ginseng Nutrition
Decoction in Patients with Dry Mouth, Prog. Med. 21: 1037-1039, 2001
19) Umino M., Nagao M., Muroga S.: Effects of White Tiger plus Ginseng
Decoction in Elderly with Dry Mouth - Analysis of the correlation between
improvement in subjective symptoms and the diagnostic pattern, Kampo
Medicine (Jap. Journal of Oriental Medicine) 45: 107-113, 1994

5. Lung
Many diseases of the respiratory tract are in daily
practice treated with Kampo medicine. The use of
Kampo medicines for the treatment of the chronic
phase of bronchial asthma has so far achieved quite
remarkable results. Since the spread of steroid
inhalants has fundamentally changed the basic
western medical therapy of asthma, Kampo

preparations are now used less frequently than in thepast. Still, since problems frequently develop in people
continuously using bronchodilators or steroids, there is
still a strong demand for Kampo preparations.
Currently, the question of how Kampo therapy ofpatients otherwise treated with the most advanced
modern western medical therapies should be employedis the subject of actively pursued research1,2).
Among the extract preparations, Minor Blue Dragon
Decoction, Ephedra, Apricot, Licorice and Gypsum
Decoction, Five Tiger Decoction, Combind Minor

Bupleurum Decoction and Pinellia and Magnolia
Decoction, Mistery Decoction, Dwarf Lilyturf Decoction
etc., are used for spleen deficiencies; Middle-Reinforcing
and Qi-Benefiting Decoction, Four Gentelmen Decoction
etc., for the elderly with kidney deficiency Kidney Qi
Pill, Ophiopogon, Schizandra and Rehmannia Pill
(Eight-immortal Pill for Longevity, which can besubstituted with a combination of the extract
preparations Dwarf Lilyturf Decoction + Six
Ingredient Pill with Rhemannia) are used. Refer to thesection on pediatric disease regarding pediatricasthma.
Cumulative research includes RCTs using

Combind Minor Bupleurum Decoction and Pinellia
and Magnolia Decoction and multi-center case series
studies3,4), both of which have achieved favorable
results. Moreover, results of multi-center case series
studies about Minor Blue Dragon Decoction showed abetter than intermediate improvement in more than
52.2% of the cases5). Also, treatment of adults sufferingfrom bronchial asthma associated with dry coughusing Dwarf Lilyturf Decoction revealed an antitussive
effect in 69.4% of the cases6).
1) Ito T.: The Role of Kampo Therapy in the Age of Steroid Inhalants, Kampo
Medicine (Jap. Journal of Oriental Medicine) 55(4): 447-453, 2004
2) Terasawa K.: Allergy and Kampo Therapy, Allergy 47 (1), 1998
3) Nakajima S., Takagi H., Tsutani Y. et al.: Examination of the Usefulness of

Combind Minor Bupleurum Decoction and Pinellia and Magnolia Decoction
Extract Fine Granules for the Treatment of Bronchial Asthma, Prog. Med.
9: 3138-3151, 1989
4) Egashira Y. and Nagano H.: A multicenter clinical trial of Combind Minor
Bupleurum Decoction and Pinellia and Magnolia Decoction in patients withsteroid-dependent bronchial asthma. Ann. NY Acad. Sci. 685: 580-583, 1993
5) Egashira Y., Yoshida M., Nagano J.: Clinical Effects of Minor Blue Dragon
Decoction on Bronchial Asthma - evaluation of a multi-facility open trial,
Kampo Medicine (Jap. Journal of Oriental Medicine). 45(4): 859-876, 1995
6) Tamaki T., Nizuma T.: Clinical Effects of Dwarf Lilyturf Decoction andAnalysis of Excretatory Components in the Urine - Antitussive effects ofDwarf Lilyturf Decoction on bronchial asthma and active principles.
Journal of the Tokyo College of Medicine and Dentistry 57(1): 23-30, 1999

There are several approaches to the treatment ofchronic obstructive pulmonary disease (COPD).
Middle-Reinforcing andClinicaltrialsusing
Qi-Benefiting Decoction extract have been performed,
but did not necessarily result in marked
improvements7). This disease is difficult to treat withextract preparations. Using decoctions, Haimoto on
the other hand, reported outstanding results8). A
number of studies deal also with pulmonary
emphysema9).

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21

Volume 1, Special Edition | Current Kampo Medicine 2005
7)

Sugiyama

Y.,

Kitamura

S.:

Effects

of

the

Kampo

Medication

Middle-Reinforcing and Qi-Benefiting Decoction in the Treatment of
COPD, Japanese Thoracic Clinics 56: 105-109, 1997
8) Haimoto H.: Treatment of Chronic Obstructive Pulmonary Disease - A
compromise between Chinese and western medical therapies, The Kampo
15(2): 46-1, 1997
9) Shimoda T., Taniguchi T. Yasuoka A.: Clinical Effects of Combind Minor
Bupleurum Decoction and Pinellia and Magnolia Decoction in theTreatment of Chronic Pulmonary Emphysema and its Influence on
Bronchial Hypersensitivity, J. Trad. Med. 8: 426-427, 1991

Bronchitis is also a good indication for Kampo.
Depending on the conditions of the cough andproperties of the sputum, many different preparations
are used. Cumulative research showed that forpatients presenting either watery sputum, wheezing or
cough, observation of the effects of Minor Blue Dragon
Decoction during DB-RCT, revealed that the observed
general improvement and improvement of individual
symptoms were both significantly better than in theplacebo groups10). Treatment of this disease requires
identification of the etiologic agent, and based on thesefindings, administration of appropriate antibacterial
drugs, but Kampo preparations are often used in
combination with those antibacterial drugs. Somestudies are emerging that focus on the observation ofvariations in pulmonary function during combination
therapy with Combind Minor Bupleurum Decoction
and Pinellia and Magnolia Decoction and macrolide
antibiotics11).
There are case series studies indicating that theuse of Pueraria Decoction Plus Szeshwan Lovage andMagnolia is effective for the treatment of theThisdiseaseissinobronchial
syndrome12,13).
characterized mainly by the symptoms of bronchitis,
but treatment of inflammation of the paranasal sini
responsible for the condition, allows consequentpursuit of improvements.
10) Miyamoto S., Inoue H., Kitamura S.: Minor Blue Dragon Decoction for theTreatment of Bronchitis - Placebo controlled double-blinded comparative
study, Clinical Pharmacology 17(8): 1189-1214, 2001
11) Tanno Y.: Kampo Therapy for Respiratory Diseases (round-tablediscussion) - Variations in pulmonary functions before and after a
combination therapy with Combind Minor Bupleurum Decoction andPinellia and Magnolia Decoction and macrolides, Kampo Medicine (Jap.
Journal of Oriental Medicine) Vol. 21, Nol 10: 6-7, 199712) Egashira Y., Ushijima M.: Effects of a Combination Treatment of theSinobronchial Syndrome (SBS), in Particular Erosive Panbronchiolitis with
Pueraria Decoction Plus Szeshwan Lovage and Magnolia, Kampo andAllergy 4: 33-41, 1990
13) Kato S., Kishiro I., Onuma N. et al.: Long-term Combination Therapy
Using Erythromycin and Pueraria Decoction Plus Szeshwan Lovage andMagnolia for the Treatment of Sinobronchial Syndrome, Breathing 17(8):919-926, 1998

Bronchiectasis, during acute exacerbations,requires modern western medical treatment, mainly
using antibiotics, but during the chronic phase it is acomparatively good indication for Kampo therapy.
Lung-Clearing Decoction, Yin Nourishing Realtreasure Decoction, Tuckahoe, Licorice, Dried giner,

Magnoliavine, Manchurian wildginger herb, Pinellia
rhizoma and Apicot kernel Decoction have been used

for the treatment.
Among the pulmonary infections, community-acquired
22

pneumonia is currently treated primarily with modern
western medicine. However, Kampo therapy has beenused so frequently, that it has actually controlled thesurvival prognosis. Accordingly, there have been manystudies and combination therapies are still employed
today. Thus, administration of antibacterial agents still
represents the basics and Kampo medicine should not
be the treatment of first choice.
Hospital acquired pneumonia develops based on amultitude of different factors and while it is generally
not possible to provide a specific therapy, the condition
is usually marked by a decrease in immune function
associated with a high likelihood of infections. Under
these circumstances either only Qi tonifying or else
both Qi and Blood tonifying preparations like
Middle-Reinforcing and Qi-Benefiting Decoction or
Ginseng Nutrition Decoction are used. In cases of
MRSA infections, or infections with non-specificacidophilic bacteria, effectiveness of antibacterial
agents may hardly be expected and the same holds true
for chronic infections of the lungs.
Ideopathic fibrotic interstitial pneumonia is a groupof several disease entities. Except in a small number of
exceptions, all of these forms are exceedingly difficult totreat. While that is so, there are a number of casereports dealing with Kampo medicine. Ito reported thatmild cases of interstitial pneumonia can be treated with
Kampo14). Preparations used so far in published cases
include representative items like Minor Bupleurum
Decoction, Cassia Twig Decoction plus Atractylodes andAconite, Bupleurum Cassia Twig and Dried Ginger
Decoction, Kidney Qi Pill, Tuckahoe, Apricot Seed andLicorica Decoction etc. Several valuable case reports
have been published by Honma and also have been
described in the introduction15).
14) Ito T.: Kampo Therapy for Respiratory Diseases, Kampo Medicine (Jap.
Journal of Oriental Medicine) 54: 29-46, 2003
15) Honma Y.: Kampo Medical Treatment under Health Insurance,
Respiratory Division (26), Ideopathy Interstitial Pneumonia (IIP) 29:
562-563, 1993

Note:
It is known that several Kampo preparations may
induce drug interstitial pneumonia. Since 1992 several
cases of drug interstitial pneumonia due to Minor
Bupuleurum Dragon Decoction have been reported.
Statistically the condition occurs in about 4 out of
10,000 people. Considering that the incidence ofinterstitial pneumonia caused by the use of interferon inpatients with chronic hepatitis is 25 times higher, thisrate does not seem to be so high. Being completely
different in nature from the interstitial pneumonia
described in the main body of this text, this condition
can be diagnosed early based on subjective symptoms
and chest x-rays and discontinuing the offending drugat that time will lead to recovery. In severe cases
treatment with steroids may be required, but thedisease will basically run a benign course.

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Volume 1, Special Edition | Current Kampo Medicine 2005

6. Heart
In traditional Kampo medicine there is no concept
for blood pressure. Congestive heart failure is viewed
as a form of edema, while coronary artery diseases aredescribed as Kyohi (xiong bi = chest qi-blockage) andclassified and treated under different entities. Only
recently these symptoms have been summarized as
circulatory diseases. Following the progress in modern
medicine therapies, Kampo medicine is also
developing.
The incidence of coronary artery diseases, thatused to be rather low in Japan, is continuously
increasing in association with the westernization ofdiet and life style.
Some forms of angina pectoris are an indication for
Kampo medicine. The prognosis of patients withangina pectoris in Japan, compared to the prognosis of
the same disease in America, is comparatively goodand patients accordingly can be managed mostly on
ordinary pharmacotherapy. Yet, often there are also
indications for percutaneous transluminal coronary
angioplasty (PTCA) or coronary artery bypass grafts(CABG). The frequency of both of these procedures isrising. The use of Kampo medicine is restricted topatients managed by pharmacotherapy. In particular,
the use of Kampo preparations for effort angina
requires a sufficiently thorough diagnosis. Conversely,
Kampo medicine for atypical angina caused by
vascular spasms is often rather effective and therefore
warrants a try more than in patients with effort
angina1). However, in these cases treatment withextracts proves to be difficult, so that decoctions areused. There are a number of case reports2). Japanesepeople often present the indications for phlegm
dispelling preparations like Trichosanthes Fruit,
Chinese Chive and Pinellia Decoction, while blood
activating and stasis resolving preparations are notrequired as much as in China. Otherwise, Bupleurum
plus Dragon’s Bone and Oyster Shell Decoction, Coptis
Detoxificating Decoction, Bupleurum Cassia Twig andDried Ginger Decoction, Angelica Decoction andsimilar preparations are also used. During the acutephase of a myocardial infarct, Kampo therapy iscontraindicated.
After
initiating
rehabilitation
following the acute phase, however, Kampo therapy is
employed in order to improve the general conditionand prevent recurrences3).
1) Haimoto H.: Traditional Chinese Medical Therapeutic Effects on Angina
Pectoris and Coronary Angiographic Findings - from a standpoint offunctional and structural diseases, The Kampo 15(1): 7-16, 1997
2) Kimura H., Furuta K., Mitsuma T.: Major Sinking Into the Chest Decoction
for the Treatment of Microvascular Angina Pectoris - Clinical experiences,
Kampo Medicine (Jap. Journal of Oriental Medicine) 54(5): 945-950, 2003
3) Sato Y.: Ischemic Heart Diseases and Rehabilitation: Kampo and Advanced
Therapies 4(4): 361-365, 1995

Disorders of the pulse rate are classified as rhythm
disorders, i.e., some forms of arrhythmia are
indications for Kampo therapy. The medication varies

depending on the pathology. The classification into
Kampo types and the names of western medical
diagnoses do not necessarily match, but generally
Pinellia and Magnolia Decoction, Cassia Twig plus
Dragon’s Bone and Oyster Shell Decoction, Roasted
Licorice Decoction, Bupleurum plus Dragon’s Bone andOyster Shell Decoction, Bupleurum Cassia Twig andDried Ginger Decoction and similar preparations areoften used for paroxysmal supraventricular tachycardia
and Roasted Licorice Decoction for the treatment ofventricular extrasystoles. There are cumulative studies
regarding the use of Bupleurum plus Dragon’s Bone andOyster Shell Decoction4).
4) Konnai K., Munakata M., Sato A.: Clinical Effects of Bupleurum plus
Dragon’s Bone and Oyster Shell Decoction on Tachycardia Developing
during Administration of Ritodrine Hydrochloride, Obstetrics andGynecology 65(12): 1767-1770, 1997

Among the forms of heart failure, the acute phase ofcongestive heart failure is principally an indication fortreatment with modern medicine using diuretics andcardiotonic agents. Among the case reports where Kampo
medicine had been used, there are occasional examples,
where its use caused a remarkable improvement.
Extracts are indicated for the chronic phases, causing
improvement of mild congestive heart failure.
Preparations used include Fourstaman Stephania
Decoction, Roasted Licorice Decoction, Kidney Qi Pill,
North Water God Decoction5,6,7).
Congestive heart failure5) Yakubo S., Kinoshita Y. et al.: Clinical evaluation of Fourstaman Stephania
Decoction(Mu-fang-Yi-Tang): A Japanese and Chinese traditional
medicine for heart failure, J. Trad. Med. 19: 159-163, 2002
6) Ebe Y..: Treatment of Senile Heart Failure with Modifications of North
Water God Decoction - 30th Japan Oriental Medicine Conference,
Chu-Shikoku Branch General Assembly at the Tottori Conference 2001
(presentation)7) Katayose H., Shirato K.: Experiences with North Water God Decoction for
the Treatment of Patients with Severe Heart Failure Associated with
Marked Atrial Blocks - 52nd General Assembly of the Japan Society for
Oriental Medicine 2001 (presentation)

7. Systemic Hypertension
The first choice of treatment for hypertension is
life
style
guidanceandadministrationofantihypertensive drugs. In Japan there is no notion oftrying to control high blood pressure by Kampo
medicine alone. Although many case reports show thata successful reduction in blood pressure had beenachieved with the administration of Kampo
preparations alone, Kampo medicines are notconsidered to have a more reliable effect than diuretics,
ACE inhibitors, ARB, calcium antagonists, β-blockers,
α-blockers and similar preparations. Two cumulative
studies deal with Uncaria Powder1,2). Both systolic anddiastolic effects were observed. In actual clinicalpractice Uncaria Powder is widely used and attempts
have been made to increase the antihypertensive effectby adding Uncaria Powder to this extract
preparation3).
This preparation acts by pacifying the liver andsubduing yang in conditions marked by ascendant

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hyperactivity of liver yang, which is a condition inmodern hypertensives. Several reports describe theuse of preparations for other pathologic conditions
such as the use of Pinellia, Largehead Atractylodes andTall Gastordia Decoction for congestions and excess of
Barbary
Wolfberry,phlegm-dampness,andChrysanthemum and Rehmannia Pill or Kidney Qi
Pill for liver and kidney deficiency4,5,6,7,8,9).
Generally,
Kampo
medicinesarenotantihypertensives per se, but can be used for andappear to be useful for, associated symptoms.
Frequently used extract preparations include among
others, Major Bupleurum Decoction, Coptis Detoxificating
Decoction, Three Huang Heart-Clearing Decoction withThree yellow color Herbs, Bupleurum plus Dragon’s Boneand Oyster Shell Decoction, Divaricate Saposhnikovia
Miraculous Powder, Seven Herbs Decoction for
Hypertension and similar preparations.
1) Nagata K., Hara K., Kinoshita T. et al.: QOL in Hypertension and the
Effects of Uncaria Powder, J. Trad. Med. 8: 252-253, 1991
2) Nagata K., Okamoto A., Kamano Y. et al.: Treatment of Hypertension with
Uncaria Powder and QOL, J. Trad. Med. 6: 426-427, 1989
3) Bando S.: Practice of Kampo Therapy Based on Disease Names, Medical
Yukon, 2004
4) Ogawa I.: Effectiveness of Bupleurum plus Dragon’s Bone and Oyster Shell
Decoction for the Treatment of Hypertension, Kampo Therapy 12, 1993
5) Sasaki A., Matsunaga A., Kusuda M. et al.: Effects of Major Bupleurum
Decoction and Uncaria Powder on Essential Hypertension, Clinics andResearch 70: 269-279, 1995
6) Ishikawa T., Umemura S.: Special: Strategies of Hypertension Therapies Oriental medial therapies for hypertension, Therapy 82(4): 1367-1372, 2000
7) Arakawa K., Saruta T., Abe K. et al.: Double-Blinded Controlled Study of
the Effects of Coptis Detoxificating Decoction on Accessory Symptoms ofHypertension, Clinics and Research 80(2): 354-372, 2003
8) Horino M.: Effects of Three Huang Heart-Clearing Decoction with Threeyellow color Herbs on Hypertension, Kampo Medicine (Jap. Journal of
Oriental Medicine) 53(1-2): 41-46, 2002
9) Katayose H.: Experiences with Bupleurum plus Dragon’s Bone and Oyster
Shell Decoction in the Cardiovascular in Ambulatory Practice, Kampo
Medicine (Jap. Journal of Oriental Medicine) 52(1): 25-38, 2001

8. Blood Vessels and Lymphatics
Most of obstructive arterial diseases are caused byatherosclerotic changes, but there is almost no clinicalresearch pertaining to the mechanism of action of
Kampo medicine on this etiologic factor. Yet, a
substantial amount of basic research has been
performed. For example, treatment of rabbits withexperimental models of atherosclerosis using

Bupleurum plus Dragon’s Bone and Oyster Shell
Decoction, showed that the treatment was reportedly
able to prevent disturbances of vascularization andsome other effects1).

1) Hasegawa M.: Antiatherosclerotic Modes of Action of Kampo Preparations
and their Effects, Prog. Med., 15: 131-140, 1995

Regarding obstructive arterial diseases of the lower
extremities, there is considerable experience pertaining
to the treatment of intermittent claudication in patientswith arteriosclerosis obliterans. Currently, mainly blood
activating and stasis resolving preparations areadministered, but kidney deficiency due to aging or

24

rheum turbidity, heat toxins also occur, so that it isoften not possible to treat these conditions simply
using the blood activation and stasis resolving
principle. Widely used extract preparations include

Evodia, Fresh Ginger plus Chinese Angelica Cold Limbs
Decoction, Cassia Twig and Tuckahoe Pill,
Channels-Dredging and Blood-Activating Decoction,
Szechwan Lovage andAngelica Decoction forRegulating Blood Flow, Kidney Qi Pill etc.2,3,4,5). The
pathology of Buerger's disease may be different, but
treatment principles are similar6). Evodia, Fresh
Ginger plus Chinese Angelica Cold Limbs Decoction isoften used for Raynaud's disease and there are
relevant case series studies7).
2) Takahashi K., Sugano M., Totsuka O. et al.: Patients Treated with
Channels-Dredging and Blood-Activating Decoction Plus Coix Seed forArteriosclerosis Obliterans, Kanto Koshin Etsu Branch of the Japan Societyof Oriental Medicine, 1999 Sectional Meeting in Gunma Prefecture(presentation)3) OikawaO., Fujiki N., Matsumoto A. et al.: Attempts at Treating
Arteriosclerosis Obliterans (ASO) Induced Chronic Pain of the Lower
Extremities with Combination Therapy - Autogenic Training and Kampo(Peony and Licorice Decoction and Cassia Twig Decoction plus Atractylodes
and Aconite) - 35th General Conference of the Japan Society of Oriental
Psychosomatic Medicine in 1999 (presentation)4) Ide Y., Sekiyama H., Kitamura M. et al.: Three Patients withArteriosclerosis Obliterans Successfully Treated with Kampo Medicine,
Journal of the Japanese Pain Clinic Society 5(3): 327, 1998
5) Kaneki M.: Practical Application of Japanese Kampo Medicine for theTreatment of Arteriosclerosis Obliterans, Three cases, Kampo Medicine(Jap. Journal of Oriental Medicine) 47(6): 150, 1997
6) Kubo T.: Case Report of a Patient Following Quadruple Amputations due to
Buerger's disease with Refractory Pain Treated with Life-preserving
Kidney-Qi Pill, Hokkaido Study Group for Kampo Treatment of Elderly
Patients, 7th Conference 1998 (presentation)7) Kaneuchi H.: Comparison of Raynaud's Phenomenon in Patients with
Connective Tissue Diseases and Thermographically Observed Skin
Temperature - Pharmacologic Evaluation of Evodia, Fresh Ginger plus
Chinese Angelica Cold Limbs Decoction, Summaries from the Public
Toyooka Hospital 11: 69-76, 1999

Orthostatic hypotension is a good indication for
Kampo therapy. Here Tuckahoe, Cassia Twig,
Largehead Atractylodes and Licorice Decoction, Poria
Powder with Five Herbs and similar preparations areused8,9). Controlled clinical trials regarding thetreatment of diabetics with orthostatic hypotension
using Poria Powder with Five Herbs have beenreported and demonstrated good results10). Moreover,
North Water God Decoction, Pinellia, Largehead
Atractylodes and Tall Gastordia Decoction and similar
preparations have also been used for the treatment ofhypotension.
8) Shiotani Y., Shintani T., Fujinaga H. et al.: Discussion of the Modes of
Action of Tuckahoe, Cassia Twig, Largehead Atractylodes and Licorice
Decoction and its Clinical Application, Kampo Medicine (Jap. Journal of
Oriental Medicine) 50(1): 21-28, 1999
9) Shibahara N., Goto H., Kita T. et al.: Two Cases of Orthostatic Hypotension
Where the Use of Tuckahoe, Cassia Twig, Largehead Atractylodes andLicorice Decoction was Effective - a discussion, Kampo Medicine (Jap.
Journal of Oriental Medicine) 53(6): 244
10) Nakamura H., Nakamura T., Nakagawa T. et al.: Effects of Poria Powder
with Five Herbs on Orthostatic Hypotension in Diabetics, Diabetes Frontier
11: 561-563, 2000

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9. Blood
In TCM there are such concepts as blood deficiency
and blood stasis. Although they do somewhat resemble
hematologic diseases like anemia or congestion as they
are understood in modern medicine, they are inpractice different concepts. Accordingly, when treating
diseases of the blood with Kampo medicine, anintegration of these traditional and modern medical
concepts has to be achieved.
For the treatment of diseases that can be treatedwith current medical methods, there is little use of
Kampo medicine, but in cases where standard
therapeutic methods cannot be established, they may
have their practical application. Aplastic anemia or
idiopathic thrombocytopenic purpura (ITP) are
examples.
Anemia may have many causes and therapy
depends on the relevant cause. Iron deficiency anemia
is treated using preparations with added iron powder,but currently iron can also be administered orally or
intravenously, so that former methods have now
become redundant. Thus, with the progress of modern
medicine, Kampo medicine in this field is used only
under special circumstances.
For example, if substantial blood loss isanticipated during major surgeries, autologous blood issometimes collected prior to surgery and thus
artificially induces anemia. Under these circumstances
attempts have been made to achieve an early recovery
through treatment with Kampo medicine1,2).
Regarding leukemia and other myeloproliferative
disorders, modern medical therapies are given priority.
There is only a limited number of reports about
treating these disorders with Kampo medicine. The
same applies to lymphomas.
Idiopathic thrombocytopenic purpura (ITP) is nottreated easily with Kampo medicine, but there areexamples where Back to the Spleen Decoction,
Modified Back to the Spleen Decoction, Bupleurumand Cassia Twig Decoction have led to favorable
changes3). This applies also to aplastic anemia or theosteomyelodysplastic syndrome for which there aresome cumulative studies4,5).
1) Aoe H., Matsuo T., Ebisutani M. et al.: Effects of Ten Strong Tonic Herbs
Decoction on Presurgical Autologous Blood Pooling in Cancer Patients,
Progress in Obstetrics and Gynecology 17: 67-71, 2000
2) Aoe H., Sumida Y., Takada K. et al.: Effects of a Combination Therapy with
Erythropoetin Preparations and Ginseng Nutrition Decoction on
Presurgical Autologous Blood Pooling, Progress in Obstetrics andGynecology 15: 67-71, 1998
3) Sakuragawa N., Yasunaga K., Nomura T. et al.: Multi-center Clinical
Evaluation of TJ-137 (Modified Back to the Spleen Decoction) for theTreatment of Idiopathic Thrombocytopenic Purpura (ITP), Clinics andResearch 70(11): 3711-3718, 1993
4) Miyazaki T., Uchino H., Kimura I. et al.: Clinical Usefulness of EK108,
Ginseng Nutrition Decoction, for the Treatment of Aplastic Anemia,
Clinical Medicine and Pharmacology 10(11): 2591-2603, 1994
5) Miyazaki T., Uchino H., Kimura I. et al.: Clinical Usefulness of Ginseng
Nutrition Decoction for the Treatment of Osteomyelodysplastic Syndrome,
Clinical Medicine and Pharmacology 10(11): 2575-2590, 1994

10. Alimentary Tract
Diseases in this field are extremely common indaily life and an enormous variety of Kampo medicines
are provided for their treatment. An abundance of
preparations are used that allow minute responses.
Among the forms of dyspepsia, functional
indigestion is a good indication for Kampo therapy. For
symptoms like pain or discomfort mainly in the upper
abdominal region (upper abdominal distention,
burning sensation, tympanism, yawning, nausea,
retching, vomiting) the use of Kampo medicines should
be considered, because they may be more useful thanfor other symptoms. Frequently used preparations
include Pinellia Heart-Purging Decoction, Coptis
Decoction, Bupleurum and Cassia Twig Decoction,
Stomach-Calming Powder, Stomach-Calming Powder,
Middle-Soothing Powder, Tuckahoe Decoction,
Ginseng Decoction etc. Many reports deal with NUD
and there are relevant cumulative studies1). Available
data suggest that the preparation Six Gentlemen
Decoction facilitates the excretory function of thestomach and a number of studies revealed theeffectiveness of this preparation2,3,4,5). Not restricted tothese preparations, there are also a number of otherformulas for indefinite complaints of the upper
abdomen. In particular, Stomach-Calming Powder
suits the physical disposition of the Japanese, who areeasily affected by dampness, and for people who areexposed to cold, Middle-Soothing Powder is afrequently used formula. For the above describedreasons these two formulas are widely used as OTC
preparations.
1) Muraki T., Sugiyama M.: Kampo Therapy of NUD (Non-Ulcer Dyspepsia) Discourse on Kampo preparations - New Drugs and Clinics 46(4): 433-437, 1997
2) Harasawa S., Miyoshi A., Miwa T. et al.: Postmarketing Multi-Facility Joint
Clinical Trial on the Effects of Six Gentlemen Decoction on Dysmotility
Type Indefinite Complaints of the Upper Abdomen - intergroup comparisonin double-blinded groups, Progress in Medicine 187(3): 207-229, 1998
3) Miyoshi A., Yachi A., Masamune O. et al.: Clinical Effects of Six Gentlemen
Decoction on Indefinite Gastrointestinal Symptoms like Chronic Gastritis Multi-Facility Comparative Trial Using Cisapride as Control, Prog. Med.
11: 1605-1631, 1991
4) Hamamoto T., Kadohara M., Yoshimura T. et al.: Multi-Facility Clinical
Evaluation of Six Gentlemen Decoction for Indefinite Complaints of theUpper Abdomen, Clinics and Research 71(7): 1888-1894, 1994
5) Sato J., Shima H., Asaki S. et al.: Multi-Facility Clinical Evaluation of Six
Gentlemen Decoction for Chronic Gastritis Associated with Indefinite
Complaints of the Upper Abdomen, Prog. Med. 11: 1633-1645, 1991

While Kampo medicine provides a variety of
formulas for the treatment of constipation, it attempts
to regulate intestinal function without using laxatives
to improve bowel movements. For conditions requiring
the use of laxatives, Formula include Rhubarb, inparticular Rhubarb and Licorice Decoction, isfrequently used6). This is a very simple preparation
combining only the crude drugs Daio (rhubarb root)and Kanzo (licorice root) that is mild and regularly
used by many people in whom constipation is not
associated with abdominal pain. For scybalum Hemp
Seed Pill with its "moistening the intestines to loosen

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Volume 1, Special Edition | Current Kampo Medicine 2005

the bowel" action is used, a condition particularly frequentin the elderly with an accordingly high demand7).
Conversely, Minor Middle-Strengthening Decoction or
Major
Middle-Strengthening
Decoctionarepreparations lacking any laxatives and therefore serve
to regulate intestinal function.

11) Namiki M., Yachi A., Yoshida Y. et al.: Investigation into the Usefulness ofThree Huang Heart-Clearing Decoction with Three yellow color Herbs andCoptis Detoxificating Decoction for the Treatment of Gastritis or Peptic
Ulcer, Clinics and Research 71: 1585-1597, 1994
12) Watanabe H.: Examination of Maintenance Therapy for Peptic Ulcer Using a
Combination with Kampo Medicine, Kampo Igaku, Vol. 19, No.1: 6-7, 1994
13) Haimoto H.: Isolated Kampo Therapy for the Acute Phase of
Gastroduodenal Ulcer 3(1): 4-6, 2001

6) Miyoshi A., Masamune O., Fukutomi H. et al.: Clinical Effects of Rhubarb
and Licorice Decoction According to New Evaluation Criteria, Alimentary
System 22: 314-328, 1996
7) Sato H.: Elderly and Kampo (constipation, diarrhea, loss of appetite, gastricdistention), Kampo and advanced therapies for disorders of the alimentarytract 2(1): 15-18, 1993

Irritable bowel syndrome in Japan is exceedingly
frequent, found in about 35% of outpatients visiting
departments of gastrointestinal diseases. This disease,
being a sort of psychosomatic disease, may not be easily
resolved by using Kampo medicine, but is generally
considered to be a good indication for frequently usedpreparations like Pinellia Heart-Purging Decoction or
Cassia Twig Decoction plus Peony. Classified by types
Ginseng Decoction, North Water God Decoction,
Ginseng, Poria and Atractylodes Macrocephala Powder,Open the Spleen Decoction and similar preparations
are used for the treatment of the diarrhetic type, while
for the constipation type Modified Merry Life Powder,
Rhubarb and Licorice Decoction, Hemp Seed Pill,
Cassia Twig Decoction plus Piony and Rhubarb areused. For a form characterized by alternating
constipation and diarrhea Cassia Twig Decoction plus
Peony, Cold Limbs Powder, Important Formula for
Painful Diarrhea and the like are used, but for the gas
type associated with abdominal pain Areca Seed
Decoction with Nine Herbs or Cyperus and Perilla Leaf
Powder is used. There is an extremely large number ofcase reports, and for Cassia Twig Decoction plus Peony,
Stomach-Calming Powder and Cyperus and Perilla
Leaf Powder also cumulative studies14,15,16,17).

Among the forms of diarrhea, acute diarrhea isprincipally an indication for western medical
treatment. Poria Powder with Five Herbs is very
effective for the treatment of rota virus induced acutegastroenteritis, so that this is an often selected
preparation8). This applies also to Norwalk virus
induced conditions. Most of the chronic forms ofdiarrhea are non-inflammatory and among these asubstantial portion is considered to be due to irritablebowel syndrome (IBS). The treatment of IBS conforms
to that of diarrhea. Crohn's disease and ulcerative
colitis will be discussed later.
8) Hashimoto H.: Comparative Study of Applications of Poria Powder with
Five Herbs and Minor Bupleurum Decoction, Poria Powder with Five Herbs
Applied as Enemas as Treatment for Pediatric Viral Gastroenteritis
Associated with Vomiting, Kampo Igaku 25: 73-75, 2001

Among the diseases of the stomach and duodenum,
H. pylori induced gastritis can now be relieved due tothe advances in antibacterial therapies, so that therole of Kampo medicine has declined in this field. Yet,
Kampo preparations are still used as a first choicetreatment for this disease. The prescriptions match
those described above for indigestion. For Pinellia
Heart-Purging Decoction there are some cumulative
studies9). Six Gentlemen Decoction is used forendoscopically confirmed erosive gastritis and hasreportedly been associated with a 92.9% ratio of better
than mild improvement10).
9) MiyoshiA., Murohisa B., Kitagawa M. et al.: Examination of the Usefulnessof Kanebo's Pinellia Heart-Purging Decoction for the Treatment of Gastritis(Acute Gastritis, Acute Exacerbations of Chronic Gastritis), Prog. Med. 13:
1627-1632, 199310) Makino S., Yasutake K., Irie K. et al.: Effects of Six Gentlemen Decoction
on Verrucose Gastritis, Kampo Igaku Vol. 20, No. 6: 17-21, 1996

Currently H 2 -blocker and proton pump inhibitors
are available for the treatment of gastroduodenal
ulcers, so that Kampo medicine is used only in a
supplementary function. Regarding the use of Three

Huang Heart-Clearing Decoction with Three yellow
color Herbs and Coptis Detoxificating Decoction there

are cumulative studies11). Moreover, Kampo medicine
is also administered in patients in whom peptic ulcers
have healed, in order to prevent their recurrence andreportedly have been proven to be useful12). Also, anumber of case reports showed that Kampo therapy
was effective, when modern medications could not be
used for one reason or other13).
2614) Sasaki D., Uehara A., Hiwatashi N. et al.: Clinical Effects of Cassia Twig
Decoction plus Peony on Imitable Bowel Syndrome, Clinics and Research
75: 1136-1152, 199815) Mizuno S., Nagata K., Yoshida K. et al.: Therapeutic Effects of Cassia Twig
Decoction plus Peony on Imitable Bowel Syndrome, Diagnosis and Therapy
73: 1143-1152, 1985
16) Tokutomi K.: Results of Using Stomach-Calming Powder for Imitable
Bowel Syndrome, Kampo and Clinics 43: 1187-1194, 199617) Shiramine K., Hisamura M., Akita K. et al.: Effects of Cyperus and Perilla
Leaf Powder on Gas Type Irritable Bowel Syndrome, Kampo Igaku Vol. 23,
No. 2, 1999

Crohn's disease is an intractable condition forwhich there is a small number of valuable casereports18). Treatment is not aimed directly at thisdisease, but rather at the symptoms of ileus that may
be caused by it and the available cumulative research
revealed its usefulness19).
18) Kogure T., Shimada Y., Tosa H. et al.: A Patient with Recurrent Crohn's
Disease in whom Treatment with Japanese Kampo Medicine Proved to beHighly Effective, Kampo Medicine (Jap. Journal of Oriental Medicine)19) Takazoe M., Yamauchi H.: Attempt at Medical Treatment of Symptoms ofIleus in Crohn's Disease: Usefulness of Major Middle-Strengthening
Decoction, Research Team for the Investigation of Refractory Inflammatory
Intestinal Disorders, 1997 Research Report: 137-141, 1998

Ulcerative colitis responds well to treatment with
Kampo medicine and numerous studies have been

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

Volume 1, Special Edition | Current Kampo Medicine 2005

performed20,21). In mild cases Kampo may be used
independently, but in intermediately to severe cases
Kampo is administered in the form of a combination
therapy with salazopirine or steroids. Used extracts
include Cassia Twig Decoction plus Peony, Cassia Twig
Decoction plus Piony and Rhubarb, Minor Bupleurum
Decoction, Poria Powder with Five Herbs, Bupleurumand Cassia Twig Decoction, Scutellaria Decoction,

pain associated with spasms of the internal sphincter
muscle of the anus, Peony and Licorice Decoction isadministered and, according to a number of studies,
produced favorable results30). Moreover, for thetreatment of incarceration of hemorrhoids Ephedra,
Apricot, Licorice and Gypsum Decoction is used andoccasionally has produced dramatic results, but thisusage is peculiar to Japan.

preparations; but for serious therapy, decoctions are
required. There is cumulative research regarding28) Yoshio T., Ynagida K., Sumiyama Y. et al.: Clinical Effects of ”B”Character
Decoction on Internal Hemorrhoids, New Drugs and Clinics 40: 2087-2096
29) Honda T. et al.: Women and Hemorrhoidal Diseases, No. 4 - Effects of
Kampo (”B” Character Decoction) - Maternal Hygiene Vol. 31, No. 1, 1990
30) Endo T.: Clinical Results of the Application of Peony and Licorice Decoction
for Pain Associated with Spasms of the Internal Sphincter Muscle of Anus
Due to Anal Laceration, New Drugs and Clinics 49: 712-719, 2000

Szechwan Lovage Rhizoma, Angelica Root, Ass-hide
Glue and Argy Womwwod Leaf Decoction and similar
Minor Bupleurum Decoction, Poria Powder with Five
Herbs22,23).

20) Matsuike T., Suzuki Y., Nozawa H. et al.: Significance of Kampo Therapy
for the Treatment of Ulcerative Colitis, Prog. Med. 19(4): 879-885, 199921) Takahashi T.: Kampo Therapy for Inflammatory Bowel Diseases(Ulcerative Colitis, Crohn's Disease), Kampo and Advanced Therapies 5(3):225-229, 199622) Suzuki Y., Matsuike T., Nozawa H. et al.: Indications for and Limitations of
Minor Bupleurum Decoction, Poria Powder with Five Herbs in theTreatment of Ulcerative Colitis, Current Medicine 11: 132-136, 199623) Okubo A., Masuda H., Hayashi N. et al.: Experiences with the Use of
Kampo Therapy (Minor Bupleurum Decoction, Poria Powder with Five
Herbs) for Ulcerative Colitis, Medical Journal of Nippon University 55:
286-289, 1996

Kampo medicines are also useful in the field of
abdominal surgery. There is cumulative research
regarding the use of Major Middle-Strengthening
Decoction for the treatment of Ileus caused byabdominal surgery24,25,26,27). Moreover, in a departmentof abdominal surgery, Major Middle-Strengthening
Decoction was administered to facilitate the recovery
of intestinal peristaltic, which resulted in a shorteningof the hospital stay by several days. Consequently, thisis useful in improving cost efficiency.
Kubo N., Uchida Y., Akiyoshi T. et al.: Effects of Major
Middle-Strengthening Decoction on Ileus - Multi-facility study, Prog. Med.

24)

15 (9): 1962-1967, 1995
25) Yokota H., Kobayashi H., Kasamaki S. et al.: Research into the Preventionof Postsurgical Adhesive Ileus, Japan Medical News 3986: 16-18, 2000
26) Sugiyama M.: Investigation of the Usefulness of Major
Middle-Strengthening Decoction for Postsurgical Adhesive Ileus, Prog. Med.
12: 1668-1372, 1992
27) Furukawa Y., Kawasaki N., Hanyu N.: Effects of Major
Middle-Strengthening Decoction on Ileus Following Surgery of Alimentary
Tract - Basics and Clinics - Kampo and Advanced Therapies 12(3): 235-241,
2003

Among the diseases of the anus, hemorrhoids andhemorrhoidal bleeding are indications for Kampo
therapy. For hemorrhoids, the preparation ”B”
Character Decoction, developed in the 19th century bya Japanese physician, is widely used and there are
relevant cumulative studies28). Clinically, dependingon the pathologic condition, this is frequently
combined with 'activating blood and resolving stasis’,‘'clearing heat and removing toxins’, ‘Qi tonifying’ and‘upraising’ preparations. In puerperal women,
attention has to be paid to hemorrhoids that do not
improve within one month following delivery. Some
cumulative studies show the results of the applicationof this preparation in such patients29). Conversely, for

11. Liver, Biliary Tract and Pancreas
Among the lesions of the liver, those associatedwith icterus used to be major indications for thistherapy for diseases like acute hepatitis A and the
below described lesions of the gallbladder. Beside these
conditions, the final stage of hepatocytic damage livercirrhosis and a number of complicating conditions
were the subject of initial therapeutic attempts. Since
therapeutic interventions during the early stages ofchronic hepatitis recently became possible, and in
conjunction with the progressive clarification of the"state of disease" even for other forms of liver diseases,
Kampo therapies using Kampo preparations have beendeveloped. Kampo medicine is frequently used forchronic viral hepatitis, regardless of whether this is
hepatitis B or C. Some DB-RCT studies examined theuse of Minor Bupleurum Decoction for the treatment of
hepatitis B and reportedly achieved significantly
better results than in the control groups1). Yet, many
physicians do not consider Minor Bupleurum
Decoction to be the ideal preparation and administer it
rather as a decoction that can be freely modified2,3,4,5,6).
The other comparatively frequently used extracts
include Modified Merry Life Powder, Minor

Bupleurum Decoction plus Cassia Twig and Tuckahoe
Pill, Bupleurum and Cassia Twig Decoction,
Bupleurum Cassia Twig and Dried Ginger Decoction

and similar preparations. A number of physicians havepointed out that histologically the morphology ofhepatitis C differs from that of hepatitis B, and viewed
from the standpoint of Kampo medicine, deficiency
patterns are more frequent; so that prescriptions varyfrom those applied for hepatitis B. Middle-Reinforcing
and Qi-Benefiting Decoction, Summer Heat-Clearing
and Qi-Benefiting Decoction, Six Gentlemen Decoction
and similar spleen and stomach tonifying preparations
are used7,8,9). Recently, combination therapies using
PEG-interferon and ribavirin have become thestandard therapy, but available data indicate that afurther combination with Kampo medicines achieves
better results. There are cumulative studies dealing
with interferon combination therapies. Moreover,regarding transition from hepatitis C to liver cirrhosis
following an interferon therapy, a number of excellent

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studies show significantly better effects than forordinary liver protective drugs10).
1) Mizuta M., Murata K., Morimoto T. et al.: Evaluation of Minor Bupleurum
Decoction for the Treatment of Chronic Hepatitis - Investigation Using
Single and Double Blinded Studies - Liver, Gallbladder, Pancreas 12(1):155-168, 1986
2) Fujiwara K., Mochida S.: Kampo Therapy for Diseases of the Liver,
Gallbladder and Pancreas - Kampo therapy for viral hepatitis - Kampo andAdvanced Therapy 5(3): 240-246, 1996
3) Itoh T.: Effect of Kampo Treatment on chronic viral hepatitis on the basis of
traditional diagnosis, Journal of Traditional Medicines 16（1）: 7-14, 1999
4) Nakada K., Furue M., Takakuwa H. et al.: Kampo Therapy for Chronic
Liver Disorders, Japanese Oriental Medical Journal 33(3): 25, 1983
5) Baba H.: Effects of Modified Merry Life Powder in the Treatment of Chronic
Hepatitis, Kampo Medicine (Jap. Journal of Oriental Medicine) 33(4): 29-34,
1983
6) Haimoto H.: New Traditional Chinese Medical Therapies for Chronic Active
Hepatitis - Pilot study dealing with detoxification/resolving phlegm/
activating blood - Clin. J. Trad. Chin. Med. 16(2): 146-150, 1995
7) Ito T., Nagasaka K., Kita T. et al.: Clinical Effects of Middle-Reinforcing and
Qi-Benefiting Decoction in the Treatment of Patients with Chronic
Hepatitis C - Correlation between the presence of Qi deficiency pathology
and effectiveness - Kampo Medicine (Jap. Journal of Oriental Medicine)50(2): 215-223, 1999
8) Shimizu H.: Hepatitis C - Concepts and Therapies - Clin. J. Trad. Chin. Med.
15(4): 370-374, 1994
9) Kumada H.: Effects of Minor Bupleurum Decoction for the Treatment of
Hepatitis C Non-responsive to Interferon, Clinics of Adult Diseases 24(8):1103-1109, 1994
10) Nakajima O., Sone Y., Onishi H. et al.: Inhibitive Effects of Minor
Bupleurum Decoction on the Progression from Hepatitis C to Liver
Cirrhosis, Clinics and Research 76(5): 1008-1015, 1999

Regardingautoimmune
hepatitis,
reports
indicated that in individual cases certain ingenuous
modifications of the prescriptions led to a relief of thesymptoms, while the standard therapy with steroids
was used more in the sense of a complementary
therapy and thus allowed a gradual dose reduction oreven interruption of the steroid therapy. Certain
cumulative studies document the latter case using

Minor Bupleurum Decoction, Poria Powder with Five
Herbs11).

11) Masuda A., Kajii N., Omura R. et al.: Therapeutic Effects of Minor
Bupleurum Decoction, Poria Powder with Five Herbs on Autoimmune
Hepatitis Regarding Steroid Dose Reduction and Relief of Side Effects Diagnosis and Therapy 81(4): 911-915, 1993

Fatty liver (both alcoholic and non-alcoholic fatty
liver diseases) is caused mainly by alcohol
consumption,
obesity,diabetes
mellitus,
hypertriglyceridemia etc. To improve these factors, inparticular the fatty liver due to overfeeding, Major
Bupleurum Decoction was administered and found in
cumulative studies to be useful12).
12) Ishioka T., Miura H., Shinoi T. et al.: Clinical Research into the Effects ofMajor Bupleurum Decoction on Fatty Liver due to Overfeeding, Basics andClinics: 4425-4431, 1992

Regarding liver cirrhosis, the state of disease in
Kampo terms differs for the compensated anddecompensated phases, so that the type of preparation
varies.
During the compensated phase, the therapy
follows the therapy for chronic hepatitis, but fibrosis ishere viewed as a manifestation of blood stasis, so that
often activating blood and resolving stasis medicinals

28

are added. The decompensated phase calls mainly forskillful management of water metabolism, requiring
foremost combinations of diuretics13). In extremelyrare cases, administration of large doses of Poria
Powder with Five Herbs reportedly resulted in theovernight disappearance of large amounts of ascites14).
Moreover, the use of Poria Powder with Five Herbs inpatients with decompensated liver cirrhosis associatedwith ascites non-responsive to diuretics, hadreportedly been effective in 40% of the patients15). The
above described studies used extracts, but generally
decoctions are prescribed for decompensated livercirrhosis. Middle-Reinforcing and Qi-Benefiting
Decoction, Qi-Reinforcing and Middle-Being Healthy
Decoction, Separate and Reduce Decoction, Areca Seed
Decoction with Nine Herbs, Bolster the Spleen
Decoction, North Water God Decoction, Augmented
Five-Ingredient Powder with Poria and similar
formulas are basic preparations. Conversely,
cumulative studies showed that treatment with
GinsengNutrition
Decoction
improved
thethrombocytopenia associated with liver cirrhosis.16).
13) Okubo H., Amaki S., Fujita S. et al.: Kampo Therapy for Liver Cirrhosis,
Kampo and Advanced Therapies 5(3): 247-252, 1996
14) Imadaya A. et al.: Elimination of Refractory Ascites Through Sweating - A
case treated with large amounts of Poria Powder with Five Herbs extracts Kampo Medicine (Jap. Journal of Oriental Medicine) 32(4): 37-42, 1981
15) Takamori S., Furuki T., MiyazakiT. et al.: Investigation of the Usefulness
of Poria Powder with Five Herbs for the Treatment of Compensated Liver
Cirrhosis, Kampo Igaku 13(10): 300-305, 1989
16) Iwata K., Kamimura S., Shijo S. et al.: Administration of Ginseng
Nutrition Decoction for the Treatment of Liver Cirrhosis - In particularregarding the effects on thrombocytopenia, Clinics and Research 72(3):746-750, 1995

Some research has been done on the inhibition of
the progression from liver cirrhosis to liver cancer
through administration of Kampo medicines. Thesestudies
clearly
showedthatthroughtheadministration of Minor Bupleurum Decoction or Ten
Strong Tonic Herbs Decoction the incidence of livercancer decreased significantly17,18). Recent publishedstudies indicated this as a possible mechanism for thefunctioning of Minor Bupleurum Decoction as a radical
scavenger.
17) Oka H., Yamamoto S., Kuroki T. et al.: Prospective Study of
Chemoprevention of Hepatocellular Carcinoma with Minor Bupleurum
Decoction（Tj-9）, Cancer 76(6): 743-749, 1995
18) Higuchi K., Watanabe A.: Investigation of the Inhibition of the Progression
from Liver Cirrhosis to Liver Cancer Through Administration of Ten Strong
Tonic Herbs Decoction Methods in Kampo Pharmacology 5: 29-33, 2000

Gallstones, excluding asymptomatic cases, arecurrently removed by endoscopic cholecystectomy.
While today the surgical removal constitutes thegeneral form of treatment, this condition used to be agood indication for Kampo medicine. Even today
Kampo medicines are used in some selected cases.
Major Bupleurum Decoction is a representative
preparation and there are 2 cumulative studies
dealing with it19,20). The removal of stones with Chinese
medicine is not performed in Japan. Regarding

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Volume 1, Special Edition | Current Kampo Medicine 2005

cholecystitis or choledocholithiasis there are some casereports, but generally these conditions are notconsidered to be indications for Kampo therapy.
19) Shoda J., Matsuzaki, Y., Tanaka N. et al: The inhibitory effects of
dai-chai-hu-tang (dai-saiko-tou) extract on supersaturated bile formation incholesterol gallstone disease. Am. J. Gastroenterol 91(4): 828-30, 1996
20) Fujita K.: Effects of Major Bupleurum Decoction for Cholelithiasis Attacks,
Kampo Medicine (Jap. Journal of Oriental Medicine) 45(2): 411-421, 1994

Among diseases of the pancreas, mild forms ofacute pancreatitis are an indication for Kampo
medicine, but usually are treated with western
medicine, so that there are only few case reports andno cumulative studies. During the intermittent phasesof compensated chronic pancreatitis, this condition isfrequently treated with Kampo medicine. Yet, there
are only a few published studies. Tanaka et al.
reported on Kampo therapy used with 62 patients
presenting hyperamylasemia, who were suspected tosuffer from chronic pancreatitis. Combined efficiency
was 38.8%, and among the preparations, Bupleurumand Cassia Twig Decoction was used in 15 patients,
Liver-Soothing Decoction in 16, Pinellia Heart-Purging
Decoction in 9, Life-Prolonging Pinellia Decoction in 6,
Middle-Soothing Powder plus Tuckahoe in 4, Nourish

the Stomach Decoction with Aucklandia and Amomumin 5 and Galanga and Bitter orange Decoction in 3

patients21). The efficacy in this trial was notparticularly high, but the trial included mostly
patients that had already consulted multiple western
medical facilities and for whom Kampo therapy
eventually became the final resort. When taking thissituation into consideration, the standard results
would probably be evaluated higher.
21) Nakada K., Hosono Y., Hosono H. et al.: Kampo Therapy of Chronic
Pancreatitis, Kampo Medicine (Jap. Journal of Oriental Medicine) 36(4):25-44, 1986

12. Gynecology
Since women have menstruations and give birth,the necessity to comprehend pathologic conditions thatdiffer from those in men has been recognized sinceancient times. Traditionally, the Jin gui yao lue,compiled by the end of the second century establisheda specialty of treating women. Later in the "Qian jinfang" (compiled by the middle of the seventh century),
the section on gynecology was put at the top of thisscript. In Japan, this field was separated from otherfields since the 15th century and in the first half of the
18th century Genetsu Kagawa (1700-1777) discovered
approximately at the same time as the British William
Smellie, that the fetus assumes an inverted position
within the uterus and developed a large number ofinnovative techniques and preparations. Current
gynecologists and obstetricians still inherit thistradition, skillfully using a small number of Kampo
medicines for the relevant therapies. Many of thediseases in this field are indications for Kampo

therapy based on experience.
Regarding abnormal bleeding prior to menopause,
Kampo medicines are frequently used for both
hypermenorrhea and dysfunctional uterine bleeding.
Generally hormone therapy is performed, but specialists
also use Kampo therapy either as an adjunctive or
independent therapy. There are cumulative studies
regarding Szechwan Lovage Rhizoma, Angelica Root,
Ass-hide Glue and Argy Womwwod Leaf Decoction1,2,3).
Naturally, in the presence of organic disease, modern
medical treatment is given priority.
1) Iwabuchi S.: Hemostatic Effects of Szechwan Lovage Rhizoma, Angelica
Root, Ass-hide Glue and Argy Womwwod Leaf Decoction on Dysfunctional
Uterine Bleeding, Kampo Medicine (Jap. Journal of Oriental Medicine) 50:
883-890, 2000
2) Hatano K., Terawaki S., Tomonari S.: Hemostatic Effects of Szechwan

Lovage Rhizoma, Angelica Root, Ass-hide Glue and Argy Womwwod Leaf
Decoction, Medical Journal of the Oita Prefectural Hospital 14: 95-103,
1985
3) Inaba Y., Hori S., Hosoi N. et al.: Treatment of Dysfunctional Uterine
Bleeding with Szechwan Lovage Rhizoma, Angelica Root, Ass-hide Glueand Argy Womwwod Leaf Decoction Extract, Obstetrics and Gynecology 8:
825-836, 1983

Premenstrual tension syndrome (PMS) is a good
indication for Kampo therapy. Presenting as a typical
pattern of Qi stagnation and blood stasis, treatment
with Kampo medicine has already developed into astandard4). The representative preparation Modified
Merry Life Powder is frequently used, while Angelica
and Peony Powder, Cassia Twig and Tuckahoe Pill,
Warm the Menses Decoction and Goddess Powder are
also widely used.
4) Ushiroyama T.: Kampo Therapy for Dysmenorrhagia and Prementrual
Syndrome, Kampo Therapeutic Manual for Physicians Specializing in
Gynecology (Nagai Publications): 56-59, 2003

Dysmenorrhagia is almost always associated with
Oketsu (blood stasis) so that blood activating andstasis resolving medicinals are used in relevantprescriptions. Cassia Twig and Tuckahoe Pill is afrequently used preparation and besides this, Peach
Kernel Purgative Decoction, Negotiation Decoction,
Modified Merry Life Powder and similar preparations
are also widely used. When channel warming and cold
dispelling (Onkei Sankan) is required, Evodia, Fresh
Ginger plus Chinese Angelica Cold Limbs Decoction or
Middle-Soothing Powder may be considered.
Middle-Soothing Powder is reportedly very effective
for menorrhalgia associated with marked stomach cold
affecting the entire body. In cases of blood deficiency,
Angelica and Peony Powder, or for spleen deficiency
Minor Middle-Strengthening Decoction or else
Angelica
Middle-Strengthening
Decoctionarecommonly used. As a special use, the short-term
administration of Cassia Twig and Tuckahoe Pill
during menstruation has been recommended andproduced favorable results5). Moreover, research
conducted in recent years clearly showed that Peonyand Licorice Decoction inhibits the prostaglandin

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Volume 1, Special Edition | Current Kampo Medicine 2005

production, so that attempts have been made toadminister this preparation in synchronization withthe menstrual cycle6). Secondary dysmenorrheal, due
to endometriosis or submucosal myomata, is also agood indication for Kampo therapy, but often thewestern medical treatment receives priority.
5) Ota H., Tanaka T., Kushima T.: Short-term Administration of Cassia Twig
and Tuckahoe Pill During Menstruation for the Treatment of
Dysmenorrhea, Progress of Kampo Research in Gynecology and Obstetrics
17: 48-50, 2000
6) Imai A, Ito M., Tamaya T.: Mechanisms of the Inhibition of Prostaglandin
Production by Peony and Licorice Decoction, Kampo Igaku 20: 218-221, 1996

Regarding irregular menstruation Cassia Twig
and Tuckahoe Pill, Peach Kernel Purgative Decoction

and similar blood acitivating and stasis resolving
preparations are widely used. In addition, Modified
Merry Life Powder and like Qi stagnation blood stasis
formulas, blood tonifying preparations like Four Herbs
Decoction, Evodia, Fresh Ginger plus Chinese Angelica
Cold Limbs Decoction, Aconite and Ginseng Decoction
and the like Yang tonifying and cold dispellingprescriptions, Qi mobilizing drugs like Pinellia andMagnolia Decoction, Cyperus and Perilla Leaf Powder
or else heat clearing preparations like Coptis
or
Three
Huang
Detoxificating
Decoction

Heart-Clearing Decoction with Three yellow color
Herbs also find, their application depending on the14) Tanaka T.: Effectiveness of Cassia Twig and Tuckahoe Pill Extract Tablets
Administered with the Purpose of Avoiding Surgery in Endometriosis like
Diseases, WE No. 4: 7-8, 2003

Several clinical reports deal with ovarian
insufficiency. Studies in which Angelica and Peony
Powder was administered to all patients with ovarian
insufficiency showed a tendency towards increasing
concentrations of estrogen and progesterone during
the luteal phase15). Patients with various ovarian
disorders were treated either with clomiphene alone(52 patients) or a combination therapy of clomipheneand Angelica and Peony Powder (41 patients) and led
to the publication of highly interesting results16).
Moreover, when 34 patients with polycystic ovarian
syndrome (PCOS) presenting hypertestosteronemia
were treated with Angelica and Peony Powder, a
reduction in testosterone levels was reported for 30(91%) of these patients17).
15) Koyama T, Ohara M, Ichimura M. et al.: Effect of Japanese Kampo
medicine on hypothalamic-pituitary-ovarium function in women withovarian insufficiency, Am J Chin Med, 16: 47-55, 1988
16) Yasui T., Kahara M., Aono T. et al.: Investigation of the Efficacy of a
Combination Therapy of Clomiphene and Angelica and Peony Powder inPatients Without Ovarian Disorders, Journal of the Japan Society ofInfertility 40: 83-91, 1995
17) Takahashi K., Kitao M.: Polycystic Ovarian Syndrome (PCOS) and Kampo,
Gynecology and Obstetrics 42: 201-208, 1990

Smooth muscle myoma uteri is the most frequently
observed benign tumor of the female genitalia andthere are many reports about its treatment with
Kampo medicine9,10,11). The question whether the
myoma can be reduced in size using Kampo medicine
is very important and there have been several related
studies. Inoue et al. used Cassia Twig and Tuckahoe
Pill and measured the size of the myoma withultrasound. A number of studies reported the relevant
ratios of size reduction12,13).

Patients non-responsive to western medical
therapies for infertility are treated with Kampo
medicines, which often successfully lead to pregnancies.
Generally, Angelica and Peony Powder, Cassia Twig
and Tuckahoe Pill, Peach Kernel Purgative Decoction,
Warm the Menses Decoction, Modified Merry Life
Powder, Minor Middle-Strengthening Decoction, Ten
Strong Tonic Herbs Decoction and similar preparations
are used. Infertility in patients with hypertestosteronemia
or hyperprolactinemia is treated with Peony andLicorice Decoction, which reportedly leads to asignificant reduction in the concentration of both
hormones18,19). Moreover, in patients with antibodies
against sperm, treatment with Minor Bupleurum
Decoction, Poria Powder with Five Herbs has beenreported20). Please refer to the section on urogenital
diseases regarding male infertility.

9) Sakagami S.: Myoma Uteri, Gynecology and Obstetrics 42: 79-91, 1990
10) Aiba S.: Is Kampo Effective? Gynecology and Obstetrics 45: 1192-1193, 1991
11) Dozono H.: Kampo Therapy of Myoma Uteri, Gynecology and Obstetrics
71: 669-672, 1995
12) Inoue S., Nakada M., Kataoka Y. et al.: Investigation of the Myoma Uteri
Size Reducing Effect of Cassia Twig and Tuckahoe Pill Measured with
Ultrasound, Progress of Kampo Research in Gynecology and Obstetrics 14:
59-62, 1997
13) Inoue S., Nakada M, Kataoka Y. et al.: Investigation of the Myoma Uteri
Size Reducing Effect of Cassia Twig and Tuckahoe Pill Measured with
Ultrasound (second report), Progress of Kampo Research in Gynecology and
Obstetrics 15: 57-62, 1997

18) Yanaginuma T., Okamura T., Takeuchi T. et al.: Blood Androgen
Concentration Lowering Effects of Peony and Licorice Decoction in Women
with Hypertestosteronemia, Ovulation inducing effects and safety multi-facility joint study, Journal of the Japan Society of Infertility 33:
606-616, 1988
19) Ito N., Omi Y., Inazawa N. et al.: Experiences with Peony and Licorice
Decoction in Women with Latent Hyperprolactinemia, Practice ofGynecology and Obstetrics 49: 1161-1164, 2000
20) Kano T., Furudo M., Okuyama K. et al.: Causes of Infertility in our Clinic
and Analysis of Treatment Results Obtained Mainly with Minor Bupleurum
Decoction, Poria Powder with Five Herbs, Japan Infertility Journal 38:
671-679, 1993

Endometriosis is frequently identified as the cause
for abnormal bleeding or secondary dysmenorrhea andKampo therapy is often attempted. The administrationof Cassia Twig and Tuckahoe Pill for the purpose of
avoiding surgery has been reported14).

Generally, menopausal syndrome is treated withhormone therapy, but many physicians also consider
Kampo medicine to be a treatment of first choice.
According to an investigation by Margaret Lock, there

presenting pattern. In this area Kampo medicines areprescribed as a standard therapy7,8).

7) Kawakami S., Umeki M., Ikuta Y. et al.: Kampo Therapy in our Clinic andits Effects on Irregular Menstruations, Progress of Kampo Therapy in
Gynecology and Obstetrics 21: 52-56, 2004
8) Ushiroyama T.: Kampo Knowledge for Gynecologists and Obstetricians, 6.
Kampo Therapy and relief from irregular menstruation (General Remarks)

30

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are major differences between symptoms reported byAmericans and Europeans on the one hand andJapanese women on the other. Japanese womenallegedly suffer from a greater variety and more severe
symptoms21). This is an appropriate view and in Japan
there is abundant experience with the application of
Kampo medicines that are used for very minutely
tuned treatments22). For hot flashes, Modified Merry
Life Powder, Coptis Detoxificating Decoction, Bupleurum
plus Dragon’s Bone and Oyster Shell Decoction,
Bupleurum Cassia Twig and Dried Ginger Decoction,
Warm the Menses Decoction and similar preparations,as well as for numerous indefinite complaints otherthan the above listed formulas. Drugs like Pinellia andMagnolia Decoction, Cyperus and Perilla Leaf Powder,

Tangerine Peel, Pinellia Rhizoma plus Liver-Inhibiting
Powder,Powder, Cold Limbs Powder, Goddess
Modified Back to the Spleen Decoction, Uncaria
Powder etc. are also selected depending on thepresenting pattern. There are also a number ofclinical studies23,24,25,26,27,28,29,30). The osteoporosis
associated with menopause is basically considered to
be a kidney deficiency and thus treated using Kidney
Qi Pill, Six Ingredient Pill with Rhemannia andsimilar preparations31). One report states that Kidney
Qi Pill is effective for the treatment of senile
vaginitis32).

21) Lock M.: Mythologies of Menopause in Japan and North America 1993
22) Ushiroyama T.: Kampo Therapy for Climacteric Disorders, Kampo
Therapeutic Manual for Physicians Specializing in Gynecology (Nagai
Publications): 50-55, 200323) Maruo T., Katayama K., Mochizuki M. et al.: Kampo Therapy for
Climacteric Disorders - in particular examination of the usefulness ofCassia Twig and Tuckahoe Pill, Gynecology and Obstetrics 45: 167-176,
199324) Morioka N., Wakatsuki A., Sagara Y. et al.: Effects of Modified Merry Life
Powder on Climacteric Disorders, Progress of Kampo Research in
Gynecology and Obstetrics 12: 79-85, 1993
25) Koyama T., Aso T.: Kampo Therapy for Women in Effulgant Fire Age,
Evaluation using simplified climacteric indices, Progress of Kampo
Research in Gynecology and Obstetrics 9: 30-34, 1992
26) Tamaya T., Ito M., Ito T.: Unidentified Clinical Syndrome, in Particular
Investigation of the Usefulness of Kampo Preparations for Climacteric
Disorders (Bupleurum Cassia Twig and Dried Ginger Decoction, Modified
Merry Life Powder, Bupleurum plus Dragon’s Bone and Oyster Shell
Decoction), Kampo Medicine (Jap. Journal of Oriental Medicine) 44: 71-81,
199427) Nishimura K., Umekawa T., Kanazawa K. et al.: Experiences with Uncaria
Powder for the Treatment of Climacteric Disorders, Progress of Kampo
Research in Gynecology and Obstetrics 17: 125-127, 2000
28) Chimura T., Nakahara K., Miyata R. et al.: Clinical Effects of Modified
Merry Life Powder on Indefinite Complaints During Climacteric Disorders,
Medical Care and New Drugs 27(11): 18-24, 1990
29) Chimura T., Koseki K., Sanjo N. et al.: Clinical Effects of Modified Merry
Life Powder on Indefinite Complaints During Climacteric Disorders (II),Medical Care and New Drugs 29(3): 145-151, 1992
30) Sagara Y., Morioka N., Wakatsuki A.: Experiences with Modified Merry
Life Powder for the Treatment of Climacteric Disorders - In particularregarding evaluation methods of combinations of subjective and objective
symptoms - Gynecology and Obstetrics 60(2): 290-296, 1993
31) Ushiroyama T.: Kampo Therapy of Elderly Women - Urinary incontinence,arteriosclerosis, osteoporosis - Kampo Therapeutic Manual for PhysiciansSpecializing in Gynecology (Nagai Publications): 89-94, 2003
32) Inoue S., Ueno T., Kusanishi H. et al.: Therapeutic Effects of Six
Gentlemen Decoction on Senile Vaginitis, Progress of Kampo Research in
Gynecology and Obstetrics 17: 140-145, 2000

13. Obstetrics
Medical questions related to pregnancy andchildbirth have since ancient times been discussed
separate from other issues. In medical schools
established in the 8th century, women specialists weretrained in this field. Since the 15th century, obstetrics
was separated from the other medical specialities andrelevant specialists engaged in comparatively highlevels of medical practice. Marked progress wasachieved after the emergence of the aforementioned
Kanetsu Kagawa in the 18th century.
Pregnancy is associated with various disordersthat are treated with Kampo medicines1). For example,
for the treatment of the common cold during pregnancy,
Cyperus and Perilla Leaf Powder or Cassia Twig
Decoction are used instead of modern prescriptions.
Minor Pinellia Decoction plus Tuckahoe or Pinellia
and Magnolia Decoction have been used for morning
sickness. Cough during pregnancy has been treatedwith Dwarf Lilyturf Decoction. Angelica and Peony
Powder is administered by Japanese physicians toensure an uneventful pregnancy and Nakata et al.
reported "its administration during pregnancy
resulted in a 100% safe delivery ratio"2). They also
reported that for "patients visiting our clinic because of
their inability to conceive or the occurrence of
spontaneous abortions early after conception, e.g.,patients with so-called "habitual abortion", Angelica
and Peony Powder is extremely effective, so that 4 outof 5 patients were safely able to conceive and deliver achild". Also, due to its inhibition of uterine
contractions, this preparation is expected to beeffective for the treatment of threatened abortion3).
Therapeutic attempts have been made with
Kampo medicine for Preeclampsia. The results ofobservations of the effect of Angelica and Peony
Powder in 5,000 pregnant women reported by Noguchi
et al. showed that in the treatment group the incidenceof preeclampsia decreased significantly4). Kampo
medicines, including mainly diuretic preparations, will
be helpful for the prevention of this condition.

Szechwan Lovage and Angelica Decoction forRegulating Blood Flow is used to regulate the physicalcondition following delivery. This preparation, with its
blood activating and stasis resolving properties, wasdeveloped by a famous physician in China of the Ming
period to treat various postpartum symptoms. Later
this concept was inherited in Japan and thus led to its
present use. There are a number of case reports5).
1) Ushiroyama T.: Pregnancy and Kampo, Kampo Therapeutic Manual for
Physicians Specializing in Gynecology (Nagai Publications) P50-55, 2003
2) Nakata K., Yamaoka K., Konishi E. et al.: Clinics of Angelica and Peony
Powder, Kampo Medicine (Jap. Journal of Oriental Medicine) 28(3):101-107, 1978

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3) Chimura T. et al.: Effects of Treatment with Angelica and Peony Powder for
Threatened Abortion, Gynecology and Obstetrics 41(8): 722-731, 1989
4) Noguchi K.: Investigation of Patients with Preeclampsia Over the Past 10
Years in our Clinic, in particular regarding the administration of Kampo
medicine and maternal classes, Jap J Prim Care 8: 131-133, 1985
5) Kiuchi C.: Case Report: Szechwan Lovage and Angelica Decoction forRegulating Blood Flow: The Kampo for the Practical Physician, No. 6: 11-13, 2000

14. Arthritis and Musculoskeletal Disorders
Many of these disorders are associated with pain.
Among patients consulting medical facilities
specializing in Kampo therapy, the most frequent
complaint is pain associated with the locomotor system.
The cervical syndrome, periarthritis humeroscapularis(frozen shoulder), low back pain, sciatica, gonarthrosis
and similar disorders are all good indications for
acupuncture therapy and equally good indications for
Kampo therapy.
Osteoarthropathy (osteoarthritis) is in daily life acommonly observed disorder. Among the patientsseeking Kampo therapy, gonarthrosis is the mostfrequent disorder and represents, unless the deformity
has reached a rather extreme degree, a good indication
for Kampo therapy1,2). The nature of this disorder in
the initial phase is mainly a dysregulation of water
metabolism, so that treatment results withpreparations suitable for the presenting pattern, even
if it is associated with the development ofhydrarthrosis, are comparatively good. Cassia Twig
plus Yu Bi Decoction and Stephania and Astragalus
Decoction are widely used preparations and often
rather effective. A number of cumulative studies
dealing with Stephania and Astragalus Decoction
show that the addition of Hobushi (prepared aconite
tuber) powder apparently improved the efficacy3).
Cumulative studies about Yue Bi Decoction for
Relieving Edema plus Atractylodes showed significant
improvements in clinical findings and results ofsynovial fluid examinations of patients presenting
with local heat sensation, swelling and tenderness ofthe joints4). When these diseases run a somewhat
protracted course, blood stasis develops and thus
makes blood activating and stasis resolving
preparations like Cassia Twig and Tuckahoe Pill,

Szechwan Lovage andAngelica Decoction forRegulating Blood Flow necessary5). In case of severe
pain, aconite tuber is added.
When the disease has been present for a certain
period and is associated with severe deformations,acupuncture treatment or blood letting is usedconcomitantly. Naturally, inclusion of these treatment
forms is recommended right from the beginning.

1) Nagao K.: Comprehensive Oriental Medical Therapy of Gonarthrosis,
Kampo and Most Advanced Therapies 5(4): 343-348, 2000
2) Nishizawa Y., Nishizawa K., Amenomori Y. et al.: Analgesic Effects ofAnti-inflammatory drugs and Kampo Preparations for Bilateral
Gonarthrosis - Comparison of the capability for continuous locomotor
function and improvement of the quality of life, Pain and Kampo Medicine
8: 17-32, 1998

32

3) Otani T., Matsumoto H., Kawakubo M. et al.: Clinical Effects of Stephania
and Astragalus Decoction on Gonarthrosis, Journal of the Tokyo Knee
Society, The Tokyo Journal of Knee Joint 18: 31-33, 1998
4) Sugiyama S.: Effects of Yue Bi Decoction for Relieving Edema plus
Atractylodes for Gonarthrosis, Kampo Medicine (Jap. Journal of Oriental
Medicine) 48(3): 319-325, 1997
5) Matsumoto K.: Explanation of Kampo Preparations, Szechwan Lovage andAngelica Decoction for Regulating Blood Flow - First modification - On
Blood Stasis, Oriental Medicine 8(6)The use of Stephania and Astragalus Decoction inpatients in whom hydrarthrosis developed following
surgical removal of the lateral meniscus underorthoscopic observation reportedly led to favorable
results6).
6) Otsuka K.: Effects of Stephania and Astragalus Decoction in Patients After
Knee Surgery, Kampo Igaku 25(1): 15-17, 2005

Among the crystal arthropathy forms, gout is thedisease that is most frequently observed. Kampo
therapy is somewhat effective for acute attacks. The
pathology is viewed as damp heat and the preparations

Yue Bi Decoction for Relieving Edema plus
Atractylodes and Gentian Liver-Purging Decoction are
widely used for this condition. In case of severe pain
the treatment is combined with western medical
measures, but the independent use of Kampo is quite
effective and it remains useful even after the most
severe pain has subsided. Continuous use of the
preparation therefore, provides comparatively quick
relief of both swelling and pain. Currently, no
preparations have been reported, that would be able todefinitively decrease the hyperuricacidemia. Yet, there
are some theoretical hypotheses and a few case reports.
Neck pain is a frequently observed condition
among the pain syndromes. In Japan, this is often
called the cervical syndrome. Chronic neck pain inmost cases is caused by osteoarthropathy and isgenerally subject to conservative therapy. Yet, this is agood indication for acupuncture therapy. With thistreatment modality, pain is frequently relieved after
short treatment periods.
Kampo therapy appears to be extremely useful.
The muscles of the neck and shoulder are associatedwith the greater and brighter yang areas, so that
Pueraria Decoction by itself may be used to improve
pathologic conditions in these regions. Modifications
obtained by addition of Sojutsu or Bushi are alsofrequently used. Nishina administered Pueraria
Decoction to a total of 78 patients, including 41
patients with cervical spondylosis, 31 patients withcervical syndrome, 3 trauma patients and 3 patientswith other conditions and reported, that undersuitable conditions the treatment was effective in two
thirds of the patients7). Beside from Pueraria
Decoction, Cassia Twig Decoction plus Atractylodes
and Aconite, Channels-Dredging and Blood-Activating
Decoction, Swordlike Atractylodes and Largehead

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Atractylodes Decoction, Coix Seed Decoction andsimilar preparations are also used.
7) Nishina F.: Pueraria Decoction and the Pulse in Orthopedic Diseases,
Kampo Therapy Vol. 4, No. 3: 48-50, 1985

Reference

Although almost unnoticed in America and Europe, "stiffshoulders" is an extremely important symptom in Japan. An often
asked question is, whether the concept of "shoulder stiffness" isprevalent in Japan. Numerous works deal with this symptom andresearchers like Kuriyama have discussed this from a historicalpoint of view, which is of great interst from the perspective of
current Kampo medicine8). In modern Japan this symptom
frequently observed in daily practice is not a disease, but still
disturbs daily life. Many researchers also view this condition as thepreliminary stage for the development of other diseases. For
example, the associated symptom of hypertension, one of thesymptoms preceding stroke (when the muscles of the neck stiffen,
this may interfere with the blood flow from the neck and thus leadto congestion of cerebral venous system and thus eventually tovessel rupture). Treatment of shoulder stiffness associated withcervical syndrome may help to improve the aforementioned
conditions, so that this is a very important symptom. Naturally,
acupuncture treatment and blood letting can provide instant relief,
but Kampo medicine can be very effective too. The most commonlyused preparation is Pueraria Decoction. A number of studies havethermographically investigated the effect of this formula onshoulder stiffness9).
8) Kuriyama S.: Reflections on Shoulder Stiffness, edited by Yamada,Kuriyama: Disease and Medicine in History, 37-62, Shibunkaku
Publications 1997
9) Yakubo S., Komaki K., Yagi H. et al.: Improvement of Shoulder Stiffness
Using Pueraria Decoction and Thermographic Investigations, Kampo
Medicine (Jap. Journal of Oriental Medicine). 47(5): 795-802, 1997

Whiplash injuries are a relatively common traumaof the neck. If the initial treatment is not successful, it
may result in a protracted course of the condition
which consists of a mixture of psychosomatic
symptoms that may prove to be difficult to heal. There
are a number of good Kampo preparations for thiscondition. During the acute phase, the conditions are
considered to be characterized by blood stasis. In order
to expel the formed blood stasis from the body,
preparations also including cathartics like For
Contusion Decoction or Dreging and Dissipating
Powder, are used. The chronic phase is considered to
be characterized by Qi stagnation and blood stasis andthus Modified Merry Life Powder is used. Whendampness accumulates within the muscles of the neck,preparations like Pueraria Decoction, Cassia Twig
Decoction plus Atractylodes and Aconite or Swordlike

Atractylodes and Largehead Atractylodes Decoction

are used.
Scapulohumeral periarthritis (frozen shoulder) is afairly common condition among Japanese and most areprobably due to disorders of the rotator cuff. It occurs
comparatively frequently in both men and women over
the age of 40. Based on the age of onset, the conditionis popularly called "50-year-old Shoulder" (pain in theshoulders around the age of 50). This too is a good
indication for acupuncture treatment and caneffectively be supplemented by Kampo medicine10). For
neck pain preparations like Pueraria Decoction plus
Atractylodes and Aconite, Cassia Twig Decoction plus
Atractylodes and Aconite, Swordlike Atractylodes andLargehead Atractylodes Decoction or Coix Seed
Decoction are used. For cases of long standing, thepresence of blood stasis is considered, so that the
aforementioned drugs are used in combination withblood activating and stasis resolving preparations like
Cassia Twig and Tuckahoe Pill.
10) Ogawa H.: Scapulohumeral Periarthritis and Cervical Spondylosis, Kampo
and Most Advanced Therapies, 9(3): 229-234, 2000

For low back pain, acupuncture is the treatment of
first choice and supplemented by Kampo medicine; but
the latter is also very effective by itself. Yet, both
effectiveness and the choice of preparations varydepending on the etiology11,12). Even in cases ofherniation of a lumbar intervertebral disk associatedwith radicular pain, treatment with Kampo medicine
may help to alleviate the symptoms. Among extract
preparations, Cassia Twig and Tuckahoe Pill, Evodia,

Fresh Ginger plus Chinese Angelica Cold Limbs
Decoction, Kidney Qi Pill, Channels-Dredging andBlood-Activating Decoction, Powder for Five Kinds ofStagnations etc. and among the decoctions
Yin-Tonifying Decoction, Angelica Pubescens andSanjisheng Decoction and similar preparations areused. In cases of severe pain, the addition of aconite
tuber may be required.

11) Fukuda Y.: Kampo Therapy for Low Back Pain and Lumbar Spondylosis,
Kampo and Most Advanced Therapies 5(4): 359-362, 1996
12) Shirafuji T.: Kampo Therapy for Neuralgia (including herpes zoster),Modern Oriental Medicine 14(2): 35-39, 1993

For the treatment of low back pain due to lumbar
spinal canal stenosis, Kidney Qi Pill has been used andcumulative studies showed an efficacy of 68%, while
similar cumulative studies with Life-preserving
Kidney-Qi Pill showed an efficacy of 55%, thus a highefficacy for either of these formulas13,14).
13) Hayashi Y., Saito E., Takahashi O.: Usefulness of Kidney Qi Pill for theTreatment of Lumbar Spinal Canal Stenosis Geriatr. Med. 32(5): 585-591,
199414) Yamagami H., Hashizume K., Sakamoto T. et al.: Effects of Life-preserving
Kidney-Qi Pill in the Treatment of Lumbar Radicular Pain - with particularfocus on variations in subjective and objective symptoms, Pain and Kampo
7: 25-28, 1997

The concept of autoimmune disease did not exist in
TCM. Yet, for articular rheumatism, a representative
disease of this group, many therapies have beendevised. The other forms of connective tissue diseases
were almost not recognized and probably only
individual symptoms were dealt with. Currently,
better therapies for these diseases are available than
before.
Rheumatoid arthritis (RA) is a disease for which
Kampo offers hope. This disease includes various types,
stages and grades. Based on these, the prognosischanges, Kampo therapy is particularly effective

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33

Volume 1, Special Edition | Current Kampo Medicine 2005

during the initial stages of RA. Early diagnostic
criteria for ARA showed that the probability for people
who were suspected of having RA, the number ofpatients in a Kampo treatment group (in whom thediagnosis of RA was definitely established) after
several years, reportedly appeared to be lower than ina group of patients not treated with Kampo15). Besides
this report, there is an abundance of other reports that
also provide similar suggestions16,17,18).
Traditionally, the symptoms of RA are considered
to be due to the intrusion of the three evils wind, coldand dampness in the body. Clinically, these symptoms
also include a feeling of heat in the joints, so that thesymptoms are also often viewed as heat symptoms.
Choice of the prescription has to be modified
depending on the degree of pain, heat sensation andthe general condition. For the therapy, basic
preparations like Cassia Twig Decoction plus
Atractylodes and Aconite, Cassia Twig Peony, andAnemarrhena Decoction, Two-parts Cinnamon Twig

Decoction and One-part Maidservant from Yue
Decoction, Stephania and Astragalus Decoction,
Disband Painful Obstruction Decoction are used andthenmodified
dependingontherelevant
considerations of cold and heat factors. Usually thisdisease can not be properly treated with extracts, sothat many physicians use the corresponding decoctions.
In particular, the skillful application of Wild Aconite
Tuber constitutes a key point of the therapy andspecialized physicians conduct the therapy by exactly
controlling the amount of alkaloids like aconitine andmesaconitine. Some RA case reports have described
dramatic improvements by using formulas containing
comparatively large amounts of Wild Aconite Tuber19).
There are some cumulative studies dealing with Minor

Bupleurum Decoction, Poria Powder with Five Herbs
or Stephania and Astragalus Decoction20,21,22).

15) Ebe K.: New Cases of Chronic Rheumatoid Arthritis, Investigation of 10
cases, Φυτο 1(4): 4-12, 200116) Haimoto H.: Recent Situation Regarding Chronic Rheumatoid Arthritis,
Clin. J. Trad. Chin. Med. 18(4): 370-381, 1997
17) Fukuda Y.: 54th Academic Conference of the Japan Society of Oriental
Medicine, Academic Symposium: Kampo Therapy for Rheumatoid Arthritis,
1. Probing the possibilities of Kampo preparations, Kampo Medicine (Jap.
Journal of Oriental Medicine) 54(6): 1064-1067, 2003
18) Nagasaka K., Hikiami H., Tatsumi T. et al.: Examination of 43 Patientswith Chronic Rheumatoid Arthritis, Kampo Medicine (Jap. Journal of
Oriental Medicine) 51(2): 241-246, 2000
19) Furuta K., Mitsuma T., Shintani T. et al.: Three Cases of Dramatic
Improvements Associated with Poisoning Symptoms Using Uzu Containing
Preparations, Kampo Medicine (Jap. Journal of Oriental Medicine) 50(2):247-255, 199920) Matsuura M.: Effects of Minor Bupleurum Decoction, Poria Powder with
Five Herbs in the Treatment of Chronic Rheumatoid Arthritis (RA),Recordings of the 10th Clinical Wakan Yaku Research Group Modern
Physician, 14: 403-408, 199421) Borijini, M. J. et al: TJ-114(Minor Bupleurum Decoction, Poria Powder
with Five Herbs), an herbal medicine in rheumatoid arthritis. A
preliminary “go-no go” clinical trial. J. Clin.Rheumatol 2: 309-316, 199622) Tanaka M., Ono S., Suzuki T. et al.: Usefulness of Stephania andAstragalus Decoction for the Treatment of Chronic Rheumatoid Arthritis,
Journal of the Japan Society of Oriental Medicine 40: 73-77, 1989

34

Regarding other connective tissue diseases like
SLE, PSS or SSc, Kampo therapy is added to therespective western medical therapies, but so far there
are only a few reports23,24,25).
23) Ono S.: Kampo Therapy for Systemic Lupus Erythematodes, Kampo andMost Advanced Therapies 2(4): 333-339, 199324) Imadaya A.: Withdrawal from Steroid Therapy Facilitated by Kampo
Therapy, a case of Long-term Remission in a Patient with Systemic Lupus
Erythematodes, The Journal of Traditional Sino-Japanese Medicine 104,198925) Matsuda K.: Therapeutic Guidelines for Kampo Health Care Services,
Progressive Systemic Scleroderma (PSS), revised edition (Organization:
Japan Society of Oriental Medicine): 199-202, 1993

Behcet's disease, with its aphthous ulcers of theoral mucosa, genital ulcers and skin symptoms, can be
sufficiently treated with Kampo medicine and is thus acomparatively good indication for this treatment
modality. Generally, Warming and Clearing Decoction,
Ten Strong Tonic Herbs Decoction, Modified Merry Life
Powder and similar preparations are used. For the oral
lesions, Coptis Detoxificating Decoction or Licorice
Decoction are taken into the mouth, in such a way thatthe drugs come in contact with the affected sites before
swallowing. For Warming and Clearing Decoction
there are placebo controlled clinical trials and caseseries studies26,27).
26) Kaneko F.: Warming and Clearing Decoction for the Treatment of Behcet's
Disease, Prog. Med. 6: 384-386, 198627) Hashimoto T., Takeuchi A., Mori S. et al.: Clinical Effects of Warming andClearing Decoction for the Treatment of Behcet's Disease, Therapy and
New Drugs 20(10): 2283-2285, 1983

Kampo therapy has also been tried for thetreatment of Sjögren’s syndrome, for dryness of theoral cavity and the eyes. Basically, dryness is
considered to be due to a lack of fluids and therefore
Yin tonifying formulas are administered. Dwarf
Lilyturf Decoction, Ginseng Nutrition Decoction,

Bupleurum Cassia Twig and Dried Ginger Decoction

and similar preparations are comparatively well used.
There are comparative trials and case series studies
using Dwarf Lilyturf Decoction, as well as multi-center
case series studies using Ginseng Nutrition
Decoction28,29,30).
28) Ono S., Suzuki T., Doi Y.: Effects of Dwarf Lilyturf Decoction on Disordersof Saliva Secretion in Sjögren Syndrome, Rheumatism 30: 10-16, 1990
29) Tonotsuka N., Abe M., Tahara K. et al.: Effects of Dwarf Lilyturf Decoction
on Dryness of the Eyes in Sjögren’s Syndrome, Journal of the Society for
Wakan Yaku 6: 436-437, 1989
30) Yokohari R., Kishimoto S., Tanimoto K. et al.: Clinical Effects of Ginseng
Nutrition Decoction (EK-108) on Dryness of the Eyes and the Oral Cavity in
Sjögren’s Syndrome, Clinical Medicine and Pharmacology 9: 1959-1968,
1993

15. Kidney
Kidney diseases are often associated with edema.
Yet, examination of literature older than 100 years,
makes the distinction of whether the edema mentioned
in the relevant works is due to cardiac or renal
diseases difficult. Naturally, at that time, thehistologic identification of the lesions had not yet beenpossible so that application of records of those days to

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Volume 1, Special Edition | Current Kampo Medicine 2005

current clinical practice, with a few exceptions, isdifficult. On the other hand, there is a growing trend
in recent years to apply the data of hematologic
examinations and histopathologic findings to Kampo
clinical practice.
Chronic renal diseases remain difficult to treat
with western medicine and in the end have to rely on
dialysis. Kidney transplantations are performed inJapan, but the number of cases is small. A variety ofdifferent approaches to these diseases using Kampo
therapy have been attempted, and among these, someepoch-making forms have received considerable publicattention. Yet, for these attempts, no extracts wereused. Rather large amounts of crude drugs wereselectively administered in special treatment forms.
First, it has been proven that creatinine levels
decrease in response to treatment with large amountsof astragalus(milk-vetch) root. Haimoto discovered
during the treatment of several patients with chronic
renal insufficiency that among numerous crude drugs,
astragalus root is independently capable of decreasing
the creatinine level1). Moreover, treatment results
indicated that efficacy improves even further byadding red peony root. Conversely, Ebe devised, basedon his own original theory and again centering on
astragalus root formulations, a mixture made up ofdifferent crude drugs (red peony root, rhubarb rhizoma,
trichosanthes seeds, pinellia tuber) with similar effects
and has already used this formula for several dozens ofpatients2,3). Among these there is a substantial numberof patients in whom the start of the dialysis treatment
could be significantly delayed or else the frequency of
the required dialysis sessions decreased.
The findings obtained from these studies indicatedthat rhubarb apparently decreased BUN andcreatinine4,5,6,7). According to relevant clinical andexperimental research, these effects have been verified.
Traditionally, Poria Powder with Five Herbs, Separate
and Reduce Decoction, Bolster the Spleen Decoction,
Middle-Reinforcing and Dampness-Removing Decoction,and similar preparations have been used as diuretics.
With a few exceptions, sufficient efficacy was observed
only in rare cases. In recent years, based on Chineseexperiences, the combination of Houttuynia herb,
astragalus radix and imperatae rhizoma has proven tobe effective. Recent follow-up studies from Japan
yielded similar results. This drug mixture too is used
as a decoction and appears to be effective8).
Kampo medicine can be used for various conditions
in dialysis patients. For example, Warming andClearing Decoction is administered for dermal pruritus
developing in patients undergoing dialysis and its
efficacy has been shown in case studies9). Peony andLicorice Decoction is administered for muscle cramps
and case studies10) have shown an efficacy of 88.5%.
Case studies regarding the use of Minor Bupleurum
Decoction plus Poria Powder with Five Herbs forosteoarthritis related to dialysis11,12) have shown anefficacy of 61%. In any case, the usefulness of Kampo
medicines was very good.
1) Haimoto H.: Efficacy of Astragalus Root in Decreasing Serum Creatinine
Levels in Chronic Renal Failure, Φυτο 7(1): 4-9, 2005
2) Hashimoto M., Ebe Y.: Kampo Therapy for Chronic Renal Failure (1)Clinical Journal of Traditional Chinese Medicine 25(4): 482-487, 2004
3) Hashimoto M., Ebe Y.: Kampo Therapy for Chronic Renal Failure (1)Clinical Journal of Traditional Chinese Medicine 26(1): 88-94, 2005
4) Oura H., Yokozawa T.: Pharmacologic Action and Effects of Rhubarb The
Journal of Traditional Sino-Japanese Medicine 12(2): 87-92, 1991
5) Tarasawa K., Shibahara N.: the Role of Kampo Therapy in the Treatment ofRenal Diseases - Opinions by Kampo Experts, Kampo & the Newest
Therapy 8(2): 101-105, 1999
6) Oura H., Yokozawa T.: Efficacy of Japanese and Chinese Medicine (Wakan
Yaku) in the Treatment of Experimental Renal Failure - Kidney and
Dialysis (Extra Edition) 26: 38-42, 1989
7) Mitsuma T. et al.: Research into Rhubarb and Rhubarb Containing Kampo
Preparations for the Treatment of Chronic Renal Failure (Second Report),
The Japanese Journal of Nephrogy 29: 195-207, 1987
8) Haimoto H. et al.: Traditional Chinese Treatment of Chronic Nephritis andNephrotic Syndrome, The Kampo 14(3): 62-68, 1996
9) Arisaka M., Kusano E., Asano Y. et al.: Clinical Experiences with the Use of
Onsei In for the Treatment of Pruritus in Dialysis Patients, Kidney and
Dialysis 35: 565-569, 1993
10) Kumakura M., Hyodo T., Tomimitsu E. et al.: Fast-acting Properties ofPeony and Licorice Decoction for Muscle Cramps in Dialysis Patients,
Dialysis Care 6: 75-79, 2000
11) Oka Y., Miyazaki M., Takatsu S. et al.: Importance of Early Discovery of
Osteoarthritis in Dialysis Patients - Study of the Usefulness of Minor
Bupleurum Decoction, Poria Powder with Five Herbs, Journal of the Japan
Dialysis Society 33: 1371-1376, 2000
12) Takasu S., Hatamura T., Sasahara K.: Clinical Effects of Minor Bupleurum
Decoction, Poria Powder with Five Herbs on Osteoarthritis in Dialysis
Patients, Kampo Shinryo 15: 18-21, 1996

The concept of glomerular nephritis wasestablished in recent years. Moreover, this disease wasonly treated when it was associated with such
macroscopically visible anomalies of the body likeedema. Today, in addition to the aforementioned sign,abnormal biochemical data, proteinuria or hematuria(including microscopic hematuria) have become
treatment indications and the range of treatment
indications for Kampo medicine has also beenbroadened.
Acute postinfectious glomerular nephritis used to
be a frequently observed disease, but today its
incidence has decreased due to the wide spread use ofantibiotics, so that the chances to treat the condition
with Kampo have diminished. Some forms of IgA
nephropathies respond well to Kampo therapy andthere are RCTs verifying this finding13). Nephrotic
syndrome is a disease for which Kampo medicine has
been used widely and even today continues to be underused, although under fairly restricted conditions.
Histopathologic examination shows that disorders ofthe minimal change group and membranous
nephropathy respond well to Kampo medicine. There
are relevant data regarding the use of Minor

Bupleurum Decoction, Poria Powder with Five
Herbs14,15,16,17). Moreover, a combination of the above

mentioned Houttuynia cordata, astragalus radix andimperata rhizoma is effective for the treatment of
edema and proteinuria, characteristics of this disease.

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13) Yoshikawa N., Ito T., Sakai T. et al.: Prospective Controlled Study Using
Minor Bupleurum Decoction, Poria Powder with Five Herbs for theTreatment of Pediatric IgA Nephropathy with Focal, Minimal Mesangial
Proliferation, The Japanese Journal of Nephrogy 39: 503-556, 1997
14) Tojo S., Yoshitoshi Y., Nagasawa T. et al.: Ethical Kampo Preparations for
Chronic Glomerular Nephritis and Nephritic Syndrome: Clinical Effects ofMinor Bupleurum Decoction, Poria Powder with Five Herbs (First Report),
Multi-facility Open Trial, Kidney and Dialysis 31(3): 613-625, 199415) Ito K., Okada T., Kitagawa T. et al.: Ethical Kampo Preparations for
Pediatric Chronic Glomerular Nephritis and Nephritic Syndrome: ClinicalEffects of Minor Bupleurum Decoction, Poria Powder with Five Herbs,
Multi-facility Open Trial, Kidney and Dialysis 36: 1237-1246, 1994
16) Yoshikawa T., Ito T., Takekoshi Y. et al.: Pediatric Steroid Reactive
Nephritic Syndrome, Initial Steroid Treatment Period and Recurrence inPatients Treated with a Minor Bupleurum Decoction, Poria Powder with
Five Herbs Combination Therapy - Prospective Controlled Study, The
Japanese Journal of Nephrogy 40: 587-590, 1998
17) Yasaki T., Hirose S.: Clinical Effects of Minor Bupleurum Decoction, Poria
Powder with Five Herbs on Pediatric Nephritic Syndrome, Journal of
Traditional Medicine 4: 203-206, 1987

16. Urology
Regarding urologic diseases, ancient textbooks
refer to the "Five Lin" (five stranguries): stone, Qi,
unctuous, consumptive and bloody Lin. These are
general terms for conditions currently designated as
cystitis, urinary stones, hematuria, syphilis anddysuria etc. Today, specific therapies have been
proposed for these individual conditions and not thetraditional concept of "Lin"1).
1) Ishibashi A.: Kampo Therapy of Urologic Diseases (Continued), for Practical
Physicians, The Kampo No.3: 2-7, 1999

Among the urogenital infections Kampo medicine
is effective for acute cystitis, but the condition isusually treated with antibiotics. In ordinary clinicalpractice it is, however, not possible to provide a
preventive therapy with antibiotics, so that Kampo
therapy is given to those patients for whom thecondition has progressed to the chronic stage.
Umbellate Fungus Decoction, Combind Umbellate
Fungus Decoction and Four Herbs Decoction, Gentian
Liver-Purging Decoction, Powder for Five Kinds ofStranguria, Heart-Clearing Lotus Seed Decoction,
Kidney Qi Pill are frequently used preparations. Thereare case series studies dealing with the use of Combind

Umbellate Fungus Decoction and Four Herbs
Decoction for the treatment of ureter syndrome2).

2) Sugaya K., Nishizawa O., Noto H. et al.: Effects of Umbellate Fungus
Decoction and Combind Umbellate Fungus Decoction and Four Herbs
Decoction for the Treatment of Ureter Syndrome, Urology Bulletin 38:
731-735, 1992

Among the forms of bacterial prostatitis, acuteinfections are an indication for antibiotics. Chronic
bacterial prostatitis, nonbacterial prostatitis or thechronic prostatitis syndrome cause similar symptoms
for which western medical treatment is not sufficiently
effective. For these conditions Kampo therapy is oftenvery effective. Gentian Liver-Purging Decoction isfrequently used3). Combination with Kidney Qi Pill may
in some cases give better results. Beside these formulas,
there are studies dealing with Life-preserving
36

Kidney-Qi Pill and Cassia Twig and Tuckahoe Pill.
Cumulative studies have been performed for Cassia
Twig and Tuckahoe Pill among the above mentioned
preparations and showed effectiveness in 12% andslight effectiveness in 66.4% of the treated patients4).
3) Takashi M., Haimoto H.: Experiences with Kampo Therapy for Patientswith Chronic Prostatitis presenting with a Greasy Tongue Coating,Φυτο 1(2): 16-18, 2001
4) Harada K.: Usefulness of Blood Stasis Expelling Drugs for the Treatment ofChronic Prostatitis - Using Mainly Cassia Twig and Tuckahoe Pill, WE
No.7: 9-10, 2004

In most cases of urinary tract stones causing
colicky pain, Kampo medicine alone cannot provide
relief, but there have been many attempts at using it.
Peony and Licorice Decoction, Umbellate Fungus
Decoction and Peony and Licorice Decoction, Major
Middle-Strengthening
Decoctionandsimilarpreparations have been prescribed. A new indication inthis field is the excretion of the stone fragments
following
ESWL(extracorporeal
shock
wave
lithotripsy). For this purpose, the combination of large
amounts of fluid replacement with the administrationof Umbellate Fungus Decoction has been proposed andtested in comparative clinical trials5).
5) Takada M., Yano H., Kambara N. et al.: Effects of Umbellate Fungus
Decoction on Post-ESWL stone excretion, Acta Urologica Japonica
43:311-314 1997

Erectile dysfunction in men is not due to a single
cause and the indications for Kampo therapy are
limited, but it is used for psychogenic or age dependentcases. Kidney Qi Pill, Middle-Reinforcing and
Qi-Benefiting Decoction, Bupleurum plus Dragon’s
Bone and Oyster Shell Decoction, Cassia Twig plus
Dragon’s Bone and Oyster Shell Decoction have been
selectedandused6).
Middle-Reinforcing and
Qi-Benefiting Decoction is frequently used for thetreatment of oligospermia or insufficient motility ofsperm found in cases of male infertility. Several hours
after the administration of Middle-Reinforcing and
Qi-Benefiting Decoction the number of sperm andsperm motility have been confirmed to markedly
increase7,8). Preparations like Kidney Qi Pill or
Life-preserving Kidney-Qi Pill have similar modes ofaction and the latter preparation has been shown incase series studies to increase the number of sperm incase of oligospermia and very efficiently improve
motility in asthenospermia9).
6) Ikeuchi T.: EBM in Kampo Therapy - Current Situation - 3. Overview overthe current situation of EBM in various fields, 7) EBM and Renal and
Urologic Diseases, Prog. Med. 22(9): 53-56, 2002
7) Li Ping, Takase K., Mukobayashi M. et al.: Clinical Effects ofMiddle-Reinforcing and Qi-Benefiting Decoction in the Treatment of Male
Infertility, Progress in Obstetrics and Gynecology 48(4): 406-410, 1996
8) Akiyama M., Oeda T., Akiyama H. et al.: Clinical Experiences with
Middle-Reinforcing and Qi-Benefiting Decoction in the Treatment of Male
Infertility, Chapter of Urology in Western Japan 59(5): 442-446, 1997
9) Ohashi M., Ishikawa H., Yauchihara H. et al.: Efficacy of Life-preserving
Kidney-Qi Pill in the Treatment of Male Infertility - Seminal Fluid Findings
Obtained with an Automatic Seminal Fluid Analyzer, Journal of theJapanese Society of Fertility and Sterility 39(2): 79-83, 1994

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Volume 1, Special Edition | Current Kampo Medicine 2005

The initial stages of prostate hypertrophy are an
indication for Kampo therapy. Kidney Qi Pill is afrequently used preparation and there are case series
studies dealing with its application10,11). When treatment
with Kidney Qi Pill alone is insufficiently effective, thehypertrophy of the prostate gland can be viewed as amanifestation of blood stasis. Some studies demonstrated
that treatment with blood activating and stasis resolving
preparations like Cassia Twig and Tuckahoe Pill or
Rhubarb and Moutan Bark Decoction (in case of adecoction Choryu To) appears to be beneficial12).
10) Harada K.: Treatment of Urological Diseases with Japanese and Chinese
Medicine; 4. Diseases of the Prostate and Micturation Disorders, Clinical
Urology 45: 295-300, 1991
11) Yoshida K., Nakagawa Y., Tani Y. et al.: Clinical Effects of Kidney Qi Pill
for Prostrate Hypertrophy, The Clinical Report 9: 2861-2870, 1991
12) Yamamoto I.: Outline of Kampo Therapy for Diseases of the Lower Urinary
Tract; Miscellaneous Records of Oriental Medicine 3, (“Essays of eastern
medicine” Vol.3): 637-648, 1983

Urinary incontinence is frequently observed inelderly patients, particularly in women. It is likelythat patients do not report this symptom because ofembarrassment. For the treatment of pressureincontinence, the preparation Middle-Reinforcing and
Qi-Benefiting Decoction with its "upraising"properties is widely used13). Kase et al. administered
Middle-Reinforcing and Qi-Benefiting Decoction toseven patients who did not wish to undergo surgicaltreatment of pressure incontinence, and evaluatedthe results with the questionnaire proposed by theInternational Consultation on Incontinence (ICI).
They found that the average incontinence score
reportedly dropped from 10.4±3.7 points to 6.3±5.0
points14). Moreover, in recent years it has been noticed
that Pueraria Decoction also has incontinence
inhibiting actions. The discovery of this effect wasmade by Prof. Shin, who found that treatment offemale outpatients in an obstetrics and gynecology
clinic suffering from common cold with Pueraria
Decoction resulted in an alleviation of the incontinence
occurring simultaneously with the cure of the cold.
Prof. Shin conjectured that this effect is probably due
to a contraction of the internal cystic sphincter inducedby the ephedrine contained in Pueraria Decoction,
while the component paeoniflorin of peony root seems
to induce relaxation of the smooth muscles of the
bladder15). Impending incontinence is considered to be
one pathologic form of kidney deficiency, so that here
kidney tonifying preparations like Kidney Qi Pill andLife-preserving Kidney-Qi Pill are widely used16).
13) Murakami Y.: Effects of Middle-Reinforcing and Qi-Benefiting Decoction
on Mobile Kidneys and Pressure Incontinence, Acta Urologica Japonica 34:
1841-1843, 1988
14) Kase H., Akashi M., Sato T.: Effects of Middle-Reinforcing and Qi-Benefiting
Decoction on Pressure Incontinence, Kampo Igaku 29(3): 19-21, 200515) Shin S. et al.: Usefulness of Pueraria Decoction on Pressure Incontinence;
47th Conference of The Japan Society for Oriental Medicine, Summary
Collection P126, 1996
16) Yamanaka H., Suzuki T., Tokunaga S. et al.: Kampo Therapy for
Micturation Disorders, Kampo Igaku 21(8): 2-10, 1977

17. Nervous System
Many diseases in this field are indications for
acupuncture therapy, but a combination therapy with
Kampo medicine is more effective. Traditionally there
has been a lot of experience with stroke and headache.
For various forms of degenerative cerebral diseases,
Kampo therapy has been effective to a certain extent
and today numerous therapeutic trials are performed.
Regarding headache, both tension headache andmigraine are both good indications for Kampo therapy.
Widely used preparations include Evodia Decoction,
Poria Powder with Five Herbs, Pueraria Decoction,

Pinellia, Largehead Atractylodes and Tall Gastordia
Decoction, Tea-Blended Szechwan Lovage Powder,
Cassia Twig plus Ginseng Decoction, Coptis
Detoxificating Decoction and similar formulas. Eachof these preparations are used for corresponding
disease states, but the TCM classification may notnecessarily always be the same, so that prescriptions
may differ. Among these, Poria Powder with Five
Herbs is a characteristic Japanese formula not foundin Chinese textbooks. Haimoto found through skillful
application of clinical epidemiologic methods anefficacy of over 90% when the preparation was used forthe treatment of headache associated with a drop in
atmospheric pressure. The odds ratio of the correlation
between headache and the drop in atmosphericpressure was reportedly 16.21). In Japan, Evodia
Decoction has traditionally been used for thetreatment of this condition and there are a substantial
number of related studies. A case series study showed
better than simple improvements in 77 out of 147
patients2). The data of another case series study
examining 30 patients with tension headache showedthat the treatment was effective in 23 patients (that is
an efficacy of 76.3%)3). Yet, in actual clinical practicethe efficacy does not seem to be that high. Moreover,treatment with this preparation reportedly results inimprovements of vascular headache, but statisticaldifferences were not observed. However, sometimes
there are cases with dramatic improvement. Case
series studies examining the use of Pueraria Decoction
for the treatment of tension headache showed at the
fourth treatment week an efficacy of 66.3%4). Somecase series studies deal with the treatment of tension
headache using Uncaria Powder, or else chronicheadache in patients with cerebrovascular disorders andreported effectiveness for both conditions5,6). Treatmentof trigeminal neuralgia follows the therapeutic
guidelines for headache.
1) Haimoto H.: Discussion of Clinical Epidemiologic Research into Chronic
Headache and the Correlation with Shifting Atmospheric Depressions,Φυτο 1(3): 8-15, 1999
2) Maeda K., Miyagi A., Sugawara T. et al.: Effects of Evodia Decoction on
Chronic Headache, Kampo Igaku 22: 55-57, 1998
3) Akamine M., Hyoudo Y., Ashihara M. et al.: Usefulness of Evodia Decoction
for Tension Headache, Japan Oriental Psychosomatic Medical Research 15:
36-38, 2000

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Volume 1, Special Edition | Current Kampo Medicine 2005
4) Yamamoto M.: Clinical Effects of Pueraria Decoction on Chronic Tension
Headache Caused by Stiffness of Shoulders and Neck, The Japanese
Journal of Clinical and Experimental Medicine 72: 1299-1303, 1995
5) Kimura K., Sasao S.: Clinical Effects of Tsumura's Uncaria Powder for
Chronic Headache in Patients with Cerebrovascular Disorders, Geriat. Med.
27: 445-449, 1989
6) Takada O.: Usefulness of Uncaria Powder for Chronic Tension Headache,
Kampo Igaku 22: 121-124, 1998

Throughout a lengthy history, a number ofdifferent therapies have been administered for epilepsy.
During the 18th century in Japan, apart from theordinary treatment, "vomitting" (intentional inductionof emesis) was performed occasionally as part of thetherapy, but did not produce sufficient results.
Currently, various adapted forms of Kampo therapy
are used in conjunction with modern western medical
treatment, but independently cannot be expected to beeffective. For the treatment of refractory pediatricepilepsy there are reports about using Minor

Bupleurum Decoction plus Cassia Twig Decoction plus
Peony, Minor Bupleurum Decoction plus Minor
Middle-Strengthening Decoction, Bupleurum andCassia Twig Decoction and similar preparations,where the data indicate an efficacy of 30-70%. For
details please refer to the section on pediatrics.
Cerebrovascular disorders have for a long time
been recognized as an extremely frequent conditionand constituted the number one cause of death in theJapan 50 years ago. Today, in conjunction with theprogress in modern medicine, fatal cases have becomemuch rarer, but the incidence of small infarcts andbleedings are still frequent. Additionally, these
conditions as a sequela of surgical intervention haveemerged as a new pathology. During the acute phase of
these diseases, western medical treatment is given
priority. Kampo therapy is performed during the acutephase only under special conditions or else during thechronic phase (late effect period). In recent studies,
Kimoto administered Poria Powder with Five Herbs inorder to alleviate cerebral edema immediately
following a stroke (including lacunar stroke) andreported achieving a better prognosis than with theordinary therapy alone7). For the treatment of sequelaeof this disease (hemiplegia, articulation disorders andthe like) acupuncture is very well suited and Kampo
therapy
is usedmore
supportively. Coptis
Detoxificating Decoction, Major Bupleurum Decoction,

Bupleurum plus Dragon’s Bone and Oyster Shell
Decoction, Uncaria Powder, Liver-Inhibiting Powder,Angelica and Peony Powder, Cassia Twig andTuckahoe Pill, Cassia Twig Decoction plus
Atractylodes and Aconite, Kidney Qi Pill and similar

preparations are used. In this field many case series
studies and randomized controlled trials have been
performed8,9,10,11,12,13,14,15,16).
Regarding treatment with decoctions, further
modifications of the therapy have been applied.
387) Kimoto H.: Application of Kampo medicine to acute cerebral infarction:
Summary of 14 cases and comparison of their clinical prognosis with theresult of Japan Standard Stroke Registry Study (JSSRS) J. Trad. Med.
20(2): 68-73, 2003
8) Ushikubo Y., Sakurai T., Yokouchi T. et al.: Effects of Coptis Detoxificating
Decoction on Cerebrovascular Disorders and Quantitative Evaluation of
Blood Flow, Journal of New Remedies & Clinics 47: 176-183, 1998
9) Ito E., Takahashi A., Kuzuya F.: Clinical Effects of Coptis Detoxificating
Decoction on Stroke, Geriat. Med. 29: 303-313, 1991
10) Otomo E., Togi H., Kogure K. et al.: Usefulness of Coptis Detoxificating
Decoction for the Treatment of Cerebrovascular Disorders - Controlled
study with Ca Hopantenate as the Control Using the Envelope Method,
Geriat. Med 29: 121-151, 1991
11) Araki G.: Effects of Coptis Detoxificating Decoction on the Sequelae of
Cerebrovascular Disorders - Particularly discussing improvements in
cerebral circulation (vertigo, dizziness), Geriat. Med 29: 1587-1599, 199112) Ito E., Uchida M., Sakakibara T. et al.: Effects of North Water God
Decoction on the Sequelae of Cerebrovascular Disorders, The Japanese
Journal of Clinical and Experimental Medicine 71: 562-568, 199413) Matsushita S., Ueda S., Ouchi Y. et al.: Usefulness of Uncaria Powder for
the Treatment of Accessory Symptoms of Cerebrovascular Disorders,
Chronic Cerebral Circulatory Insufficiency and Hypertension, Geriat. Med
33: 1333-1341, 1995
14) Ito K., Yamamoto H., Nishihara T. et al.: Investigation of the Usefulness ofKidney Qi Pill for the Treatment of Various Symptoms in Patients with
Hypertension or Cerebrovascular Disorders (excluding the acute phase) Multi-facility crosover double-blinded trial, Diagnosis and Treatment 76(4):1096-1114, 1988
15) Fukushima T., Tomonaga M., Tanaka A. et al.: Clinical Effects of Angelica
and Peony Powder on the Sequelae of Cerebrovascular Disorders, The
Japanese Journal of Clinical and Experimental Medicine 71: 1065-1070,
199416) Goto H., Shimada Y., Mitsuma T. et al.: Effect of Cassia Twig and Tuckahoe
Pill on asymptomatic cerebral infarction for short term, J. Trad. Med 19:
46-50, 2002

Regarding cerebrovascular dementia, research
about Uncaria Powder and similar preparations is
progressing. Please refer for further details to thesection on mental diseases.
Several preparations have been tried in form of
combination therapies with western medical
treatment during the initial phase of Parkinsonism. So
far, Liver-Inhibiting Powder and Tangerine Peel,
Pinellia Rhizoma plus Liver-Inhibiting Powder are
representative formulas17). In recent years case series
studies with Coptis Detoxificating Decoction,
Tea-Blended Szechwan Lovage Powder, Six Gentlemen
Decoction and similar formulas have also been
performed18,19,20).
17) Ogawa S.: Purpose and Application of Liver-Inhibiting Powder andTangerine Peel, Pinellia Rhizoma plus Liver-Inhibiting Powder, Kampo
Medicine (Jap. Journal of Oriental Medicine) 49(3): 330-334, 199818) Ito M.: Clinical Experiences with Coptis Detoxificating Decoction for theTreatment of Parkinson's Disease, The Clinical Report 26: 1519-1524, 1992
19) Shizuma N., Muramatsu S., Ikeguchi K. et al.: Effects of Tea-Blended
Szechwan Lovage Powder on the Dyskinesia of Parkinson's Disease, Kampo
Medicine (Jap. Journal of Oriental Medicine) 51: 1087-1091, 200120) Hiyama Y., Tosa H., Terasawa K. et al.: The effects of Six Gentlemen
Decoction on Parkinsonian patients with unstable effect oflevodopa/carbidopa, J. Med. Pharm. Soc. WAKAN-YAKU 8: 83-88, 1991

Since approximately 60% of the patients with
Bell's palsy recover spontaneously without any
treatment, many patients do not necessarily require
therapy. This condition is a good indication for
acupuncture therapy and improvement immediately

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Volume 1, Special Edition | Current Kampo Medicine 2005

after the treatment is not uncommon. Therefore theuse of Kampo medicine is not required. Several RCTs
have been reported that compare this medication witha steroid group21,22). According to these studies, there
were not any major differences between the twogroups.
21) Horiguchi I., Otake T.: Comparison of the Therapeutic Effects of Steroids
and Minor Bupleurum Decoction, Poria Powder with Five Herbs on
Peripheral Facial Palsy (Bell's Palsy), Kampo & the Newest Therapy 7(4):363-368, 199922) Obata H., Otake T., Ishikura H.: Usefulness of Minor Bupleurum
Decoction, Poria Powder with Five Herbs for the Treatment of Facial Palsy A comparison with steroids, Pain Clinic, Pain Clinic 16(１): 49-52, 1995

Occasionally the use of Kampo medicine in thetreatment of myasthenia gravis makes a dose reduction
in anticholinesterase agents possible. Several casereports indicated the use Middle-Reinforcing and
Qi-Benefiting Decoction or Pueraria Decoction andthere is research on the use of Six Gentlemen
Decoction23).
23) Oikawa O.: Application of Six Gentlemen Decoction in the Field of
Neurology, Prog. Med. 23(8): 2163-2169, 2003

18. Psychiatric Disorders
A multitude of mental diseases have been recorded
from ancient to modern times. In TCM, various
preparations have been devised depending on the stateof the relevant disorders. Since there had been noclassification of diseases like those used today (forexample the DSM classification), it remains difficult todetermine what modern disease the disorders
described in those days correspond to. The disorders inthis field were viewed as anomalies of the Zhang-Fu,
the viscera and organs, revealing most often problemsof heart, liver, spleen and gallbladder. In the course of
the pattern, identification anomalies of these visceraand bowels were found causing the problem. In Japan,
the "Shang han lun" or “Jin gui yao lue” offers adiversity of preparations for the treatment of these
conditions. Active research into relevant formulas
has been conducted since the Tang dynasty and led tosuitable applications.
Among common psychiatric disorders, Kampo
therapy is used as an integral part of behavior therapy,social therapy, psychotherapy and medical treatmentof stress & adjustment disorders (situational disorders).
Regarding anxiety disorders, the components of theanxiety may be either psychogenic or somatic. Kampo
medicines include preparations capable of reducing theanxiety in itself and are used as a matter of course. Itis frequently observed that through improvement of
the physical symptoms, the related anxiety isalleviated. For this reason, it is necessary to base theprescription not on disease names, but follow the
Kampo medical pattern identification. The mostfrequently observed general anxiety disorders areoften treated with preparations like Pinellia andMagnolia Decoction, Tangerine Peel, Pinellia Rhizoma

plus Liver-Inhibiting Powder, Bupleurum and Cassia
Twig Decoction, Bupleurum plus Dragon’s Bone andOyster Shell Decoction, Middle-Reinforcing and
Qi-Benefiting Decoction, Back to the Spleen Decoction,
Modified Merry Life Powder, Cyperus and Perilla Leaf
Powder, Warm the Gallbladder Decoction, Goddess
Powder, and Coptis Detoxificating Decoction. These
formulas are also employed for panic disorders andobsessive-compulsive disorders (OCD) and suitabledrugs are administered based on the SHO (symptoms
and signs). There are a number of case series studies
regarding this topic1,2,3,4,5).

1) Kudo Y., Mori A., Asai M. et al.: Clinical Effects of Modified Merry Life
Powder for Various Forms of Necrosis, Journal of Clinical Therapeutics &Medicine 8(12): 2989-3007 1992
2) Okamoto K., Hasama T., Okamoto R. et al.: Effects of Pinellia and Magnolia
Decoction on Neurosis, The Journal of Traditional Sino-Japanese Medicine
15(4): 571-576, 1994
3) Ohara K., Fukazawa H., Suzuki Y. et al.: Clinical Effects of Bupleurum plus
Dragon’s Bone and Oyster Shell Decoction and Pinellia and Magnolia
Decoction on Neurosis, Journal of New Remedies & Clinics 34(1): 131-141,
19854) Shinozaki T.: Effects of Tangerine Peel, Pinellia Rhizoma plus
Liver-Inhibiting Powder in 30 Neurosis Patients with Irritation as Their
Chief Complaint, Kampo Shinryo 18(2): 42-44, 1999
5) Shinozaki T.: Effects of Bupleurum plus Dragon’s Bone and Oyster Shell
Decoction in 15 Neurosis Patients with Irritation as Their Chief Complaint,
Kampo Igaku 24(3): 122-124, 2000

Somatoform disorders (abnormal illness behavior)
are a group of disorders that are very difficult toconceptualize. Yet, Kampo therapy occasionallyappears to be useful. These conditions are notapproached directly from their mental aspects, but byrelieving physical problems with Kampo therapy therelevant mental conflicts are sometimes relieved.
Many Kampo preparations act by improving physicaldysfunction and are administered in order to improve
the physical disposition of the patients. For chronic
pain disorders, Kampo therapy does not appear to bevery effective. However, it can in rare cases, beeffective when the pathology is properly identified
according to Kampo medical concepts.
To date no systematic studies on the application of
Kampo therapy for schizophrenic disorders have been
performed. Yet, there are a number of accessory
approaches. One of these was the administration of
Coptis Detoxificating Decoction to 10 patients in whom
symptoms had been stabilized through treatment with
antipsychotic drugs, where subsequently during theobservation period an improvement in the total scoreof the brief psychiatric rating scale (BPRS) was noted.
This took the form of significant improvement indepressive moods, delusions of guilt, delusions ofpersecution and agitation6). Another approach was thetreatment of 12 patients complaining of mild tomoderate restlessness with Kidney Qi Pill extract. The
observation of the four parameters: loss of motivation,
anxiety, restlessness and depressive moods, showedsignificant improvement7).

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6) Yamada K., Kamba S., Onishi M. et al.: Clinical Effects of Coptis
Detoxificating Decoction During Convalescence From the Active Phase of
Schizophrenia, Kampo Medicine (Jap. Journal of Oriental Medicine) 47(4):603-607, 19977) Ozaki S., Morita H., Shimomura Y.: Clinical Effects of Kidney Qi Pill andNeedling of the Back on Schizophrenia (inhibition of auditory
hallucinations through kidney tonification), Oriental Medicine 21(3): 69-75,
1993

Among mood disorders (depression & mania),
history shows a comparatively large number ofattempts at using Kampo therapy for depression which
led to the selection of several effective preparations.
Clinically, these are effective when used in the form of
combination therapies with western medications.
Middle-Reinforcing and Qi-Benefiting Decoction,
Modified Back to the Spleen Decoction, Pinellia andMagnolia Decoction, Cyperus and Perilla Leaf Powder,
Six Gentlemen Decoction, Minor Middle-Strengthening
Decoction, Ginseng Nutrition Decoction, Bupleurum
plus Dragon’s Bone and Oyster Shell Decoction andsimilar preparations are used. There are also caseseries studies for these formulas8,9,10,11).
8) Ohara K., Nishimoto M., Miyasato K. et al.: Effects of Middle-Reinforcing
and Qi-Benefiting Decoction on the Loss of Appetite Associated with
Depression, Prog. Med. 14(6): 1705-1712, 1994
9) Kudo Y., Mori A., Asai M. et al.: Clinical Evaluation of Kami Kihi in theTreatment of Various Neurotic Disorders, Journal of Clinical Therapeutics& Medicine 8(12): 2989-3007, 1992
10) Ohara K., Fukazawa H., Suzuki Y. et al.: Clinical Effects of Bupleurum
plus Dragon’s Bone and Oyster Shell Decoction and Pinellia and Magnolia
Decoction in the Treatment of NeurosisJournal of New Remedies & Clinics
34(1): 131-141, 1985
11) Tsutsui S., Igarashi M., Takekoshi I. et al.: Experiences with Pinellia andMagnolia Decoction in the Treatment of Depression and Depressive Moods,
Journal of New Remedies & Clinics 42(9): 1913-1920 1993

Insomnia is treated among the sleep disorders
with psychotherapy, life style guidance andpharmacotherapy in that order; but in reality,
hypnotics are applied rather lightheartedly. Kampo
medicines do not act like western soporific medications,but are more adjusted in a way to suit the various
disease states. From a Kampo medical point of view,
sleep disorders are considered to be caused byanomalies of organs like the heart, liver, or gallbladderand prescriptions are administered according to therelevant pathologies. Wild Jujube Seed Decoction,
Coptis Detoxificating Decoction, Modified Merry Life
Powder, Pinellia and Magnolia Decoction, Back to theSpleen Decoction, Warm the Gallbladder Decoction,
Liver-Inhibiting Powder and similar preparations are
selected. By treating patients who developed atriazolam dependency, with Wild Jujube Seed
Decoction, Ozaki et al. succeeded in gradually
decreasing the frequency of the triazolam use.
Reportedly, many patients were finally able to sleep
relying only on Wild Jujube Seed Decoction12).
Moreover, when Ozaki et al. used a combination
therapy of zopiclone and Wild Jujube Seed Decoction,
the sleep duration increased in spite of a facilitated40

elimination of zopiclone from the blood and the QOL
on the following day reportedly improved13).
12) Ozaki T.: Description of Patients who were Able to Completely Withdraw
from Hypnotics by Using Tsumura's Wild Jujube Seed Decoction, Japan
Society of Ryodoraku Medicine 42(7): 4-15, 199713) Ozaki T., Ohara S., Saito K.: Combined Effect of Zopiclone and Wild Jujube
Seed Decoction in the Treatment of Insomnia, Kampo Igaku 22(5): 22-23,
1998

Dementia is a disease difficult to treat. It isfrequent among the elderly and currently there are no
therapeutic measures available for the treatment of
the three forms of cortical dementia. Research into theuse of Kampo medicine for this condition has justbegun, but some interesting results have already been
published. First, DB-RCTs using Uncaria Powder havereceived much attention. Terasawa et al. administeredin several facilities either Uncaria Powder or a placebo
to 139 patients with cerebrovascular dementia andreported for the former a signficantly better
improvement than that obtained with the latter14). The
studies conducted by Shimada et al. could also beinterpreted in a similar way (placebo and RCTs)15).
Based on these studies the improvement inspontaneous conversations, poor facial expressions,decreased calculation abilities, night delirium, sleep
disorders, hallucinations and delirium was in the
Uncaria Powder group significantly better than in theplacebo group. There are also multi-facility case series
studies using Coptis Detoxificating Decoction thatshow significant improvements16,17). Uncaria Powder is
not effective for cerebrovascular dementia, but is for
Alzheimers disease18). Regarding this disease, there
are a number of excellent studies using Angelica andPeony Powder19). Hagino et al. focused on theneuroendocrine action of this drug and found inexperiments using rats that it causes an increase in
the number of nicotinic acetylcholine receptors and theconcentration of catecholamines in the cerebral cortex
and hippocampus, thereby determining that this has
an inhibitive effect on the dementia20). Results ofresearch in this area look very promising.
14) Terasawa K., Shimada Y., Kita T. et al: Uncaria Powder in thetreatmentnt of vascular dementia a double-blind, placebo controlled study,
Phytomedicine 4: 1522, 199715) Shimada Y., Terasawa K., Yamamoto T. et al: A well-controlled study ofUncaria Powder and placebo in the treatment of vascular dementia, J. Trad.
Med. 11: 246-255, 199416) Araki G.: Investigation of the Effects of Coptis Detoxificating Decoction on
Dementia, Journal of Senile Dementia 4: 110-117, 1990
17) Araki G.: Effects of Coptis Detoxificating Decoction on Senile Dementia,
Therapeutic Research 15: 986-994, 1994
18) Yamamto T.: Kampo Therapy of Alzheimer's Disease, Current Medicine 5:
96-102, 1989
19) Inanaga K., Dainoson K., Ninomiya Y. et al.: Therapeutical of Angelica andPeony Powder on Senile Cognitive Disorders, Multi-facility Joint Research,
Prog. Med. 16: 293-300, 199620) Hagino N., Koyama T.: Stimulation of nicotine acetylcholine receptor
synthesis in the brain by Angelica and Peony Powder(TJ-23).Recent
Advances in the Pharmacology of Kampo (Japanese herbal) Medicines
144-149, Excerpta Medica, Tokyo, 1988

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19. Endocrinology
The growing knowledge about various hormones inthe body and the organs that secrete them has inrecent years clarified many questions. Regarding
diseases in this area, hyperthyroidism is marked byvisible characteristics and specific clinical symptoms.
This condition has been recognized since ancient times,
but most other diseases in this field were not clearly
defined. This is only natural because there had been
no concept of endocrine function. Even though thenature of these diseases has gradually been clarified inrecent years, there are almost no studies showing theefficacy of Kampo therapy. The only condition forwhich there are many reports is hyperthyroidism.
Regarding this disease, a modern biomedical therapy
has been established and Kampo therapy is used only
ancillarily. Roasted Licorice Decoction, Bupleurum
Cassia Twig and Dried Ginger Decoction, Bupleurum
plus Dragon’s Bone and Oyster Shell Decoction andsimilar preparations are frequently used. Several
reports also deal with combinations of thyroid drugs
and Kampo medicines1). Tachino described three cases
in which good control was achieved using thyroid
drugs and Roasted Licorice Decoction. Moreover, hereported a comparative study treating 35 patients
divided in two groups Group A treated with thyroid
drugs and Roasted Licorice Decoction and group B
treated with thyroid drugs and propranololhydrochloride. The improvements in tachycardia andsubjective symptoms were reportedly much better ingroup A2).
1) Yukimura Y.: Combination Therapies with Kampo Preparations forHyperthyroidism - Kampo Medicine (Jap. Journal of Oriental Medicine)35(2): 47-54, 1984
2) Tatsuno I.: Three Cases of Hyperthyroidism, Modern Kampo Therapy:
280-283 Toyo Gakujutsu Shuppansha, 1985

20. Diabetes Mellitus
Diabetes mellitus has been known since ancient
times in both western Europe and China as a disease
where sweet urine is passed. Yet, during antiquity or
the middle ages, it was not known that this disease
was due to an insufficient secretion of insulin and theresulting hyperglycemia. Likewise it was not known
that leaving the condition unattended anduncontrolled
will
eventually
resultinthemanifestation of microvascular lesions. In TCM,
symptoms like intensely dry mouth, voracious appetiteand the passing of large amounts of urine wereclassified as being related to the upper, middle or lower
portion of the body and thus appropriate therapies
were devised. Although this is a useful classification
indicating suitable therapies and preparations, thebasis of diabetes therapy remains diet and exercise.
Diet, caloric intake in particular, in relation tocarbohydrates, poses problems for which Yoichiro Ebe

has proposed an epoch-making diet (since this is notdirectly related to Kampo medicine its description will
be omitted here). Naturally, Kampo medicine is helpful
for the therapy on any level of the disease. White Tiger
Phis Ginseng Decoction, Major Bupleurum Decoction,
Kidney Qi Pill, Heart-Clearing Lotus Seed Decoction,
Poria Powder with Five Herbs and similar
preparations are prescribed depending on thesymptoms. Wagazuma et al. performed a randomized
controlled study treating 18 patients with type II
diabetes with Heart-Clearing Lotus Seed Decoction
and compared these with the patients in a control
group. The researchers observed a significant
difference between the two groups, where combined'improvement'
and'slight
improvement' wasreportedly 58.38%1). Moreover, Wagazuma et al. also
described obtaining favorable results with long-term
treatment of diabetics with Poria Powder with Five
Herbs2).
The focus of interest in Kampo therapy regarding
diabetes is its effects on the manifestation of
peripheral neuropathies associated with this disease.
Some case series studies have described the effects ofKidney Qi Pill and Life-preserving Kidney-Qi Pill3,4,5,6).
Also, some reports state that Life-preserving
Kidney-Qi Pill appears to be effective for the treatment
of diabetic corneal disorders7).
1) Azuma M., Motomiya M., Toyoda T.: Results of Clinical Trials Using
Heart-Clearing Lotus Seed Decoction for the Treatment of Diabetes, Kampo
Medicine (Jap. Journal of Oriental Medicine) 45: 339-344, 1994
2) Azuma M., Sato G., Fukuzawa M.: Long-term Course of Diabetes Therapy
Using Poria Powder with Five Herbs, Journal of Traditional Medicine 19(S):56, 2002
3) Mikura R., Suzuki S., Iino S.: Therapeutic Effects of Kidney Qi Pill and Six
Ingredient Pill with Rhemannia on Diabetic Neuropathies, Bell Medico,
7(6): 21-22, 1992
4) Sakamoto N., Sato Y., Goto Y. et al.: Oriental Medical Treatment of Diabetic
Neuropathies - Comparative Trial with Life-preserving Kidney-Qi Pill andCobalamine, The Journal of the Japan Diabetes Society 30(8): 729-737, 1987
5) Tawata M., Kurihara A., Nitta K. et al: The effects of Goshajinnkigan, aherbal medicine, on subjective symptoms and vibratory threshold inpatients with diabetic neuropathy. Diabet.Res.Clin.Pract 26: 121-128, 1994
6) Taniuchi K., Kashimura H., Fujiwara K. et al.:Clinical Effects of a 1-Year
Administration of Life-preserving Kidney-Qi Pill for Diabetic Neuropathies,
Journal of New Remedies & Clinics 36(4): 636-646, 1987
7) Nagaki Y., Hayasaka S., Hayasaka Y. et al: Effects of Life-preserving
Kidney-Qi Pill on corneal sensitivity supedcial punctate keratopathy andtear secretion in patients with insulin-dependent diabetes mellitus AM, J.
Chin. Med. 31: 103-109, 2003

21. Lipid Abnomalies
Almost none of the metabolic diseases had beenrecognized in the past as a disease. The concept of lipid
anomalies was first established when the technologies
to measure lipid concentrations in blood became
available and the relevant knowledge regarding
metabolism had developed. Accordingly, new Kampo
concepts were needed and corresponding therapies
sought.

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Regarding hyperlipemia, there are no preparations
that definitely lower total cholesterol and neutralize
fat concentrations, but Major Bupleurum Decoction or

Bupleurum plus Dragon’s Bone and Oyster Shell
Decoction reportedly did lower these values to acertain extent1,2,3,4,5). Research into effects of Kampo
preparations influencing the lipid metabolism onarteriosclerosis has begun. Itakura concentrated his
experiments on the LDL cholesterol in rabbits andassumed that Major Bupleurum Decoction inhibits
oxidation of LDL cholesterol, phagocytosis bymacrophages and prevented the adhesion of lipid tothe vessel wall6). Hasegawa treated patients for 4
years with Bupleurum plus Dragon’s Bone and Oyster
Shell Decoction and then examined vascular function
by measuring the aortic pulse wave velocity and the
carotid arterial system using ultrasonic transduction.
Reportedly, antiarteriosclerotic activity was observedin either case7). For these studies, extract preparations
were used. By proper adjustments of decoctions evenslightly better results are expected and currently are
the subject of investigation.
1) Murakami T., Oku J., Kimura Y. et al.: Treatment for Hyperlipidemia by
Kampo-drugs, J. Trad. Sino-Japanese Med. 11(1): 35-40, 1990
2) Sasaki A., Matsunaga A., Handa K. et al: Effects of Major Bupleurum
Decoction on Hyperlipemia - Comparison with Clinofibrate, The Japanese
Journal of Clinical and Experimental Medicine 68: 3861-3871, 1991
3) Yamano S., Sawai F., Hashimoto T. et al.: Effects of Major Bupleurum
Decoction on Serum Lipids and Brain Circulation - Comparison withelastase, Kampo & the Newest Therapy 4: 309-313, 1995
4) Miki S., Yashijima A., Wada M. et al.: Effects of Major Bupleurum Decoction
on Serum Lipids and Examinations of the Coagulation System in Diabetics,
Journal of Traditional Medicine 7(2): 120-124, 1990
5) Onuma, T. et al: Effects of Bupleurum plus Dragon’s Bone and Oyster Shell
Decoction (Kampo medicine) on abnormal plasma lipoprotein and glucose
metabolism in diabetic Patients, A comparison to Dai-saiko-to, J. Trad. Med.
12: 124-128, 1995
6) Itakura H.: Kampo Medicine and Arteriosclerosis (interview), Kampo Igaku
20(4): 11-13, 1996
7) Hasegawa M.: Anti-arteriosclerotic Actions of Bupleurum plus Dragon’s Boneand Oyster Shell Decoction (interview), Kampo Igaku 21(5): 11-13, 1997

22. Nutrition
Establishment of sound knowledge pertaining tonutrition is a rather recent event. Comprehension of
the necessary amounts of nutrition and an evaluationof the nutritional status in Kampo medicine has beenvague in the past making the overall image obscure
until the establishment of modern nutrition science.
Among the nutrition disorders, the one being
viewed as particularly problematic for modern man is
obesity. The basic situation in obesity is a problem
with caloric intake (in particular carbohydrates) andcaloric consumption. Thus, the condition does not callfor an active use of Kampo medicine. However, theuse of Kampo medicine can occasionally lead toweight reduction of a few kilograms. One aspect of
this weight loss is a Kampo medicine stimulated

42excretion of surplus body water, for which, forexample, Stephania and Astragalus Decoction can beused1). When this preparation is administered during
the treatment of gonarthrosis, it induces analleviation of articular symptoms and at the sametime may often result in a weight reduction of about
2-3 kg. Yoshida et al. administered Stephania andAstragalus Decoction to 19 patients with diabetes ofthe viceral obesity type for whom exercise is difficult
because of the underlying disease and reportedly
observed a significant decrease in viceral fat as well
as a decrease in cholesterol levels2). Another suitablepreparation is Divaricate Saposhnikovia Miraculous
Powder. This preparation has traditionally beenclassified as an exterior-interior releasing formula,but because it contains Rhubarb and Mirabilite, it
improves bowel movements and thus facilitates theexcretion of surplus materials through the feces.
Several studies have dealt with this topic3). Akiyama
et al. administered Divaricate Saposhnikovia
Miraculous Powder to obese patients with mutationsof the β 3 -adrenergic receptor gene, finding a marked
reduction in the waist/hip ratio and reportedly also
observed an improvement in insulin resistance4).
1) Sento S., Tanaka N.: Effects of Stephania and Astragalus Decoction on
Physical Symptoms due to Anomalies in Water Metabolism and Obesity,
Therapic Research 20(6): 2021-2028, 1996
2) Yoshida M., Takamatsu J., Yoshida S. et al.: Effects of Stephania andAstragalus Decoction in Diabetics with Viceral Type Obesity, Kampo
Medicine (Jap. Journal of Oriental Medicine) 49(2): 249-256, 1998
3) Sekine N.: Investigation of the Clinical Usefulness of Divaricate
Saposhnikovia Miraculous Powder for Hypertension and Obesity, Prog. Med.
24(11): 2803-2806, 2004
4) Akiyama T., Yoshikawa H., Tanaka H. et al.: β ３ adrenergic receptor Effectsof Divaricate Saposhnikovia Miraculous Powder in Obese Patients with
Gene Mutations, Digestion and Absorption 21(2): 159-162, 1998

Several reports indicated that treatment with
Kampo medicine is beneficial for the eating disorderanorexia nervosa5). The use of Minor Bupleurum
Decoction, Liver-Inhibiting and Spleen-Assisting
Decoction has been recommended, but the ratio of
successful treatments is not very high. Regarding
bulimia nervosa, there are no reports. Disorders ofvitamin metabolism are not considered to be anindication for Kampo medicines.
5) Otsuka K.: Five Case Reports About Anorexic Disorders (Psychogenic Lackof Appetite), Jap. J. Orient. Med. 7: 21-22, 1956

23. Infectious Diseases
The development of TCM is closely related to
infectious diseases. One important Chinese classic text,
the “Shang han lun", is widely known for its
descriptions of the treatment of so-called cold induced
disease. Even for infectious diseases that appeared
later, it provided the basis for the development oftherapies based on entirely new concepts for the age.
The episodes surrounding Li Dong-Yuen's creation of

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the formula Middle-Reinforcing and Qi-Benefiting
Decoction in the 12th century are famous. Following
epidemics of new diseases from the 16th to the 17th
century, the concept of "heat induced disease" wasestablished, later providing major contributions to thetreatment of infectious diseases, so that it came to belisted as an important item in most textbooks.
Historically, since the “Shang han lun" was taken
very seriously in Japan, the prescriptions listed in thisclassic text have been applied widely for this kind of
disease. For infectious diseases of the warm type,prescriptions developed later have been used for the
relevant conditions.
Today, progress in public health and hygiene aswell as improvements in comprehensive patientmanagement due to the appearance of antibiotics orantibacterial
agents,variousvaccines,
fluid
replacements etc. led to a significant reduction in
potentially fatal infections. For this reason theapplication of Kampo medicine to the treatment of
infectious diseases in modern Japan is now quite
limited. Yet, there are still many diseases treatedeither solely with Kampo preparations or else incombination with modern medical therapies.
For the common cold and the common cold
syndrome, Kampo medicine is used as the treatment of
first choice and there are numerous dissertations
documenting its use. The symptoms of the common
cold are similar to those appearing during upper
respiratory infections or diseases of the upper
alimentary tract and often develop later into specificdiseases. In Japan there is the proverb "The cold is theorigin of all diseases". Not only during the initialstages of the common cold, but also with a whole groupof similar conditions attempts have been made to curethe emerging symptoms with Kampo medicine.
Regarding Kampo medicine, great importance was
assigned to the "Shang han lun" since the middle of the
18th century and medical care performed based on its
medical concepts. It offers preparations suitable forthe treatment from the onset of acute febrile diseases
and through their various stages. The methodology
outlined in this book enables practical application of
Kampo to the treatment of common cold and thetreatment carried out along its guidelines. Japanesephysicians actually practicing Kampo medicine
consider the "Shang han lun" as the therapeutic
foundation regarding infectious diseases and thetreatment of the common cold meticulously
implements the contents of this book. Many physicians
specialized in Kampo medicine consider the treatmentof the common cold to be the basics of Kampo therapy
and a large number of dissertations deal with this
topic1,2).

The most frequently used formula is Pueraria
Decoction. Because this formula suits the Japanesephysique very well, it is generally used during theearly phase of the common cold and apart from that
may also be useful as a preventive medication during
epidemics3,4,5). Basic studies show that it inhibits therelease of PGE2 etc. and have clarified a number ofother actions as well6,7). Generally, many prescriptions
can be used for the wind and cold induced common cold.
During the early phase, other formulas beside
Pueraria Decoction, like Ephedra Decoction, Cassia
Twig Decoction, Cassia Twig and Ephedra half andhalf Mixture Decoction, Bupleurum and Cassia Twig

Decoction, Ephdra, Aconite and Manchurian
Wildginger Decoction, Cyperus and Perilla Leaf
Powder, Ginseng and Perilla Decoction are used.
Following the passage of a few days, Minor Bupleurum
Decoction and its modifications or Bamboo Shavings
Gallbladder-Warming Decoction are used. In case of a
protracted
course,Middle-Reinforcing
andQi-Benefiting Decoction and other tonifying formulas

come into use. Kampo preparations permit generaltreatment even when patients are allergic to western
medicines8).
In Japan there are a few prescriptions forwind-heat conditions. This is due to the fact that theconcept of heat induced disease was not adequately
introduced in Japan from China. Until the middle ofthe 19th century there were relatively few epidemics ofheat induced disease. While the representative
extracts Honey Suckle and Forsythia Powder or
Mulberry and Chrisanthemum Flower Decoction are
not available, this concept has now found wide
acceptance and both preparations are used as
decoctions. OTC prescriptions are employed, or elsethese preparations are substituted with Head-Clearing
Divaricate Saposhnikovia Decoction or Schizonepeta
and Forsythia Decoction.
Cumulative research indicates that in RCT using
both Ephdra, Aconite and Manchurian Wildginger
Decoction and generic cold medicines Ephdra, Aconite
and Manchurian Wildginger Decoction apparently led
to a significantly better improvement in the symptom
complex during the early phase of the disease9). Again,
DB-RCT studies showed that after more than 5 days
following onset, patients with common cold(corresponding to the lesser yang disease state) treatedwith Minor Bupleurum Decoction fared significantly
better than the placebo group10). The efficacies ofDwarf Lilyturf Decoction and dextromethorphanhydrobromide were examined in a comparative
study11) for the treatment of cough as the soleremaining symptom, after the other cold symptoms
had subsided.

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1) Ito T.: Treatment of the common cold syndrome in Kampo medicine, ClinicalAll-round 49(10): 2697-2698, 2000
2) Homma Y.: Usefulness of Kampo medicine for the treatment of patientswith febrile syndromes, Kampo Medicine (Jap. Journal of Oriental
Medicine). 46(2): 285-291, 1995
3) Yanagi K. et al: Usefulness of a single dose of Pueraria Decoction during theearly phase of common cold, in: Summaries of the lectures held at the 52ndGeneral Conference of The Japan Society for Oriental Medicine, P243, 2001
4) Kaji M., Kashiwagi S., Hayashi J. et al: Clinical effects of Pueraria
Decoction for the common cold, Jpn. J. Clin. Exp. Med. 70: 3266-3272, 1993
5) Nishimoto T., Higasa K., Matsumoto K.: Clinical effects of Pueraria
Decoction drinks for the common cold (Medical Care and New Drugs) 28:
1433-1440, 1991
6) Nakahata N., Ishimoto H., Ohizumi Y. et al: Effects of Pueraria Decoction,
Minor Bupleurum Decoction and Ephedra Decoction on prostaglandin
production and hydrolysis of inositol phospholipids in cultured rabbit
astrocytes, Kampo Igaku 17: 200-217, 1993
7) Kurokawa M., Imakita M., Kumeda C. A. et al.: Pueraria Decoction
suppressed interleukin-1α production responsive to interferon andalleviated infkuenza infection in mice, J. Trad. Med. 13(3): 201-209, 1996
8) Yamaguchi H.: Common cold in patients with drug induced hepatitis;
Lecture seminar on Kampo medicine for medical students, 19979) Homma Y., Takaoka K., Yozawa H.: Comparative study using the envelop
method to determine the usefulness of Ephdra, Aconite and Manchurian
Wildginger Decoction for the common cold syndrome, Kampo Medicine (Jap.
Journal of Oriental Medicine) 47(2): 245-252, 1996
10) Kaji M., Kashiwagi S., Yamakido M.: Double-blinded comparative study
using Minor Bupleurum Decoction and a placebo for the treatment of thecommon cold, Jap. J. Clin. Exp. Med., 78(12): 2252-2268, 2001
11) Fujimori K., Suzuki E., Shimojo F.: Comparison of the efficacy of Dwarf
Lilyturf Decoction; Ophiopogon Decoction to and dextromethorphanhydrobromide for residual cough following improvement of the common cold
syndrome (pilot study), Kampo Medicine (Jap. Journal of Oriental
Medicine), 51(4): 725-732, 2001

In daily clinical practice, antiviral agents like
Tamiflu, Relenza or Symmetrel, are used for thetreatment of influenza. Kampo preparations whenemployed skillfully, are also quite effective12,13,14).
Many of the formulas given in the “Shang han lun" areused for the treatment of this kind of disease in Japan.
This particular classic lists an abundance ofprescriptions designed for the treatment of pathologic
conditions caused by the invasion of wind cold evil.
Among extracts, Ephedra Decoction is frequently used,
but a combination of Cassia Twig Decoction andEphedra, Apricot, Licorice and Gypsum Decoction toprepare Major Blue Dragon Decoction, also finds
application15). During influenza epidemics Pueraria
Decoction has been used for prevention and reportedly
was found to be effective16).
12) Iwasaki K.: Special: New strategies for the treatment of cold andinfluenza; Cold and cold remedies as viewed in Kampo medicine, Current
Therapy 20(10): 1049-1053, 2002
13) Koizumi K.: Special: Management of the common cold syndrome andinfluenza for the primary care physician; An approach to the common cold
with Kampo medicine, Journal of Therapy 85(12): 3205-3210, 2003
14) Kimoto H., Kuroki H.: Significance of Kampo medicine during influenza
epidemics, Journal of Traditional Medicine 20(S): 146, 2003
15) Mitani K.: Case studies of patients with high fever treated the extract
preparation Major Blue Dragon Decoction, phil KAMPO 4: 15-16
16) Yakazu D.: Prevention of influenza, Sokai December issue 1975: 93-94

Most of the other infectious diseases require
western medical treatment. Yet, some infectious
44

diseases, difficult to treat with western medicine, arestill treated with Kampo preparations. For example,
Middle-Reinforcing and Qi-Benefiting Decoction, Ten
Strong Tonic Herbs Decoction or Ginseng Nutrition
Decoction are used for the treatment of chronic MRSA
infections17,18).
17) Kitahara M., Ishikawa S., Hara K.: Protective effect of Ten Strong Tonic
Herbs Decoction against infection after acute ischemic stroke in elderly
patients, Biotherapy 17(3): 287-298, 2003
18) Kitahara M.: The Effect of Supplementing Formulas for the Treatment of
MRSA infections in Neurosurgery, Evolving Kampo 2005, 1(1): 14-15

Regarding HIV infections, research has juststarted, but future results are anticipated with great
expectations. Please refer to the section on pediatricdiseases regarding measles, epidemic parotiditis,
roseola infantum, rota virus infections, Kawasaki
syndrome and similar pediatric diseases.
24. Cancer
In this field there are no Kampo prescriptions thatare definitely effective. However, Kampo medicine isused as adjunctive therapy following surgery forvarious malignant tumors, or else in combination withchemotherapy or radiation therapy and here plays asignificant role1). Frequently used preparations
includeMiddle-Reinforcing
andQi-Benefiting
Decoction, Ten Strong Tonic Herbs Decoction, Ginseng
Nutrition Decoction etc. and there is an extensive bodyof research pertaining to these drugs2,3,4,5,6). The
purpose of the Kampo therapy is to provide relief forthe suffering of the patients, prevent or alleviate theside effects of western medical therapies, improve
immune function, prolong survival and improve the
QOL. Each of the above mentioned preparations
improve immune function and influences NK cell
activity. In this field there is an abundance of basic
research and the drugs are topics in the relevant
academic societies7,8,9). Many basic studies have been
performed on those topics and their results support theclinics. Saiboku has investigated the inhibitive actionsof the aforementioned three preparations on thedevelopment of metastases and it is now becoming
clear that there are differences in their respectivemode of action. He states that the manifestation of theeffects of Kampo preparations may possibly be related
to physical disposition or else organ selectivity10).
In actual therapy, a number of cases that can betreated with extracts are rather limited, so that theuse of decoctions is required. Here the experiences
gathered in China prove to be useful and a significant
number of physicians put them to practical use. Those
physicians determine the Kampo medical pattern(SHO) according to the location of the malignant tumor
and its type and then prepare and administer suitable
formulas (which contain crude drugs with antitumor
activity)11). Shimizu selects the crude drugs

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corresponding to the malignant tumors of theindividual’s bowels and viscera and has proposed
preparations to be administered following surgery,radio- or chemotherapy respectively12).
1) Okamoto T., Sairenji M.: Significance of Kampo in the Treatment of Cancer,
Kampo and Most Advanced Therapies 4（2）: 123-128, 1995
2) Kuroda T., Imai J., Tamakuma S.: Prevention of Anticancer Drug Side
Effects by Ten Strong Tonic Herbs Decoction and Clinical Immunologic
Investigations Biotherapy 3（4）: 789-795, 1989
3) Fujiwara M., Kohmoto Y.: Usefulness of Ten Strong Tonic Herbs Decoctionin the Treatment of Myelostasis due to Chemotherapy for Gynecologic
Cancers, Journal of the Gynecology and Obstetrics in Chugoku andShikoku Region 47(2): 153-157, 1999
4) Abe K.: Effects on Side Effects due to Chemotherapy Following Cancer
Surgery, Prog. Med. 9: 2916-2922, 1989
5) Hasegawa K., Fukunishi H., Kiyoshige T. et al.: Journal of Traditional
Medicine 11, 181-187 1994: Clinical Effects of a Combination Therapy with
Kampo preparations (Ginseng Nutrition Decoction, Ten Strong Tonic Herbs
Decoction) to Alleviate the Side Effects of Carcinostatic Agents6) Sugimachi K.: Research into the Usefulness of Ginseng Nutrition Decoction
as an Adjuvant Chemotherapy After Surgery for Gastric Cancer, Clinics
and Research 72(2): 182-186, 1998
7) Kawakita T., Nomoto K.: Immunopharmacologic Actions of Ginseng Nutrition
Decoction and its Clinical Application, Prog. Med. 19: 2113-2121, 1999
8) Kawakita T., Nomoto K.: Immunopharmacologic Actions ofMiddle-Reinforcing and Qi-Benefiting Decoction and its ClinicalApplication, Prog. Med. 18: 801-807, 1998
9) Nakawa H., Sai B., Tsuno N. et al.: Effects of Ten Strong Tonic Herbs
Decoction and Middle-Reinforcing and Qi-Benefiting Decoction on Cells
with Induced Cancer Genes, Kampo and Most Advanced Therapies 4(2):129-132, 1995
10) Saiki I.: Cancer Metastases and Kampo Preparations, Science 75(7):842-845, 2005
11) Kotaka S.: Regarding Therapies for Malignant Tumors - Discussion, TCM
Clinics 17(2): 2-5, 1996
12) Shimizu H.: New Medical Revolution, Shuei Publications: 139-145, 2004

25. Pediatrics
The field of pediatrics, even when viewed
historically, has been from a comparatively early
period divided into subspecialities leading to theemergence of specialists, so that there is an abundant
body of experience with various diseases. In particular,
the ancient experiences with infectious diseases are
currently very helpful. Yet, the progress of modern
medicine in recent years resulted in a comparative
narrowing of the range of indications for Kampo
therapy. Simultaneously, new indications have arisenor have been developed, opening a new field.
Regarding acute infections, applications have been
attempted, in particular for the early phase of theso-called viral common disease. For the treatment of
epidemic parotitis (mumps) the use of Minor
Bupleurum Decoction1), for measles Cimicifuga andPueraria Decoction1) and White Tiger plus Ginseng
Decoction2), for roseola infantum White Tiger plus
Ginseng Decoction3) has been reported.
Due to the low age of onset, the treatment ofinfluenza with antiviral preparations is limited andtherefore often calls for the administration of Kampo
medicine. Ephedra Decoction, Pueraria Decoction andsimilar preparations are widely used. Abe conducted acomparative trial observing 783 patients divided into agroup treated with Kampo medicine and a control
group treated with western medications. According tothis study, progression to severe stages occurred in the
Kampo treatment group only infrequently4).
1) Abe K.: Clinical Effects of Minor Bupleurum Decoction for the Treatment of
Mumps and Cimicifuga and Pueraria Decoction for the Treatment ofMeasles, Journal of the Japan Pediatric Oriental Medicine Society 13(1):14-20, 1997
2) Mizutani K.: Experiences with the Use of White Tiger plus Ginseng
Decoction (TJ-34) for the Treatment of Pediatric Febrile Diseases - Inparticular regarding measles, Pediatric Clinic 43(6): 1361-1364, 1990
3) Abe K. Tanaka K.: Effects of White Tiger plus Ginseng Decoction on Roseola
Infantum, Kampo Medicine (Jap. Journal of Oriental Medicine) 47(6): 118, 1997
4) Abe K.: Comparison of Therapeutic Results of Treating Type A Hongkong
Influenza with Kampo Medicine, Western Medicine or Amantadine
Hydrochloride, 63rd Yamakage Pediatric Conference, 1999

The common cold is a good indication for Kampo
medicine. During the early stages, Pueraria Decoction,
Ephedra Decoction, Bupleurum and Cassia Twig
Decoction, Ephdra, Aconite and Manchurian
Wildginger Decoction and similar preparations areused. There are a number of case series studies, but
their description will be omitted here. Clinicallyproblematic is interference with ordinary daily life inchildren due to recurrent upper respiratory tract
infections. These children are highly susceptible to thecommon cold, and once they are affected, the disease
tends to run a protracted course. They may only beable to consume small amounts of food, suffer fromrecurrent diarrhea and become exhausted with lightphysical exercise. This type of child in Japan is said tohave a "weak constitution". Long-term application of
Minor Bupleurum Decoction or Bupleurum and Cassia
Twig Decoction to these children has often been
observed to reduce their susceptibility to infections
and builds physical strength5). Akiba et al.
administered Bupleurum and Cassia Twig Decoction
for a long period to 14 children suffering fromrecurrent infections (catching cold easily) and reported
an efficacy of 78%6). There are also other case series
studies dealing with the use of Bupleurum and Cassia
Twig Decoction in similar cases, where Koga et al.
found an efficacy of 88% (total number of patients 16)7),
Mine found 90% (total number of patients 10)8). Somecase series studies also investigated Minor Bupleurum
Decoction9). Iwama et al. treated 12 children withrecurrent tonsillitis with Bupleurum Liver-Clearing
Decoction and reported an efficacy of 80%10).
5) Hirose S.: Children With Weak Constitution, 3(3): 253-257, 1994
6) Akiba T., Araki Y., Nakajima A. et al.: Improvements Caused by Long-term
Application of Bupleurum and Cassia Twig Decoction in Children
Susceptible to Common Cold, Kampo Medicine (Jap. Journal of Oriental
Medicine) 41: 149-155, 1991
7) Kouga M.: Easy Susceptibility to Infection (recurrent airway infections) and
Saiko Preparations, Journal of the Research of Japan Kampo Medicine for
Pediatrics 13(1): 71-75, 1997

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8) Mine M.: Practical Experiences with Bupleurum and Cassia Twig Decoctionin the Treatment of Nursery School Children Suffering from Frequent
Recurrent Infections, General Meeting at the Third Conference of The
Society of Ambulatory and General Pediatrics of Japan, 1993
9) Iwama M., Iriyama E.: Effects of Minor Bupleurum Decoction on Recurrent
Febrile Airway Infections, Kampo Igaku 25: 115-117, 2001
10) Iwama M.: Bupleurum Liver-Clearing Decoction for the Treatment ofRecurrent Tonsillitis, Journal of the Japan Society of Pediatrics, 1995

Regarding infections of the gastrointestinal tract,
vomiting associated with the early phase of acute viralgastroenteritis and treatment with Poria Powder with
Five Herbs has received much attention. In particular,
for the treatment of vomiting associated with rota
virus induced gastroenteritis, this medication applied
as suppository or enema has frequently been reported
as being extremely effective11,12,13,14). This formula has
traditionally been applied orally like other Kampo
formulas, but in cases of vomiting, the administration
may prove difficult. If a rapid onset of the effect isrequired, pediatricians sometimes prepare andadminister suppositories or enemas themselves.
Regarding this use, section 74 of the "Shang han lun"lists the "water reversal pattern" and describes thepractical application of Poria Powder with Five Herbs
for its treatment. Moreover, in developing countries,
where modern medical equipment like intravenous
drip infusions are not available, this preparation could
play an important role in lowering mortality.
11) Hashimoto H.: The Effects of Poria Powder with Five Herbs on Vomiting
Associated with Common Cold Induced Gastroenteritis - Ideas offacilitating oral application, Kampo Igaku 25: 178-180, 2001
12) Fukutomi O., Matsuo N., Teramoto T. et al.: Examination of Poria Powder
with Five Herbs Enemas for the Treatment of Vomiting Associated with
Acute Pediatric Gastroenteritis, Japanese Journal of Pediatric 53: 967-970,
200013) Hashimot H.: Comparative Study of Poria Powder with Five Herbs andMinor Bupleurum Decoction, Poria Powder with Five Herbs Enemas for theTreatment of Vomiting Associated with Pediatric Viral Gastroenteritis,
Kampo Igaku 25: 73-75, 2001
14) Yoshida M.: Effects of Poria Powder with Five Herbs Suppositories for theTreatment of Vomiting in Infants and Children, Oriental Medicine 28(3):36-38, 2000

Acute bronchitis, asthmatic bronchitis etc. areamong those respiratory diseases for which Kampo
medicines are frequently used. Ephedra, Apricot,
Licorice and Gypsum Decoction, Minor Blue Dragon
Decoction, Minor Bupleurum Decoction, Combind

Minor Bupleurum Decoction and Pinellia andMagnolia Decoction, Dwarf Lilyturf Decoction andsimilar preparations are frequently used, but sincethese are very ordinary diseases, no case series studies
are available. Mycoplasmal pneumonia does notparticularly require treatment with Kampo medicine,but during the acute phase, a combination of theantibacterial medication with Minor Bupleurum

Decoction and Lophatherus and Gypsum Decoction

was able to shorten the required treatment period withthe antibacterial agents and also decreased the46

duration of the morbidity in the treatment group15).
Moreover, some studies showed that in a group treatedwith Ephedra, Apricot, Licorice and Gypsum Decoction
during the chronic phase, it shortened the duration of
coughing and led to an earlier normalization of the
CRP values16).
15) Miyazaki Z., Mori K.: Acute Mycoplasmal Pneumonitis, Minor Bupleurum
Decoction and Lophatherus and Gypsum Decoction, 200116) Miyazaki Z., Mori K.: Convalescence Period of Mycoplasmal Pneumonitis,
Ephedra, Apricot, Licorice and Gypsum Decoction, 1994

Among the diseases of the cardiovascular system,
Kampo therapy is often applied to orthostatic
hypotension. Mori et al. treated 74 patients meetingthe diagnostic criteria for orthostatic dysregulation
with Bupleurum and Cassia Twig Decoction andobserved improvement for all symptoms. The severityof all symptoms after 4 weeks of treatment wassignificantly lower than that before treatment.
Regarding the chief complaint, a more than mild
improvement was reported for 64.7% of the cases17).
There are also reports about the use of Pinellia,
Largehead Atractylodes and Tall Gastordia Decoction,
Middle-Reinforcing and Qi-Benefiting Decoction,
Minor Middle-Strengthening Decoction and similar
preparations18,19), either of which showed favorable
results. Arrhythmia too is an indication. Otsuka et al.
treated 31 children with extrasystoles with Roasted
Licorice Decoction extract and found an improvementin supraventricular extrasystoles of approximately
70%, for ventricular extrasystoles a rate of 62%, andreported the resolution of the comparatively dangerous
ventricular tachycardia in 4 out of 5 patients20).
17) Mori M., Yamada K., Saka M. et al.: Clinical Application of Bupleurum andCassia Twig Decoction for Orthostatic Dysregulation, Japanese Journal of
Pediatrics 45: 1964-1974, 1992
18) Tsuru N.: Clinical Experiences with of Pinellia, Largehead Atractylodes
and Tall Gastordia Decoction and Minor Middle-Strengthening Decoction in
the Treatment of Orthostatic Dysregulation, Japanese Journal of Pediatric
48: 585-591, 1995
19) Tomita H., Chiba S., Kadowaki J. et al.: Clinical Effects of Middle-Reinforcing
and Qi-Benefiting Decoction for Orthostatic Dysregulation in Children, The
Journal of Pediatric Practice 60: 162-167, 199720) Otsuka Y.: Extrasystoles (Arrhythmias), The Journal of Pediatric Practice67: 1481-1481, 1988

Kampo medicine is also used for the treatment ofconstipation in children. Muramatsu et al. treated 72
constipated children without any organic disease withMajor Middle-Strengthening Decoction extract andreported improvement in 69.4% of the cases after one
week and 79.2% after two weeks21). Aoki et al. treatedrefractory constipation in severely handicappedchildren with Hemp Seed Pill and Rhubarb andLicorice Decoction
and observed a significantly
increased frequency of spontaneous bowel movements
and also a significantly decreased frequency of enema
administrations and thus stated that bothpreparations are useful22).

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

Volume 1, Special Edition | Current Kampo Medicine 2005

The range of application of Kampo therapy in
pediatrics
has
recently
widened.
Major
Middle-Strengthening Decoction is used to treat
early transport disorders or the development ofadhesive ileus following gastrointestinal surgery
and in many reports, has been described as very
useful23,24). When western medical treatment ofpediatric hemorrhoids or perianal abscesses provesdifficult, the application of Middle-Reinforcing and
Qi-Benefiting Decoction reportedly led to good results.
Muramatsu et al. treated 65 patients (all children
were male and age ranged from 22 days to 5 years)
with perianal abscesses or hemorrhoids with Ten
Strong Tonic Herbs Decoction, observing the course incomparison to a 28-patient control group in which only
incisions and pus drainage were performed. In thetreatment group (3 patients dropped out, because they
were unable to use the medication) 13 required an
incision and 1 patient required surgery, but theremaining 48 patients (77.4%) reportedly healed.
There is a report describing that short-term
therapeutic results were best in the Ten Strong Tonic
Herbs Decoction treatment group25).
21) Muramatsu T., Kawamura K., Kuriyama Y. et al.: Usefulness of Treatment
with Middle-Reinforcing and Qi-Benefiting Decoction for Chronic PediatricConstipation - Evaluation with a constipation score, Japanese Journal of
Pediatric Surgery 32: 285-290, 2000
22) Aoki H., Nishikura T., Ono S. et al.: Kampo Therapy for Constipation in
Severely Handicapped Children - Comparison of Hemp Seed Pill andRhubarb and Licorice Decoction, Kampo Igaku 21(28): 21-24, 1997
23) Fukushige T., Takamatsu H., Noguchi H. et al.: Clinical Experiences withMajor Middle-Strengthening Decoction for Insufficient Postsurgical
Peristalsis, Ileus, Prog. Med. 17(9): 2554-2558, 199724) Kawase K., Satomi A., Yoshida H. et al.: Clinical Experiences in Our
Department with Major Middle-Strengthening Decoction, Prog.Med. 17(9):2550-2553, 199725) Muramatsu T., Fuseya S.: Clinical Experiences with Ten Strong Tonic
Herbs Decoction for the Treatment of Perianal Abscesses in Infants,
Japanese Journal of Pediatric Surgery 32: 1322-1325, 2000

In most cases, idiopathic thrombocytopenic
purpura (ITP) develops as an acute form and isresolved spontaneously after a few months, but forpatients with chronic forms not responsive totreatment, Kampo therapy is also performed. Takeda
et al. administered Modified Back to the Spleen
Decoction to 7 children with ITP resistance to western
medical treatment and achieved an efficacy of 33%26).
Occasionally there are also individual case reports
about this disease.
26) Takeda T., Nagatate N., Hatae Y. et al.: Clinical Experiences with Tsumura
Modified Back to the Spleen Decoction for the Treatment of Chronic
Thrombocytopenic Purpura, Iryo 46(12): 1016-1019, 1992

Kampo therapy is used for patients with
Henoch-Schönlein purpura resistant to western
medical treatment. Single case reports have been
published27).
27) Tsuji Y., Abe Y., Hisano M. et al.: Cases of Allergic Purpura Effectively
Treated with Kampo, Kampo Igaku 27: 169-172, 2003

The application of Kampo therapy during the earlystages of Kawasaki disease is reportedly associatedwith a favorable prognosis. Hirota et al. divided 19
patients in the acute phase of Kawasaki disease into
two groups and treated both groups with the required
western medical therapy. Group 1 (including 11
patients) received Coptis Detoxificating Decoction andwas then compared with a placebo group (8 patients).
The results revealed that a combination therapy ofvitamin E and Coptis Detoxificating Decoction for
Kawasaki disease improves the anti-inflammatory
effects and lipid metabolism, also improving the
prognosis for the vascular changes and has therefore
been described as an excellent therapy28).
28) Hirota A., Senaga R., Kawashima S.: Examination of the Effects of Coptis
Detoxificating Decoction on Kawasaki Disease Using a Double-Blind Study,
Japanese Journal of Pediatrics 38: 2329-2335, 1985

The therapy for pediatric bronchial asthma inrecent years has made enormous progress, so that theopportunities for using Kampo medicine are now lessfrequent than before. Yet, a wealth of experiences withthe application of Kampo therapy for this disease has
accumulated and is now used widely. Numerous
preparations are used, but the most widely usedpreparation is Combind Minor Bupleurum Decoction
and Pinellia and Magnolia Decoction and several caseseries studies have investigated its application. Ito etal. conducted a randomized controlled trial (RCT)examining 43 pediatric patients with bronchial asthma
divided into a Combind Minor Bupleurum Decoction
and Pinellia and Magnolia Decoction treatment group
including 23 patients and a tranilast treatment groupof 21 patients. Twelve weeks after the treatment,
general improvement and better than mild
improvement was observed in 95% of the patients in
the Combind Minor Bupleurum Decoction and Pinellia
and Magnolia Decoction group, whereas the same ratio
was reportedly 73.7% in the tranilast group29).
Watanabe et al. treated 22 patients with atopic asthma
over a period of three months with Combind Minor

Bupleurum Decoction and Pinellia and Magnolia
Decoction extract and found improvements in 16 of thepatients (72.8%) and better than mild improvements
in 22 patients (100%)30). Minor Blue Dragon Decoctionis also frequently used. Inoue et al. treated 9 patients
about to develop an attack that started with runnynose, sneezing and then developed into cough andphlegm with Minor Blue Dragon Decoction extracts.
This reduced the number of attacks significantly. In sixof these patients, improvements were observed31).
When the treatment with extract preparations
remains ineffective, the application of decoctions is
worth a try and has been reported to produce goodresults32).

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

47

Volume 1, Special Edition | Current Kampo Medicine 200529) Ito S., Mikawa H.: Effects of Combind Minor Bupleurum Decoction andPinellia and Magnolia Decoction in the Treatment of Pediatric Bronchial
Asthma - Multi-facility joint research And Comparative Trial with Tranilast,
The Clinical Report 26: 3993-3998, 1992
30) Watanabe H.: Long-term Administration of Combind Minor Bupleurum
Decoction and Pinellia and Magnolia Decoction for Exercise Induced
Asthma and Airway Hypersensitivity in Bronchial Asthma, Kampo
Medicine (Jap. Journal of Oriental Medicine) 41: 233-239, 199131) Inoue K.: Clinical Effects and Limitations of Kampo Therapy for Bronchial
Asthma, Pediatrics of Japan 31: 531-540, 1990
32) Yamaguchi H.: Experience with the Use of Decoctions for the Treatment ofPediatric Bronchial Asthma Where Western Medical Treatment Has
Become Difficult, Φυτο 1(4): 14-17, 2001

Bupleurum
Liver-Clearing Decoction, Wind Dispersing Powder,
Coptis Detoxificating Decoction, Middle-Reinforcing
and Qi-Benefiting Decoction, Warming and Clearing
Decoction, For Eczema Decoction, White Tiger plus
Ginseng Decoction, and similar preparations are
Regardingatopicdermatitis,prescribed and there are many related studies.
Temporarily, high hopes have been placed on Kampo
therapy for this disease in Japan due to an aversion tosteroids. Yet, except for a very small number of cases,
it has been shown that with proper skin care thetreatment of this condition is not that difficult Today
Kampo medicines are not used as frequently as in thepast and independent treatment with Kampo medicine
is not performed. Still, Kampo therapy does have acertain beneficial effect on this disease. Among thecase series studies, particular attention has been paid
to the effects of Middle-Reinforcing and Qi-Benefiting
Decoction for the treatment of infants (which differsfrom that in adults). Tsuji et al. administered
Middle-Reinforcing and Qi-Benefiting Decoction to 187
patients aged between 3 and 6 years with atopic
dermatitis. Observing these patients for a period of 24
weeks, workers found improvements for all the items:
pruritus, erubescence, papules, vesicles, erosion,
hyperplasia, lichenification and scratch marks. In the
24th week, the number of patients that could be
evaluated was 71. Marked improvement was found in
23.9%, intermediate improvement in 62.0% and better
than mild improvement in 85.9%. Further, the use of
topical steroids could significantly be decreased33).
When Ito et al. treated 25 children with atopic
dermatitis in whom topic medications had not been
sufficiently effective over a period of 12 weeks, theyobserved significant differences in the improvement
following the second week and thus reportedly
achieved a better than mild improvement in generalcondition in about 80% of the patients34).
33) Tsuji Y., Tsujimoto Y., Iikura Y. et al.: Investigation of the ClinicalUsefulness of Middle-Reinforcing and Qi-Benefiting Decoction for theTreatment of Pediatric Atopic Dermatitis, The Japanese Journal of Clinicaland Experimental Medicine 70: 290-299, 199334) Ito S.: Clinical Experiences with the Use of Bupleurum Liver-Clearing
Decoction Granules for the Treatment of Atopic Dermatitis, The Journal of
Traditional Sino-Japanese Medicine, Vol. 10 No.1, Supple. Kampo Therapy
for Intractable Diseases or Conditions, second volume: 202-203, 1989

48

Regarding renal and urinary diseases, several
studies have dealt with the use of Kampo medications
for chronic glomerular nephritis, nephrotic syndrome
and IgA nephropathy. Minor Bupleurum Decoction,
Poria Powder with Five Herbs extract wasadministered over a period of 1 year to 101 patientswith chronic glomerular nephritis (including 32
patients with IgA nephropathy) and 129 patients withnephrotic syndrome in a multi-facility case series study.
Improvements were achieved in 63.8% of the patientswith chronic glomerular nephritis and 61.5% of thepatients with nephrotic syndrome. Regarding thetissue forms, this patient population included 46
patients with proliferative changes of whom 62.5%
showed better than mild improvements with 36.4% of
the 11 patients with focal sclerosis showing mild
improvement In 28 patients with IgA nephropathy,
Better than mild improvements were observed in
67.9% of the cases, and in 94 patients with nephrotic
syndrome presenting minimal changes, better thanminor improvements were reportedly observed in
61.7% of the cases35). Yazaki et al. treated 80 pediatricpatients with nephrotic syndrome over an average
period of one year with Minor Bupleurum Decoction,
Poria Powder with Five Herbs and thus could
reportedly observed some degree of prevention ofrecurrences and a dose reduction in steroids36). Ito et al.
used Minor Bupleurum Decoction, Poria Powder with
Five Herbs extract for 221 patients with nephrotic
syndrome in combination with steroid medications andobserved a reduction in the frequency of recurrences37).
Yoshikawa et al. used Minor Bupleurum Decoction,
Poria Powder with Five Herbs for 101 patients withIgA nephropathy showing mesangial proliferation in a
RCT and found after 2 years normalization of theurinary findings in 46% of these patients, which was asignificantly higher ratio than in the control group38).
Based on these facts, Ito et al. concluded that Minor

Bupleurum Decoction, Poria Powder with Five Herbs

alone in the treatment of IgA nephropathies duringchildhood, characterized histologically by minimalchanges or else focal mesangial proliferation, iscapable of significantly inhibiting proteinuria andhematuria39). Although few in number, some reports
also describe purpuric nephritis40).
Since aggravation of IgA nephropathy may betriggered by infections, it has become clear that
tonsillectomy in conjunction with steroids leads to an
improvement in the hematuria. In other words, if no
infections occur, there will also be no aggravation in
the renal lesions. As stated above, since treatment
with Kampo medicine decreases the susceptibility toinfection, formulas like Bupleurum and Cassia Twig
Decoction or Minor Bupleurum Decoction (theseformulas are included in the preparation Minor
Bupleurum Decoction, Poria Powder with Five Herbs)
etc. are used in order to decrease the chances for
infection in attempts at improving the prognosis of thisdisease.

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Volume 1, Special Edition | Current Kampo Medicine 2005
35) Yoshikawa N., Ito T., Takekoshi Y. et al.: Combination Therapy with Minor
Bupleurum Decoction, Poria Powder with Five Herbs for Patients with
Steroid-reactive Pediatric Nephrotic Syndrome During the Early Treatment
Phase with Steroids and Recurrences - Prospective controlled study Journal of The Japanese Society of Nephrology 40: 587-590, 1998
36) Yasaki T., Hirose S.: Clinical Effects of Minor Bupleurum Decoction, Poria
Powder with Five Herbs for Pediatric Nephrotic Syndrome, Journal of
Traditional Medicine 4: 203-206, 198737) Ito K., Okada T., Kitagawa T. et al.: Ethical Kampo Medicines for Pediatric
Chronic Glomerular Nephritis and Pediatric Nephrotic Syndrome: ClinicalEffects of Minor Bupleurum Decoction, Poria Powder with Five Herbs Multi-facility open trial - Kidney and Dialysis 36: 1237-1246, 1994
38) Yoshikawa N., Ito T., Sakai T. et al.: Prospective Controlled Trial Using
Minor Bupleurum Decoction, Poria Powder with Five Herbs for theTreatment of Pediatric IgA Nephropathy Showing Focal and Minimal
Mesangial Proliferative Lesions, The Japanese Journal of Nephrogy 39:
503-556, 199739) Ito K., Miyagawa S.: Chronic Nephritis, IgA Nephropathy, Purpuric
Nephritis, The Journal of Pediatric Practice 67: 1462-1466, 2004
40) Tsuru N., Tokieda K., Niimi K.: Clinical Effects of Tsumura Minor
Bupleurum Decoction, Poria Powder with Five Herbs in the Treatment ofPediatric IgA Nephropathy and Purpuric Nephritis, The Japanese Journalof Clinical and Experimental Medicine 67(9): 236-242, 1990

Among the neurological diseases Kampo medicine
is frequently applied for epilepsy. Several reports
describe the use of Bupleurum and Cassia Twig
Decoction, Minor Bupleurum Decoction and Cassia
Twig Decoction plus Peony, Bupleurum plus Dragon’s
Boneand
OysterShell
Decoction,
Minor
and
similar
Middle-Strengthening
Decoction
preparations for the treatment of refractory epilepsy
difficult to control by western medical treatment. Okabe
administered Kampo medicine to 26 patients withrefractory epilepsy and reportedly observed marked
effectiveness in one patient (disappearance of attacks)
and an effectiveness in 12 patients41). Sugimoto et al.
administered in addition to the ongoing treatment,
anticonvulsants Tsumura Minor Bupleurum Decoction
Minor
extract
granulesandTsumuraMiddle-Strengthening Decoction extract granules to 30
patients (24 patients with mental retardation, 8
patients with cerebral paralysis) with refractory
epilepsy, particularly patients presenting complex
partial seizures. They observed 2.5 years after
initiation of the combination therapy, a marked
effectiveness in 5 patients, effectiveness in 6,
temporary effectiveness in 5, no effects in 10 andaggravation in one patient, resulting in an overall
efficacy of 40%42). Seki too administered Minor

Bupleurum Decoction and Cassia Twig Decoction plus
Peony to 24 patients with refractory epilepsy andreportedly observed marked effectiveness in 4 patientsand effectiveness in 3, resulting in an overall efficacy
of 29%43).
41) Okabe T.: Kampo Therapy of Neurologic Diseases in Children, The Journalof Traditional Sino-Japanese Medicine 12: 29-37, 199142) Sugimoto T., Yasuhara A., Nishida N. et al.: Kampo Combination Therapy
for Refractory Epilepsy - Treatment with Minor Bupleurum Decoction andMinor Middle-Strengthening Decoction, Japanese Journal of Pediatrics
45(12): 2875-2880, 1992

43) Seki T.: Effects of Kampo Medicine (Combined Application of Minor
Bupleurum Decoction, Cassia Twig Decoction plus Peony) on Refractory
Epilepsy, Oriental Medicine19: 16-22, 1995

In the field of Kampo therapy many attempts at
improving the various problems or disturbances
occurring during the developmental phase of children
have been made. Kin et al. used Licorice, Wheat andChinese Date Decoction for 8 pediatric patients withbreath holding spells and intractable epilepsy to theantiepileptic agents, and reported clear findings ofclinical efficacy with four complete responses and four
effective responses44). Itakura et al. used Licorice,
Wheat and Chinese Date Decoction for 24 patientswith night terrors and reported finding an efficacy of
87%45). The formula Liver-Inhibiting Powder is also
used for this disease. Several attempts have also been
made for patients with autism or ADHD, in whom
pharmacotherapy is difficult. Ida administered Major
Cold
Limbs
Powder,
Bupleurum
Decoction,
Liver-Inhibiting Powder and similar preparations to 30
autistic patients (including adults), in whom treatment
had been initiated under the age of 13 years anddescribed an overall improvement ratio including 100%
improvement in sleep disorders, 88.9% improvement in
hyperactivity, 71.4% improvement of temper tantrums,
78.3% improvement of panic attacks, 87.5%
improvement for self-mutilation, 90.0% improvement of
sudden outbursts of violence, 77.8% improvement ofcompulsive
retention,
68.8%
improvementincompulsive behavior, 80.0% improvement of ritual
behavior, 83.3% improvement of unreasonability and80.8% improvement in communication skills46).
Okashima et al. used various different Kampo
medicines in the treatment of severely handicappedchildren presenting night terrors, displaying violent
behavior and similar symptoms and described favorable
results obtained through this treatment. The formulas
used included Licorice, Wheat and Chinese Date
Decoction extract, Liver-Inhibiting Powder extract,
Modified Merry Life Powder extract and similar
preparations47). Takeuchi et al. treated various problems
in children with developmental disorders (Asperger
disorder, higher function autism, ADHD, extensive
developmental disorders, mental retardation with
autistic tendencies) with Kampo medicine and described
9 cases in which an improvement had been achieved48).
Liver-Inhibiting Powder is a formula frequently used
for diseases in this field. This formula was listed by the
famous physician Xue Kai in his own textbook ofpediatrics in the 16th century. It is particularly
noteworthy that he added a statement that "bothmother and child should take the drugs". As an
excellent pediatrician he was well aware of themother's influence on the child's diseases and thus

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

49

Volume 1, Special Edition | Current Kampo Medicine 2005

explained the importance of treating the mother aswell when children are sick. A number of reports havedescribed
thepractical
applicationof
thisconcept49,50,51,52,53).
Egawa treated 97 patients with the Kampo medical
pattern (SHO) of the Liver-Inhibiting Powder with

Tangerine Peel, Pinellia Rhizoma and Liver-Inhibiting
Powder and reported an efficacy of 55%. Although he isa pediatrician, he included mothers, aged 30-50, in his
study. They were also treatred with this formula. The
author explains that treating the mother facilitates
follow-up observations of the children54). Nishimura etal. explained that the simultaneous treatment ofmother and child based on historical views and thecurrent variety of clinical applications can besubstantiated citing multiple cases55).
In the treatment of adult psychosomatic orders,Kampo medicine may not have any effect on the mental
aspects. However, in children it is extremely effective
for hyperactivity, tension, sleep disorders, tantrum andsimilar neuropsychologic symptoms. The situation hereis markedly different from that in adults.
44) Kin M., Murata R., Matsuoka O. et al.: Effects of Licorice, Wheat and Date
Decoction for Breath Holding Spells and Epileptic Children, The Journal of
Pediatric Practice 47(2): 268-272, 1988
45) Itakura T., Yamaoka K., Konishi H..: Effects of Licorice, Wheat andChinese Date Decoction for Night Crying, Sleep Drunkenness, Kampo
Shinryo 11(12): 44-45, 1992
46) Iida M.: Autism The Journal of Pediatric Practice 67: 1489-1492, 2004
47) Okajima Y., Yamada T.: Usefulness of Kampo Extract Preparations for theTreatment of Night Crying, Excitation, Violence and the Like in Children
with Severe Developmental Disorders, Iryo 43(6): 700-703, 198948) Takeuchi N., Ishizaki A.: Children with Developmental Disorders andTheir Treatment with Oriental Medicine, Jpn. J. Pediatr. Surg. 37(3):348-351, 200549) Egawa M.: Family Therapy Examples for School Refusal, Kampo Formula
Manual, Tangerine Peel, Pinellia Rhizoma plus Liver-Inhibiting Powder,
Shibunkaku Publications: 348-349, 1991
50) Egawa M.: Anorexia Nervosa, Kampo Formula Manual, Tangerine Peel,
Pinellia Rhizoma plus Liver-Inhibiting Powder, Shibunkaku Publications:348-349, 1991

5051) Matsuda K.: Treatment of Mother and Child with Yokkan San Ka
Shakuyaku in Cases of School Refusal, Practical Kampo Therapy Based on
Cases, Sogensha: 169-170, 199252) Miyazaki Z.: Effectiveness of Simultaneous Treatment of Mother and Child
with Tangerine Peel, Pinellia Rhizoma plus Liver-Inhibiting Powder,
Journal of Kampo Medicine 42: 333-336, 1995
53) Kobayashi T., Nagasawa K.: One Case of Myospasia Impulsiva Where
Simultaneous Treatment of Mother and Child with Liver-Inhibiting Powder
was Markedly Effective, Kampo Igaku 27: 75, 2003
54) Egawa M., Matsuda K., Otsuka Y.: Clinical Trials for Liver-Inhibiting
Powder, Tangerine Peel, Pinellia Rhizoma plus Liver-Inhibiting Powder,
Kampo Medicine (Jap. Journal of Oriental Medicine) 38(4): 13-17, 1988
55) Nishimura K., Watanabe K.: Simultaneous Treatment of Mother and Child,
The Journal of Pediatric Practice 67: 1514-1518, 2004

Yamaguchi, employed at a large hospital in Aichi
prefecture, treats almost all conditions ranging fromthose encountered in a pediatric emergency room tomany chronic diseases. While training many interns,
and being the head of the pediatric department, he hasat the same time a profound knowledge of Kampo
medicine. He treated 89 patients with Kampo medicine(decoctions) for whom standard western medical
treatment proved difficult and published the results.
The overall improvement ratio of 64% was very positive.
This work certainly verifies that Kampo medicine willplay in the future a very important role in this field56).
56) Yamaguchi H.: Kampo Therapy for Patients Difficult to Treat with
Western Pharmacotherapy - Experience with Kampo decoction in pediatrics- The Journal of Pediatric Practice67: 1542-1546, 2004

Conclusions
Current Kampo therapy for a number ofrepresentative diseases has been described. Kampo
medicine is a system with an extremely broad range ofapplications of which only a portion has been described
here. Due to the lack of space, descriptions of thetheoretical aspects of Kampo medicine have been kept
to a minimum. A comprehensive list of thesedescriptions is found in cited references.

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Volume 1, Special Edition | Current Kampo Medicine 2005

Manufacturing Process for the Prescriptionsof Kampo Medicine
The

large

majority

of

Kampo

Medicines

manufactured by Japanese pharmaceutical companies
are extract preparations (history of which has beenpreviously

described).

There

pharmaceuticalcompanies

manufacturing

Kampo

are

in

over

Japan

Medicine

fifteenwho

extractsarewithgovernment approval. Their manufacturing is governedby the regulations of the Pharmaceutical Affairs Law, andstrictly controlled by other government regulations,
including GMP (Good Manufacturing Practice). The GMP
for pharmaceutical products include (1) reduction of human errors
to a minimum, (2) prevention of contamination of the drugs ordeceasing quality, and (3) establishment of a system to guarantee
high quality. As a result, products are assured of quality
and safety at the highest level.

Material
Of all the crude drugs used as raw material for
Kampo Medicine, about 200 major drugs (herbal
medicines) are listed in the Japanese Pharmacopoeia (JP),which imposes quality standards on them. The quality
standards provide detailed requirements for identifying
the names of the original plant species (or original animal
species or mineral for crude drugs derived from animals
or minerals), parts used for medicinal purposes (e.g. roots,
stems, leaves, flowers or fruits), preparation methods,
methods of purity test and other physical/chemical tests
for the purpose of quality evaluation, as well as the test
methods for the presence of microbes.
Of all the crude drugs not listed in the JP, the ones infrequent use are published in the Japanese Herbal
Medicine Codex (1989) which provides quality standards
established by a research team organized by thegovernment. Pharmaceutical companies must use crude
drugs which comply with these quality standards as theirraw material. Some crude drugs do not have official
specifications such as those above. When this is the case,companies

quality standards.
II. Quality Control of Extracts
Extracts are manufactured in the following processes:
First, liquid extract is made by processing cut crude
drugs mixed according to a prescribed composition in hot
water (separation of effluent and residual). Residues fromthe crude drugs are removed from the liquid extract.
After the liquid is concentrated under reduced pressure,
it is spray-dried into a powdered form. Next, theappropriate measures of the powdered extract and fillers(preparation materials) are mixed together to form a raw
material for preparation. It is then processed into theform of granules or tablets, and filled and packaged as afinished product. As the Kampo Medicine extracts arehighlyhygroscopic,

pharmaceuticallyadvanced

techniques are used to protect finished products frommoisture. (For outline, see diagrams in pages 54-55.)

I. Quality Standards for Crude Drugs Used as Raw

pharmaceuticalprocess of being incorporated into the JP with upgradeddevelop

their

own

specifications so as to ensure quality of their products.
At present, of the crude drugs listed in the JapaneseInitially, the quality of Kampo Medicine extracts
releasedtomarketmanufacturing

variedmethods

due

used

to
by

differencesinpharmaceuticalcompanies. Consequently, the government issued anadministrative guidance (notice) in 1985 in an attempt toensure better quality and uniformity of these products.
Generally, the administrative guidance (notice) prescribesthat standard decoction must be prepared for eachprescription with the prescribed method; that two or moreindicator constituents (“Indicators”) must be selected andquantified for the purpose of ensuring the equivalence
between the final product and standard decoction; andthat the amount of the “Indicators” contained in a daily
dose must be 70% or more of the amount contained in thestandard decoction.
Kanebo Pharmaceutical, Ltd. which agreed to aninterview, is staunchly committed to quality. A consistentquality control system has been employed from the
supply of crude drugs through to the finished products inorder to ensure that the Kampo Medicine extracts forclinical use produced by Kanebo are equivalent in potency
to the standard decoction. For this purpose, Kanebo uses
several technical means to extract various constituentsefficiently from crude drugs, and provide a stable supplyof quality products.

Herbal Medicine Codex, widely used ones are in the

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Volume 1, Special Edition | Current Kampo Medicine 2005

The following example is provided.
(1) Obtaining crude drugs of predictable quality①

The quality of herbal medicines is influenced by

the growing region and climate, so herbal medicinesof predictable quality can be obtained by designating
the area where each medicine is grown.
②

To avoid deterioration in quality and bacterial

the cathartic effect is markedly decreased. To
constantly maintain the sennoside content, extractionof Rhubarb is performed in a short time during thelatter half of the extraction process.
③

Measures to prevent enzymatic reaction:

It has been reported that herbal medicines containenzymes that degrade various ingredients. Baicalin isa major ingredient of Scutellaria root that iscontamination during the storage of herbal medicines,

degraded

thermostatically controlled storage is used, and cut

amygdalin (a major ingredient of Peach kernel andherbal medicines are stored at a low temperature.

Apricot kernel) is degraded by emulsin. Generally,③

A system has been established so that any

problems with the quality of finished products can betraced back to a specific growing area.
(2) Management of the extraction process
The individual steps of the various processes from theextraction during the manufacture in the factory overseparation of solids from liquids and concentration to thedrying of the extract powder are conducted in extremely
large-scale equipment. Neglecting quality control during
any of these processes could have marked effects on thequality of these traditional formulas. The items listed
below are carefully observed during the manufacturing

bybaicalinasetobaicalein,while

the optimum temperature range for enzyme activity
is 35-40℃. Heating time is shortened in order toprevent enzymatic reaction.
④

Measures to preserve volatile ingredients:

Volatile ingredients, cinnamaldehyde in Cinnamonbark, paeonol in Tree peony bark, ligustilide in
Szechwan lovage rhizoma etc., can diffuse out moreduring the graduation process. To maintain these
ingredients in the finished product at the specified
level,

theeffluent

after

extraction

process

iscontrolled below 60℃ at temperature and between
quadruple to octuple in a graduation rate.

process. Moreover, all processes are controlled via(3) Control of the manufacturing processes of extracts

computer using an automatic control system.

(final products)①

Measures to increase the dissolution rate ofinsoluble ingredients:
Saponins such as Bupleurum saponins, Ginseng
saponins etc. are important ingredients and are
insoluble. The surface structure of Ephedra herb is sotight that it prevents the penetration of water andthis makes it difficult to dissolve ephedrine, a major
ingredient. To promote the efficient dissolution ofthese ingredients, the particle sizes of these herbal
medicines are adjusted appropriately.
②

Measures to reduce the degradation of heat

labile ingredients:
Sennosides of Rhubarb are pharmacologically active
ingredients of a crude drug, and are representative
heat labile substances. The sennoside content of a
extract is dependent on the amount dissolved from
Rhubarb and the extent of degradation. When heatedat 100℃ for 1 hour, most sennoside is degraded and52

The obtained extract powders are precisely weighed
and then mixed with filling material before they arefurther

processed

into

granulesortablets.

The

manufactured granules or tablets are then packed inaluminum foils (SP package) or else placed in containers.
After that they are further wrapped and packed in boxes
for shipment. In the factory, completely computerized
production control systems have been introduced. Under
this system, all the information pertaining to the
manufacturing process, from the receptance of stocks tothe shipment of the final products is completely
controlled.
①
After storing the various extract powders
serving as crude materials for the products and fillingmaterials in a warehouse with automatic
temperature control, the production control systemreleases upon instruction from the warehouse only
those materials passing quality tests from thewarehouse into the production process.

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

Volume 1, Special Edition | Current Kampo Medicine 2005

② Weighing of prescription crude materials is
conducted as an interactive process with thecomputer and all weighing results are stored in thecomputer.

As crude drugs are natural products, the presence ofsome bacteria and fungus is unavoidable. The JPprescribes the baseline limit for presence of microbes incrude drugs and preparations made with crude drugs.

After the extract powders and the filling

Although almost all microbes are eliminated by heatmaterials are mixed during the manufacture of fineduring the extraction process, Kanebo employs a brief

granularsterilization of graduated fluid and carries out an③

products,

thesystemautomaticallyinspection for microbes in the final stage of the

manufactures the relevant granules.
④

Moreover, during the manufacture of tablets, atablet, press observation device, tablet weighing
device, a metal detector, and a transport device workin unison allowing unmanned operation.
⑤

All the steps involved in packaging or filling incontainers of the granules or tablets obtained inabove described steps (2), (3) and (4) are performed ina clean area.
⑥

production to ensure the safety of its product. The
company ships only products for which inspection has
confirmed the microbial count to be below the baseline
limit.
Although monographs of crude drugs may indicate
their use in the form of pill or powder, they convert theamount specified in the monograph to water-extracted
equivalent for its extract products. This in itself isirrelevant to the efficacy of our drugs, but it is significant

Sensors are installed to detect whether theindividual packages are properly packaged during

in terms of the elimination of toxic elements such as
microbial contamination.

the packaging process, controlling the entire systemin such a way to prevent the necessity for
replacements due to defective packages or products.
⑦

Products packaged on the individual lines arethen transported by the automatic transfer system tothe automated warehouse.
⑧

Untested products or non-standard products arelocked out by the manufacturing control system andmanaged in a way that prevents them from being
handled or shipped.

IV. Environmental Protection
The factory of Kanebo, which we visited, met thestandards of the ISO 14001: Environmental Management
System.
The original text records the use of pills andpowdered drugs. For our extracts we convert the amounts
given in the original texts into the amount of aqueous
extracts, a form which also allows to achieve a uniform
distribution. This renders carrying the products easierand serves also the function of excluding contamination

III. Prevention of Pesticide and Microbial Contaminations

with bacteria or other hazardous substances.

Pesticides have low solubility in water, instability inheat, and are evaporative. Some residual pesticides may
be found in a crude drug used as material. Less than
one-tenth of the amount will be transferred to theheat-processed extract. The amount of the residue will be
reduced below the detection limit in the final product,meeting the safety standard. Yet, with its strong
commitment to quality and safety, Kanebo carries out astrict inspection of every batch of crude drugs it receives
by measuring residual amounts of several types oforganochlorine,
pesticides.

organophosphorus

andpyrethroid

Acknowledgements:

We thank Kanebo Pharmaceutical, Ltd., andQingdao Huazhong Pharmaceutical, Co., Ltd. forproviding information to cover this article.

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Cutting raw herbal
medicines

Extraction tank

Store cut herbal
medicines

Top of separator ofsolid and liquid

To promote the efficient dissolution

To maintain volatile ingredients in the finishedof insoluble ingredients, the particle

product at the specified level, the effluent after

sizes of herbal medicines are

extraction process is controlled below 60℃ at

adjusted appropriately.

temperature and lowered in a graduation rate.

Mixture of
raw herbal
medicines

Decoction(Extraction)

Separationof effluent
and residual

Graduation

Splay
dry

Extraction
powder1) To maintain the sennoside content, extractionof Rhubarb is performed in a short time during
the latter half of the extraction process.
2) Heating time may be shortened in order toprevent enzymatic reaction.

Residua/disposal after
solid/liquid separation

54

Instant fungus
reduction machine

Hot-air generator
for drying

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

Central control room

Volume 1, Special Edition | Current Kampo Medicine 2005

Weighing

MixingMixingWeighing

Granulating tablets

Fine granule,
tablets etc.

SP packaging

Packaging

Finishedproducts

Fillers

Automatic Transfer System

Automated Warehouse

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Volume 1, Special Edition | Current Kampo Medicine 2005

Quality Evaluation of Kampo
Medical Extracts
As has been introduced in section "Manufacturing
Process of Kampo Medicine", the quality of Kampo
medical extracts is strictly controlled in the Kanebo
factory producing these extracts. Appropriate quality
assurance requires the provision of suitable analyticaltechnologies. This section will introduce a portion of
Kanebo's quality management.
I. Analytical evaluation of crude drugs
The quality of the crude drugs directly influences
the final extract products. In order to verify that thedelivered crude galenicals meet our company's
standards, they are upon receipt subjected to rigorous
examinations.
The Japanese Pharmacopoeia and the Japanese
Herbal Medicine Codex, naturally provide that thematerial is thoroughly inspected and subjected tomorphologic examinations under the microscopic. For
identification and quantitative measurements ofindicator
substances(asoutlinedinthe"Manufacturing Process of Kampo Medicine II") andsimilar physical examinations, including loss on
drying, purity test, total ash, acid-insoluble ash,extract content, essential oil content etc.; applicablestandards and test methods are defined. In addition tothese items Kanebo performs its own unique tests likemicrobial tests and residual agricultural chemical
examinations.
Microbial tests:
This includes testing for viable cell counts withmicrobial limit tests for aerobic bacteria, fungi andyeasts, as well as measurement of enteric bacteria andother Gram-negative bacteria and identification ofEscherichia coli, Salmonella and Staphylococcus
aureus with specific microorganism tests.
Residual agricultural chemical examinations:
These tests are performed to determine organic
chlorine pesticides (Total BHC’s, total DDT’s etc.),organic phosphorous pesticides (Diazinon, Malathion,
Parathion etc.) and pyrethroids (Cypermethrin,
Fenvalerate) and similar pesticides. Organic chlorine

56

pesticides and pyrethroids are measured using gas
chromatographs equipped with electron capture
detectors (ECD), whereas for the organic phosphorous
pesticides, mesurements using gas chromatographs
equipped with flame photometric detectors (FPD) arefrequently employed. These devices are characterized
by their outstanding detectability and selectivity.
II. Extract quality evaluation
In order to perform quality checks of extract
powders for each lot obtained by drying the extracts
after mixing the crude drugs based on individual
formula compositions, the materials are subjected to
identification, quantitative tests, loss on drying, purity
tests, total ash, acid-insoluble ash, extract content,
microbial tests and residual agricultural chemical
examinations. The results of these analyses have tomeet specified evaluation criteria.
Moreover, to test whether the quality of the extract
powder is constant, or if the material has been mixed
with other galenicals, the gradient method
chromatographs equipped with photodiode array
detectors (PAD) is employed even during HPLC
analysis. Sequential modification of the solvent ratio
in the mobile phase results in successive elution ofcomponents with differing properties and renders
visual comparison of multiple components with
continuous wavelengths with a Multi-wavelength
device easier. This procedure is excellent at identifying
impurities.
III. Product (final products) quality evaluation
Each lot of the final products including theaddition of diluting agents to the extract powders to
produce the commercial products is subjected to
identification, quantitative tests, loss on drying, purity
tests, measurement of total ash, acid-insoluble ash,extract content, microbial tests, residual agriculturalchemical examinations and additionally to producttests investigating deformations etc. i.e. particle size
distribution tests for preparation disintegration tests
and mass variation tests.
These test results are registered in the mastercomputer and the system is built, so that only products
confirmed to meet specific evaluation criteria will beshipped.

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

Volume 1, Special Edition | Current Kampo Medicine 2005

A 3-dimensional chromatogram of the ”B”Character Decoction extract
HO

O

O

Glc

HO

Glc

O

O

Glc

O

O

OH

OH

HO

Ap i

O

Glc

Ap i

OH

HO

O

Glc

GlcA

O

O

リクイリチン

アピオリクイリチン

COOH

Glc

O

O

O

O

アピオイソリクイリチン

Apioliquiritin

Liquiritin

O

HO

COOH
O

イソリクイリチン

Apioisoliquiritin

OH

O

OH

バ イカリン

Isoliquiritin

Baicalein

セ ンノシドＡ

Sennoside A
240
270
300
330
360
40

42

44

46

48

50

52

54

60

62

64

66

68

70

72

74

56

58

60

240
270
300
330
360
76

COOH

78

80

O
OCH
GlcA

O

OCH

3

O

GlcA

O

O

HO

O

HO

3

O

OH
H 3 CO

OH

O

Glc

HO
OH

O

OH

O

Fuc

GlcA

O

GlcA

O
OH

CH 2 OHO

オ ー ゴ ニ ン - 7 - G lc A

オ ロ キ シ リ ン Ａ - 7 - G lc A

バイカレイン

サ イ コサ ポ ニ ン ｂ２

グリチル リチン酸

オーゴニン

Wogonin- 7-GlcA

Oroxylin A-7-GlcA

Baicalein

Saikosaponin b 2

Glycyrrhizic acid

WogoninSetting for microbial testing

Example of analyzing devices (HPLC)The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

57

Volume 1, Special Edition | Current Kampo Medicine 2005

Herbs Covered by Health Insurancein Japan
Yoshiro Sahashi
Herbal medicines have been used for more than
1500 years in Japan. Despite the decision of the new
government in the Meiji era to adopt Western
medicine, the sale of herbal medicines at drug storesthroughout Japan has continued, and these drugs arein popular use. Pharmacologists have studied theseherbs and achieved noteworthy results, including
identification of the medicinal properties and theactive ingredients. For example, Chokichi Nagai
isolated ephedrine from the herb called Mao (Ephedra).
Japanese investigators have also been playing aleading role in research in this field. Many researchfindings have been reported in various journals, suchas the Journal of Traditional Medicines and Natural
Medicines.
When the National Health Insurance (NHI)
system was started in Japan, some medicinal herbs
were listed on NHI drug price tariff, besides a numberof Western medicines, so that they could be used for“prescriptions based on Kampo (Traditional Chinese
Medicine: TCM) theories”. In 1965, 43 herbal
medicines were covered by insurance. This was very
favorable for the subsequent progress of TCM in Japan,
and served as a base for later authorization of some ofthe herb preparations for overall medical use under
the NHI system. At present, about 200 herbal
medicinal preparations are covered by the NHI in
Japan.

Types and trend of use of herbal medicines
covered by insurance
At present, about 200 herbal medicines are coveredby the NHI in Japan. Some tendencies related to
traditions of Japan can be recognized in the types ofherbs that were covered by insurance. As described in
the section on History, the prescriptions recommended
in the classical monographs “Shang han lun” and“Jingui Yaolue” began to be used frequently in TCM in
Japan, as early as in the 18th century. As a result, theherbs needed for these prescriptions began to be usedwidely in Japan and they started to become freely
available in the market. This tendency to attach
importance to classical monographs continued even58

through the 1930s, when use of TCM was revived inJapan. Adoption of herbs listed on the NHI drug pricetariff was also affected by this tendency. At present, allherbs used for TCM preparations for medical use,
except for Shinkiku (Medicated leaven), are covered by
the NHI. Of course, a large number of herbs notcovered by insurance, are also available in the market
for clinical use, even if the cost needs to be borne
completely by the patient. Most of the prescriptions
used in China at present can also be administered inJapan. Thus, there are no problems relating to theclinical use of such prescriptions in Japan.

Herbal medicines unique to Japan
More than 90% of the herbs consumed in Japan
are imported from foreign countries. Such dependence
on imported herbs has continued ever since TCM was
first introduced in Japan from the Korean Peninsula
and China. During this period, Japanese investigatorssought similar herbs in Japan, and in fact, discovered
several that can be used in place of the imported herbs.
About 300 years ago, during the Tokugawa Shogunate
era, cultivation and collection of Japanese herbs wererecommended within the framework of the economic
policy. As a result, some herbs unique to Japan began
to be marketed, including Boi (Orientive Stem), Toki
(Japanese Angelica Root), Oren (Coptis Rhizoma),
Saiko (Bupleurum Root) and Byakujutsu (Atractylodes
Rhizoma). Ninjin (Ginseng) had been entirely
imported until that time, and was, therefore, very
expensive (various anecdotes have been documented
relating to this herb).
Through the efforts of government officials,
cultivation of several herbs was conducted successfullyin Fukushima, Nagano and Shimane prefectures.
Early in the 18th century, these herbs began to beexported to foreign countries. (The current situation onthese herbs is slightly complex, since large amounts ofthese herbs are now imported, and some amounts areexported.)
For the reasons mentioned above, several herbs
with different origins from those used in China are
now used in Japan. These herbs are also included in theofficial compendium (e.g., Japanese Pharmacopoeia)
prepared by the Ministry of Health, Labour and Welfare.
Examples are cited in the next page.

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Volume 1, Special Edition | Current Kampo Medicine 2005

Boi: In China, this is referred to as Stephania
tetrandra. In the Japanese Pharmacopoeia, it isdescribed as Sinomenium acutum (in China,
Sinomenium acutum refers to another herb called
Seihuto). However, it has been shown through datafrom many clinical cases, that Japanese Boi can beused as Chinese Hun-boi.
Toki (Japanese angelica root): In China, this isreferred to as Angelica sinensis. In Japan, it is more
often referred to as Angelica acutiloba or var.
sugiyama. It is grown in diverse areas, including
Hokkaido and the Honshu region (the main island ofJapan).
Oren (Coptis rhizoma): In China, this is referred toas Coptis chinensis. In Japan, it is generally referred
to as C. japonica. Oren grown in Japan is a vivid
yellow and was exported to China for some time as
high-quality Oren.
Senkyu (Cnidium rhizoma): In China, this isreferred to as Ligusticum chuanxiong. In Japan, it isreferred to as Cnidium officinale, belonging to theumbelliferous family. It is widely grown in Hokkaido
and some other districts.
Byakujutsu (Atractylodes rhizoma): In China, thisis referred to as Atractylodes ovata; in Japan, it isgenerally referred to as A. japonica. A. japonica
contains large amounts of essential oil. A. japonica issuperior to A. ovata in terms of its composition.

For some herbal medicinal plants, the part of theplant used as medicine is unique in Japan. For
example, “Keishi“ makes used of the bark of
Cinnamomum Cassia, but doesn’t use the fresh
branches. The bark of Cinnamomum Cassia is called“Keihi“. The term Saishin (Asiasarum Root) is used
when only the root, after the parts above the groundare discarded. The part of Saishin above the groundcontains aristolochic acid, which has strong
nephrotoxicity. In Japan, not only the parts of Saishin
above the ground, but also other herbs containing
aristolochic acid (Koboi: Aristolochia fangchi,
Kanmokutsu: Stem of Aristolochia manshuriensis, etc.)
are banned from the market.

Herb testing standards
The Japanese Pharmacopoeia (JP) stipulates
standards for herbs, including identification, purity,
ash content, loss on drying, composition, etc.
Standards on contamination by agrochemicals, heavy
metals, bacteria, etc. are stipulated for some herbs in
the JP. However, herb manufacturers in Japan conduct
tests on their herb preparations for thesecontaminants, even when no standards are stipulated
in the JP. In Japan although a large proportion is still
imported from foreign countries, only herb productsthat have passed stringent tests of quality, aredistributed in the market.

The herbal medicines covered by the NHI in Japanare listed in the table on the next page.

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Chinese Herbs Covered by Medical Insurance
ENGLISH NAME
Akebia Stem
Aloes
Amomum Seed
Amomum Seed powder
Anemarrhena Rhizoma
Angelica Dahurica Root
Apricot Seed
Areca Seed
Areca Seed powder
Arece Peel
Argy Wommood Leaf
Arisma Rhizoma
Arisma Rhizoma powder
Artemisia Capillaris Flower
Asiasarum Root
Asiatic Cornelian Cherry Fruit
Ass Hide Glue
Astragalus Root
Astragalus Root powder
Atractylodes Lancea Rhizoma
Atractylodes Lancea Rhizoma powder
Atractylodes Ovatae Rhizoma
Atractylodes Ovatae Rhizoma powder
Atractylodes Rhizoma
Atractylodes Rhizoma powder
Balloonflower RootBalloonflower Root powder
Bambusae caulis in taeniis
Barbary Wolfberry Fruit
Bark of Mulberry Root
Biond Magnolia Flower-bud
Black Seasame
Bunge Pricklyash
Bupleurum Root
Cape Jasmine Fruit
Cape Jasmine Fruit powder
Cardamon
Cardamon powder
Cassia Bark (Cinnamon Bark)
Cassia Bark (Cinnamon Twig)
Cassia Bark powder
Cassia Seed
Chinese Clematis RootChinese Gentian
Chinese Gentian powder
Chinese Ligusticum Rhizoma
Chinese Waxgourd Seed
Chrysanthemum Flower
Cicada Slough
Cimicifuga Rhizoma
Clove
Clove powder
Cnidium Rhizoma
Cnidium Rhizoma powder
Coastal Glehnia Root
Cochinchinese Asparagus RootCoix Seed
Coix Seed powder
Combined Spicebush RootCommon Cnidium Fruit
Common Floweringquince Fruit
Common Selfheal Fruit-spike
Coptis Rhizoma
Coptis Rhizoma powder
Crataegus
Dioscorea Rhizoma
Divaricate saposhnikovia Root
Double-teeth Pulbescent Angelica RootDragon's bone
Dried Bitter-Orange Peel
Dried Ginger
Dried Ginger powder
Dried Rehmannia Root
Ephedra60

BOTANICAL NAMECHINESE NAME

Akebia quinata or A. trifoliata
Aloe ferox
Amomum xanthioides
Amomum xanthioides
Anemarrhena ashodeloides
Angelica dahurika
Prunus armeniaca or P. armeniaca var. ansu
Areca catechu
Areca catechu
Areca catechu etc
Artemisia princeps 、A. montana
Alisma orientale
Alisma orientale
Artemisia capillaris
Asiasarum heterotropoides var. mandshuricum
Cornus officinalis
Ass
Astragalus mongholicus
Astragalus mongholicus
Atractylodes lancea
Atractylodes lancea
Atractylodes ovata
Atractylodes ovata
Atractylodes japonica or Atractylodes ovata
Atractylodes japonica
Platycodon grandiflorum
Platycodon grandiflorum
Bambusa tuldoides
Lycium barbarum
Morus alba
Magnolia biondii etc
Sesamum indicum
Zanthoxylum bundeanum
Bupleurum falcatum
Gardenia jasminoides
Gardenia jasminoides
Amomum cardamomum
Amomum cardamomum
Cinnamomum Cassia
Cinnamomum Cassia
Cinnamomum Cassia
Cassia obutusifolia or C. tora
Clematis chinensis
Gentiana scabra
Gentiana scabra
Ligusticum sinense etc
Benincasa cerifera or B.cerifera forma emarginta
Chrysanthemum morifolium
Cryototympana atrata(pustulata) etc
Cimicifuga dahurica and C.heracleifolia
Syzgium aromaticum
Syzgium aromaticum
Cnidium officinale
Cnidium officinale
Glehnia littoralis
Asparagus cochinchinensis
Coix lachryma-jobi var.mayuen
Coix lachryma-jobi var.mayuen
Lindera strychnifolia
Cnidium monnieri
Chaenomeles lagenaria
Prunella vulgaris
Coptis chinensis
Coptis chinensis
Crataegus cuneata
Dioscorea batatas
Aposhnikovia divaricate
Angelica pubeacens or A. pubeacens Form biserrata etc
Big fossil animal bone
Citrus aurantium
Zingiber officinale
Zingiber officinale
Rehmannnia glutinosa var hueichingensis
Ephedra sinica

Bai Mu tong（白木通）
Lu hai（芦薈）Sha ren（砂仁）
Sha ren fen（砂仁粉）
Zhi mu（知母）Bai zhi（白芷）Xing ren（杏仁）Bing lang（檳榔）Bing lang fen（檳榔粉）
Da fu pi（大腹皮）
Ai ye（艾葉）
Ze xie（沢瀉）Ze xie fen（沢瀉粉）
Yin chen hao（茵蔯蒿）Xi xin（細辛）Shan zhu yu（山茱萸）E jiao（阿膠）Huang qi（黄耆）huang qi fen（黄耆粉）Cang zhu（蒼朮）Cang zhu fen（蒼朮粉）
Bai zhu（白朮）Bai zhu fen（白朮粉）
Bai zhu（白朮）Bai zhu fen（白朮粉）
Jie geng（桔梗）Jie geng fen（桔梗粉）
Zhu ru（竹茹）Gou qi zi（枸杞子）
Sang bai pi（桑白皮）
Xin yi（辛夷）Hei zhi ma（黒芝麻）
Hua jiao（花椒）Chai hu（柴胡）Zhi zi（梔子）
Zhi zi fen（梔子粉）
Xiao dou cou（小豆蔲）Xiao dou cou fen（小豆蔲粉）
Rou gui（肉桂）Gui zhi （桂枝）Rou gui fen（肉桂粉）
Jue ming zi（決明子）
Wei ling xian（威霊仙）Long dan cao（竜胆草）Long dan cao fen（竜胆草粉）
Gao ben（藁本）Dong gua zi（冬瓜子）
Ju hua（菊花）Chan tui（蝉蛻）Sheng ma（升麻）Ding xiang（丁香）
Ding xiang fen（丁香粉）
Chuan xiong（川芎）Chuan xiong fen（川芎粉）※2Tian men dong（天門冬）Yi yi ren（薏苡仁）Yi yi ren fen（薏苡仁粉）
Wu yao（烏薬）
She chuang zi（蛇床子）
Mu gua（木瓜）Xia ku cao（夏枯草）
Huang lian（黄連）Huang lian fen（黄連粉）
Shan zha zj（山査子）
Shan yao（山薬）
Fang feng（防風）Du huo（独活）Long gu（竜骨）Chen pi（橙皮）
Gan jiang（干姜）Gan jiang fen（干姜粉）Shen di huang（生地黄）Ma huang（麻黄）JAPANESE NAME
MokutsuAroe matsu
Syukusya
Syukusya matsu
Chimo
Byakushi
KyoninBinroji
Binroji matsu
Daihukuhi
Gaiyo
Takusya
Takusya matsu
Intinko
Saishin
Sansyuyu
Akyo
Ogi
Ogi matsu
Sojutsu
Sojutsu matsu
Byakujutsu
Byakujutu matsu
Byakujutsu
Byakujutu matsu
Kikyo
Kikyo matsu
Chikujo
Kukosi
Sohakuhi
Shin'i
Goma
Kasyo
Saiko
Sanshishi
Sanshishi matsu
Shozuku
Shozuku matsu
Keihi
Keishi
Keihi matsu
Ketsumeishi
IreisenRyutanRyutan matsu
Kohon
Togashi
KikukaSentai
Shoma
Cyoji
Choji matsu
SenkyuSenkyu matsu
Hamabohu
Tenmondo
Yokuinin
Yokuinin matsu
Uyaku
Jyasyoushi
Syuhimokka
KagosoOren
Oren matsu
SanzashiSanyaku
Bohu
Todokukatsu
Ryukotsu
Tohi
SyokyoShokyo matsu
Jio
Mao

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

BitterCold
Bitter
Cold
Sour
Warm
Sour
Warm
Bitter,sweet
Cold
Pungent
Warm
BitterSlightly warm, slightly poisonous
Pungent, bitter
Warm
Pungent, bitter
Warm
BitterSlightly warm
Bitter, pungent
Warm
Sweet, tastelessCold
Sweet, tastelessCold
BitterSlightly cold
Pungent
Warm
Sour
Slightly warm
Sweet
Mild (Natural)
Sweet
Slightly warm
Sweet
Slightly warm
Sour, bitter
Warm
Sour, bitter
Warm
Bitter, sweetWarm
Bitter, sweetWarm
Bitter, sweetWarm
Bitter, sweetWarm
Bitter, sour
Mild (Natural)
Bitter, sour
Mild (Natural)
Sweet
Slightly cold
Sweet
Mild (Natural)
Sweet
Cold
Pungent
Warm
Sweet
Mild (Natural)
Pungent
Hot, slightly poisonous
Pungent, bitter
Slightly cold
BitterCold
BitterCold
Pungent
Warm
Pungent
Warm
Pungent, sweetHot
Pungent, sweetWarm
Pungent, sweetHot
Sweet, bitter, salty Slightly cold
Sour, salty
Warm
BitterCold
BitterCold
Pungent
Warm
Sweet
Cold
Sweet, slightly bitter Slightly cold
Sweet
Cold
Pungent, sweet
Slightly cold
Pungent
Warm
Pungent
Warm
Pungent
Warm
Pungent
Warm
Slightly sweet
Slightly cold
Sweet, bitter
Extremely cold
Sweet, tastelessSlightly cold
Sweet, tastelessSlightly cold
Pungent
Warm
Pungent, bitter
Warm
Sour
Warm
Bitter, pungent
Cold
BitterCold
BitterCold
Sour, sweet
Slightly warm
Sweet
Mild (Natural)
Pungent, sweet
Cold
Sour, bitter
Warm
Sweet, astringent
Slightly cold
Pungent, slightly bitter Warm
Pungent
Hot
Pungent
Hot
Sweet, bitter
Cold
Pungent, slightly bitter Warm

Volume 1, Special Edition | Current Kampo Medicine 2005

ENGLISH NAMEBOTANICAL NAMECHINESE NAME

Eucommia Bark
Eucommia ulmoides
Du zhong（杜仲）Evodia Fruit
Evodia rutaecarpa or E..officinalis
Wu zhu yu（呉茱萸）FennelFoeniculum vulgare
Xiao hui xiang（小茴香）Figwort Root
Scrophularia ningpoensis or S. buergeriana
Xuan shen（玄参）Fineleaf Schizomepeta herb
Schizonepeta tenuifolia
Jing jie（荊芥）Forsythia Capsule
Forsythia suspensa
Lian qiao（連翹）Fourleaf Ladybell Root
Adenophora tetraphylla or A. axilliflora
Nan sha shen（南沙参）Fourstamen Stephania Root
Stehania tetorandora
Fang ji（防已）Fresh Ginger
Zingiber officinale
Sheng jiang（生姜）Fresh Rehmannia Root
Rehmannnia glutinosa var hueichingensis
Xian di huang（鮮地黄）Galangal Rhizoma
Alpinia officinarum
Gao liang jiang（高良姜）
Gambir powder
Acacia catechu
Hai er cha（孩儿茶）Gambirplant Hooked Stem and Branch
Uncaria rhynchophylla or U. sinensis
Gou teng（鈎藤）Gentian Root
Gentiana lutae
Europian herb. No Chinese
Geranium Herb
Geranium thunbergii
Lao guan cao（老鸛草）
Geranium Herb powder
Geranium thunbergii
Lao guan cao fen（老鸛草粉）
Ginseng
Panax ginseng
Ren shen（人參）Great Burdock Achene
Arctium lappa
Niu ban zi（牛蒡子）
Gypsum (Calcium Sulphate Dihydrate)
CaSO4･2H2O
Shi gao（石膏）
Hawthorn Fruit
Crataegus pinnatifida var. major
Shan zha rou（山査肉）Hemp Seed
Cannabis sativa
Huo ma ren（火麻仁）
Honey
Feng mi（蜂蜜）Honeysuckle Stem
Lonicera japonica
Ren dong teng（忍冬藤）
Houttuynia Herb
Houttuynia cordata
Yu xing cao（魚腥草）
Immature Bitter Orange
Citrus aurantium
Zhi qiao（枳殻）Indian Bread Exodermis
Poria cocos
Fu shen（茯神）Jackinthepulpit Tuber
Arisaema consanguineum etc
Tian nan xing（天南星）Japanese Angelica RootAngelica acutiloba or var.sugiyamae
Dang gui（当帰）Japanese Angelica Root powder
Angelica acutiloba or var.sugiyamae
Dang gui fen（当帰粉）
Japanese Dwarf Quince
Chaenomeles sinensis
Ming zha（榠楂）Japanese Pagodatree Flower-bud
Sophora japonica
Huai mi（槐米）
Jujube (Chinese Date)
Zizyphus jujuba var.inermis
Da zao（大棗）Kaolinum
Hydrated halloysite（Al203・2Si02・2H20・4H20）
Hua shi（軟滑石）
Lalang Grass Rhizoma
Imperata cylindrica
Mao gen（茅根）Licorice Root
Glycyrrhiza uralensis
Gan cao(甘草)Licorice Root powder
Glycyrrhiza uralensis
Gan cao fen（甘草粉）
Lightyellow Shora Root
Sophora flavescens
Ku shen（苦参）Lightyellow Shora Root powder
Sophora flavescens
KU shen fen（苦参粉）
Lily Bulb
Lilium lancifolium, L..brownii var. colchesteri etc
Bai he（百合）
Lithospermun Root
Lithospermum erythrorhizon
Zi cao（紫草）Lobed Kudzuvine Root
Pueraria lobata
Ge gen（葛根）Longan Aril（Longan Fruit）
Euphoria longana
Long yan rou（竜眼肉）Lonicerae Fros
Lonicera japonica
Jin yin hua（金銀花）Loquat Leaf
Eriobotrya japonica
Pi pa ye（枇杷葉）Lotus Seed
Nelumbo nucifera
Lian zi（蓮子）
Lycium Bark
Lycium chinense
Di gu pi（地骨皮）
Magnesium sulfate
MgSO4・7H2O※2
Magnolia Bark
Magnolia obovata, M. officinalis or M. officinalis var.biloba Hou po（厚朴）Magnolia Bark powder
Magnolia obovata, M. officinalis or M. officinalis var.biloba Hou po fen（厚朴粉）
Malt
Hordeum vulgare
Mai ya（麦芽）Malt Sugar
Rice & Malt
Yi tang（飴糖）
Mandarin Orange Peel
Citrus reticulata
Chen pi（陳皮）Mandarine Orange Peel
Citrus reticulata
Chen pi（陳皮）Mirabilite
Nature Na2SO4・10H2O
Mang xiao（芒硝）
Mud Tortoise Carapace
Amyda japonica or A. sinensis
Bie jia（鼈甲）MyrobalanTerminalia chebula
He zi（訶子）Nandinae Fructus
Nandina domestica and forma leucocarpa
Nan tian zhu zi（南天竹子）
Nature Chrysanthemum Flower
Chrysanthemum indicum
Ye ju hua（野菊花）Non-prepared Aconiti tuber
Aconitum carmichaeli
Wu tou（烏頭）Nuphar Rhizoma
Nuphar japonicum
None in China
Nutgrass Galingale Rhizoma
Cyperus rotundus
Xiang fu（香附）Nutgrass Galingale Rhizoma powder
Cyperus rotundus
Xiang fu fen（香附粉）
Nutmeg Seed
Myristica fragrans
Rou dou kou（肉豆蔲）Ophiopogon Tuber（Dwarf Lilyturf Root）
Ophiopogon japonicus
Mai dong（麦冬）Orientive Stem
Sinomenium acutum
Qing feng teng（青風藤）Oyster Shell
Oatrea gigas
Mu li（牡蛎）Oyster Shell powder
Oatrea gigas
Mu li fen（牡蛎粉）
Panax Japonicum Rhizoma
Panax japonica
Zhu jie shen（竹節参）Peach Seed （Peach Kamel）
Purunus persica or var.davidiana
Tao ren（桃仁）
Perilla Herb（Perilla Leaf）
Perilla frutescens etc
Zi su cao（紫蘇葉）Perlla Fructus
Perilla frutescens etc
Su zi（蘇子）Persimmon Calyx
Diospyos kaki
Shi di（柿蒂）Peucedanum praeruptorum (Peucedanum decurisivum) Peucedanum praeruptorum
Qien hu（前胡）Pharbitis Seed
Pharbitis nil or P. purpurea
Qian niu zi（牽牛子）
Phellodendron Bark
Phellodendron amurense
Huang bai（黄柏）JAPANESE NAME
Totyu
Gosyuyu
Uikyo
GenjinKeigaiRengyoSyajinHun boi
Sensyokyo
Jio
RyokyoAsen'yaku matsu
Chotoko
Gentiana
Gennosyouko
Gennosyouko matsu
NinjinGoboshi
Sekko
Sanzashi
Mashinin
Hatimitsu
Nindo
JuyakuＫｉｊｉｔsｕ（Kikoku）
BukuryoTennannsyo
Toki
Toki matsu
Mokka
Kaika
Taiso
Kasseki
Bokon
Kanzo
Kanzo matsu
Kujin
Kujin matsu
ByakugoShikon
KakkonRyuganniku
Kinginka
BiwayoRenniku
Jikoppi
MgSO4・7H20
Koboku
Koboku matsu
BakugaAme（Koi）
ChinpiKippi
Na2SO4・10H2O
DobekkoKasi
Nantenjisu
KikukaUzu
Senkotsu
Kobushi
Kobushi matsu
Nikuzuku
Bakumondo
Boi
Borei
Borei matsu
Chikusetsuninjin
Tonin
Soyo
ShisoshiShｉｔｅｉ
Zenko
Kengoshi
Obaku

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

Sweet
Warm
Pungent
Hot, bitter, poisonous
Pungent
Warm
Bitter, sweet, salty Cold
Pungent
Slightly warm
BitterSlightly cold
Sweet
Slightly cold
Bitter,sour
Cold
Pungent
Slightly warm
Sweet, bitter
Cold
Pungent
Hot
Bitter, astringent
Mild (Natural)
Sweet
Slightly cold
Sweet, bitter
Bitter, slightly pungent Mild (Natural)
Bitter, slightly pungent Mild (Natural)
Sweet, slightly bitter Mild (Natural)
Pungent, bitter
Cold
Pungent, sweet
Extremely cold
Sour, sweet
Slightly warm
Sweet
Mild (Natural)
Sweet
Mild (Natural)
Sweet
Cold
Pungent
Slightly cold
Bitter, pungent
Slightly cold
Sweet tastelessMild (Natural)
Bitter, sour
Warm, poisonous
Sweet, pungent
Warm
Sweet, pungent
Warm
Sour
Warm
Slightly cold
Slightly cold
Sweet
Warm
Sweet, tasteless
Cold
Sweet
Cold
Sweet
Mild (Natural)
Sweet
Mild (Natural)
BitterCold
BitterCold
Sweet, slightly bitter Mild (Natural)
Sweet
Cold
Sweet, pungent
Cool
Sweet
Slightly warm
Sweet
Cold
BitterCold
Sweet, astingent
Mild (Natural)
Sweet, tastelessSlightly warm
Salty, bitter
Extremely Cold
Bitter, sour
Warm
Bitter, sour
Warm
Sweet
Mild (Natural)
Sweet
Warm
Bitter, sour
Warm
Bitter, sour
Warm
Salty, bitter
Extremely Cold
Salty
Cold
Bitter, sour, astringent Mild (Natural)
Sour, sweet
Mild (Natural)
Bitter, pungent
Slightly cold
Pungent, bitter
Extremely hot, great poisonous
Slightly bitter
Slightly cold
Pungent
Slightly bitter
Pungent
Slightlly bitter
Pungent
Warm
Sweet, slightly bitter Slightly cold
BitterMild (Natural)
Salty,astringent
Slightly cold
Salty,astringent
Slightly cold
Sweet,slightly bitter Slightly warm
BitterMild (Natural)
Pungent
Warm
Sour
Warm
Bitter astringent
Mild (Natural)
Bitter,sour
Slightly cold
BitterCold,poisonous
BitterCold

61

Volume 1, Special Edition | Current Kampo Medicine 2005

ENGLISH NAME
Phellodendron Bark powder
Pinellia Tuber
Plantago Herb
Plantago Seed
Polyporus Sclerotium
Prepared Aconiti Daughter Tuber
Prepared Aconiti Tuber
Prepared Coastal Glehnia Root
Prepared Dried Ginger
Prepared Rehmannia RootPruni Cortex
Puncturevine Cltrop Fruit
Quercus Bark
Red Ginseng
Red Ginseng powder
Red Peony Root
Rhizoma and Root Forbes Notopterygium
Rhubarb
Rhubarb powder
Rice（Oryza Seed）
Rose fruit
Rose fruit powder
Safflower
Saffron
Sappan Wood
Saussurea Root powder
Saussurea Root（Aucklandia Root）
Schisandra Fruit （Chinese Monkshood）
Scutellaria Root
Scutellaria Root powder
Senega Root
Senega Root powder
Senna Leaf
Senna Leaf powder
Sharpleaf Galangal Fruit（Bitter Cardamon）
Shurb Chastetree Fruit
Siberian Motherwort Herb
Smilax Rhizoma
Smilax Rhizoma powder
Smoked Plum
Tall Gastrodia Rhizoma
Tall Gastrodia Rhizoma powder
Tatarian Aster Root
Tea Leaf
Thinleaf Milkwort Root
Thinleaf Milkwort Root powder
Tonkin Sophora RootTortoise Plastron Glue
Trapae Fructus
Tree Peony Bark
Tree Peony Bark powder
Trichosanthes Root
Trichosanthes Semen
Tuber Fleeceflower Root
Tuckahoe（Poria Sclerotium）
Tuckahoe（Poria Sclerotium）powder
Turmeric Rhizoma
Turmeric Root-tuber
Twotooth Achyranthes Rootuva-urusi leaves
Valerian Root
Valerian Root powder
Wheat Fruit
White Peony RootWhite Peony Root powder
Wild Mint
Wrinkled Gianthyssop Herb
Yanhusuo
Younger Immature Bitter Orange
Zanthoxylum Fruit
Zanthoxylum Fruit powder
Zedoary
Zedoarypowder
Zhejiang Tendrilleaf Fritillary Bulb
Zizyphus Seed
References: Chinese Herbal Medicine
Japanese Pharmacopoeia Ⅹ, Ⅳ

62

BOTANICAL NAME
Phellodendron amurense
Pinellia ternata
Plantago asiatica
Plantago asiatica
Polyporus umbellatus
Aconitum carmichaeli
Aconitum carmichaeli
Glehnia littoralis
Zingiber officinale
Rehmannnia glutinosa var hueichingensis
Purunus jamasakura
Triburus terrestris
Quercus acutissima etc
Panax ginseng
Panax ginseng
Peonia lactiflora
Notopterygium incisum or N. forbesii
Rheum palmatum and R.tanguticum
Rheum palmatum and R.tanguticum
Oryza sativa
Rosa multiflora
Rosa multiflora
Carthamus tinctorius
Crocus sativus
Caesalpinia sappan
Saussurea lappa
Saussurea lappa
Schisandra chinensis
Scutellaria baicalensis
Scutellaria baicalensis
Polygala senega or var. latifolia
Polygala senega or var. latifolia
Cassia acutifolia and C. anngustifolia
Cassia acutifolia and C. anngustifolia
Alpinia oxyphylla
Vitex rotundifolia or V. trifolia
Leonurus sibiricus
Smilax glabra
Smilax glabra
Prunus mume Siebold
Gastrodia elata
Gastrodia elata
Aster tataricus
Cammelia sinensis
Polygala tenuifolia
Polygala tenuifolia powder
Sophora subprostrata
TortoiseTrapa japonica
Paeonia suffruticosa
Paeonia suffruticosa
Trichosanthes kirilowii
Trichosanthes kirilowii
Polygonum multiflorum
Poria cocos
Poria cocos
Curcuma longa
Curcuma longa
Achyranthes bidentata
Arctostaphylos uva-ursi
Valeriana fauriei
Valeriana fauriei
Triticum aestivum
Peonia lactiflora
Peonia lactiflora
Mentha arvensis var. piperascens
Pogostemon cablin
Corydalis turtschaninovii Besser forma yanhusuo
Citrus aurantium
Zanthoxylum piperitum
Zanthoxylum piperitum
Curcuma kwangsiensis
Curcuma kwangsiensis
Fritillaria verticillata var. thubergii
Zizyphus jujuba

CHINESE
Huang bai fen（黄柏粉）
Bab xia（半夏）Che qian （車前）
Che qian zi（車前子）Zhu ling（猪苓）Fuzi（附子）
Fuzi（附子）
Sha shen(沙参:北沙参）
Chi gan jiang（赤干姜）
Shou di huang（熟地黄）Japanese herb.(桜皮）※2
Ji li（蒺藜）Hu pi（槲皮）
Hong shen（紅参）Hong shen fen（紅参粉）
Chi shao（赤芍）Qiang huo(羌活）Da huang（大黄）Da huang fen（大黄粉）
Jing mi（粳米）Ying shi（営実）Ying shi fen（営実粉）
Hohg hua（紅花）Xi hong huo（西紅花）
Su mu（蘇木）Mu xiang fen（木香粉）
Mu xiang（木香）Wu mei zi（五味子）
Huang qin（黄芩）Huang qin fen（黄芩粉）※2None in China
Fan xie ye（番瀉葉）Fan xie ye fen（番瀉葉粉）Yi zhi ren（益知仁）
Man jing zi（万荊子）
Yi mu cao（益母草）Tu Fu ling （土茯苓）Tu Fu ling fen（土茯苓粉）
Mu mei（烏梅）Tian ma（天麻）Tian ma fen（天麻粉）
Zi yuan（紫苑）Cha ye（茶葉）Yuan zhi（遠志）Yuan zhi fen（遠志粉）
Shan dou gen（山豆根）
Gui ban jiao（亀板膠）Ling（菱）Mu dan pi（牡丹皮）
Mu dan pi fen（牡丹皮粉）
Tian hua fen（天花粉）
Gua lou ren（栝楼仁）He shou wu（何首烏）Fu ling（茯苓）Fu ling fen（茯苓粉）Jiang huang（姜黄）Yu jin（鬱金）Niu xi （牛膝:川牛膝）Europian herb. No Chinese
Xie cao（纈草）※1
Xia cao fen（纈草粉）Xiao mai（小麦）Bai shao（白芍）Bai shao fen（白芍粉）Bo he（薄荷）Hou xiang（藿香）Yan hu suo（延胡索）
Zhi shi（枳実）Shan jiao（山椒）Shan jiao fen（山椒粉）
E zhu（莪朮）E zhu fen（莪朮粉）Zhe bei mu（浙貝母）Suan zao ren（酸棗仁）

JAPANESE NAME
Obaku matsu
Hange
Syazenso
Syazenshi
Chorei
Busi
Hobushi
Hokusyajin※
KankyoJio（juku）
Ohi
Shiturishi
Bokusoku
Kojin
Kojin matsu
Sekisyaku※
Kyokatsu
Daio
Daio matsu
Kobei
EijituEijitu matsu
Koka
Sahuran
SobokuMokko matsu
Mokko
Gomishi
Ogon
Ogon matsu
SenegaSenega matsu
Senna
Senna matsu
YakuchiMankeishi
Yakumoso
Sankirai
Sankirai matsu
Ubai
Tenma
Tenma matsu
Shion
Cyayo
Onji
Onji mastu
SanzukonAkyo（Kibankyo）
Hisinomi
Botanpi
Botanpi matsu
KarokonKaroninKasyuuBukuryo
Bukuryo matsu
Ukon
Senngyokukin※3
Goshitsu
Uwaurusi
Kanokoso
Kanokoso matsu
Shobaku
Shakuyaku
Shakuyaku matsu
Hakka
KakkouEngosaku
Ｋｉｊｉｔsｕ
SansyoSansyo matsu
Gajutsu
Gajutsu matsu
Baimo
Sansonin※1 Xie cao (纈草): V.officinalis

TASTE

BitterCold
Sour
Warm,poisonous
Sweet
Cold
Sweet
Cold
Sweet, tastelessMild (Natural)
Pungent
Hot, poisonous
Pungent
Hot, poisonous
Sweet
Slightly cold
Pungent
Hot
Sweet
Slightly warm
Slightly
Mild (Natural)
Bitter, pungent
Mild (Natural)
ＢｉｔｔｅｒMild (Natural)
Sweet, slightly bitter Warm
Sweet, slightly bitter Warm
BitterSlightly cold
Pungent, bitter
Warm
BitterCold
BitterCold
Sweet
Mild (Natural)
Sour
Slightly cool
Sour
Slightly cold
Pungent
Warm
Sweet
Cold
Sweet, salty, pungent
Mild (Natural)
Pungent, bitter
Warm
Pungent, bitter
Warm
Sour
Warm
BitterCold
BitterCold
Sweet, slightly bitter
Sweet, slightly bitter
Sweet, bitter
Extremely cold
Sweet, bitter
Extremely cold
Pungent
Warm
Pungent, bitter
Cool
Pungent, bitter
Slightly cold
Sweet, tastelessMild (Natural)
Sweet, tastelessMild (Natural)
Sour
Mild (Natural)
Sweet
Mild (Natural)
Sweet
Mild (Natural)
Bitter, sweet
Slightly warm
Bitter, sweet
Slightly cold
Bitter, sour
Slightly warm
Bitter, sour
Slightly warm
BitterCold
Sweet, slightly sour Mild (Natural) slightly cold
Sweet
Slightly cold
Bitter, pungent
Slightly cold
Bitter, pungent
Slightly cold
Bitter, slightly sweet, sour Cold
Sweet
Cold
Bitter, sweet, astringent Slightly warm
Sweet
Mild (Natural)
Sweet
Mild (Natural)
Pungent, bitter
Warm
Pungent, bitter
Cold
Bitter, sour
Mild (Natural)
Slightly
Pungent, bitter
Warm
Pungent, bitter
Warm
Sweet
Slightly cold
Sour, bitter
Slightly cold
Sour, bitter
Slightly cold
Pungent
Cool
Sour
Slightly warm
Pungent, bitter
Warm
Bitter, pungent
Slightly cold
Pungent
Hot,Slightly poisonous
Pungent
Hot,Slightly poisonous
Pungent, bitter
Warm
Pungent, bitter
Warm
Bitter, sweet
Slightly cold
Sweet, sour
Mild (Natural)※2 not use in China

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

CHARACTER※3 not in Medical InsuranceVolume 1, Special Edition | Current Kampo Medicine 2005

Societies for Kampo Medicine
Kampo Medicine was a de jure medicine until the
Meiji-Restoration in 1886. During this period, scholars did
not take the initiative to develop an academic society. Long
after the Meiji Restpration the government decided toauthorize German medicine as a formal medicine. Doctors
who were practicing Kampo medicine reacted to thegovernment and as a consequence developed a number ofpolitical associations which attempted academic actions
resulting in Kampo medicine becoming a social outcast. In
the true sense of the word, the first society of Kampo
medicine came into existence in the 1930’s.
At that time, there were few doctors, pharmacologists andacupuncturists who gathered to form societies for the studyof Kampo Medicine, but rather took action individually.
Eventually, they took counsel together and established theJapanese Society of Kampo Medicine” and published theofficial journal Kampo and Chinese Herbs. This was the firstsociety of Kampo medicine in Japan.
After the Second World War, this society could notcontinue because Japanese society as a whole experienced
significant change. However, when postwar adjustments
were finished, people who established the previous society,re-established the Japanese Society of Oriental Medicine in1950. This society continues today and plays an importantrole in Kampo medicine in Japan.
Associations which play an active part in Kampo Medicine
today are:

1. Japanese Society of Oriental Medicine
This society represents Japanese Kampo medicine and is
the most authoritative in Japan. It was established tobroaden communication among practitioners and to foster
cooperation among researchers. Its primary goal was toadvance Kampo medicine in 1950 by medical doctors,
pharmacologists, and acupuncturists who were practicing
this medicine. Its sphere of activity comprehends Kampo
Medicine, acupuncture and most areas of Kampo Medicine.
Present actions are:
Major activities(1) To hold a congress and academic meetings and publish
the official journal and other publications,(2) To authorize a specialist of Kampo medicine,(3) To investigate and research Oriental medicine,(4) To interchange and cooperate with facilities at home andabroad, and(5) Other activities to achieve the above-mentioned purpose.
Present state of activities(1) Publishing of its official journal, Kampo Medicine
Published 6 times a year, plus a special issue for theannual academic congress. The journal reached number 225(Vol.54 No.2) as of March 2003.
Authors must be a member of the society in principle andaccess not only the Japanese, but also the English literature.

(2) Holding an academic congress
Holding one general congress each year, sectional
meetings at the 8 branches, prefectural meetings and lecture
meetings for authorized doctors, totaling 70 meetings per
year.
(3) Authorizing a specialist in Kampo Medicine
Since 1989, this system is used to generate a council of
authorized doctors. Such authorization by the society
requires:¾ Have a national license of medicine, be a member ofthe society over 5 years, take designated credits.
¾ Turn in case reports and to pass a written and an oral
certification examination which is hold once a year.
¾ Renewal term:every 5 years¾ Number of authorized doctors: 3,487 person(4) Numbers of members as of March 2003.
Full members: 8,247
Supporting members: 367
Total: 8,614（Breakdown of full members:medical doctors 6,998,
dentists 41, pharmacologists 873, acupuncturists 323,
other scholars 12）(5) Committees
The society conducts its activities mainly throughpermanent and special committees. Current committees are:ⅰ. Committee for editing and publishing official journal - Kampo

Medicine
ⅱ. Committee for editing and publishing the English version of

Kampo Medicine
ⅲ. Committee for science and education
To conduct various educational seminars and to edit
textbooks
ⅳ. Committee for public relations
To interact and cooperate with facilities at home and abroadⅴ. Committee for health insuranceManagement of health insurance issues about Chinese herbs
and traditional prescriptions
ⅵ. Committee for health insurance
To take measures to advance national policies for healthinsurance
ⅶ. Committee for planning and management
To advance the image of the society and to make inquiries forthe board of directors.
ⅷ. Committee for the system of authorized doctors
To examine and authorize doctors of Kampo medicine.
ⅸ. Committee for investigation of medical plants for Kampo
prescriptions
To investigate and research medical plants for Kampo
prescriptions and folk medicine.
x. Committee for indications of Acupoints
To research acupoints from a historical point of view, thedevelopment of acupuncture and educational programs
ⅺ. Committee for technical terms
To publish the glossary of “Kampo Medicine” and it’stranslation to English.
ⅻ. Special committee for EBM
To investigate the EBM in Kampo Medicine
xⅲ. Committee for public information
To service and maintain the home-page of the society

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2. Medical and
WAKAN-YAKU

PharmaceuticalSocietyforassociation, "Clinical Kampo", is published as vertical print
and thereby preserves the ancient form of traditional

The Wakan Yaku symposium (1967-1983) focused

medicine comparatively well.

mainly on research into Wakan Yaku (the crude drugs

In the past, its official publication represented the main

serving as material for the preparation of Kampo medicines)

activity of this association, but in 1991 at the academic

was the parent organization for the establishment of thisgeneralsociety in 1984. The society holds one annual national

established and henceforth published many excellent,conference. While the Japan Society for Oriental Medicine

strongly traditionally inclined research results.

primarily publishes clinical research results, publications
pertaining to crude drugs, preparations and basic research
are the primary focus in this society.
The society also publishes its own official organ, the"Journal of the Wakan-Yaku Society".
This society has the following purposes.
(1) Meetingandexchanging
information
among
pharmaceuticalresearchers,
physicians
andpharmacists regarding various forms of research into
Wakan Yaku.
(2) Gathering of colleagues studying the various systems of
Kampo medicine and traditional medicine and exchangeof relevant information.
(3) Attempts to fuse science based on reductionism and theconcepts of "complex systems, diverse systems" dealt
with in traditional medicine.

meeting,"KampoMedicine

Research"wasCurrently, the association has about 1,600 members,
comprising

mainlyphysicians,

pharmacists

andacupuncturists, and is engaged in the following main
activities.
(1) Publication of the association's official organ "Kampo
Medicine Research".
(2) Study groups, lectures, other activities considerednecessary for the promotion of traditional medicine.
(3) Commendations of Kampo researchers(4) Exchange withorganizations.

relateddomestic

andforeign

4. Japan Society of Medical History
This academic society was founded in 1927 for"research into and spread of medical history research".
It holds one general conference annually. In addition,(4) Establishment of new therapeutics and providing theobtained knowledge for the general population.

there are several regional meetings with comparatively few

Since 2002 the "central curriculum of medical education"

the official organ "Journal of Japanese Medical History".

in medical facilities has been initiated. It includes the item
"ability to explain Wakan Yaku", so that this society too is
actively pursuing the integration of this concept.

3. The association of east-Asian medicine

attendants, but a high level of activity. The society publishes
Members of this academic society include a variety of
researchers regardless of whether they specialize in westernor oriental medical history, many of whom actually specializein the history of Kampo medicine or acupuncture andmoxibustion. Many researchers of Chinese medical history,

In 1938 the leaders in Kampo medicine at the time

live in Japan, but in comparison to Chinese researchers

convened and decided to promote an exchange between East

these researchers publish a great deal of elaborate work

Asian medicine in general and TCM. It established thecharacterized by unique points of view. This is particularly

Association of East-Asian Medicine for the prosperity of thistrue for the field of acupuncture and moxibustion.

form of medicine, supporting the activities of the JapaneseThis academic society has the following purposes.

Kampo Medical Society as a by-product of their program.

(1) Organization of academic conferences, lectures andacademic exhibitions.

After World War II, during a period of confusion, theassociation remained dormant for a period, but resumed its
activities in 1954 that continue to the present day. Whereas
the highest priority of The Japan Society for Oriental
Medicine is academic research, the Association of East-Asian
Medicine deals with the transmission of traditions, using
traditional methods for its research. The Association
maintains a mutually supporting relationship with The
Japan Society for Oriental Medicine. The official organ of the64(2) Publication of the official organ "Journal of Japanese
Medical History", "Newsletter of the Japan Society for
Medical History" and related books.
(3) Maintaining an exchange with related domestic andforeign organizations as a representative of theacademic world of Japanese medical history.
(4) Conducting activities
above-mentioned goals.

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Education for Kampo Medicine
Oriental medicine was a traditional form of medicine
which supported Japanese health since the 5th century
A.D. After the Meiji Restoration in 1868, however,Western medicine became the field of medicine thatwas taught at schools, and the entire medical affairs
system was established and operated based onWestern medicine. Accordingly, for more than 100
years Oriental medicine was hardly ever taught at
medical schools. Oriental medicine was only practiced
by a small number of physicians who studied medicineon their own after graduating from medical school, andby pharmacists who handled herbal medicine which
remained in use. Pharmacologists who specialized in
the study of herbal medicine and pharmacology helped
them from the sidelines. But with very few educational
opportunities available, they were supported only by asmall number of private research groups. In many
instances, education was provided from teacher tostudent, or that is to say, from one individual toanother.

TABLE 1
E.

Basics of Clinical Practice2.

Knowledge of Basic Medical Treatment(1)

Treatment with Japanese Kampo Medicine
General Goals

1.

2.

In April 2003, the Ministry of Health, Labor andWelfare made it a requirement for medical schools to
include Kampo Medicine in their core curriculum.
Professor Katsutoshi Terasawa, who has been involvedin this matter since the beginning and who has worked
hard for the establishment of this requirement, has
instituted the study of Kampo Medicine in the corecurriculum as follows.

Study of the basics required for an application of Japanese Kampo
medicine within clinical practice (basic concepts of Kampo
medicine, diagnostics, use of individual prescriptions).
Development of a holistic perspective, acquisition of the ability toselect the optimal therapy for any given patient, including the useof Japanese Kampo medicine.
Achievement Goals

1.

Acquisition of the ability to explain characteristics and basic
concepts of Kampo medicine (functions of qi, blood, water;comprehension of the conceptual pairs deficiency - excess,superficial - deep, hot - cold)2.

Ability to explain the basic differences between Kampo and Western
medicine.

3.
4.
5.
6.
7.

1. Undergraduate Education at Medical Schools
Now that Chinese herbal medicine used for
medicinal purposes is covered by public healthcare
insurance, the situation has changed – and many
medical schools have started to teach Kampo Medicine.
The first medical school to offer courses in Kampo
Medicine was Toyama Medical and Pharmaceutical
University, followed by Tokyo Women’s Medical
College. With other medical schools subsequently
considering the need to teach Kampo Medicine, theseschools now teach it to their students through avariety of different programs.

Plan for Model Core Curriculum at Toyama Medical andPharmaceutical University

Ability to explain Kampo medical diagnostics (comprehension of thefour diagnosis methods: observation, listening and smelling, patientquestioning and palpation).
Ability to explain the Kampo concept of "Sho (pattern) "(comprehension of pattern orientated therapy).
Ability to explain the composition of Kampo preparations,
pharmacologic actions and their indications.
Ability to explain representative side effects of Kampo preparations
and relevant precautions.
Ability to explain EBM in relation to Kampo medicine andintegration with western medicine.

Table 1: Proposed Model Core Curriculum at Toyama Medical andPharmaceutical University

According to a survey conducted by Nikkei Medical
magazine in February 2004, 79 of the 80 medical
schools in Japan now teach Kampo Medicine. Thoseschools offer lectures on the subject, specially arranged
to meet their individual needs.
An example of this is the enhanced educational
program at Toyama Medical and Pharmaceutical
University, as follows:
TABLE 2 Syllabus of Medical Treatment and Japanese Kampo
Medicine at Toyama Medical and Pharmaceutical University forpre-graduation in 2002
2nd YearIntroduction of Japanese Kampo Medicine
30 hours
History Medical and Pharmaceutical Science
30 hours
4th Year

Medical Treatment and Japanese Kampo Medicine

30 hours

5th YearJapanese Kampo Medicine,
Coursework of Clinical Applications

5 hours

5th and
6th Year

Clinical Training of Japanese Kampo Medicine

31 hours(5 days)

Table 2: Syllabus of “Medical Treatment and Japanese Kampo
Medicine” at Toyama Medical and Pharmaceutical University

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Subject of StudyContent of Learning

1

The role of Kampo Medicine inmodern western medical care Five viscera concept

Comprehensionofthecharacteristics of western andKampo Medicine as well as thefive viscera concept.

2

Qi -Blood-Fluid concept, Qi
deficiency, Qi stagnation, Qi
reversal

Regarding preparations for themain symptoms of Qi deficiency,Qistagnation,
Qi
reversalconditions according to the Qi-Blood-Fluid concept

3

Qi deficiency,
stagnation

Comprehension of preparations
for the main symptoms of Qi
deficiency,
Oketsu,Fluidstagnation.

4

Yin-yang,
deficiency-excess,cold-heat and exterior-interior
concept

No.

5

6

7

Oketsu,

Fluid

Comprehension of the concept andthe disease stages of andpreparations
for
the
main
symptoms of six-channel diseases.

Composition of preparations

Comprehension of the compositionof Kampo medicines

1st Day
9:00

Tue

Wed

Thu

Gain an understanding regarding
the reconciliation of oriental andwestern medicine as well as side
effects of Kampo medicines
through practical examples.

Table 3: Main Theme of “Medical Treatment and Japanese
Kampo Medicine” Lesson at Toyama Medical and Pharmaceutical
University

8:00〜8:30
Reading Circle

8:30〜
Orientation

8:00〜8:30
Reading Circle

9:00〜
Clinical Clerkship(ambulatory
practice)
9:00〜
Clinical Clerkship(ambulatory
practice)
9:00〜
Clinical Clerkship(ambulatory
practice)
9:00〜
Clinical Clerkship(ambulatory
practice)Mon

Recognition and comprehension oftheindividual
yin-yang,
deficiency-excess, cold-heat andexterior-interior disease states.

Six-channel diseases (greateryang, brighter yang, lesser yang,greater yin, lesser yin orreverting yin)

Reconciliation of oriental andwestern medicine - side effects of
Kampo medicines

Based on this educational program, the othermedical schools have devised and offer curricula thatare best geared to their individual needs.
A number of universities and research institutes
have devised special curricula by which they holdlectures in Kampo Medicine. For instance, the Japan
Institute of TCM has with favorable results been
holding a 6-day camp-style seminar for medical
students throughout Japan (who feel that the course
offered at their own university is not enough).

Fri

8:00〜8:30
Reading Circle

8:00〜8:30
Reading Circle

8:00〜8:30
Reading Circle

10:00〜
17:30〜ClinicalClinicalClerkship
Conference(stationarycare)
Clinical Clerkship(stationary care)

Clinical Clerkship(stationary care)

13:30〜15:30
Professor’s
Round

16:30〜
Abstract
Reading

ClinicalClerkship(stationarycare)

16:00〜
17:00
Wrap-up

Table 4: Clinical Training in Japanese Kampo Medical
Treatment at Toyama Medical and Pharmaceutical University

2nd Day
Breakfast

3rd Day
Breakfast

4th Day
Breakfast

5th Day
Breakfast

6th Day
Breakfast

Kampo pathology②

Kampo dosimetry①

Kampo therapy

Workshop①

Special lecture⑨

Kampo diagnostics

Kampo dosimetry②

Special lecture④

Workshop②

Lunch

Lunch

10:30
Special lecture⑪

12:00

Special lecture⑫

13:00
14:00

Lunch

Lunch
Lunch

Assembly（14:00）
Kampo Medicine
around the World

Kampo pharmacology

Special lecture②

Kampo physiology

Special lecture①

Special lecture③

DinnerDinnerDinnerSpecial lecture④
Excursion

15:30

Clinical conference

17:00

19:00
20:00

DinnerDinnerSpecial lecture⑤

Special lecture５

Drug practiceKampo pathology①
Clinical lectures
Kampo pathology②

21:00

Table 5: Japan Institute of TCM’s Curriculum for “Kampo Medicine Seminar for Medical Students”

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Diagram 1: Texts Used in “Kampo Medicine Seminar for
Medical Students”

These texts include an outline of Kampo Medicine,the history of Kampo Medicine, its physiology, etiology
and pathology, as well as the study of its diagnosis,
drugs, prescriptions and therapeutics.

2. Postgraduate Education and System ofSpecialized Medicine
Kampo Medicine is taught in a variety offormats at the postgraduate level. This educationis conducted in many different forms. There aremany independent study groups around Japan,
including courses sponsored by the Japan Society
for Oriental Medicine, research groups sponsoredby pharmaceutical companies, and researchgroups sponsored by local physician associations
around Japan.
The Japan Society for Oriental Medicine,which holds lectures at its various chapters,
endeavors to contribute to the continuing
education of medical specialists, while local
physician associations around Japan periodicallyhold seminars suited to clinical and everyday
purposes. Pharmaceutical companies offer
lectures delivered by top speakers in the field, tofurther improve the use of their products in theirendeavors to spread correct and accurate
knowledge.

In 1989 the Japan Society for Oriental
Medicine introduced a system of specialized
medicine. With the emergence of this system, themembership of the Japan Society for Oriental
Medicine has doubled. This has resulted in avariety of different studies being conducted at thesame time, so that in addition to traditional
medical research methods used thus far, there
have emerged methods employing Chinese herbal
medicine based on Western medical methodology.
As a result, Kampo Medicine has entered a newphase, including the development of new
medicines to treat specific diseases. And
education programs have developed accordingly.
Among the problems in education at thepresent time are how to teach academic systemsof Kampo Medicine which are not necessarily
simple, and how to position traditional medicine
of Japan from an international perspective.
In order to breathe life into Kampo Medicine
on both clinical and everyday levels amid therapidly progressing field of Western medicine,
Chinese herbal medicine must not merely exist as
a substitute for Western medicine but rather
Kampo Medicine must be understood as a system
in its own right. The basis of education exists here.
Education in Kampo Medicine in Japan is still ina period of transition.

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Journals of Kampo Medicine
Prior to 1890, journals devoted to Kampo medicine, did not exist since the social basis for its existence had notbeen laid. For the next ten years, individuals who were trying to preserve Kampo medicine and protect it frompolitical influences, developed a number of publications. All were discontinued by 1900.
Following a relatively long period, a number of journals appeared due to the revived interest in Kampo
medicine. Among those, Kampo Medicine and Chinese Herbs, first published in 1934, provided the mostcomprehensive content. As a result it took a leadership role in the field of Kampo medicine at that time. It was
discontinued in 1944 due to the impact of World War II.
The Japan Society for Oriental Medicine was founded after World War II, and immediately published its
journal, Kampo Medicine. This was followed with the development of the Association of East-West Medicine
with its journal, Journal of Kampo Medicine. This journal finally provided researchers in the field an
appropriate environment for publishing their research. Various pharmaceutical companies also began to
publish their own research journals, as did a number of commercial entities. Many of these continue to prosper
today. Below, the reader will find an introduction to the most important journals available at this time in Japan.
Kampo Medicine
Official journal of the JapaneseSociety for Oriental Medicine. The
most authoritative journal in thisfield. Includes dissertations, theses,
case reports, record of lectures about
Kampo Medicine, and some articles
on acupuncture. Articles written in
Japanese with attached English
summary. Kampo literature in
English is rare. Started in 1949,
published 4 times a year,

Journal of Traditional Medicine

Official journal of the Medical andPharmaceutical Society for
WAKAN-YAKU. Includes dissertations
and theses about most Chinese Herbs andsome prominent clinical reports. About ahalf of the articles are written in English.
Papers written in Japanese haveattached English summaries. Started in
1983, published 4 times a year.

Journal of the Japan Society of
Medical History

Official journal of the Japan Society of
Medical History. Carries not only thehistory of Japanese medicine but alsoworld medicine (approximately 50:50).
Includes literature on Kampo medicine
and acupuncture. Articles written in
Japanese include an English summary.
Articles written in English are rare.
Published 4 times a year, 21.0×15.0cm.
pages 160〜200. For members only.

Clinical Journal of Traditional
Chinese Medicine

Published to introduce current TCM in
China. Carries articles written byauthorities in China, theoretical research
by Japanese, case reports, explanation of
Kampo prescriptions, and latest news
from China (for example the therapy of
SARS). No English summary. Published 4times a year.

Journal of Kampo Medicine

Official journal of the Association of
East-Asian Medicine. Includes a wide
range of articles about this area. Includes
dissertations, theses, case reports, recordof lectures about Kampo Medicine,
acupuncture, medical essays, medical
history, tete-a-tete talk, clinical research,round table talk, explanation of Kampo
prescriptions, interpretation of classics.
The literature of ”Kampo Medicine” isrigorously judged and includes many
articles from related disciplines. No
English summaries. Started in 1954,
published 12 times a year, 21.0×15.0cm.
Pages 80〜100. For members only. Sold ina few specific book stores. Price900Yen.

68

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

Journal of Kampo Medicine & Herb

Edited from the standpoint of socalled ”Japanese Kampo”. Carries
clinical research reports, case reports,
explanation of Kampo prescriptions,round table talk, etc. No English
summary. Published 6 times a year.

Volume 1, Special Edition | Current Kampo Medicine 2005

Research KampoΦυτο

Published by Nagoya-Byakugokai whichis the research circle of Kampo in Nagoya.
Applies the epidemiological method andcreates the new world in this field.
Carries unique articles, for example, casereports, value of Chinese herbs and so on.
No English summary. Started in 1998,
published 2-3 times a year.

An academic journal of
Kotaro-Kampo. Has the longest historyof the journals of
Kampo
Medicinepublishedby
Pharmaceuticalcompany.
Carriesdissertations, theses, case reports,
medical essays, medical history,
clinical research, round table talk,
explanation of Kampo prescriptions,etc. No English summary. Started in1949. published 12 times a year, 26.0×
18.0cm. Pages 20〜24. Price 800Yen.

Kampo Igaku

Wakanyaku

One of the academic journals of Tsumura.
Carries fundamental research, clinicalresearch, interview of specialists, roundtable talk, explanation of Kampo
prescriptions, introduction to Kampo
clinics, etc. No English summary.
Published 6 times a year.

An academic journal of
Uchida-Wakannyaku. Because thiscompany is a wholesale dealer ofChinese herbs, this journal has many
articles about Chinese herbs. Carries
botany, cultivation and harvesting ofChinese herbs, fundamental research
for Chinese Herbs, introduction ofChinese Materia Medica and feu
clinical research, etc. No English
summary. Published 12 times a year,
29.5×21.0cm Pages 16〜20.

Traditional Medicine

Tradition & Medicine

One of the academic journals of Tsumura.
Edited from the viewpoint of current
TCM in China. Carries case reports,
explanation of Kampo prescriptions,latest news from China, interpretation ofTheory of TCM, round table talk. No
English summary. Published 4 times a
year, 26.0×21.0cm, Pages 24〜30. Price
980Yen.

Phil Kampo

One of the academic journals of KANEBO,
a successor of “THE KAMPO” 1983-2001).
Carries tete-a-tete talk, clinical research,round table talk, explanation of Kampo
prescriptions. No English summary.
Started in 2002, published 4 times a year,
Pages 20〜24. Price 1000Yen

An academic journal of Matsuura.
Carries dissertations, theses, casereports, medical essays, medical
history, clinical research, round table
talk,
explanationofKampo
prescriptions, etc. No English summary.
Published 4 times a year, 29.5×21.0cm
Pages 16〜20.

Medical Kampo

An academic journal of Osugi. Carriescase reports, medical essays, clinicalresearches, explanation of Kampo
prescriptions, etc.
No English
summary. Published 2 times a year,
29.5×21.0cm Pages 16〜20.

Kampo Medicine ResearchWe

One of the academic journals of KANEBO.
Enlightening
contents.
Carriessummaries of current clinical research,round table talk. No English summary.
Started in 2000, published 4 times a year,
A4 size, Pages 20〜24. Price 1000Yen

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

An academic journal from Tsumura.
Carries information for pharmacist
engaging
prescriptionof
Kampo
medicine including instruction on dosage,etc. while more medical institutions are
adapting Kampo medicine. Started in
1992, published 6 times a year, A4 size,
Pages 20.

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Medical Insurance in Japan
Naoya Ono
Department of Health Promotion and Human Behavior, Division of Health Determinants,
School of Public Health, Graduate School of Medicine, Kyoto University

Foreword
The practice of Kampo medicine in Japan is sustained by the country’s medical system. The reason that
Kampo medicine is so widely used for medical purposes is due to its acceptance by medical insurance. The medical
system in Japan is not the same as that in other countries. With a unique Japanese framework, and operated
through the political support of the Health, Labor and Welfare Ministry; the Japanese medical system hassustained the health of the Japanese people. When considering the role played by Kampo medicine in Japanese
healthcare, it is extremely important to look at how Kampo medicine is managed within the medical system.
As noted in other parts of this journal, the reasons that physicians educated in Western medicine can practiceKampo medicine are (1) drugs used in Kampo medicine can be dispensed easily, and (2) the existence of 148 typesof these drugs which have a high level of compliance in their use. After learning a certain degree of traditional
medical concepts, physicians introduce these drugs into their own clinical practice. Utilizing these drugs, and theinsurance system that sustains their operation, they perform clinical tests and independent research, including
research based on the accumulation of case studies and comparative studies.
Meanwhile, there are medical institutions, though not many, which provide medical treatment based on
Kampo medicine, at their own expense. In particular, there are many places that use herbal medicine astherapeutic drugs. While more than 160 types of herbal medicine are accepted by healthcare insurance, it isfinancially difficult for herbal medicine to be used with health insurance treatment. This is due to such problems
as their excessively low cost, the fact that they require a great deal of manpower and shelf space, and the difficulty
in securing pharmacists who posses a high degree of knowledge in this area. While providing medical treatment at
one’s own expense is much simpler than providing health insurance treatment, it is another form of Kampo
medicine practiced in Japan.
This article, written by Ono, explains the medical system in Japan. The overall theme is much larger than
Kampo medicine, and has very little to do with clinical Kampo medicine. Nevertheless, we have included it to letreaders know that medical treatment is based on this system. This article also contains information that will be
useful to people who intend to study about the Japanese medical system.
Editorial Staff
1. History of Development of the Medical System(1) Medical Security System and Social Security
Broadly defined, Social Security in Japan includes
protection and pensions for victims of war. Narrowly
defined, it means public assistance (livelihood
assistance), social welfare (for the physically disabled,
mentally disabled, elderly, children, single mothers,etc.), social insurance (medical insurance, annuity
insurance,
nursing
insurance,
unemployment
insurance, industrial injury insurance, etc.) and publichealth (tuberculosis, infectious disease, drug-related
measures,waterworks
anddrainage,waste
management, etc.). Other than exceptional cases suchas people who receive livelihood assistance based on
low income (0.8% of the total Japanese population), allJapanese citizens currently have a form of medical
insurance, which is one of the medical services
guaranteed to all Japanese citizens.

70(2) History of the Medical Security System① Structure of Universal Health Insurance System
The history of medical insurance in Japan dates backto the establishment of the Health Insurance Law in1922. This law became institutionalized for employees
at factories and elsewhere, amid the rise of the labor
movement during the development period of
capitalism at the beginning of the 20th century.
Subsequently, in 1938, the system of national healthinsurance was established for individual proprietors
and farmers. As a result, in 1945 approximately 60% of
the Japanese population had medical insurance.
However, with the chaos of World War II, it became
impossible to provide sufficient healthcare to people,
and the system was in danger of collapsing. With theeconomic and social reconstruction after the war, theconstruction of a genuine system of social security
began. And the system of medical insurance, which
had been on the brink of collapse, was also
reconstructed.

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The national treasury assumed the burden of
government-managed health insurance in 1954. In
1963 a 3-year period of health insurance provision
which had been in place thus far was abolished, thetime limitation on insurance during recuperation waseliminated, and plans to improve health insurance
were discussed.
Meanwhile, based on revisions in 1954, themanagement of national health insurance wasrevamped from the regular Blue Cross system
conducted by individual cities, towns and villages, topublic management by municipalities. In addition, it
became compulsive for municipalities managing
national medical insurance to make this insurance
available to residents. In order to stabilize the financesof national health insurance, based on revisions in
1955, a system of national treasury assistanceequivalent to 20% of recuperation expenses becamelaw.
Under such conditions, the National Health
Insurance Law was completely revised in 1958, and a
yearly plan was decided for the realization of universal
health insurance over a period of four years. In 1961, asystem of national health insurance was put into effectin all municipalities for individual proprietors andfarmers who did not have employee’s health insurance.
The result was universal health insurance in Japan,
based on employee’s health insurance and national
health insurance. After that, it became compulsive for
all Japanese citizens to have either employee’s healthinsurance or national health insurance – both of which
are forms of social insurance.
② Establishment of Healthcare System for the
RetiredIt is a qualification requirement that people
receiving employee’s health insurance in Japan be
employed at a place of business enumerated in the law.
After an employee retires because he or she hasreached retirement age or for another reason, that
employee is no longer employed at the place ofbusiness, and as a general rule will no longer receive
employee’s health insurance – but instead will receive
national health insurance.
The level of health insurance for such aged retirees
drops at a time when their need for healthcare is on
the rise, resulting in the problem whereby they must
depend on the national treasury and national healthinsurance premiums to pay their healthcare expenses.
For this reason, a medical care system for the retired
was established in 1984 to ensure fairness in theprovision of healthcare and the burden of its costs
throughout the lifetime of people who receive
employee’s health insurance, and to correct

irrationality between medical care systems. While therate increases at which healthcare is provided to aged
retirees who formerly had employee’s health insurance
but who have since begun receiving national healthinsurance, this system pays for that healthcare by the
insurance premiums from retirees who had been
receiving employee’s health insurance and bycontributions from employee’s insurance.
③ Establishment of Health Insurance System for the
Elderly
As mentioned above, due to the relationshipbetween employee’s insurance and National Health
Insurance, the percentage of elderly people who have
National Health Insurance increases as society ages.
Furthermore, as the structure of employment inJapanese society changes from primary industry to
secondary industry, and from secondary industry totertiary industry, the younger segment of society
switches to employee’s insurance rather than National
Health Insurance. As a result, the age composition of
insurants with National Health Insurance has
gradually risen. In 1998, the average age of people
with an insurance policy was 51.3 years for National
Health Insurance through municipalities, 36.9 years
for government-managed health insurance, and 33.6
years for union-managed health insurance. The
percentage breakdown for elderly people with healthinsurance is 25.3% for National Health Insurance
through municipalities, 5.7% for government-managed
health insurance and 2.8% union-managed for healthinsurance.
If the situation by which the age composition of
insurants is made light of is projected into insurance
area of finance, if there were no system of adjustment
between types of coverage, the higher the age
composition in a system of insurance the more difficult
it becomes to finance that system. And overall the
insurance premium revenue obtained from elderly
people is not as large as that obtained from theyounger segment. Meanwhile, as far as expenses areconcerned, since the per-person healthcare costs forthe elderly is five times that of the younger segment,
as the percentage of elderly people increases soincrease healthcare costs. (As a result, in 1999,
healthcare costs for the elderly accounted for 38%, or
11.8 trillion yen, of the total of 30.9 trillion yen innational healthcare costs. What’s more, the percentageof healthcare costs for the elderly increases each year.)Also, in 1973, based on revisions in the Elderly
Welfare Law, a system was established whereby
so-called free healthcare costs for the elderly (theamount for which the individual elderly person is
responsible under healthcare insurance), are paid for
at public expense. With the subsequent rapid increase

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in healthcare costs for the elderly, there has been morepressure for the financing of National Health
Insurance.
For this reason, the difference in age composition
among insurers that comes with the aging of society
has been corrected – and from the viewpoint of
spreading the burden of healthcare costs for theelderly fairly among the Japanese people a healthservice system for the elderly was established in 1983.
Also, health and medical treatment measuresprovide for the treatment of disease – and based on theknowledge that comprehensive measures for thehealth of the elderly have been lacking, not only does
the health service system for the elderly deal withproblems of finance, but it also has to do withcomprehensive insurance for the elderly, which
includes measures for preventing and detecting
disease early on, during the prime of life, so that theincreasing number of elderly people can live healthy
lives.
④ Establishment of a System of Nursing Insurance
As society ages there has been a sudden increasein the number of people who require nurses, including
those who are bedridden and those who suffer fromdementia. Meanwhile, changes in social conditions,
including the growing number of nuclear families andthe social advancement of women, have witnessed adecrease in the function of nursing provided byfamilies.
However, since nursing service for the elderly wasformerly provided under two different types ofcoverage – welfare coverage for the elderly andinsurance coverage for the elderly – there was adisproportion in the burden of cost and usage
procedure, so that the situation was inadequate forcomprehensive nursing measures. For this reason, sothat elderly people who require nursing or care will beable to lead meaningful lives in accordance with theirown ability, a system of nursing insurance coverage
was established in April 2004, to provide
comprehensive
service,includinginsurance,
healthcare and welfare services, based on user
selection.
⑤ Maintenance of the System for Healthcare
Provision
The modern healthcare system in Japan began in
1874 with the establishment of the medical system.
The National Healthcare Law was subsequently
established in 1942, and with the difference between
hospitals and clinics being clarified, a system for
permitting physicians to establish clinics was put into
effect.

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After the war, in 1948, the Healthcare Law, on
which the system for healthcare provision in Japan isbased, was established. Also, with the Doctor and
Dental Practitioner Law being gradually put into place,there has been a quantitative expansion of healthcare
provision for acute medical treatment.
Subsequently, with changes in the structure ofdisease and the aging of society, there has been areview of the system of healthcare provision.
In 1985, a healthcare planning system byprefecture was introduced for the purposes of revising
the system of healthcare provision locally as part of
the first round of revisions of the Healthcare Law, andobtaining the cooperation of healthcare facilities. Also,an adequate number of hospital beds have beenrealized.
In 1992, the Healthcare Law was revised a second
time for the purposes of (1) realizing conceptual
regulations for providing healthcare, and (2) thesystemizing the function of medical facilities withtechnologically advanced hospitals and extended careunits having been systematized.
Furthermore, when the Healthcare Law wasrevised for a third time in 1997, (1) informed consent
regulations were realized, (2) extended care units wereexpanded into clinics, (3) community health support
hospitals were systematized, and (4) the system of
healthcare planning was reviewed.
When the Healthcare Law was revised for a thirdtime in 2000, (1) a distinction was made between beds
for general patients and beds used for the purpose ofrecuperation, and the provision of healthcare waspromoted to suit the condition of the individual
patient; (2) there was an easing of required
regulations; (3) there was a securing of the observanceof hospital arrangement standards; and (4) measures
were adopted for easing advertising regulations.
2. Structure of Disease
The structure of disease in Japan has changed
from acute infectious disease to chronic lifestyledisease, based on such things as improvement innourishment, higher hygienic standards, advances inmedicine and medical technology, and changes inhealth awareness. In view of the annual transition in
the percentage of cases of hospitalized treatment,
there has been a remarkable decrease in infectious andparasitical diseases, with a drastic increase in diseaseofcirculatoryorgan
systems,
including
cerebrovascular trouble, as well as neoplasm such as
cancer. Also, death ratio according to cause of deathindicates a sudden decrease in the death rate fromThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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tuberculosis, and an increase in the death rate from
cerebrovascular disease and malignant growths.
3. Healthcare Costs(1) Total Healthcare Costs and Their Breakdown
National healthcare costs in Japan are on an
upward trend, even under conditions of slumping
economy. Healthcare costs reached 30,933,700 million
yen in 1999, or 244,200 yen per person.
This notion of national healthcare costs represents
the cost for treating ailments among the Japanese
population at medical facilities over a 1-year period.
These costs are calculated based on expenditures for
public healthcare insurance. Included in national
healthcare costs are medical treatment fees, theresponsibility of patients to pay for a portion of thecosts, the cost of providing medicine, nursing costs,
and transportation costs. However, expenses fornormal birth, expenses required for medical checkups
for the maintenance and promotion of health, expenses
for amenity bed, and a portion of the construction costs
for public medical institutions are not included. Also,
as a general rule, since healthcare costs are free ofconsumption tax, there are no taxes for their expense.
In Japan, the details of medical practice, theadministering of medication and medical examinations
appear in statements submitted by medical
institutions as the foundation of a progress payment
system based on a nationally standardized medical
treatment fee bill used by both hospitals and clinics.
And so, by totaling up the amount paid based on
medical fee statements, the particulars and monetaryamounts of medical treatment performed at medical
facilities are understood on the national level. And
based on such social insurance statistics, national
healthcare costs are determined with the addition ofdata other than social insurance, including healthcare
costs paid for at public expense.
Including the cost of purchasing medicine, publichealth expenses (including medical checkups andvaccinations), managerial and operational costs, andresearch and development costs, this corresponds tothe total healthcare costs of the OECD. Total
healthcare costs in Japan (1998) are 7.4% of the GDP,
which ranks number 18 among nations belonging to
the OECD. However, in terms of monetary amount,
this represents 283,558 million dollars, second only to
the 1,125,555 million dollars of the United States. The
per-capita healthcare cost is 2,242 dollars for Japan(ninth), with Germany at 2,697 dollars (fifth), France
at 2,324 dollars (eighth), and the Netherlands at 2,172
dollars (tenth) – which means that there is not such a
big difference in per-capita healthcare cost among
these nations.

Looking at the breakdown of healthcare costs inJapan in terms of national healthcare costs (fiscal
1999) by consultation type, general consultation costs
involving admittance to the hospital account for 36.8%,
dental clinics account for 8.2%, dispensing pharmacies
account for 7.8%, costs for meals and medical
preparations when patients are admitted to thehospital account for 3.5%, health service facilities forthe recuperation of the elderly account for 2.5%, andhome nursing and medical costs for the elderly accountfor 0.3%.
Breaking things down by category of expense at
medical institutions (fiscal 1998), personnel costs
involving healthcare attendants account for 50.9%, thecost of medical supplies accounts for 19.4%, the cost of
medical materials accounts for 6.1%, and consignment
expenses account for 5.2%. By fiscal resources (fiscal
1999), public expenses account for 32.9%, the cost of
insurance premiums accounts for 52.5%, with othercosts accounting for 14.7%.
(2) Healthcare Costs for the Elderly
Healthcare costs for people of the age of 70 andolder (including bedridden people between the ages of
65 and 70) (hereinafter referred to as “healthcare
costs for the elderly”) reached 11,804 billion yen in
fiscal 1999. The trend for increasing healthcare costs
for the elderly is remarkable, with these costs
accounting for 38% of total national healthcare costs.
Breaking down national healthcare costs by maincauses for this increase, increase in populationaccounted for 0.2% of the 3.7% increase in fiscal 1999,
the aging population (change in the population
composition by age level) accounted for 1.6%, withother increases (change in the structure of disease,advances in healthcare, etc.) accounting for 1.9% of thetotal increase – which means that the effect of aging isgreat. Also, while the total cost of national healthcare
increased by 3.7%, the increase in healthcare costs foryoung people was 1.0%, with the increase inhealthcare costs for the elderly at 8.4%.
The reasons that the cost of healthcare for theelderly causes healthcare costs to increase are becauseof the increase in the population of elderly people, andbecause of the fact that per-capita healthcare costs forthe elderly are five times greater than the costs ofhealthcare for young people. When comparing thedifference between healthcare costs for the young andold in Japan to that in American and European
countries based on data from the OECD, the differencein Germany is 2.68 times (1994) and the difference inFrance is 3.00 times (1993), so that the difference
between the young and old is generally between 2 and4 times – which means that this difference is higher in

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Japan than in Western countries. In Japanconsideration must be given to the fact that the costs ofnursing have traditionally been calculated ashealthcare
costs,duetoso-called“socialhospitalization,” whereby people are hospitalized at
medical institutions due to such factors as outdated
nursing services provided to the elderly, although
medical treatment might not be necessary.
The cause of high healthcare costs for the elderly
has to do with each of the three elements of healthcare
cost per capita. Among the three elements, the“consultation rate” is an index indicating how often aperson with healthcare insurance is seen at a medical
institution per month. In this case, the number of
instances of consultation is the same as the number ofbills for medical treatment issued by medical
institutions, with one bill per patient issued by each
medical institution. The consultation rate for theelderly is 6.2 times that of young people for patients
who are hospitalized, and 2.6 times that of young
people for outpatients.
The next element, “number of days per instance,”
is the average of the actual number of days of
consultation per month as indicated in the
consultation fee statements from medical institutions.
The number of days per instance for elderly people is
1.3 times greater than that number for young people
who are hospitalized, and 1.4 times greater than that
number for young people who are outpatients.
The “per-day consultation cost,” which is theconsultation cost (billed to the medical insurance eachmonth) divided by the actual number of days ofdiagnosis and treatment, means the unit price of
healthcare service. This per-day consultation cost for
the elderly is 0.9 times greater than that for young
people who are hospitalized, which means that it isless for the elderly than for the young. The per-day
consultation cost for outpatients is 1.2 times greaterfor the elderly than it is for young people.
As indicated above, the reason that the cost ofhealthcare for the elderly is higher than it is for young
people is due to the fact that the consultation rate forthe elderly is much higher than it is for young people,
both for patients who are hospitalized and for
outpatients. Amid this situation it is surmised thatelderly people, who have numerous adult lifestylediseases such as diabetes and high blood pressure,frequently consult physicians at medical institutions.
Furthermore, with the free access in the Japanese
healthcare system which enables patients to choose
the medical institution where he or she will consult aphysician, it is believed that other reasons include thefact that there is a smaller percentage of elderly people

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who take the responsibility of healthcare costs uponthemselves, and the fact that the excessive number ofhospital beds and outdated nursing services promoteso-called social hospitalization.
Of course, the average life expectancy in Japan is
77 years for men and 84 years for women, both ofwhich are the highest in the world. With the average
healthy life for men and women in Japan at 74.5 years,
the WHO, both in quality and equality, ranks theJapanese insurance and healthcare systems number
one in the world. However, with the further advance of
aging in the future, it is estimated that national
healthcare costs will reach 81 trillion yen in 2025, 45
trillion yen, or 56%, of which will be accounted for byhealthcare costs for the elderly. These national
healthcare costs account for 12.5% of the national
income, for an increase of approximately 1.7 times thatof the 7.5% figure for 2000.
Before there is a sudden rise of healthcare costs forthe elderly, it is important for Japan to establish
measures for the prevention of disease and general
healthcare, keeping in mind the matter of lifestyledisease. In addition, Japan faces the urgent task ofreforming the system of healthcare for the elderly.
4. System for Providing Healthcare(1) Amnesty for the System of Providing Healthcare inJapan
The system for providing healthcare in Japan has
the following nine features. (1) There is a system inplace by which physicians and dentists are free toestablish clinics if they notify the prefectural governorof that establishment. (2) Hospital doctors are working
doctors. (3) There are no restrictions on consultation
fees. (4) There is a high percentage (approximately
80% of the number of facilities) of private hospitals(medical corporations); there is a high percentage ofsmall and mid-sized hospitals with 200 beds or less(approximately 70% of the number of facilities). (5)Some clinics have beds, and clinics are equipped withmedical equipment and facilities. (6) Hospitals takeoutpatients, and the consultation rate for thosepatients is high. (7) It is prohibited for hospitals or
clinics to operate for profit. (8) People are free tochoose the medical institution where they will consult
a physician. (9) On the average, patients in Japanremain hospitalized for more days than patients inmany of the other countries belonging to the OECD;
Japanese hospitals have more beds per patient thanmany of the other countries belonging to the OECD;
Japanese hospitals have a fewer number of physicians
and nurses on staff per bed than many of the othercountries belonging to the OECD.

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(2) Medical Facilities
Broadly speaking, medical facilities can be divided
into three categories: hospitals, clinics and maternity
clinics.
Hospitals are medical facilities that have at least
twenty beds, and must receive permission from theprefectural governor to be established.
Some hospitals, known as “technologicallyadvanced hospitals,” provide advanced healthcare, andbased on an application submitted by the individual
hospital are individually approved by the Ministry of
Health, Labor and Welfare to perform development,
evaluation and training in advanced healthcare.
Specifically speaking, these include university
hospitals and national cancer centers, with 82 such
facilities having been approved as of April 2002.
Also, from the viewpoint that family doctors anddentists should be supported in order to ensure
healthcare in local regions, there exists a system of“hospitals supporting local healthcare,” approved by
the prefectural governor. As a condition for being
approved, hospitals supporting local healthcare must
provide healthcare to referred patients, provide
support to local healthcare facilities by such means as
the joint-utilization of facilities and equipment andmaking facilities and equipment openly available,
provide emergency medical care, and train healthcare
attendants in the local region. As of April 2002, there
were 35 facilities that had been so approved.
Clinics either are medical facilities that have nobeds at all or have hospitalization facilities of 19 beds
or less. If a physician or a dentist opens a clinic, he or
she must notify the prefectural governor (the mayor of
the city or special district where the public healthcenter is set up). If a person other than a physician or adentist opens the clinic, he or she must receive
permission from the prefectural governor (the mayor of
the city or special district where the public healthcenter is set up).
Maternity clinics are medical facilities that either
have no beds at all or have hospitalization facilities of
9 beds or less, and where midwives work. If a midwife
opens a clinic, she must notify the prefectural governor(the mayor of the city or special district where thepublic health center is set up). If a person other than a
midwife opens a clinic, that person must receive
permission from the prefectural governor (the mayor of
the city or special district where the public healthcenter is set up). The prefectural governor must grant
permission to a facility that so applies if its structuralequipment and stationed personnel conform to acertain standard. However, the prefectural governor

might not grant permission for the establishment ofsuch a facility if the person applying for permission
intends to operate that facility for profit.
(3) Healthcare Attendants
The number of doctors and dentists in Japan is on
an upward trend each year, and as of 2000 there were
255,792 doctors and 90,857 dentists. While this is lessper capita than those numbers for other advanced
nations, Japan achieved the target of having “150doctors and 50 dentists per 100,000 people by 1985,”
which was set in 1970. In order to ease the excessive
number of personnel in the future, the university
admission capacity has been decreased.
And in efforts to improve quality and raise thelevel of clinical ability, clinical training for graduates
was systemized and enhanced.
The number of nursing personnel per capita inJapan is on the same level as that in other advanced
nations, but the number of nurses per hospital bed
remains low. According to the forecast regarding
recipients of nursing services in December 2000,
demand at the end of 2001 will exceed supply byapproximately 35,000 people due to such factors as therealization of a more cordial system of nursing,
improvements in working conditions, and the carrying
into effect of a system of nursing insurance coverage.
However, it is forecasted that supply and demand willbalance out at about 1,300,000 people by 2005.
There are two types of nurses. One is the so-calledassociate nurse, who receives a license after passing atest offered by the prefectural governor. The other isthe regular nurse, who receives a license after passing
a test offered by the minister of health, labor andwelfare. The former changing to the latter and theimprovement of quality have become issues.
(4) Healthcare Corporations
According to the Healthcare Law, a hospital, or aclinic where doctors and/or dentists work, or a
corporation or foundation that intends to establish ahealth service facility for the elderly may make thatfacility into a healthcare corporation. The approval of
the prefectural governor (or the minister of healthlabor and welfare, for two or more businesses) is
required to establish a healthcare corporation. As
conditions for approval to establish a hospital, theestablisher must have a capital adequacy ratio of 20%
or more, and there must be three directors, one
inspector, and as a general rule the chief director must
be a doctor or a dentist.
A healthcare corporation is prohibited from having
a dividend of surplus, and any contingent business is

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limited to being within the scope of the training ofhealthcare practitioners. What’s more, as a generalrule business for profit is prohibited.
Healthcare corporations are subject to thefollowing taxes: corporation tax (the same tax rate as a
joint stock company) and enterprise tax (anything
having to do with social health insurance treatment
rewards is tax-free, and tax rate reductions apply toanything having to do with diagnosis and treatment
chosen at the discretion of the patient).
Included among healthcare corporations are“specified healthcare corporations” which, based on theSpecial Taxations Measures Law, are approved by theminister of finance as a corporation which meets
certain conditions, including operating a business
which has a high level of public interest, and/or which
is publicly managed. Also included among healthcare
corporations are “special healthcare corporations”
which, based on the Special Taxations Measures Law,
are approved by the prefectural governor for meetingthe same conditions. Special healthcare corporations
receive corporation tax rate reductions. And special
healthcare corporations are allowed to operate certain
types of business for profit.
(5) Evaluation of Medical Practice
Against a backdrop of increased popularawareness for healthcare and rising concern among
affiliates for the quality of healthcare, the Project for
the Evaluation of Hospitals by a Third Party was
carried into effect in 1997.
Through this evaluation project, the quality ofdiagnosis and treatment, nursing, and other careprovided by a medical institution, patient satisfaction
and the situation of management are evaluated by theJapan Council for Quality Health Care, as a third
party from a neutral standpoint, based on a requestfrom the hospital. If the results of the evaluation are ofa certain standard or above, a certificate of approval isissued to the hospital. Although hospitals are notrequired to undergo this evaluation, 725 hospitals hadreceived a certificate of approval as of August 2002.
From the viewpoint of improving the quality ofhealthcare, progress can be expected from theevaluation of medical practice by a third party. But inorder to promote this trend hospitals are now allowed
to publicize the results of their healthcare evaluation.
And through revisions of healthcare fees in 2002, theinclusion of palliative care has become a condition for
approval by the Japan Council for Quality Health Careand for ISO certification.

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5. Healthcare Insurance Coverage(1) Classification of Coverage① Employee’s InsuranceA) Beneficiaries and Insurers
Depending on the beneficiaries to whom thecoverage applies, types of healthcare insurance areroughly divided into employee’s insurance (occupation
insurance) for employees and their families, andNational Health Insurance (regional insurance) for
people engaged in the agriculture and fishingindustries and individual proprietors.
And depending on the difference in beneficiaries,
employee’s insurance is divided into health insurance(union-managed
healthinsurance
andgovernment-managed health insurance), seaman’s
insurance and insurance for the different kinds ofmutual aid unions. Health insurance coverage forgeneral employees is the biggest, accounting for
approximately 55% of all subscribers. Under thesystem of health insurance coverage, offices of thenational government, corporate offices (including
offices), and private offices engaged in certain types ofbusiness which regularly employ five or more people
are offices of compulsive application, and all employees
who work at those offices are compulsion application
insurants. Nearly all types of businesses are deemedbusinesses to which this insurance applies. Classifying
health insurance coverage from the point of view of
insurers, this insurance can be divided into
government-managed health insurance that is
managed directly by the government, andunion-managed health insurance that is managed by ahealth insurance union established individually or
jointly by the owner or owners of the business.

Union-managed Health Insurance

Health insurance unions are public corporations
not affiliated with the government, and are
established individually or jointly by the owner orowners of businesses which employee 300 people ormore per one or two or more places of business.
(Actually an individual union has 700 or more people,
while an integrate union has 3,000 or more people – inorder to secure its ability to diffuse risk.) Healthinsurance unions are made up of business owners,
employees of places of businesses who have employee’s
insurance, and people who have arbitrary insurance.
Health insurance unions manage the union members
who are insured and the heath insurance itself. Since acertain number of subscribers are needed to establish
a health insurance union because of the necessity todiffuse risk, union-managed insurance is mainly forpeople who are insured through large corporations.
The number of health insurance unions at the end of
March 2001 was 1,756.

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Government-managed Health Insurance

The government manages the health insurance ofpeople with insurance that is not managed by a union.
Government-managed health insurance is mainly for
employees of small and medium-sized businesses who
have insurance.

Other Types of Employee’s Insurance

The mutual aid union is a system of healthcare
insurance coverage that was established for special
occupations to serve people with seaman’s insurance
and civil servants.
People insured under the system of seaman’s
insurance include captains and crewmembers ofvessels which meet certain requirements. This type of
insurance, which is managed by the government,
accounts for 0.2% of all subscribers (as of the end of
March 2000).

Mutual aid unions provide coverage for workers inspecific occupations, including civil servants. This
coverage is divided according to specific occupation.
Currently there are three types of mutual aid unions.
These are mutual aid unions for employees of thenational government, mutual aid unions for employees
of local governments, and mutual aid unions for
personnel of private schools. Mutual aid unions
account for 7.9% of all subscribers (as of the end of
March 2000).

rest of the healthcare cost is paid by the insurer to the
medical institution as a benefit in kind. When an
insurant cannot receive a benefit in kind – for example,
in a circumstance when he or she has had no choice
but to receive medical treatment overseas – theinsurant pays the entire medical bill and is later
reimbursed for that amount by the insurer. Cashbenefits include cash benefits for sickness andmaternity benefit money as compensation for taking
off from work, transportation expenses as a benefit forcompensation of actual expenses, lump-sum payments
for childbirth and childcare, and funeral costs.
Childbirth expenses are not only paid as healthcare
benefits, but also as cash benefits in lump-sum
payments for childbirth and childcare.

Benefit Rate

The benefit rate for healthcare benefits is 80% for
the insurant, 80% if a family member is hospitalized,
and 70% for outpatient treatment. However, after
April 2003, all of these will be 70%, with 30% as a
co-payment. (The benefit rate for infants under three
years old is 80%.)
For union-managed health insurance, in order toreduce the co-payment of insurants, authorization has
been granted by the Ministry of Health, Labor andWelfare to arbitrarily apply fringe benefits beyond thebenefits stipulated by law, according to the financial
situation of each individual union.

Responsibility for Pharmaceutical Expenses

B) Benefits

Details of Benefits

Healthcare insurance is a system of coverageagainst financial loss, including that resulting from
illness, injury, death and birth, and is provided for the
purpose of treating ailments. The scope of theseinsurance benefits is stipulated to include medical
examinations, medicine and materials used in medical
treatment, medical treatment such as surgery andother procedures, the management of the recuperationof patients at home as well as nursing and other formsof care required for that recuperation, and admittanceto a hospital or clinic as well as nursing and otherforms of care required for recuperation. There is notime limit involved. Employee’s insurance is provided
not only to the employee who has the insurance, butalso to a specified range of nonworking dependents.
Benefits are broadly divided into healthcare
benefits and cash benefits. Healthcare benefits are thehealthcare services provided through healthcare
insurance. In Japan a person with insurance receives
healthcare services at a medical institution designatedby the Ministry of Health, Labor and Welfare as aninsurance medical institution. As a general rule, that
insurant only needs to pay a co-payment, while theIf a patient who regularly goes to a medical
institution receives medication, he or she pays aportion of that cost as a co-payment, based on the typeand quantity of the medication. However, after April
2003 there will be no co-payment.

Meals During Hospitalization

Regarding the cost of meals during hospitalization,
for all forms of coverage the patient pays a standard
amount determined by the cost of food for the average
household (780 yen per day; and for people with low
income 650 yen per day for the first three months of
hospitalization, and 500 yen per day after fourmonths), and the rest is paid through the healthcare
insurance as meal recuperation expenses duringhospitalization.

High Medical and Recuperation Cost Coverage

Furthermore, in order to ease the effect of highhealthcare costs on household finances, all types of
insurance coverage have incorporated a system
whereby if a patient’s co-payment exceeds a certain
amount, he or she is afterwards reimbursed for theexcessive amount through health insurance coverage.
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(healthcare costs – 361,500 yen) x 1%. However, theamount is determined by a person’s income.
Based on the reimbursement afterwards for highmedical and recuperations cost, the effective benefit
rate is 80.2% for union-managed insurance, and 78.8%
for government-managed insurance.

Specific Recuperation Cost

It is prohibited for healthcare service which
exceeds the level provided for by the medical
treatment fee point table to be claimed by being added
to the usual co-payment, or to combine insured
diagnosis and treatment with diagnosis and treatment
outside the realm of insurance coverage and collectfrom the patient the cost of the diagnosis andtreatment outside the realm of insurance coverage(principle of the prohibition of combined diagnosis andtreatment). In other words, for diagnosis andtreatment, or for the administering of medicine, which
are not covered by healthcare insurance benefits – thatis to say, those which are not listed in the medical
treatment fee point table or among the standard prices
of medicine – all of the healthcare treatment regarding
the patient in question shifts from the object of theinsurance claim and becomes outside the realm of
insurance coverage, and the patient is responsible forthe entire amount. However, a system of specified
healthcare coverage has been adopted to address the
emergence of new technology and the diversification ofpatients’ needs, against a backdrop of remarkableadvances in medical technology in recent years. Amongthe costs for lifestyle service and having a pleasantenvironment (amenities) (for example, special costs forprivate rooms, and services including special dental
materials such as gold teeth), and the healthcare costs
accompanying advancements in technology andresearch and development, the costs for normal service
and healthcare are paid for through healthcare
insurance as specific recuperation costs, with othercosts being outside the realm of insurance coverage.
C) Fiscal Resources
Insurance premiums and the national treasury
cover health insurance business costs.

Insurance Premiums

Insurance premiums are calculated by multiplying
the premium rate by the standard monthly salary(determined regularly once every year) paid to an
employee, and are collected monthly. Standard
monthly salaries are classified from Grade 1 (98,000yen) to Grade 39 (980,000), and each insurant falls
under one of those grades depending upon his or her
salary.

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Premium Rates for Union-managed Insurance

Premium rates for union-managed insurance aredetermined by the various health insurance unions,
within the range of 3.0% to 9.5%, with the approval of
the Ministry of Health, Labor and Welfare. The
average premium rate for all unions in March 2003
was 8.514%. As a general rule, the responsibility forthe payment premium is split between the employer
and the insurant. However, the maximum percentagethat the insurant can be responsible for is 4.5%, andthe amount that the employer are responsible for may
be increased to more than half of the premium amount.
As of March 2003, the average premium rate for allunions was 4.787% for business owners, and 3.727%
for insurants. The premium amount for which an
insurant is responsible is withheld by the employer
from the insurant’s pay, and the employer are
obligated to make the premium payment. The level ofpremium payment responsibility (fiscal 1998) is
159,000 yen for insurants (364,000 yen when theamount for which business owners are responsible foris included).

Premium Rates for Government-managed Insurance

Premiumrates
forgovernment-managed
insurances range from 6.6% to 9.1%, and can bechanged by the minister of health, labor and welfare
through deliberation of the Social Security Council. In
2001 the rate was 8.5%. The insurance premium issplit between the insurant and the employer. The levelof premium payment responsibility (fiscal 1998) is
152,000 yen for insurants (333,000 yen when theamount for which business owners are responsible foris included).

Special Insurance Premiums

Bonuses are normally paid in Japan. The
proportion of the bonus to total salary varies fromindividual to individual. In order to ensure fairness inpremium payment responsibility, a special insurance
premium is collected from the bonus, which is separate
from the monthly insurance premium. Healthinsurance unions can set the rate of premiums forunion-managed health insurance within the 1.0%
range and collect those premiums accordingly.
However, it is left up to the unions to decide whether tocollect the premiums. The rate for special insurance
premiums of government-managed health insurance is1%, and the responsibility of paying these premiums is
split between the employer and the insurants. The
insurants’ responsibility is exempted by 2/5, and thenational government pays the difference. After April
2003, a total salary system for levying insurance
premiums against bonuses as they are levied against
standard salary will be introduced.

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Responsibility of National Treasury

nursing and recuperation costs, high cost healthcare,lump-sum payments for childbirth and childcare,funeral costs, and transportation costs. In addition
there are arbitrary benefits in the form of cash benefits
for sickness and cash benefits for childbirth which may
be arbitrary according to municipal ordinances orunion regulations. Each of these types of insurance
benefits are similar in content too those of healthinsurance coverage.

For government-managed health insurance, in
addition to clerical expenses the national treasury is
also responsible for paying 13.0% of benefit costs, and16.4% of the health contributions for the elderly (to be
discussed later). The reason that union-managed
health insurance is so generously subsidized at public
expense is because since the insurants are mainly
employees of small and medium-sized business theirsalary level is lower than that of employees of large
corporations. And so the relative burden of paying
their insurance premiums is eased by the nationaltreasury.

The rate of healthcare benefits is 70% (30% is the
responsibilityoftheinsurant).
Withthereimbursement that is received afterwards because ofhigh healthcare costs, the effective benefit rate is
78.4% for National Health Insurance throughmunicipalities.

Since union-managed health insurance is left to theautonomous management of health insurance unions,as a general rule the national treasury is not
responsible for making those payments, with the
exception of a portion of the clerical expenses. However,Blue Cross, which faces a stringent financial situation,
receives assistance for an extremely small fixedamount.

② National Health Insurance CoverageA) Beneficiaries and Insurers
National Health Insurance coverage is acompulsory system of healthcare insurance forindividual proprietors, people engaged in the
agriculture and fishing industries, and retirees who
are not eligible for employee’s insurance. It represents
the last opportunity for universal health insurance.
Even foreigners can receive this insurance as long as
they are registered as an alien and are expected to stayin Japan for a period of one year or longer.
Insurers of National Health Insurance are mainly
cities, towns and villages which are basicmunicipalities, of which there are 3,242 nationwide.
They cover 33.4% of all subscribers. In addition to thisare National Health Insurance unions, which are
made up of health insurance groups of individual
proprietors of the same industry. Currently, the main
professions and industries which have National
Health Insurance unions are physicians, dentists,
pharmacists, the food sales industry, the engineeringand construction industries, cosmetology, the bathing
industry, and lawyers. There are 166 of these unions
nationwide. These do not cover all individual
proprietors; and some of them cover the whole nation,
while others cover individual prefectures. These
unions account for 3.4% of all subscribers.
B) Benefits
There are benefits for recuperation costs. There
are also benefits required by law, including those formeals and recuperation costs during hospitalization,
specific recuperation costs, recuperation costs, at-homeC) Fiscal Resources

Insurance Premiums

The method and level of insurance premiums
differs from municipality to municipality, and aredetermined by individual ordinances and/or rules.
However, it is common among all municipalities tocollect premiums directly from insurants. There are
two types of systems of insurance premiums: one iscollected as a premium literally as a National Health
Insurance premium; the other is collected as a
National Health Insurance tax as a type of local tax.
Currently, many municipalities use the tax type ofsystem, but aside from the difference in their legal
characteristics, the calculation methods for both arebasically the same.
There are two types of National Health Insurance
premiums. One is the portion that an insurant is
responsible for paying, based on what he or she iscapable of paying (capable percentage), calculated as alevy standard on the amounts of his or her income andassets, which are determined based on the municipal
citizens tax levied by the municipality in which he or
she resides. The other is the portion that an insurant
is responsible for paying, based on the profit that he or
she earns (profit percentage), calculated by a fixedamount for each insurant or for his or her household,which is based on the amount of profit that theinsurant receives. As a general rule the ratio between
the capable percentage and the profit percentage isfifty-fifty.
However,inactuality,inmanymunicipalities the ratio accounted for by capable
percentage is higher. Individual premiums for each
insurant in a household are paid in one lump sum by
the head of that household, adding together thecapable percentage and the profit percentage of each
insurant. The responsibility level for insurance
premiums per household (fiscal 1998) was 154,000 yen
for National Health Insurance through municipalities.

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Since the premium imposed on low-income earners issometimes too burdensome, measures have been taken
to reduce the burden of those premiums. Those eligible
for these measures are households whose income of theprevious year was below the basic exemption
equivalent value, and households who fell below thebasic exemption equivalent value when a fixed amount
was deducted per insurant, excluding the head of thehousehold. In each case, the portion that an insurant is
responsible for paying, based on the profit that he or
she earns, is reduced to 60% and 40%, respectively.

Responsibility of National Treasury

The national treasury is responsible for paying
50% of health insurance contributions for elderly
people. In addition, the national government also pays
one half of the portion of reductions on insurance
premiums of low-income earners carried out bymunicipalities, with the remainder being the
responsibility of prefectures and municipalities.
Generally, many of the people with National Health
Insurance are low-income earners, and many of thosepeople are only capable of paying a small amount inpremiums. Also, since their employer is not
responsible for paying their premium as is the case forpeople with employee’s insurance, a sound means of
insurance financing is made possible throughassistance by the national government for high rates
and large amounts of money. In other words, in order
to assure fairness regarding the benefits andresponsibilities between types of coverage, the lower
the financial capability of the insurance system, thehigher the rate of assistance.
③ Healthcare Coverage for Retirees
Basically speaking, since elderly retirees subscribe
to National Health Insurance after retirement, thelevel of their benefits drops at a time when their needfor healthcare increases, and the burden of paying
those healthcare costs lies mainly with the nationaltreasury and other subscribers to National Health
Insurance. In order to correct this irrationality, asystem of healthcare coverage for retirees wasestablished in 1984.
The entities enforcing this system aremunicipalities, which are the insurers of National
Health Insurance. The beneficiaries are people whohave National Health Insurance (except for elderly
people who receive healthcare), elderly people who
receive pensions based on pensioners laws (for theright to receive a total pension for an elderly, theperson must have subscribed for 20 years or more; orfor people beyond the age of forty, for 10 years) andtheir nonworking dependents.

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The fiscal resources needed for this system of
insurance coverage are comprised of the premiums(tax) that retired insurants pay for National Health
Insurance, and recuperation benefit expense grants
covered by donations of insurers of employee’s
insurance. The amount of the recuperation benefit
expense grants is the amount remaining after
deducting the National Health Insurance premiums
for retirees who had employee’s insurance (tax) fromthe amount which is half of the costs required for
healthcare benefits for retirees who had employee’s
insurance and the contributions for the healthcare costfor the elderly who had employee’s insurance, and thisis delivered each year to municipalities from the Social
Insurance Medical Fee Payment Fund. The costs ofpaperwork regarding the healthcare of retirees for therecuperation benefit expense grants and the Social
Insurance Medical Fee Payment Fund are covered inpart by the recuperation benefit expense contributions
collected from insurers of employee’s insurance
through this fund, and by clerical work expense
contributions. For this, the amount that each insurer
must contribute is the amount of the total
contributions divided by the total of the standard
compensation amount paid by each insurer.
The healthcare benefit rate is 80% for retirees who had
employee’s
insurance.
For
their
nonworking
dependents, it is 70% for outpatient care, and 80% for
hospitalization. However, after April 2003, all of thesebenefit rates will be 70%.
④ Health Insurance Coverage for the Elderly
Under the Elderly Health Law, comprehensive
health-related business, including the prevention andtreatment of disease, and function training thereof, iscarried out to ensure sound health maintenance andadequate healthcare for Japanese citizens in their oldage, for the purpose of improving the health ofJapanese citizens and improving the welfare of theelderly. And based on the spirit of self-help and unity
among Japanese citizens, in addition to constantly
endeavoring to maintain and improve their health,with an awareness of the physical and mental changes
which accompany aging, and distributing the burdenof healthcare costs for the elderly fairly, the basic
philosophy of this law is to provide adequate healthservices to the elderly at the place of work, locally andat home, in accordance with one’s age, and mental andphysical condition, in order to maintain people’s healthin old age.
In addition to healthcare benefits, thehealth-related business based on this law includes thedelivery of health notebooks, health education, healthcounseling, health checkups, function training andat-home or on-site instruction, all of which are carriedout by municipalities.

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Municipalities are in charge of healthcare-related
matters for the elderly under the Elderly Health Law.
The beneficiaries of this healthcare for elderly
residents of the municipality in question are those whohave healthcare insurance, and who are 75 years ofage or older, or who are 65 years of age or older but
have been recognized by the mayor of the municipality
in question as being disabled (so-called bedridden) as
prescribed by government ordinance.
The healthcare benefits received are the same as
those received under the healthcare insurance laws,
and the costs charged for this healthcare are based on
medical fees for the elderly.
The responsibility for a portion of elderly patientshas been fixed since the establishment of the Elderly
Health Law in 1988, and the level of that
responsibility differs from the responsibility for a
portion of young patients, with a 20% or 30% portion of
the responsibility being set at fixed rates lower thanthose for young people who require it.
The amount has been raised based on revisions to
the law, and a system has been introduced for revision
based on the rate of fluctuation of consumer prices
since 1995. Currently, while the ability of elderly
people to pay for healthcare costs has increased due tomaturation of pensions, the sense of responsibility forthis payment has increased among young people. An
appropriate relationship of responsibility that takes
root in the unity between generations is a precondition
for maintaining Japanese Social Security in the future.
For this reason, rather than the uniform assumptionthat the elderly are weak, the idea is becoming moreprevalent that elderly people should be responsible forthe portion of their healthcare costs that is suited totheir financial ability.
With the reforms in the healthcare insurance
system in 2000 came the idea that elderly people
should be responsible for a suitable portion of theirhealthcare costs, and revisions were made to change
the fixed 10% rate of responsibility for a portion ofpatients who had thus far been paying a fixed amount.
However, so that the responsibility of elderly people
would not increase to an excessive amount, amaximum monthly amount has been established, withpreferential measures being established for physicians
running their own practices to allow them to choose
the system of fixed amount from the viewpoint of therequired paperwork load.
Furthermore, with the reforms in the healthcare
insurance system in 2002, the age of elderly people
eligible for this healthcare increased from those 70
years of age or older to those who are age 75 or older,
for a gradual increase in the rate of the public expenseload from 30% to 50% over a 5-year period. Also, thepercentage for which the patient himself or herself isgenerally responsibility was increased to 10% (20% for
people whose income exceeds a certain amount).
However, starting from the age of 70 patients are
generally responsible for paying the same 10% as
patients who are age 75 or older.
Thirty percent (to gradually increase to 50% overthe 5-year period starting in January 2002) of fiscal
resources for the necessary benefit costs for healthcare
for the elderly are covered at public expense, with thenational government responsible for 2/3, prefectures
for 1/6 and municipalities for 1/6. The remaining 70%
is donated by insurers of government-managed healthinsurance, union-managed health insurance andNational Health Insurance through municipalities. In
addition to the above-mentioned portion paid for at
public expense, the donated funds are theresponsibility of the national treasury, with 16.4% forgovernment-managed health insurance and 50% for
National Health Insurance through municipalities.
This results in tax fiscal resources of about 50% of
benefit costs for healthcare for the elderly, when the
30% which is paid for at public expense is combinedwith the donations from the national treasury.
(2) Healthcare Covered at Public Expense
Healthcare covered at public expense is a system ofcoverage by which the national government or local
authorities compensate patients for the cost of medical
treatment and/or other healthcare expenses, using
taxes as a fiscal resource. In healthcare covered at
public expense, for diseases which require treatment
from the point of view of the national government,
including tuberculosis, mental disease and legal
communicable diseases, patients are compensated forthe cost of medical treatment, while economicallyand/or socially-disadvantaged people, including
low-income earners, the physically disabled, elderly
people, children, people wounded in war, andatom-bomb survivors, are compensated for all or a
portion of their healthcare expenses.
Some healthcare covered at public expense
includes healthcare costs for which the priority of the
responsibility is with the public expense andhealthcare costs for which the priority is withhealthcare insurance. All or a substantial amount ofhealthcare costs for which the priority of the
responsibility is with public expense is covered by thenational government or local authorities, with theremaining portion being applied to insurance. The
remainder of the insurance benefits (the portion forwhich the patient is responsible) or a certain amountof healthcare costs for which the priority is withhealthcare insurance is covered at public expense.

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(3) Nursing Insurance System
In the past there were two different types ofcoverage – welfare for the elderly and healthcare forthe elderly. But there were disproportions in the usage
procedures and the responsibility of users, andproblems occurred in the provision of service based on
government measures for welfare for the elderly. In
addition to restructuring both types of coverage, asystem of nursing insurance was established in April
2000 as a system of social health insurance which
would allow users to use the service that they
themselves chose.
Under the nursing insurance system, the insurers
are municipalities, with the national government,
prefectures, healthcare insurers, and pension insurers
providing important support. The insurants are
divided into two categories: first insurants, who are
age 65 or older, and second insurants, who arehealthcare insurance subscribers between the ages of
40 and 64. The benefit rights and responsibility forpaying premiums differ between the two categories.
Benefits from nursing insurance are provided for a
first insurant if it is determined that he or she requires
nursing or another form of support. Benefits fromnursing insurance are provided for a second insurant if
it is determined that he or she is bedridden with a
specific disease, as stipulated by the Nursing
Insurance Law, or otherwise requires nursing or
another form of support.
To obtain these insurance benefits an elderly
person who is determined to require nursing or amember of his or her family applies with themunicipality for these benefits, and that person mightthen be recognized as requiring these benefits by thenursing recognition examination committee of thatmunicipality. Those committees are made up of people
with academic backgrounds in health insurance,
healthcare or welfare. The committee findings are
based on results from a computer based on an
examination of the physical and mental condition of
the elderly person (first judgment), and a written
report by the physician in charge. Then, after theapplicant is notified by the municipality of the resultsof recognition for the requirement of nursing, if he or
she has any objections to those results, that person
may challenge those results with the prefectural
government or the nursing insurance examinationcommittee.
After being recognized as requiring nursing, if thenursing is to be provided at the patient’s home, thepatient or his or her family member may then submit arequest to a company that provides at-home nursing
care for a care plan to be drawn up, taking into
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consideration the recognized degree of nursing
required, the wishes of the patient and the situation of
his or her family. If the nursing care is to be provided
at a nursing facility, the facility will draw up the care
plan.
Service provided to patients who require care athome include home help service and day service. Oneof these types of service are then provided based on thecare plan, with the user responsible for paying 10% of
the cost. It is the same for nursing care provided at anursing facility, with the patient responsible for paying
10% of the cost all services provided, with the
exception of meals. If the user desires special services
which he or she has chosen, these services may beprovided if the user pays the entire cost of the services.
Fifty percent of the cost of the required nursing
benefits is covered by the public expense, with the
exception of that portion which is the responsibility of
the user at the time that the service is rendered. The
breakdown is that national government pays 25% of
the total, with the prefecture or municipality paying
for 12.5%. The 50% of the cost other than the portion
covered at public expense is covered by the insurance
premiums paid by the insurant. The breakdown
between 2000 and 2002 was 17% for first insurants
and 33% for second insurants.
Insurance premiums for first insurants are
determined for each municipality in accordance withincome level. People whose pension exceeds a certain
amount have the premium deducted from theirpension. All others pay the municipality on their own.
Insurance premiums for second insurants are
determined based on the method of calculation of thehealthcare insurance to which they subscribe. The
healthcare insurer collects these premiums in
one-lump payments with the healthcare insurance.
(4) Financial Conditions of Healthcare Insurers
Financial conditions of the systems of healthcare
insurance have shown deficits across the board.
Taking a look at the closing of accounts ofgovernment-managed healthcare insurance, net losses
have appeared continuously since 1995, with losses of
316.3 billion yen in fiscal 1999. If things continue as
they are, it is believed that the 803.9 billion yen
reserve fund from the end of fiscal 1999 will bottom out
in fiscal 2002.
Union-managed healthcare insurance has
also recorded total losses of 203.3 billion yen (forecast
for the end of fiscal 1999), with the total number ofunions showing losses at approximately 70%. With thisincrease in the number of unions showing losses,
insurance premiums of healthcare insurance unions

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are at an average of 8.51%, which is higher than the
8.5% for government-managed healthcare insurance.
There has also been an increase in the number ofunions which have been dissolved.
The difference between revenues and expenditures infiscal 1999 for National Healthcare Insurance throughmunicipalities showed an overall loss of 119 billion yen.
Amid this worsening financial situation, withindividual insurers which are municipalities showing
losses of an approximate 61%, many municipalities arecarrying over their fiscal resources for deficit financing
from general accounting to special accounting for
National Healthcare Insurance.
6. Medical Treatment Fee System(1) Mechanism of Health Insurance Treatment
A distinguishing feature of the Japanese healthinsurance system is that rather than the insurer
concluding a contract directly with the medical
institution, the medical institution is specified by thesecretary-general of the local social insurance based on
an application by the medical institution.
The specified medical institution is obligated toprovide the insurant with recuperation benefits,
including medical treatment, as a health insurance
medical institution, with the medical fees being paidby the insurer to the health insurance medical
institution through an examination payment
organization as the cost of the examination.
When receiving medical treatment, insurants pay
the portion of the cost for which they are responsible atthe payment desk of the health insurance institution.
What’s more, not only the medical institution but thephysician who is actually in charge of the recuperationmust be registered with the secretary-general of thelocal social insurance as a health insurance physician(double specified system of health insurance
treatment). Accordingly, when receiving healthinsurance treatment, insurants must go to thespecified insurance medical institution and receive
this treatment by a registered health insurancephysician.
Presently, this applies to almost all medical
institutions in Japan.
Although all of the medical treatment activities forthe same patient are performed by the same medical
institution, the reason that insurance medical
treatment is specified as double is because all of the
medical treatment is administered to the patient by
the physician, and based on this, that physician must
personally decide what medication, injections ortreatment to administer, and bear the responsibility
thereof.

(2) Summary of Medical Treatment Fee System
As the cost of recuperation benefits provided byinsurance medical institutions, the specified amountthat must be paid to the healthcare institution is the
medical treatment fee – and the amount remaining
after subtracting (from the total medical treatmentfee) the portion which is the responsibility of thepatient is paid to the healthcare institution. The
medical treatment fee is made up of those diagnostic
fees specified in detail, including those for
examinations,administereddrugs,
injections,
treatment, surgery and tests, as well as the basic fees
for hospitalization. The medical treatment fee isrevised just about every two years. The medical
treatment fee is indicated in points, with 1 point
equaling about 10 yen.
Or the medical treatment fee is determined whenthe minister of health, labor and welfare asks theCentral Social Insurance Medical Council* for its
views.
In the guaranteed healthcare of Japan, as a
general rule healthcare services provided for the
purpose of curing disease are not for the cost ofhealthcare, but rather they are provided as a benefit to
the insurant as healthcare services for direct diagnosis
and treatment, under the principal of benefit in kind.
However, aside for some exceptions, there are twosystems of coverage: the system by which therecuperation costs are paid in cash afterwards, and thesystem of cash benefits.
The Social Insurance Medical Fee Payment Fundand the National Health Insurance Federation, after
received payment consignment, pay medical fees to theinsurance medical institutions for the value of
healthcare treatment provided. The amount iscalculated by the physician’s medical treatment fee
point table for physicians, the dentist’s medical
treatment fee point table for dentists, and thepharmaceutical fee point table for pharmacies. These
point tables are characterized as unit price tables fordiagnoses, used to evaluate diagnoses.
Medical fees are revised as part of the Survey in
Economic Conditions on Health Care which is
conducted once every two years. This revision is madeto ensure sound medical business management overall,heeding the deliberation of the Central Social
Insurance Medical Council, and giving overall
consideration to trends in prices and wages, advancesin medical science and healthcare, and the various
situations surrounding medical treatment, including
the financial situation of insurers.

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* Central Social Insurance Medical Council: This council is made up of people involved in diagnosis andtreatment (8 committee members representing physicians, dentists and pharmacists), people involved in
payment (8 committee members representing insurers of health insurance, seaman’s insurance, and National
Health Insurance, as well as business owners and ship owners), and people representing the public interest (4committee members representing the public interest). Appointment of committee members representing the
public interest must be approved by both Houses of the National Diet.

Sources
1) Trends in National Hygiene (edited by the Health and Welfare Statistics Association, 2003)
2) White Papers on Public Welfare and Labor, 2003 edition (supervised by the Ministry of Health, Labor andWelfare); Gyosei, 2003
3) White Papers on Healthcare, 2003 edition (supervised by the Medical Treatment Economic Research
Organization); planned by the Japan Medical Treatment Project, 2003
4) White Papers on Medical Business (edited by the Editorial Committee of Medical Business); planned by theJapan Medical Treatment Project, 2003
5) Introduction of Social Security 2004 (edited by the Editorial Committee of Introductive Social Security);
Chuohoki Publishers, 2004
6) Problems and Perspectives for Reform of Medicare System (edited by the Office of Reform of Elderly Medicare
System, the Ministry of Health, Labor and Welfare); Gyosei, 2001
7) Introduction of Medical Insurance and National Health Insurance Drug Price System (edited by the ResearchCommittee for NHI Price System, Association of Tokyo Medical Products Manufacturing Industry); Tokyo
Medical Products Manufacturing Company, 2001

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APPENDIX – Composition and Indications of 148 Prescriptions
1. Aconite and Ginseng Decoction
附子人参湯Fu-zi-Ren-Shen-Tangbushininjinto
Composition
Ginseng 3.0g
Licorice root 3.0g
Atractylodes ovatae rhizoma 3.0g
Steamed and dried ginger 3.0g
Prepared aconite root 1.0g
2. Angelica and Peony Powder
当帰芍薬散Dang-Gui-Shao-Yao-San
tokishakuyakusan
Composition
Japanese angelica root 3.0g
Cnidium rhizoma 3.0g
White peony root 4.0-6.0g
Tuckahoe 4.0g
Atractylodes ovatae rhizoma 4.0g
Arisma rhizoma 4.0-5.0g

Indications
1. Acute enteritis (diarrhea)
2. Acute gastritis
3. Irritable bowel syndrome
4. Intercostal neuralgia

Indications
1. Irregular menstruation
2. Dysmenorrhea
3. Endometriosis
4. Menopausal disorder
5. Sterility,
6. Infertility (prevention of miscarriage)
7. Alzheimer disease
8. Vascular dementia
9. Hiesho*

3. Angelica and Peony Powder plus Aconite
当帰芍薬加附子湯Dang-Gui-Shao-Yao-Ja- Hu-Zi-San
tokishigyakukabushito
Composition
Indications
Japanese angelica root 3.0g
1. Dysmenorrhea
Cnidium rhizoma 3.0g
2. Endometriosis
White peony root 6.0g
3. Irregular menstruation
Tuckahoe 4.5g
4. Sterility
Atractylodes ovatae rhizoma 4.5g
5. Menopausal disorder
Arisma rhizoma 3.5g
6. Hiesho*
Prepared aconite root 1.0g
4. Angelica Decoction
当帰湯Dang-Gui-TangtokitoComposition
Japanese angelica root 4-5g
Pinellia tuber 4-5g
White peony root 3-4g
Magnolia bark 2.5-3g
Cassia twig 2.5-3g
Ginseng 2.5-3g
Steamed and dried ginger 1.5g
Astragalus root 1.5g
Zanthoxylum fruit 1.5g
Licorice root 1.0g

Indications
1. Irritable bowel syndrome
2. Angina pectoris

5. Angelica Middle-Strengthening Decoction
当帰建中湯Dang-Gui-Jian-Zhong-Tangtokikenchuto
Composition
Indications
Japanese angelica root 4.0g
1. Dysmenorrhea
Cassia twig 4.0g
2. Hemorrhoids
Dried ginger 4.0g
3. Anemia
Chinese date 4.0g
White peony root 5-6g
Licorice root 2.0g
Malt sugar 20.0g
6. Angelica Decoction, Antipruritus
当帰飲子
Dang-Gui-Yin-Zi
tokiinshi
Composition
Japanese angelica root 5.0g
White peony root 3.0g
Cnidium rhizoma 3.0g
Puncturevine caltrop fruit 3.0g
Divaricate saposhnikovia root 3.0g
Dried rehmannia root 4.0g
Fineleaf schizonepeta herb 1.5g
Astragalus root 1.5g
Fleeceflower root 2.0g
Licorice root 1.0g

Indications
1. Pruritus
2. Chronic eczema
3. Atopic dermatitis

7. Antiphlogictic Decoction with Ten Herbs
十味敗毒湯
Shi-Wei-Bai-Du-Tangjumihaidokuto
Composition
Indications
Bupleurum root 2.0-3.0g
1. Seborrheic dermatitis and dandruff
Pruni jamasakura bark 2.0-3-0g
2. Pyoderma, folloculitis, furunculosis
or Quercus bark 2.0-3.0g
Balloonflower root 2.0-3.0g
3. Atopic dermatitis, eczema
Cnidium rhizoma 2.0-3.0g
4. Urticaria
Tuckahoe 2.0-4.0g
5. Pulmoplantar pustolosis
Double-teeth pulbescent angelica
root 1.5-3.0g
Divaricate saposhnikovia root 1.5-3.0g 6. Rosacea
Licorice root 1.0-1.5g
7. AcneDried ginger 1.0g
Fineleaf schizonepeta herb 1.0-1.5g
Forsythia capsule 2.0-3.0g
8. Areca Seed Decoction with Nine Herbs
九味檳榔湯
Jiu-Wei-Bing-Lang-Tangkumibinroto
Composition
Indications
Areca seed 4.0g
1. Irritable bowel syndrome
Magnolia bark 3.0g
2. Subileus
Cinnamon bark 3.0g
3. Congestive heart failure
Mandarine orange peel 3.0g
4. Beriberi
Perilla leaf 1.5g
Licorice root 1.0g
Rhubarb 1.0g
Dried ginger 1.0g
Aucklandia root 1.0g
Medicinal evodia root 1.0g
Tuckahoe 3.0g

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9. Astragalus Middle-Strengthening Decoction
黄耆建中湯Huang-Qi-Jian-Zhong-Tang
ogikenchuto
Composition
Indications
Cassia twig 3-4g
1. Decubitus
Dried ginger 3-4g
2. Urticaria
Chinese date 3-4g
3. Atopic dermatitis
White peony root 6.0g
4. Suppurations of skin
Licorice root 2-3g
5. Night sweat
Astragalus root 3-4g
6. Anal fistula
Malt sugar 20.0g
7. Weak constitution
10. “B” Character Decoction
乙字湯Yi-Zi-Tangotsujito
Composition
Japanese angelica root 4.0-6.0g
Bupleurum root 4.0-6.0g
Scutellaria root 3.0g
Licorice root 2.0-3.0g
Cimicifuga rhizoma 1.0-2.0g
Rhubarb 0.5-1.5g
11. Back to the Spleen Decoction
帰脾湯
Gui-Pi-TangkihitoComposition
Ginseng 2-3g
Atractylodes ovatae rhizoma 2-3g
Tuckahoe 2-3g
Astragalus root 2-3g
Japanese angelica root 2.0g
Thinleaf milkwort root 1-2g
Licorice root 1.0g
Aucklandia root 1.0g
Chinese date 1-2g
Dried ginger 1-1.5g
Wild jujube seed 2-3g
Longan aril 2-3g

Indications
1. Hemorrhoids
2. Anogenital pruritus

Indications
1. Stasis, depressed state
2. Insomnia
3. Anxiety disorder
4. Disfunctional uterine bleeding
5. ITP
6. Anemia

12. Balloon Flower Root and Gypsum
桔梗石膏
Jie-Geng-Shi-Gao
kikyosekko
Composition
Indications
Balloonflower root 3.0g
Gypsum 10.0g
It adds for the effect reinforcement
due to the inflammation andsuppuration disease.
13. Balloon Flower Root Decoction
桔梗湯Jie-Gebg-TangkikyotoComposition
Balloonflower root 2.0g
Licorice root 1.0-3.0g

86

Indications
1. Peritonsillitis

14. Bamboo Shavings Gallbladder-Warming Decoction
竹茹温胆湯
Zhu-Ru-Wen-Dan-TangchikujountantoComposition
Indications
Bupleurum root 3-5g
1. Bronchitis
Bamboo shavings 3.0g
2. Pneumonia
Tuckahoe 3.0g
3. Insomnia
Dwarf lilyturf root 3-4g
Dried ginger 3.0g
Pinellia Tuber 3-5g
Nutgrass galingale rhizoma 2.0g
Balloonflower root 2-3g
Tangerine peel 2-3g
Immature bitter orange 1-2g
Coptis rhizoma 1-2g
Licorice root 1.0g
Ginseng 1-2g
15. Bupleurum and Cassia Twig Decoction
柴胡桂枝湯Chai-Hu-Gui-Zhi-Tangsaikokeishito
Composition
Indications
Bupleurum root 5.0g
1. Common cold
Pinellia tuber 4.0g
2. Bronchitis
Scutellaria root 2.0g
3. Dyspepsia, chronic gastritis
Licorice root 1.5-2g
4. Gastroduodenal ulcer
Cinnamon bark 2-3g
5. Irritable bowel syndrome
White peony root 2-3g
6. Cholelithiasis
Chinese date 2.0g
7. Chronic hepatitis
Ginseng 2.0g
8. Anxiety disorder
Dried ginger 1.0g
9. Epilepsy
16. Bupleurum Cassia Twig and Dried Ginger Decoction
柴胡桂枝乾姜湯Chai-Hu-Gui-Zhi-Gan-Jiang-Tangsaikokeishikankyoto
Composition
Indications
Bupleurum root 5-6g
1. Common cold
Cinnamon bark 3.0g
2. Bronchitis
Scutellaria root 3.0g
3. Anxiety disorder
Oyster shell 3.0g
4. Insomnia
Licorice root 2.0g
5. Chronic hepatitis
Snakegourd fruit 3-4g
6. Arrhythmia
Steamed and dried ginger 2.0g
7. Chronic purulent inflammation
17. Bupleurum Liver-Clearing Decoction
柴胡清肝湯
Chai-Hu-Qing-Gan-Tangsaikoseikanto
Composition
Indications
Bupleurum root 2.0g
1. Atopic dermatitis, eczema
Japanese angelica root 1.5g
2. Acute and chronic tonsillitis
White peony root 1.5g
Cnidium rhizoma 1.5g
Dried rehmannia root 1.5g
Coptis rhizoma 1.5g
Scutellaria root 1.5g
Chinese corktree bark 1.5g
Cape jasmine fruit 1.5g
Forsythia capsule 1.5g
Balloonflower root 1.5g
Arctium fruit 1.5g
Snakegourd fruit 1.5g
Wild mint 1.5g
Licorice root 1.5g

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Volume 1, Special Edition | Current Kampo Medicine 2005
18. Bupleurum plus Dragon's Bone and Oyster Shell Decoction
柴胡加竜骨牡蛎湯Chai-Hu-Jia-Long-Gu-Mu-Li-tang
saikokaryukotsuboreito
Composition
Indications
Bupleurum root 4-5g
1. Anxiety disorder, panic disorder
Pinellia tuber 4.0g
2. Insomnia
Tuckahoe 2-3g
3. Hypertension
Cinnamon bark 2-3g
4. Menopausal syndrome
Chinese date 2-2.5g
5. Arrhythmia
Ginseng 2-2.5g
6. Hyperthyroidism
Oyster shell 2-2.5g
7. Conversion disorder
Dried ginger 2-3g
Scutellaria root 2.5g
Rhubarb 1.0g
Dragon's bone 2-2.5g
19. Cape Jasmine and Corktree Bark Decoction
梔子柏皮湯
Zhi-Zi-Bai-Pi-Tangshishihakuhito
Composition
Indications
Cape jasmine fruit 3.0g
1. Atopic dermatitis
Licorice root 1.0g
2. Acute and chronic hepatitis
Chinese corktree bark 2.0g
20. Capillary Wormwood Decoction
茵蔯蒿湯
Yin-Chen-Hao-Tanginchinkoto
Composition
Rhubarb 0.8-2g
Cape jasmine fruit 2-3g
Capillary wormwood herb 4-6g

Indications
1. Acute and chronic hepatitis
2. Urticaria
3. Cholecystitis・cholelithiasis

21. Capillary Wormwood plus Poria Powder with Five Herbs
茵蔯五苓散
Yin-Chen-Wu-Ling-san
inchingoreisan
Composition
Indications
Arisma rhizoma 4.5-6g
1. Acute and chronic hepatitis
Swordlike atractylodes rhizoma 3-4.5g 2. Liver cirrhosis with ascites
Umbellate pore fungus 3-4.5g
3. Nephrotic syndrome
Tuckahoe 3-4.5g
Cinnamon bark 2-3g
Capillary wormwood herb 3-4g
22. Cassia Twig and Tuckahoe Pill
桂枝茯苓丸Gui-Zhi-Fu-Ling-Wan
keishibukuryogan
Composition
Cinnamon bark 4.0g
Tuckahoe 4.0g
Tree peony bark 4.0g
Peach kernel 4.0g
White peony root 4.0g

Indications
1. Dysmenorrhea
2. Endometriosis
3. Disfunctional uterine bleeding
4. Irregular menstruation
5. Leiomyoma of the uterus
6. Menopausal syndrome
7. Sterility
8. Low back pain
9. Hemorrhoids

23. Cassia Twig and Tuckahoe Pill plus Coix Seed桂枝茯苓丸料加薏苡仁
Gui-Zhi-Fu-Ling-Wan-Liao-Jia-Yi-Yi-Ren
keishibukuryoganryokayokuinin
Composition
Indications
Cassia twig 4.0g
1. AcneTuckahoe 4.0g
2. Spot
Tree peony bark 4.0g
3. Hand and finger dermatitis
Peach kernel 4.0g
White peony root 4.0g
Coix seed 10.0-20.0g
24. Cassia Twig Decoction plus Atractylodes and Aconite
桂枝加朮附湯Gui-Zhi-Jia-Shu-Fu-Tangkeishikajutsubuto
Composition
Indications
Cinnamon bark 4.0g
1. Rheumatoid arthritis
White peony root 4.0g
2. Neuralgia
Chinese date 4.0g
3. Neck pain
Dried ginger 1.0g
4. Low back pain
Licorice root 2.0g
5. Sinusitis
Atractylodes ovatae rhizoma 4.0g
6. Sequela of cerebrovascular disorder
Prepared aconite root 0.5-1g
25. Cassia Twig Decoction plus Peony
桂枝加芍薬湯Gui-Zhi-Jia-Shao-Yao-Tangkeishikashakuyakuto
Composition
Indications
Cinnamon bark 4.0g
1. Irritable bowel syndrome
White peony root 6.0g
2. Constipation
Chinese date 4.0g
3. Ulcerative colitis
Dried ginger 1.0g
4. Dyspepsia
Licorice root 2.0g
5. Abdominal pain
6. Urge urinary incontinence
26. Cassia Twig Decoction plus Peony and Rhubarb
桂枝加芍薬大黄湯
Gui-Zhi-Jia-Shao-Yao-Da-Huang-Tangkeishikashakuyakudaioto
Composition
Indications
Cinnamon bark 4.0g
1. Constipation
White peony root 6.0g
2. Irritable bowel syndrome
Chinese date 4.0g
3. Ulcerative colitis
Dried ginger 1.0-2.0g
Licorice root 2.0g
Rhubarb 1.0-2.0g
27. Cassia Twig Decoction plus Pueraria
桂枝加葛根湯Gui-Zhi-Jia-Ge-Gen-Tangkeishikakakkonto
Composition
Indications
Cinnamon bark 3.0-4.0g
1. Common cold
White peony root 3.0-4.0g
2. Influenza
Chinese date 3.0-4.0g
Dried ginger 1.0g
Licorice root 2.0g
Pueraria root 6.0g

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28. Cassia Twig Decoction plus Tuckahoe, Atractylodes and Aconite
桂枝加苓朮附湯Gui-Zhi-Jia-Ling-Shu-Fu-Tangkeishikaryojutsubuto
Composition
Indications
Cinnamon bark 4.0g
1. Rheumatoid arthritis
White peony root 4.0g
2. Neuralgia
Chinese date 4.0g
3. Neck pain
Dried ginger 1.0g
4. Low back pain
Licorice root 2.0g
5. Sinusitis
Tuckahoe 4.0g
6. Sequela of cerebrovascular disorder
Atractylodes ovatae rhizoma 4.0g
Aconite root 0.5-1.0g

33. Cassia Twig plus Magnolia and Apricot Decoction
桂枝加厚朴杏仁湯
Gui-Zhi-Jia-Hou-Pu-Xing-Ren-Tangkeishikakobokukyoninto
Composition
Indications
Cassia twig 3-4g
1. Common cold
White peony root 3-4g
2. Bronchitis
Chinese date 3-4g
3. Athma
Dried ginger 3-4g
Licorice root 2.0g
Magnolia bark 1-4g
Bitter apricot kernel 3-4g

29. Cassia Twig Peony, and Anemarrhena Decoction
桂芍知母湯Gui-Shao-Yao-Zhi-Mu-Tangkeishakuchimoto
Composition
Indications
Cinnamon bark 3.0g
1. Rheumatoid arthritis
Common anemarrhena rhizoma 3.0g 2. Arthropathy
Divaricate saposhnikovia root 3.0g 3. Neuralgia
Dried ginger 1.0g
White peony root 3.0g
Ephedora 3.0g
Atractylodes ovatae rhizoma 4.0g
Licorice root 1.5g
Prepared Aconite root 1.0g

34. Cassia Twig Decoction
桂枝湯
Gui-Zhi-Tangkeishito
Composition
Cassia twig 3-4g
White peony root 3-4g
Chinese date 3-4g
Dried ginger 4.0g
Licorice root 2.0g

30. Cassia Twig plus Astrgalus Decoction
桂枝加黄耆湯Gui-Zhi-Jia-Huang-Qi-Tangkeishikaogito
Composition
Indications
Cassia twig 3-4g
1. Pyoderma
White peony root 3-4g
2. Atopic dermatitis
Chinese date 3-4g
3. Urticaria
Dried ginger 4.0g
Licorice root 2.0g
Astragalus root 3-4g
31. Cassia Twig plus Dragon's Bone and Oyster Shell Decoction
桂枝加竜骨牡蛎湯
Gui-Zhi-Jia-Long-Gu-Mu-Li-Tangkeishikaryukotsuboreito
Composition
Indications
Cinnamon bark 3-4g
1. Anxiety disorderWhite peony root 3-4g
2. Insomnia
Chinese date 3-4g
3. Nocturnal enuresis
Dried ginger 3-4g
4. Arrhythmia
Licorice root 2.0g
5. Nocturnal emission
Dragon's bone 2.0g
Oyster shell 3.0g
32. Cassia Twig plus Ginseng Decoction
桂枝人参湯
Gui-Zhi-Ren-Shen-Tangkeishininjinto
Composition
Indications
Cinnamon bark 4.0g
1. Dyspepsia
2. Chronic diarrhea, IBS (diarrhea
Ginseng 3.0g
type)
Atractylodes ovatae rhizoma 3.0g
3. Acute enterogastritis
Licorice root 3.0g
4. Headache, migraine
Steamed and dried ginger 2.0g

88

Indications
1. Common cold
2. Influenza

35. Channels-Dredging and Blood-Activating Decoction
疎経活血湯
Shu-Jing-Huo-Xie-Tangsokeikakkestuto
Composition
Indications
Japanese angelica root 2.0g
1. Neck pain
Dried rehmannia root 2.0g
2. Low back pain, sciatic neuralgia
Cnidium rhizoma 2.0g
3. Rheumatoid arthritis
Swordlike atractylodes rhizoma 2.0g 4. Osteoarthritis(osteoarthritis of knee)
Tuckahoe 2.0g
5. Rotator cuff disorders
Peach kernel 2.0g
6. Neuralgia
White peony root 2.5g
7. Trigger finger (snapping finger)
Twotooth achyranthes root 1.5g
8. Thrombophlebitis
Clematidis root 1.5g
Fourstamen stephania root 1.5g
Notopterygii root 1.5g
Divaricate saposhnikovia root 1.5g
Wine-fried Chinese gentian root 1.5g
Dried ginger 1-1.5g
Tangerine peel 1.5g
Dahurican angelica root 1-1.5g
Licorice root 1.0g
36. Cimicifuga and Pueraria Decoction
升麻葛根湯Sheng-Ma-Ge-Gen-Tnag
shomakakkonto
Composition
Indications
Pueraria root 5-6g
Cimicifuga rhizoma 1-3g
Dried ginger 1-3g
White peony root 3.0g
Licorice root 1.5-3.0g

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

1. Measles
2. Rubella
3. Varicella

Volume 1, Special Edition | Current Kampo Medicine 2005
37. Coix Seed Decoction
薏苡仁湯Yi-Yi-Ren-Tangyokuininto
Composition
Ephedra 4.0g
Japanese angelica root 4.0g
Atractylodes ovatae rhizoma 4.0g
Coix seed 8-10g
Cinnamon bark 3.0g
White peony root 3.0g
Licorice root 2.0g
38. Cold Limbs Powder
四逆散
Si-Ni-San
shigyakusan
Composition
Bupleurum root 2-5g
White peony root 2-4g
Immature bitter orange 2.0g
Licorice root 1-2g

Indications
1. Rheumatoid arthritis
2. Osteoarthritis
3. Neck pain
4. Rotator cuff disorders

Indications
1. Anxiety disorder
2. Irritable bowel syndrome
3. Chronic gastritis
4. Cholecystitis、cholelithiasis
5. Conversion disorder
6. Somatization disorder

39. Combined Minor Bupleurum Decoction and Pinellia and Magnolia
Decoction
柴朴湯Chai-Pu-Tangsaibokuto
Composition
Indications
Chinese date 2-3g
1.Asthma
Bupleurum root 4-7g
2. Acute and chronic bronchitis
Scutellaria root 3.0g
3. Dyspepsia
Tuckahoe 5.0g
4. Anxiety disorder
Perilla leaf 2.0g
Licorice root 2.0g
Dried ginger 3-4g
Ginseng 2-3g
Pinellia tuber 5-6g
Magnolia bark 3.0g
40. Combined Minor Bupleurum Decoction and Minor Chest Congestion
Decoction
柴陥湯Chai-Xian-Tangsaikanto
Composition
Indications
Bupleurum root 5.0-7.0g
1. Bronchitis
Pinellia tuber 5.0g
2. Dyspepsia, gastritis
Scutellaria root 3.0g
3. Pleuritis
Chinese date 3.0g
4. Anxiety disorder
Ginseng 2.0-3.0g
5. Reflux esophagitis
Coptis rhizoma 1.5g
Licorice root 1.5-2.0g
Dried ginger 3.0-4.0g
Snakegourd fruit 3.0g

41. Combined Tuckahoe Decoction and Pinellia and Magnolia Decoction
茯苓飲合半夏厚朴湯Fu-Ling-Yin-He-Ban-Xia-Hou-Pu-Tangbukuryoingohangekobokuto
Composition
Indications
Tuckahoe 5.0g
1. Acute or chronic gastritis
Atractylodes ovatae rhizoma 4.0g
2. Dyspepsia
Ginseng 3.0g
3. Reflux esophagitis
Dried ginger 1.0-1.5g
Tangerine peel 3.0g
Immature bitter orange 1.0-2.0g
Pinellia tuber 5.0-6.0g
Magnolia bark 3.0g
Perilla leaf 2.0g
42. Combined Umbellate Fungus Decoction and Four Herbs Decoction
猪苓湯合四物湯Zhu-Ling-Tang-He-Si-Wu-Tangchoreitogoshimostuto
Composition
Indications
Each component of umbellate(Pore) 1. Cystitis・urethritis
Fungus decoction
Japanese angelica root 3.0-4.0g
2. Chronic prostatitis
White peony root 3.0-4.0
3. Idiopathic renal hemorrhage
Cnidium rhizoma 3.0-4.0
4. Urinary calculus
Dried rehmannia root 3.0-4.0
43. Combined Half Cassia Twig Decoction and Ephedra Half Decoction
桂麻各半湯
Gui-Ma-Ge-Ban-Tangkeimakakuhanto
Composition
Indications
Cassia twig 3-3.5g
1. Common cold
White peony root 2.0g
2. Influenza
Dried ginger 2.0g ＊3. Urticaria
Licorice root 2.0g
Ephedra 2.0g
Chinese date 2.0g
Bitter apricot kernel 2-2.5g
44. Coptis Decoction
黄連湯
Huang-Lian-TangorentoComposition
Coptis rhizoma 3.0g
Licorice root 3.0g
Steamed and dried ginger 1-3g
Ginseng 2-3g
Cassia twig 3.0g
Chinese date 3.0g
Pinellia tuber 5-6g

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

Indications
1. Acute and chronic gastritis
2. Gastroduodenal ulcer
3. Dyspepsia
4. Reflux esophagitis
5. Irritable bowel syndrome
6. Stomatitis
7. Atopic dermatitis

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45. Coptis Detoxificating Decoction
黄連解毒湯
Huang-Lian-Jie-Du-Tangorengedokuto
Composition
Coptis rhizoma 1.5-2g
Chinese corktree bark 1.5-3g
Scutellaria root 3.0g
Cape jasmine fruit 2-3g

Indications
1. Anxiety disorder, insomnia
2. Acute or chronic gastritis
3. Gastrointestinal bleeding
4. Stomatitis, glossitis, period
ontitis toothache (odontalgia)(dentalgia)
5. Atopic dermatitis, eczema
6. Photodermatitis
7. Hypertension
8. Epistaxis,gingival bleeding

46. Cyperus and Perilla Leaf Powder
香蘇散
Xiang-Su-San
kososanComposition
Indications
Nutgrass galingale rhizoma 3.5-6g
1. Common cold
Perilla leaf 1-2g
2. Anxiety disorder
Tangerine peel 2-3g
3. Irritable bowel syndrome
Licorice root 1-1.5g
4. Urticaria (depends on the seafood)
Dried ginger 1-2g
5. Menopausal syndrome
6. Chronic gastritis
47. Divaricate Saposhnikovia Miraculous Powder
防風通聖散
Fang-Feng-Tong-Sheng-San
bofutsushosan
Composition
Indications
Japanese angelica root 1.2g
1. Common cold, bronchitis
White peony root 1.2g
2. Sinusitis
Cnidium rhizoma 1.2g
3. Pyoderma, urticaria
Cape jasmine fruit 1.2g
4. Obesity
Forsythia capsule 1.2g
5. Hypertention
Wild mint 1.2g
6. Constipation
Dried ginger 1.2g
Fineleaf schizonepeta herb 1.2g
Divaricate saposhnikovia root 1.2g
Ephedora 1.2g
Rhubarb 0.5g
Mirabilite 1.5g
Atractylodes ovatae rhizoma 2.0g
Balloonflower root 2.0g
Scutellaria root 2.0g
Licorice root 2.0g
Gypsum 2-3g
Talc 3-5g
48. Dreging and Dissipating Powder
通導散
Tong-Dao-San
tsudosanComposition
Japanese angelica root 3.0g
Rhubarb 3.0g
Mirabilite 3-4g
Immature bitter orange 2-3g
Magnolia bark 2.0g
Tangerine peel 2.0g
Akebia stebia stem 2.0g
Safflower 2.0g
Sappan wood 2.0g
Licorice root 2.0g

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Indications
1. Contusion
2. Irregular menstruation
3. Dysmenorrhea
4. Hypertension
5. Menopausal syndrome
6. Constipation

49. Dwarf Lilyturf Decoction
麦門冬湯
Mai-Men-Dong-Tangbakumondoto
Composition

Indications

Dwarf lilyturf root 8-10g
Pinellia tuber 5.0g
Rice 5.0g

1. Bronchitis (with dry cough)
2. Asthma
3. Dry eye

Chinese date 3.0g
Ginseng 2.0g
Licorice root 2.0g

4. Sjögren syndrome
5. Dyspepsia, chronic gastritis

50. Ephedra, Aconite and Manchurian Wildginger Decoction
麻黄附子細辛湯
Ma-Huang-Fu-Zi-Xi-Xin-Tangmaobushisaishinto
Composition
Indications
Ephedra 4.0g
1. Allergic rhinitis
Manchurian wildginger herb 3.0g 2. Common cold
Prepared aconite root 1.0g
3. Bronchitis
4. Headache

51. Ephedra, Apricot, Licorice and Gypsum Decoction
麻杏甘石湯
Ma-Xing-Gan-shi-Tang
makyokansekito
Composition
Indications
Gypsum 10.0g
Bitter apricot kernel 4.0g
Ephedra 4.0g
Licorice root 2.0g
52. Ephedra Decoction
麻黄湯
Ma-Huang-Tang
maoto
Composition
Ephedra 4.0-5.0g
Bitter apricot kernel 4.0-5.0g
Cinnamon bark 3.0-4.0g
Licorice root 1.5-2.0g

1. Common cold
2. Acute and chronic bronchitis
3. Asthma
4. Hemorrhoids

Indications
1. Common cold
2. Influenza
3. Rhinostenosis

53. Ephedra, Apricot, Coiw and Licorice Decoction
麻杏薏甘湯
Ma-Xing-Yi-Gan-Tang
makyoyokukanto
Composition
Indications
Coix seed 10.0g
1. Rheumatoid arthritis
Bitter apricot kernel 3.0g
2. Arthralgia（joint pain）
Ephedra 4.0g
3. Myalgia
Licorice root 2.0g
4. Neuralgia
5. Warts
54. Evodia Decoction
呉茱萸湯Wu-Zhu-Yu-Tanggoshuyuto
Composition
Medicinal evodia root 3-4g
Ginseng 2-3g
Chinese date 3-4g
Dried ginger 4-6g

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

Indications
1. Headache, migraine
2. Acute or chronic gastritis
3. Gastroduodenal ulcer
4. Nausea, vomiting

Volume 1, Special Edition | Current Kampo Medicine 2005
55. Evodia, Fresh Ginger plus Chinese Angelica Cold Limbs Decoction
当帰四逆加呉茱萸生姜湯
Dang-Gui-Si-Ni-Jia-Wu-Zhu-Yu-Sheng-Jiang-Tangtokishigyakukagoshuyushokyoto
Composition
Indications
Japanese angelica root 3.0g
1. Low back pain, sciatic neuralgia
Cinnamon bark 3.0g
2. Headache
Akebia stebia stem 3.0g
3. Dysmenorrhea
Manchurian wildginger herb 2.0g 4. Abdominal pain
Medicinal evodia root 1-2g
5. Raynaud’s syndrome
Licorice root 2.0g
6. Chilblain(erythema pernio)
White peony root 3.0g
Dried ginger 4.0g
Chinese date 5.0g
56. Five Tiger Decoction
五虎湯
Wu-Hu-Tang
gokotoComposition
Ephedra 4.0g
Bitter apricot kernel 4.0g
licorice root 2.0g
Gypsum 10.0g
White mulberry root-bark 2-3g
57. For Contusion Decoction
治打撲一方
Zhi-Da-Pu-Yi-Fang
jidabokuippo
Composition
Cassia twig 3.0g
Cnidium rhizoma 3.0g
Nuphar rhizoma 3.0g
licorice root 1.5g
Rhubarb 1-1.5g
Cloves 1-1.5g
Quercus bark 3.0g
58. For Eczema Decoction
治頭瘡一方
Zhi-Tou-Chuang-Yi-Fang
jizusoippo
Composition
Cnidium rhizoma 3.0g
Swordlike atractylodes rhizoma 3.0g
Forsythia capsule 3.0g
Divaricate saposhnikovia root 2.0g
licorice root 1.0g
Fineleaf schizonepeta harb 1.0g
Safflower 1.0g

Indications
1. Common cold
2. Acute and chronic bronchitis
3. Asthma

Indications
1. Contusion

Indications
1. Atopic dermatitis, eczema
2. Seborrheic dermatitis

Rhubarb 0.5g
Lonicera reef and stalk 2.0g
59. Four Gentlemen Decoction
四君子湯Si-Jun-Zi-Tang
shikunshito
Composition
Ginseng 4.0g
Atractylodes ovatae rhizoma 4.0g
Tuckahoe 4.0g
Chinese date 1-2g
licorice root 1-2g
Dried ginger 3-4g

Indications
1. Chronic gastritis･gastric atony
2. Chronic wasting disease

60. Four Herbs Decoction
四物湯
Si-Wu-Tang
shimotsuto
Composition
Japanese angelica root 3-4g
white peony root 3-4g
Cnidium rhizoma 3-4g
Dried rehmannia root 3-4g

Indications
1. Dysmenorrhea
2. Irregular menstruation
3. Menopausal syndrome

61. Fourstaman Stephania Decoction
木防已湯
Mu-Fang-Yi-Tangmokuboito
Composition
Indications
Gypsum 10.0g
1. Congestive heat failure
Fourstamen stephania root 4.0g
2. Asthma
Cinnamon bark 3.0g
Ginseng 3.0g
62. Gentian Liver-Purging Decoction
竜胆瀉肝湯Long-Dan-Xie-Gan-tang
ryutanshakanto
Composition
Dried rehmannia root 5.0g
Japanese angelica root 5.0g
Akebia stebia stem 5.0g
Scutellaria root 3.0g
Plantain seed 3.0g
Arisma rhizoma 3.0g
Licorice root 1-1.5g
Cape jasmine fruit 1-1.5g
Wine-fried Chinese gentian root
1-1.5g63. Ginseng and Perilla Decoction
参蘇飲
Shen-Su-Yin
jinsoinComposition
Pinellia Tuber 3.0g
Tuckahoe 3.0g
Lobed kudzuvine root 2.0g
Balloonflower root 2.0g
Tangerine peel 2.0g
Chinese date 1.5g
Ginseng 1.5g
licorice root 1.0g
Immature bitter orange 1-1.5g
Perilla leaf 1-1.5g
Dried ginger 1.5g
White flower hogfennel root 2.0g
64. Ginseng Decoction
人参湯
Ren-Shen-Tangninjinto
Composition
Ginseng 3.0g
Atractylodes ovatae rhizoma 3.0g
licorice root 3.0g
Steamed and dried ginger 2-3g

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

Indications
1. Cystitis, urethritis
2. Chronic prostatitis
3. Anogenital pruritus
4. Atopic dermatitis
5. Hypertension
6. Anxiety disorder

Indications
1. Common cold
2. Bronchitis
3. Bronchial asthma

Indications
1. Acute and chronic gastritis
2. IBS(diarrhea type)
3. Acute enterogastritis
4. Anorexia

91Volume 1, Special Edition | Current Kampo Medicine 2005
65. Ginseng Nutrition Decoction
人参養栄湯
Ren-Shen-Yang-Rong-Tangninjinyoeito
Composition
Ginseng 3.0g
Japanese angelica root 4.0g
white peony root 2-4g
Dried rehmannia root 4.0g
Atractylodes ovatae rhizoma 4.0g
Tuckahoe 4.0g
Cassia twig 2.5g
Astragalus root 1.5-2.5g
Tangerine peel 2-2.5g
Thinleaf milkwort root 1.5-2g
Chinese magnoliavine 1-1.5g
licorice root 1-1.5g
66. Goddess Powder
女神散
N¨u-Shen-San
nyoshinsan
Composition
Nutgrass galingale rhizoma 3-4g
Cnidium rhizoma 3.0g
Swordlike atractylodes rhizoma 3.0g
Japanese angelica root 3-4g
Scutellaria root 2-4g
Cassia twig 2-3g
Ginseng 1.5-2g
Areca seed 2-4g

Indications
1. Improvement of weakening according
to chronic disease
2. After operation, after radiotherapy
3. Thrombocytopenia
4. Mucous membrane dryness
5. Pressure sore･chronic skin ulcer
6. Insomnia

Indications
1. Anxiety disorder
2. Postpartum psychiatric disorder
3. Irregular menstruation

Coptis rhizoma 1-2g
licorice root 1-1.5g
Clove flower-bud 0.5-1g
Aucklandia root 1-2g
67. Head-Clearing Divaricate Saposhnikovia Decoction
清上防風湯Qing-Shang-Fang-Feng-Tangseijobofuto
Composition
Indications
Baikai skullcap root 3.0-5.0g
1. AcneBalloonflower root 2-3g
2. Atopic dermatitis, eczema
Cape jasmine fruit 1.5-3g
3. Common cold･tonsillitis
Cnidium rhizoma 2-3g
4. Chronic sinusitis
Divaricate saposhnikovia root 2-3g
Dahurican angelica root 2-3g
Forsythia capsule 2-3g
Coptis rhizoma 1-1.5
licorice root 1-1.5g
Immature bitter orange 1-1.5g
Fineleaf schizonepeta harb 1-1.5g
Wild mint 1-1.5g

92

68. Heart-Clearing Lotus Seed Decoction
清心蓮子飲Qing-Xin-Lian-Zi-Yin
seishinrenshiin
Composition
Indications
Dwarf lilyturf root 4.0g
1. Chronic cystitis
Tuckahoe 4.0g
2. Chronic prostatitis
Baikai skullcap root 3.0g
3. Neurogenic bladder
Plantain seed 3.0g
4. Diabetes mellitus
Ginseng 3.0g
Astragalus root 2.0g
licorice root 1.5-2g
Lotus seed 4.0g
Chinese wolfberry root-bark 2.0g
69. Hemp Seed Pill
麻子仁丸
Ma-Zi-Ren-Wan
mashiningan
Composition
Rhubarb 3.5-4g
Immature bitter orange 2.0g
Bitter apricot kernel 2-2.5g
Magnolia bark 2.0g
White peony root 2.0g
Hemp seed 4-5g

Indications
1. Constipation･scybalum
2. Frequent urination (pollakiuria)

70. Instant Effective Powder
立効散
Li-Xiao-San
rikkosanComposition
Manchurian wildginger herb 1.5-2g
Cimicifuga rhizoma 1.5-2g
Divaricate saposhnikovia root 2-3g
Licorice root 1.5-2g
Wine-fried Chinese gentian root
1-1.5gIndications
1. Toothache(odontalgia)(dentalgia)
2. Periodontitis

71. Intestinal Carbuncle Decoction
腸癰湯Chang-Yong-TangchoyotoComposition
Coix seed 9.0g
Peach kernel 5.0g
Waxgourd seed 6.0g
Tree peony bark 4.0g
72. Intestines-Moistening Decoction
潤腸湯
Run-Chang-Tangjunchoto
Composition
Dried rehmannia root 6.0g
Japanese angelica root 3.0g
Scutellaria root 2.0g
Immature bitter orange 0.5-2g
Bitter apricot kernel 2.0g
Magnolia bark 2.0g
Rhubarb 1-3g
Licorice root 1-1.5g
Hemp seed 2.0g

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

Indications
1. Appendicitis
2. Pelvic inflammatory disease

Indications
1. Constipation･scybalim

Volume 1, Special Edition | Current Kampo Medicine 2005
73. Kidney-Qi Pill
八味地黄丸
Ba-Wei-Di-Huang-Wan
hachimijiogan
Composition
Dried rehmannia root 5.0-6.0g
Dogwood fruit 3.0g
Chinese yam 3.0g
Arisma rhizoma 3.0g
Tuckahoe 3.0g
Tree peony bark 3.0g
Cinnamon bark 1.0g
Aconite root 1.0g

74. Licorice Decoction
甘草湯
Gan-Cao-Tang
kanzotoComposition
Licorice root 5-8g

Indications
1. Chronic nephritis, nephritic syndrome
2. Hypertension
3. Diabetes mellitus, diabetic
neuropathy
4. Prostatic hypertrophy, chr. prostitis
5. Urge urinary incontinence
6. Low back pain
7. Osteoporosis after menopause
8. Cataract
9. Senile pruritus
10. Male infertility
11. Erectile dysfunction
12. Asthma
13. Congestive heart failure

Indications
1. Pharyngodynia

75. Licorice, Wheat and Chinese Date Decoction
甘麦大棗湯Gan-Mai-Da-Zao-Tangkambakutaisoto
Composition
Indications
Chinese date 5.0g
1. Conversion disorder
Licorice root 5.0g
2. Breath holding spells
Wheat 20.0g
3. Sleep terrors
4. Anxiety disorder
76. Life-Preserving Kidney-Qi Pill
牛車腎気丸
Niu-Che-Shen-Qi-Wan
goshajinkigan
Composition
Dried rehmannia root 5-6g
Asiantic cornelian cherry Fruit 3.0g
Chinese yam 3.0g
Arisma rhizoma 3.0g
Tuckahoe 3.0g
Tree peony bark 3.0g
Cinnamon bark 1.0g
Prepared aconite root 0.5-1g
77. Liver-Inhibiting Powder
抑肝散
Yi-Gan-San
yokukansan
Composition
Swordlike atractylodes rhizoma 4.0g
Tuckahoe 4.0g
Cnidium rhizoma 3.0g
Japanese angelica root 3.0g
Bupleurum root 2.0g
Licorice root 1.5g
Gambirplant hooked
branch 3.0g

stem

and

Indications
1. Diabetic neuropathy
2. Low back pain, sciatic neuralgia
3. Frequent urination (pollakiuria)

Indications
1. Anxiety disorder
2. Insomnia
3. Senile dementia
4. Menopausal syndrome
5. Parkinson's disease, Parkinson's
syndrome
6. Autism, ADHD
7. Sleep terror, night cry, tic disorder

78. Liver-Inhibiting Powder plus Tangerine Peel, Pinellia Tuber
抑肝散加陳皮半夏
Yi-Gan-San-Jia-Chen-Pi-Ban-Xia
yokukansankachimpihange
Composition
Indications
Japanese angelica root 3.0g
1. Anxiety disorder
Gambirplant hooked stem and branch 3.0g 2. Isommnia
Cnidium rhizoma 3.0g
3. Senile dementia
Atractylodes ovatae rhizoma 4.0g
4. Menopausal syndrome
Tuckahoe 4.0g
5. Parkinson'sdisease, Parkinson's
syndrome
Bupleurum root 3.0g
6. Autism, ADHD
Licorice root 1.5g
7. Sleep terror, night cry, tic disorder
Tangerine peel 3.0g
8. Chronic gastritis
Pinellia tuber 5.0g
79. Lung-Clearing Decoction
清肺湯Qing-Fei-Tangseihaito
Composition
Japanese angelica root 3.0g
Dwarf lilyturf root 2.0g
Tuckahoe 3.0g
Scutellaria root 2.0g
Balloonflower root 2.0g
Bitter apricot kernel 2.0g
Cape jasmine fruit 2.0g
White mulberry root-bark 2.0g
Chinese date 2.0g
Tangerine peel 2.0g
Licorice root 1-1.5g
Chinese magnoliavine 0.5-2g
Dried ginger 1.0g
Bamboo shavings 2.0g
Dwarf lilyturf root 3.0g
Tendrilleaf fritillary bulb 2.0g

Indications
1. Bronchitis
2. Bronchiectasia
3. Asthma
4. Pneumonia

80. Magnolia Flower, Lung-Clearing Decoction
辛夷清肺湯
Xin-Yi-Qing-Fei-Tangshin’iseihaito
Composition
Indications
Common anemarrhena rhizoma 3.0g
1. Sinusitis
Scutellaria root 3.0g
2. Hypertrophic nasal polypCape jasmine fruit 1.5-3g
3. Bronchitis
Dwarf lilyturf root 5-6g
4. Sino-broncho syndrome
Gypsum 6.0g
Cimicifuga rhizoma 1-1.5g
Magnolia flower 2-3g
Lilii bulbus 3.0g
Loquat leaf 1-3g
81. Major Bupleurum Decoction
大柴胡湯
Da-Chai-Hu-Tangdaisaikoto
Composition
Bupleurum root 6.0g
Pinellia tuber 3.0-4.0g
Dried ginger 4.0-5.0g
Scutellaria root 3.0g
White peony root 3.0g
Chinese date 3.0g
Immature bitter orange 2.0g
Rhubarb 1.0-2.0g

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

Indications
1. Hypertension
2. Dyspepsia, acute and chronic gastritis
3. Cholelithiasis, cholecistitis,
pancreati- tis
4. Hyperlipemia
5. Obesity
6. Anxiety disorder, insommia
7. Asthma
8. Alopecia areata
9. Constipation93

Volume 1, Special Edition | Current Kampo Medicine 2005
82. Major Bupleurum Decoction without Rhubarb
大柴胡湯去大黄
Da-Chai-Hu-Tangdaisaikotokyodaio
Composition
Indications
Bupleurum root 6.0g
1. Hypertension
Pinellia tuber 3.0-4.0g
2. Dyspepsia, acute and chronic
gastritis
Dried ginger 1.0g
3. Cholelithiasis, cholecistitis,
pancreati- tis
Scutellaria root 3.0g
4. Hyperlipemia
White peony root 3.0g
5. Obesity
Chinese date 3.0g
6. Anxiety disorder, insommia
Immature bitter orange 2.0g
7. Asthma
8. Alopecia areata
83. Major Divaricate Saposhuikovia Decoction
大防風湯
Da-Fang-Feng-Tangdaibofuto
Composition
Indications
Astragalus root 3.0g
1. Rheumatoid arthritis
Dried rehmannia root 3.0g
2. Arthralgia (joint pain)
White peony root 3.0g
Swordlike atractylodes rhizoma 3.0g
Japanese angelica root 3.0g
Divaricate saposhnikovia root 3.0g
Cnidium rhizoma 2.0g
Licorice root 1.5g
Twotooth achyranthes root 1.5g
Chinese date 1.5g
Ginseng 1.5g
Notopterygii root 1.5g
Eucommia bark 3.0g
Steamed and dried ginger 1.0g
Prepared aconite root 0.5g
84. Major Middle-Strengthening Decoction
大建中湯Da-Jian-Zhong-Tang
daikenchuto
Composition
Indications
Ginseng 2-3g
1. Ileus
Zanthoxylum fruit 1-2g
2. Constipation
Steamed and dried ginger 3-5g
3. Urinary stone disease
Malt sugar 20.0g
85. Major Purgative Decoction
大承気湯Da-Cheng-Qi-Tangdaijokito
Composition
Magnolia bark 5.0g
Immature bitter orange 3.0g
Rhubarb 2.0g
Mirabilite 1.3g

94

Indications
1. Constipation

86. Meridian-Warming Decoction
温経湯Wen-Jing-TangunkeitoComposition
Dwarf lilyturf root 3-10g

Pinellia tuber 3-5g
Japanese angelica root 2-3g
Licorice root 2.0g
Cinnamon bark 2.0g
White peony root 2.0g
Cnidium rhizoma 2.0g
Ginseng 2.0g
Tree peony bark 2.0g
Medicinal evodia root 1-3g
Dried ginger 1-2g
Donkey-hide gelatin 2.0g

Indications
1. Abnormal menstrual cycle(oligomenorrhea, polymenorrhea,
menstrual irregularity)
2. Dysmenorrhea
3. Menopausal symptome
4. Progressive palmoplanter
keratoderma
5. Chilblain

87. Middle-Reinforcing and Qi-Benefiting Decoction
補中益気湯
Bu-Zhong-Yi-Qi-Tanghochuekkito
Composition
Indications
Astragalus root 3-4g
1. Increase of physical strength
Ginseng 4.0g
2. Chronic gastritis・anorexia
Licorice root 1-1.5g
3. Nutritional supplementation before
and after surgical operation,radiation
sockness (prevention and treatment)
Chinese date 2.0g
4. Myasthenia gravis
Japanese angelica root 3.0g
5. Atopic dermatitis
Tangerine peel 2.0g
6. Idiopathic renal hemorrhage
Dried ginger 0.5g
7. Infection caused by methicillinresistant staphyiococcus aureus
Bupleurum root 1-2g
Cimicifuga rhizoma 0.5-1g
88. Middle-Soothing Powder
安中散
An-Zhog-San
anchusanComposition
Cinnamon bark 3-5g
Corydalis tuber 3-4g
Oyster shell 3-4g
Fennel fruit 1.5-2g
Villous amomum fruit 1-2g
Licorice root 1-2g
Lesser galangal rhizoma 0.5-1g
89. Minor Blue Dragon Decoction
小青竜湯
Xiao-Qing-Long-Tangshoseiryuto
Composition
Ephedra 2-3g
Cinnamon bark 2-3g
Manchurian wildginger herb 2-3g
Pinellia tuber 3-6g
White peony root 2-3g
Licorice root 2-3g
Steamed and dried ginger 2-3g
Manchurian wildginger herb 1.5-3g

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

Indications
1. Dyspepsia
2. Reflux esophagitis
3. Acute or chronic gastritis
4. Gastroduodenal ulcer
5. Chronic pancreatitis
6. Dysmenorrhea

Indications
1. Allergic rhinitis - allergic conjunctivitis
2. Asthma, asthmatic bronchitis
3. Common cold
4. Nephrotic syndrome

Volume 1, Special Edition | Current Kampo Medicine 2005
90. Minor Bupleurum Decoction
小柴胡湯
Xiao-Chai-Hu-Tang
shosaikoto
Composition
Bupleurum root 4.0-7.0g
Scutellaria root 3.0g
Chinese date 2.0-3.0g
Ginseng 2.0-3.0g
Licorice root 2.0g
Dried ginger 4.0g
Pinellia tuber 4.0-5.0g

Indications
1. Common cold, influenza
2. Tonsilitis, otitis media
3. Bronchitis, asthma
4. Pleuritis
5. Dyspepsia
6. Acute and chronic hepatitis
7. Anxiety disorder
8. Subacute thiroiditis

91. Minor Bupleurum Decoction plus Poria Powder with Five Herbs
柴苓湯
Chai-Ling-Tangsaireito
Composition
Indications
Chinese date 2-3g
1. Nephrotic syndrome
Bupleurum root 4-7g
2. Chronic nephritis, IgA-nephritis
Scutellaria root 3.0g
3. Rheumatoid arthritis
Tuckahoe 3-4.5g
4. Serous otitis media
Cinnamon bark 2-3g
5. Gastroenteritis
Umbellate pore fungus 3-4.5g
6. Reproductive autoimmune failure
syndrome (RAFS)
Licorice root 2.0g
Dried ginger 4.0g
Ginseng 2-3g
Pinellia tuber 4-5g
Arisma rhizoma 5-6g
Atractylodes ovatae rhizoma 3-4.5g
92. Minor Bupleurum Decoction plus Balloon Flower Root and Gypsum
小柴胡湯加桔梗石膏
Xiao-Chai-Hu-Tang-JiaJie-Geng-Shi-Gao
shosaikotokakikyosekko
Composition
Indications
Bupleurum root 4-7g
1. Pharyngitis - tonsillitis - peritonsillitis
Pinellia tuber 4-7g
2. Parotitis
Dried ginger 4.0g
3. Bronchitis
Scutellaria root 3.0g
4. Otitis media
Chinese date 2-3g
5. Subacute thyroiditis
Ginseng 2-3g
Licorice root 2.0g
Balloonflower root 3.0g
Gypsum 10.0g
93. Minor Middle-Strengthening decoction
小建中湯
Xiao-Jian-Zhong-Tang
shokenchuto
Composition
Indications
White peony root 6.0g
1. Dyspepsia
Cinnamon bark 3-4g
2. Constipation, irritable bowel syndrome
Chinese date 3-4g
3. Gastroduodenal ulcer
Licorice root 6.0g
4. Chronic hepatitis
Dried ginger 3-4g
5. Infirm constitution
Malt sugar 20.0g

94. Minor Pinellia Decoction plus Tuckahoe
小半夏加茯苓湯
Xiao-Ban-Xia-Jia-Fu-Ling-Tan
shohangekabukuryoto
Composition
Indications
Pinellia tuber 5-8g
1. Morning sickness
Dried ginger 5-8g
2. Nausea, vomiting
Tuckahoe 3-5g
3. Hyperemesis gravidarm
95. Modified Back to the Spleen Decoction
加味帰脾湯
Jia-Wei-Gui-Pi-Tangkamikihito
Composition
Indications
Ginseng 2-3g
1. Stasis, depressed state
Atractylodes ovatae rhizoma 2-3g
2. Insomnia
Tuckahoe 2-3g
3. Anxiety disorder
Astragalus root 2-3g
4. Disfunctional uterine bleeding
Japanese angelica root 2.0g
5. ITPThinleaf milkwort root 1-2g
6. Anemia
Bupleurum root 3.0g
Cape jasmine fruit 2.0g
Licorice root 1.0g
Aucklandia root 1.0g
Chinese date 1-2g
Dried ginger 1.5g
Wild jujube seed 2-3g
Longan aril 2-3g
96. Modified Merry Life Powder
加味逍遥散
Jia-Wei-Xiao-Yao-San
kamishoyosan
Composition
Japanese angelica root 3.0g
White peony root 3.0g
Atractylodes ovatae rhizoma 3.0g
Tuckahoe 3.0g
Bupleurum root 3.0g
Tree peony bark 2.0g
Cape jasmine fruit 2.0g
Licorice root 1.5-2g
Dried ginger 1.0g
Wild mint 1.0g
97. Mystery Decoction
神秘湯Shen-Bi-Tang
shimpito
Composition
Tangerine peel 2.5-3g
Perilla leaf 1.5-3g
Bupleurum root 2-4g
Ephedra 3-5g
Licorice root 2.0g
Magnolia bark 3.0g
Bitter apricot kernel 4.0g

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

Indications
1. Premenstrual syndrome
2. Dysmenorrhea
3. Irregular menstruation
4. Menopausal syndrome
5. Chronic hepatitis
6. Liver cirrhosis（early stage）
7. Chronic gastritis
8. Irritable bowel syndrome
9. Anxiety disorder, insomnia
10. Hand and finger dermatitis

Indications
1. Bronchial asthma
2. Bronchitis

95

Volume 1, Special Edition | Current Kampo Medicine 2005
98. North Water God Decoction
真武湯Zhen-Wu-Tang
shimbuto
Composition
Tuckahoe 5.0g
White peony root 3.0g
Dried ginger 1.0g
Atractylodes ovatae rhizoma 3.0g
Prepared aconite root 1.0g

99. Open the Spleen Decoction
啓脾湯
Qi-Pi-TangkeihitoComposition
Swordlike atractylodes rhizoma 4.0g
Tuckahoe 4.0g
Chinese yam 3.0g
Ginseng 3.0g
Oriental waterplantain rhizoma 2.0g
Tangerine peel 2.0g
licorice root 1.0g
Lotus seed 3.0g
Manchurian wildginger herb 2.0g

Indications
1. IBS, chronic diarrhea
2. Congestive heat failure
3. Vertigo, dizziness, meniere’s disease
4. Common cold - bronchitis
5. Nephritis - nephrotic syndrome
6. Urticaria - pruritus

Indications
1. Chronic diarrhea
2. IBS (diarrhea type)100. Peach Kernel Purgative Decoction
桃核承気湯
Tao-He-Cheng-Qi-Tang
tokakujokito
Composition
Indications
Peach kernel 5.0g
1. Constipation
Cassia 4.0g
2. Anxiety disorder, conversion disorder
Rhubarb 1-3g
3. Endometritis
Licorice root 1.5g
4. Contusion
Mirabilite 1-2g
5. Menopausal syndrome
101. Peony and Licorice Decoction
芍薬甘草湯
Shao-Yao-Gan-Cao-Tang
shakuyakukanzoto
Composition
White peony root 3-6g
Licorice root

3-6g

Indications
1. Cramp of the leg muscles
2. Hyper prolactinism
3. Acne102. Peony, Licorice and Aconite Decoction
芍薬甘草附子湯Shao-Yao-Gan-Caoshakuyakukanzobushito
Composition
Indications
White peony root 3-6g
1. Low back pain
Licorice root 3-6g
2. Cramp of the leg muscles
Aconite root 1.0g
3. Dysmenorrhea

104. Pinellia Heart-Purging Decoction
半夏瀉心湯
Ban-Xia-Xie-Xin-Tang
hangeshashinto
Composition
Indications
Pinellia tuber 4-5g
1. Dyspepsia
Scutellaria root 2.5-3.0g
2. Acute and chronic gastritis
Steamed and dried ginger 2.0-2.5g
3. Gastroduodenal ulcer
Ginseng 2.5-3.0g
4. Irritable bowel syndrome
Licorice root 2.5-3.0g
5. Reflux esophagitis
Chinese date 2.5-3.0g
Coptis rhizoma 1.0g
105. Pinellia, Largehead Atractylodes and Tall Gastordia Decoction
半夏白朮天麻湯Ban-Xia-Bai-Shu-Tian-Ma-Tang
hangebyakujutsutemmato
Composition
Indications
Pinellia tuber 3.0g
1. Vertigo
Atractylodes ovatae rhizoma 3.0g
2. Meniere's syndrome (meniere's
disease)Swordlike atractylodes rhizoma 3.0g
3. Headache
Tangerine peel 3.0g
4. Dyspepsia
Tuckahoe 3.0g
5. Chronic sinusitis
Malt 1.5-2.0g
Tall gastrodia rhizoma 2.0g
Dried ginger 0.5-2.0g
Astragalus Root 1.5g
Ginseng 1.5g
Arisma rhizoma 1.5g
Chinese corktree bark 1.0g
106. Poria Decoction with Four Herbs
四苓湯Si-ling-Tangshireito
Composition
Indications
Arisma rhizoma 4.0g
1. EdemaTuckahoe 4.0g
2. Nephritis
Atractylodes ovatae rhizoma 4.0g
Umbellate pore fungus 4.0g
107. Poria Powder with Five Herbs
五苓散
Wu-Ling-San
goreisanComposition
Arisma rhizoma 5.0-6.0g
Tuckahoe 3.0-4.5g
Atractylodes ovatae rhizoma 3.0-4.5g
Umbellate pore fungus 3.0-4.5g
Cinnamon bark2.0-3.0g

103. Pinellia and Magnolia Decoction
半夏厚朴湯
Ban-Xia-Hou-Pu-Tang
hangekobokuto
Composition
Indications
Pinellia tuber 5-6g
1. Anxiety disorder
Magnolia bark 3.0g
2. Dyspepsia
Tuckahoe 5.0g
3. Asthma
Perilla leaf 2.0g
4. Foreign-body sensation in the throat
Dried ginger 3-4g

96

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

Indications
1. Headache
2. Rotavirus infection
3. Edema
4. Cerbral edema in acute stage of
cerebral infarction
5. Chronic nephritis
6. Hydrocelle testis
7. Vertigo, dizzinessVolume 1, Special Edition | Current Kampo Medicine 2005
108. Powder for Five Kinds of Stagnations
五積散
Wu-Ji-Sangoshakusan
Composition
Indications
Tuckahoe 2.0g
1. Enterogastritis (gastroenteritis)
Atractylodes ovatae rhizoma 3.0-4.0g 2. Low back pain
Tangerine peel 2.0 g
3. Arthralgia; joint pain
Pinellia tuber 2.0g
4. Menalgia
Japanese angelica root 1.5-2.0g
5. Oversensitivity to cold
White peony root 1.0 2.0g
Cnidium rhizoma 1.0-2.0g
Magnolia bark 1.0-2.0g
Dahurican angelica root 1.0-2.0g
Immature bitter orange 1.0-2.0g
Balloonflower root 1.0-2.0g
Dried ginger 1.0-2.0g
Cinnamon bark 1.0-2.0g
Ephedra 1.0-2.0g
Chinese date 1.0-2.0g
Licorice root 1.0-2.0g
109. Powder for Five Kinds of Stranguria
五淋散Wu-Lin-San
gorinsanComposition
Indications
Tuckahoe 5.0-6.0g
1. Cystitis･urethritis
Japanese angelica root 3.0g
2. Chronic prostatitis
Scutellaria root 3.0g
Licorice root 3.0g
White peony root 2.0g
Cape jasmine fruit 2.0g
Dried rehmannia root 3.0g
Arisma rhizoma 3.0g
Akebia stebia stem 3.0g
Talc 3.0g
Plantain seed 3.0g
110. Pueraria Decoction
葛根湯Ge-Gen-Tang
kakkonto
Composition
Pueraria root 8.0g(4.0g)
Ephedra 4.0g(3.0g)
Chinese date 4.0g(3.0g)
Cinnamon bark 3.0g(2.0g)
White peony root 3.0g(2.0g)
Licorice root 2.0g(2.0g)
Dried ginger 1.0g(1.0g)

Indications
1. Common cold, influenza
2. Neck pain, rotator cuff disorders
3. Sinusitis, otitis media, conjunctivitis
4. Trigeminal neuralgia, facial paralysis
5. Temporomandibular arthritis
6. Urticaria
7. Oligogalactia
8. Stress urinary incontinence

111. Pueraria Decoction plus Atractylodes and Aconite
葛根加朮附湯Ge-Gen-Jia-Shu-Fu-Tang
kakkonkajutsubuto
Composition
Indications
Pueraria root 4.0g
1. Trigeminous neuralgia
Ephedra 3.0g
2. Neck pain
Cinnamon bark 2.0g
3. Rotator cuff disorders (frozen
shoulder)Licorice root 2.0g
4. HeadacheWhite peony root 2.0g
5. Chronic sinusitis
Chinese date 3.0g
Dried ginger 1.0g
Swordlike atractylodes rhizoma 3.0g
Prepared aconite root 0.5g

112. Pueraria Decoction plus Szeshwan Lovage and Magnolia Flower
葛根湯加川芎辛夷
Ge-Gen-Tang-Jia-Chuan-Xiong-Xin-Yi
kakkontokasenkyushin’i
Composition
Indications
Pueraria root 8.0g(4.0g)
1. Acute or chronic sinusitis
Ephedra 4.0g(3.0g)
2. Allergic rhinitis
Chinese date 4.0g(3.0g)
3. Serous otitis media
Cinnamon bark 3.0g(2.0g)
White peony root 3.0g(2.0g)
Licorice root 2.0g(2.0g)
Dried ginger 1.0g(1.0g)
Cnidium rhizoma 2.0-3.0g
Magnolia flower 2.0-3.0g
113. Purple Cloud Ointment
紫雲膏
Zi-Yun-Gao
shiunko
Composition
Sesame oil 100.0g
Japanese angelica root 10.0g
Lithospermum root 10.0g
White beeswax 27.0g
Lard 1.8g

Indications
1. Burn
2. Hemorrhoids

114. Pus-Discharging Powder and Decoction
排膿散及湯
Pai-Nong-San-Ji-Tanghainosankyuto
Composition
Indications
Balloonflower root 4.0g
1. Suppuration
licorice root 3.0g
2. Palmoplantar pustulosis
Immature bitter orange 3.0g
3. Pyoderma
white peony root 3.0g
Chinese date 3.0g
Dried ginger 1.0g
115. Rhubarb and Licorice Decoction
大黄甘草湯
Da-Huang-Gan-Cao-Tangdaiokanzoto
Composition
Indications
Rhubarb 4.0g
1. Constipation
Licorice root 1.0-2.0g
116. Rhubarb and Moutan Bark Decoction
大黄牡丹皮湯Da-Huang-Mu-Dan-Pi-Tangdaiobotampito
Composition
Indications
Rhubarb 1.0-2.0g
1. Appenndecitis
Tree peony bark 4.0g
2. Constipation
Peach kernel 4.0g
3. Pelvic inflammatory disease
Mirabilite 4.0g
4. Hemorrhoids
Waxgourd seed 4.0-6.0g
117. Roasted Licorice Decoction
炙甘草湯
Zhi-Gan-Cao-Tangshakanzoto
Composition
Roasted licorice root 3.0-4.0g
Dried ginger 1.0g
Cinnamon bark 3.0g
Hemp seed 3.0g
Chinese date 3.0-5.0g
Ginseng 2.0-3.0g
Dried rehmannia root 4.0-6.0g
Dwarf lilyturf root 6.0g
Donkey-hide gelatin 2.0g

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

Indications
1. Palpitation, arrhythmia
2. Hyperthiroidism
3. Angina pectoris

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118. Schizonepeta and Forsythia Decoction
荊芥連翹湯
Jing-Jie-Lian-Qiao-Tangkeigairengyoto
Composition
Indications
Japanese angelica root 1.5g
1. Common cold
White peony root 1.5g
2. Acute tonsillitis
Cnidium rhizoma 1.5g
3. Acute and chronic sinusitis
Dried rehmannia root 1.5g
4. Acne
Coptis rhizoma 1.5g
5. Atopic dermatitis
Scutellaria root 1.5g
Chinese corktree bark 1.5g
Cape jasmine fruit 1.5g
Forsythia capsule 1.5g
Fineleaf Schizonepeta harb 1.5g
Divaricate saposhnikovia root 1.5g
Wild mint 1.5g
Mature bitter orange 1.5g
Licorice root 1.0-1.5g
Dahurican angelica root 1.5-2.5g
Balloonflower root 1.5-2.5gt
Bupleurum root 1.5-2.5g
119. Scutellaria Decoction
黄芩湯
Huang-qin-tang
ogontoComposition
Scutellaria root 4.0g
White peony root 3.0g

Indications
1. Acute enteritis
2. Salmonella gastroenteritis,
gastroenteritis caused by Escherichia
coli

Licorice root 3.0g
Chinese date 4.0g
120. Seven Herbs Decoction for Hypertension
七物降下湯
Qi-Wu-Jiang-Xia-Tangshichimotsukokato
Composition
Indications
Japanese angelica root 3.0-4.0g
1. Hypertension
White peony root 3.0-4.0g
2. Menopausal syndrome
Cnidium rhizoma 3.0-4.0g
Dried rehmannia root 3.0-4.0g
Gambirplant hooked stem andbranch 3.0-4.0g
Astragalus root 2.0-3.0g
Chinese corktree bark 2.0g
121. Six Gentlemen Decoction
六君子湯Liu-Jun-Zi-Tangrikkunshito
Composition
Ginseng 2.0-4.0g
Atractylodes ovatae rhizoma 3.0-4.0g
Tuckahoe 3.0-4.0g
Pinellia tuber 3.0-4.0g
Tangerine peel .20-4.0g
Chinese date 2.0g
Licorice root 1.0-1.5g
Dried ginger 0.5g

98

Indications
1. Dyspepsia(GARD)
2. Chronic gastritis
3. Gastroduodenal ulcer
4. Anorexia
5. Anxiety disorder
6. Irritable bowel syndrome
7. Reflux esophagitis

122. Six-Ingredient Pill with Rehmannia
六味丸
Liu-Wei-wan
rokumigan
Composition
Indications
Dried rehmannia root 5.0-6.0g
1. Diabetes mellitus
Dogwood fruit 3.0g
2. Chronic nephritis, nephritic
syndrome
Chinese yam 3.0g
3. Urge urinary incontinence,pllakiuria
Arisma rhizoma 3.0g
4. Prostatic hypertrophy, chr.
prostitis
Tuckahoe 3.0g
5. Low back pain
Tree peony bark 3.0g
6. Hypertension
7. Growth failure123. Stephania and Astragalus Decoction
防已黄耆湯Fang-Yi(ji)-Huang-Qi-Tangboiogito
Composition
Indications
Astragalus root 5.0g
1. Osteoarthritis (of knee),hydroarthrosis
Fourstamen stephania root 4-5g
2. Rheumatoid arthritis
Atractylodes ovatae rhizoma 3.5g
3. Chronic nephritis, nephritic
syndrome
Chinese date 3-4g
4. Idiopathic edema
licorice root 1.5-2g
5. Obesity
Dried ginger 3.0g
124. Stomach-Calming Powder
平胃散
Ping-Wei-San
heiisanComposition
Swordlike atractylodes rhizoma 4.0g
Magnolia bark 3.0g
Tangerine peel 3.0g
Chinese date 2.0g
Licorice root 1.0g
Dried ginger 0.5-1.0g

Indications
1. Dyspepsia
2. Acute and chronic gastritis
3. Reflux esophagitis

125. Stomach-Calming Powder and Poria Powder with Five Herbs
胃苓湯
Wei-Ling-TangireitoComposition
Indications
Swordlike atractylodes rhizoma 2.5-3g 1. Dyspepsia
Magnolia bark 2.5-3g
2. Acute or chronic enterogastritis
Tangerine peel 2.5-3g
Umbellate pore fungus 2.5-3g
Arisma rhizoma 2.5-3g
White peony root 2.5-3g
Atractylodes ovatae rhizoma 2.5-3g
Tuckahoe 2.5-3g
Cinnamon bark 2-2.5g
Chinese date 1.5-3g
Dried ginger 1.5-2g
Licorice root 1-2g
Villous amomum Fruit 2.0g
Coptis rhizoma 2.0g

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

Volume 1, Special Edition | Current Kampo Medicine 2005
126. Stomach-Regulating Purgative Decoction
調胃承気湯
Tiao-Wei-Cheng-Qi-Tangchoijokito
Composition
Indications
Rhubarb 2.0-2.5g
1. Constipation
Licorice root 1.0g
Mirabilite 1.0g
127. Summer Heat-Clearing and Qi-Benefiting Decoction
清暑益気湯
Qing-Shu-Yi-Qi-Tangseishoekkito
Composition
Indications
Ginseng 3.0-3.5g
1. Chronic hepatitis
Atractylodes ovatae rhizoma 3.0-3.5g 2. Anorexia
Dwarf lilyturf root 3.0-3.5g
3. Malaise
Japanese angelica root 3.0g
4. Heat stroke
Astragalus root 3.0g
Tangerine peel 2.0-3.0g
Chinese magnoliavine 1.0-2.0g
Chinese corktree bark 1.0-2.0g
Licorice root 1.0-2.0g
128. Swordlike Atractylodes and Largehead Atractylodes Decoction
二朮湯Er-Shu-Tangnijutsuto
Composition
Indications
Atractylodes ovatae rhizoma 1.5-2.5g 1. Rotator cuff disorders
Tuckahoe 1.5-2.5g
2. Neck pain
Tangerine peel 1.5-2.5g
3. Osteoarthritis
Arisaematis tuber 1.5-2.5g
4. Low back pain
Nutgrass galingale rhizoma 1.5-2.5g
5. Rheumatoid arthritis
Scutellaria root 1.5-2.5g
Clematidis root 1.5-2.5g
Notopterygii root 1.5-2.5g
Pinellia tuber 2.0-4.0g
Swordlike Atractylodes rhizoma
1.5-3.0g
Licorice root 1.0-1.5g
Dried ginger 0.6-1.0g
129. Szechwan Lovage and Angelica Decoction for Regulating Blood Flow芎帰調血飲
Xiong-Gui-tiao-Xue-Yin
kyukichoketsuin
Composition
Indications
Japanese angelica root 2.0g
1. Subinvolution of uterus
Cnidium rhizoma 2.0g
2. Postnatal stasis
Dried rehmannia root 2.0g
3. Dysmenorrhera
Atractylodes ovatae rhizoma 2.0g
4. Premenstrual syndrome
Tuckahoe 2.0g
5. Dysfunctional uterine bleeding
Tangerine peel 2.0g
6. Osteoarthritis(knee)
Combined spicebush root 2.0g
7. Arteriosclerosis obliterans
Nutgrass galingale rhizoma 2.0g
8. ITP
Tree peony bark 2.0g
Motherwort Herb 1.5g
Chinese date 1.5g
Licorice root 1.0g
Dried ginger 1.0-2.0g

130. Szechwan Lovage Rhizoma, Angelica Root, Ass-hide Glue and Argy
Wormwood Leaf Decoction
芎帰膠艾湯Xiong-Gui-Jiao-Ai-Tangkyukikyogaito
Composition
Indications
Cnidium rhizoma 3.0g
1. Hemorrhoidal bleeding
Licorice root 3.0g
2. Dysfunctional uterine bleeding
Argyi leaf 3.0g
3. Anemia
Japanese angelica root 4.0-4.5g
4. ITPWhite peony root 4.0-4.5g
Dried rehmannia root 5.0-6.0g
Donkey-hide gelatin 3.0g
131. Tea-Blended Szechwan Lovage Powder
川芎茶調散
Chuan-Xiong-Cha-Tiao-San
senkyuchachosan
Composition
Indications
Dahurican angelica root 2.0g
1. Headache
Notopterygii root 2.0g
2. Common cold
Fineleaf Schizonepeta herb 2.0g
3. Allergic rhinitis
Divaricate saposhnikovia root 2.0g
4. Sinusitis
Wild mint 2.0g
Licorice root 1.5g
Green tea reef 1.5g
Cnidium rhizoma 3.0g
Nutgrass galingale rhizoma 4.0g
132. Ten Strong Tonic Herbs Decoction
十全大補湯
Shi-Quan-Da-Bu-Tangjuzentaihoto
Composition
Indications
Ginseng 2.5-3.0g
1. Increase of physical strength after
operation and after chemotherapy
Astragalus root 2.5-3.0g
2. Radiation sickness, radiation injury
Atractylodes ovatae rhizoma 3.0g
3. Anemia
Tuckahoe 3.0g
4. Puressure ulcer
Japanese angelica root 3.0g
5. MRSA infection
White peony root 3.0g
6. Rheumatoid arthritis
Dried rehmannia root 3.0g
7. Wasting state,wasting disease
Cnidium rhizoma 3.0g
Cinnamon bark 3.0g
Licorice root 1.5g
133. Three Herbs Baikal Skullcap Decoction
三物黄芩湯San-Wu-Huang-Qin-Tangsammotsuogonto
Composition
Indications
Scutellaria root 3.0g
1. Palmoplantar pustulosis
Sophora root 3.0g
2. Hand and finger dermatitis
Dried rehmannia root 6.0g
3. Atopic dermatitis, eczema
134. Three Huang Heart-Clearing Decoction with Three yellow color
Herbs
三黄瀉心湯
San-Huang-Xie-Xin-Tang
san’oshashinto
Composition
Indications
Rhubarb 1.0-2.0g
1. Acute or chronic gastritis
Scutellaria root 1.0-1.5g
2. Gastrointestinal bleeding
Coptis rhizoma 1.0-1.5g
3. Epistaxis,gingival bleeding
4. Anxiety disorder, insomnia
5. Hypertension
6. Constipation

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135. Tuckahoe Decoction
茯苓飲Fu-Ling-Yin
bukuryoin
Composition
Tuckahoe 5.0g
Atractylodes ovatae rhizoma 4.0g
Ginseng 3.0g
Dried ginger 1.0-3.0g
Tangerine peel 3.0g
Immature bitter orange 1.0-2.0g

Indications
1. Dyspepsia
2. Acute or chronic gastritis
3. Reflux esophagitis

136. Tuckahoe, Cassia Twig, Largehead Atractylodes and Licorice Decoction
苓桂朮甘湯Ling-Gui-Shu-Gan-Tangryokeijutsukanto
Composition
Indications
Tuckahoe 6.0g
1. Vertigo
Cinnamon bark 4.0g
2. Orthostatic hypotension
Atractylodes ovatae rhizoma 3.0g
3. Headache
Licorice root 2.0g
4. Meniere's syndrome (Meniere's
disease)5. Hypotension
137. Tuckahoe, Ginger, Largehead Atractylodes and Licorice Decoction
苓姜朮甘湯Ling-Jiang-Shu-Gan-Tangryokyojutsukanto
Composition
Indications
Tuckahoe 6.0g
1. Low back pain, sciatic neuralgia
Steamed and dried ginger
2. Frequent urination (pollakiuria)
Atractylodes ovatae rhizoma 3.0g
Licorice root 2.0g
138. Tuckahoe, Licorice, Dried Ginger, Schisandra, Manchurian
Wildginger, Pinellia and Apricot Decoction
苓甘姜味辛夏仁湯
Ling-Gan-Jiang-Wei-Xin-Xia-Ren-Tangryokankyomishingeninto
Composition
Indications
Bitter apricot kernl 4.0g
1. Acute and chronic bronchitis
Pinellia tuber 4.0g
2. Bronchiectasis
Tuckahoe 4.0g
3. Pulmonary emphysema
Chinese magnoliavine 3.0g
Licorice root 2.0g
Manchurian wildginger herb 2.0g
Steamed and dried ginger 2.0g
139. Two Vintage Herbs Decoction
二陳湯Er-Chen-Tangnichinto
Composition
Pinellia tuber 5.0-7.0g
Tuckahoe 3.5-5.0g
Tangerine peel 3.5-4.0g
Dried ginger 1.0g
Licorice root 1.0-2.0g

100

Indications
1. Acute or chronic gastritis
2. Bronchitis

140. Umbellate Fungus Decoction猪苓湯
Zhu-Ling-Tangchoreito
Composition
Umbellate pore fungus 3.0g
Tuckahoe 3.0g
Talc 3.0g
Arisma rhizoma 3.0g
Donkey-hide gelatin 3.0g
141. Uncaria Powder
釣藤散
Diao(gou)-Teng-San
chotosanComposition
Gambirplant Hooked Stem and Branch
3.0g
Tangerine peel 3.0g
Pinellia tuber 3.0g
Dwarf lilyturf root 3.0g
Tuckahoe 3.0g
Ginseng 2.0g
Divaricate saposhnikovia root 2.0g
Chrysanthemum flower 2.0g
licorice root 1.0g
Steamed and dried ginger 1.0g
Gypsum 5.0-7.0g

Indications
1. Cystitis, urethritis
2. Urinary calculus
3. Hematuria

Indications
1. Hypertension
2. Headache
3. Vascular dementia
4. Alzheimer disease
5. Tinnitus
6. Parkinson disease
7. Sequela of cerebrovascular system

142. Warming and Clearing Decoction
温清飲
Wen-Qing-Yin
unseiinComposition
Indications
Japanese angelica root 3.0-4.0g
1. Atopic dermatitis, eczema
Dried rehmannia root 3.0-4.0g
2. Urticaria
White peony root 3.0-4.0g
3. Abnormal menstrual cycle(oligomenorrhea, polymenorrhea,
menstrual irregularity)
Cnidium rhizoma 3.0-4.0g
4. Behcet’s disease
Coptis rhizoma 1.5-2.0g
5. Hypertension
Scutellaria root 1.5-3.0g
6. Stomatitis
Cape jasmine fruit 1.5-2.0g
7. Endometriosis
Chinese corktree bark 1.5-2.0g
143. White Tiger plus Ginseng Decoction
白虎加人参湯Bai-Hu-Jia-Ren-Shen-Tang
byakkokaninjinto
Composition
Indications
Common anemarrhena rhizoma 5-6g
1. Diabetes mellitus
Gypsum 15-16g
2. Atopic dermatitis
licorice root 2.0g
3. Heat stroke
Ginseng 1.5-3g
4. Stomatitis
Rice 8-10g
5. Periodontal diseases
6. Rhumatoid arthritis
144. Wild Jujube Seed Decoction酸棗仁湯
Suan-Zao-Ren-Tangsansoninto
Composition
Wild jujube seed 7.0-15.0g
Common anemarrhena rhizoma 5-6g
Cnidium rhizoma 3.0g
Tuckahoe 5.0g
Licorice root 1.0g

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

Indications
1. Insomnia
2. Anxiety disorder
3. Lethargy

Volume 1, Special Edition | Current Kampo Medicine 2005
145. Wind Dispersing Powder
消風散
Xiao-Feng-San
shofusanComposition
Japanese angelica root 3.0g
Dried rehmannia root 3.0g
Gypsum 3.0-5.0g
Divaricate saposhnikovia root 2.0g
Swordlike atractylodes rhizoma 2.0g
Akebia stebia stem 2.0-5.0g
Arctium fruit 2.0g
Common anemarrhena rhizone 1.5g
Hemp seed 1.5g
Cicada slough 1.0g
Sophora root 1.0g
Fineleaf schizonepeta herb 1.0g
Licorice root 1.0-1.5g

Indications
1. Urticaria
2. Atopic dermatitis, eczema
3. Seborrheic dermatitis
4. Prurigo, strophlus

146. Yin Nourishing and Fire-Eliminating Decoction
滋陰降火湯
Zi-Yin-jiang-Huo-Tang
jiinkokato
Composition
Indications
Swordlike atractylodes rhizoma 3.0g 1. Chronic bronchitis
Dried rehmannia root 2.5g
2. Acute and chronic pharyngitis
White peony root 2.5g
3. Bronchiectasia
Tangerine peel 2.5g
Dwarf lilyturf root 2.5g
Chinese corktree bark 1.5g
Licorice root 1.5g
Common anemarrhena rhizoma 1.5g
Cochinchinese asparagus root 2.5g

147. Yin Nourishing Real Treasure Decoction
滋陰至宝湯
ZI-Yin-Zhi-Bao-Tangjiinshihoto
Composition
Indications
Nutgrass galingale rhizoma 2-3g
1. Acute or chronic bronchitis
Bupleurum root 1-3g
2. Bronchiectasia
White peony root 2-3g
Common anemarrhena rhizoma
2-3g
Tangerine peel 2-3g
Japanese angelica root 2-3g
Dwarf lilyturf root 2-3g
Atractylodes ovatae rhizoma 2-3g
Tuckahoe 2-3g
Licorice root 1.0g
Wild mint 1.0g
Chinese wolfberry root-bark 2-3g
Tendrilleaf fritillary bulb 1-2g
148. Yue Bi Decoction for Relieving Edema plus Atractylodes
越婢加朮湯
Yue-Bi-Jia-Shu-Tangeppikajutsuto
Composition
Indications
Gypsum 8.0g
1. Rheumatoid arthrites
Ephedra 6.0g
2. Osteoarthritis
Swordlike atractylodes rhizoma 4.0g 3. Gouty arthritis
Chinese date 3.0g
4. Atopic dermatitis
Licorice root 2.0g
5. Nephritis, nephrotic syndrome
Dried ginger 1.0g
6. Allergic rhinitis
7. Herpes zoster

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM) is published quarterly and available at
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The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

101

Volume 1, Special Edition | Current Kampo Medicine 2005

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 theUnited States from the people of Japan. In Japan, the flowering cherry tree or“Sakura”, as it is called by the Japanese people, is one of the most exalted
flowering plants. The beauty of the cherry blossom is a potent symbol equatedwith evanescence of human life and epitomizes the transformations Japanese
Culture has undergone through the ages.
Excerpted from National Park Service
102

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