Volume 1, Number 2 | Summer 2006

Kampo Medicine - Current Research
Treatment of Chronic Renal Failure with Kampo Medicine
Hiromichi Yasui
Japan Institute of TCM Research

Modern Kampo medicine has become able to treat
several renal diseases that will lead to chronic renal
failure from the stage "where they are not yetmanifest". The question now is, whether there are also
therapeutic tools and techniques applicable to theThis used to be a disease unknown in our field, but

terminal stage of chronic renal failure.

is now encountered due to the advances in modern
medicine in daily practice. Hypertension, chronic liver

The answer to this question has recently been

failure, hyperlipidemia and similar conditions areprovided by two Kampo specialists who have publishedrecognized as some of many currently problematic

two outstanding reports:1,2)

pathologic conditions. Among these, often only theterminal stages are recognized as diseases and thus
subject to treatment. Examples are the collection ofascites due to liver cirrhosis or the development of
uremia caused by chronic renal failure.

Picture 1: Hajime Haimoto, Serum Creatinine Level
Lowering Effects of Astragali Radix in Patients with
Chronic Renal Failure Φυτο Vol. 7, No. 1, p4-9, 2005

Famous physicians of the past have diagnosed suchdiseases during stages where they "are not yetmanifest" and seemed to have contrived a variety oftherapeutical means for curing them before reaching
the terminal stage. Or else these physicians tried toextend the time required to reach the terminal stage
as much as possible. Again, occasionally they may
have initiated treatment in some cases after certain
aspects of the terminal stage became manifest.
Today, due to advances in modern medicine, we areable to infer the prognosis and course of almost any
disease. Yet, even though that may be possible, it still
does not allow us to stop the progression of the disease.
This often leaves us without any therapeutical means
for its treatment.
Chronic renal failure is a classical example of sucha disease. Modern medicine is making efforts toPicture 2: Yoichiro Ebe, Clinical Experiences Using theyojinkodakuto(Nourishing the Kidney and DepressantTurbid Dampness Decoction in Patients with ChronicRenal Failure Φυτο Vol. 7, No. 2, p4-11, 2005

achieve its cure and new procedures like dialysis,
substituting for the lost renal function, have beendeveloped and currently benefit many people. Yet, forboth therapists and patients, dialysis compares tobeing chained and leaves both parties wishing for more
freedom.

However,eventhoughthegradually

declining renal function and simultaneously gradually
increasing BUN and creatinine concentrations can becontrolled to some degree by rigorous diet and theapplicationof

Kremezin(sphericalcarbonaceousabsorbent), the disease relentlessly destroys these
therapeutic efforts and pushes the patient towards
dialysis.
8The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Number 2 | Summer 2006

a particularly interesting case. The patient was a

1. Dr. Haimoto's work
Haimoto, at the beginning of his work, describes

62-year old man with an initial creatinine level of 1.3

clinical examples he experienced himself. Based on

mg/dl. From the age of 56, the value started totwo specific cases, he is now convinced that Astragali

increase gradually and reached 1.7 mg/dl by the ageRadixof 61. At that stage, treatment with Astragali Radix

iscapableoflowering

thecreatinine

concentration.

and several other crude drugs, did not produce any

In the first patient, in whom the chronic renal failure

improvement; but when Paeoniae Radix Rubra was

was due to membranous nephropathy, administration ofadded

Astragali Radix resulted in a drastic increase in urine

decreased after one month to 1.21.

volume that led to a decrease in creatinine. The second

Based on this experience this researcher concluded

patient suffered from uremia caused by chronicthat a combination of Astragali Radix + Paeoniae

nephritis. When treatment with Kampo medicine did not

Radix Rubra would be even more effective.

totheprescription,

theconcentration

produce any improvements at all, addition of Astragali
Radix to the prescription also resulted in an abrupt

Summarizing the above described results shows

decrease in the creatinine concentration (within one

that Haimoto proposed the following protocol for themonth from 8.8 mg/dl to 7.4 mg/dl.)

treatment of patients with early chronic renal failure:

Based on these results, Haimoto thought that the"Inpatients

withchronicrenalfailure

first

use of Astragali Radix alone might be able to induce aadminister Astragali Radix (15-30 g) (where even thedecrease in creatinine concentration and thus started

administration of Astragali Radix alone is effective,

the following research.

as Haimoto's case report presented in the previous

Serum creatinine level lowering effects of Astragali
Radix in patients with early chronic renal failure.

issue

clearlyshows3)).

However,whentheadministration of Astragali Radix alone does notTen patients (one of these dropped out of the study

induce a decrease in the creatinine level, Paeoniae

because of the development of efflorescences) with

Radix Rubra (10-15 g) is added. If the creatinine

early chronic renal failure who consulted his clinic

concentration still does not fall, Rhei Rhizoma is

between February 2002 and February 2005, wereadded."treated with a combination of 3-4 crude drugs
centering on Astragali Radix. Observations of theTable 1 shows the variations in serum creatinine

patients showed that underlying diseases of theand potassium(K) observed in 9 patients who werepatients varied widely.

treated with Kampo medications by Haimoto. The

This treatment resulted in a decrease in creatinine

underlying diseases in these patients included aconcentration by 0.3-0.9 mg/dl and the effect continued

variety of diseases like chronic nephritis, IgA

over a prolonged time. The effects of Astragali Radix

nephropathy, diabetic nephropathy and unknown

appeared after a rather short period (within 2 months)

causes (suspected drug induced nephritis). Theand a gradual decrease of the initially high creatinineprescriptions used for these patients all containedlevels continued even over an observation period of

15-30 g of Astragali Radix. For patients for whom anmore than 2 years. In patients with initially low

improvement in proteinuria is imperative, 10-15 g ofvalues, the concentration fell to the upper limit of theImperatae Rhizoma and 15-35 g of Houttuyniae

normal range, but subsequently did not improve any

Herba were added. In patient No. 4, Astragali Radix

further. Changes in serum potassium levels were notalone did not produce any improvement, but afterobserved.

addition of Paeoniae Radix Rubra a successful

Among the nine patients observed, one presented

reductionofthecreatinine

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

concentration

was9

Volume 1, Number 2 | Summer 2006

achieved.
Table 1 Variations in serum creatinine and potassium(K) in 9 patients receiving Kampo treatment

65

Cr/K
beforemedication
1.9／5.7

2.0／5.6―

1.6／4.2

1.6／4.3

M76

2.8／4.9

2.2／4.7

2.1／―

2.1／4.6

1.9／5.03

M

61

1.9／6.7

1.7／5.6

1.7／5.2

1.5／6.8**

1.3／4.8

1.5／5.6

4M

61

1.7／4.7

1.9／4.5

1.8／4.8

1.5／5.2

1.4／5M56

1.6／4.7

1.1／

1.1／

1.2／4.5

1.2／4.5

6

F

59

2.3／4.1

2.1／4.3

1.9／4.4

1.8／4.9

1.7／4.57M

72

1.7／4.8

1.3／4.8

1.3／4.1

8M

39

1.6／4.8

1.4／4.3

1.4／4.4

1.3／4.4

1.2／4.99M

61

2.9／5.3

2.6／5.6

No.

Sex

Age

1F2

After 2months

After 6months

After 9months

After 12months

After 24months1.9*／4.8* Patient discontinued Kampo medication on his own initiative** Start of rigorous low potassium diet

2. Ebe's new preparations

New applications of old methodology
age,

Yoichiro Ebe, who is also known as the developer ofprescriptions did not exist right from the beginning,

the classical formulation theory, has discussed chronic

but the effects of each individual crude drug wererenal failure from a point of view of this classicaldoubtlessly confirmed separately. Records of suchformulation theory, “yojinkodakuto (Nourishing theactivities of ancient people may still be found in theKidney and Depressant Turbid Dampness Decoction)”"Shen Nong (Shinno) Legend", describing a legendary

for the treatment of intractable diseases. Theoreticallyforefather of pharmacotherapy who allegedly tested

one of the active ingredients of this preparation isIn

thedawnoftheKampo

medical

100 plant species per day on himself to confirm theireffects.

Kampo

preparations

arecomposedofindividual crude drugs whose effects are well known.
Haimoto also discovered that Astragali Radix lowers
creatinine concentration through confirmation of theeffects of each individual crude drug.
The process of this discovery was a dramatic one
and reading through that work is very rewarding.
This discovery not only represents a great blessing
for patients with chronic renal failure, but will also
make a major contribution to the research in thisfield. In a field where diseases are considered to be
incurable by modern medicine, this finding may
represent the appearance of a new therapeutic drug.
This circumstance can only be described as theemergence of a new research field.

10Astragali Radix. Ebe's approach differs completelyfrom that of Haimoto, but the conclusions reachedresemble each other very closely.
Ebe with his joint researchers, Hashimoto, et al.,has reported improvements achieved with the use ofthis preparation in three patients with chronic renal
failure in the Clinical Journal of Chinese Medicine Vol.
25, No. 4, (2004), later 7 other patients in Vol. 26, No. 1(2005) and finally introduced 13 cases in the 『Φυτο』
Vol. 7, No. 2, (2005). The underlying diseases in thesepatients included such diversified conditions as
chronic

nephritis,

gouty

nephropathy,

diabetic

nephropathy, multicystic renal cysts etc. regardless ofwhether they were of renal or postrenal nature.
Moreover, the course of the individual conditions inthese patients closely resemble those described byHaimoto, although they included more severe cases

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

Volume 1, Number 2 | Summer 2006

than the patients described by Haimoto. These reports

actions of Imperatae Rhizoma are heat clearing,

also describe

creatinine

detoxification and draining damp, this drug isconcentration did not rise even after 3 years offrequently used in Chinese medicine for thetreatment, but on the contrary tended to decrease andtreatment of chronic renal failure. Yet, based on

patients inwhich thethe condition did not progress for more than a year,
although the patients had already been in thepreparatory stage for dialysis. In patients who werealready on a dialysis regimen, an increase in urine
volume led to improvements in the creatinine
concentration, so that it was in some cases evenpossible to decrease the frequency of the dialysis.
In order to comprehend this preparation it ispast experiences, it has become clear that this drug
may aggravate chronic renal failure. Even thoughfounded on known Chinese medical drug effects,
newcrudedrugs

shouldbeaddedto

thispreparation very carefully.
2. Since Kremezin absorbs ingredients compornents
ofherbs,

acombination

therapywiththisnecessary to master the classical formulation theory.

preparation may obscure the effects of the Kampo

Since this theory represents a very detailed system, it

preparation.

is difficult to represent it here in a simplified form.

3. In case of dermal efflorences caused by Astragalus

Here I would like to restrict myself to the presentation

membranaceus Bunge or Astragalus mongholicusof my conclusions. People who do no know the entire

Bunge is said to range generally between 1 andtheory will be able to obtain certain results using the3%. In patients with renal failure this ratio

below described formula.

reached approximately 10% (4/38), indicating that

Yojinkodakuto(Nourishing the Kidney and DepressantTurbid Dampness Decoction)
Astragali Radix
30 g
Paeoniae Radix Rubra
15～30 gSmilacis Rhizoma
30 g
Dioscoreae Hypoglaucae Rhizoma
10 gSalviae Miltiorrhizae Radix
12 g
Pinellia Tuber
12～15 gTrichosanthes Semen
10 g
Glycyrrhizae Radix
6～15 g*Poria
12～30 g*** In addition to the renal protective activity of

Glycyrrhizae Radix there is also a dose dependent
serum potassium lowering effect, so that its doseshould be determined based on the laboratory
values.
** Poria is basically used in twice the amount of
raw licorice.

the case of astragalus induced efflorences, it might
be beneficial to switch the prescriptions toHedysarum polybotrys Hand.-Mazz.)
4. Yojinkodakuto apparently does not affect renal
anemia. Conversely, in patients with severe
anemia marked by a hemoglobin value of less than
7.0 g/dl, it may induce nephrocyte apoptosis or
necrosis and thereby further aggravate the renal
failure. With the use of this drug under thesecircumstances,improvements

increatinine

concentration or similar parameters are notobserved. Accordingly, it is essential to treat
anemia with erythropoietin.
5. Generally, when treating renal failure with Kampomedicines there is a fear of increasing potassium
uptake. Yet, raw Glycyrrhizae Radix has a dose
dependent

Ebe lists the following precautions pertaining toserum

potassium

loweringeffectallowing control of the potassium level based onserum potassium concentration.

the use of this preparation.
1.

the said incidence may increase. (Author’s note: inImperatae Rhizoma (bai mao gen) may aggravate

6. In dialysis patients, the use of this preparation

the renal failure and its effect may last in someinduces a decrease in creatinine concentration, ancases up to 3 months. Since the pharmacologic

effect that is even observed in almost anuretic

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

11

Volume 1, Number 2 | Summer 2006

patients. In some cases, it may further increase

References

urine volume.

1.

Astragali Radix in Patients with Chronic Renal Failure

Above, I introduced the treatment patterns ofHaimoto and Ebe for chronic renal failure. As stated at
the beginning of the paper, there are no other activelyΦυτο Vol 7., No.1, 4-9, 20052.

Decoction) in Patients with Chronic Renal Failure Φυτοand so far nobody believed in the existence of drugs orvalues. However, the work of these two researchers

Vol. 7, No. 2, 4-11, 2005
3.

Haimoto H.: Astragali Radix Induces a Decline of Serum
Creatinine in Chronic Renal Failure; The Journal ofhas clearly shown that preparations centering aroundAstragali Radix are apparently capable of producing atEbe Y.: Clinical Experiences with the yojinkodakuto(Nourishing the Kidney and Depressant Turbid Dampness

pursued treatment alternatives apart from dialysis
preparations that might improve the creatinine

Haimoto H.: Serum Creatinine Level Lowering Effects ofKAIM, Vol. 1, No. 1 2006
4.

Hashimoto M, Ebe Y.: Kampo Treatment for Chronic

least a certain degree of improvement, the effects ofRenal Failure (1), Clinical Journal of Chinese Medicine,which continue for prolonged periods of time. AlthoughVol. 25, No. 4, 54-59, 2004

thesepractitioners

usedcompletelydifferent

5.

Hashimoto M, Ebe Y.: Kampo Treatment for Chronic

approaches, the conclusions they arrived at wereRenal Failure (2), Clinical Journal of Chinese Medicine,

remarkably similar.

Vol. 26, No. 1, 88-94, 2005

These two dissertations provide good news forpatients suffering from chronic renal failure.

12The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)