KAIM
T
Thhee JJoouurrnnaall ooffK
Kaammppoo,, A
Accuuppuunnccttuurree aanndd IInntteeggrraattiivvee M
Meeddiicciinnee
INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 13, Number 4 ･ Winter 2018

Editorial

Notification of Suspension of Publication of KAIM
Shuji Goto, Hiromichi Yasui and Shuichi Katai

Report from WFAS Tokyo/Tsukuba 2016

“Acupuncture for Low Back Pain and Knee Pain in Middle Age, an Anatomical Point of View”
Tomofumi Ozaki

Clinical Report (Acupuncture)
A Case of Low Back Pain
Akio Manabe

Research Review

Adverse Effects of Kampo Medicine
Toshiaki Makino and Hiromichi Yasui

Book Review

Dr. Otsuka’s “30 Years of KAMPO”
Hiromichi Yasui

ISSN:1559-033X

College Logos
We believe it is necessary to create a new way of thinking
for the total understanding of "Life, Survival, and Health".
We decided to coin the world "Lifence" to express this.
Lifence means the combination of life sceince and medicine
as well as other disciplines such as health science, psychology,
ethics, etc.
Our college logos symbolizes the above.
The ripple effect represents the ocean and the birth of life.
The rainbow colored sphere represents a safe environment
and a barrier to protect us from negative influences.
The picture by Leonardo da Vinch represents a balanced
body and health.
Completing our logos is a ring which represents the unity ofspace fulfilling the total meanings of lifence.

―

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

Volume 13, Number 4 ･ Winter 2018EXECUTIVE EDITOR

Shuji Goto
Chairman, GOTO College ofMedical Arts & Sciences

TA B L E O F C O N T E N T S

Tokyo, JapanEDITOR-IN-CHIEF

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

1 Editorial
Notification of Suspension of Publication of KAIM
Shuji Goto, Hiromichi Yasui and Shuichi Katai

CA, U.S.A.

ASSOCIATE EDITORS
Shuichi Katai
Ibaraki-ken, Japan

Hiromichi Yasui

2 Report from WFAS Tokyo/Tsukuba 2016
“Acupuncture for Low Back Pain and Knee Pain in Middle Age, an Anatomical Point ofView”
Tomofumi Ozaki

Tokyo, JapanThe Japan Conference of Clinical Acupuncture and Moxibustion

EDITORIAL STAFF

Akihiro Souma
Hiromi Sasaki
Hiroshi Tsukayama
Hitoshi Yamashita
Junko Okubo
Kazunari Ozaki
Kengo Nakata
Masayuki Kashima
Naoya Ono
Noboru Mitsuhata
Sayaka Toda
Takao Namiki
Toshiaki Makino
Toshihiro Togo

PUBLISHER

Shuji Goto
International Institute of Health andHuman Services, Berkeley

9 Clinical Report (Acupuncture)
A Case of Low Back Pain
Akio Manabe

12 Research Review
Adverse Effects of Kampo Medicine
Toshiaki Makino and Hiromichi Yasui

20 Book Review
Dr. Otsuka’s “30 Years of KAMPO”
Hiromichi Yasui

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

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

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)KOTARO PHARMACEUTICAL introduced in 1957 the world's first Kampo extract
preparations on the market. Later, in 1967, six of our preparations could be covered in Japanfor the first time by the health insurance and after 1976 more than 100 of our preparations
were used in hospitals and clinics. Now it is half a century since we put our Kampo extract
preparations on the market and believe, we made a major contribution to this industry.
In the future we intend to continue working in accordance with our company motto: "Still better
Kampo for still more people" and provide pharmaceutical products of still higher quality.

Origin of the company's name
The company was named "KOTARO" by its
founder Taro Ueda with reference to his birthplace. Close to the ancient city of Nara. Kotaro
is the name of an enormous sheer cliff, 700 m
wide and about 200 m high. Mr. Ueda felt anaffection rising to the heavens for this cliff andthus made it the company's name.

KOTARO PHARMACEUTICAL CO., LTD.
5-23 Nakatsu 2-Chome, Kita-ku, Osaka 531-0071, JAPANURL: http://www.kotaro.co.jp

Volume 13, Number 4 | Winter 2018

Editorial
Notification of Suspension of Publication of KAIM
The global spread of Oriental medicine, which began after President Nixon’s visit to China in 1972,
gathered strength and led to movements in various countries throughout the 1990s and 2000s to institutionalize
Oriental medicine, either within or separate from their existing medical care systems, against the backdrop of
conditions under which the Western countries groped for policies that might break the impasse in increasingly
serious health issues and Western medicine in advanced countries, particularly in the U.S. It was the People’s
Republic of China, however, that pushed the global diffusion of Oriental medicine as a national policy, and as
a result, Oriental medicine spread to and institutionalized in many countries around the world, where it is
now regarded as Traditional Chinese Medicine.
However, countries and regions other than China, including Japan, the Korean peninsula and Vietnam,
also have over 1,000 years of history using Oriental medicine, and throughout their own histories each country
has made unique developments that have contributed to the maintenance and promotion of the health of its
people.

In Japan, over 80% of western medical doctors now uses decoction, known as “Kampo”, in clinicalpractice, and acupuncture and moxibustion is performed as a clinical treatment that takes advantage of bothmodern and classical medicine theories.

In addition, there are researchers who study Kampo medicine andacupuncture-moxibustion professionally from the standpoints of classical and modern medicine, respectively,
and extensive excellent research has been reported.

The characteristics possessed by the decoction andacupuncture-moxibustion that have become so widely used in those countries was not known, however,including even in Japan, a situation that continues in no small way even today.
Concerned about this situation, we began publishing The Journal of Kampo Acupuncture and Integrative
Medicine (KAIM) in 2005 with the goal of telling the world about Japanese Kampo and Japanese acupuncturemoxibustion, to inform the world of the existence of Oriental medicine used broadly in Japan, which differsfrom Traditional Chinese Medicine, and explain the nature of Kampo to the world.
KAIM has been edited and printed in Japan, and published in the U.S. by International Institute of Healthand Human Services, Berkeley.

Each year we have held several editorial meetings, and over the years

published 52 issues in 13 volumes, along with special feature editions on acupuncture-moxibustion andKampo medicine.
Because of various circumstances, however, we will cease publication with this issue.
Although the extent to which we achieved our intended objectives might remain unknown, we believe wehave been able to enlighten the world about the existence and characteristics of Japanese Kampo andacupuncture-moxibustion.

Although our magazine has always been a work in progress, we hope that after

we have ceased publication a new magazine that will continue the purposes of this publication will arise.

Wealso hope that parties concerned with oriental medicine will be even more active in contributing articles tomagazines published in Europe and America, and Asia.

There are many people in Japan devoted to Oriental

medicine, and we believe – and hope – these individuals will pick up the baton and carry this work forward.
In closing, we wish to thank the many doctors and acupuncturists, pharmacists who have written for us,
and all of the people who worked so closely with us for the publication of this magazine, over the past 13 years.

Executive Editor: Shuji Goto
Associate Editors: Hiromichi Yasui
Shuichi Katai
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

1

Volume 13, Number 4 | Winter 2018

Report from WFAS Tokyo/Tsukuba 2016
“Acupuncture for Low Back Pain and Knee Pain in Middle
Age, an Anatomical Point of View”

Acupuncture & Moxibustion and outline its goals. For

1) The Japan Conference of Clinical Acupunctureand Moxibustion2) Department of Acupuncture, Faculty of Health
Sciences, Morinomiya University of Medical Sciences

2. Historical development of the Japan Conference of

this purpose I present one case report of a patient withlow back pain and knee pain.

Tomofumi Ozaki
Clinical Acupuncture & Moxibustion
The society was founded in 1960 under the name of"Japan Acupuncture & Moxibustion Electrical Skin
Resistance Study Group". It had the purpose of building

1. Introduction
The Japan Conference of Clinical Acupuncture &Moxibustion started out when in 1960 Bunshi Shirota
and othermotivated persons attempted toputacupuncture and moxibustion on a scientific foundationand gathered for that purpose under the guidance ofprofessor Tachio Ishikawa at Kanazawa University tofound its predecessor, the "Japan Acupuncture &Moxibustion Electrical Skin Resistance Study Group",
which in 1983 was then given its current name. Basedon the concept of "considering all treatment forms if they
are based on modern medical comprehension ofpathologies"

the

group

strovetoimprovethequalification of clinical acupuncturists. Up to now it has
actively exchanged information pertaining to casereports and clinical studies1) mainly among members.
Improving the qualification of acupuncturists, meaning
enabling

practitioners

toproperlycomprehend

pathologies, acquire appropriate therapeutic skills andpedagogic techniques requires first of all the acquisitionof basic knowledge about modern medical diagnostics,
understanding of pathologies and therapeutics toimplement the aforementioned skills. The reason for thisis the necessity to be able to communicate withphysicians and co-medical staff on the same level. In thiscontext a common medical record form for diseases
designatedasindicationsforacupunctureandmoxibustion like neck-shoulder-arm pain, low back andleg pain, shoulder joint pain, knee joint pain etc. has
been proposed. It has already been listed in text books
and is currently used in the education of acupuncture
therapists2,3).
Here I would like to briefly introduce the historicaldevelopment of the Japan Conference of Clinical2

a scientific foundation for acupuncture and moxibustion
based on the viscerosomatic reflex theory and the use of
the dermometer proposed by doctors Hidetsurumaru
and Tachio Ishikawa.
1983: Based on the concept that improving acupuncture
therapist qualification will also increase the value of the
medical services by these therapists and establish aposition of acupuncture and moxibustion in medical care,
the study group was renamed into "The Japan
Conference of Clinical Acupuncture & Moxibustion".
The conduction of clinical conferences seems to be theshortest way to improve the clinical capabilities ofacupuncture therapists. In other words, the group wastermed Japan Conference of Clinical Acupuncture &Moxibustion, because the understanding of pathologies
based on bedside interviews and examinations, judging
whether a given condition is an indication orcontraindication for acupuncture and moxibustion,
possible referral to medical specialists, assessing the
prognosis and determining the best possible treatment
form can be deducted from free discussions among
acupuncturists based on case studies.

3. Case study: current situation of a patient with low
back pain and knee pain and the acupuncture andmoxibustion treatment
The Comprehensive Survey of Living Conditions
conducted in 2013 reports the ratio of the five leading
symptoms among person reporting to have symptoms
classified by sex (several answers possible).
The leading symptom in men is low back pain, in second
place followed by shoulder stiffness, in third place by
nasal congestion, in fourth place by cough and sputum.

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

Volume 13, Number 4 | Winter 2018

The fifth most frequent symptom was pain of joints ofaccumulation and diarrhea. At times of diarrhea hearms or legs. On the other hand, the leading symptom insuffered from marked pain and tenderness in he left

women was reportedly shoulder stiffness, followed in

BL52 region. An x-ray taken during a visit to an

second place by low back pain, in third place pain oforthopedist showed a mild degree of scoliosis, thejoints of arms or legs4). Pain of joints of arms or legs

formation of bone spurs and the physician also pointed

should be understood as referring to the shoulder andout a mild degree of osteoarthritis of the spine (Figure 1).

knee joint. In other words, low back pain and gonalgia

Therefore the physician diagnosed "fatigue induced low

are considered to be a very common symptom amongback pain". Later, the patient experienced acute low

Japanese people.

back pain attacks once or twice per year. Each time theAmong the symptoms treated in acupuncture clinics

condition improved after acupuncture and moxibustion

many patients complain of low back pain and gonalgia

treatment.

and many of the patients over the age of 40 complainingof low back pain and gonalgia should be considered tosuffer from osteoarthritis of either the spine or the knee
(OA). Being characterized by irreversible elements these
conditionsarechronic

diseasestreatedwith

acupuncture and moxibustion in order to slow down
diseaseprogression,

alleviate

pain

and

improvefunctional disorder5,6).

4. Case report
Patient: dull low back pain and knee pain
Male, 60-years old, acupuncturist, height 173 cm, weight
68 kg, BMI 22.9
Chief complaint: (1) left low back pain, (2) discomfort
and pain of the left knee (ST35), low back pain (left >right)(1) Since the age of 20 the patient experienced chronic
dull low back pain and the muscle of the lumbar region
often tended to be tense. The left leg was the patient's
dominant leg and when he paid attention, he could feelshifting his body weight towards the left side. When
tired, a table tennis ball sized muscle induration
developed in the left lumbar region (BL52) and caused
pain. Pressure was felt as pleasant. Since the age of 40
work related busyness gradually increased, working
hours tended to be irregular and he slept only 4-5 hours,
so that the chronic lack of sleep had already become theabdominal

bloating(2) Since his time in university the patient loved to run
and formerly did jog and commuted 2-3 time per week toand cannot find any time for sports, rendering exercises● Medical history

condition.

(spondylopathy)

a gym for his health management, but now he is too busy

Interest: jogging

normalFigure 1: x-ray findings of the lumbar region

Occasionally
from

he

experienced

gastrointestinalgas

performed once every two weeks largely insufficient. His
weight gradually increased from 60 kg to 68 kg.
Since the age of 30 he participated maybe a dozen times
in full marathons. The gonalgia developed because heoriginally planned to run 100 km per months as training
starting 4 months ago. However, being busy with hiswork kept him from actually implementing the training
schedule and when he actually started training,
discomfort and gonalgia developed after running a
distance of approximately 5 km. An x-ray of the kneetaken during a visit to an orthopedist was normal(Figure 2). From this time onward overuse induced pain
was pointed out. He did not undergo any particulartreatment. He decided to observe the course while being

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

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Volume 13, Number 4 | Winter 2018

treated with acupuncture and moxibustion. The● General findings

acupuncture and moxibustion treatment provided someBlood pressure 110/70 mmHg, pulse rate 72 bpm,

relief. Later he experienced some mild knee pain after

brachial biceps tendon reflex, triceps tendon reflex,

excessive running. He also experienced some discomfort

brachioradial tendon reflex, patellar tendon reflex,of the left knee while walking and jogging, aggravating

Achilles tendon reflex were all normal, abdominal

after a certain distance and developing into pain duringpercussion showed generalized tympanicity, muscle

exercise. Climbing and descending stairs too resulted intension (left > right) in the lumbar region, loss of lumbar

mild pain. Due to injections into the thigh received

lordosis (Figure 3). A table tennis ball sized induration

during infancy there was a mild degree of quadriceps

and marked tenderness were observed in the vicinity offemoris muscle atrophy. Occasionally shoulder stiffness

the left BL52. Tenderness was also observed at CV12,developed.

ST25, ST26, BL17, BL18, BL25.

Figure 2: x-ray findings of the knee joint
General condition: The patient has appetite andexcessive eating sometimes causes abdominal bloatingor vomiting, sleep duration is short, about 4 hours, bowel
movement frequency varies between once every 1 to 3

Figure 3: Findings of inspection of lumbar region anddays.

knee of a 60-year old man

The annual health check does not show any particular
problems, but he had been advised to take precautions● Findings of physical examinations

against hypertension and pneumonia.

(1) Lumbar mobility (bending forward, backward,● Past history

sideways, rotation) was normal. The finger-floor

Surgery for left paranasal sinusitis, partial resection of

distance was 15 cm and although there was no pain, thebone because of a deviation of the nasal septum (at the

body was stiff. SLR test (-), K-Bonnet test（-）, Kemp's

age of 17), hospitalization for 17 days (at the age of 48)

sign (-), walking on tip toe (possible), plantar and dorsal

becauseorganizing

flexion of the first toe was normal on both left and rightpneumonia, laser photocoagulation (at the age of 50) forside, sensation too was normal on both sides, internal

right retinal tear, atypical pneumonia treated withand external rotation test of the hip joint (-), Newton's

Cravit,oftest (-), normal pulse of A. dorsalis pedis, tibialis

hypertension (at age 58) and is since then treated withposterior, femoralis, no percussion tenderness, FNS test

the antihypertensive agent UNISIA (Camshia) one(-). Tender points: left BL22 (+), BL25 (+), left BL52 (+3),

tablet in the morning.

tension of the erector spinae muscles left > right7).

4ofbronchiolitis

Carbocysteine(atobliterans

age

58),

diagnosis

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

Volume 13, Number 4 | Winter 2018

(2) No rubor, warmth or swelling of the knee joint, nopatient occasionally developed diarrhea, disrupting thevarus deformity, but there is a distance of 4 cm between

regularity of his daily life. His current condition

both knees, no valgus deformity (Figure 3), no flexion

conceivably developed before this background. The low

deformity, atrophy of the left and right thighs. The

back pain and gonalgia were conceivably caused by thesecircumference of the thighs (15 cm above the patella atvarious forms of stress. The low back pain was also

sites of marked indentations) was 47.4 cm on the rightbrought about by an accumulation of muscle fatigue, but

and 47 cm on the left; at a distance of 10 cm above theis basically due to some minor degree of spondylopathy

patella these values were 42 cm on both left and right;

and muscle fatigue. Here I decided to alleviate thecircumference at the level of the patellar base was 37.4

individual symptoms with acupuncture and moxibustion

cm on the right and 37 cm on the left, patellar ballotment

treatment and add some general conditioning.

(-), patella grinding test (-), varus / valgus stress test of(1) Relief of muscle tension in the low back area and overthe knee (-), Steinman test (-), McMurray's test (-),

the back, administering some comfortable needle

anterior drawer test (-), posterior drawer test (-),

sensation at the point of maximal tenderness (BL52). I

Lachman test (-), flexion impairment (-), quadriceps

also added treatment to regulate the gastrointestinal

femoris power (-). Tender points: ST31, GB31, ST34,

function.

SP10, particularly marked at medial Ex218).

(2) Treatment to achieve relief of muscle tension in the● Identifying the pathology

thigh and lower leg to alleviate pain, administering some(1) The x-rays of the lumbar vertebrae showed some

comfortable needle sensation at the point of maximal

minor osteophyte development and based on thetenderness (Ex-LE4).

presence of scoliosis and rotation of the lumbar● Treatment

vertebrae as well as the medical history and the absence

I used 40 mm No. 18 Seirin disposable needles andof positive pathologic findings, the condition was

needled mostly sites of tenderness or indurations10).

considered

age-related

Needling sites were BL10, GB21, SI14, BL43, LI10,

spondylophathy. Constant strain on the left lumbar

ST36, Ex-HN5. Each of these points were needledregion then led through overuse to hypertonic stress ofapplying some thrusting and lifting manipulation to

the erector spinae muscles etc., which then probably

obtain a pleasurable needling sensation. Treatment

resulted in myofascial low back pain.

duration was about 20 minutes.

tobemainlydueto(2) Knee x-rays were normal. Medical history andpathologic examinations allowed to rule out meniscus
damage or lesions of either the anterior crucial ligamentor the collateral ligaments. Injections the patient
received during infancy into the thigh caused a mild

Tenderness/indurations

GB31

degree of quadriceps femoris atrophy, but muscle testing
did not reveal any problems. Exercises like walking andrunning etc. likely strained the patient's knee. A mild
degree of soft tissue inflammation induced by overuse isalso conceivable9).

● Treatment plan
Being very busy with his work, a chronic lack of sleep,
paired with irregular meal times and excessive eating
and drinking caused gastric bloating or nausea. The
gastrointestinal functioning was not really well and the

Figure 4: Left BL52 needling and needling sensation
50 mm disposable needles, No. 24, insertion depth 4 cm
perpendicular to the body surface, with maximal
needling sensation
At GV20 a needle was retained until the end of thetreatment to raise the pain threshold and promote
sleeping. To regulate gastrointestinal function I madesingular insertions at CV12, ST27 and ST36.

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

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Volume 13, Number 4 | Winter 2018

(1) On the back thrusting and lifting manipulation at

Later acupuncture and moxibustion treatment was

BL17, BL18, BL20, BL22, BL25. Application of acontinued for maintenance at a rate of twice a week.

pleasurable needling sensation at BL5211).

During the treatments the quiet breathing of the(2) Singular insertions on the thigh at ST31, SP10, ST34,

sleeping patient could be heard and after the treatments

Ex-LE4, ST36, GB31; on the posterior side BL37, BL40,

he reportedly felt very refreshed. Even though he

KI10 and BL56. Needles were retained at ST31, ST34,

complained generally about occasional low back pain

Ex-LE4, ST36, GB31 and on the posterior side at BL37,

and stiff shoulders, acupuncture and moxibustion

BL40, KI10 and BL56.

treatment administered early after the onset of those

Needle retention for 7 minutes at ST31, SP10, ST34, Ex-symptoms usually led to an early improvement. He is

LE4, ST36, GB3112).

still very busy with his work and sleeps only about 5hours, but since the acupuncture and moxibustion

ST31

RectusfemorisTensor fasciae latae

Iliotibial tract
Biceps femorissartorius

BL37
GB31

VastusMedialissemimembranosus
SP10 ST34

semitendinosus
Vastus lateralis

Ex-LE4

KI10

BL39

ST35

Figure 5: Basic acupoints for the treatment of gonalgia

treatment has improved his general condition, theSeiichiro Kitamura et al.: Color Atlas of Local Anatomy fortreatment frequency was changed from twice a week to

Acupuncturists and Judo Therapist; Nanzando; 101-111

once a week. Even though the sleep duration has notchanged, he reported to sleep better recently and bothResults

appetite and bowel movements are well regulated. This

The muscle tension in the lumbar and femoral regions

gives the impression of a good health management.

decreased after the acupuncture and moxibustion
treatment and the patient reported a VAS 10 → 1
improvement for the low back pain and a VAS 10 → 5
improvement for the knee pain. The treatment effects
lasted for 2-3 days. After 3 days a similar treatment
resulted in a VAS 5 → 1 improvement for the low backpain and a VAS 5 → 1 improvement for the knee pain.
After the third session the VAS score improvement of 3
→ 0 was achieved for both low back pain and knee pain.

6

5. Discussion
1) Necessity for an accurate assessment of thepathology
BL40

Acupuncture and moxibustion is a treatment form witha long history and has been handed down as an
unbroken tradition. When acupuncturists practice basedon modern medical examination methods and with anunderstanding of pathology, they can accurately assess
the pathology of their patients, assess whether

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

Volume 13, Number 4 | Winter 2018acupuncture and moxibustion treatment is indicated or

acupuncture and moxibustion treatment lies. However,contraindicated, the question of whether the patient

the therapists should inform the patient prior to theshould be referred to a specialist, and holding

acupuncture

discussions with physicians and co-medical staff enables

importance of a regular daily life. Medical care basicallythem to cooperate in medical care. Also, in case thestrives to bring about improvement of symptoms or

conditionahealing, but the essence of acupuncture and moxibustion

contraindication for acupuncture and moxibustion

treatment does not restrict its attention to specific bodytreatment, it is necessary to recommend seeing a

regions or conditions, but rather aims at healthspecialist13).

management (maintenance) and the prevention of2) Tender points and needling points

diseases. Health is sleeping well, eating well and

The needling sensation elicited at the left BL52 induced

pleasantin this patient marked improvement. Acupuncture andmoxibustion treatment can maintain these three healthmoxibustion comprises many different techniques. We

factors10-14).

isconsideredorsuspected

tobeas acupuncture therapists use tender points or
indurations, motor points, trigger points etc. fortherapeutic purposes based on an anatomical point ofview. Treatment point locations often coincide withacupoints, but their selection is not restricted to oriental
medical examinations, but local tender points also
constituteusefulsourcesofinformation

for

an

assessment of the condition at hand and the actual
needling requires a search for the point of maximal
tenderness and identification of its accurate anatomical
location14).

3) Acupuncture and moxibustion treatment for local
and general symptoms
Three years ago this patient had suffered frompneumonia and thus was worried about his health.
While being in general confident about his health, he
was kept very busy and thus had to deal with chronic

and

bowel

moxibustion

movements.

treatmentof

Acupuncture

the

and

5. Conclusions
Above I briefly described The Japan Conference ofClinical Acupuncture & Moxibustion and offered myopinion about the merits of Japanese acupuncture andmoxibustion by presenting a case report. The basis for acorrect understanding of pathologic conditions byacupuncturists

is

the

acquisitionofknowledge

pertaining to modern medical examination techniques,assessment of pathologies and available therapies aswell as the careful observation of tender spots andindurations on the body surface. Acupuncture andmoxibustion treatment is not restricted to local
treatment, but can treat the whole body and thus
presents a holistic medical care allowing to include
health management and maintenance (reconditioning
treatment).

feelings of fatigue. On this occasion an extended period

6. Referencesof acupuncture and moxibustion treatment led to1.

Tomofumi Ozaki: Fifty years development of The

improved sleep and bowel movements, helping to relief

Japan Conference of Clinical Acupuncture andaccumulated fatigue. The treatment also increased theMoxibustion,

patient's awareness pertaining to health management

Acupuncture & Moxibustion, 27-1, 22-23, 2014

and daily efforts related to health maintenance. Clinical

2.

tasks

and

outlook,

Clinical

Sakae Yoneyama: Proposal for the commemorationacupuncture and moxibustion is characterized accordingof the 50th anniversary of the foundation of the The

to Hirohisa Yoneyama10) and Sakae Yoneyama14) not only

Japan Conference of Clinical Acupuncture &by treatment form for diseases, but also as a form of

Moxibustion – Is EBM required for clinicalhealth management, in other words for regularacupuncture and moxibustion? 27-1, 10-21, 2014

maintenance (reconditioning treatment) and the author
too is convinced, that this is where the real value of

3.

Katsuhiro Yamada: The future of clinical acupuncture
and moxibustion in Japan – The past, present and

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

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Volume 13, Number 4 | Winter 2018

future

of

The

Japan

ConferenceofClinicalAcupuncture & Moxibustion; 27-2, 21-37, 20144.

Yukari Ikeda, Satoshi Yamaguchi, Tomokazu
Kikuchi: The Japanese Journal of Japanese
Acupuncture and Moxibustion Therapies, 78-1,
161-166, 20195.

Hideki Ochi: Clinical research into gonarthrosis;
Osaka

JournalofClinicalAcupuncture&

Moxibustion; 18-4, 33-39, 2002
6.

Tadasu Matsumoto: Acupuncture and moxibustion
treatment for low back pain; Osaka Journal of
Clinical Acupuncture & Moxibustion; 13-4, 47-56,
1997 勅7.

Tatsunori Sakamoto: Low back and lower extremity
pain; Clinical Acupuncture & Moxibustion Pocket
Guide; Artemisia; 77-91, 20108.

Tatsunori

Sakamoto:

Acupuncture&

Gonalgia;

Moxibustion

ClinicalPocketGuide;

Artemisia; 94-107, 20109.

Ken Nakata: Listen to a leading authority in sports
research; Newest insights pertaining to thetreatment and care of the knees; The Japanese
Journal of Japanese Acupuncture and Moxibustion
Therapies; 78-1, 19－27, 201910. Hirohisa

Yoneyama:My

acupunctureandmoxibustion therapeutics; The Japanese Journal ofJapanese Acupuncture and Moxibustion Therapies;
Tokyo 1985
11. Tomofumi Ozaki: Watching the back of my teacher;
The Japanese Journal of Japanese Acupunctureand Moxibustion Therapies; 2005；738. 188-193
12. Toyoji Sakamoto, Seiichiro Kitamura et al.: Color
Atlas of Local Anatomy for Acupuncturists andJudo Therapist; Nanzando; 2016, 106・96; ST31
13. Masami Sato: Case reports about cooperation in
medical care with specialists for the knee joint; The
Japanese Journal of Japanese Acupuncture andMoxibustion Therapies; 78-1, 148-154, 201914. Sakae Yoneyama: Essentials of the treatment ofstiff shoulders - acupuncture and moxibustion
treatment for stiff shoulders -; CLINICIAN, 44-461,
36-44, 1997

8

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

Volume 13, Number 4 | Winter 2018

Clinical Report (Acupuncture)
A Case of Low Back Pain

Case Study
75 year old man
Akio Manabe

Acupuncture & Moxibustion Care Unit of East Asian
Traditional Medicine,
Ehime Prefectural Central HospitalFirst visit:
May 11th of X year
Chief complaint:
Left lumbago, right buttock pain, stiff neck(started from June of X-1 year)

Introduction
When we diagnose and treat our patients, we

Past History:emphasize on the time series data obtained frompatient's life and medical history.

By writing theinformation in the Chronological Chart (Fig.1), we
can find the relation between patient's life eventsand their chronic health problems and will be able tounderstand them structurally. This understanding is

Otitis media operation and tonsillectomy in hischildhood, decompression surgery for trigeminal
neuralgia in his 49 year old, hemorrhagic
operation in his 60 year old, treatment ofhypertension in his 69 year old, shingles on theright front forehead in his 71 year old.

comprehensive and useful for planning MITATE(diagnosis, treatment and prognosis) that weemphasize.

Figure 1
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

9Volume 13, Number 4 | Winter 2018

Present illness:
In June of X year, he went to see an orthopedic
doctor because he bruised the waist when heassisted his mother taking bath. He wasadmitted to the hospital because of a first lumbar
compression fracture for 40 days. After thedischarge his muscular strength fell down andhe had a lumbar pain and right buttock pain
while he bent or stood up. The orthopedic doctor
mentioned the reason not of lumbar fracture butof the muscle pain. He remembered that he wastreated well his right elbow pain in our
acupuncture and moxibustion care unit, so hedecided to come to see us again.
Living conditions:
He was running a company with wife and taking
care of a 95 year old mother living in theneighborhood in the same town.
Present status:
His height is 167cm and his weight is 67kg. His
blood pressure is 137/84mmHg(pulse 71c/s) andcontrolled well with telmisartan 40mg/day.
Subjective problem:
Severe coldness in his toes

Objective findings:
Straight leg raising and femoral nerve stretching
tests are within the normal range
Oriental medical findings:
Tongue diagnosis;
purple colored, extended sublingual veins,swelling tongue and tooth impression
Pulse diagnosis;
sunken pulse
Abdominal diagnosis;
umbilical tenderness and resistance near
ST27, weakness of the lower abdominal

region.

This means Kidney qi deficiency
Back diagnosis;
Small superficial vessels near GV4.
This means traumatic blood stagnation also
his many operations history.
Pressure sensitive hardening near BL17,
Pressure sensitive depression near GV11・
GV12. This means somatoform disorders
caused by the life stress of taking care of his
mother. Treatment: (Fig.2)

Figure 2
10(Fig.2)The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 13, Number 4 | Winter 2018

Our treatment for this patient is mainly as

Conclusion

follows.

When we treat our patient we emphasize on

1)

The traumatic blood stagnation was treatedtheir constitutional condition such as; traumaticby bloodletting of small superficial veinsstagnation, qui deficiency, and somatoform

near 命門(GV4).

disorder. These basic treatment prevent the

The Kidney qi deficiency was treated byrecurrence of their disease. As for this kind of

moxibustion on the top of needle near CV4.

diagnosis,

The somatoform disorder was treated byprevention) we call them together MITATE.

2)
3)

treatment

andprognosis(ordirect moxibustion on GV11・GV12.
4)

Moxibustion to right buttock pain, The pintof ONODERA buttock points.
The pint of ONODERA buttock points aregood for lumbago as well as stomach pain.

5)

The herbal medicine keishibukuryogan wasusedbecauseof

thetraumatic

blood

stagnation.
Clinical course:
The patient was treated every 2-4 weeks. Fourweeks after the first visit, left lumbago pain
decreased from 10 to 5 in numeric rating scale(NRS) and right buttock pain decreased from10
to 5.
After 3 months, the degree of left lumbago pain
decreased from 5 to 1, the right buttock was
painless and only dull feeling.
After treating for about a year, patients wereable to continuing self medication of moxibustion
at home, so treatment was terminated.

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

11

Volume 13, Number 4 | Winter 2018

Research Review
Adverse Effects of Kampo Medicine

considerable side effects [1] 。 In the past, whenunexpected incidents occurred by the administration

Toshiaki Makino1) and Hiromichi Yasui2)of Kampo medicine, those are not recognized as1) Department of Pharmacognosy, Graduate School of
Pharmaceutical Sciences, Nagoya City University,
Nagoya, Japan
2) Japan Institute of TCM Researchadverse effects but the drugs used are prescribedunder incorrect diagnosis in the patient's symptomor the essential worse reaction to make a fullrecovery. However, now the adverse effect of Kampo

In the past in Japan, when unexpected incidents
occurredbytheadministration

of

Kampo

prescriptions, those are not recognized as adverse
effects but the drugs used are prescribed underincorrect diagnosis in the patient's symptom or the
essential worse reaction to make a full recovery.
However,now

theadverseeffectofKampo

prescriptions are well recognized, and when it
happens, the medication should be stopped andsuitable treatment is needed. The most frequent
adverse effect occurred by Kampo prescriptions isgastrointestinal disorders, and rehmanniae radix,
gypsum, ephedrae herba, and angelicae radix
sometime cause. In addition, drug eruption andcystitis due to allergy sinetunes occur with several
kinds

of

crude

drugs.

Furthermore,varioussymptoms caused by the sympathetic stimulation ofephedrine

contained

inephedraeherba,

pseudoaldosteronism caused by glycyrrhizae radix,
aconitine poisoning caused by aconiti radix processa,
interstitial pneumonia and drug-induced liver injury
causedbyscutellariae

radix,

mesentericphlebosclerosis caused by gardeniae fructus has
been reported.

allergy,

pseudoaldosteronism,

interstitial

pneumonia, drug-induced liver injury, mesentericphlebosclerosis

treatment is needed.
Kampo formula is a mixture of several crude
drugs, and their adverse effects can be explained by
the crude drugs contained therein. The side effects
that can be caused by each crude drug are described
below.
1. Gastrointestinal disorders
The most frequent side effects of Kampo
medicines are gastrointestinal disorders. Typicalcrude drugs that induce gastrointestinal disorders
includegroundrehmanniae

radix,

gypsum,ephedrae herba, angelicae radix, cnidii rhizoma, andzizyphi spinosi semen. Among them, rehmanniae
radix often causes anorexia, epigastric discomfort,
epigastric pain, diarrhea, etc. Ephedrae Herba also
causes anorexia and epigastric pain.
Most of these symptoms usually relieve if the
drugs

are

basically

stopped.

Kampo

administeredprescriptions

beforemeals,

arebutadministration after meals may avoid to cause such

2. Drug allergy
It is known that some crude drugs easily cause
allergic reactions to the living body. The mostcommon symptom is on the skin (drug eruption).

Japan has a centralized medical system centeredon Western medicine, and Japanese traditional
Kampo medicine is also used in this system. In
recent years, with the spread of Kampo medicines, it
has been found that Kampo prescriptions also have12

the medication should be stopped and suitable

symptoms.

Keywords: Kampo prescriptions, adverse effects,
drug

medicines are well recognized, and when it happens,

Rash or pruritus is sometimes caused by cinnamomi
cortex, ginseng radix, astragali radix, rehmanniae
radix, tritici fructus, oryzae fructus, dioscoreae
rhizoma, and perillae herba [2; 3]. In addition tothese crude drugs, there are reports on crude drugs

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

Volume 13, Number 4 | Winter 2018

and prescriptions that caused a rash upon taking

3. Licorice-induced pseudoaldosteronism

drugs. Drug allergies occur not only in crude drugs

Glycyrrhizae radix is the dried root and stolon,

but also in Western drugs at a certain rate, so it iswith (unpeeled) or without (peeled) the periderm, ofnecessary to pay close attention to the patient's

Glycyrrhiza uralensis Fischer or Glycyrrhiza glabra

medical history in order to prevent the occurrence.

Linné (Leguminosae), and it is commonly called as
licorice root. This causes pseudoaldosteronism with

<Case report>

some frequency. Therefore, it is necessary to pay

The patient is a 56-year-old man. A few years ago,

attention to physical findings (edema, increased

renal function was pointed out, but a doctor at a

blood pressure) during the administration and tovisiting hospital told him that his serum creatinine

measure potassium in the blood regularly. In Europe,level was so high that hemodialysis would be needed

where licorice is used as a food additive sweetener,

soon. Then, he visited my clinic on May 6, 20XX. The

this side effect has long been reported [5-8]. In Japan,

serum creatinine level was 5.78 mg/dl. I prescribed

the incidence of pseudoaldosteronism due to Kampo

him for yojinkodakuto. Astragali radix was 20 g.

prescriptions was said to be higher rate among

Creatinine continued to fall as expected, reachingelderly women. However, this is not true, and2.16 mg/dl on July 31. However, at this point, aalthough there are large individual differences in thestrong pruritic rash appeared on his entire body, andonset, it occurs in all generations regardless of

I was forced to discontinue the prescription. His

genderserum creatinine level began to rise gradually,

pseudoaldosteronism depends to some extent on thereaching 3.85 mg/dl on November 28, but when I

amount of licorice intake, and when using Kampo

administered the same prescription instead ofprescriptions containing 2.5 g or more of licorice per

astragali radix, the rash appeared two weeks later,day, be sure to pay attention to the onset of this side

serum creatinine dropped to 3.21 mg/dl.

effect. In addition, licorice is the most commonlyatprescribed
In addition, drug-induced cystitis has beenreportedforsaireito,

shosaikoto,

a

fixed

crude

rate

drug

[9].

in

The

Japanese

onset

of

Kampo

prescriptions. There is a possibility that thesaibokuto,

combination of Kampo prescriptions may not besaikokeishito, seijobofuto, and unseiin. It has been

noticed, or exceed amount when combined with thereported that the administration of these Kampo

use of licorice as a food additive.

prescriptions caused cystitis-like symptoms, such as
dysuria,dysuria,

pollakiuria,

pusuria,

Symptomsofpseudoaldosteronism

includeandhypokalemia, increased blood pressure, sodium/bodyhematuria [2; 3]. The pathological condition is drug-

fluid retention, edema, and weight gain. In severe

induced cystitis, i.e., eosinophilic cystitis withcases, it causes myopathy and rhabdomyolysis.

eosinophil infiltration. Some allergic mechanism has

Therefore, attention should also be paid to weakness,been speculated. As of 2011, 90 cases of cystitis weremuscle pain, limb spasms and paralysis, CK (CPK),

reported due to Kampo prescriptions in Japan, andetc. When licorice is used, serum potassium levels

among these prescriptions, 80 cases are using

should be measured sufficiently. If abnormalities areprescriptions including scutellariae radix [4]. Theseobserved, the administration should be discontinued,

are rare side effects, and withdrawal of the drug

andoften improves the symptoms promptly, but careadministration of potassium agents should be taken

must be taken.

as necessary. It also improves when used inappropriate

treatments

such

as

the

combination with aldosterone antagonists such as
eplerenone [10].

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

13

Volume 13, Number 4 | Winter 2018

The component that causes pseudoaldosteronism

patient said that after taking this prescription, urine

caused by licorice is glycyrrhetinic acid (GA), a

was flowing only once. I thought this was a adverse

metabolite of glycyrrhizin contained in licorice byeffect of ephedrae herba and stopped it immediately,

11β-

and i changed my prescription to ryutanshakoto. The

hydroxysteroid dehydrogenase (11β-HSD) 2 present

dysuria disappeared, and the pain of the first toe ofinthe left foot gradually resolved.

intestinalrenalbacteria.
tubularGA

inhibits

epithelial

cells,

type
and

the

accumulated cortisol activates mineralocorticoid
receptors, thereby excreting potassium to promoteWhenadministering

Kampo

reabsorption of sodium and sodium, resulting incontaining

ephedraetohypokalemia [7; 8]. However, since GA appears as a

circulatory disorders such as angina pectoris andmetabolite in the blood of all patients who takemyocardial infarction, with severe hypertension,licorice, it cannot explain the individual differences

renal

in the occurrence of pseudoaldosteronism, so a

hypertrophy, prone to insomnia, careful observation

search for a true causative substance instead of GA

and discretion should be taken not to exacerbate

was conducted, At present, glycyrrhetinic acid-3-O-

these diseases and conditions. The incidence of thissulfate, another metabolite of glycyrrhizin, isside effect has individual differences and dose-

estimated to be the causative substance [11], anddependency to some extent.

disorder,herba

prescriptions
patients

hyperthyroidism,

withprostatic

hypoalbuminemia is considered as one of the risk
factor to cause pseudoaldsteronism [12].

5. Aconite poisoning
Aconiti radix processa is the dried tuberous root

4. Palpitations, tachycardia caused by Ephedraeof Aconitum carmichaeli Debeaux or AconitumHerbajaponicum Thunberg (Ranunculaceae) prepared byEphedrae herba is the dried terrestrial stem of

the following processes. 1: Autoclaving. 2: Heating orEphedra sinica Stapf. This crude drug contains

autoclaving after rinsing in salt or rock salt solution.

ephedrine that is a similar chemical structure to

3: Treating with calcium hydroxide after rinsing inadrenaline and has a mixed sympathetic nervous

salt solution. Before processing, contains aconitine,system effect. The bronchodilating activity resulting

mesaconitine, etc., has strong analgesic activity, buttherefrom can be said to be a scientific basis for thealso has strong toxicity [13; 14]. By heat-processing,

medicinal effects of ephedrae herba, but adverse

aconitine and mesaconitine were hydrolyzed toeffects sometimes occur including hypertension,

become benzoylaconine and benzoylmesaconine,tachycardia, palpitations, insomnia, and urinary

respectively, and their toxicity were reduced about

retention.

1,000-fold

[14].

The

Japanese

Pharmacopoeia

describes the upper limits on the contents ofaconitine and mesaconitine in aconiti radix processa,<Case report>
68-year-old man. Two days ago, he arrived mythat makes it relatively safe to use, but may still

clinic due to severe pain accompanied by swelling at

cause poisoning in sensitive patients. The initial

the first toe of his right foot. Until now, it was

symptoms of sticking poisoning are numbness andpointed out that the uric acid level was high, but hepalpitations, and the patients with those symptoms

said that he had left it alone. I diagnosed a goutneed to stop using or reduce the dosage. Among theattack, and prescribed eppikajutsuto extract. The

preparations of aconiti radix processa marketed inpatient came to my clinic the next day, and although

Japan, some manufacturers produce the contents ofthe pain in the left first toe was alleviated, theaconitine and mesaconitine near the upper limit to14

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

Volume 13, Number 4 | Winter 2018

have high analgesic effect, but these products may

preparations is currently contraindicated. In aeasily cause side effects. On the other hand, thesurvey of Tsumura ethical shosaikoto extract

active ingredient of aconiti radix processa for

preparations from October 1995 to March 1997, 69

neuropathic pain is not the highly toxic alkaloid, butcases (2.8%) out of 2,495 patients were reported toneoline, an alkaloid that does not hydrolyze. [15].

have adverse effects including abnormal laboratory

Therefore, even if the heat treatment is performed

test.

well to completely decompose highly toxic alkaloids,<Case report>[18]it is also useful for neuropathic pain.

A 71-year-old woman was hospitalized with adiagnosis of pneumonia. She had fever, cough,<Case report>[16]The patient is a 78-year-old woman. Since X–31

dyspnea, and diffuse granular reticular shadows inyear ago, she has suffered from rheumatoid arthritis.

both lung fields on chest X-ray. I suspected summer-

She visited my clinic in the year X. Administration

type hypersensitivity pneumonitis, but I chose noofof

medication since the condition is not but. However,

unprocessed aconiti radix markedly improved her

her condition had been further exacerbated, I

joint pain and laboratory findings. However, thesuspected

joint pain was exacerbated on October 7th, X+2 year.

medications were discontinued and prednisolone

Then, the drug was changed to uzuto decoction

was administered. Chest X-rays improved markedly.

containing 4.5 g of unprocessed aconiti radix. On

Transbronchial lung biopsy showed interstitial

October 11th, one hour after the oral administration,

pneumonia, and lymphocyte stimulation test showedshepharyngeal

positive for shosaikoto. The challenge test revealed

strangulation, and vomited three times. Since thefever, hypoxemia, and the appearance of interstitialheart rate dropped to 60/min and the blood pressure

pneumonia on chest X-ray. This case report appears

dropped to 90 mmHg, blood vessels were secured andto be the first of drug-induced pneumonia caused by

the electrocardiogram was monitored. Although heshosaikoto.

daibofuto

decoction

developed

blurredcontaining

eyes

and

4.5

g

drug-induced

pneumonia,

and

all

did not receive any special treatment, it improved as
Following this report, the similar adverse effects

it was.

were seen in more than 15 Kampo extract
6. Interstitial pneumonia and drug-induced liver

formulations including scutellariae radix that is theinjury

dried

root

of

Scutellaria

baicalensis

Georgi

These side effects of Kampo medicines have been

(Labiatae), from which the periderm has beenreported since 1989. Prior to that, it may have been,

removed. Then, it was speculated that this adverse

but never mentioned. Of particular note was theeffect was probably due to scutellariae radix. It isreport that 88 patients who took Shosaikoto

predicted baicalin, which is contained in scutellariae

developed interstitial pneumonia in the three years

radix in relatively large amounts binds to albumin tosince 1994, of which 10 died. However, its frequency

become hapten, and that the sensitization isis extremely low, and according to Homma's research,

established. However, this is only a prediction andthe frequency of occurrence is almost 100,000 per 4

future research is required.

people / year [17]. Among them, most of the patients

Scutellariae radix has also been suspected to

had chronic hepatitis B and C, and interferon wascause drug-induced liver injury. Some patients have

used

the

increased ALT/AST in a short time after taking

concomitant use of shosaikoto and interferon

scutellariae radix [19]. Although the frequency isinalmostallpatients.

Therefore,

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

15

Volume 13, Number 4 | Winter 2018

extremely low, it is often asymptomatic. Therefore, it

Althoughinterstitial

pneumonia

and

drug-

is desirable to conduct a liver function test within a

induced liver injury caused by Kampo prescriptions

few weeks after administration of the preparation.

are not so frequent, these adverse effects should be

In addition, the cases of fever have been reported.

noted. When fever, cough, dyspnea, or abnormal lung

Fever is also a subjective symptom, and is relatively

sounds (fine crackles) appears, the administration ofeasy to find. It is reported by Terashi et al. [20].

Kampo prescriptions should be discontinued, chest

At present, about 40 kinds of Kampo formulas

X-rays should be immediately examined, and thethat caused liver disorders, and about 30 kinds ofappropriate treatment such as the administration of

Kampo formulas that caused lung disorders havecorticosteroids should be performed. It is also

been reported. It is said that these cases arenecessary to conduct liver function tests regularly torelatively common in the elderly, but this is notprevent drug-induced liver injury.

always the case, and the cause is thought to be due
to a specific constitution such as allergy. Therefore,

7. Mesenteric phlebosclerosis caused by gardeniae

the only way to prevent these adverse effects is tofructuscarefully detect and respond to the history of drug orItfood allergies at the time of drug administration.

has

been

reportedthat

mesentericphlebosclerosis caused by Kampo prescriptions. In

interstitial

2013, the Research group funded from Ministry ofpneumonia: Shosaikoto, daisaikoto, saikokeishito,

Health, Labor and Welfare conducted national

saibokuto,

Formulasreported

to

cause

saireito,

saikokeishikankyoto,

survey, and reported that over 80% of mesentericsaikokaryukotsuboreito,

hangeshashinshinto,

phlebosclerosis patients took Kampo prescriptions

hochuchuekkito,

containing gardeniae fructus. More than 90% of thegoshajimkigan, seihaito, shin’iseihaito, junnchoto,patients had taken the drugs more than 5 years [21].

seishinreshiin, boiogito, bofutsushosan, otsujito,

Gardeniae fructus is the dried fruit of Gardenia

shoseiryuto,

bakumondoto,

keigairengyoto,jasminoides Ellis (Rubiaceae). There are manysanoshashinto,

Kampo formulas containing gardeniae fructus, but

shakuyakukanzoto, daikenchuto, ryuchoshakoto.

the special attention is needed for eight formulas

Formulas reported to cause drug-induced

such as kamishoyosan and orengedokuto. If theliver injury and jaundice: Otsujito, daisaikoto,patients who have been taking these prescriptions

shosaikoto, shosaikotokakikyosekko, saikokeishito,

for 5 years or more have repeated abdominal pain,

saikokaryukotsuboreitoto,

diarrhea,

orengedokuto,
nijutsuto,

yokukansan,

unseii,gorinsan,saikokeishikenkyoto,

constipation,

abdominal

bloating,saibokuto, saireito, orengedokuto, sanmotsuogonto,

nausea/vomiting, or have positive fecal occult blood

shakuyakukanzoto,(asymptomatic),

hangeshashinto,

unseiin,itisnecessarytoconduct

shoseiryuto, maobushisaishinto, kakkonto, seihaito,

colonoscope and CT inspection. If there are

seijobofuto,

shin’iseihaito,

bakumondoto,

characteristic symptoms such as dark purple ornyoshinsan,

keishibukuryogan,kamishoyosan,bronze color on the mucous membrane at the rightrikkunshito, hochuekkito, ninjinyoeito, daikenchuto,colon, linear or dotted calcification along the colon

nijutsuto, juzentaihoto, boiogito, bofutsushosan,

wall or mesenteric vein on CT, the calcification ofjunchoto,

goshajinkigan,

venous wall and the increased collagen fibers in the

keigairengyoto, seishinrenshiin, yokukansan,

histopathology, the drugs should immediately beryutanshakanto,

discontinued. The prognosis is generally good by thegoreisan.

inchinkoto,sanoshashinto,

goshuyuto,

withdrawal of Kampo prescription, but it takes along time to improve fibrosis and calcification. In the

16

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

Volume 13, Number 4 | Winter 2018

case

of

long-term

administration

of

Kampo

and children is clinically experienced, it is better toprescription containing gardeniae fructus, it isuse

lactose-freedesirable to conduct a fecal occult blood test, regularsymptoms

colonoscopy once every 1 to 2 years, simple

gastroenteritis.

of

Kampo

preparations

prolongedfordiarrhea

the
after

abdominal CT test, etc. [22].
9. Aristolochic acid-induced kidney injury and cancer
It was reported in Belgium that people who took

<Case report>[22]The patient is a 65-year-old woman. In July in X

weight-loss herbal preparations developed kidney

year, she visited my hospital to take Kampo

injury that required dialysis and transplantation

medication for hepatitis C. Initially, hochuekkito had

between 1990 and 1992 [25]. In this preparation,

been

Aristolochia fangchi (Aristolochiaceae) that contains

administered,saikokeishikankyoto,

and

then

changedkeishibukuryogan,

to
etc.

aristolochic

acid,

which

are

nephrotoxic

andThereafter, the dosage of gardeniae fructus was

carcinogenic, was found. In Japan, there have been

temporarily reduced to 5 g/day, but had been soon

some case reports of kidney injury caused byreturned to 15 g/day and continued. At X+13 year,

Tokishigyakukagosyuyushokyoto preparation using

her cumulative intake of gardeniae fructu was 5,379

the stem of Aristolochia manshuriensis as ang for 9.4 years. There were no findings such as

ingredient instead of akebiae caulis, the dried stem

abdominal pain, abdominal distension, abdominalof Akebia quinata Decaisne or Akebia trifoliata

tenderness, etc., but under the patient's consent,

Koidzumi (Lardizabalaceae), and herbal dietarycolonoscopy was performed in May in X+17 year.

supplements containing aristolochic acid [26; 27].

Blue pigmentation and mild edema were observed on

At present, the distribution of crude drugs

the mucosa of the cecum, ascending colon, andcontaining aristolochic acid is banned not only intransverse colon. Histopathological test also showed

Japan but also in other countries. Therefore, it isincreased submucosal collagen fibers in the cecum,

thought that the toxicity of aristolochic acid will not

ascending, and transverse colon. This confirms theoccur with regular drugs. However, the possibility todiagnosis of mesenteric venous sclerosis

use the products distributed in unregulated internet
market or the old herbal product before ban is

8. Lactose allergy and intolerance

undeniable, care must be taken account.

Drug adjuvants such as excipients are containedin Kampo extract prescriptions. Commonly used

Conclusion

excipients are lactose, starch, cellulose and so on.

As descried above, Kampo medicines also haveAmong these, lactose contained only a small amountmany adverse effects. Diarrhea caused by rhei

of milk-derived protein as an impurity, which could

rhizoma, the dried rhizome of Rheum palmatum

be a problem for milk allergy patients. However,Linné (Legminozae), etc. or sal mirabilis, a mineraleven patients with relatively severe milk allergy

substance, mainly composed of sodium sulfate

have no abnormalities in the results of oral lactose

hydrate (Na2SO4•10H2O) is not adverse effect but

tolerance test [23]. Lactose intolerance has been

the excessive mistaken dosage. However, in clinicalreported to be less than 1% in ethical Kampo

practice, a wide variety of adverse effects from very

prescriptions using lactose as an excipient [24].

slight allergies to severe liver damage has been

Therefore, it is considered to be of little concern

experienced. These can be can be led quickly in aclinically.

lactoseshort period without any serious situation if theintolerance such as after gastroenteritis in infants

physician and pharmacist find it and perform

However,sincesecondary

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

17

Volume 13, Number 4 | Winter 2018

appropriate

treatment

immediately.

Careful9.

Yoshino, T, Yanagawa, T, Watanabe, K (2014)

observation is the best way to deal with adverse

Incident of pseudoaldosteronism. The generaleffects.

meeting of Medical and Pharmaceutical Society
for Wakan-yaku Abstracts. 8: 60.
10. The Japanese Society of Hypertension, 2009.

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2.

Shimada, Y, Fujimoto, M, Nogami, T, Watari, H,

Guidelines for the management of hypertension.

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11. Hirasawa, A, Mitamura, M, Maki, Y, Ishiuchi, K,

Patient safety incident reports related toMorinaga, O, Yasuji,a, T, Yuasa, H, Makino, T

traditional

medicines:(2018) Exploration of genuine causative agents

medication errors and adverse drug events in aof licorice-induced pseudoaldsteronism part 3.

university hospital for a ten-year period. BMC

The

generalmeetingofComplement Altern Med 17: 547.

PharmaceuticalSocietyfor

Motoyama, O, Shigetomi, Y, Ohara, A, Iitaka, K

Abstracts 09: 115.

Japanese

Kampo(2002) A boy with recurrent hemorrhagic cystitis

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Suzuki, O, Watanabe, K (Eds.), Drugs andLicorice-induced

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19

Volume 13, Number 4 | Winter 2018

Book Review
Dr. Otsuka’ s “30 Years of KAMPO“Such clinical style of Dr. Otsuka takes over the
tradition from the Edo period. System1 with Clinical

Hiromichi Yasui

Pearls as its background is emphasized, on the otherJapan Institute of TCM Researchhand, System2 which needs theory such as TCM israrely used in that book. Providing only description

Dr. Keisetu Otsuka summarized his case reports

of facts without theory. This is fresh even from theand wrote a book entitled "Kampo Shinryo 30 Nen (30viewpoint of modern medicine, due to its objectivity.

Years of Kampo)” in 1959 following 30 years of

There are also Clinical Pearls created by Dr. Otsuka

practice in Kampo medicine treatment. There is nohimself some sections of the book, and some very

TCM

interesting descriptions.

(Traditional

Chinese

Medicine)

theorymentioned in any case report out of a total number of
374 cases in this book. In each case, only thesymptoms and signs of the patient and theprescription used are described. He did not write
down anything about pathological theories or reasonsfor choice of the prescriptions on each case. One day, I

This book conveys the wonderfulness oftreatment of Kampo medicine around the late
1920s to the late 1950s when Western medicine was
not yet producing sufficient results. What we canasked him, "Why did you not write down the reasons

get from this book is bigger than what we imagine.

for using the prescriptions?" Then he answered, "Such

I sincerely thank Dr. Hong-Yen Hsu from Taiwan

a thing will be considered by the latter person."

who translated this book into English.

“30 Years of Kampo”
Japanes original

20“30 Years of Kampo”
English version

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)Make the most of Kampo in modern medicine

Foundation: 1905
A century of tradition ――――We are a manufacturer consistently controlling the entire process fromthe import of crude herbs to the manufacture of Kampo extracts and assuch have contributed to the development of Japanese Kampo.
We sincerely hope to continue in the future with our contribution tomodern medicine through "Kampo".

OHSUGI Pharmaceutical Co., Ltd.

1-1-2 Tennojicho, Minami, Abeno-Ku, Osaka, Japan
Phone: +81-6-6693-3301

The crude drugs like many other creatures on earth areraised by bountiful NATURE.
Humankind earns as well grace from Mother Natureand is blessed as a member of natural world.
PROFILE of

TOCHIMOTO

Since Tochimoto was appointed as aJapan-China friendship trading firm in
1963, we have expanded our businessoverseas, mainly with China.
We import a variety of quality-controlled
natural resources from all over the world
for maintaining wellness.

TOCHIMOTO TENKAIDO CO., LTD.
3-21 Suehiro-cho, Kita-ku, Osaka 530-0053, JAPANwww.tochimoto.co.jp