Volume 9, Number 2 | Summer 2014

Kampo Medicine - Current Research
Clinical Applications of Kakkonto – Part 2

also be applied to some cases of hypertrophic
rhinitis and nasal polyp. It may also be used for

Hiromichi Yasui

recurrences after surgery and when symptoms do

Japan Institute of TCM Research

not improve.”1) Additionally, Hosono et al. write as
follows regarding the emergence of effect: “For such

Kakkonto is a prescription that first appeared in
the great Chinese classic Shokanron (treatise on cold
damage) and came to be widely used in Japan fromthe latter half of the 19th century. Particularly since
Yodo

Odai

(1799-1870)

introduced

variousindications for the prescription, it has become afrequently-used prescription that is applied to a wide
variety of diseases.

nasal conditions, kakkonto commonly works byincreasing the amount of nasal discharge over the
first several days and even making the discharge
even thicker and more purulent than usual, andthereafter gradually decreasing the nasal discharge
so that is becomes less thick and eventuallydisappears.”2)

Byomei Kampo chiryo no jissai (practical Kampo
therapy

Clinical applications (continued)
In Shokanron, indications for which kakkonto isused are acute infectious diseases. However, fromJapan’s more than 150 years of experience, kakkonto
is known to be a prescription that is effective for an
extremely wide range of indications and is todaybydiseasename)defines

kakkontokasenkyushin’i as the basic prescription
for acute rhinitis, and recommends the addition of

kikyosekko (Platycodi Radix+ Gypsum Fibrosum;in the case of viscous rhinorrhea) or yokuinin(Coicis Semen; in the case of watery rhinorrhea).3)
Hanawa writes that for chronic sinusitis, using

below, in continuation from the previous issue.

kakkonto alone has a sharper effect than
kakkontokasenkyushin’i4), and notes that because
kakkonto has a strong drainage effect, using it

3. Rhinitis, allergic rhinitis, sinusitis

when the discharge opening is blocked sometimes

applied to many diseases. These are introduced

Kakkonto is widely known to cure inflammatory
diseases of the face, such as the ears, nose, throat
and eyes, and is frequently used for this purpose. A
particularly large number of cases has beencauses a severe headache because the discharge has
nowhere to go.4) He also reports that due to thisdischarge effect, there was a case where a child withnasal allergy took the prescription with goodreported regarding diseases of the nose.

progress but the closing of his wound after surgery

Kampo shinryo iten (dictionary of Kampo
medicine) mentions the application of kakkonto forthis reason, he warns that kakkonto may be used insinusitis as follows: “It is used in the initial stage ofthe acute phase, and works well when used for such
symptoms as fever, heavy head, nasal obstruction,
purulent discharge, and stiff shoulders.”1) It also
states that “For cases that become chronic, 2.0g
each of kakkonto+senkyu (Cnidii Rhizoma), ogon
(Scutellariae Radix), kikyo (Platycodi Radix), andshin’i (Magnoliae Flos) are used. For cases thathave a tendency of inner heat or constipation, 5.0g

sekko (Gypsum Fibrosum) and 0.5 to 1.0g daio
(Rhei Rhizoma) are added. The preparation may

6

for acute appendicitis took longer than usual.4) For
cases where there is a natural discharge route, but
if not, it should not be used readily.4)
Chronic sinusitis
The following cases have been reported regarding
chronic sinusitis. Kakkonto is frequently used as adecoction blended with something else. There arealso many cases of kakkontokasenkyushin’i andkakkonkajutsubuto. Kikyosekko extract or yokuinin
extract are also added to kakkonto in some cases.

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

Volume 9, Number 2 | Summer 2014

temperature of 37.8°C. She had a floating andCase 1: Chronic sinusitis

slightly rapid pulse.

Patient: 13-year-old girl
The patient suffered nasal congestion, rhinorrhea

When she was given kakkonto with 10.0g of

and a heavy head that persisted for several years.

Yokuinin, her face suddenly felt lighter in the

There was nothing to note in particular in her family

morning after taking the prescription at night, andmedical history or past medical history. Height

she slept soundly. As she woke up, a large amount of

151cm, weight 43kg, both eardrums normal. Herpus poured out to her throat. Furthermore, after fivenasal mucosa was red and slightly swollen, and adays of taking the preparation, no new inflammation

large amount of discharge and viscous secretion wasappeared in the affected area, and the patient

observed in both nasal passages. The pharynx had

completely forgot about the pain. Yokuinin was

mucosal redness and postnasal discharge. Paranasal

added to kakkonto, as it has drainage and analgesic

sinus X-ray examination found a moderate shadow

effects.
Keisetsu Otsuka, Shoukou ni yoru Kampo chiryo no

in both maxillary sinuses.
Diagnosis: Chronic sinusitis of both paranasal

jissai (practical Kampo therapy based on symptoms, p.

sinuses21, Nanzando, 1963

Observation of present illness from the perspectiveof oriental medicine: Medium build, somewhat wellmuscled, good facial complexion, floating and tense

Allergic rhinitis
Meanwhile, kakkonto is also effective against
some types of allergic rhinitis. In Kampo shinryo iten,

pulse, slightly dry tongue.
A daily dose of 5g kakkontokasenkyushin’i was

it is written: “Some types of allergic rhinitis that isprescribed as the symptoms suggested an excessive

accompanied by constant stiffness in the shoulders,pattern.

susceptibility to colds and frequent sneezing, may be

Afterapproximatelytenweeks,

thedischarge from both nasal passages decreased

treated by this prescription (kakkonto).”5)

significantly, nasal congestion was alleviated, and an
improvement was seen in the shadow that appearedin the paranasal sinuses in the sinus X-ray
examination.

Case 1: Allergic rhinitis
44-year-old male. From around four years ago, thepatient began to experience bouts of sneezing, runny

Shigeto Osako, Cases of chronic sinusitis, Gendai nonose and minor eye irritation in spring, which lasted

Kampo chiryo (modern Kampo therapy), p. 582, Toyofor roughly a whole month. He was diagnosed with

Gakujutsu Shuppansha, 1985

cedar

pollenallergyandsomehowkept

the

symptoms at bay with Intal nasal drops and an
Case 2: Maxillary empyema

antihistamine.

However,

becausetakingtheA 39-year-old woman with chronic maxillaryantihistamine made him sleepy and lethargic such

empyema complained that the right side of her facethat he could not concentrate on his work, he visited

began to hurt intensely since a few days ago such

us four days after a bout occurred. He had a steadythat she cannot eat or sleep at night.

pulse, stiffness at the back of his neck and no

An examination found that the center of her rightdyspepsia, dry mouth or coldness, so he was told toupper jaw was swollen to the size of the tip of atake kakkontokasenkyushin’i extract for a week.

thumb and was slightly red. Even rubbing the area

Efficacy of the prescription appeared immediately

caused strong pain. Her right nasal cavity wasafter taking it, and the patient’s bouts completely

blocked, and her right shoulder was particularly stiff.

disappeared in four days. He said he was able to

She sometimes felt chills, and had a high bodyspend the spring season this year in comfort.

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

7

Volume 9, Number 2 | Summer 2014

Katsutoshi Terasawa, Shin Kampo shohou manual(new Kampo prescription manual), p. 54, Shibunkaku

Case 1: Nasal congestion caused by taking anantipsychotic drug
16-year-old male student in his first year of highShuppan, 1991

schoolFamily medical history / Past medical history:

Case 2: Allergic rhinitis
A 28-year-old woman complained that, since

Nothing in particularseveral years ago, she was prone to sneezing for a

History of present illness: From around May 1990

while every morning after she woke up. It was minor

when the patient entered high school, he began toin summer but worsened from autumn to winter. Her

suffer from paranoia, thinking that others are trying

doctor diagnosed her with allergic rhinitis and gave

to set him up. He pushed himself to go to school, but

her medicine, but she said the sneezing still has not

on August 1, he was told by a friend that he isstopped.

“gloomy.” This triggered a sense of strong anxiety in

The patient is a tall, fair-skinned, plumpish

him, to the point that the thought of suicide crossed

woman. Her pulse was slightly floating but not rapid.

his

Her abdominal pattern showed that a spot above thehospitalization on that same day.

umbilical region that was sensitive to pressure. I

Progress in hospital (Fig. 1): A general biochemicalgave her kakkonto for this. No changes were

blood examination and neurological examination

observed over the first seven days, but her symptoms

conducted

improved

completely

abnormality. Diazepam (DZP) and thioridazine (TR)disappeared after four weeks, and she experienced

were administered, and in roughly two weeks, theno frequent sneezing after that.

patient’s paranoia and anxiety abated. Suddenly on

after

two

weeks.

They

mind.

He

therefore

upon

had

hospitalizationanemergency

showedno

Keisetsu Otsuka, Shoukou ni yoru Kampo chiryo no

August 26, he displayed psychomotor agitation,jissai (practical Kampo therapy based on symptoms), p.

punching the wall while yelling, “I’m famous. I’ve

73, Nanzando, 1963

done nothing wrong. Why is everyone saying suchbad things about me?” The erroneous perception

Nasal congestion as a side effect of a psychotropic

disappeared in roughly four weeks, after injections

drugof haloperidol (HP) and levomepromazine (LP) andKakkonto is also used at times for nasal

oral

administrationofmainlyLP.

However,congestion that is not caused by inflammation. For

immediately after administering HP and LP, severe

example, there are cases where it has been usednasal congestion and mouth dryness emerged. Fromagainst nasal congestion that occurred as a side

the perspective of otorhinolaryngology, a slighteffect of an antipsychotic drug.

swelling of the nasal mucosa was observed. Theofpatient was therefore given kakkonto (daily dose of

kakkonto extract by administering the extract to five5g). On the following day, the nasal congestion

patients of schizophrenia who developed nasal

improved so that he was able to breathe more easily,congestion as a side effect of an antipsychotic drug.

and disappeared after about a week of taking the

As a result, he reports that two cases showed marked

prescription. The patient gained consciousness of the

improvement,disease and was discharged on October 4.

Akira

Kurokouchi

twostudied

cases

the

showedefficacy

moderate

improvement, and one case with a history of chronic

Akira Kurokouchi, The efficacy of kakkonto on nasal

sinusitis showed slight improvement, and that nocongestion caused as a side effect of an antipsychotic

side effects were observed whatsoever.6)

drug, Kampo Medicine, Vol. 43, No. 2, pp. 79-83, 1992

8

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

Volume 9, Number 2 | Summer 2014

Other nasal diseases

4. Otitis media and others

Kakkonto is also used for nasal polyps. Hanawa
recommends kakkonto or kakkontokasenkyushin’i

indications to use kakkonto. In Kampo shinryo iten,

for allergic nasal polyps (type I allergy).7) There is a

it is written as follows: “Use [kakkonto] when there

famous case in which Yodo Odai (1799—1870) used

is pain inside the ear, chills, fever and headache ina prescription of kakkonto blended with otherthe initial stage, and the pulse is floating andsubstances for a patient with chronic sinusitis

strong. It may also be used when the patientaccompanied by nasal polyps. In roughly half a year,

complains of stiff shoulders or displays symptoms

the nasal polyps dropped off and a sudden

resembling those of meningitis. If the symptoms

improvement was seen.8)

accompany vomiting, add 5.0g Hange (pinellia

Symptoms of acute otitis media are frequently

Additionally, there are reports of cases in whichtuber), and if the patient complains of severe

kakkonto was used for such symptoms such as

dryness of the mouth, add 3.0g kikyo (Platycodi

snoring caused by rhinitis and erosion of the skin

Radix) and 5.0g sekko (Gypsum Fibrosum).”9)

below the nose due to nasal discharge.

Cases that have been reported to date are
introduced below. Case 5 is a case of discomfort

Case 1: Pediatric snoring caused by hypertrophic

around the auricular region and not a case of otitis

rhinitismedia, but it has been included as a case related to

The patient was a four-year-old boy. His firstthe ear.

medical visit was in June 1965. Immediately after
birth, he became susceptible to colds, and when he

Case 1: A patient who developed otitis media from acame down with a cold, it was habitual for his nosecold

to become blocked, produce a large amount of

A two-year boy developed otitis media after

discharge, and bleed. An ear, nose and throat doctor

catching a cold and was seeing an ear and nose

treated him for hypertrophic rhinitis and tonsillitis,

doctor, but he came to see me at the recommendation

but he was not cured. Moreover, he was the talk ofof a neighbor. His chief complaint was the discharge

his family because he had stiff shoulders and snoredof pus from his left ear. This was verified, but there

profusely even though he was only a child. He also

was nothing else of particular note. No abnormality

complained of stomach aches sometimes, had night

was seen in his defecation or urination, and he had

sweats from his neck to head, and had a palea healthy appetite. He was given kakkonto, and on

complexion although he had good nutrition. Both of

the third day, the pus stopped, and he washis abdominal rectus muscles were tense.

completely cured after three weeks.

To treat the patent’s stiff neck and nasal blockage,

Keisetsu Otsuka, 30 Years of Kanpo, Sogensha, 1959

kakkonto extract powder 1.0g was administered
twice. The prescription works well when it works,

Case 2: Tubal obstruction (?)

and the patient no longer caught a cold after taking

37-year-old female

it. His nasal blockage lightened considerably, heAround six to seven years ago, the patient says

became able to breather more easily, and the awful

her hearing became poor and her ear began to feel

pediatric snoring completely disappeared, thereby

blocked, causing her pain. Furthermore, the sound of

making the entire family happy.

her breathing echoed strongly in her ear, and at theDomei Yakazu, Kampo chiryo hyakuwa (hundredstories of Kampo therapy), Part 5, p. 200, Ido-noNippon-Sha, 1971

same time, her voice became a falsetto voice.
Since then, she complained that the same
symptoms occurred whenever she rode an airplane.

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

9Volume 9, Number 2 | Summer 2014

When I asked if she has a bad nose, she did notknow, but she said she often has a runny nose.
An examination found her to be of medium heightand build with an abdominal strength that was

Yet after another three weeks in mid-spring, thepatient said her symptoms of allergic rhinitis that
occurred every year, such as runny nose and blocked
nose, were extremely minor this year.

slightly weak, minor clapotage and palpitation in the

Around three-and-a-half months after taking theepigastric region, and “Otsuka’s point of smallprescription, the patient said she felt stronger andresistance and tenderness just above the umbilicus.”

did not tire as easily as she used to, which she did

This small resistance and tenderness just above

not claim in the beginning, and the redness of her

the umbilicus is an abdominal pattern that Dr.

throat that was seen in the beginning of spring had

Keisetsu Otsuka defines in Kampo shinryo iten as adisappeared. As predicted, her deficiency patterntarget of kakkonto. However, the figure in the bookand chronic inflammation in the nose and throat

is difficult to understand. I have therefore provided

were of an allergic nature.

my own definition of “Otsuka’s point of resistanceand tenderness just above the umbilicus” as theAround four months later, she said her ear wasfine even when she rode an airplane.

cord-like

After six months, when she was climbing down

anatomical white line is felt above the naval whenfrom the mountain on a hiking trip, her right ear

pressed in small circles with the tip of the index

began to hurt. She feared a recurrence of the disease

finger or middle finger in perpendicular direction toand sought the attention of a nose and ear doctor, but

the linea alba and that area is a source of pain to theshe was diagnosed with otitis externa, and waspatient, and regard it as an indication for kakkonto.

relieved that it was irrelevant to her previousThis

disease.

abdominal

patternmaydifferwhere

slightly

a

short

from

Dr.

Otsuka’s

explanation, but it generally holds true as the target
for kakkonto.

The patient, being an eager person, took theprescription for a year and continued to seek medical

I suspected that because this patient had rhinitis,pressure changes in high places probably made her

attention for quite some time after that before
terminating the prescription.

susceptible to tubal obstruction, and judging by her

Terutane Yamada, Kampo no shinryo to chiryo

abdominal pattern, I diagnosed her as having a(Ouyou-hen) (Kampo examination and treatment

kakkonto pattern. However, her abdominal pattern(Advanced edition)), p. 45, Taniguchi Shoten, 1993

trended slightly toward deficiency, so I added 3.0g
Jutsu (Atractylodis Rhizoma), and to reduce the

5. Tonsillitis and pharyngitis

inflammation of her rhinitis and salpingitis (?), I also

Tonsillitis is generally said to be caused by thedecided to add 1.5g each of senkyu (Cnidiui

invasion of the wind-heat pathogen, but it also

Rhizoma) and kikyo (Platycodi Radix).

occurs when a person with heat accumulation (liver

The result was such that approximately two
weeks later, she had less nasal discharge, and she nofire and stomach heat) is invaded by an external
pathogen (whether it is wind-cold or wind-heat).

longer blew her nose as much as she used to,

Kakkonto alone is usually not effective against

although she admitted that she still had somepharyngitis and tonsillitis, and in many cases,

postnasal discharge.

gypsum is added, or other measures are taken to

Afteranothertwo

weeks,

therhinorrhea

disappeared, and the postnasal discharge becamealmost negligible.

dispel the accumulated heat. Extract preparations
should be supplemented with kikyosekko extract.
In Kampo shinryo iten, it is written as follows:“Use [kakkonto] when the patient has a fever and

10

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

Volume 9, Number 2 | Summer 2014

sore throat in the initial stage, to promote

Chief complaint: Finger tremor, pain in both eyes,

perspiration. If the patient has a high fever, add 2.0g

tearing,kikyo and 10.0g sekko ; if vomiting occurs, add 5.0g
hange (Pinelliae Tuber). This preparation iseczema on both palms.

commonly used for 1 to 2 days...”10)

treated for one-and-a-half years but is receivingeyedischarge,

photophobia,

vesicular

Past illnesses: Syphilis—The patient has beenongoing

treatment.

Arteriosclerosis—His

blood

pressure has increased to around 150/100 since a few

Case 1: Pharyngitis
18-year-old female; first visit on August 1973

years ago, and is causing heaviness of the head,

The patient had a sore throat since the night

insomnia, etc. to come and go. Due to sciatica on the

before, and said it was red and swollen. She also had

right side, he has pain from his right hip to lower

stiff shoulders and a temperature of 37.2°C. She didright leg that still persists. Since a few years ago, he

not cough or feel nausea, and had an appetite,began to experience fine finger tremors on bothalthough she did not each much. She also had a

hands along with high blood pressure, a condition

headache. She was given kakkonto+kikyo+sekko

that also still persists. Three years ago, he had

and told to take it after gargling. After taking two

surgery for cholelithiasis.

doses,

Present symptoms, history of present disease andsheforgot

about

the

pain,

and

her

progress: The patient was being treated in hospital

temperature also went down.
Tomie Omura, Kampo chikenrei (Kampo clinicalfor the above diseases. In early May, he suddenly

trials),developed a strong reddening of the conjunctiva in

Journal of Kampo Medicine, Vol. 22, No. 6, p. 37, 1963

both eyes, eye pain, photophobia and eye discharge
along with stiffness in both shoulders. A culture testof the eye discharge and a drug resistance test were

6. Conjunctivitis

Kakkonto is used against diseases (particularly

performed, and as a result, short bacillus was found.

inflammatory diseases) that are relatively close to

He was thus told to apply a few drops a day of an

the surface of the eye, such as the eyelid, conjunctiva

antibiotic eyedrop and steroid eyedrop. However, as

Kampo shinryo iten notes thatindications for kakkonto are found in the initial

this had no effect, internal medicine, including anstage of stye, marginal blepharitis, dacryocystitis,

administered but only slight improvement was seen,

conjunctivitis,

and the patient was not completely cured. Thisandcornea.

trachoma,andconjunctival

antibiotic and anti-inflammatory drug, were alsosuggested that he had bacterial conjunctivitis

phlyctenule.12)

Yunokiryu ganryou hidensho (secrets of Yunoki-accompanied by an allergic reaction. The stiffness instyle eye treatment), a book on ophthalmology fromboth shoulders was severe, so all Western medicine

the Edo Period, writes about the application of

was canceled with the aim of alleviating the

kakkonto preparations (such as Rhei Rhizoma) toinflammation in both eyes and the stiffness in the

inflammatory diseases such as of the conjunctiva

shoulders, and a switch was made to Kampo therapy.

and cornea. Ganka ichikagen (personal views of

The patient was administered 6g/day of kakkonto

ophthalmology) also contains cases of clinical trials

extract for three days, but already on the second daythat used kakkonto.

the symptoms in both eyes and entire body markedly
improved. The inflammation in the eyes, eyedischarge and other symptoms virtually disappeared,

Case 1: Conjunctivitis
Patient: 58-year-old male. Occupation: Gardener.
Small, slender build.

and the finger tremors and vesicular eczema on both
palms

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

improvement,

so

the

11

Volume 9, Number 2 | Summer 2014

prescription was continued for another week. The

they had disappeared before she realized it. Thispatient was thus cured of almost all symptoms

time, the same trigeminal neuralgia on the left side

except for the sciatica on the right side. This was

occurred from last autumn, but the pain was more

improved only somewhat and was not cured, so theintense than before. Clear saliva kept flowing inside

patient is continuing to take the internal medicine

her mouth, but she could not move her mouth due to(total of 10 days so far).

the pain and could neither swallow nor throw up.

Hiroshi Nishimura, Shorei hokoku (case reports),

Progress in Kampo Medicine, 1968 Vol. 7, p. 14, 1968

Presently, she is receiving various treatments by adoctor specializing in neuralgia, but hardly any
improvement has been seen. Recently, she said herhead hurts, and even a slight touch of her lips feels

7. Trigeminal neuralgia
With regard to this disease’s indications forlike an electric shock and is extremely painful. She

kakkonto, it is written in Kampo shinryo iten that“[kakkonto] is used in the initial stage of

can open her mouth only slightly, so she cannot talkdevelopment of trigeminal neuralgia, to achieve a

because she can neither chew nor swallow solids. In

condition characterized by a strong pulse andthis state, she says her shoulders, and especially her

tension in the muscles.”13) Kakkonto is thus

left shoulder, have become extremely stiff.

as she wishes, and all she can eat are liquid meals

commonly used in the initial stage of development of

The patient has sallow skin and complexion thatthe disease, but it is also effective in chronic cases if

give the impression of fluid retention. Her pulse is

the conditions are right.

rather sunken and somewhat string-like, tense andSaito conducted a study on 141 patients of

rapid. The pulse above her spleen is particularly

trigeminal neuralgia and reported that among 18

weak (spleen deficiency pulse). She has pressure

patients who were given kakkonto alone, thepain in the right Hiyu (bladder) point. Her tongue

prescription was non-effective or unreliable in 14

has a thick white coating and is well moist. When I

patients (77.8%) but significantly effective andtouch her abdomen, she cries out that it hurts, so I

effective in 2 patients each (total 22.2%).14)

cannot examine her abdomen carefully because theTayama et al. report that among 50 patients ofpain increases when I have her lie down. Even so,

idiopathic trigeminal neuralgia and symptomaticthe abdominal wall was found to be somewhat

facial pain (treated by the nerve block method andbloated with fat and water, and the skin at the corner

analgesic administration), 12 patients were givenof her lower left abdominal region was extremely

kakkonto with the result that kakkonto was effective

sensitive.

in 4 patients each of the two diseases.15)

tenderness in the left iliac region (abdominalI

suspected

resistance

and

sharp

These findings suggest that a certain rate ofindications for Tokakujokito). I therefore swiftly

efficacy could be achieved even if kakkonto isapplied Okibari needle patches to the left Kyousha

administered regardless of pattern.

(stomach) point and the left and right Rekketsu(lung) points, Okibari embedded needle patches toCase 1: Trigeminal neuralgia on the left side (female)the right Hiyu (bladder) point, and moxibustion to

Two years ago, the patient developed a severe

the Ketsuinyu (bladder) point (both sides). The paincase of trigeminal neuralgia in her left cheek. Her
doctor said that pain was coming from her teeth andpulled out her teeth one after the other, but her
symptoms did not improve at all. Even so, after
receiving shots in her mouth, gums and on her face,12

immediately subsided to a certain degree.
I

also

administeredadecoctionofkakkontokasojutsubushi (Puerariae Radix 4.5g,
Ephedrae Herba 2.5g, Cinnamomi Cortex 3.0g,
Paeoniae Radix 4.7g, Glycyrrhizae Radix 2.0g, Ziziphi

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

Volume 9, Number 2 | Summer 2014

Fructus 3.0g, Zingiberis Rhizoma 4 cloves, Atractylodis

Lanceae Rhizoma 5.5g, Aconiti Radix Processa 1.0g =Case 1: Facial palsy
A 56-year-old woman suddenly developed facial
palsy ten days ago. She complained that she could

daily dose).
Two days later, some signs of improvement
appeared. It is not certain whether the drug or the

not close her left eye, her mouth drooped on one side,and she felt depressed.

acupuncture took effect, but acupuncture was

Her pulse was floating and large, and she said herapplied some more to the Yoryosen (GB34) point, theneck was stiff, but there were no other abnormalities.

Rinkyu (GB41) point and the Tanyu (BL19) point on

She was given kakkonto. After taking five doses, sheboth sides. This, however, aggravated the patient’s

was 90% cured, and after another five days, she wascondition. Acupuncture stimulation was apparently

completely cured.
Keisetsu Otsuka, 30 Years of Kanpo, p. 119, Sogensha,

excessive.
I then administered kakkontokasojutsubushi
withslightlydifferent

ratiosofingredients(Atractylodis Lanceae Rhizoma 8.25g, Aconiti Radix

Zingiberis Rhizoma 5 cloves,
Puerariae Radix 7.0g, Ephedrae Herba 4.0g,
Cinnamomi Cortex 5.0, Paeoniae Radix 7.0g,
Glycyrrhizae Radix 1.5g, Ziziphi Fructus 4.5g = daily

Processa

1959

1.5g,

9. Temporomandibular arthrosis
The temporomandibular joint, or jaw joint, iswhere the middle yang (stomach) meridian flows.
Thus, when considering that it is a part of the middle
yang parts of the body, it is understandable why

kakkonto is used for this disorder.

dose) for two weeks.
Thereafter, I received good news from Tokyo. The

Kazuo

trigeminal neuralgia that was so painful gradually

kakkonto

subsided since taking the preparation, and thetemporomandibular arthrosis and observed thepatient became able to more or less eat and talkclinical efficacy two weeks later, with the result that

normally. However, she noted that she sometimes

out of 28 patients, the preparation was significantly

experienced stinging pain at unexpected moments,

effective in 6 patients (21.4%), effective in 7 patients

so I sent her three weeks’ dose of the previous(25%), somewhat effective in 9 patients (32.3%) andpreparation. When I saw her again in Tokyo, she was

non-effective in 6 patients (21.4%).17)

more than 90% better, and in about a month, she was

Onuma

Sano

et

extract

et

al.

al.

administered

granulestoadministered

Tsumurapatientsofkakkonto andcured, and her symptoms seemed long-forgotten.

Kamishoyosan to 50 patients of temporomandibular(@Tokyo clinic)

arthrosis and report that the prescription brought an

Shiro Hosono, Kampo igaku jikko (lectures on Kampo
medicine), p. 91, Sogensha, 1982

improvement or more in 80.0% of the patients, with
5 patients showing a marked effect, 35 patients an
improvement effect, and 10 patients no effect.18)

8. Facial palsy

Kakkonto is good for facial palsy in its initialstage of development. In Kampo shinryo iten, it is
written as follows: “Use [kakkonto] in the initial

Case 1: Temporomandibular arthrosis

stage of development. It is especially effective

Thereafter, he felt dull pain whenever he chewed oragainst facial palsy that occurs after a cold. The

yawned, so he visited our clinic. He could only open

target is a condition characterized by a strong pulse

his mouth 23mm without pain. A tenderness wasand tension in the muscles.” 16)observed in his left jaw joint and masseter muscle,

16-year-old male. From around two weeks ago, apain emerged in the patient’s left masseter muscle.

and there was pain ein his left jaw joint whenever he

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

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Volume 9, Number 2 | Summer 2014

moved his jaw laterally to the right. He also had stiff

osteoporosis for the past ten years. She sometimes

shoulders.

ofcomplained of stiff shoulders and headaches, but

kakkonto, and although there was still someinternal and external anti-inflammatory analgesics

tenderness a week later, it was gone after two weeks.

had improved them. From early-September of 1993,

He became able to open his mouth 54mm, and theshe developed a stiffness from the back of her neckstiffness in his shoulders also disappeared. The

to shoulder blades and a dull headache that felt as

clinical result showed marked efficacy.

though she were wearing a pot on her head. She was

He

was

administered

7.5g/dayKazuo Sano et al., Gakukansentsusho to kakkonto

diagnosed with tension-type headache (muscle(temporomandibular arthrosis and kakkonto), Kampo

contraction headache) and given 1.5mg etizolam

Medicine, Vol. 23, No. 1, p. 25, 1995

(divided into three portions), 150mg eperisonehydrochloride (divided into three portions) and 3.0g
pyrine analgesic (divided into three portions).

10. Headache
As with the mechanism of stiff shoulders, when

However, her symptoms failed to improve, and she

fluid from the neck does not flow, the muscle is notcomplained of nausea and vomiting, so she wasnourished, and when muscle tension becomes severe,administered 7.5g Tsumura goshuyuto extracta headache occurs in addition to stiff shoulders. In

granules (medical use) to be taken in three portions

most cases, this is a tension-type of headache.

before each meal.

Kakkonto also has the effect of curing such

However, no effect was observed, possibly because
the pattern was not right. The patient went toheadaches.
Yoichi Hashimoto et al. administered 7.5g ofanother hospital to receive a head CT examination

Tsumura kakkonto extract granules (divided into

because she was worried about an intercranial lesion,

three portions) to patients who complained of abut no abnormality was found. An occipital nerve

tension-type headache and examined the efficacy

block drug was also used in combination, but it wasfrom the subjective and objective viewpoints. Given

non-effective. The patient complained of stomachthat “marked improvement,” “improvement” orpain from taking the analgesic, so the analgesic was“slight improvement” were observed in more thancanceled, but because she had an excess pattern of

80% of the patients, he stated that kakkonto had a

stiff shoulders, she was newly given 7.5g Tsumura

greater effect on people who had greater muscle

kakkonto extract granules (medical use) to be taken

tension.19)

in three portions before each meal. From the second

Additionally, Hosono states that headaches thatday of taking the prescription, the headache andoccur from sinusitis are sometimes improved withstiffness in the shoulders improved and completely

kakkonto preparations and gives two case examples.

disappeared a week later. Presently, she is happy

There are thought to be many types of headaches

that she could treat her stiff shoulders and headachethat could be improved with kakkonto, but few cases

solely with kakkonto, without taking a muscle

have been reported, possibly because such cases arerelaxant or analgesic in combination.
Hiroaki Tanaka, A case in which kakkonto was

too ordinary.

effective for tension-type headache, Kampo Shinryo,

Case 1: Tension-type headacheVol. 12, No. 12, p. 5, 1993

75-year-old female. Height 152cm, weight 61kg,
sturdy and solid build. No cold sensitivity.
History of present illness: The patient has been
receiving treatment for high blood pressure and

14

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

Volume 9, Number 2 | Summer 2014

References
1)

Keisetsu

Otsuka,Domei

Yakazu,TotaroShimizu: Kampo shinryo iten (dictionary of
Kampo medicine), p. 250, Nanzando, 1963.
2)

Shiro Hosono et al.: Seikoen Clinical Report 6.
Clinical practice for headaches, Collection of

discussions written by Shiro Hosono, Vol. 3, p.
167, Gendai Shuppan Planning, 1995.
3)

Shozo Bando: Byomei Kampo chiryo no jissai(practical Kampo therapy by disease name),
Medical Yukon Publishing, p. 421, 2002.

4)

Hisashiko Hanawa: Kampo chiryo no ressun(Kampo therapy lessons), p. 206, Kanehara
Shuppan, 1995.

5)

Keisetsu

Otsuka,Domei

Yakazu,TotaroShimizu: Kampo shinryo iten (dictionary of
Kampo medicine), p. 248, Nanzando, 1963.
6)

Akira Kurokochi: The efficacy of kakkonto on
nasal congestion caused as a side effect of an
antipsychotic drug, Kampo Medicine, Vol. 43, No.
2, pp. 319-323, 1992.

7)

Hisahiko Hanawa: Kampo chiryo no ressun(Kampo therapy lessons), p. 205, Kanehara
Shuppan, 1995.

8)

Yodo Odai: Seikan igen, Part II, 1868.

9)

Keisetsu

Otsuka,Domei

Yakazu,TotaroShimizu: Kampo shinryo iten (dictionary of
Kampo medicine), p. 243, Nanzando, 1963.
10) Keisetsu

Otsuka,Domei

Yakazu,TotaroShimizu: Kampo shinryo iten (dictionary of
Kampo medicine), p. 253, Nanzando, 1963.

11) Keisetsu Otsuka: 30 Years of Kanpo, p. 122,
Sogensha, 1959.
12) Keisetsu Otsuka, Domei Yakazu, Totaro
Shimizu: Kampo shinryo iten (dictionary of
Kampo medicine), pp. 215-223, Nanzando, 1969.
13) Keisetsu Otsuka, Domei Yakazu, Totaro
Shimizu: Kampo shinryo iten (dictionary of
Kampo medicine), p. 158, Nanzando, 1969.
14) Takao Saito: Trials of Kampo administration fortrigeminal neuralgia, Gendai no Kampo chiryo(modern Kampo therapy), pp. 308-310, Toyo
Gakujutsu Shuppansha, 1985.
15) Fumitaka Tayama et al.: Sansashinkeitsuu tokakkonto (trigeminal neuralgia and kakkonto),
Science of Kampo Medicine, Vol. 8, No. 11, pp.
19-23, 1984.
16) Keisetsu Otsuka, Domei Yakazu, Totaro
Shimizu: Kampo shinryo iten (dictionary of
Kampo medicine), p. 165, Nanzando, 1963.
17) Kazuo Sano et al.: Usage experience of kakkonto
for temporomandibular arthrosis, Journal of theJapanese Society of Oral and Maxillofacial
Surgeons, Vol. 33, No. 8, pp. 204-210, 1987.
18) Katsuhiro Onuma et al.: Clinical study of the
combined use of kakkonto and kamichoyosan for
temporomandibular arthrosis, Abstracts of the
41st annual meeting of the Japan Society for
Oriental Medicine, p. 46, 1990.
19) Yoichi Hashimoto et al.: Study of the efficacy of
kakkonto for tension-type headaches, Abstractsof the 45th annual meeting of the Japan Society
for Oriental Medicine, p 213, 1994.

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