Volume 3, Number 4 | Winter 2008

Kampo Medicine - Current Research
Can Hypertension be Controlled with Kampo Medicine?
Hiromichi Yasui
Japan Institute of TCM Research

performance with decoction formulations.
Hypertension treatment started only when anenvironment was built to enable the measurement ofblood pressure. Thus, it makes sense that hypertension
treatment did not exist in ancient China. Fine-tuned

Introduction

delicate treatment of hypertension has eventually“Whether or not hypertension or high blood pressure

become practicable in the present time when bloodcan be controlled with Kampo medicines” is anpressure can be measured with a sphygmomanometer.

important and interesting question. To this question,

Furthermore, today disorders caused secondarily bystudies conducted in the past have provided almost nohypertension

answers. On the other hand, there are not a few caseantihypertensive drugs of fine quality have emerged.

havebecomeknownandvarious

reports describing the results of its successful control

As it stands now, Kampo medicines are rarely usedusing Kampo medicines. Further there are the results“as antihypertensive drugs” in the typical healthcareof case-series studies available, although very limited

setting. It is often the case, however, that Kampo

in number. Thus it cannot definitively be said thatmedicines

Kampo medicines have necessarily no effect at all.

accompanying a variety of symptoms. For the condition

Current situation in hypertension treatment withKampo medicines
Namiki of Chiba University says about theindication of Kampo therapy for hypertension as
follows:[Hypertension for which Western-style medicines are
the first-line agents]
a. Essential hypertension without subjective symptoms
b. Hypertension with severe complications

haveeffects

onmildhypertension

under which antihypertensive drugs cannot be used inanticipation of side effects, the use of Kampo medicine
needs to be taken into account.
Introduced hereunder is Yoshinori OTSUKA’s own
case. Otsuka showed, for the first time in Japan,
effectivenessandpotentiality

ofhypertension

treatment with Kampo medicines.
Experience by Yoshinori OTSUKA (1900-1981)
Yoshinori Otsuka, one of the most distinguishedc. Secondary hypertension

physicians who played a leading role in the Japanese[Hypertension for which Kampo medicines has theKampo medicine during a period from the middle to theindication]

latter half of the 20th century, realized for the first timea. GradeⅠ(mild) Hypertension (140-159/90-99mmHg)

that his blood pressure was high when he had fundalb. Hypertension with an intense psychosomatic

hemorrhage.

tendency (for instance, some cases of white coat

hypertension were not elucidated as in the present days,

hypertension)and good antihypertensive drugs were seldom available.

c. Hypertension in the elderly with its accessory

In such condition, having a visual threat, he devised asymptoms

formulation and got over the difficulty. There is a welld. As a particular case, hypertension complicated byknown episode about him as below:

Inhisdays,manythings

about

visceral fat obesity
I (Otsuka) began to feel dizzy, sigh in the afternoon,
In Kampo therapy that uses conventional extractand have hot flashes leading to headache between

formulations, the Namiki’s standards are regarded astimes from about summer of 1951 when I was 51 years

beingpractitioners.

old. In autumn, lowback pain occurred and it became

However, if Kampo practitioners are very abledifficult to roll over. Even putting on my socks in thespecialists,

mornings also became painful. At the time, my blood

12

very

commontheyforcould

Japanese
producemuchbetter

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

Volume 3, Number 4 | Winter 2008

pressure might have been very high, but I thought thatthese would go away before long as they were from

80mmHg.
When I told Dr. Baba, then Prime Minister’s doctor,
about

fatigue, and I continued to see patients as usual.
On March 20 of the following year, it was raining. Iwas not able to see things clearly and thought it
unusual. But I persuaded myself to think that it was so
because the weather was not clear and I was still
uncareful. It was in the morning of May 31; when I
looked at words on a framed picture from the bed’sposition, something was apparently strange. With theright eye closed, I was able to see almost nothing.
Although it was very odd, I still did not realize it wasocular fundal hemorrhage.
However, I felt uneasy about it and visited anearby ophthalmologist. The physician told me that it
was severe fundal hemorrhage, bleeding wasseemingly taking place for quite a long time, and athis,henamedtheformulationasshichimotsukokato.
This Otsuka’s experience has assured Japanese
Kampo physicians that hypertension can be controlledwith Kampo medicines. After this, many cases werereported and many studies were conducted, including
the one by Mori and Miyazaki. Their study reports only
successful cases. I will present their study, although notRCT, as it will serve as a useful reference for futurestudies.
Study by Mori and Miyazaki
Mori and Miyzaki selected the patients withhypertension based on the following criteria forpart of the blood formed connective tissues.

conducting a study. They added their consideration toEverything was too late. The eyesight did not get

their study.

recovered but rather deteriorated at an accelerating

The subjects were 57 patients with hypertension

pace. Two months later, I was unable to distinguish(male 17 cases, female 40 cases, average age 66.6) who

whether it was light or dark.

visited their clinics during a month from July 1, 2003

The records of my blood pressure in those days
showed no records till April 4th, 147/90mmHg on April
5, April 10 175/105mmHg, April 15 158/90mmHg, andMay 25 170/l04mmHg. The highest levels were marked
on April 10 and May 25. What concerned me wasthehigh diastolic pressure.
During that time, I used the formulations such as

to July 31, 2003, had treatment with Kampo medicines
alone and achieved the target blood pressure levels.
Mori and Miyazaki studied on classification ofhypertension, risk classification Table1, improvementof associated symptoms, dosing pattern, dosing method,and side effects based on the ”Hypertension Treatment
Guidelines 2000” prepared by the Japanese Society ofhachimijiogan, orengedokuto, yokukansan, shakanzoto,

Hypertension. Target blood pressure levels were set atsaikokaryukotsuboreito, and kairosan. However, they

below 130/85mmHg for young adults, the middle aged,

were unable to stop the progress of the condition. So,and individuals with accompanying diabetic disease; inafter thinking a lot, I created my own new formulation

the elderly, below 140/90mmHg for 60s, below

with the composition of shimotsuto plus Uncaria Uncis

150/90mmHg for 70s, and 160/90mmHg for 80 or more.

Cum Ramulus, Astragali Radix, and Phellodendri

The age distribution of the subjects was 45 to 87,Cortex.

and the elderly of 60 or more accounted for 71.9%.

I started using my formulation on May 30. The bloodpressure

ontheday

was140/90mmHg.

(Table2)Then

126/86mmHg on June 3, 136/86mmHg on June 4,114/80mmHg on June 5, and 120/80mmHg on June 6 –the systolic pressure became below or above 120mmHg,
and the diastolic pressure also became below or above

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

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Volume 3, Number 4 | Winter 2008

Table 1

Classification of Hypertension & Risk Classification

Risk factors otherthan blood pressureof classification ofhypertension

Mild hypertension(140-159/90-99mm Hg)

Moderate
hypertension (160179/100-109mmHg)

Severe hypertension(≧ 180/≧110m mHg)

No risk factors exist.

Low riskIntermediate risk

High risk

Risk factors otherthan diabetes exist.

Intermediate risk

Intermediate risk

High risk

Diabetes or organ
disorderorcardiovasculardisease exists.

Classification
hypertension,ofrisk

classification, and details ofcomplications of the subjects
are shown in Table 3. Under
theclassificationofhypertension, there were 50
High risk

High risk

High risk

subjects in the mild group(87.7%), 7 in the moderategroup, and nil in thesevere group. In terms of the risk classification, 38
Table 2 Age Distribution of Subjects

subjects were classified under the low risk group

45 to 59 years old:

16 subjects (male 5/female 11)(66.7%), 14 under the moderate risk group, and 5 under60 to 69 years old:

20 subjects (male 6/female 14)

the high risk group. There were complications in 18

70 to 79 years old:

15 subjects (male 4/female 11)

subjects

80 to 87 years old:

6 subjects (male 2/female 4)neuropsychiatric

or

30%

of

all

diseaseinincluding4

subjects

andImprovement

factorsofhyperlipidemia in 3.

Table 3 Details of Subjects
Classification of Hypertension:

collateral

Mild- 50 subjects / Moderate–7 subjects/ Severe–not applicable.

symptoms

associatedwith the treatment with only
Kampo medicine are shown in

Risk Classification:
Low risk-38 subjects / Moderate risk-14 subjects / High risk-5 subjects
Complication of Other Diseases:

Table 4. The number of subjects
who had associated symptoms was56, except for one. Associated

Neuropsychiatric disorder-4 subjects / Hyperlipidemia-3 subjects /Diabetes-2 subjects / Cardiac disease-2 subjects / Bronchial asthma-2
subjects / Others – 5 subjects

symptoms were mostly headaches,
stiffnessinthenape,stiffshoulders, and insomnia, and theseverityof

these

symptoms

Table 4 Improvement Factors of Collateral Symptoms Associated withTreatment with Kampo Medicines aloneimproved by more than half in all

Symptoms improved by nearly half (The condition became 5 from 10):

improvement from “substantiallyMale-2 subjects / Female-4 subjects

Total 6 subjects

Symptoms substantially improved (The condition became 2-4 from 10):
Male-9 subjects / Female-16 subjects

Male-5 subjects / Female 20 subjects

subjects,

Total 25 subjects* Assuming the condition before the use of Kampo medicines is 10,
degrees of improvements with Kampo treatment are shown in figures.

andtherateofimproved” to “resolved” was 82.9%.
Longer the administration, greaterthe improvement.

Total 25 subjects

Symptoms mostly resolved – Resolved (The condition became 0-1from 10):14

subjects,

Dosing pattern is shown in
Table 5. Group A, or the group ofKampo medicines alone from theoutset, had 32 subjects (56%).
Group B, or the group that

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

Volume 3, Number 4 | Winter 2008

initially used Kampo medicines and Western-style

say how soon the effect appeared.

medicines in combination but later changed to Kampo

However, the result of this study suggests that themedicines alone, had 13 (23%). The severity ofapplication of Kampo medicine alone is useful in thedisorders in many of the subjects in Groups A and B

elderly/mild hypertension/low risk. These are mostly

was mild with a high or intermediate risk. And Group

matches with Namiki’s criteria.

C, the group that discontinued the previouslyprescribed Western-style medicine and switched toStudy by Nagata, et al.

Kampo medicines, had 12 (21%).

Nagata administered Extractof

Table 5 Dosing Patternchotosanpatients

Group A (The group that used Kampo medicines alone):

7.5g/daywithto24

essential

hypertension (age 49.2±5.6) for

32 subjects /56% (Male 9 : Female 23)

two weeks and observed changes

Group B (The group that initially used Kampo medicines and Western-style
medicines in combination and later changed to Kampo medicines alone):
13 subjects / 23% (Male 5 : Female 8)

beforeandadministration

afterinthesubjective

symptoms and changes in theGroup C (The group that discontinued the previously prescribed Westernstyle medicines and switched to Kampo medicines):
12 subjects / 21% (Male 3 : Female 9)

results of Shellong’s tilting test.

Changes of statistical significance(p＜0.05) were observed in systolicblood pressure after the standing

Details of used formulations are shown in Table 6.
Varieties of formulations as many as 21 were used frompositionfor10

minutesshichimotsukokato for 16 subjects to shimbuto for 11,(before→after; 192±25→178±14),

chotosan for 10 and orengedokuto for 10.

diastolic blood pressure in therecumbent position (98±3→86±7),

Table 6 Used Formulations

diastolic blood pressure after the

1: shichimotsukokato for 16 subjects (Male 1 vs. Female 15)

standing position for 10 minutes

2: shimbuto for 11 subjects (Male 2 vs. Female 9)(104±10→99±11), cardiac index inthe

3: chotosan for 10 subjects (Male 4 vs. Female 6)

recumbent

position(3.8±1.0→4.1±0.8), total peripheral

4: orengedokuto for 10 subjects (Male 5 vs. Female 5)

resistance

5: hachimijiogan for 9 subjects (Male 4 vs. Female 5)

position

Other 16 formulations including keishibukuryogan for 4 subjects, andbofutsushosan for 2 subjects.

in

the

recumbent(1960±410→1450±440),

and total peripheral resistanceafter the standing position for 10
minutes (2160±620→1720±510).

These patients began to take Kampo medicines atItems of significance in subjective symptoms weresome point due to hypertension and their bloodconcern about patient’s own health, appetite, sleep,pressure thereby gradually lowered

pain, sex life, fulfillness of daily life, and fulfillness ofand reached the normal pressure range when thefamily life.

investigation was conducted. So, the administration

Nagata conducted one more similar study with his

period was inconsistent and the patients did not clearlycollaborator, in which Extract of chotosan 7.5g/day wasThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 3, Number 4 | Winter 2008

administeredto72

patients

withessential

hypertension (age 52.6±7.5) to observe changes insubjective symptoms and in Shellong’s tilting test. Theyobtained similar results as those shown above.
Summary
Some of the studies conducted in Japan on
hypertension treatment with Kampo medicines wereintroduced as above. These studies show that bloodpressure often lowers secondarily when Kampo
medicines are administered to target symptoms. This
does not make a denial of the hypertension treatment
with antihypertensive drugs, but rather suggests thatacombination

useofKampo

medicines

andantihypertensive drugs will provide better results. This
also indicates that mild hypertension can possibly becontrolled by making better use of Kampo medicines.
However, extract preparations have their limits. If
better results are required, decoction preparations
need to be used. Shichimotsukokato that Otsuka used
for his own treatment was also in the form of decoction.
References
1) NAMIKI T.: Junkanki shikkan (cardiovasculardiseases), Kamp Chiryo Manual, Gendai Shuppan
Planning Co.,Ltd. 2010
2) OTSUKA Y.: Kampo Shinryono Jissai, Sogen-Sha
3) MORI K., MIYAZAKI R.: Study of Cases ofHypertension that could successfully controlledwith Kampo Medicines alone. Journal of Kampo
Medicine VOL52 No.6 29-36 2005
4) NAGATA K., OKAMOTO A., KAMANO Y., et al.:

Chotosan niyoru Koketuatsu no Chiryo to QOL(Jinsei no Shitsuteki Level). Journal of Traditional
Medicines, 6:426-427, 1989.
5) NAGATA K., HARA K., KINOSHITA T., et al.:
Koketsuatsu niokeru QOL to Chotosan no Kouka.
Journal of Traditional Medicines, 8:252-253, 1991.

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