KAIM
T
Thhee JJoouurrnnaall ooffK
Kaammppoo,, A
Accuuppuunnccttuurree aanndd IInntteeggrraattiivvee M
Meeddiicciinnee
INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 7, Number 3 ･ Fall 2012

Editorial
Clinical Trials and Kampo
Takao Namiki

Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (5) – Orthopedic Disorders B
Hiroshi Yamamoto

Kampo Medicine - Current ResearchChildren’s Emotions and Kampo
Hideaki Yamaguchi

Clinical Report 1 (Acupuncture)
A Case Report on Moxibustion Effectively Used for Obstruction of the Digestive Tract after Gastrectomy
Shoko Masuyama and Hitoshi Yamashita

Clinical Report 2 (Kampo Medicine)

A Case in Which Keishikaryukotsuboreito Had a Marked Effect on Post menopausal Anxiety
Hisae Wada

Medical History in Japan“Historical Significance of Standardization of Acupoint Locations”, the Second Japanese Acupoint Committee (7)Makoto Mayanagi

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 7, Number 3 ･ Fall 2012EXECUTIVE EDITOR
Shuji Goto
Chairman, GOTO College ofMedical Arts & Sciences

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

Tokyo, JapanASSOCIATE EDITORS
Shuichi Katai

1 Editorial
Clinical Trials and Kampo
Takao Namiki

Ibaraki-ken, Japan

Hiromichi Yasui
Tokyo, JapanEDITORIAL 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

3 Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (5) – Orthopedic Disorders, B
Hiroshi Yamamoto

6 Kampo Medicine - Current ResearchChildren’s Emotions and Kampo
Hideaki Yamaguchi

16 Clinical Report 1 (Acupuncture)
A Case Report on Moxibustion Effectively Used for Obstruction of the Digestive Tractafter Gastrectomy
Shoko Masuyama and Hitoshi Yamashita

PUBLISHER
Shuji Goto
International Institute of Health andHuman Services, Berkeley
2550 Shattuck Avenue, Berkeley
California 94704-2724, U.S.A.

19 Clinical Report 2 (Kampo Medicine)
A Case in Which Keishikaryukotsuboreito Had a Marked Effect on Postmenopausal
Anxiety
Hisae Wada

Website: www.kaim.us
E-mail: info@kaim.us

21

Medical History in Japan”Historical Significance of Standardization of Acupoint Locations”, the Second Japanese
Acupoint Committee (7)Makoto Mayanagi

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 7, Number 3 | Fall 2012

Editorial
Clinical Trials and Kampo
Clinical trials have become extremely difficult to perform in recent years, even in Western medicine.
Strong emphasis is placed on protecting privacy, ensuring proper storage of clinical data and maintaining
authenticity without risk of manipulation. Furthermore, it goes without saying that heavy weight isplaced on managing sensitive personal information such as genetic information, depending on the datathat is handled. In evidence-based medicine (EBM), randomized control trials (RCT) with a high level ofevidence are valued, because researchers’ bias is not reflected, and subjective evidence can be acquired.
In Europe and USA, RCT is thus actively performed. However, in these clinical trials it is necessary tonote in particular that the criteria of choosing subject patients will necessarily form a group of subjects
who are readily able to participate, and that the trial would be performed under a limited patient. In otherwords, the problem lies in the fact that cases included in such trials represent only a portion of all patients.
Nonetheless, our Kampo specialists wish to answer to doubts by Western doctors of whether Kampo
really works (we, personally, do not need such data, because we have no doubt that Kampo is effective).
The problem, however, is that Kampo diagnosis is characteristically based on proof and evidence (sho),and emphasizes individualization. RCT and similar trials are intrinsically unsuited for evaluating Kampo
drugs. To preserve sho used for Kampo medicine is difficult to perform clinical trials of Western medicine
by Kampo medicine method. One of a clinical study design is to classify the diseases in Western medicine.
When performing an RCT under this method, the effects of Kampo drugs are likely to be underestimated,
but if RCT could prove effects of them, it would be considered valid to administer Kampo drugs by
disease name (that means these diseases exhibit homogenous conditions (sho)). On the other hand, studies
have also been performed by combining the selection of a disease name and the sho concept in Kampo
medicine. For example, there are ways to choose patients by physical data, health conditions and thepatient’s complaints. There are some previous reports proved the efficacy of Kampo drugs by thesemethod.
Now, the question is why Japanese Kampo is able to perform clinical trials at a high level of quality.
The greatest reason lies in the consistent and stable extract products made by Japanese pharmaceuticalcompanies. This means that Kampo clinical studies particularly for short-term trials of a few cases could
be performed by using Kampo extracts preparations decocted with the same rod and contained same
ingredients Additionally, unlike decoctions, extract preparations could be considered drugs that canmaintain their quality for a long period (years) if they are stored appropriately. When examining
decoctions in a study, it is necessary to unify the quality and amount of herbs, and using the addition andsubtraction method would render the study unsuitable for RCT. Severe paying attention also is needed at
the method of decoction. In a certain study, it was found that the same decoction prepared at home by apatient had largely varying ingredients on different occasions. While there are apt to be differences in thequality of herbs, even taking this into consideration, it can be said that each patient takes a different
decoction every day. Decoction studies thus require extremely careful attention.

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

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Volume 7, Number 3 | Fall 2012

To perform clinical studies of Kampo drugs at a high level of quality, we adopt principles that lean
toward Western medicine. However, while this has proven that Kampo drugs as a whole havepharmaceutical effects, the largest issue lies in how to apply the interpretation of EBM results to thetreatment of individual patients at hand. I offer that concurrently adopting the Kampo concept of sho is apossible solution to such individualization, and intend to study examination methods and administrationof medicine toward making sho reproducible.

Takao Namiki
Department of Japanese-Oriental Kampo Medicine
Graduate School of Medicine and School of Medicine
Chiba University

2

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

Volume 7, Number 3 | Fall 2012

Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (5) – Orthopedic
Disorders B

Currently, Randomized Controlled Trials (RTCs)
provide the highest level of reliability for highquality epidemiological studies targeting a specific

Hiroshi Yamamotogroup of people and represents a way to make

Department of Health Sciences
Kansai University of Health Sciences

recommendations for treatment methods, protocols
and research topics. From the perspective of
Acupuncture

B Low Back and Legs
1. Concerning Acupuncture and Moxibustion for
Low back and Legs
One particular characteristic of Japanese
Acupuncture and Moxibustion (Traditional Oriental
Medicine) is that each patient is treated as anindividual, one by one, based on their uniquecondition, so an appropriate treatment method,
protocol and amount of stimulation is selected,
ensuring

comfortableandeffective

treatment

sessions. Further, practitioners endeavor to develop
a relationship with the patient, the psychologicaleffectsof

thisrelationshipgreatly

improvetreatment efficacy. From the initial greeting at theclinic to the medical interview and exceptionally
comfortableacupunctureandmoxibustion

treatment, the high quality of care naturally touches
thepatient.

Japanesetraditional

medicine’s

significant efficacy depends on maximizing thepatient’s natural healing power. To elicit andmaximize the patient’s natural healing potential, thereal goal of acupuncture and moxibustion treatment,
the practitioner’s attitude, word choice, friendliness
and ways of touching the patient cannot be
overestimated. It seems that a combination oftreating a wide variety of patients and conditions
utilizing

the

above

mentionedfavorable

circumstances, over many years, contributes to thedevelopmentof

excellent

Acupuncture

andMoxibustion practitioners.
For the past 30 years, medical research has been
underway, focusing on the objective effects ofphysical stimulation in the fields of health science.
As a result, Evidence-Based Medicine (EBM) has
necessarily

becomethegoldstandardforscientifically valid health-related research protocols.

andMoxibustion

treatment

thePlacebo Effect must be considered carefully, however,
it is frequently excluded from consideration in RCTs.
Namely, the problem is that the placebo effect isoften considered to be identical in all people andstudies. Included within modern medicine andtreatment effects, the Placebo Effect is often
considered“extra”orin“error,however,intraditional medicine it is considered an important
treatment effect that should be protected and sought
after. Perhaps, it can be considered that the wide
variety of placebo effects appearing in the research
literature can be accounted for by the variety oftreatment styles and experience level of thepractitioners. The placebo effect is just one healingmechanism, from the human unconscious, not unlike
hormones and the autonomic nervous system, andonce qualitatively and quantitatively clarified, could
help diversify our treatment models.
In any case, for each practitioner, the placebo
effect is different and depending on their technicalskill, medical knowledge and humanity the variation
will be greatly affected. Further, it is essential to becareful here, do not make the mistake of imaginingthat the placebo effect is simply elicited by changing
your words or manner of speech. This is the firstthing practitioners must understand. Nonetheless,considering

current

world-wide

acupuncture

treatment effects using RCTs introduced here,
obtaining objective evaluation of acupuncture andmoxibustion

treatments

continues

toparamount

importance.

However,

the

be

of

current

dispute in many RCT papers focuses on the very
difficult prospect, “Acupuncture works!”. There aremany problems that are usually different in each
RCT

research

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

differing

reactionsto3Volume 7, Number 3 | Fall 2012

descriptions of informed consent and screening

designs, increasing subject numbers (respondents)

methods, stimulation methods and amounts, control

and assuring consistent protocol parameters must be

selection

points,confirmed before more definite conclusions can betreatment time, duration of treatment, evaluation ofmade regarding treatments for osteoarthritis of thetherapeutic effects (outcome), subjects that are more

knee.

and

parameters,

treatmentor less reactive to acupuncture, acupuncturists who

Worldwide trends in RTCs including Japan have

do not distinguish important aspects of theirbeen

research. Therefore, naturally there are many

Acupuncture and Moxibustion. Several excellent

different results, so arriving at an all-inclusive

medicalconclusion will likely take quite a long time. To thatparticularly for osteoarthritis of the knee and low

end, here, we are introducing some reference

back pain using evidence-based acupuncture andmaterials focusing on chronic low back pain andmoxibustion2, 3). Among these, RTCs from Germany

osteoarthritis of the knee obtained from recent

using acupuncture and moxibustion for low backinternationally relevant RCTs. Additionally, we hopepain, these researchers used an acupuncture groups

to convey some of the most common developments inand a sham acupuncture group and calculated theJapanese research in general, as well as insignificant differences between the test groups. They

Acupuncture

concluded that, compared to results following

andMoxibustion

treatmentinintroduced

by

the

commentaries

Japan

have

been

Societyofpublished,modern medical guidelines, better treatment results

particular.

were observed using acupuncture4). In addition, a
2. Effect of Acupuncture and Moxibustion on
Lumbar area and Lower limbs
In 2009, the National Center for Complimentary

United States based RTC report for Osteoarthritis ofand Alternative Medicine (NCCAM), a researchcombining

center within the National Institute of Health (NIH)

acupuncture with health education significantlyin the United States, announced a list of recent RCTs

increased clinical effectiveness5).

the knee, divided the subjects into acupuncture andsham

acupuncture
standard

groups.

They

medical

found

that

treatments

andnoted for their high level of validity1). As a summary

Unfortunately, there are few RCTs from Japan onof these results, with respect to general treatment

the effects of acupuncture for the Lumbar region andwith modern medicine, for example, in cases where

lower limbs. But cited among the current issues are

drugs are ineffective for chronic low back pain,

reports on the small number of RCTs and, in contrast,

complementing the protocol with acupuncture anda great variety of reported acupuncture andmoxibustion

Further,moxibustion techniques6). Just for your information,acupuncture and moxibustion should be considered as

the author conducted acupuncture treatment RCTs7)

effective as pharmaceuticals on their own as theyon 35 subjects with degenerative osteoarthritis of thehave been shown to increase the efficacy of generalknee joint and, although the number of subjects wastreatment when used in conjunction with standard

too small to make a strong conclusion, following

drug protocols. However, it must also mentioned thatstatisticalongoing research will of course be required to refine

treatment symptoms, acupuncture and moxibustion

the most effective complimentary methods andwere found to be significantly effective. However, thetechniques. Similarly, concerning osteoarthritis of theplacebo acupuncture control group also reported

knee, definitive conclusions about effective treatment

improvement following the session, needless to say,cannot yet be made as most treatments only reduce

we recommend further research to elicit definitivepain, some life style and functional improvements

results.

must

beconsidered.

analysis comparing pre- and post-

have been confirmed but removing flawed research
4

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

Volume 7, Number 3 | Fall 2012

*note As a rule, RCT criteria require emergency
responses to disease, severe conditions often create
ethical problems, the limits of appropriate conditions
can make them difficult to recommend for suchresearch projects. For these reasons, often researchers
select chronic conditions that are not life threatening.
For example, severe low back pain or leg pain
accompanied by numbness, both chronic conditions of
the lumbar region and lower limbs, make more
ethically appropriate candidates for research. Further,acupuncture research for osteoarthritis of the knee
joint is being conducted around the world. The
following criteria for osteoarthritis of the knee provides
a clear and easy-to-understand definition of andguidelines for diagnosis: diagnosis by an X-ray image,
45 years of age or older, chronic persistent andrelatively localized pain and stiffness, and valid
evidence that this pain is negatively influencing thepatient’s quality of life (using a self-administeredassessment method such as the (WOMAC)8).

References
1) “Acupuncture for pain” NCCAM Publication No.
D435, Created May 2009, Updated August 2010
2) National Japan Acupuncture and Moxibustion
Society (Edition), Corporation: Evidence based
research on Acupuncture and Moxibustion for
Osteoarthritis of the Knee Joint, Ishiyaku
Publishers, Tokyo, 2007
3) National Japan Acupuncture and Moxibustion
Society (Edition), Corporation: Evidence based
research on Acupuncture and Moxibustion for
Low Back Pain, Ishiyaku Publishers, Tokyo, 2010
4) Haake M, Müller HH, Schade ─ Brittinger C, etal: German Acupuncture Trials (GERAC) for
Chronic

Low

Back

Pain:

Randomized,

Multicenter, Blinded, Parallel ─ Group Trial With
3 Groups. Arch Intern Med 167: 1892─1898, 2007
5) Berman BM, Lao L, Langenberg P, et al:
Effectivenessoftherapyosteoarthritis

inrandomized,

acupuncture

controlledasadjunctive

of

the

knee:

trial.

AnnInternalaMedicine 141(12): 901─ 910, 2004
6) Yamashita

H,

Masuyama

S:

Acupuncture

treatment for low back pain in Japan: A brief
review based on clinical research papers. JAM 2:
55─58, 2010
7) Yamamoto

Hiroshi,

Umeda

Yohtaro,Kibi

Yoshihoka, et al.: Acupuncture and Moxibustion
Treatment and Clinical Effects on Osteoarthritisof the Knee 3 ─ randomized controlled trials ─.
Bulletin of the Kansai Medical University 3: 3640, 20098) Bellamy N, Buchanan WW, Goldsmith CH:
Validation study of WOMAC: A health status
instrument for measuring clinically importantpatient relevant outcomes to antirheumatic drug
therapy in patients with osteoarthritis of the hipor knee. J Rheumatol 15: 1833─1840, 1988

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

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Volume 7, Number 3 | Fall 2012

Kampo Medicine - Current ResearchChildren’s Emotions and Kampo

deficiencies related to the kidneys could easily
manifest as developmental disorders. This is not

Hideaki Yamaguchi

much different from our modern understanding of
the characteristics of developing children. Kampo
medicines that have been used for children can

Introduction
In response to the changing social environment ofhistoricallybeclassified

according

to

these

children in recent years, the likelihood of dealing

characteristics (Table 1). In this paper I will selectwith emotional problems in pediatric care has beenamong these specifically Kampo medicines related toincreasing.

emotional problems. In other words, I would like toInparticular“neurodevelopmental

thedisorders”

concept
has

of
been

considerKampo

medicineswithemotional

popularized and accordingly the relative interest in

stabilizing effects. Regarding other effects I would

this field has been increasing. With some exceptions

like to ask the reader to refer to the references1).

the pharmacotherapy for children with emotional
problems is not supported by sufficient evidence,side effects cause problems and the general

Table 1 Easily comprehensible classification of Kampo
medicines used for children
1physician may have difficulties to use the relevant
drugs. On the other hand, Kampo medicines have along history of experience based clinical application

2

for emotional problems. Naturally, as viewed fromthe context of EBM they are subject of debate, but

3they are nevertheless considered to have thequalities of one possible choice of pharmacotherapy.
In the present paper I would like to outline theuse of Kampo medicines for emotional problems inchildren in a way easily comprehensible even for

45physicians not familiar with Kampo.
6

I. How were children viewed in ancient Chinese

Easy development of fever, resulting in convulsions,disturbances of consciousness→ Kampo medicines with immune function regulating
actions for infections
Getting easily agitated, mentally unstable→ Kampo medicines with emotionally stabilizing
effects
Immature digestive function easily leads to weakened
function→
Kampo medicines with digestive function
improving actions
Immature respiratory function easily leads toweakened function→ Kampo medicines with antitussive actions
Easy occurrence of developmental disorders, weakvital energy→ Kampo medicines that support development
Addition→
Kampo medicines with water metabolism
regulating actions

medicine?
In traditional Chinese medicine there are anumber of expressions describing the characteristics
of children, but probably the most important among
these

is:

"two

excesses(heart,liver),

three

II.

Emotionallystabilizing

effectsof

Kampo

medicines
Kampo medicines are composed of multiple crude
drugs (simply processed roots, stems, fruits of plants,

deficiencies (lung, spleen, kidneys). A modernminerals,interpretation of this expression would be, that independing on the therapeutic purpose. Currently,

case of excesses in heart and liver easy development

Kampo medicines in Japan are mostly used in theof fever, convulsions, disturbances of consciousness

form of extract preparations, the basic compositionand other neurological symptoms are observed, otherof which has already been indicated 2,000 years ago.

manifestations include easy mental excitation or

Details of the process of the establishment of

instability, while deficiencies of lung and spleen may

these drugs are unknown, but probably man used his

resultprimitive senses for the initial choice of the crudein

respiratory6

hypoactivity
andofdigestive

the

still

functionsimmature
and

small

the

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

animalproducts)

combined

Volume 7, Number 3 | Fall 2012

drug, after that millennia of clinical experience(occasional human experimentation) accumulated
and thus presumably led to the development of these
Kampo medicines.
Kampo medicines as drugs are characterized inbeing compositions having multiple therapeutic
effects. These sets of multiple therapeutic effects
precisely are the characteristic of Kampo medicines.
In humans multiple functional systems are mutuallyinterrelated.

If

the

characteristicsof

Figure 2 Brewing Kampo medicine

Kampo

medicines adequately match any disturbances ofthese human functional systems, it will presumably
allow adjustment of the entire body.

Yokukansan

will

be

consideredasarepresentative example of a Kampo medicine withemotional stabilizing effects. As shown in Figure 1

yokukansan is composed of the seven crude drugs
Uncariae Uncis Cum Ramulus, Bupleurium Radix,
Angelicae Acutilobae Radix, Cnidii Rhizoma, Poria
Atractylodis Rhizoma and roasted Glycyrrhizae
Radix. Today it is used either as a decoction asshown in Figure 2 or else an extract preparation asshown in Figure 3. In general almost always the

Figure 3 Kampo extract preparation

more practical extract preparation is used.

Uncariae Uncis Cum

Bupleurium Radix (Saiko)

Poria (Bukuryo)Angelicae Acutilobae Radix

Cnidii Rhizoma (Senkyu)(Toki)

Ramulus

Atractylodis Rhizoma(Byakujutsu)

Roasted Glyzirrizae Radix

Figure 1 The constituent crude drugs of yakukansan

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

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Volume 7, Number 3 | Fall 2012

Table 2 shows Chinese crude drugs generally
thought to have emotionally stabilizing effects. I will
omit the details, but the important thing here is,that related to the emotions

items with violent

actions have been excluded, concentrating on
invigorating and suppressing effects (not necessarily
precise), because each of the crude drugs has apartfrom the emotionally stabilizing effects also various
other effects on the body. Examining yakukansan
from this point of view (Table 3), it contains many
emotionally stabilizing drugs centering around theclassical

anticonvulsant

uncariaindicatedbyunderlining and while the main purpose is clearlyemotional stabilization (sedation), other secondary
effects include improvement of digestive function,
regulationofhydration,

improvement

of

the

microcirculation.
Table 2 Crude drugs with emotionally stabilizing actions

8

Perillae Herba

Glycyrrhizae Radix

Menthae Herba

Jiziphi Semen

Chrysanthemi Flos

Nelumbis semen

Purnellae Spica

Polygalae Radix

Gardeniae Fructus

Longan Arillus

Coptidis Rhizoma

Ostreae Testa

Poria

Tritici Fructus

Magnoliae Cortex

Ostreae Testa

Evodiae Fructus

Saigae tataricae Cornu

Cyperi Rhizoma

Gastrodia Tuber

Curcumae Rhizoma
Saussuerae Radix

Uncariae
Uncis
Ramulus
Bombyx Batryticatus

Cnidii Rhizoma

Gentianae Scabrae Radix

Salviae Miltiorrhizae Radix

Cicadae Periostracum

Rehmanniae Radix

Visci Herb

Ginseng Radix

Pinellia Tuber

Ziziphi Fructus

Arisaematis Rhizoma

Cum

Table 3 Yokukansan (Hangechinpi)
Source: "Bâo yïng cuö yào"(synopsis of caring for infants
Uncariae Uncis Cum Ramulus………anticonvulsive,
emotionally stabilizing (sedation)
Bupleurium Radix………antifebrile, emotionallystabilizing, upraisingAngelica Acutilobae Radix………improving
microcirculation, laxation
Cnidii Rhizoma……………improving microcirculation,
analgesic, emotionally stabilizing
Atractylodis Rhizoma…………adjusting water
metabolism, improvement of digestive function
Poria…………adjusting water metabolism, improvementof digestive function, emotionally stabilizing
Roasted Glycyrrhizae Radix…………improvement ofdigestive function, muscle relaxation, mitigating drug
properties
Generalized effects……anticonvulsive, emotionallystabilizing, improvement of digestive function, adjustingwater metabolism, improving microcirculation(The originally anticonvulsive preparations can today be
expected to have emotionally stabilizing actions)III. Mental and psychological disease patterns fromthe traditional Chinese medical perspective
Table 4 summarizes the deficiency and excess
aspects of mental and psychological disease patterns
according to the traditional Chinese medical visceralorgan-function system as described in a book on
Chinese medicine2),3). Due to the large number oftechnical terms I will omit a detailed explanation,
but the important point here is, that mental andpsychological disease patterns are viewed as equal tophysical patterns. Based on a comprehension of theirmutual correlation among these in particular theheart, liver and gallbladder organ-function systems
are closely related and Table 5 shows their disease
patterns.
IV. Categorization and cases for simple explanations
The unfolding of this kind of theoretical andtechnical discussion is generally extremely difficult
to understand. Moreover, the classifications of these
disease patterns have since ancient times beenrefined by experience through long use of Kampo
medicines, so that the classification of disease names
differs from modern Western medical views,
representing so to speak a cross-section of Western
medical disease names.

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

Volume 7, Number 3 | Fall 2012

Table 4 Disease patterns from the traditional Chinese medical perspective on psychological andmental aspects
Five viscera
Lung

Deficiency (scarcity)

Excess (surplus; stagnation)

Lung Qi deficiency
Heart Qi deficiency (fearfulness),Heart

Blood (Yin) deficiency

SpleenSpleen Qi deficiency

Liver

Liver Blood (Yin) deficiency(Gallbladder)
KidneyGallbladder Qi deficiency(fearfulness)

Heart fire, phlegm-heat

Stagnation and sluggishness of hepatic Qi,
liver fire, managing gloom
Gallbladder fire, stagnant heat

Kidney essence deficiency
Reference: Differential Diagnosis of Chinese Medical Symptoms, 2nd Edition2)
Table 6 Simple Classification for Kampo Treatment

Table 5 Close correlation to mind and psychological stateHeart: maintain sound consciousness, thinking

Category 1[Key words] All right, don't be afraid, at ease

Functional disorder→anxiety, fright, insomnia,[Symptoms] No confidence, worrying temperament,

excessive dreaming, irritability, irascibility

apprehensive, nervous and other similar emotions

Liver: promote the flow of Qi and development
Functional disorder→prevents unconstrained
development, depressive feeling, irritability,
irascibility, violent mood swings
Gallbladder: controls will and decision making
Functional disorder→ perplexity, fear

Accordingly, in this manuscript I will follow theabove mentioned traditional medical concepts as far
as possible, but at the same time tried to explain

continue – related to the heart and gallbladder[Formulas] kanbakutaisoto, kamikihito,

saikokaryukotsuboreito, sansoninto etc.
Category 2[Key words] Don't huddle up, develop unconstrained[Symptoms] High tension, depressive, irritability, easymood swings ― related to the liver[Formulas] shigyakusan, saibokuto, kamishoyosan,

kososan, saikosokansan etc.
Category 3

matters using the classification shown in Table 6 in[Key words] Relax, take it easyorder to facilitate the use of Kampo medicines[Symptoms] Irritability, depressive, restless etc.,

through simplification. In other words, threecommon sense categories are set up centering on thetherapists view regarding "how should the therapy
be aimed at the patient's symptoms". Kampo

mainly mild excitement related symptoms―heart,
liver, gallbladder related[Formulas] yokukansan, yokukansankahangechinpi,

daisaikoto, orengedokuto, chikujountanto,
tokakujokito etc.

medicines belonging to each of these categories areshown and the Kampo therapy outlined with case

1. A category 1 casestudies.

Case No. 1

This classification is not a standard Kampo

3-year old boy, pavor nocturnus

method, but considered to be useful for providing

The boy entered kindergarten in April. From thesimple explanations. So please bear with me taking

middle of the same month onward he would

the liberty of adopting this everyday language

suddenly wake up during the night and vehemently

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

9Volume 7, Number 3 | Fall 2012

weep and cry, exhibiting a behavior marked byeasily startled. She avoided school related topics.

running around once or twice a week. Since May thisHer late grandmother reportedly suffered fromhappened every night and troubled the family, so

depressionthat they brought him on the 11th of the same monthpollakisuria.

andfrequently

complainedof(after the condition continued for one month) to thisInitially I thought, the condition was due toclinic. He seemed to be a little downcast. Generalexcessive tension, inhibiting normal development

condition was good.

(category 2) and prescribed saikosokanto decoction

I diagnosed the condition as pavor nocturnus andconsidered

possible

adaptation

problems(feel relieved). Yet, two weeks later there were noinchanges at all and the girl appeared during the second

kindergarten, contacted it and gave instructions

consultation to have lost confidence and clearly madepertaining to acceptance at home. However, since

an apprehensive impression (category 1). Therefore I

the condition had continued until the next clinic visit

switcheda week later, I judged the condition be marked bydecoction (don't fear, everything will be fine).

theprescriptiontosansonintokagen

fright and anxiety (category 1) and started the child

Two weeks later the micturition frequency

on a twice a day prescription of kanbakutaisoto (Gandecrease by half and she seemed to be more composed.

Mai Da Zao Tang). The symptoms disappeared

One month later she almost did not need to go to thealmost completely immediately after taking thebathroom during classes and the feeling of residual

medicine.

urine disappeared. A mild degree of pollakisuria

Kanbakutaisoto is comprised of Glycyrrhizae
Radix, Tritici Fructus and Ziziphi Fructus used as apersisted. She complained about worries pertaining tosweeteners and thus is a simple formula that canyear the pollakisuria grew worse due to the cold

almost be called a foodstuff. It is easy to take andweather, so that I added cinnamon bark and Aconiti

widely used among both children and adults.

Radix Processa (warming components) and achieved

entrance examinations. In January of the following

alleviation. In February she passed the senior highCase No. 2

school14-year old girl, junior high school third grade,

disappeared and since she had calmed down, the drug

nervous pollakiuria

administration was discontinued. After that the

From June 20xx pollakisuria and a feeling ofresidual

urine

developed,

but

entrance

examination,thepollakisuria

patient did not visit the clinic.

examinations

performed in this clinic ruled out organic diseases,

2. Category 2 cases

leading to the suspicion of the involvement ofCase No. 1

psychological factors. During the summer holidays

14-year old girl, junior high school student, general

the symptoms decreased slightly but the girl hadlassitude, sensitivity to cold

pollakisuria while in boarding school. Due to an

She has an anamnesis of atopic dermatitis,

aggravation of symptoms in September I invited herbronchial asthma. One month ago she indulged inby the end of the same month to the Kampo

excessive eating of eggs and chocolate, resulting in

outpatient service. Until then I prescribed thethe development of generalized urticaria and shepatient Tofranil, but because it caused drowsiness,wasshe could not take the drug and choreito wasaggravation of the AD. During the height of theineffective. The frequency of 12-13 micturitions

summer on August 15 she visited the clinic

while in school and 7-8 times more after returningcomplaining of generalized lassitude and chills. She

home irritated her and she complained of being

reported being tired since about one month ago and

10hospitalized for

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)ashort period duetoVolume 7, Number 3 | Fall 2012

since about 2 weeks ago she felt cold like being

cleared his throat with a dry cough. Physicalattached to a cooler. Since before she had alreadyexamination and general laboratory tests did not

had conflicts with her mother and on this occasion

reveal any anomalies. I suspected maladjustment tothere was trouble too. Physically, apart from a minor

school conditions and diagnosed psychogenic coughdegree of AD, no abnormal findings were observed.

(vocal tic).

Simultaneously with the generalized lassitude

I explained to the grandmother the involvement

and sensitivity to cold she felt hot in the chest andof psychogenic factors and chose to observe thecomplained about getting irritated. Her pulse wascourse with only an antitussive over a period of two

wiry and the abdominal muscles were tense. Basedweeks. The cough itself slightly improved, but sinceon the course and findings I thought stress had

his clearing of his throat worsened, I added

induced excessive tension and caused a mild degreesaibokuto extract. Following the begin of theof microcirculatory disorder (category 2).

medication the cough and clearing of his throat

I

used

shigyakusan

psychosomatic

tensionextractand(toreleasefacilitate

markedly decreased, and the anxious impression

anabated. Since the symptoms had almost completely

unrestrained development). After four days ofbe alleviated 4 weeks later, the treatment was

medication the generalized lassitude was relieved,

discontinued

but the sensitivity to cold remained unchanged.

occasionally took medicine on his own will, but

After 10 days of medication the generalized lassitude,commuted lively to school. From the Kampo medicalsensitivity to cold and chilliness of hands and feetperspective the Qi flow was considered to have

had disappeared. After 15 days of medication she

stagnatedappeared to be very healthy and I discontinued theunrestrained

medication. This is a typical category 2 case.

respiratory symptoms (category 2). Based on theoutcome

old

the

this

8

weeks.

caseanddevelopment,
use

of

After

thus

that

he

prevented

manifestinginsaibokuto (shosaikoto +hangekobokuto) extract was considered to have been

Case No. 2
10-year

in

after

by,

elementary

schoolstudent,

effective.

psychogenic cough (vocal tic)
The parents divorced during his infancy and he

3. Category 3 cases

lives now mainly with the father's side grandparents.

Case No. 1

There is no obvious history of asthma and no

3-year old girl, atopic dermatitis (AD)problem with school attendance. Approximately two

Six months after birth eczema and at the age of 2

months ago a persisting cough developed for which

years AD was diagnosed. Eight months ago thehe commuted to several clinics. He was treated withconditions worsened, the girl was taken to four

antitussives, expectorants and macrolides, but sincedifferent clinics and a pharmacy consulted, butthese did not produce any relief, he was introduced

because of insufficient relief in spite of theto this clinic in November 20XX and came with his

administered medication, she was brought to thisgrandmother for consultation. Examination did notclinic. She complained of itching after trouble withreveal any anomalies. The cough was dry and hefriends in kindergarten. She is always very nervous.

frequently cleared his throat. There was no cough

There is also night crying. She was calm at the time

during sleep. There was discomfort in the throat andof consultation, but throughout asked her mother tohe felt suffocated in enclosed spaces. He is timid andscratch her (almost all of which was more like gentle

becomes easily tense. Recently he seemed to be

stroking). The symptoms had aggravated after her

anxious. During his outpatient visits he frequently

younger sister was born. The eczema had developed

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

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Volume 7, Number 3 | Fall 2012

only on the neck and the extremities. I surmised theviolent

symptoms to be a manifestation of separation

conspicuously marked by kicking his desk evenanxiety.

during classes, when he did not like things and

In Kampo terms the patient was diagnosed asmoodstormingoutswings

of

and

the

his

behaviorclassroom.

wasFollowing

category 3 and yokukansan extract prescribed,

recommendation by the class teacher he visited thisexpecting it would relief the complaints. Two weeks

clinic during summer holidays.

later the patient was markedly calmer and after 4

He was fidgety, irascible, showed impulsive

weeks the scratching frequency and intensity had

behavior, was disorganized, but also gentle and crieddecreased to 1/3 of the original level. After 4 months

easily.

the scratching behavior had disappeared and thechecklist: 13/17 (standard 6/17), predominantly

medication was discontinued. Later however thehyperactive and impulsive, high-functioning autism,scratching behavior exacerbated, so that medication

Aspergerwas restarted, resulting again in relief andpsychosomatic checklist: below standard value,

subsequently continued over a period of one year.

WISC: normal.

Pavor

nocturnus:

checklist:

below

once/month,standard

ADHD

value,

Based on the above described findings I diagnosed
Case No. 2

an attention deficit hyperactivity disorder. From a

5-year old boy, extensive developmental disorder

Kampo medical point of view the probability of a

At the age of 3 years he was diagnosed withcategory 3 disorder was high, but an involvement ofautism and started to commute to specialized facility.

category 1 also conceivable. Therefore I prescribed

Because of a marked communication disorder,

yokukansan extract for 2 weeks, expecting to obtaindelayed speech development and hyperactivity andsome sedative effect. After two weeks some

impulsive behavior at home, he was brought to thisimprovement had been achieved, so that I added

clinic requesting Kampo treatment. During the

kanbakutaisoto and another two weeks later theoutpatient visit he avoided my gaze, ignored thepatient had calmed down. In school too the impulsive

environment and wandered restlessly around. I

behavior had decreased as compared to the first term.

diagnosed category 3 and prescribed a decoction

The class teacher said: "During the second term hecentering mainly on the formula yokukansan,

could almost follow the class schedule. The problem

expecting a tranquillizing effect. Two weeks after thehas been markedly reduced." At home the impulsive

begin of the medication some changes were observed

behavior decreased from a level of 10 to 3. He himself

and four weeks later the hyperactivity and impulsive

said: "Taking the medicine makes things easier" andbehavior had been alleviated so much as to astonish

took it voluntarily. The medication was continued forthe facility he commuted to. The administration was

about three years and after that gradually tapered

continued over a period of 3 months, but after that

off.

discontinued, because he moved far away.

Although this may deviate slightly from the pointof this argument, in Table 7 I show some case series

4. When two categories are mixed

studies

pertaining

Case No. 1

neurodevelopmental disorders that in recent years

6-year old boy, elementary school first grade,have become a problem in the fields of pediatrics andattention deficit hyperactivity disorder

psychiatry.

During infancy he was a restless, easily angeredchild, but during kindergarten this did not causemuch problems. After school started there were

12

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

to

Kampo

treatmentforVolume 7, Number 3 | Fall 2012

Table 7 Reports pertaining to the correlation between

After one week of medication the abdominal pain,

pediatric developmental disorders and Kampo treatment

frequent defecation behavior and night crying had(Case series studies)

stopped and after two weeks she started to dislike

・ Autism: daisaikoto, yokukansankahangechinpi,

being accompanied, so that her mother stopped

shigyakusan

accompanying

Iida (2004) – 30 cases4); marked improvement of tension
related symptoms
・ Generalized developmental disorders:
17 formulas, Kawashima (2007) – 53 cases5)
49% improvement of mental symptoms，yokukansan,

her.

She

could

now

commutenormally to school. After that there was no
abdominal pain any longer. The medication was
discontinued after 4 months. (both the mother andthe class teacher had the following impression:

yokukansankahangechinpi, kanbakutaisoto has a highalthough she had been so quiet as to cause concern,

efficacy rate, markedly improved hyperactivity, behavior

after the treatment began, she suddenly became

disorders, panic disorders

much livelier and played with the boys).

・ Pediatric mental disorders (mainly developmental

Shokenchuto is a Kampo formula used in case ofdisorders): yokukansankahangechinpi，

low strength and easy fatigability. In particular in

Ujiie (2010) – 73 cases6), efficacy 81%. Improvement ofchildren it warms the body and relieves excessive

irritability, rage and similar emotional behavior disorders

tension of the digestive tract and is therefore used to
improve digestive functions. It is frequently used,

5. Kampo medicines used for other purposes can also

like in the present case, for troubles with digestive

expected to have emotionally stabilizing effects

functions and of its components only jujube fruit

Case No. 1(Taiso) is a crude drug with emotionally stabilizing

6-year old girl, psychogenic abdominal pain

effects, but it relieves generalized tension and helps

The girl had a history of night crying andrecurrent fever and ate very little.
She had the habit of having bowel movements

to bring ataractic actions about. This formula is easy
to take and widely used in children (Table 8).
Table 8 Shokenchuto

Source: "Shang Han Lun / Jinafter returning home from the kindergarten. After

Gui Yao Lue"school started she could not return home by her

・Cinnamon twig: warms the body, induces mild sweating

accustomed bowel movement time and thus held the・Peony root: relieves muscle tension, improves

urge back. She tried to have bowel movements in the

microcirculation

morning, but from the middle of May complained of・Jujube fruit: improves digestive function, stabilizes

abdominal pain and began to go to the bathroom 2 to
4 times. She did not attend school for about 3 days,
but after that required her mother to accompany her
on her way to school and the night crying recurred
too. For this reason she visited this department in
the middle of June. She was diagnosed withemotions
・Ginger root: warms the body, improves digestive function
・Roasted Glycyrrhiza: improves digestive function, relievesmuscle tension, mitigates drug effects
・ Malt sugar: supplementing nourishment, antitussive
Effects: improves digestive function, relieves muscle
tension, stabilizes emotions

psychogenic abdominal pain and in Kampo medical
terms her condition was considered to be due todisharmony of liver and stomach (stress induced
tension that decreased digestive function). I usedshokenchuto extract to relieve muscle tension andimprove digestive function.

Mental problems in children can not always be
fitted neatly into categories, but those are still
considered have a certain degree of real meaning
regarding the selection of appropriate Kampo
medicines. That is why I have listed them here.
Moreover, several of the Kampo medicines included

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

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Volume 7, Number 3 | Fall 2012

in these categories have characteristic medicinal
effects, but because of limited space will not be

VI. Dose
Regarding

the

dose

of

Kampo

extract

detailed here. I would like to refer the reader to the

preparations for children generally Von Harrnak's

reference works for further details.

calculation based on body surface and body weight isThis may be a little digression, but the mostused, but depending on the individual condition it

important Kampo classic "Shan Han Lun" is an

may be necessary to increase this dose, so that those

excellent guideline for the treatment of acutevalues should be regarded as estimates.

infections. The crude drugs and Kampo medicines

Note that the dose for adults may also vary

described therein are still today used for a variety of

depending on the manufacturing pharmaceuticalconditions and are considered to have various

company or the type of administered drug. Basicallynatural immune function adjusting actions (anti-

drugs are taken divided into three portions per day,inflammatory actions). On the other hand, recently

but it is also possible to use two portions. In principle

various psychophysiological and neuritic conditions

they should be taken before meals, but there is nothave been receiving much attention7),8). Currently

really any major difference when taking them afterthemeals9).

mechanisms

underlying

theemotionallystabilizing effects of Kampo medicines are still
obscure, but their "anti-inflammatory" actions may

Conclusion
In this article I tried to explain as simple as

be one possible hint.

possible the fundamental properties of Kampo
medicines in relation to psychiatric problems in

V. Characteristics of Kampo treatment
stabilizingchildren. Naturally, there are limits to the treatment

action from Kampo treatment has both merits andwith Kampo medicines, but using their property of

demerits.

being compounds to complement Western medicine,

Naturally,

expectingemotionally

A merit is, that in conjunction with an emotional
stabilization physical (mainly digestive function)

I believe we can extend the pharmacological therapyof psychiatric problems in children still further.

functions can be expected to improve, the treatment
is mild, it does not induce drowsiness, cause loss ofappetite, dryness of the mouth or other side effects.
Again, although this is not much discussed and apartfrom the degree of their efficacy, these formulas canbe used without much reservation for patients withvarious mental problems. In this respect they meetthe expectations of both patients and their families,
allowing to link to the subsequent development.
A demerit is, that in cases of domestic violenceetc., requiring a fast sedation, that kind of powerfulaction can not be expected. Taste may also be a
problem, requiring some ingenious measures tofacilitate the administration and finally, there arealmostnoreportspresenting

highlyreliableevidence.

14

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

Volume 7, Number 3 | Fall 2012

References1)

Hideaki Yamaguchi (2012): Outline of pediatricKampo medicine．The Journal of Ambulatory
and General Pediatrics; 15：305-312

2)

Ji Xiao fan：Chief editor (2004): Pediatrics: 4-5．
China Science Publishing & Media Ltd, Beijing,
China

3)

Tao Nei li Chief editor (2000): Differential
Diagnosis of Chinese Medical Symptoms, 2nd
Edition. Peoples Medical Publishing Hous,
Beijing, China

4)

Makoto Iida (2004): Pediatric Kampo therapy –Autism．The Journal of Pediatric Practice 67:1489-1492

5)

Koichiro Kawashima (2007): Study into theusefulness

of

Kampo

for

generalized

developmental disorders. Kampo Medicine 58：
175
6)

TakeshiUjiie(2010):

The

effectsof

Yokukansankahangechinpi for the treatment ofpediatric psyciatric disorders; Phil Kampo №
32： 18-19
7)

Akira Moji (2012): Neuritis hypothesis of
psychiatricdisorders;

Psychiatria

etNeurologia Japonica 114：124-133
8)

Hiroshi Ihara, et al.: (2012) Depression as aform of inflammation. Japanese Journal of
Clinical Psychiatry 41: 1065-1073

9)

Shinichi Tashiro (2001): Correlation between
the time of ingesting Kampo medicines andmeals． The Journal of Practical Pharmacy 52：
1138-1144

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

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Volume 7, Number 3 | Fall 2012

Clinical Report 1 (Acupuncture)
A Case Report on Moxibustion Effectively Used for
Obstruction of the Digestive Tract after Gastrectomy

She had been complaining from before about
shoulderDepartment of Acupuncture,
Morinomiya University of Medical Sciences

Absorption disorder, diarrhea, dumping syndrome
etc. can be sequelae of gastrectomy. We report a casemoxibustion

treatmentwasmarkedlyeffective for gastrointestinal passage disorders
occurring in a patient on chemotherapy following
total gastric resection performed for scirrhous
gastric cancer.

Height 150 cm, weight 38 kg; lost 10 kg as compared
to before the development of the scirrhous gastricshoulderstothesuperior

scapularangle,

interscapular region and next to the spinous
processes of the 4 th and 5th lumbar vertebrae.
[Acupuncture and moxibustion treatment]
Initially we used Seirin type J or Yamasho needles witha diameter between 0.16 mm – 0.20 mm and a lengthof 40 mm – 50 mm in our clinic for the local treatment

insertions,

or

low

frequency

for the complaints of passage disorders. Either moxa

[Chief complaints]
Left neck pain (at first visit), loss of appetite becauseof passage disorder (from January 20XX + 1 year)
In August 20XX a scirrhous gastric cancer wasdiagnosed in hospital O, which then was resected in
September of the same year. Pharmacotherapy
chemotherapeutic
fluorouracil)

agents(TS-1,

administeredinintervals of 4 weeks followed by 2-week rests. The
chief complaint developed when she started to use ahigh pillow for the night to prevent regurgitation ofduodenal fluid into the esophagus. She also felt
anterior tibial

muscle andexperienced pain of the skin of the scalp. She had
been treated with acupuncture once every 2-3
months for about 10 years and now visited us
following the recommendation by her husband, who
is a patient in the acupuncture and moxibustion
clinic affiliated with our university.
[Anamnesis]
Total gastrectomy in November of 20XX due toscirrhous gastric cancer.

cigars or direct moxibustion (3 to 5 cones, the size of arice grain) was applied next to the spinous processes of
the 7th to 12th thoracic vertebae, from the epigastric to[Present illness]of theshortelectroacupuncture. Moxibustion treatment was added

November 26, 20XX

the hypogastric region and outside the surgical scar weapplied in conjunction with scarcely skin piercing
needle retention warming moxibustion with moxa
cigars and direct moxibustion (5 to 7 cones). About one
year after the first visit the patient underwent aballoon dilatation procedure from the duodenum to theesophageal anastomosis in the same hospital to treat
the passage disorder induced poor appetite. After that,
however, chilling and pain of the epigastric region as
well as a feeling of congestion extending from theepigastric to the umbilical region developed.
September, 20XX+1

Palpation revealed the clear manifestation ofindurations from the epigastric region down to theregions left and right to the umibilicus that tended
to become more marked with increasingly stronger
complaints of passage disorder, so that we gradually
increased the number of moxa cones applied.

[Accessory symptoms]
16

also

[Present illness; finding]single[First visit]

wearinessisdepending on the symptoms either for needle retention,

Y.I.; female, 57 years

methotrexate,

Thereof shoulder and neck stiffness as well as low back pain

[Patient]of

stiffness.

cancer. Tenderness in the region from the top of theIntroduction

consistedneckconstipation and low back pain.

Shoko Masuyama and Hitoshi Yamashita

where

and

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

Volume 7, Number 3 | Fall 2012

November, 20XX+1

enthusiastically started yoga, facial esthetics, joined

Readmission, after discharge in the following

a painting class and in our clinic also underwent

October we switched to multiple cone direct

cosmetic acupuncture.

moxibustion treatment.
January, 20XX+2[Treatment frequency]

In spite of decreasing tumor marker levels, aOver a period of 25 months from the first visit until

stricture of the small intestines and metastases tothe patient's retirement in December 2 years after

the right ovary were observed 21 months after the

20XX the patient visited our clinic in intervals offirst visit (August, 20XX+2), so that she underwent

once every 1-2 months because she was still

surgery in the following month, but because

commuting to work, but over a period of 9 months

peritoneal dissemination and colon metastases wereafter her retirement (December, 20XX+2) she visited

also found,

our clinic once every other week.

anticancer agent was switched in October of theboth ovaries

were resected.

Thesame year to paclitaxel and treatment

Jan. 20XX+1

Apr. 20XX+3

May, 20XX+3

25days later

Jan. 20XX+3

11days later

Jul. 20XX+3

21days laterFig.1 Chronological changes in symptoms and palpable masses[Course] Fig. 1 shows the complaints of abdominal

initiated administering the drug 3 times a weekindurations and the changes over time. One year

followed by one week of rest. A port imbedded

after 20XX she started visiting also anothersubcutaneously

acupuncture clinic offering acupuncture treatment

introjection of high caloric infusions, after which her

for cancer patients.

condition improved, so that we recommended to use

on

the

right

chest

allowedpaper mounted moxa at home. Application of thispaper mounted moxa during meals provided a

January, 20XX+2
Oligophagy

due

to

anticancer agent

dysgeusia.

Thepatient

complained

inducedfeeling of refreshing relief, resulted in borborygmus

ofand enabled her to eat well.

food

accumulating in the stomach, the lack of relief of thefullness and a lingering feeling of heaviness. Apart

April, 20XX+3

from the treatment in our clinic the patient started

Suspension of the chemotherapy made food passage

to perform box (warming) moxibustion at home withworse, but application of the paper mounted moxa

a self-made box. During this time the patient

increased intestinal motility.

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

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Volume 7, Number 3 | Fall 2012

After 2 years and 10 months after the first visit in

The patient relied for the treatment of the cancer on

September, 20XX+3 a total of 47 treatment sessions

Western medicine and chose to combine this withhad been administered. The following month, theacupuncture and moxibustion treatment in our clinic

chemotherapy was discontinued and until she wasfor her complaints of passage disturbance and otherreadmitted three days before her death palliative

symptoms. In particular the moxibustion helpedcare continued at home. She passed away 36 months

ease the ingestion of food per os and conceivably

after treatment begin (on November 17, 20XX).

helped to ease pain and her fears. The stressproblems of oral food ingestion causes patients after[Discussion, conclusions]
BunshiShirotasurgery for cancer and during chemotherapy is a
"Basicmajor source of suffering in those patients. Relief

Acupuncture and Moxibustion Treatment" a total of

also helps to spend the remaining time more

40 diseases of the digestive system and 16 among

meaningful. We believe, that moxibustion treatment

these are related to gastric diseases. In that work hefor passage disorders following surgery for gastricdescribes the use of acupuncture points which had

cancer represented for this patient a useful means ofempirically been found to show a high clinicalpalliative care.

usefulness.

listedinFrequently

his

work

mentioned

pointsfordigestive system diseases is first of all CV12,
followed by BL17 (Fig. 2). In the present case

Referencetreatment of disturbances of gastrointestinal tract

1) Shirota B. Shinkyu Chiryo Kisogaku. Ido No
Nippon Sha, 1940.

passage with moxibustion on the abdomen was more
effective than the use of points on the back or legs forrelieving the symptoms. CV12 is an acupoint used
not only for the treatment of postsurgical gastriccancer, but frequently also for the treatment ofdigestive system disorders.

Frequency of appearance

25

20

23

15

13

10

12

12

9

9

5

8

7

0
CV12

BL17

BL20

ST21

ST34

ST36

BL21

Fig.2 Frequently used acupoints by Bunshi Shirota

18

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

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Volume 7, Number 3 | Fall 2012

Clinical Report 2 (Kampo Medicine)
A Case in Which Keishikaryukotsuboreito Had a Marked
Effect on Postmenopausal Anxiety
Hisai Wada
Wada Clinic

Case
58-year-old female
Past medical history & family history: Nothing
particular to mention. Entered menopause at 55
years of age.
Chief complaint: Anxiety, hot flashes, insomnia

Summary

Keishikaryukotsuboreito had a marked effect in a

History of present illness: From around June of
XXXX-3, the patient began to experience hot flashes,case where there was a hesitation to apply hormone

but she ignored them, as they did not particularly

replacement therapy to a patient who enteredbother her. In the same year, she had a medical

menopause several years ago and whose chief

checkup and was told her blood pressure was on thecomplaint was anxiety.

high side. It was not so high that she needed to see
a doctor, but because her blood pressure had always

Introduction
The period from when the gonadal function
begins to decline toward the final cessation of
menstruation to when it eventually falls andstabilizes,

isunidentified

calledmedicalmenopause,
syndrome

that

and

the

appears

during this period is called menopausal symptoms.
Hormonereplacement

therapyismarkedly

been low until then, the diagnosis shocked her, suchthat she was gripped by a sense of anxiety andexperienced palpitations whenever she measured
her blood pressure after that. No abnormality was
found in subsequent medical checkups, but from the
beginning of XXXX, the patient’s anxiety mounted
for no reason, and she began to measure her bloodpressure at home. She also began to wake up in theeffective against such vasomotor symptoms as

middle of the night, and tended to experience hot

sweating and hot flashes, but it frequently fails to

flashes when she woke up. She would then thinkhave a sufficient effect on psychological symptoms

about bad things and lose sleep out of anxiety. She

such as depression and anxiety. Additionally,

created a stream of worries for herself to the point

applying hormone replacement therapy several

that she could not get any housework done, andyears after menopause increases the risk of side

thus made a first visit to my hospital on February

effects, so it is not a realistic first choice of22.

treatment.

Furthermore,prescribing

anAppetite: Not much appetite, although some foodantidepressant is met with strong resistance fromis consumed.

both gynecologists and patients who visit a

Bowel movement: Once a day

gynecologist with a chief complaint of general

Urination: 5 – 8 times/day; nighttime urination:

malaise.

1 – 2 times

This paper is a report on a case where Kampo

Sleep: Falls asleep, but tends to fall into a doze,

treatment had a marked effect on a patient who

andfrequently

experiences

nocturnalsought medical attention for a chief complaint of

awakening.

anxiety experienced several years after menopause.

Present condition: 155cm, 47kg, blood pressure
127/71mmHg
Overall findings: Hair is short, disheveled, andtangled. No makeup. Clothes are not worn
properly.

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

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Volume 7, Number 3 | Fall 2012

Abdominal findings: Weak (abdominal strength2/5). Tension in the rectus muscle on both sides,

Observations

Keishikaryukotsuboreitoaprescription

composed of cinnamon bark, keel bone and oyster

paraumbilical region. Slight painfulness in theshell. It works on deficiency patterns that call for the

right

use

side

of

the

chest.

Slightepigastricdiscomfort.

sleep,

Tongue: Red, swollen, light yellow coating
Progress: The patient was administered 7.5g ofkeishikaryukotsuboreito extract three times a day
and 1 tablet of an estrogen-progesterone compound
drug once a day, for a week.
When the patient made a visit the following week,
she was not wearing makeup, but she had brushed
her hair, and was wearing tidy clothes. She said she
became magically better from the following night
after she began taking her medicine. She reported
that sleeps well at night, and her feeling of anxiety,negative thoughts, hot flashes and palpitations all
disappeared. She did not want to take hormones, so
she was prescribed only Kampo medicine thereafter.
sometimes

treatment,thestrengthened

patient’s
afterakeishito or keishikashakuyakuto, andexcessive

anxietynocturnal

awakening or when there was an earthquake ortyphoon, but her condition improved on the wholeafter she was prescribed an additional 2.5g/day ofkambakutaisoto. By the time a year passed, thecloseattentiontoherpalpitations,andIn the above case, keishikaryukotsuboreito wasused, based on palpation findings such as poor
abdominal strength, tension in the abdominal rectus
muscle and palpitations, accompanied by thepatient’s chief complaints of anxiety and insomnia.
Hot flashes and seating were observed since
immediately after menopause, so a female hormone
was initially prescribed, but the patient improved
solely with keishikaryukotsuboreito. The symptoms
were not due to hormonal decline, but rather, it wasthought that the kidney qi declined with age and theheart qi worsened on the whole, thereby causing a qi
counterflow mainly brought about the patient’s
illness.
During menopause, patients are affected not only
by hormonal changes, but also changes in social
background and changes accompanying age. Kampo
treatment that corresponds to each condition isthought to be effective.

patient was seen wearing attractive makeup andgivingdreaming,

nocturnal emissions.

｀

Duringofimproves anxiety, tendency to be surprised, shallow

Pulse: Slightly floating and string-like

clothes.

Keishikaryukotsuboreito was gradually reduced in
response to her improvement, and when she came infor a consultation in February XXXX+2 “to makecertain, although she thinks she is alright now,” shewas prescribed 2.5g/day of keishikaryukotsuboreito
worth a month. This completed her treatment.

20

isand strong palpitations from the epigastric to the

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

Volume 7, Number 3 | Fall 2012

Medical History in Japan
Historical Significance of the Standardization of Acupoint
Locations”, the Second Japanese Acupoint Committee (7)“Detailed Guide to the Location of Acupoints” from thecalssics to the WHO standardization”, pp411-422, Tokyo,
Ishiyaku Publishing, June 2009 (partially revised)
Makoto Mayanagi
Graduate School of Humanities
Ibaraki University(continued from KAIM Joural vol.6 no.1, no.2, no.3,
no.4, vol.7 no.1 and vol.7 no.2)

6 Tertiary standardization – unification on anational level

Figure 10 Bronze figure (Tokyo National Museum)

After the Tang period and through a period of 5
generations of confusion China was reunited under the
Northern Sung government, and maybe also due to theemperor's pursuit of a civilian controlled policy,
attached great importance to medical policies. On thisfoundation "Su Wen", "Ling Shu" and similar medical
classics were revised, books on herbology also enlarged
and revised a large portion of medical encyclopedias
newly compiled and using the wood-block printing
technique that had spread at that time governmental
editions published. The effects of acupuncture andmoxibustion too were acknowledged by the emperor
himself, so that he ordered the medical officer Wang
Wei Yi to correct the confusion about meridians andacupoints. By imperial command Wei Yi prepared his"Illustrated Meridians" (illustrations and descriptivetext) and in the following year based on that work
created a 3-dimensional figure, that was "newly cast"and he revised the 14 meridians and 354 acupoints in
1026, publishing the "Illustrated Meridians" as the 3volume work "(Newly casted) Tong Ren Shu Xue Shen
Jiu Tu Jing [14].

Figure 11 Rubbed copy of a gravestone

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

21

Volume 7, Number 3 | Fall 2012

By the way, the Northern Song editions of the timeused characters of coin size and even B4 paper size
large characters, were mostly luxury books for the
court and government officials and consequently too
expensive for ordinary people or physicians.
Therefore, subsequent publishing of small print
editions for the general population was common for
medical books. Yet, trying to create a small printed
version of the "Tong ren shu xue shen jiu tu jing"makes it difficult to contain the bronze figure
illustrations. Presumably this seems to have been thereason why there has been no small print edition ofthis work, but the government had this book carved
as a stone relief that was then erected in the capitalof Bianjing (today's Kaifeng) and spread by having
people make rubbed copies of it. The casting of thisbronze figure and publishing of the book, and again
the rubbed copies obtained from the stone relief wereused as a means for the careful spread of thisknowledge and had the purpose of achieving
unification on a national level. It is no exaggeration tocall precisely this the tertiary standardization.
Incidentally, quotations in the "Xia Ma Jing" or"Ishinpo" derived from the "Chang Jing" or Pelliot
text No. 2675 show that the discourse pertaining to
the determination of the type of meridian or the
acupoints to be avoided depending on the location of
the human spirit was very popular until the Tang
period. Whether this view already prevailed from thestage of the "Ming Tang " is unknown, but they arereferred to twice in the "Illustration of the Brass Man
Acupuncture and Moxibustion". The widespread
discourse could apparently not be neglected.
Figure 10 shows the bronze figure at the Tokyo
National Museum, which had originally been cast in
Northern Song and had been called "Tensei dojin".
This originates according to Chen cunren theory to
the joining of the Japanese army when the allied
forces of eight countries attacked Beijing during theBoxer Rebellion and carried it away from the oldpalace in Beijing. However, Professor Hiroshi Kosoto
from Kitazato University showed beyond any room for
dispute that this particular bronze figure had beencast by the acupuncture medical officer Jizen
Yamazaki upon order from the shogunate during the22

Edo period by the end of the 18th century and been in
the possession of the Edo Medical School [15].
Figure 11 shows a rubbed copy of the stone relief
immediately after it had been set up in Bianjing [16]and "First Volume of the Newly Cast Bronze Figure
Illustration of Acupuncture and Moxibustion" isfound in the left lower corner. This stone relief was
moved during the Yuan period to Beijing and had
there been preserved until the Ming period. Thisparticular stone remnant was discovered during
excavations at Beijing's castle wall and a portion of it
is now on display on the 6th floor of the The Chinese
Academy of Sciences in Beijing. Further, the Ming
government also completely replicated the Northern
Song stone relief because of damage and wear andallowed to make rubbed copies of it to spread theknowledge. The library of the Imperial Household
Agency is in the possession of a complete rubbed copy
from the Ming period that originally had been
together with the bronze figure shown in Figure 10 in
the possession of the Edo Medical School.

Figure 12 [Newly published with supplementary notes]
Tóng Rén Shù Xué Zhēn Jiǔ Tú Jīng

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

Volume 7, Number 3 | Fall 2012

On the other hand, the 1027 year Northern Song
edition of the Tóng Rén Shù Xué Zhēn Jiǔ Tú Jīng
does not exist any more. Later, in the year 1186
during the Jin dynasty an enlarged, 5-volume
edition, the [Newly published with supplementary
notes] Tóng Rén Shù Xué Zhēn Jiǔ Tú Jīng was
reprinted, but this Jin edition too did not survive tothe present day. Figure 12 is called the popular[Newly published with supplementary notes] Tóng
Rén Shù Xué Zhēn Jiǔ Tú Jīng, but is actually a
Yuan replica, the only extant copy of which is in the
National Library of Taiwan. Yang Shoujing obtained
this particular book while visiting Japan during theearly Meiji period, which is part of the shogunate
acupuncture

medicalofficer

Yamazakifamilycollection, who casted the bronze figure. Later, it wastransferred by Shoujing to Liu Shih-heng and Shihheng, while knowing that this was the Yuan edition
called the book Jin edition that was then reprinted
by the end of the Qing dynasty. This has today been
published in China as an imitation gold reprint [17].
On the other hand, this book itself has been in thepossession the Central Library founded in Nanking
by the Chinese government in and until the present
day undergone many modifications.

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

23

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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".

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Since Tochimoto was appointed as aJapan-China friendship trading firm in
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We import a variety of quality-controlled
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TOCHIMOTO TENKAIDO CO., LTD.
3-21 Suehiro-cho, Kita-ku, Osaka 530-0053, JAPANwww.tochimoto.co.jp