Volume 2, Number 2 | Summer 2007

Kampo Medicine - Current Research
Efficacy of Goshuyuto for Migraines
Hiromichi Yasui
Japan Institute of TCM Research

he did not go made such behavior and it was a furious
headache. Yoshimasu hurriedly prepared two doses ofgoshuyuto and administered him. After the use ofthem, the headache disappeared.

Since this reported, the use of goshuyuto has
1. Introduction

become a kind of common sense and many cases

Migraine is a disease that has been around thehave been reported till now. Some clinicians

world dating far back to the ancient times and it

discussed a variety of conditions in which goshuyuto

occurs periodically. The patients with migraine have

was effective and according to the tips gained fromto go through a considerably difficult time coping

the discussions and handed down orally, thewith the severe symptoms it produces: Once aprescription has been applied.

migraine attack takes place, it can almost interferewith patients’ day-to-day life. In recent years,
migraine treatment has greatly been advance andwith the availability of triptan preparations,migraines have become a far better controllable
disease than before. Even then, currently thecomplete and total effect cannot be expected frommodern medications.
On the other hand, migraines are considered to
be a disease easy to care for in Kampo medicine. The
reason is that though migraines, having many types,
are triggered by a variety of factors, Kampo
medicine is the medicine capable of doing rightthings for each of triggers and types with pinpoint
precision. To cure the pains, many prescriptions areready for use. Hereunder, a few experiences inJapan of a typical prescription goshuyuto (goshuyuto,Wu-Zhu-Yu-Tang, 呉茱萸湯) are introduced.
2. Case Study on Goshuyuto for Migraines
A case report on goshuyuto for a migraine was
first made in Japan about 200 years ago by Nangai
Yoshimasu (1750-1813) as follows:
Patient: An adult male, age unknown, had always
migraines. A heavy headache attack occurred on acertain day with vomiting, disabling him to speak. He
continuously slapped his neck by his hand. It looked
like a puppet, giving a weird impression. People
around him did not know that his behavior was from aheadache and they thought he went out of order.
Nangai Yoshimasu saw the behavior and knew that

Following are the cases of interest:
Case Report 1:
The patient was a 29-year old female. In her highschool days, headache began to develop by the triggers
of stresses and the crowd. Headache always started in
the muscles of the left shoulder, spreading to the backof the entire head from the left back side of the head,leading to a pain behind the eyes and then making her
to feel like vomiting. . An attack occurred especiallybefore the onset of menstruation and persisted forabout a day. The patient had cephalic CT scans but
nothing abnormal was detected. The analgesic drugs
she used to take, although initially effective, graduallybecame less effective and unworkable, so Kampo
treatment was started. With the administration ofgoshuyuto, mild headaches were experienced only 2-3times before the onset of menstruation and severe
agonizingheadaches
disappeared
completely.
Thereafter, not only has an attack not occurred before
the onset of menstruation, but also menstrual pains
and constipation have been improved.1)
This is a representative case report on goshuyuto.
In case the analgesic drug initially effective becomesineffective, like this case, the treatment by a
medical specialist is required. However, goshuyuto
is effective in many of such cases.
Case Report 2:
The patient was a 49-year old female with amedium build. Since two years before, the patient
sometimes had experienced paroxysmal attacks ofsevere headache. Before and after the attack, thepatient always had a stomach disorder, or distended

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

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Volume 2, Number 2 | Summer 2007

stomach or pain in the stomach. She felt like vomiting
but did not throw up. The nuchal region and the broadof the back became stiff. Appetite slightly decreased.
The epigastric region was often distended with a heavy
sensation in the region and hands and feet became cold.
There were no significant changes in two-times stools.
Pulse was deep and slow. The tongue had a moderatecoating of white moist furs. The abdominal strength
was slightly flaccid. Mild resistance and tenderness onpressure were felt in the epigastric region andclapotage was demonstrated. These symptoms werediagnosed as the conditions (sho) of goshuyuto, andthus the one-week doses were given. After a week,
discomfort in the epigastric region dissipated. After
three weeks of administration, medication wasdiscontinued. Although it has passed one year sincethen, a headache attack has not recurred.2)

nausea. While answering, she seemed to have nausea
attacksand
frequently
threwupsomegastric-fluid-like substance into a washbowl. To myquery of whether she felt cold in the hands and feet,she said she felt them considerably cold. On the basisof these findings, I thought goshuyuto might be theapplication targeting cold in the extremities, headache,and vomiting, and gave her on site a dose of the extract
dissolved in half a cup of hot water. I always havesome doses of goshuyuto extract in my bag with me
when I make a patient’s house call. It may beunbelievable but vomiting stopped before me and in
about five minutes, such rampant headache was
reduced to only a fraction of the intensity she felt
originally. And she was able to rise from therecumbent position and sit on the floor.3)

Headaches that have indications for goshuyuto

headache after the administration of goshuyuto on a

are generally associated with underlying internal

potion basis. It is very rare that such a marked

cold caused by a lack of yang Qi, to which external

effect was obtained in day-to-day clinical practice. It

influences are added to develop an attack. This casemay not be extremely rare but it does not mean that

had several symptoms considered indications forany patient shows such an effect. The person who isgoshuyuto, which will be described later in thisas responsive as this patient will not have apaper. It may be a marked improvement that sincemigraine recurrence by taking this medication for athree weeks medication, no headache episode haslong period of time, like several months to one year.

been experienced for a year.

In other words, migraines can be cured.

Case Report 3:
The patient was a 55-year old female. The patient
had the problem of high blood pressure on a daily basis
and made visits to our hospital. Sometimes, she wasplagued by headaches. As seen in many women ofabout her age, blood pressure numbers were not stable.
At a certain night of November 1983, I received atelephone call from her family, saying that the patient
had come down with a headache since daytime, atnightfall began to have a severe pain and now wassuffering from vomiting. I made a house call, taking
cerebral vascular disorder into account. Her sensorium
was clear and her response was also clear without
motor paralysis and stiff neck. So I breathed a littleeasier. When I asked her the type of the pain, she
replied that at nightfall the pain became a pulsatingtype of throbbing sting with the appearance of violent

Case Report 4:
The patient was a parous female of 27 years old.
Before becoming pregnant, the patient used to haveheadaches. In the 13th week of pregnancy, she had aheadache attack disabling her to do family work. She
did not take analgesics thinking of adverse influencesof the drug on her fetus. She was given goshuyuto on
the moment. On her way home, she fell asleep in thetrain. She also had a good night sleep and when she
woke up, she found the headache disappeared.
Attention is called to it that during the period ofpregnancy, the medication should not be administeredwithout careful consideration.4)

8

This is the case that showed a rapid relief ofIn many of women with migraine, a sharp
decrease in the frequency of the attack due topregnancy has generally been observed together
with relief of migraine symptoms. However, this isThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 2, Number 2 | Summer 2007

Although not many headaches get worse withand remained unchanged 16 (10.9%). Usefulness
consists of: extremely useful 18 cases (12.2%), useful61 (41.5％), slightly useful 53 (36.1％), and not useful
15 (10.2％). The cases that achieved useful and higher
effects for each type of headache are: vascular
headache 61.7％, muscle-contraction headache 47.8％,and combined headache 48.1％ with many cases ofimprovement in vascular headache. Production ofeffects was seen in 51.7% of cases within two weeks.

pregnancy, they are not scarce. In any event things

The above is a case series using goshuyuto.

are significantly serous to the people who suffer

Despite the low level of evidence, efficacy of thefrom headaches. Kampo medication offers only amedication is clearly demonstrated. The medication

few choices but they can be expected to yield safe

tends to be more effective for vascular headaches

and high efficacy. One of these choices is goshuyuto,(migraines). However, since headaches that wereon which other cases were reported.

originally migraines must have been included in

not applicable to any woman. Indeed, the researchby Ratinahirana et al. reports that cases offrequency and symptoms became worse in pregnant
woman represented 6.8%.5) Moreover, the researchby Maggioni et al. reports that improvements inwomen experienced pregnancy twice or more were
not as good as in the first time pregnancy.6)

other types of headache, this medication may be
3. Clinical Study on Goshuyuto for headaches

said to be more effective for migraines.

Many clinical experiences similar to the above
have been reported and it has become a kind of2) Study by Odaguchi et al.: Study on thecommon knowledge in Japan that goshuyuto isadministration of goshuyuto in the same dose toeffective for migraines. However, details of thispatients with chronic migraine.8)
The subjects participated in this study were 49
persons who, in principle, took some medicine once amonth for headache attacks due to chronic primaryheadache (male/female=6/43, age 43±14), and scores
were given to improvement in the severity of headache,improvement in the frequency of headache episodes,improvement in the cold sensation, improvement inmenstrual pains, and improvement in stiff shoulders,which were then divided on the basis of given
standards into two groups – Responder Group(R-Group 36 patients) and Non Responder Group(N-Group 13). And then the patients in the two groups
were equally administered goshuyuto Extract in thesame dose of 7.5g x 3/day for a month and the exact
test of a contingency table was performed.

medication have not been elucidated as to underwhat environments migraines occur in what types ofpersons and efficacy percentages. Thus, someresearchers have conducted clinical studies on thesepoints. The studies included tension headaches aswell as migraines. So, though the efficacy ofmigraine has not thoroughly been elucidated inthese studies, the data are very useful from aclinical view point. Introduced hereunder arerepresentative studies.
1) Study by Maeda et al.: Efficacy of Goshuyuto for
Chronic Headache7)
Goshuyuto Extract was administered to 147
patients with chronic headache (Male 46, Female 101)
to assess the overall improvement, general safety, andusefulness. The details of the cases are: vascularheadache 47 cases, muscle-contraction headache 46,and combined headache 54. Overall improvement
comprises: markedly improved 16 cases (10.9%),
improved 61 (41.5%), slightly improved 54 (36.7%),

The

results

indicated

that

R-Grouphadsignificantly high points in “do not get motionsickness” (R-Group 34 patients, N-Group 8: P=0.01)
among subjective findings and “have tenderness inthe paraumbilical region” (R-Group 15 patients andN-Group 1: P=0.04) among objective findings. The
study also indicated that R-Group tended to show

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

9Volume 2, Number 2 | Summer 2007

higher points in the finding of subjective cold

no signs and symptoms associated with goshuyuto.

sensation, finding of discomfort with pain when

The study by Oda et al. was conducted frompressed in the epigastric region (“kyokyo-kuman”),

somewhat Kampo point of view, whereas as thisfacial hot flushing, and non-finding of tenderness instudy excluded unfair views favoring Kampo

the sigmoid region. The findings that exceeded 0,5

medicine when possible, it may be natural that thein both sensitivity and peculiarity were subjective

results differ between the two studies. This is ancold sensation, menstrual pains, hard epigastrium

aspect of goshuyuto. In addition, although the resultwith a sensation of heaviness (“shinka-hikou”), andshowed that efficacy was not related to the type oftenderness in the region between umbilicus andheadache, some of tension headaches and combined

epigastricheadaches may have progressed to migraines.

fossa,whereasnon-findings

that

exceeded 0,5 in both sensitivity and peculiarity areperspiration, irregular menstruation, weak abdominal
power, and flaccid lower abdomen.

4. Target in the use of goshuyuto for migraine

Goshuyuto first appeared in “Shang han lun”.
The section of “kecchin” disease (power to stay alive

This study investigated to find differences in thealmost extincts) of the prescription text has thesigns and symptoms between the patients group that

description meaning “goshuyuto is applied for theobtained efficacy (Responder Group) of goshuyutoconditions of feel like vomiting but nothing isand the patients group that had poor efficacy

brought(Non-Responder Group) and is a groundbreakingheadache…”

study as a step forward for clarifying the wholereferring to the description. Traditional Chinese

picture of goshuyuto. The results prominently appear

medicine uses the medication for vomits caused byin subjective symptoms and abdominal diagnostic

excessive fluids in the cold stomach, whereas infindings, offering clues for future applications of theJapan, the medication is an important prescription

medication.

applied for migraines as a first choice medicine.

up,throwTheupliquids,medication

personisnowwithapplied

goshuyuto is beneficial, in theory, for headaches3) Study by Hayashi et al.: Clinical Study on

caused by cold evil invading into the condition

Goshuyuto for Chronic Headache9)

lacking yang Qi or heat energy, which reversely

Goshuyuto was administered to 32 patients withchronic headache with the result of efficacy at 34.4%.
However, factors associated with the efficacy ofgoshuyuto (level of p<0.05) were not recognized andthe medication may not be said to be specificallyeffective for any one of migraine, tension headache andcombined headache.

flows upward through the liver meridian. It may beThis study investigated more than 100 items of

distinction between responders and non responders

subjective and objective signs and symptoms toto goshuyuto by investigating subjective andelucidate the sho of goshuyuto and multivariableobjective findings in detail. The content of theanalysis was conducted. The methodology was quite

investigation shows that the characteristics ofobjective, eliminating views from the angle ofgoshuyuto appear in the subjective symptoms andKampo medicine to a maximum extent. The result

abdominal sho. Especially abdominal sho confirms

from this methodology was that there were almost

the10

extremely difficult to grasp signs and symptoms
that can clinically support this theory.
Most recently, the study by Odagukuchi et al. has
madesubstantial

progressinelucidating

indications for goshuyuto and has made a clear

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

thefindings

describedin