KAIM
T
Thhee JJoouurrnnaall ooffK
Kaammppoo,, A
Accuuppuunnccttuurree aanndd IInntteeggrraattiivvee M
Meeddiicciinnee
INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 1, Number 1 ･ Spring 2006

Foreword

Kampo, Acupuncture and Integrative Medicine
Shuji Goto

Japanese Acupuncture - Current Research
Efficacy of Acupuncture Treatment for Headache
Satoru Yamaguchi

Kampo Medicine - Current Research
Efficacy of “Goreisan” for Headache
Hiromichi Yasui

Clinical Report 1 (Japan)

Acupuncture for Overactive Bladder
Naoto Ishizaki, Hiroshi Kitakoji

Clinical Report 2 (Japan)

Astragalus Root Provides a Decline in Serum Creatinine in Chronic Renal Failure
Hajime Haimoto

Clinical Report 3 (Japan)

Maoto Demonstrated as Highly Effective for the Treatment of Influenza (B)Kazuhiro Oribe
Efficacy of Kampo Medicine for Influenza with Particular Focus on Maoto
Chizuno Hidaka, Hiromichi Yasui, Hideaki Yamaguchi

Clinical Report 4 (Japan)

Headache - Two Unique Cases
Yoshihide Yakazu, Hiromichi Yasui

Clinical Report from Europe
Case Study: Classical Migraine
Ulrich Eberhard

Introduction of Japanese Acupuncture
Considering the Therapist’s Hand
Shuichi Katai

Medical History in Japan

Japanese Acupuncture and Moxibustion under the Rule of GHQ after World War II
Takako Okutsu

Book Review“Japanese Acupuncture: A Clinical Study” written by Stephen Birch and Junko Ida
Reviewed by Emily Katai

ISSN:1559-033X

Volume 1, Number 1 | Spring 2006

A good motive creates a selfless devotion.
“I just want my customers to feel better, body and soul. Just to see
their faces light up with hope and happiness, I’d do anything,”
remarks Masao Tsuji, President of Ominedo Pharmaceutical Industry
Company. He visits various sites where raw herbs and substances foruse in their Kampo products are picked. And he believes this is the
tradition Ominedo had maintained for over a century now since thecompany was founded in 1900.
The same philosophy is applied in handling the numerous
high-quality formulas created at their labs where highly advanced
scientific and pharmacological researches are conducted. The
company’s state-of-the-art facilities that comply with GMP standards
turn out various extracts to be incorporated into their pride products.
“Every merchandise is the by-product of our sincere devotion todelivering a lineup of products that not only work for the customers’
body, but also bringing peace of mind as well,” Tsuji concludes,“delivering the right product to customers who appreciate ourknowledge and devotion is our ultimate goal.”

Ominedo Pharmaceutical Industry Co., Ltd.
574, Nenarigaki, Yamatotakada-City, Nara 635-0051, Japan
URL: www.ominedo.co.jp
Contact: info@ominedo.co.jp
FAX (81) 745-23-2540

Volume 1, Number 1 | Spring 2006

The Journal of
Kampo, Acupuncture andIntegrative Medicine(KAIM)

TThhee JJoouurrnnaall ooff

K
Meeddiicciinnee
Kaammppoo,, A
Accuuppuunnccttuurree aanndd IInntteeggrraattiivvee M
Volume 1, Number 1 ･ Spring 2006

Research on Theory, Practice and Integration

EXECUTIVE EDITOR

Shuji Goto
Chairman, GOTO College ofMedical Arts & Sciences
Tokyo, JapanEDITOR-IN-CHIEF

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

ASSOCIATE EDITORS
Shuichi Katai
Ibaragi-ken, Japan

Hiromichi Yasui
Tokyo, JapanEDITORIAL STAFF

Akihiro Soma
Akinori Suzuki
Hiroshi Tsukayama
Hitoshi Yamashita
Naoya Ono
Noboru Mitsuhata
Shigeru Tajima
Yoshiro Sahashi

EDITORIAL BOARD
Denmei Shuto
Hajime Haimoto
Hideaki Yamaguchi
Hidemi Takahashi
Katsutoshi Terasawa
Kazushi Nishijo
Keigo Nakata
Keishi Yoshikawa
Koji Ebe
Shohachi Tanzawa
Tadashi Yano
Takahisa Ushiroyama
Tomomasa Moriyama
Toshihiko Hanawa
Yoichiro Ebe
Yoshiharu Motoo
Yoshiro Yase

PUBLISHER

Shuji Goto
International Institute of Health andHuman Services, Berkeley

TA B L E O F C O N T E N T S
1 Foreword
Kampo, Acupuncture and Integrative Medicine

Shuji Goto, Executive Editor

2 Japanese Acupuncture - Current Research
Efficacy of Acupuncture Treatment for Headache
7 Kampo Medicine - Current Research
Efficacy of “Goreisan” for Headache

Satoru Yamaguchi

Hiromichi Yasui

12 Clinical Report 1 (Japan)
Acupuncture for Overactive Bladder

Naoto Ishizaki, Hiroshi Kitakoji

16 Clinical Report 2 (Japan)
Astragalus Root Provides a Decline in Serum Creatinine in Chronic Renal Failure
Hajime Haimoto

18 Clinical Report 3 (Japan)
Maoto Demonstrated as Highly Effective for the Treatment of Influenza (B)Kazuhiro Oribe

Efficacy of Kampo Medicine for Influenza with Particular Focus on Maoto
Chizuno Hidaka, Hiromichi Yasui, Hideaki Yamaguchi

23 Clinical Report 4 (Japan)
Headache - Two Unique Cases

Yoshihide Yakazu, Hiromichi Yasui

24 Clinical Report from Europe
Case Study: Classical Migraine

Ulrich Eberhard

25 Introduction of Japanese Acupuncture
Considering the Therapist’s Hand

Shuichi Katai

27 Medical History in Japan
Japanese Acupuncture and Moxibustion under the Rule of GHQ after World War II
Takako Okutsu

32 Book Review“Japanese Acupuncture: A Clinical Study” written by Stephen Birch and Junko Ida
Reviewed by Emily Katai

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

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

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

Volume 1, Number 1 | Spring 2006

Volume 1, Number 1 | Spring 2006

Foreword

Kampo, Acupuncture and Integrative Medicine
Today there are three great systems of traditional medicine in the world. They are Yunani(Greco-Arab), Ayur Veda (Indian) and traditional Chinese medicine (TCM).
TCM, which originated in ancient China, has spread to surrounding countries through the ages,
establishing itself as the standard system of medicine in the Chinese cultural sphere. The Acupuncture,
moxibustion, and Chinese herbal medicine practiced in Japan are forms of TCM. Since this Japanesesystem of oriental medicine has the same origin as its counterpart in China, the two systems share many
essential features. However, there are also numerous differences between them. Many of these are due tohistorical differences as well as differences in the ways they have been accepted within their respective
healthcare systems. It is the purpose of this journal to present in the English language the most recent
conditions of this medical science – possessed as it is of such a unique form – and referring to the work of
researchers in other countries, to explore joint-research of the future.
In Japan acupuncture and moxibustion are practiced by acupuncturists. These acupuncturists
undergo three or four years of professional training at a college or university. They are then required topass a national examination to receive their license, after which they may begin their medical practice. In
addition to the research conducted at universities and research institutes, there are a lot of interestingstudies that come from acupuncturists who operate private practices.
Chinese herbal medicine, on the other hand, is practiced by medical doctors and pharmacists inJapan. Unlike China and Korea, this system of medicine is operated as part of an integrated healthcare
system, similar to Europe and the United States – and its methodology can be demonstrated to the rest of
the world as a model of integrative medicine. A substantial number of papers have been presented on this
topic, many of which include essential elements of Western medicine. This is the reason that this journal iscalled “Journal of Kampo, Acupuncture and Integrative Medicine” — Kampo being the Japanese term for“Chinese herbal medicine”. In addition observing the distinguishing aspects of acupuncture,
moxibustion, and Chinese herbal medicine as practiced in Japan, readers may also discover the role of
TCM in the Japanese healthcare system.
Published quarterly, each issue of this journal will present the latest research on acupuncture andChinese herbal medicine in Japan. Also published will be three special editions – “Current Kampo
Medicine,” “Japanese Acupuncture” and “CAM in Japan.” In addition to presenting an overall view of
their respective themes, these publications will assist people in understanding the connections which have
led to integrative medicine.
By providing readers with a better understanding of acupuncture, moxibustion, and Chinese
herbal medicine in Japan, it is our hope to contribute to the practice of this system of medicine in othercountries.
Shuji Goto, Ph.D.
Executive Editor
Chairman, Acupuncture and Integrative Medicine College
Berkeley, U.S.A.
Chairman, International Institute of Health and Human Services
Berkeley, U.S.A.
Chairman, GOTO College of Medical Arts & Sciences
Tokyo, JapanThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

1

Volume 1, Number 1 | Spring 2006

Japanese Acupuncture - Current Research
Efficacy of Acupuncture Treatment for Headache
Satoru Yamaguchi
Department of Oriental Medicine,
Saitama Medical School1.

Introduction

Headache is a symptom frequently encountered indaily practice, but many questions regarding themechanisms of its onset, diagnostics, and therapy still
remain unanswered. The classificiation,1) firstpublished by the International Headache Society in
1988, has been adopted by many clinicians andresearchers. However, in 2003, based on recent
progress in headache research this classification has
been revised by the above mentioned academic society
and published as the International Classification of
Headache Disorders 2nd Edition (Table 1)2).
IHS
ICHD-II
code

WHO ICD-10NA
code

Part one

Diagnosis
The primary headache

1

[G43]

Migraine

2[G44.2]Tension-type headache (TTH)

3[G44.0]Cluster headache and other trigeminal
autonomic cephalalgias

4[G44.80]

Other primary headaches

Part two

The secondary headache

5.

[G44.88]

Headache attributed to head and/or necktrauma6.

[G44.81]

Headache attributed to cranial or cervicalvascular disorder

7.

[G44.82]

Headache attributed
intracranial disorder

8.

[G44.4 or G44.83]

Headache attributed to a substance (2) or
its withdrawal

9.

tonon-vascular

Headache attributed to infection

10.

[G44.882]

Headache attributed
homoeostasis

11.

[G44.84]

Headache or facial pain attributed todisorder of cranium, neck, eyes, ears, nose,
sinuses, teeth, mouth or other facial or
cranial structures

12

[R51]

Headache attributed to psychiatric disorder

Part
three

to

disorderof

Cranial neuralgias, central and primary
facial pain and other headaches

13[G44.847, G44.848 Cranial neuralgias and central causes ofor G44.85]
facial pain

14

[R51]

Other headache, cranial neuralgia, centralor primary facial pain

Table 1: International Classification of Headache Disorders 2nd Edition(ICHD-II)

2

When complaining about headache in Japan, themost frequent form is tension headache, as describedin the classification. This can be treated withacupuncture as a characteristic form of oriental
therapy, with considerable success. Conversely, thesame therapeutic modality is more useful for
prevention than treatment of actual migraine orcluster headache (functional) attacks. In this study, we
introduce the mechanisms of the onset of tension
headache as a form of transient headache and describe
the effects of acupuncture therapy and its modes ofaction. We also describe acupuncture treatment for
migraine and cluster headache.

2.

Tension headachea. Acupuncture therapy
The author used plethysmography, EMGs andthermography for an investigation of the mechanism of
onset and the modes of action of the acupuncture
therapy. The results of the study showed that for themechanism of onset of headache, excessive tension of
the posterior muscle, groups of the head, the posteriorneck muscles as well as the suprascapular andinterscapular muscle groups are more important thanthe muscles of the head3). Acupuncture therapy is
performed in order to facilitate the relaxation of theexcessive tension of these muscle groups andnormalize the hemodynamics in these muscles.
In the posterior neck region points in the trapezius
and semispinalis capitis muscles, Tenchu (BL10),
Fuchi (GB20), Kankotsu (GB12) by the mastoid
process (insertion of the splenius capitis muscle) the
suprascapular region Kensei (GB21) within the upperfibers of the trapezius muscle; Koko (BL43) where
various muscle cross each other in the interscapularregion; or points in the lateral region of the neck in the
splenius muscle or the levator scapulae muscle; or also
in the region of the angulus superior scapulae(insertion of the levator scapulae muscle) are selected
as treatment sites.
Actual acupuncture stimulation is adjusted to thepatient's physical strength, general condition andseverityofthesymptoms.
Basically,
electro-acupuncture (1 Hz, 10-20 min) is performed in
the regions of the various hypertonic muscles.

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

Volume 1, Number 1 | Spring 2006

Inrefractory

cases,

facet

joint

needlingissometimes performed in the C2-3 intervertebral space(medial branches of the dorsal rami of the spinal
nerves).
b. Modes of action of acupuncture therapy3-5)
The study also included application of the above
mentioned

non-invasive

EMG

examination

thatprovided for repeated examinations and open loop
video pupillography. This allowed for quantitative
measurement of autonomic nerve function to examine
the

modes

of

actionofacupuncture.

These

examinations provided the following results.
(1) Acupuncture therapy causes relaxation of theexcessive tension of the muscles groups in theposteriorneck,

suprascapularandinterscapularregions. It also facilitated normalization of thehemodynamics

and

therebycontributed

toanalleviation of the headache (Figure 1).

(3) Acupuncture treatment of the muscle groups in theposterior neck, suprascapular and interscapularregions in patients with tension headache, did not only
elicit local reflexes (axon reflexes), but the evidence
also indicated the possibility of an influence on higher
centers.
(4) The reaction of patients with tension headache toacupuncture treatment (autonomic nervous system)
differed from that obtained in healthy persons,suggesting that the acupuncture therapy apparently
contributes to an improvement in the homeostasis of
the body. (Figure 2a, b)
A1

Mean±SE.

（mm2)
44

Control (n=30eyes)＊ p<0.05,＊＊＊＊
p<0.01 vs Before

Control (n=30eyes)

Patients (n=60eyes)

Patients (n=60eyes)

42
40
38

＊
＊

＊
＊＊
＊＊ ＊

36
34
32
30
28
26
Before

0

10min

20min

0

Before

10min

20min

Acupuncture(15min)
Acupuncture(15min) Acupuncture(15min)
Acupuncture(15min)Figure 2: Variations in pupillary reactions in patients with tension
headache before and after acupuncture treatmenta)Pupillary area prior to light stimulation (A1)

a: The pupillary area after light stimulation in patients with tension
headache decreased immediately, 10 and then 20 minutes after theacupuncture treatment. In healthy persons no significant variations
between the conditions before and after the acupuncture treatment
were observed.

Figure 1: Thermograms of patients with tension headache before andafter acupuncture treatment

AC/％A1(mm22/sec22)
650

Upper row: Type 1 covers the posterior area of the neck to thesuprascapular region, Type 2 covers the posterior area of the neck tothe suprascapular region and refers to areas of elevated temperature;

Mean±SE.

Control (n=30eyes)* * p<0.01
vs vsBefore
Beforep<0.01

Patients (n=60eyes)

600

＊＊
＊＊ ＊＊
＊＊

550

＊＊
＊＊

thermograms of patients with tension headache can be grossly divided
into two patterns.

500

Lower row: Improvement of symptoms due to acupuncture treatment450

is associated with a decrease in skin temperature in the areas ofincreased temperature, thus approaching the temperature of thesurrounding areas.

400
350
Before(2) The modes of action of acupuncture partially differ
from that of central acting muscle relaxants.

0

10min

20min

Acupuncture(15min)b)

Before

0

10min

20min

Acupuncture(15min)

Maximal pupillary contraction velocity (AC)The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

3

Volume 1, Number 1 | Spring 2006

b: Maximal pupillary contraction velocity following acupuncture
treatment of patients with tension headache led to an immediate
increase, 10 and then 20 minutes after the acupuncture treatment. In

Unknown

healthy persons no significant variations between the conditions before

Worse

and after the acupuncture treatment were observed.

c. Effects of acupuncture treatment
Patients with tension headache were referred fromdepartments of neurology etc. to our department for aninvestigation of the therapeutic effects of acupuncture.
The study included 86 patients, 22 men and 64 womenwith an average age of 53.6±14.9 years. A visual
analogue scale (VAS) and pain score (PS) were used as
evaluation tools for the therapeutic effects on thepatients' subjective symptoms. The improvement ofsymptoms was calculated in conjunction with theobjective findings: improvement of more than 80%
more than 60% as effective, more than 40% as slightly
effective, less than 40% ineffective and an increase in
symptoms as aggravation.
The results showed that in the patient group,
29.1% of the patients also had diseases of the cervicalvertebra and related conditions, while 72.1%
complained of neck and/or shoulder stiffness. In 17(19.8%) of these patients acupuncture treatment wasmarkedly effective, in 39 (45.3%) effective, and in 14(16.3%) slightly effective; so that the overall efficacy
was 81.4% (Figure 3). Acupuncture treatment and theimprovement in shoulder stiffness showed an
extremely high positive correlation (r=0.912; Figure 4)
that resulted in some patients requiring a reduction ofmuscle relaxants or anti-inflammatory drugs.

ShoulderStiffiness

Unchanged
MinimalImprovement
Moderate
Improvement
MarkedImprovement

Y = .614 + .827 * X; R^2 = .832
MarkedImprovement

MinimalImprovement

Moderate
Improvement

Worse

Unchanged

Unknown

HeadacheFigure 4: Therapeutic results for tension headache and shoulder
stiffness

3.

Migraine and cluster headache

Acupuncture treatment for migraine is performed
primarily for preventive purposes mainly during
remission rather than during actual attacks. During
an attack, a combination therapy with triptan
medications is desirable. Since the mechanism of theonset of cluster headaches differs from that of
migraine, this condition is treated in the classificationof the International Headache Society as anindependent item; but the acupuncture treatment is,
except for the attacks, approximately the same as thatfor migraine.
a. Acupuncture treatment
For the region in which headache occurs mostfrequently, namely in the vicinity of the acupoints
Ganen, Kenryo, Kenri (GB 4-6) and Zui (St8); as well
as for migraine, the vascular mechanism of onset oftrigeminal neuralgia is considered to be likely.
Therefore, points in the course of that nerve, like theheadache86

MarkedImprovement

shoulderstiffiness62

selected. Moreover, for the purpose of regulating

MinimalImprovement

autonomic nerve functions of the circulatory system,

Unchanged

Jingei (needling of the carotid sinus) has been added toWorsethe list of needled regions. Application of distantdizziness

11

Unknown

upper limb
pain 11
0%

20%

40%

60%

80%

supraorbital incisure or the point Gekan (St7), areModerate
Improvement100%

needling described in the classics (use of the brighteryang stomach channel of the leg, greater yang bladderand lesser yang gall bladder channels), choosing points
on the legs like Taikei (KI3), Shoyo (LI1), Ichu (BL40),

Figure 3: Results of acupuncture treatment of tension headache andassociated symptoms

4

Konron (BL60), Yoryosen (GB34), Kyukyo (GB40),
Rinkyu (GB41), and similar points are also very

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

Volume 1, Number 1 | Spring 2006

important. The courses of these channels on the legs

temperatures in the posterior region of the neck, as

closely resemble that of the sciatic nerve, so thatwell as the supra and interscapular regions. The

stimulation of distant regions presumably acts via theacupuncture

nervous system. Taking stimulation of the temples astemperature, observing an approximation to thethe local site of the pain into account during

surrounding skin temperature (Figure 1) and thus

consideration of the mechanisms of onset, suggests

suggests a partially different mode of action from thatthat a light stimulation (manual thrusting and liftingof central acting muscle relaxants.

treatment

led

to

a

decreasein(Jakutaku) manipulation of the needles, rotation and

For the assessment of the influence of acupuncture

electric stimulation of the needles at 30 to 100 Hz)

treatment on the autonomic nerve function in patients

inhibitswithtriggeringofattacks

andaggravation.

tensionAlleviation of complicating complaints or fatigue andpupillography

improvement

non-invasive,

of

the

generalcondition

is

also

important.

headache,
was

an

open

employed,repetitive

which

and

loop

video

permitted
quantitative

measurements of the autonomic nerve function. The
results showed that prior to light stimulation the4.

Discussion

pupillary area was decreased in size and the primary

Recent epidemiologic studies6) of patients withindicators of the parasympathetic nervous function,

headache in Japan indicate that 8.4% of the patientsmaximal pupillary contraction velocity, and maximal

suffer from migraine and 22.3% from tension headache,pupillary contraction acceleration were increased

indicating a significantly higher incidence for the(Figure 2a, b). Yet, no significant changes werelatter condition. This high incidence of tension

observed for the indicator of sympathetic nerve

headache makes it a good indication for acupuncture

function maximal pupillary dilatation. In healthy

treatment and the condition may be expected topeople, significant changes were not observed forcorrespond well to this treatment modality.

sympathetic and parasympathetic nerve function.

The author used plethysmography, EMGs andRegarding pupillary innervation, pupillary dilatation

thermography for an investigation of the mechanism ofis controlled by sympathetic nerves with their centersonset and the modes of action of the acupuncture

located in the spinal cord (C8-TH1). Pupillary

therapy and reported that the muscle groups of thecontraction on the other hand, is controlled byposterior neck region, as well as suprascapular andparasympathetic nerves having their center in theinterscapular muscles, play an important role in the

Edinger-Westphal

development of headache. These results closely

central grey matter. Deduction from these acupuncture

resemble the findings observed during daily clinicaltreatment induced changes in pupillary reaction inpractice and indurations or tenderness in the posteriorpatients with tension headache, suggests an increase

neck and suprascapular muscles. These are frequently

in parasympathetic nervous function. These results

encountered. In the International Classification ofindicate that acupuncture treatment does not only act

Headache Disorders 2nd Edition as revised in 2004,

on the muscle groups in the posterior region of thetender spots are considered of pivotal importance. The

neck, supra and interscapular regions (via axon

effect of acupuncture treatment for these patientsreflexes), but probably also has an influence on higher

showed that wave amplitude and the electric discharge

centers. This influence on higher centers suggests a

from the muscles approached those of healthy persons,close relationship to the mechanism of action ofindicating that the acupuncture treatment led to aacupuncture analgesia.
The results of the investigation by the authors of
the influence of acupuncture treatment on cerebral
blood flow in patients with cerebrovascular disorders
reportedly revealed that the acupuncture therapy led

relaxation of the excessive muscle tension andimprovementin

hemodynamics.

Thermographic

examinations in the same patients revealed a skintemperature

distribution

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

and

the

surrounding5

Volume 1, Number 1 | Spring 2006

in a group of patients with markedly decreased
cerebral blood flow, to an improvement of the cerebral
circulation7). Among these results, the above describedacupuncture induced variations in pupillary reaction
in patients with tension headache. Healthy persons, on
the other hand, indicate that acupuncture treatment
elicits different reactions depending on the presence orabsence of symptoms and their severity. This clearlyshows that the treatment contributes to an
improvement in homoeostatic regulation.

5.

Future prospects

Content of the new International Classification ofDisorders 2nd Edition published in
September 2003 by the International Headache Society,also contained cephalagia2). Tension headache isclassified into the following 4 types: occasional
recurrent, frequently recurrent, chronic, plus a suspectform. For further subdivisions relevant diagnostic
criteria have been established. Adopting these criteria
for further investigations into the effects ofacupuncture based on EBM principles is required.
Regarding the mechanisms of onset progress inbiochemical investigations of the influences on higher
centers, will help to illuminate the pathophysiology
and clarify the modes of action of the acupuncture
treatment.

Headache

6

Reference
1) Headache Classification Committee of the International
Headache Society. Cephalalgia 8 (Suppl 7): 1-96，1988.
2) Headache Classification Subcommittee of the International
Headache Society. The International Classification of

Headache Disorders, 2nd ed. Cephalalgia 24 (Suppl 1):
1-160, 2004.
3)

Yamaguchi

S,

Matsuo

H,

Omata

H,

et

al.:

Thermography in Patients Receiving Oriental Medical
Care: Biomedical Thermology 8 (1): 185-187, 1988
4) Yamaguchi S: Influence of Acupuncture Treatment on
Pupillary Responses. Journal of the Japanese
Association of Physical Medicine, Balneology andClimatology 58 (4): 232-240, 1995
5) Yamaguchi S, Omata H, Arai C, et al.: Oriental

Medical Therapy for Tension Headache, (6th Report),
Japanese Journal of Headache 26 (1) 45-47, 1997
6) Igarashi H: Journal of The Japanese Society ofInternal Medicine 90 (4): 567-573, 2001
7) Maruki Y, Shimazu K, Okubo T, et al.: Effect ofacupuncture on cerebral blood flow in patients withCVD (abstr). Journal of Cerebral Blood Flow andMetabolism 9 (suppl.1): 695 1989, Raven Press, NewYork

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

Volume 1, Number 1 | Spring 2006

Kampo Medicine - Current Research
Efficacy of “Goreisan” for Headache

results in technical journals3).

An epidemiological research study on the relationshipbetween chronic headache and atmospheric depression
Hiromichi Yasui
Japan Institute of TCM Researchthat the prescription should be effective for headache,“Goreisan” has been a popular Kampo prescription
in its 1,800 year history. This medicine improves
abnormal water metabolism and is often used for thiskind of disorder. Source: “Shang han” cold induced
disease. This goreisan has many applications and is
documented in research papers. (Refer to *Reference.)
One of the most interesting studies on headache ispresented below1).

with this preparation4). Based on these experiences, he1) Haimoto H: Observations pertaining to the correlation
between the clinical epidemiology of chronic headache andmigratory cyclones (case-control study of patients for whom

Dr. Doumei Yakazu, who read this paper, thought
as written in Murai’s note, and applied it to patients
suffering from headache. Marked effects were obtained
when patients with migraine at his clinic were treatedlater treated other migraine patients with thispreparationandachieved

very

good

results5).

Considering the possibility that this may also be
effective for other forms of headache, patients visiting
the clinic were subsequently treated with thispreparation as the prescription of first choice. Many ofthese case reports were published in the latter half ofthe 1950s and in the 1960s in the "Journal of Kampo
Medicine".
Based on the results he found, he engaged in further

the treatment with goreisan had been effective or ineffective)

research.

Fromcarefulanddetailed

physicalΦυτο Vol.1 No.3 p4-9, 1998

examination, he attempted to specify the types ofheadache for which the prescription would be effective.
However, even he, who studied for several decades,
could not identify definitive patterns in its use. His
reports inspired other doctors to conduct research, andas a result many excellent papers were written, but
none were able to definitively resolve the conditions forwhich it would be effective. The resolution of thisproblem had to wait until the revolutionary discovery
by Dr. Haimoto almost 40 years after the publication of
Yakazu.

Figure 1: Φυτο Vol.1 No.3 1998

Previous studies and history of the use of “Goreisan”
for headache
The use of goreisan on headaches is not popular in
China. The use of this goreisan in Japan wasdeveloped in recent years and is documented inresearch and case studies. Its first use began
approximately 200 years ago, documented in a thinhandwritten notebook by a doctor named Kinzan
Murai (“Goreisan is Effective on Serious Headache”2).
Dr. Keisetsu Otsuka (1900-1982) who was one of thefirst persons to revive Kampo medicine in recent years,
found this notebook at a secondhand bookstore. Basedon the writing, he applied it for a refractory trigeminal
neuralgia, made dramatic progress, and reported the

The direction of smoke from a chimney pipe inspired
his research
Figure 2 and 3 depict scenery from Dr. Haimoto’s
upstairs window. This shows the chimney of a paper
mill (as seen in the left picture, from right to left) fromwhich he deduced, that when the wind blows from west
to east, it will not rain that day. On the contrary, itrains when the wind is from the east. Thisphenomenon is known by many women that live near
this place who judge by the direction of the smoke
whether they can do their laundry that day. The
discussion of this phenomenon will become apparent
as the discussion of headache and atmosphericpressure unfolds below.

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

7

Volume 1, Number 1 | Spring 2006
The Paper Mill, Its Chimney, and the Flow of the Smoke

Figure 2

Figure 3

In his everyday attendance, Dr. Haimoto noticed that on days when the smoke flows from east to west,
headache patients increased, and also that much of the headache can be lightened by taking goreisan. Therefore,
he hypothesized that headaches caused by gradually lowering air pressure can be lightened by taking goreisan.
In order to establish this hypothesis, he started research with his fellow doctors. The first step was to have thepatients keep a record on the headache calendar (Table 1). It can be confirmed that the patients realizedheadache before the weather changes for the worse.

DATE
HEADACHE

SUN

MON

TUE

WED

THU

FRI

SAT

29 NOV.

30 NOV.

１ DEC.

２ DEC.

３ DEC.

４ DEC.

５ DEC.

○○○
CLOUDYWEATHER

↓

FINE

FINE

FINE
Table 1: Headache Calendar

Subject of the investigation
This study investigated patients with chronicheadache as their chief complaint who visited four
related medical facilities between October 10, 1988
and August 15, 1999. Among these patients, thosecomplaining of headaches that lasted more than threemonths and occurred with a frequency of more thanonce per week served as the subjects for this study.
A consent was obtained from the patients prior totreatment. Eighty-six items pertaining to daily life andthier symptoms, 26 items pertaining to physicalfindings as well as other items; a total of 140 items,
were examined.

8

？

？

FINE

RAIN

↓

↓

RAIN

CLOUDY○

CLOUDYRAIN

The 56 patients examined in the study included 14
men and 42 women. Useable data concerning the effects
was possible in a total of 42 patients, 9 men and 33
women. They were treated with goreisan for a period
varying between 2 and 4 weeks.
A breakdown of the diseases observed included 42
patients with tension headache, 1 patient with mixedheadache and 13 patients without specification (cases
in which a western medical diagnosis was difficult).
Coexistent diseases were observed in 40 patients(including 18 patients with neuroses, 7 withdepressive moods, 9 with psychosomatic diseases, 3
with autonomic dysregulation and 3 with insomnia).
Thirteen patients had cardiovascular diseases(including 11 patients with hypertension and 1 patient

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

Volume 1, Number 1 | Spring 2006

with angina pectoris). Other symptoms were detected:
5 patients with dizziness, 4 patients with metabolic
disorders (including 2 diabetics and 2 patients withhyperlipemia), 3 patients with skin diseases (2patients with atopic dermatitis), 2 patients withmusculoskeletal diseases, 1 patient with a gynecologic
disease, and 1 patient with a hematologic disease.

Research methods and results
The physicians participating in this study instructed
patients who were diagnosed with chronic headache tokeep a headache calendar including frequency of theirheadache and observe changes in the correlation
between the weather and headache as well as
treatment with goreisan. These patients were treatedwith 5.0 g - 7.5 g/day of goreisan extract and the effects
evaluated after a period ranging from 2 to 4 weeks. An
almost complete alleviation of the headache wasdefined as "markedly effective", a reduction in thefrequency of the headaches to less than half of its
pretreatment incidence as "effective" and failure to fall
below

half

of

the

pre-treatment

incidence"ineffective".

as

These results were then subjected to a statisticalanalysis (multivariate analysis) in order to deduce therelevant conclusions.
The following results were obtained:
Examination of the factors with a significant
correlation to the effectiveness of goreisan for thetreatment of chronic headache showed that among the
42 patients treated with this powder, the results were
evaluated as "effective" in 21 patients (50.0%). Next thepatients were divided into a group effectively treatedwith this powder and an ineffective group. The results
for which a statistical analysis of the correlation
between the various factors and efficacy showed asignificant odds ratio are listed in Table 2.
The strongest positive correlation with theeffectiveness of goreisan was found for "Symptoms
become worse on the day before it starts raining". Herean odds ratio of 16.3 and a risk of 0.25% were
statistically significant. In other words, this powder is 16
times more likely to be effective in patients who statedthat "Symptoms become worse on the day before it starts
raining" than in patients responding "they do not". The
Goreisan was effective in 19 (90.5%) out of the 21
patients in whom symptoms actually exacerbated on the
day before it started raining.

Item

Goreisaneffective

Goreisanineffectivep

Odds ratio

Symptoms become worse on the day before it
starts raining (YES/NO)(19/2)(2/19)

0.0025

16.3(7/14)(7/14)(4/17)(13/8)(3/15)(2/19)(8/13)(1/20)(1/11)(14/7)(14/7)(10/11)(18/3)(15/6)(7/14)(15/6)(6/15)
(4/5)

0.045
0.035
0.039
0.0064
0.054
0.053
0.017
0.073
0.083

0.26
0.24
0.22
0.22
0.20
0.17
0.16
0.13
0.12

(1/20)(6/15)

0.054

0.11

(7/14)(9/12)(17/4)(18/3)

0.00310.0055

0.10
0.093

(4/8)

(8/1)

0.024

0.052

Easily catch cold (YES/NO)
Hands are cold (YES/NO)
Palpitation (YES/NO)
Feet are cold (YES/NO)
Strengh of the pulse (weak/normal)
Shortness of breath (YES/NO)
Dizziness (YES/NO)
Chest dyscomfort (YES/NO)
Menstrual blood loss (profuse＋scant/intermediate)
Color of tounge fur (yellow＋dark yellow＋burnt＋
gray＋black＋gree＋other/white)
Orthostatic syncope (YES/NO)
Strong anxiety (YES/NO)
Thumb-sized blood clots in the menstrual blood(YES/NO)
Table 2: Results and Odds Ratio

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

9Volume 1, Number 1 | Spring 2006

This indicated that goreisan is effective in patientsobservations

made

by

researchers,

a

drop

in

in whom headaches develop on the day before it starts

atmospheric pressure from 1013 hPa to 1000-995 hPa

raining, much higher than in people in whom this is

triggers the onset of these headaches.

not the case. Regarding the correlation with theweather,theresults

showedclearlythat

At this point, the headaches in question are mostly

thetension headaches and not pulsating headaches

administration of goreisan for headaches developing(migraine). Occasionally mixed headache forms arewhen atomospheric pressure drops gradually, isobserved. Yet, as Haimoto et al. have pointed out,

effective in more than 90% of the cases.

goreisan is not only effective for headaches triggered

The effectiveness of goreisan for patients in whomby a drop in atmospheric pressure. It may also be

the headaches exacerbate on days preceding rain is

effective for other forms of headache as well. For

conspicuous from this table, but examination items

example, among the case reports published by many

reveal other interesting results. Also, apart fromresearchers like Yakazu, and other several have also

whether goreisan is effective or not, examination of thedescribed migraine, headaches, indicating they aresigns with significant correlations to headaches onsuitable for the effects of this preparation.

days before it starts to rain, clearly showed, for

Another factor needs to be taken into consideration.

example, that the consumption of coffee or raw

Goreisan is not the only preparation effective forvegetables reduced the likelihood of the development

headaches triggered by a drop in atmospheric pressure.

of headaches on days before rain. This study included

Our

many other fascinating data. The reader is encouraged

ryokeijutsukanto or hangebyakujutsutemmato may

to review the original literature.

under certain circumstances be effective.

Haimoto et al. have deduced the following

2)

clearly

shown

that

In the former case, from a point of view of Traditional

Goreisan has a probability of 90% to be effective

metabolism has been considered responsible, so that thefor headaches which occur with a frequency of 1-2

three crude drugs also found in goreisan, namely

times per week with an onset days before it starts

Cinnamomi Cortex, Porea and Atractylodis Rhizoma

raining. It is not effective for headaches thatprobably play an important role. In the latter case,occur daily.

based on TCM etiologic concepts, phlegm is considered

Factors that decrease the likelihood of goreisan

the relevant causative factor. These results suggest thatbeing effective include orthostatic syncopes,

similar headaches may not only be triggered bystrong anxiety, dizziness (occurring daily), cold

stagnant water and moisture, but also by phlegm.

feet,

cold

hands

and

palpitations.

TheseThus, there is not only one preparation for thesymptoms suggest a correlation to psychosomatic

treatment of headaches induced by a drop in

headache.

atmospheric pressure, although there are as yet no

Reflections on the results
This study showed that goreisan is effective for someforms of headache triggered on days preceding rainwith comparatively sudden drops in atomosphericpressure. Haimoto interpreted this with a correlation
with migratory cyclones. Japan’s climate has four
distinct seasons and migratory cyclones are likely topass over Japan in spring and autumn. Headache
forms that are indications for goreisan are also likely
to occur during these seasons. According to

10

have

Chinese Medicine (TCM), an anomaly in water

conclusions from this study.
1)experiences

clear indications as to which of the above describedprescriptions should be used. Nevertheless, theresearch of Haimoto et al. is relevant, because it
indicates efficacy of the treatment with goreisan inthese cases.

Possible future applications
This report suggests the possibility of using goreisan
for the treatment of various diseases triggered bychanges in atmospheric pressure, in particular, drops
in atmospheric pressure.

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

Volume 1, Number 1 | Spring 2006

For example, headache, diarrhea or similar physicalchanges developing when mountaineering people
reach an altitude of about 1,000-m above ground levelin a comparatively short time; the obstruction of theauditory tube and ear pain due to edema developing inpassengers of ascending planes after take-off; Caisson
disease developing in divers or surfacing submariners,
and similar conditions, may in some cases, beconsidered indications for goreisan.
Currently, some physicians who learned of thisresearch, install a barometer in their consultation
rooms in order to establish the diagnosis. Undercertain circumstances they wear wrist watches with abarometer and constantly pay attention to changes inatmospheric pressure.

*Reference
Composition, dosage and indication of goreisan inJapan today.
Composition
Alismatis Tuber

Indications
1. Headache, Migraine

5.0-6.0g
Poria

2. Acute gastroenteritis

3.0-4.5g
Atractylodis Rhizoma
3.0-4.5g

3. Chronic subdural hematoma

Polyporus 3.0-4.5g

4. Cerebral edema

Cinnamomi Cortex

5. Acute stage of cerebral

2.0-3.0g

infarction
6. Edema generally
7. Hydrocelle testis
8. Ear pain during airplaneflightCited references
1) Haimoto H: Discussion of the correlation between the clinical epidemiology of chronic headache andmigratory cyclones (case-control study of patients for whom the treatment with goreisan had been effective
or ineffective), Фυτο 1 (3): 4-9, 1998
2) Murai K: Clinical note of Dainen Murai, end of the 18th or beginning of the 19th century3) Otsuka K: Goreisan for persistent trigeminal neuralgia, Oriental Medicine 1 (4): 1953
4) Yakazu D: First part "Journal consultation room", Journal of Kampo Medicine 1 (1): 47-48 and (2): 58-60, 1954
5) Yakazu D: Treatment experiences with goreisan and its application, Journal of Kampo Medicine 4 (12): 3-12,
19576) Ogawa A: Headache and goreisan, Journal of Kampo Medicine 14 (9): 16-21, 1967

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

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Volume 1, Number 1 | Spring 2006

Clinical Report 1 (Japan)
Acupuncture for Overactive Bladder
Naoto Ishizaki1)
Hiroshi Kitakoji2)
Department of Clinical Acupuncture and Moxibustion I1)
Department of Clinical Acupuncture and Moxibustion II2),
The Chief of Acupuncture Center
Meiji University of Oriental Medicine, Kyoto, Japan

Introduction
Lower urinary tract symptoms (LUTS), including
increased urinary frequency, urgency, urinary
incontinence, urinary weak stream, interruption andresidual feeling after micturition, are common
problems in elderly people1). Our previous study
showedthat
acupuncture
relieved
urinaryincontinence, increased urinary frequency, urgency
and nocturnal enuresis2-4).
In 2002, the International Continence Society (ICS)
identified “overactive bladder” (OAB) as a symptom
syndrome defined as urgenct, with or without urge
incontinence, and usually with frequency andnocturia5).
This report presents a successful clinical case studyof an individual with overactive bladder treated byacupuncture using the current definition of thesymptoms associated with OAB.

periosteum (50 to 60 mm), and then the bilateralneedles were maneuvered up and down manually for
10 minutes. The treatment was repeated once a week.
To assess the symptoms before and after acupuncture,
the International Prostate Symptom Score (IPSS) andIPSS quality of life index (IPSS QOL index) were used.
The IPSS questionnaire is used by the American
Urological Association symptom index6). The score ofeach symptom of the IPSS, including 4 voiding
symptoms (incomplete emptying, intermittency, weakstream and hesitancy) and 3 storage symptoms(frequency, urgency and nocturia), ranged from 0 to 5
points. A total IPSS score was obtained by summing up
each score (0 to 35) and categorized into 3 groups of theseverity as mild (0 to 7), moderate (8 to 19) or severe (20to 35). Assessment of quality of life (QOL) by urinary
symptoms was ranged from 0 (delighted) to 6 (terrible).
Additionally, urinary frequency and voided volume were
estimated from a frequency volume chart (FVC).

Zhongliao（BL-33)

Case Report
This case study is based on an 81 year-old man who
underwent acupuncture treatment for refractory
symptoms of increased urinary frequency (voiding 8 ormore times), nocturia (awakening 3 or more times atnight to void), urgency and urge incontinence due tobenign prostate hyperplasia. He had previously failedalpha-1 blocker and underwent acupuncture treatment.
Acupuncture was performed using a disposable
stainless steel needle (0.3mm in diameter, 60mm inlength, SEIRIN Kasei, Shimizu, Japan) with thepatient in the prone position. Acupuncture needles
were inserted into the bilateral Zhongliao points(BL-33, as standardized by the World HealthOrganization), on the skin of the third posterior sacralforamina in the cranial direction (Fig. 1). The needle
was inserted into each side of the foramina sufficiently
deep for its tip to be placed close to the sacral

12Fig. 1: Schematic diagram showing acupuncture points inbilateral Zhongliao (BL-33)

Baseline FVC showed a maximum voided volume of
120 ml with postponing micturition as long as possible.
Additionally, assessment of quality of life where urinary
symptoms were terrible, were assessed by the
self-administered questionnaire using International
Prostate Symptom Score quality of life index (IPSS QOL
index) before acupuncture. After the 4th treatment a
maximum voided volume was 200 ml with tolerable topostpone voiding written in FVC, however, assessment of
QOL was unchanged. After the 8th treatment a maximum
voided volume was 330 ml and assessment of QOL wassatisfied. Urgency and urge incontinence disappeared
after the 8th acupuncture treatment (see Table 1).

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

Volume 1, Number 1 | Spring 2006

Beforeacupuncture

After 4th
acupuncture

After 8th
acupuncture

daytimefrequency

886nocturia

3

3

1

maximum
voidedvolume (ml)

120

200

330

17
(moderate)
6(severe)16(moderate)
6(severe)5(mild)
1(satisfied)IPSS
QOL index

Table 1: IPSS: International Prostate Symptom Score, QOL
index: quality of life index

Comment
Overactive bladder (OAB) is a symptom complex
that includes urinary urgency with or without urge;
incontinence, urinary frequency and nocturia,
identified by the International Continence Society(ICS) in 2002 (Fig 2) 5). OAB is an empiric diagnosis
used as the basis for initial management after
assessing lower urinary tract symptoms (LUTS),
physical findings, urinalysis, and the other indicatedevaluations. In addition, OAB is defined based on
symptoms.

Overactive bladderUrge
incontinence

UrgencyStressincontinence

Increased urinary
frequency
Nocturia

Mixedincontinence(Urge+Stress)

Fig. 2 Symptomatology of overactive bladder

OAB is highly prevalent worldwide. In the U.S., astudy showed that the prevalence of OAB was 16.0% in
men and 16.9% in women aged 18 years or older7).
Therefore, OAB might affect 34 million individuals in
the U.S. In Europe and Scandinavia, a study showedvirtually the same prevalence of OAB (16.6%) in
individuals, men and women aged 40 years or older,selected from the general population in France,
Germany, Italy, Spain, Sweden and the United

Kingdom8). In Japan, the prevalence was 12.4% in men
and women aged 40 years or older9). The total cost of
OAB is estimated to be $12.6 billion (year 2000 dollars)in the U.S. Still, the vast majority of OAB sufferers
remain untreated.
In our previous study, it was shown that
acupuncture might be beneficial in the treatment of
OAB2-3). We applied acupuncture to Zhongliao points
on the skin of the third posterior sacral foramina as inthis study with 11 patients with urge incontinence orurgency and found an improvement of the symptoms
in 9 (82%)2). The treatment induced increase in bothmaximum cystometric bladder capacity and bladdercompliance, with statistical significance. It is therefore
conceivable that acupuncture stimulation might
increase bladder capacity by inhibiting bladdercontraction or urinary sensation. Additionally,
acupuncture has been reported to inhibit detrusor
hyperreflexia in 13 patients with spinal cord injury3).
In the study, incontinence disappeared in 2 (15%) anddecreased to 50% or less incontinence volume ascompared to the baseline in 6 (46%), resulting insatisfactory therapeutic effects obtained in 8 (62%).
These results indicate the possible mechanism ofneurological (such as spinal segmental) inhibition
through which bladder contraction might besuppressed by acupuncture. In this report the patient
had suffered from urgency, urge incontinence,increased urinary frequency and nocturia. Because thesymptoms might be in accord with OAB, acupuncture
was performed for relieving the symptoms. The
urgency and urge incontinence were relived after
acupuncture.
To ask the patient to record micturitions andsymptoms for a period of days provided individual
information. Frequency volume chart (FVC) was used
for the record of the volumes voided as well as the timeof each micturition, day and night, for at least 24 hours(Fig 3). The following measurements could be
abstracted from FVC: daytime frequency, nocturia,
24-hour frequency, 24-hour urine production, polyuria,
nocturnal urine volume, nocturnal polyuria andmaximum voided volume. In particular, daytime
frequency, nocturia and maximum voided volume are
intimately concerned with OAB. Daytime frequency is

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

13

Volume 1, Number 1 | Spring 2006

the number of voids recorded during waking hours andincludes the last void before sleep and the first void
after waking and rising in the morning. Nocturia is thenumber of voids recorded during a night’s sleep: eachvoid is preceded and followed by sleep. Maximum
voided volume is the largest volume of urine voided
during single micturition and is determined either
from FVC. FVC has the advantage that the maximum
voided volume is obtained without invasive procedures.
In this report the maximum voided volume of thepatient increased from 120 ml baseline to 330 ml after
8th acupuncture. This result supports our previous
study concerning with acupuncture for urge
incontinence or urgency.
time

examplesConclusion
Acupuncture could be an
conventional therapies for OAB.

1.

2.

3.

3:00
4:00

100 ml

5.

5:00
6:00

Waking up

7:00

100 ml
150 ml

10:00
11:00

6.

170 ml

12:00
13:00

American Urological Association Symptom Index
for benign prostatic hyperplasia, J Urol 1992; 148:

200 ml1549-57
Stewart WF, Van Rooyen JB, Cundiff GW, Abrams
P, Herzog AR, Core R, Hunt TL, Wein AJ:

7.

15:00

Prevalence and burden of overactive bladder in
the United States. World J Urol 2003; 20: 327-36

17:00
18:00

130 ml

8.

19:00
20:00
22:00

120 ml

23:00

Going to
bed

Total

1410

ml

Milsom I, Abrams P, Cardozo L, Roberts RG,
Thuroff J, Wein AJ: How widespread are thesymptoms of an overactive bladder and how are
they managed? A population-based prevalence
study, BJU Int 2001; 87: 760-6

140 ml

21:00

9.
ml

ml

Fig. 3 Example of frequency volume chart

14

standardization
sub-committeeoftheInternational Continence Society, Neurourol
Urodyn 2002; 21: 167-78
Barry MJ, Fowler FJ Jr, O’Leary MP, Bruskewitz
RC, Holtgrewe HL, Mebust WK, Cockett AT: The

150 ml

14:00
16:00

2000; 65: 190-5
Honjo H, Kawauchi A, Ukimura O, Soh J,
Mizutani Y, Miki T: Treatment of nocturnal
enuresis by acupuncture, a preliminary study, Int
J Urol 2002; 9: 672-6
Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P,
Ulmsten U, van Kerrebroeck P, Victor A, Wein AJ:

The standardization of terminology of lower
urinary tract function, Report from the

8:00
9:00

Kitakoji H, Terasaki T, Honjo H, Odahara Y,
Ukimura O, Kojima M, Watanabe H: Effect ofacupuncture on the overactive bladder. Nippon
Hinyokika Gakkai Zasshi (Japanese Journal of
Urology) 1995; 86: 1514-9 Japanese
Honjo H, Naya Y, Ukimura O, Kojima M, Miki T:

Acupuncture on
clinical
symptoms andurodynamic measurement in spinal-cord-injured
patients with detrusor hyperreflexia. Urol Int
4.

2:00

Diokno AC, Brock BM, Brown MB, Herzog AR:

Prevalence of urinary incontinence and otherurological symptoms in the non-institutionalized
elderly. J Urol 1986; 136: 1022-5.

///(Month/Day) (Month/Day) (Month/Day)

150 mltoReference

0:00
1:00

alternativeml

Homma Y, Kakizaki H, Gotoh M, Takei M,
Yamanishi T, Hayashi K: Epidemiologic survey onlower urinary tract symptoms in Japan. Nippon
Hainyokino Gakkaishi (Journal of Neurogenic
Bladder Society) 2003; 14: 266-77 Japanese.

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

Volume 1, Number 1 | Spring 2006

Introduction of University
Meiji University of Oriental Medicine, located in
the central part of Kyoto Japan, was founded in 1978
as Meiji Junior College of Oriental Medicine as a partof Meiji Institute of Oriental Medicine. The origin of
the institute dates back to 1925 as the Yamazaki
School of Oriental Medicine in Osaka, which developed
into Meiji School of Oriental Medicine, another part of
Meiji Institute of Oriental Medicine.
Meiji Junior College of Oriental Medicine had been
accredited by Educational Ministry as the first
four-year college of oriental medicine in Japan byadding a Western medical hospital in 1983. The course
for doctor of science in acupuncture and moxibustion,accredited in 1994, is the one that the school can boast
to the world. In 2002, the school added a course for
Judo-Seifuku therapist, Japanese traditional bone
fixing technique, changing the name ‘College’ to‘University’. A four-year course for Judo-Seifuku(2004) and the nursing (2006) was added. The school
currently

consistsofafour-year

coursefor

acupuncture and moxibustion, a four-year course of
Judo-Seifuku, a four-year course of nursing, has aclinic of oriental medicine and a western medical
hospital (see diagram below). The school has also been
providing postgraduate training course in the western
medical hospital for over 18 years.

The mission of Meiji University of Oriental Medicine
is to train therapists who are qualified to provide
traditional oriental medical treatment which is
supported with western medical knowledge, to provide
highly qualified integrative care of western andtraditional oriental medicine, and to investigate themechanism of the effect of acupuncture andmoxibustion and Judo-Seifuku therapy. The school has
produced over 2,700 graduates, including 111 masters,
47 doctors of acupuncture and moxibustion for over the
past 28 years, who are widely accepted as highly
qualified leaders in the field in Japan.
The Western medical hospital, equipped with highquality technology including one of the most powerful
MRI instruments in the world, has an outstanding
medical staff of Internal Medicine, Surgery,
Orthopedics, Urology, Neurosurgery, Anesthesiology,
Dentistry,
Otolaryngology,
Ophthalmology
andGynecology to provide high quality integrative care andeducation. It has a primary goal, to accumulatescientific evidence on the value of traditional oriental
medicine by collaborating with the professional
traditional therapists.
Basic research to investigate the mechanism of
traditional therapies are also made possible bycollaboration with departments of Physiology, Anatomy,
Immunology, Chemistry, Biology and Physics. The results
are reflected in curricular decisions to ensure the program
reflects the latest in medical theory and practice.

Faculty of Acupunctureand Moxibustion
Faculty of
Judo-Seifuku
Meiji University ofOriental Medicine

Faculty of
Nursing
Graduate School of
Acupuncture and Moxibustion
General Hospital

Meiji Institute ofOriental Medicine

Medical MR Center
Acupuncture Center
Research center ofOriental Medicine
Library
Meiji School ofOriental Medicine

Meiji University of Oriental Medicine, Kyoto Japan

Organization of Meiji Institute of Oriental Medicine

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

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Volume 1, Number 1 | Spring 2006

Clinical Report 2 (Japan)
Astragali Radix Provides a Decline in Serum Creatinine in
Chronic Renal Failure

Hajime Haimoto

Case: 63 years, male employee
Diagnosis: #1: hypertension, #2: chronic glomerular
nephritis, #3: chronic renal failure, #4: gout
Past history: regular health checks have shown
proteinuria and positive tests for occult urinary blood
since the patient was in his 20s.
Present illness: At the age of 40 hypertension, goutand chronic glomerular nephritis was pointed out
during a regular health check and the patient was
treated for hypertension.
In May 1998, at the age of 56, the patient
consulted the clinic for the first time, requestingtreatment for hypertension and gout. Height was 163
cm，weight 56.8 kg，blood pressure 145/93 (alreadyunder treatment with hypotensives), pulse rate 67
bpm (no arrhythmia).
Findings obtained during the first examination
included Cr 1.7 mg/dl，BUN 25.8 mg/dl，total protein
7.2 g/dl，albumin 4.2 g/dl，total cholesterol 184 mg/dl，uric acid 10.0 mg/dl，Na 144 mEq/l，K 4.7 mEq/l，Cl 105
mEq/l，antinuclear antibodies (-)，serum component
titer and IgA levels were within the normal range.
Urinary protein (++)，occult blood (++). Proteinuria
was 0.80 g 〜 1.56 g/day，24-hour CCr 57.3 ml/min，
ultrasound scans showed no postrenal lesions of the
bladder or prostate. Electrocardiogram and chest x-ray
were normal as well.
From the first consultation, calcium antagonists,
β-blockers, ACE inhibitor, ARB antagonists andsimilar hypotensives as well as 100 mg of Zyloric(allupurinol) for the hyperuricacidemia wereprescribed. This treatment controlled blood pressure at
a level of 120～135/75～90 mmHg and uric acid at 8.2
mg/dl.
Yet, Cr increased gradually, so that the levels of Cr
2.0 and K 5.1 measured in October 2002 reached by
February 1, 2004 values of 2.2 and 6.3 for Cr and K
respectively. At this time, treatment was initiated with
Astragali Radix.

16

Kampo examination: no fatigue, restlessness or
insomnia, good appetite, becomes sleepy after meals,
does not sweat, no dry mouth, neither overly sensitive
to heat nor cold, no particular thoracic or abdominal
symptoms, bowel movements: 2/day, micturition: 7/day
and 3/night
Kampo medical physical findings:
Pulse: full, wiry, pulse rate 90 bpm.
Tongue: pale-red, dark, thick, moderate dental
indentations, no patchy blood stasis, superficiallymoist，thin white fur
Abdomen: upper abdominal region generally hard,strong resistance in the hypochondrial and epigastricregions, no tenderness, no fluid accumulation in thestomach, tense rectus abdominis muscles.
Course:Initiation of treatment with 30 g of Astragali Radix(alone) on February 1, 2003 (combined otherwise with
5 mg of Norvasc，8 mg of Blopress and 100 mg of
Zyloric).
March 10 of the same year: Cr 1.7 mg/dl，K 5.6
mEq/l，addition of 10 g of Ziziphi Fructus, in order tomake the drug more palatable.
April 7 of the same year: Cr 1.6 mg/dl，K 5.6 mEq/l.
May 5 of the same year: Cr 1.6，K 5.4 mEq/l.
September 26 of the same year: Cr 1.7 mg/dl.
December 27 of the same year: Cr 1.5 mg/dl，K 6.8
mEq/l; because of an increase in the K concentration
due to excessive intake of fruits the patient was
instructed in how to maintain a low potassium diet.
February 2004: Cr 1.29 mg/dl，K 4.8 mEq/l.
August of the same year: Cr 1.40 mg/dl，K 6.1
mEq/l，repeated nutritional counseling due to anotherrise in potassium concentration.
October of the same year: Cr 1.57 mg/dl，K 5.2 mEq/l
Until June 2005 the Cr control was good, but from
June 30 to July 21st the patient discontinued his
medication over the period of a stay in Germany.
July 25 of the same year: an rise to Cr 2.78 mg/dl
and K 6.3 mEq/l was observed immediately after thepatient's return to Japan. The Astragali Radix dose
after the 25th of that month was increased to 30 g andtreatment with Glycyrrhizae Radix initiated. The shift
from Taiso to Kanzo was made in order to decrease
serum potassium concentration.

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Volume 1, Number 1 | Spring 2006

August 20 of the same year: concentration
decreased to Cr 1.76 and K 4.1 mEq/l
Currently,

September

of

the

same

year:

combination of 30 g of Ogi and 10 g of Kanzo with the
hypotensive Olmetec 10 mg, CR 20 mg of Adalat and100 mg of Zyloric.

Conclusion
We reported previously about a Cr lowering effectin chronic renal failure J. Phyto (Vol.7 No.1). The
summary of this report is that Ogi was observed tocause in 8 out of 9 patients during the early stage ofchronic renal failure a fall in creatinine (1.6≦Cr＜3.0)by an average of 21%, while in 2 patients with uremia
a decrease of 8.1→6.9 and 5.9→1.6 respectively wasobserved. From that time to the present day wetreated a total of 13 patients during the early stage ofchronic renal failure with Ogi. Excluding two patientsin whom the treatment was discontinued because ofside effects, like eruptions, in all 11 patients acontinuous Cr lowering effect was observed. Presently,
the effect of the orally applied medication continues. In
some patients, long-term control over a maximum
duration of 2.5 years is permitted.

When the treatment with Ogi was for some reason
discontinued in this kind of patient, Cr increased, butfollowing a restart of the treatment with Ogi thecreatinine fell again in 2 of the cases. In one patient,
the Cr level fell after only one month by 2.78→1.76(35%) and in the other, over a period of 3 months by Cr
1.88→1.43 (24%).
The creatinine clearance was observed in regularintervals in some of the above described 13 patientsand showed an increase in 24-hour creatinine
clearance occurring simultaneously with the fall in Cr
level, suggesting that Ogi probably acts directly on
glomerular function. Also, these cases showed that
there seems to be no potassium depleting effect, sothat diet appeared to have been more effective thanOgi. However, potassium depletion is generally known
to be a side effect of licorice, suggesting thatcombination treatment with licorice might help inpatients with chronic renal failure to achieve adecrease in potassium level.
Reduction of Cr levels in patients with chronic
renal failure and thus the possibility to avoid or delay
the necessity for dialysis had been the most importanttask and the discovery of relevant effects of atreatment of with Ogi alone. In the future, this should
lead to new developments in this field.

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Volume 1, Number 1 | Spring 2006

Clinical Report 3 (Japan)
Maoto Demonstrated as Highly Effective for the Treatment
of Influenza (B)Kazuhiro Oribe
Oribe Medical Clinic, Oita-shi

Introduction
Recently avian influenza has received a good dealof attention in the media. Currently, secondary
infection among people does not seem to occur. If sucha pathogenecity would be acquired, the disease would
be associated with considerable mortality because thehuman race does not have antibodies to use against it.
In western medicine the drug Oseltamivir (brand
name: Tamiflu) seems to be highly effective, so thatstockpiling of the drug by the individual nations has
been recommended. Yet, it must be noted that upon
indiscriminate administration, side effects cannot bedisregarded. Moreover, in order for the drug to beeffective, it needs to be administered within 48 hours
after onset and its administration has to be continued
over a period of 5 days2).
The author has 20 years of experience having
treated over 1,000 patients with influenza. This has
been done solely with Kampo medicine in his clinic
which specializes in Kampo treatment. In January lastyear, the author had a chance to use Oseltamivir,
providing the opportunity to compare it with Kampo
preparations. His experience is presented below.
One patient with influenza who was successfully
treated with Kampo is presented below.
Patient: age 32, male, employed.
Chief complaint: chills, fever, generalized arthralgia.
Family history, past history: n.p.
Description of occurrence of illness:
On January 1, 2005 the patients went to work at
9:00am, but suddenly felt chills over his back. Thiswas followed by shaking of the entire body which thepatient could not stop intentionally (shaking chills).
After a short period, he started to feel feverish,
developed a headache and joints and muscles
throughout the body started aching. At the same time
he felt drained of energy. The patient visited our clinic
at 5:00pm of that same day.
Initial Observation
Inspection: pale face and appeared generally
exhausted

18

Listening: voice was rather loud.
Reasoning: clear
History: Loss of appetite, bowel movements andmicturition remained normal. Influenza seemed to beprevalent in his environment with many people being
absent from work. He claimed to have a lot of work to
do and thus needed to recover as quickly as possible.
Palpation (physical findings):
Physical build and nutritional status were good.
Examination of the pulse showed a rate of 100/min,regular floating, tense, fast. Blood pressure was 120/78
mmHg. The throat was slightly inflammed.
Auscultation of the heart and lungs did not reveal any
anomalies.
Abdominal
examination
showedintermediate abdominal tension and mild tenderness
in the right hypochondrial region (these abdominal
findings would be designated “fullness, tenderness or
discomfort of the hypochondrium). Body temperature
was 38.3°C. There was no perspiration.
Diagnosis
Western medical: quick diagnostic kit identifies type B
influenza.
Kampo medical: according to the “Shang Han Lun” thecondition is considered to be a cold injury excess
disorder of the greater yang type.
Prescribed Course
Maoto made by Tsumura (a 7.5-g portion of the
drug contains the following amount of dried crude drug
extract 1.75 g (Ephedra 5.0 g, Apricot Seed 5.0 g,
Cassia Bark 4.0 g and Licorice Root 1.5 g) was given inpackages of 2.5 g each taken with warm water atintervals of 4 hours. The patient was instructed tocover the body until the body warmed and he started
perspiring. The patient called, reporting that after
taking three packages, the body temperature
conversely had risen above 39°C, but he was still not
perspiring. Therefore I instructed the patient tocontinue the medication.
On the next morning, the patient called again,
reporting that 30 minutes after taking anotherpackage he started to sweat profusely over the entire
body, which in turn caused a fall in his temperatureand the alleviation of the joint and muscle aches. At
the time he was calling, he said he was feelingrefreshed. After that I instructed the patient todiscontinue the medication and take a day off to rest
quietly. Four days after the initial onset, he returned
to work without any recurrences.

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Discussion
This patient followed a typical course of patientstreated during the early phase of influenza with maoto.
The author has treated over 1,000 patients with
influenza, and found that during the initial phase 90% of
the patients recovered within 2-3 days following
treatment with maoto after perspiration anddefervescence. When the fever continued, even after theadministration of 9 packages without perspiration, andin the presence of feverish restlessness or dry mouth,
switching to the preparation daiseiryuto usually resulted
in the onset of perspiration, defervescence and recovery
within 24 hours.
In case of influenza, patients usually can tell rather
precisely on “what day and at what hour” the sudden
onset of chills, fever, arthralgia, general malaise, loss ofappetite or the development of cough occurred
approximately 1 or 2 days after the infection. Thiscondition had in the latter half of the second century AD
been described in the “Shang Han Lun” edited by Zhang
Zhong Jing of the later Han period in China. In thechapter on greater yang diseases it states: “During
greater yang disease, fever develops, or if it has not yet
developed chills set in, the body starts aching, there will
be vomiting and both yin and yang pulses will be tense.”
The description in this text coincides with the “ShangHan” (Shokan) pathology.
For this Shokan condition the text states maoto
governs the greater yang condition characterized byheadache, fever, body pain, low back pain, pain in thebones and joints, chills and a lack of perspiration3).
Thus, following the instructions in the text, and taking
maoto warm, the drug results in perspiration anddefervescence and is characterized in that it
simultaneously improves all the other symptoms,
eventually leading to a complete cure without any
complications or sequelae. Yet, maoto is only effective
for the early phase of influenza. This means thecondition described in the “Shang Han Lun” as thegreater yang disease phase when it is used for the
aforementioned symptoms. This resembles theprovision that Oseltamivir should be administered
within 48 hours after onset.
As described above, Oseltamivir should be
administered within 48 hours after onset and thencontinued over a period of 5 days2). Definitely the author
achieved defervescence in all 10 patients who weretreated within 48 hours after onset, but in 2 out of 5
patients who discontinued the medication after 3 days arecurrence of fever and cough was observed 2-3 days
later. The condition here had to be viewed in Kampo
medical terms as a lesser yang condition that thenrequired treatment with shosaikoto.
When maoto is administered for its indicatedsymptoms, defervescence can be achieved in mostpatients within a period of 24 to 48 hours. Whenperspiration is not observed within a period of 48 hours
and the patient develops signs of (feverish) restlessness,
the author prescribed daiseiryuto. Application of boththese preparations led in almost 100% of the patientsthe onset of perspiration and defervescence within 72
hours. Subsequently, the course was favorable andwithout recurrences.
Considering financial aspects shows that 2 capsulesof Oseltamivir per day for 5 days would amount to,according to the Japanese drug price in the National
Health Insurance scheme, 3,780 Yen (USD31.50). The
price for a 3-day dose of maoto is only 210 Yen per day(USD1.75). Conversely, since the daiseiryuto is not aready-made extract preparation, it is prepared from twoavailable extract preparations. When preparing it using
Tsumura’s extracts, the author used 7.5 g of maoto and7.5 g of eppikajutsuto per day. In this case, the price fortwo days is 340 Yen (USD2.80). Applied for suitableindications, Kampo preparations are not only highly
effective for the treatment of influenza, but also
economically superior.

Conclusion* One case was reported where the greater yang
condition described in the “Shang Han Lun” can beviewed as a cold injury and the treatment with 7.5 gof maoto made by Tsumura per day and proved to bemarkedly effective within 2 days.
* Oseltamivir is definitively effective, but Kampo
medicine, in particular maoto and daiseiryuto, whenadministered based on a suitable pattern
identification, appear to have equivalent effects.
* Considering cost factors, maoto and daiseiryuto(combination of maoto and eppikajutsuto) seem to beeconomical.

Reference
1.

Kida H: Highly pathogenic avian influenza for zoonotic
infections and vaccines; Journal of the Japan Medical
Association, Vol. 134, No. 10, 1940-1944, 2006

2.

Kashiki S: Practical Therapy of Influenza; Journal of theJapan Medical Association, Vol. 134, No. 10, 1921-1923,
January 2006

3.

Okuda K: Shang Han Lun Lectures, Ido no Nippon Sha, 1965

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Volume 1, Number 1 | Spring 2006

Clinical Report 3 (Japan) - continued
Efficacy of Kampo Medicine for Influenza – with Particular
Focus on Maoto
Chizuno Hidaka, Hiromichi Yasui, Hideaki Yamaguchi

History records reveal that approximately 1800 years
ago there was an epidemic of a condition called “Shanghan (cold injury)” in China, that closely resembled what
we today call influenza. Descriptions of therapies for thisdisease found in the book “Shang Han Lun” are actuallyhighly effective for the treatment of influenza. In fact,
more than half of the Kampo prescriptions currently usedin Japan are derived from either this “Shang Han Lun(Treatise on cold-induced diseases)” or else the “Jin Kui
Yao Lue (Synopsis of the Golden Chamber)”. For thisreason Kampo medicines are frequently used in Japan for
the treatment of influenza. In particular, the early phase
after the onset is often an indication for the use ofprescriptions containing Ephedra like maoto ordaiseiryuto.
Clinical research
Signs considered to be indications for maoto include
chills, fever, headache, arthralgia, muscle aches, atendency towards perspiration etc.; closely resembling thesymptoms observed during the early phase of influenza.
For this reason maoto is often used for the treatment of
this condition.
Abe published detailed reports on the treatment ofinfluenza with Kampo medicine before the introduction ofantiviral agents. In these reports, he indicated that for
symptomatic treatment, Kampo medicines are superior towestern medications1). Later research comparing theantipyretic effects of amantadine and maoto revealed
almost equivalent effects.2)
In recent years, Oseltamivir has come into use, andthus many studies have been conducted examining theeffects of a combination therapy with maoto. The
combination of inhibition of the virus proliferation by
Oseltamivir, and improvement of the body defences
facilitated by maoto, is considered to provide an ideal
therapy form. Below are several clinical studies thatinvestigated these questions.
Kubo et al. treated a total if 49 patients(male:female = 24:25) with an age ranging from 5months and 13 years with influenza symptoms
including high fever of over 38°C. These were divided
into a group of 18 patients treated with Oseltamivir, agroup of 14 patients treated with a combination therapyof Oseltamivir and maoto and a group of 17 patientstreated with maoto3).

20

Among these patients those over one year of age
were diagnosed using a quick diagnostic kit for
influenza and subsequently randomly assigned into (1)a Oseltamivir (brand name: Tamiflu) group treated with
4 mg/kg for 2 days and (2) a maoto made by Tsumura
0.18 g/kg for 3 days) and (3) a combination therapy ofOseltamivir and maoto. Patients under one year, notsuitable for treatment with Oseltamivir and patients inwhom the influenza quick diagnostic test was negative,
were treated only with maoto (independent therapy).
Guardians were requested to supervise the actual
application of the drug and record measurements ofbody temperature. The study then compared thedifferences between the individual groups until
defervescence (down to 37.2°C) had been achieved.
Differences in background factors like average age at
the initiation of the treatment, male-female ratio,
duration of the fever prior to treatment begin, degree ofthe fever, history of vaccinations etc. were not observed.
Regarding the time from beginning treatment until
defervescence in all three groups was in the Oseltamivir
treatment group, on the average 31.9 hours; in the
maoto – Oseltamivir combination therapy group 21.9
hours; and in the maoto group 17.7 hours. Side effects
or adverse events were observed in none of the groups.
Similar studies have also been conducted by Kuroki,
Fukutomi et al. and Kimoto et al. Kuroki investigatedthe effects of a maoto – Oseltamivir combination
therapy for the treatment of influenza over the threeseasons from 2003 to 2005 and obtained results similar
to those reported by Kubo. In the combination therapy
group, improvement in clinical symptoms wasreportedly superior4).
Fukutomi et al. divided 24 patients diagnosed with
influenza using the quick diagnostic kit from winter2003 until spring 2004 into two groups and treatedthem with a regimen similar to that described above.
The results showed that the duration of headache indays and the number of days general malaise continued
was shorter with a combination therapy of Oseltamivir
and maoto than in the group treated only with
Oseltamivir (significant difference) 5).
Kimoto et al. treated patients diagnosed with
influenza using the quick diagnostic kit during theperiod from January to March 2004 with Oseltamivir
and then compared the clinical course with patientstreated either with maoto or else ordinary western
medications. Defervescence occurred in the grouptreated with a maoto combination therapy
approximately 12 hours earlier than in the group

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

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treated with a combination therapy with western drugs.
They also reported a tendency toward an early recovery
from fatigue, dizziness and loss of appetite. In the grouptreated with combination therapy with western drugs arise in CRP was observed in 3 patients, but in the grouptreated with a maoto combination therapy this was notobserved6).
Similar to the case reports published by Oribe,
symptoms were often relieved early in many patientstreated with maoto only. Therefore specialists of Kampo
medicine hold the view that Oseltamivir may notnecessarily be required. In Japan, generally the
diagnosis of influenza is confirmed with the quick
diagnostic kit first and patients are then treated with
Oseltamivir. For this purpose, case-control studies aremainly reports of combination therapies with maoto.
Yet, the accuracy of the quick diagnostic kit inestablishing a definite diagnosis is not 100%.
Immediately after onset in many cases positive results
are not obtained.
The Kampo preparation used predominantly during
the early phase is maoto followed by daiseiryuto. It
would be easy, if daiseiryuto were a decoction, but since
there are no extract preparations, this formula needs tobe prepared by combining two available extract
preparations. Mitani reported obtaining good results intreating patients with influenza associated with highfever by using combinations of either keishito +makyokansekito or else maoto + eppikajutsuto7). These
combinations contain in the first case, an excessive
amount of Paeonia and in the second case Atractylodes
rhizome, but reportedly were clinically effective. In thelatter case, the increase in the amount of Ephedra
needs to be carefully considered.
Other preparations beside maoto or daiseiryuto arealso used for the treatment of this disease. Patients do
not necessarily visit clinics during the early phasefollowing onset, or else because of factors like age or due
to a preexisting disposition. Maoto may not always besuitable. In these cases, a wide variety of otherpreparations are used. Kimoto et al. are conducting
research on this topic.
Kimoto et al. divided 155 patients diagnosed with
influenza, using the quick diagnostic kit, into an
Oseltamivir or amantadine treatment group, a Kampo
medicine treatment group, and a third group treatedwith a combination therapy. The results showed thatthe number of days the drugs were administered werefewer in the combination therapy group. The total of 11
drugs used here included for adults kakkonto, maoto,keishimaokakuhanto, shosaikoto and others, while forchildren four prescriptions including maoto were used8).
Costs versus effects
Oribe pointed out that regardless of whether it ismaoto or daiseiryuto, these drugs when compared toOseltamivir are inexpensive. Regarding the cost-effectratio, these drugs cannot compare with Oseltamivir. In
Japan, seven pharmaceutical companies produce andsell maoto. The drug price in the NHI scheme for each ofthese products is around 70 Yen/day. The drug price for
Oseltamivir is 756 Yen/day. That results in a pricedifference between the two drugs of more than 10-fold.
Since the research conducted so far appears toreveal that these two drugs (maoto and Oseltamivir)
have approximately equivalent effects, the cheaper
Kampo preparations should be made the drug of first
choice. Yet, for this decision, more research is called for.
Basic research
There is basic research about the most important
effective ingredient in the preparation used for thetreatment of influenza, namely Ephedra.
Mantani et al. noticed that for the growth of
influenza viri, an acid milieu is required within thevacuoles during the threshing process and thus
performed the following experiments. They used MEM
containing medium to cultivate Madin-Darby canine
kidney (MDCK) cells and then infected those with the
influenza strain A/PR/8/34 (H1N1 subtype) toinvestigate the inhibitory action of Ephedra on the
proliferation of the viri. The results showed that an
extract of Ephedra in dose-dependent manner, inhibitedthe acidification of the vacuolar fluid. Moreover,regarding the viral growth, Ephedra induced
immediately after the infection during a loading periodof 10 minutes a less than 50% inhibition. This suggeststhat Ephedra inhibits the growth of influenza viri
during the early phase9).
Ochiai conducted several other studies differingfrom the study of Mantani et al. described above andverified the inhibitory action of Ephedra on the growthof influenza viri10).
Avian influenza and new influenza types
In Japan so far, no people have been infected by, ordeveloped, avian influenza. Accordingly, we haven’t had
the opportunity to treat this disease and thus cannot
give definitive comments. However, China had theopportunity to treat patients with this disease and thegovernmental Department of Hygiene has classified the

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Volume 1, Number 1 | Spring 2006

disease into four types (four stages), suggesting
therapies for these respective stages (including
prescriptions). According to that information, avian
influenza falls under the classification of “Wen Bing(warm diseases)” and not the “Shang han (coldinjuries)”11).
Conversely, for types of avian influenza with apotential man-to-man infectivity, meaning new
influenza types, it remains obscure as to what type ofclinical picture will be presented. In the past, influenza
usually was classified as “cold injury”, but that may notnecessarily hold true for the future.
The great pandemic that occurred in 1918, andclaimed many victims during the Spanish flu epidemic,
has been classified based on the experience of thephysician specializing in Kampo medicine (Dr. Mori)into three types. The type marked mainly by pathologicchanges of the gastrointestinal tract was treated withkososan with added Indian Bread Exodermis,
Atractylodes Rhizome and Pinellia Tuber; the type withpredominantly pulmonary lesions with shoseiryuto plus
added Apricot Seed and Gypsum; while the typeassociated with encephalopathies was treated withshomakakkonto with added Angelica Dahurica Root,
Cnidium Rhizoma and Asiasarum Root. These
therapies produced excellent results12).
If new types of viri should evolve in this century, we
would like to prepare as many means as possible tokeep casualties among a human race without
immunologic protection at a minimum. The
development of vaccines against new strains will
require at least 6 months, so that the number ofeffective antiviral drugs during that period is unknown.
Under these circumstances, the experiences of Morimight prove helpful for the treatment of new forms ofinfluenza.

5. Mitani K: Case reports pertaining to the treatment ofpatients with high fever with extract preparations, Phil
Kampo No. 4: 15-16, 2003

6. Fukutomi O, et al.: Experiences with maoto for the
alleviation of influenza symptoms, Kampo Medicine 29 (5):28-30, 2005

7. Kimoto H, Kuroki H: Effects of a combination therapy ofmaoto and Oseltamivir for the treatment of influenza,
Kampo Medicine 29 (4): 16-19, 2005

8. Kimoto H, Kuroki H: Significance of Kampo medicine forthe treatment of epidemic influenza, 20th Conference on
Medical and Pharmaceutical Society for WAKAN-YAKU),
Abstract collection, p.146, 2003
9. Mantani N, Imanishi N, Sakai S, et al.: Inhibitory effects of

maoto on vacuolar acidity and inhibitory action on A/PR/8
influenza strains; 17th Conference on Medical andPharmaceutical Society for WAKAN-YAKU), Abstract
collection, 2002
10. Ochiai H: Anti-influenza treatment with Japanese andChinese medicines (Wakan Yaku) directed at vital
reactions of intracellular organelles; First Conference of
the Japan Society for Oriental Medicine, joint symposiumwith the Medical and Pharmaceutical Society for
WAKAN-YAKU), Lecture recordings 8-12, 2002
11. Notification from the Department of Hygiene of thePeople’s Republic of China “treatment of highly
pathogenic avian influenza” (2005 revised edition),
2005/11/23
http://www.3552808.com/Article_Show.asp?ArticleID=5005

12. Yakazu K: Kampo Ikkan Do Medicine, p.195, 1964

Author and affiliation
Hidaka C: Japan Medical University; Laboratory of
microbiologic immunology
Yasui H: Japan Institute of TCM Research
Yamaguchi H: Tosei Hospital, Department of Pediatrics

Reference
1. Abe K: Influenza. Enlarged edition. Infection in theoutpatient clinic and Kampo, 52, Ishiyaku Publishing, 2000
2. Abe K: Comparison of western medications and Kampo forthe treatment of cold syndrome (summer illness,
influenza); Journal of the Japan Pediatric Society for
Oriental Medicine, 19: 46-52, 2003

3. Kubo T, Nakata H: Effects of maoto on pediatric influenza
infections, 56th Conference of the Japan Society for
Oriental Medicine, Abstract collection, p 204, 2005

4. Kuroki H: Practical experiences with maoto for thetreatment of influenza, 6th Japan Pediatric Kampo Social
Gathering for Discussions, 2005
22

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Volume 1, Number 1 | Spring 2006

Clinical Report 4 (Japan)
Headache - Two Unique Cases
Yoshihide Yakazu, Hiromichi Yasui

Patient: 57 years, female
First visit: September 28, 1999
Chief complaint: periodically occurring headaches
Present history: onset of Menière syndrome following
delivery in 1970, the condition improved later but thenled to the development of periodically occurring
headaches. Episodes occurred generally at a frequency
of once per month. During attacks the patient first felt
a stabbing pain deep behind the eye. Subsequently thepain would spread throughout the entire head.
Moreover, over time shoulder stiffness also developedand eventually led to vomiting. This vomiting
reportedly felt like emptying out the stomach content
completely and required the patient to stay in bed for 2days because of exhaustion. During such periods, thepatient had to continue using analgesics (NSAID).
The headache was more likely to occur in summer
than in winter and attacks often occurred on days
preceding major weather changes.
Anophthalmologic
examination
performed
because of a suspected glaucoma, revealed no
anomalies. Neither did a visit to a neurosurgical clinic
and CT examinations did not reveal any anomalies.
Present status: height 156 cm, weight 40 kg
Diet: normal
Sleep: good
Micturition: 5-6 times/day, urinary volume is notconsidered to be small
Defecation: once/day, normal feces
Cooling of hand and feet (+), sleeps wearing socks
Stiffness of neck, shoulders, back (+)
Dry mouth (+), constantly thirsty and drinks a lot.
2-3 cups of drinks during meals
Edema (-)
Blood pressure: 134/94 mmHg
Pulse pattern: deep and slightly wiry
Tongue pattern: pale, thin white fur, slightly
greasy, moist
Abdominal pattern: nothing particular
Past history: seasonal allergic rhinitis (only in spring)
Family history: elder sister suffers from similar
headaches
Diagnosis: headaches due to deficient water
metabolism (water/dampness congestion)

Therapy: induce diuresis to alleviate edema,
unblocking yang and mobilizing Qi
Prescription: goreisan extract 6.0 g in 3 portions/day.
Application between meals
Course: following the beginning of treatment there
was a headache attack on October 5. On 11/6 theweather turned bad with rain. On 11/7 the weather
was fair. The attack lasted three days. After that theseverity of headaches developing prior to worsening
weather conditions decreased and attacks subsided
within half a day. On those occasions, the patient used
Loxonin. Nausea occurred infrequently. In May of thefollowing year (2000), half a year after treatment
began, headache attacks had become rare. However,when the patient forgot to take Poria Powder with Five
Herbs, attacks recurred. After approximately one anda half years in, April 2001, headaches subsided
completely as long as the patient took the medication.
Episodes of allergic rhinitis were treated with Zaditen.
Treatment was discontinued when the patient
moved to Osaka on August 6, 2001.
Additional case
On October 13, 2003, the patient, a 70-year old
woman, visited the clinic complaining of headaches
that had been occurring since the age of 40. In thiscase, headaches were related to the weather andcharacterized by pulsating pain in the temple regions.
The patient used Cafergot, Depas, Dogmatil.
Administration of Poria Powder with Five Herbs. After
two weeks of treatment, the severity of the headaches
had diminished considerably. After one month, they
had almost disappeared and the patient currently
continues to use this medication.
This patient was the elder sister of the above
mentioned patient. According to her testament, she
was completely free of headaches and leads a
comfortable life.

Reference
1.

Otsuka K: About Poria Powder with Five Herbs, Kampo

2.

and Kampo Drugs, Vol.4, No. 6: p.1, 1936
Yakazu D: Therapeutic experiences with Poria Powder with
Five Herbs and its practical application; 100 Stories about
Kampo: 328-342, 1960

3.

Yakazu D: The "pattern" of Poria Powder with Five Herbs(indication) and anomalies of water metabolism; 100
Stories about Kampo 3: 219-228, 1971

4.

Haimoto H, et al.: Clinical epidemiologic research into

chronic headache and the relation to migratory highs,Φυτο: 8-9, 1999

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Clinical Report from Europe
Case Study: Classical Migraine
Ulrich Eberhard

Case study: Classical migraine
A 39-year old female patient complained about
intermittent headache attacks on weekly intervals, inparticular, related to weather changes (deterioration of
weather). The onset came with neck and shoulder
stiffness, later symptoms spread over the entire scalp
and finally single-sided localization, mostly in the leftparietal region; about 12 hours after the onset,
sickness or nausea and frequent bilious vomiting.
Generally, the attack would subside spontaneously
after approximately 12 hours duration. Thesemigraine attacks began after the last delivery (thepatient has two healthy children, the first pregnancy
was normal, while during the second pregnancy an
EPH gestosis developed). Other diseases: allergic
diathesis (drugs, see food)Kampo diagnosis:
The anamnesis reveals that the patient typicallyexperiences strong thirst on the day prior to an attack,but excretes in spite of a large volume fluid intake withcomparatively little urine. Once the migraine
symptoms subside, a marked diuresis sets in that lasts
a whole day.
Findings:
Average sturdy stature, slight tendency towards
obesity and cellulitis in the regions of buttock andthighs.
Tongue: moist, thin white fur
Pulse: floating, slippery and weak in the depths(disappears upon pressure)
Abdomen: fluid sound in the stomach upon
palpation, relatively weak abdominal walltonus
SHO identification:
Greater yang stage (in particular during the initial
phase of attacks) and transition into lesser yang stage(over the course of the attack); condition intermittent
between excess and deficiency (Qi intermedio), spleen
Qi deficiency and signs of SUIDOKU*

24(* suidoku: refers to a pathologic condition of the fluid
metabolism, disturbed regulation - see Eberhard: Guide
to Kampo Medicine, p. 95)

Kampo prescription:
Poria Powder with Five Herbs (Wu Lin San): "fiveingredients mixture"
Mx:
Rhiz. Alismatis
6.0 g
Polyporus umbellatus
4.5 g
Pachyma Hoelen
4.5 g
Rhiz. Atractylodis ovatae
4.5 g
Cort. Cinnamomi
3.0 g(amount for 7 days)
Course:First prescription for a period of 7 days as adecoction, 3 x daily in portions of 150 ml before meals.
Important: patient was allergic, which required that
she be informed about Cort. Cinnamomi, since thisdrug may occasionally cause skin efflorescences.
During the next visit the patient reported a goodtolerance; therefore the prescription was prescribed foranother period of 21 days.
The next consultation was three weeks later. The
patient reported a single migraine attack during thelast four weeks, which was of longer duration (appr. 24
hours), but less pain intensity (moreover in the rightparietal region, while normally occurring on the left)
and above all, no sickness and no nausea!
Examination:
Tongue and pulse unchanged; abdomen: no fluid
sound in the stomach upon palpation, normal
abdominal tonus (previously weak abdominal tonus)
Continued treatment with Poria Powder with Five
Herbs for another 21 days, later prescriptions for 28
days each. This therapy was continued for a period of
approximately 6 months with positive results. The
frequency of the attacks were markedly reduced until
they finally subsided completely. Sickness and nausea
did not recur.
References:
Eberhard U: Guide to Kampo Medicine,
Phytotherapy, Elsevier (Urban & Fischer) 2003

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

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Volume 1, Number 1 | Spring 2006

Introduction of Japanese Acupuncture
Considering the Therapist’s Hand
Shuichi Katai
Course of Acupuncture and Moxibustion,
Department of Health, Faculty of Health Science,
Tsukuba University of Technology

1. Introduction
What characterizes Japanese style acupuncture
and moxibustion? Many times I have been asked this,but it has been difficult for me to give a reply, because
there are different styles of Japanese clinicalacupuncture and theory.
If I try to characterize Japanese style acupuncture
and moxibustion, it would have to be the importance of
palpation throughout the session. During the process
of examination the therapist touches the patient’s skin,perceives it’s condition and decides the treatment
location and protocol. Then, during the treatment, thetherapist continues to touch the patient’s skin to grasp
any changes, and according to the level of change, hecan adjust or finish the treatment. I feel this process ofnearly constant palpation is a very importantcharacteristic point of Japanese style acupuncture andmoxibustion.
In Japan, palpation has undergone unique changes
during its long history. Unfortunately, these techniques
are disappearing from Western Medicine as well as
Traditional Chinese Medicine.
Japanese practitioners of acupuncture andmoxibustion diagnose by palpating the skin,connective tissues, muscles and organs. Special
techniques and skills are needed to distinguishstiffness or hardness in a muscle, to delicately assess
apparent changes in the body surface and its
connective tissues. The therapist has to understand,with the fingertips, the distinction between, so-called
excess and deficiency in the skin and connective
tissues. In Japan, the importance of deficiency on the
body surface and connective tissues has stimulated thedevelopment of various techniques to grasp and tochange the surface of the body. As a result, Japanese
therapist training has included uniquely delicate
palpation and acupuncture techniques.

2．Palpation in East Asian Medicine
There are four fundamental methods of diagnosis
for acupuncture and moxibustion: inspection,
listening/smelling, inquiry and palpation. Thesemethods are common to the fields of acupuncture,
moxibustion, massage, as well as herbal therapies inJapanese East Asian medicine. It is vital that thepractitioner
grasp
the
patient’s
subjective
interpretation of the symptoms with one’s own fivesenses. Despite the patient’s subjective interpretationof their symptoms, the essential diagnostic methods
characteristic of Japanese medicine allow thepractitioner to objectively use his or her five senses toprecisely grasp the patient’s condition.
Roughly speaking, of the four methods, inspection,
listening/smelling and inquiry are indirect methods.
That is, the practitioner does not make direct contact
with the patient. Only touch or palpation brings thepatient and practitioner into direct physical contact.
Palpation, the foundation for touch diagnosis,
represents the most important characteristic ofJapanese acupuncture and moxibustion. Not only
diagnosis, but actual treatment relies heavily on theart of palpation; the area of the body to treat, thetreatment depth, and the level of stimulation.
Palpation allows the practitioner to discern the factors
essential to determining the treatment methods andprotocols. A further characteristic of palpation during
treatment is the quality and quantity of stimulation to
the surface of the body. Further, the collaboration
between the patient and the practitioner provides the
chance for contacting/healing the heart of the patient.
Determining the point location with anatomical
landmarks and proportional measurements represents
the theoretical foundation for the practice. Then,discrete palpation for physical responses or uniqueanatomical features adapts the method to eachindividual patient and their condition.
Within the field of palpation, pulse diagnosis
continues to hold great importance. Abdominal
palpation has, to a limited extent, been examined. But
from the point of view of clinical diagnosis and practice,research into the palpation has been insufficient.

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3．Meaning of touching and developing of humanhands
Throughout history, the human hand has enabled
us to receive and acquire valuable resources andinformation, to express ourselves and to transmit andtransfer various forms of information and stimuli. All
in all, the human hand is an outstanding feature of our
species.
Fingers can be called our second eyes、when oureyes cannot catch certain details, our fingers andhands can fill in the gaps: the sensations of heat andcold, knots, thickness, sharpness, dullness, texture,
etc…

26

Also, an example closer to our practice, a needle of
0.2mm in diameter can be distinguished with practice.
Palpation can be defined as the process of getting
information about the surface of the body with thehands and fingers. In this way, our hands help us getfrom the object of palpation to detailed information．
Also, we can assess how the object is moving andchanging in response to our touch. Moreover, our will
and intention can be transmitted.
In addition, in Japan, “hand” sometimes means
human; “hand” sometimes means emotional state. For
example, “talking hand” means “speaker”, “bitterhand” means “weak” and “poor”. Hands work, makethings, transmit and accept others.

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

Volume 1, Number 1 | Spring 2006

Medical History in Japan
Japanese Acupuncture and Moxibustion under the Rule of
GHQ after World War II
Recommendation by the Public Health and Welfare
Section for the prohibition of acupuncture andmoxibustion, and the response of the acupunctureindustry in Japan
Takako Okutsu

Acupuncture and moxibustion were first
introduced to Japan in the 5th Century AD from the
Korean peninsula and mainland China. These
therapeutic techniques subsequently developed into anindependent system for Japanese health care based on
the Chinese view of medicine. In the 16th Century,communication between Japan and China entered a
new stage, and as interaction between the two cultures
increased, acupuncture and moxibustion came into
wider use. When the Tokugawa Shogunate came into
power in Japan, acupuncture and moxibustion playeda major role in government policies regarding medical
treatment. However, after the Meiji Restoration in
1868, German medicine became the norm, andtraditional methods such as acupuncture andmoxibustion were placed under specialized andrestrictive regulations in Japan.
The new Meiji government began to issue licenses
to acupuncture and moxibustion practitioners who
could demonstrate a uniform and standard level oftechnical expertise. Acupuncture also gained protected
status as an occupation for the blind, a practice begun
under the Tokugawa Shogunate. For this reason,
acupuncture and moxibustion came to be considered as
an important pillar in the education of the blind. The
attitudes and decisions regarding acupuncture at thattime derived in great part from the outstanding
medical and political contributions to the Shogunatethat were made by Waichi Sugiyama, the gifted 16th
Century blind acupuncturist.
Under the old system of small private classes andapprenticeships that was still in place in prewar Japan,
it was difficult to guarantee the level of acupuncturist
training. It was not uncommon for acupuncturists tofocus on old ideas and to base their practice on limited
knowledge and experience. However, in the 1920s a
few talented acupuncturists who were exceptions tothis norm began a revolutionary movement that led to
the rapid modernization and systematization ofJapanese acupuncture and moxibustion during the
1930s and 1940s.

In 1937, Japan began a war of aggression thatdeveloped into World War II and that ended with theunconditional surrender of Japan in 1945. During the
war a number of medical schools were established toprovide short-term intensive training for physicians
who were then dispatched to the battlefields as
military surgeons. However, the growing shortage ofsupplies both at home and at the front created anincreasing demand for acupuncture and moxibustion,
which did not require drugs as part of the treatment
process.
The war ended in 1945, and the rebirth of Japanbegan under the direction of the Supreme Commander
for the Allied Powers (GHQ). The GHQ undertook the
democratization of all areas of Japanese life, including
medicine.
The department that was charged with reforming
the Japanese medical system was the Public Healthand Welfare Section (PHW). Headed by Brigadier
General C. F. Sams, the medical specialists of the
PHW performed detailed surveys of every region in
Japan. Their efforts were aimed at implementing a
medical system based on public health principles andat reforming the educational system to improve thequality of medical practitioners. This overall reform
would be highly respected later by the Japanese people,
who feel a deep debt of gratitude toward Brigadier
General (later Colonel) Sams.

Crawford F. Sams (1902 to 1994)
Military
surgeon,AmericanArmed
Forces. Stationed inJapan from 1945 to1951 as the director ofthe
PHW(Public
Health and Welfare
Section) of the GHQ(General Headquarters),
which was establishedin Japan in 1945. He
carried out a fullreform of the postwar
Japanese
medicalsystem, and in later
years was creditedwith protecting the defeated Japanese nation from starvationand disease. Retired in 1955, but continued to be active inresearch. Died in San Francisco in 1994 at the age of 92.
(This photo was supplied by Mainichi Newspapers.)

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Volume 1, Number 1 | Spring 2006

Among

its

many

responsibilities,

the

PHW

Recommendations of the PHW

examined numerous forms of unorthodox "folk"

In Japan immediately after WWII, the field of

medicine, and recommended the elimination of those

acupuncture moxibustion was held in high regard.

that were found to be questionable. Acupuncture andThis was partly because that system provided medical

moxibustion fell into that "questionable" category. The

treatment without drugs, which were in very short

PHW pointed to a number of problems in the field of

supply during and immediately after the war. The

acupuncture, and suggested that, in light of thosetherapeutic

problems, such treatment should be prohibited. This

moxibustion were not inferior to drug therapy, andrecommendation

tosince treatments could provide substantial therapeutic

acupuncturists as well as to people with impaired

benefits, they gained widespread acceptance first at

vision and those responsible for their education.

the upper levels of government and then throughout

Several well-known physicians and acupuncturists

the country. Practitioners who earned a place forspoke out on behalf of acupuncture and moxibustion,

themselves within the acupuncture and moxibustion

justifying the therapeutic value of this form ofcommunity were self-confident and proud of their jobs.

came

as

a

great

shock

treatment. Protests were lodged by trade associations,However,techniquesofacupuncturists

acupuncture

at

that

time

and

were

a

regulated under the "Regulation for the Control offederation of schools for the blind. Because of thisTrade in acupuncture and moxibustion Businesses"

public outcry and the dedicated efforts of some(1911). This placed them outside of the ordinary

Japanese bureaucrats, traditional acupuncture mix

medical system, and acupuncturists were generally

techniques were not abolished, but were allowed toconsidered to be a part of the service industry rather

continue. Those involved with this movement tothan the medical profession. Partly as a result, noprotect acupuncture and moxibustion then began toeducational

re-examine the status of this system in Japan, and toacupuncturists. Although there were some small

think carefully about improvements that were needed,private schools that provided a very high-level

which has led to the modernization of acupuncture andcurriculum, the certification examination was open to

moxibustion in Japan.

anyone who could provide proof of having worked as a

includingacupuncturists'

associations

andsystemhad

beenestablishedforThis article describes the path of developments

trainee for at least four years in an acupuncture

between the time when the PHW published its

moxibustion facility. The apprenticeship system was

Recommendations for the Prohibition of Acupuncture,

still widely practiced, and acupuncturists did not hold

Moxibustion and Massage and the time when Law No.

a prestigious position in Japanese society.

217, the Law for Business of Massage, Acupuncture,

In order to move forward from that situation and to

Moxa-Cautery, Judo-Orthopedics etc., which formally

improve the social status of acupuncturists as medical

established the position of Japanese acupuncturists,

practitioners, it was necessary to establish legislation

went into effect. Background research has been based

for the regulation of acupuncture and moxibustion

on source documents from the period. The effects ofpractitioners, and to reform the educational system.

PHW policies on the current status of acupuncture andMeanwhile, with Japan still under occupation by themoxibustion in Japan have also been investigated.

Allied Forces, the Constitution of Japan was proclaimed

Japanese

in 1947 to replace the Constitution of the Empire ofacupuncturists, the PHW recommendation describedJapan (the Meiji Constitution of 1889). Under the new

above was a major and unforgettable landmark in theconstitution, the old regulations governing businesspost-World War II history of acupuncture moxibustion

became null and void as of December 31, 1947, and it

in Japan.

was necessary to establish new laws in their place.

Named

28

the

"GHQ

whirlwind"by

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

Volume 1, Number 1 | Spring 2006

Those leaders in the acupuncture and moxibustion

and the Japanese government and the acupunctureindustry who had been working to improve the status ofindustry interpreted it as an "Order for the Prohibition

acupuncturists saw this as a golden opportunity, andof Moxibustion and Acupuncture."

began a movement toward establishing legal status for
acupuncture and moxibustion practitioners.

Those involved with acupuncture and moxibustion
felt that the future of traditional medicine in JapanAt the same time, as part of its independent survey

was at risk, and a movement arose to prevent the lossof Japanese folk medicine, the PHW had completed aof this medical resource. The Japanese government,

detailed survey of acupuncture and moxibustion, andcaught between the requirements of working with thewas summarizing its findings unrelated to Japanese

GHQ and the need to respond to the acupuncture

thoughts and opinions. The PHW concluded that theindustry, concluded that "Without changes in the laws

traditional therapeutic system of acupuncture andthat provide the basis for the acupuncturist system, it

moxibustion should be prohibited for reasons including

will be difficult for acupuncture and moxibustion to"inadequate disinfecting procedures," "lack of ancontinue." From that point on, governmental efforts

establishedfocused on legislative reform.

educational

system,"and"barbaric

treatment methods." These conclusions were conveyed
to the Ministry of Health and Welfare as a

Predictions and strategy of Professor Ishikawa
Professor

recommendation for the Prohibition of Acupuncture,

Hidetsurumaru

Ishikawa,

Professor

Emeritus of Kyoto Imperial University and President

Moxibustion and Massage.
Those who were affected by this recommendationof Mie Prefectural Medical School (now Mie University

remember it as a dash of cold water in the face of

School of Medicine), was one of the first to recognize

Japanese acupuncture. It came as a major shock to thethe risk to acupuncture moxibustion.
At Kyoto University School of Medicine, Professor

acupuncture industry, which had expected a bright
future for acupuncture and moxibustion after the war.

Ishikawa

hadtaughtphysiology,

and

at

Mie

This directive was prepared by the GHQ staff,

Prefectural Medical School, he continued his study ofwhose point of view was based on Western medicine.

the autonomic nervous system, which led him to

Staff members had little knowledge of Japanese

acupuncture research. As a young man, Professor

traditions, and no understanding of the theories of

Ishikawa had studied in Germany and Russia, andEastern medicine upon which acupuncture andfrom his perspective as a physician, he predicted earlymoxibustion are based. From the Western perspectiveon that "Acupuncture is far removed from Westernat that time, Japan was an exotic country of the Far

medicine, and includes procedures that will be seen as

East, and the medical traditions of acupuncture andbarbaric," and that the GHQ would raise questions

moxibustiontoregarding "inadequate disinfection procedures," "lackunderstand, both medically and culturally. It isof uniformity in acupuncturists' knowledge base andnatural for countries and peoples to have different

technical proficiency due to the lack of an establishedviewpoints, and seen in that light, it was also quite

educational system," and "ambiguity and vagueness ofnatural for the GHQ to perceive problems withtheacupuncture and moxibustion.

considered to be the most important element ofseemedstrangeanddifficultmethod'sscientificfoundations,

which

are

However, at that time the GHQ had absoluteWestern medicine." He also predicted that the future of

authority in Japan. The GHQ directive was strongly

acupuncture and moxibustion could be at risk,

worded, apparently denying the theoretical basis anddepending on how the Japanese government and thetechniques of acupuncture and moxibustion andacupuncture industry responded to these issues.

devaluing traditional elements of Japanese customs,

Immediately after the war ended, Professor

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Volume 1, Number 1 | Spring 2006

Ishikawa began to tell the acupuncturists with whom
he worked, "With Japan's defeat, there is a risk that
acupuncture and moxibustion may be prohibited.
However, fortunately the American people have aparticularly high regard for science. Acupuncture has
a much better chance of surviving if we can show thatit has a scientific basis. We need to begin preparing forthat now. So if you are interviewed or investigated byany of the Occupation forces (GHQ), I want you to say,
Ask Dr. Ishikawa at Mie Prefectural Medical School.1)
With this, he began to build a rational strategy for
responding to the GHQ.
Professor Ishikawa's statements appear to havebeen founded on two premises. First, was his rather
egotistical view that, with his mastery of both Western
medicine and acupuncture, he was the only person
who could protect acupuncture and moxibustion fromthe GHQ. The second was the very real fear that
acupuncture and moxibustion could be prohibited
immediately by the GHQ because of some naïve
demonstration or explanation of techniques by apractitioner who was not versed in Western medical
thought.

Hidetsurumaru Ishikawa (1878 to 1947)
Physiologist.

After

graduating from theFaculty of Medicine,Tokyo

Imperial

University,

hetraveled to Germany,
England, and Russia
forfurther

research

beginning in 1908. At
the age of 36 he wasappointed

asa

professor

intheSecond Department of
Physiology, Faculty of
Medicine,

Kyoto

Imperial University.
Accomplished researcher in the area of the autonomic nervous
system. Served as President of Mie Prefectural Medical School(currently Mie University School of Medicine) from 1944,
directing considerable energy into scientific research on
acupuncture and moxibustion. Died in 1947 at the age of 69.

30

Professor Ishikawa's Demonstration to the Mie
Military Government
On July 1, 1947, Professor Ishikawa was called inby the Mie Military Government of the GHQ, and washanded a list of 15 acupuncture-related questions. On
the following day, he responded to those questions
before First Lieutenant P. A. Weizmann, a militarysurgeon, and concluded his presentation by outlining"plans for the reeducation of current practitioners andthe raising of quality standards, to culminate incollege-level training."
The Military Government started that day bycitingacupuncture-related
issuesregarding"inadequate disinfection procedures," "the lack of anestablished educational system," and "barbaric
treatment methods", and announced that regulations
and restrictions would be applied to current
practitioners of acupuncture and moxibustion.
However, after the conversation with Professor
Ishikawa, they asked him to pursue further researchand to quickly provide them with a comparison ofacupuncture and modern medicine.
On July 7, Professor Ishikawa and one of his mosttalented acupuncturist assistants, Mr. Higuchi,
provided the Mie Military Government with ademonstration of an actual acupuncture treatment. In
front of six military personnel led by Surgeon
Lieutenant Weizmann, Ishikawa and Higuchi
scrubbed and disinfected as if they were preparing forsurgery. During the actual demonstration ofmoxibustion, they explained that treatment was
performed with extremely small amounts ofmoxibustion, and that burns from moxibustion could
be avoided by using the combustion ash.
Ishikawa and Higuchi then suggested that
Surgeon Lieutenant Weizmann try an acupuncture
treatment. The lieutenant agreed, and confirmed thatthe treatment was painless and that he experienced
changes in sensory perception. Acupuncture was thenperformed on other members of the audience, some ofwhom reported with considerable enthusiasm that "Itdidn't hurt, and the tension in my shoulders is gone!"That day's demonstrations achieved Professor
Ishikawa's objectives quite successfully.

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Volume 1, Number 1 | Spring 2006

Next, on September 7, Professor Ishikawa took Mr.
Higuchi and other acupuncturists to Tokyo, where they
met with the Medical Affairs Office of the Ministry of
Health and Welfare (now the Ministry of Health, Labor,and Welfare). Professor Ishikawa explained that theoffice would soon need to respond to queries from theGHQ. He bolstered the confidence of individual staff
members by describing the data from his years ofacupuncture research, which provided a scientificbasis for acupuncture. He also demonstrated the safety
and effectiveness of acupuncture treatment, using
Ministry staff members as his subjects.
This was how physicians, acupuncturists, andthose involved with acupuncture kicked off their"defensive war" against the "GHQ whirlwind."(To becontinued)

Surgeon Lieutenant Philip A. Weizmann

References
1.

Sugihara M: The footsteps of Mr. Naofumi Yamazaki,First President of Our School and Pioneer in
Acupuncture and Moxibustion Education. Publicationof the Alumni Association of Meiji School of Oriental
Medicine

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Book Review“Japanese Acupuncture: A Clinical Study” written by
Stephen Birch and Junko Ida
Reviewed by Emily Katai
L.Ac., CA, U.S.A.

Japanese Acupuncture: A Clinical Guide is the“foundation volume” in a series on the Japaneseclinical practice of acupuncture. This exciting text
brings many highly relevant, yet heretofore largely
unknown, ‘materials and methods’ to life for theWestern practitioner. The purpose of this volume isclearly stated: to set the stage for the next level ofdevelopment in the field of (English language)
acupuncture. Skills and techniques common to theJapanese acupuncturist have been translated andpresented in a very practical and informative style.
Just as the West begins to accept acupuncture to alarger degree, Japanese approaches will enjoy an
overdue boom.
The process of assimilation, integration anddevelopment of Oriental medicine in Japan is very
important to understanding where Chinese medicine
has been altered to fit Japan’s unique culture. The
unique subtlety and delicacy of Japanese acupuncture,
the “less is more” style, common to so many Japanesetraditions, receives special attention
The initial chapters present a historical overview
and an assimilation of Oriental medical theory
familiar to most Western trained practitioners. An
overview of Japanese acupuncture systems concludes
this section. Systems representative of Japanesepractice are defined and explained. The work of Dr.
Yoshi Manaka, Kodo Fukushima and Denmai Shudo
are briefly discussed under the topic of Keiraku Chiryo(meridian treatment).
The main body of the text covers palpation, needles
and needling, moxibustion (kyu), intradermal needles(Hinashin),press-tackneedles,(empishin),press-spheres (ryu), cupping (kyukaku), bloodletting(shiraku), Manaka’s wooden hammer, and needle andcase studies from the Japanese literature, including
the authors’ experience. This extensive collection,complete with illustrative photos, provides a very
comprehensive overview of Japanese techniques andthe discipline required to administer them. Where
appropriate, information about actual Japaneseclinical situations makes this volume very
comprehensive.

32

Acupuncture educationand practice in Japan are
the subjects of Appendix 1.
This information will bevery useful for educatorsand those practitioners
organizing study groups andprofessional organizations.
The presence of Appendix
2 is somewhat dubious as
there
is
no
obvious
STEPHEN BIRCH
JUNKO IDA
connection to Japaneseclinical practice. Chinesestudies using seeds taped to [Paradigm Publications
Brookline, Massachusetts 1998]
auricular points presentsinteresting information but adds nothing to thediscussion of elucidating Japanese practice.
In conclusion, this text is worthy of attention andwill undoubtedly find a place in the libraries of many aWestern practitioner. That said, one wonders why, given
the optimal timing for bringing this information toWestern practitioners, there is not a single Japanese
Kanji or Chinese Character. The authors’ clearly reliedon their hard earned skills in reading and speaking
Japanese, yet make absolutely no effort to extend thisknowledge to practitioners in the West. As practitionersof a traditionally Oriental body of medical wisdom, isthere no imperative for the Western practitioner tomake even the most rudimentary efforts to read orrecognize the original kanji? Lists of acupuncture points
identified only by number, Romanized transliteration ofJapanese terms like sotai exercises and oshide formoxibistion reveal nothing of the wisdom hidden in theterms and instead reinforce the Westerners belief that
Kanji are too complicated and numerous to botherconsidering. Until Western practitioners begin tomaster the language of the medicine we will be meretechnicians, exquisitely skilled perhaps, but in the longterm, limited by the translation on which we depend.
Birch and Ida have done us a great service,providing a necessary window into an elite world of
dynamic practitioners. But at the same time they are
keeping our perspective limited. Surely their practices
involve reading and speaking Japanese. Open dialogue
with Japanese practitioners will be the real key totransformingtheWesternizedapproachestoacupuncture from largely symptomatic point recipes towell organized reproducible root treatments. To that
end, Japanese Kanji, as well as romanization of terms
and point names must appear hand in hand.

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

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Volume 1, Number 1 | Spring 2006

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No part of this publication may be reproduced, translated, stored in a retrieval system, or transmitted in any form or by any other means,electronic, mechanical or by photo-copying without prior permission in writing to International Institute of Health and Human Services.

International Institute of Health and Human Services, Berkeley

34

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

Volume 1, Number 1 | Spring 2006

Ominedo is the only professional manufacturer of herbal extracts.

Poria Powder with Five Herbs
Wu-Ling-San
goreisanComposition
Arisma rhizoma
Tuckahoe
Atractylodes ovatae rhizoma
Umbellate pore fungus
Cinnamon bark

Ominedo Pharmaceutical Industry Co., Ltd.
574, Nenarigaki, Yamatotakada-City, Nara 635-0051, Japan
URL：WWW.ominedo.co.jp
Contact：info@ominedo.co.jp
The Journal(81)of Kampo,
Acupuncture andIntegrative
Medicine (KAIM)
Phone:
745-22-3601
Fax:(81) 745-23-2540

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Volume 1, Number 1 | Spring 2006

Kanebo Pharmaceutical, Ltd.
Like the cherry trees along Potomac River, Kanebo wishes
to play a role of the bridge for friendship and healthbetween Japan and U.S.A.

History of the Cherry Trees in Washington, D.C.
The plantings of cherry trees originated in 1912 as gift of friendship to the United Statesfrom the people of Japan. In Japan, the flowering cherry tree or “Sakura”, as it is called by
the Japanese people, is one of the most exalted flowering plants. The beauty of the cherry
blossom is a potent symbol equated with evanescence of human life and epitomizes thetransformations Japanese Culture has undergone through the ages.
Excerpted from National Park Service
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The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)