KAIM
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Thhee JJoouurrnnaall ooffK
Kaammppoo,, A
Accuuppuunnccttuurree aanndd IInntteeggrraattiivvee M
Meeddiicciinnee
INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 9, Number 4 ･ Winter 2014

Editorial

ISO and Traditional Chinese Medicine
Toshiaki Makino

Japanese Acupuncture - Current Research

Japanese Traditional Medicine Text (14) – Department of Urology
Hisashi Honjo

Kampo Medicine - Current Research
Clinical Applications of Kakkonto – Part 4Hiromichi Yasui

Clinical Report 1 (Acupuncture)

A Case of Acute Low Back Pain that Developed in a Severely Stressed 58-year-old Woman
Motoko Otsuka

Clinical Report 2 (Kampo Medicine)

Case Example of a Family whose Family Relations Improved by Administering Kampo Medicine to a Sister and Brother who were ina State of Rivalry
Hideaki Yamaguchi

Conference Report

17th International Congress of Oriental Medicine
Hiromichi Yasui

ISSN:1559-033X

College Logos
We believe it is necessary to create a new way of thinking
for the total understanding of "Life, Survival, and Health".
We decided to coin the world "Lifence" to express this.
Lifence means the combination of life sceince and medicine
as well as other disciplines such as health science, psychology,
ethics, etc.
Our college logos symbolizes the above.
The ripple effect represents the ocean and the birth of life.
The rainbow colored sphere represents a safe environment
and a barrier to protect us from negative influences.
The picture by Leonardo da Vinch represents a balanced
body and health.
Completing our logos is a ring which represents the unity ofspace fulfilling the total meanings of lifence.

―

The Journal of
Kampo, Acupuncture andIntegrative Medicine(KAIM)
Research on Theory, Practice and Integration

Volume 9, Number 4 ･ Winter 2014

EXECUTIVE EDITOR

Shuji Goto
Chairman, GOTO College ofMedical Arts & Sciences

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

Tokyo, JapanASSOCIATE EDITORS
Shuichi Katai

1 Editorial
ISO and Traditional Chinese Medicine
Toshiaki Makino

Ibaraki-ken, Japan

Hiromichi Yasui
Tokyo, JapanEDITORIAL STAFF

Akihiro Souma
Hiromi Sasaki
Hiroshi Tsukayama
Hitoshi Yamashita
Junko Okubo
Kazunari Ozaki
Kengo Nakata
Masayuki Kashima
Naoya Ono
Noboru Mitsuhata
Sayaka Toda
Takao Namiki
Toshiaki Makino
Toshihiro Togo

2 Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (14) – Department of Urology
Hisashi Honjo

9 Kampo Medicine - Current Research
Clinical Applications of Kakkonto – Part 4Hiromichi Yasui

18 Clinical Report 1 (Acupuncture)
A Case of Acute Low Back Pain that Developed in a Severely Stressed 58-year-old Woman
Motoko Otsuka

PUBLISHER

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

19 Clinical Report 2 (Kampo Medicine)
Case Example of a Family whose Family Relations Improved by administering Kampo
Medcine to a Sister and Brother who were in a State of Rivalry
Hideaki Yamaguchi

21 Conference Report
17th International Congress of Oriental Medicine
Hiromichi Yasui

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

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)KOTARO PHARMACEUTICAL introduced in 1957 the world's first Kampo extract
preparations on the market. Later, in 1967, six of our preparations could be covered in Japanfor the first time by the health insurance and after 1976 more than 100 of our preparations
were used in hospitals and clinics. Now it is half a century since we put our Kampo extract
preparations on the market and believe, we made a major contribution to this industry.
In the future we intend to continue working in accordance with our company motto: "Still better
Kampo for still more people" and provide pharmaceutical products of still higher quality.

Origin of the company's name
The company was named "KOTARO" by its
founder Taro Ueda with reference to his birthplace. Close to the ancient city of Nara. Kotaro
is the name of an enormous sheer cliff, 700 m
wide and about 200 m high. Mr. Ueda felt anaffection rising to the heavens for this cliff andthus made it the company's name.

KOTARO PHARMACEUTICAL CO., LTD.
5-23 Nakatsu 2-Chome, Kita-ku, Osaka 531-0071, JAPANURL: http://www.kotaro.co.jp

Volume 9, Number 4 | Winter 2014

Editorial
ISO and Traditional Chinese Medicine
The International Organization for Standardization, or ISO in short, is an institution that develops
international standards in all industrial sectors (mining and manufacturing, agriculture, pharmaceutical, etc.),
excluding the electricity, communication and electronic technology sectors. In 2009, a proposal was made toestablish a technical committee (TC) in ISO headquarters to discuss the international standardization of
Traditional Chinese Medicine as requested by China, and the committee was approved as TC249. The ISO/TC249
held its fifth meeting in Kyoto from May 26 to 29, 2014. I participated in the meeting as a member of Working
Group 5 (language, diagnosis and treatment methods, education methods).
First, China presented a list of the names of crude drugs and their origin, including the names of the animals
and plants or origin and their medicinal parts and code numbers. Surprisingly, the name of each crude drug waslisted in simplified Chinese characters, and in alphabetical order of their pinyin spelling. The almost
inconceivable idea of presenting a proposal for international standardization in Chinese notation invited strong
criticism from the other countries. In the end, the Chinese representative gave in, and newly proposed to spell
the names in Latin, the common language of the world and the basic language of academia, accompanied bytheir Chinese, Japanese and Korean names in alphabet. This proposal was not something Japan and South Korea
could agree to, because crude drugs of the same name in Japanese, Chinese and Korean are sometimes derived
from different plants. The Japanese and South Korean delegations insisted that the list be restricted for use in
China only, and that Japan and South Korea be excluded from the scope of the list. The discussion grewcomplicated, however, with Europe taking China’s side and placating Japan and South Korea to compromise,saying the difference was a minor issue. The Chinese representative sought Japan and South Korea’s cooperationin compiling a final list based on a list of crude drugs created by each country, but Japan and South Korea rejected
the proposal as impossible. Ultimately, it was agreed that China, Japan and South Korea would each prepare alist that describes crude drugs used in each country and present a proposal for combining the lists at the next
meeting.
With the fifth meeting of ISO/TC249 now over, Japan must prepare its own list of crude drugs and theirdescriptions by next fiscal year’s meeting. This itself is a simple task, since the origins of crude drugs in Japanare contained in the Japanese Pharmacopoeia, the official pharmacopoeia in Japan, and it suffices to translate it
into English. However, I think we should take this occasion of international standardization to devise a systemof codes composed of numbers that have meaning and relevance to consumer needs, as it is meaningless to
simply assign each crude drug a random code. In China, an official classification of crude drugs already exists
with respect to efficacy, for easy usability by consumers. In contrast, the Japanese Pharmacopoeia simply lists thenames of crude drugs in order of the Japanese alphabet, and has no classification system. The use of crude drugs
in traditional medicine in Japan largely differs according to each school of physicians and pharmacist, and eachschool also has its own classification system, so no unified system has been created for all of Japan. As a matterof fact, the problem that the use of crude drugs has not been standardized in Japan has surfaced as a result of therecent response to the ISO, and calls for urgent measures.

Toshiaki Makino, Ph.D.
Professor, Department of Pharmacognosy
Graduate School of Pharmaceutical Sciences
Nagoya City University, Nagoya, JapanThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

1

Volume 9, Number 4 | Winter 2014

Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (14) –Department of Urology

improvement of their symptoms and, following
urodynamic study, showed a significant increase inmaximum bladder capacity2). With regard to theHisashi Honjo

reliability of this research, it was not stated that the

Lecturersubjects were “randomly” assigned to test groups so

Faculty of Acupuncture and Moxibustion

the evidence cannot be considered to be of a highMeiji University of Integrative Medicine

level. On the other hand, St36 was established as thecontrol test point and was expected to produce

The positive effects of acupuncture for Urologicalconditions have been reported in international
journalssinceacupuncture

the

and

late

1980s.The

moxibustion

effectsoftreatment,inparticular acupuncture effects, have been known formany precisians in urology more than 20 years.
Bladder and urethra, as it is called the lower urinary
tract,

functionsareobviously

controlledbyautonomic and somatic nervous systems as research
has revealed1). Neuromodulation is an easy tounderstand mechanism of acupuncture treatments
as the therapeutic procedure for the lower urinary
tract symptoms (LUTS). Further, as a supplemental
treatment for refractory enuresis or incontinence(mainly side effects of drug therapy) there are highexpectations for the effectiveness of acupuncture
treatment. Actually, although there have been
numerous reports of acupuncture treatment being
used successfully for refractory enuresis, urinary
incontinence and urinary tract conditions, theusefulness of acupuncture should not be limited tothese conditions. This section outlines for indications
and effects of acupuncture treatment for domestic

distinctly different clinical effects, because it is in adifferent anatomical location, this may be considereda relevant research hypothesis. In contrast, Philip etal. collected 20 subjects complaining of urinary
frequency, urinary urgency and urge incontinence
and treated them with acupuncture. Treatmentareas included the low back, low abdomen and thelower medial leg and utilized K23, BL28, BL32, GV4,CV4 and CV6. It was reported that 77% of thesubjects stated that their symptoms had improved
and of those subjects it was found that their bladdercapacity had also increased3). This study does not
qualify as "integrated" because a control group was
not established, however, as with Chang et al.’sreport, objective improvement in bladder capacity
was confirmed among those subjects who reported
subjective improvement of their symptoms.
Further, at the beginning of 2000, several reports
were published whose titles did not include the term
“acupuncture”,

but

stimulation”

treat

to

used

“electro-acupunctureurinaryfrequency

andincontinence4-6). Up until recently, skin surface
electrodes known as “transcutaneous electricaland international research in the field of Urology.

nerve stimulation” or TENS have been used,

1. Clinical studies abroad

usefulness of electrical stimulation of the medial

The first International journal to publish researchon the effects of acupuncture for LUTS was in 1988.
Chang et al. reported on the effects of acupuncture
for urinary frequency and urgency in 52 women. The
subjects were divided into two groups: one group wastreated at Sp6 (medial lower leg) and the other at St
36 (lateral lower leg, below the knee). Results

however,

here

the

reportedonlower leg after using a needle electrode intended tostimulate the tibial nerve. The affected area is on thelower medial leg in areas almost equivalent totreating Sp6 and K3 with electro-acupuncture.
These reports implicitly indicated the usefulness ofeven low-frequency electrical stimulation using
acupuncture in clinical research.

showed 85% of women treated at Sp6 reported

2

researchers

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

Volume 9, Number 4 | Winter 2014

Klingleret al. investigated the effects of acupuncture

stimulation while creating no side effects can beat points near Sp6 on the lower medial leg in 15

useful in children.

subjects with frequent urination and urinary

This research points to a changed environment

urgency. The opposite pole plate was attached to asurrounding the lower urinary tract symptoms. In

needle below and posterior to the medial malleolus

2002, effective acupuncture treatment for lower(approximately K3), so stimulation would be appliedurinary tract symptoms was reported. The syndrome

to the posterior tibial nerve (20Hz, 30 minutes).

includes a constellation of symptoms with or without

Treatments were conducted 4 times per week for aurge

total of 12 treatments before results were confirmed.

urination or accompanied by frequent urge to

After urodynamic testing, it was found that onset ofurinate at night that has become referred to as

urination was easier, the urge to urinate was"overactive bladder" (OAB), a concept addressed bynormalized and bladder capacity was significantly

the International Continence Society (ICS).Until

increased. In conclusion, 47% of the subjects

recently, invasive inspection protocols had been used

reportedincontinence,usuallyincludingfrequent

had

completely

to diagnose such symptoms but these methods havereportedsignificant

changed significantly7). According to this new

improvement4). Vandonincket al. conducted a 12-

symptom syndrome, overactive bladder has been

week study using electro-acupuncture once a weekreported with an estimated prevalence of 16% in(20Hz, 30 minutes) near the posterior tibial nerve on

Europe and 12% in Japan. Here, clinical studies on

35 subjects complaining of urinary urgency andthe effect of acupuncture treatment for overactive

incontinence. Seventy percent of the subjects

bladder are reported.

confirmed their incidence of incontinence had been

Emmons et al. treated 85 overactive bladder patients

reduced by more than half and 46% reported

who complained of urinary incontinence. The

complete disappearance of their incontinence5). The

patients were divided by into two groups by

above integrated reports on both urinary frequency

treatment objective. The first was an acupuncture

and incontinence suggest the usefulness of thetreatment group aiming to treat their OAB

posterior

symptoms with Sp6, UB40, UB38 and CV4. The

theirdisappeared

andtibialsymptoms
20%

nerve

stimulation

for

these

conditions.

second group, considered the placebo group, aimed toSimilarly, Hoebeke et al. treated 32 school age

promotechildren (average age 12) who’s symptoms of urinary

utilized GB31, St36, UB12 and CV12. The frequency

urgency, frequency and enuresis were found to beof urinary incontinence in the treatment group

resistant to standard medical treatments. They

decreases by 59%and by 40% in the placebo trial

reported that stimulation to the posterior tibial

group. Both of these results are significant and there

nerve (20HZ, 30 minutes) once a week for 12 weeks

was no significant difference between the two groups.

eliminated the sensation of urinary urgency in 25%

It was reported that the frequency of urinaryof the subjects and improved the symptom in 36%.

urgency decreased significantly and the overall

Further, it was reported that 17% of subjects withamount of urine increased significantly only in theenuresis experienced complete elimination of theacupuncture trial group8). This RCT paper provided

symptom and 52% confirmed their symptom had

high level evidence and so is of great international

improved6). This study treats patients with ansignificance as a published journal article inintegrated research approach, and further shows

Obstetrics and Gynecology while examining thethateffect of acupuncture treatment for overactiveatherapyusing

posteriortibialnerve

relaxation

throughacupuncture

andbladder.

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

3

Volume 9, Number 4 | Winter 2014

On the other hand, acupuncture treatment for lower

the effects of acupuncture for chronic prostate

urinary tract symptoms has been adapted for

inflammation resulting in chronic pelvic pain

enuresis in children, and it usefulness has been

syndrome. They randomly divided 39 patients into

reported in the scientific literature. Björkström et al.

three groups for their RCT study. All subjects

treated 24 school age children (average age 10 years)

received life style coaching and were instructed inwith electro acupuncture (2Hz or 15Hz) on the lower

appropriate exercises as the basis for long-term

medial leg, foot and lower abdomen (Sp6, UB60, LV3change. The first group received electro-acupuncture,

and CV3 or K3, GB34, ST44 and CV4). It was

the second group received sham acupuncture and thereported that six months following the cessation of

third group received no extra stimulation and served

the treatment sessions, 46% of the subjects

as the control. After the six-week observation period,

confirmed

improved9).

the acupuncture electrical stimulation group was

Additionally, it was reported that among the subjects

compared to the other two groups, they reported

who had felt their enuresis improved, also statedsignificant (p<0.001) improvement of subjectivethat it was easier to wake up to go to the bathroom

symptoms. On the effect of acupuncture treatment

at night than it had been previously. Consequently,

for intractable chronic prostate inflammation andit was concluded that acupuncture was not only

chronic pelvic pain syndrome, this research inuseful for enuresis but is also expected to help theurology, because this RCT based evidence wassubject awaken to urinate without wetting the bed.

gleaned from a high level project, it has greatThis research is an integrated compilation of caseacademic significance.

studies, however, as a useful mechanism of effective

A urinary stone (colic) attack is cited as one of theacupuncture treatment for nocturnal enuresis it

most violent types of pain experienced in urology.

represents significant research. By the way, reports

However, the effectiveness of acupuncture as aof acupuncture treatment of urological conditions

treatment has been reported. Lee et al. randomly

are not only relevant for enuresis, urinary frequency

divided 38 male patients with colic attacks into to an

and incontinence.

acupuncture treatment or a drug administration

There are of course more painful urological disordersgroup. The acupuncture group subjects were treatedsuch as chronic prostatitis and urinary calculi. The

with points on their upper and lower back: UB21, 22,effectiveness of acupuncture as a treatment for such

23, 24, 25, 50, 51, 52, You Gan (extra point) as welldiseases has been studied and reported.

as 4-5 points on the hand were selected, needled and

The effectiveness of acupuncture has been reported

retained for about 1 minute. In the acupuncture

for pelvic pain syndrome due to non-bacterialgroup, after an average of 3 minutes treatment, an

prostatitis classified under chronic prostatitis. Chen

analgesic effect was observed and 86.4 % of subjects

et al. confirmed significant reduction of symptoms

reported their pain was completely relieved. For thefollowing

6

subjects in the analgesic group, 62.5% reported

weeks10). Two protocols were utilized. The first wascomplete pain relief, however only after an average

CV4, CV3 and 腸遺穴 (extra point) (M ─CA ─ 17) atof 15 minutes had elapsed12). This study reported the

5 Hz, for 20 minutes. The second set included UB35

effectiveness of acupuncture for urinary calculi colic

and UB53 (20 Hz, 20 minutes). This research was an

attack using RCT evidence level methods, for the

integrated review of case studies, however it hasapplication of acupuncture this should be considered

deep clinical significance regarding the usefulness of

meaningful research.

their

symptoms

bi-weekly

hadelectro-acupunctureforacupuncture therapy for treating chronic pelvic pain
syndrome. On the other hand, Lee et al. investigated

4

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

Volume 9, Number 4 | Winter 2014

2 Current status of and prospects for clinical studies

61% reported their incontinence was reduced by half

in Japanand following urodynamic study, a significant

In Japan, there have not been many reports ofincreaseacupuncture and moxibustion therapy in the field ofconfirmed(p<0.01)14). From these results, sacralurology. Until now, most research has focused on theacupuncture treatment was hypothesized to likely

perspective of impact on or changes in symptoms andinhibit over active bladder function. Further, it has

bladder function. The effects of acupuncture therapy

been suggested that sacral acupuncture treatment

for overactive bladder, urinary frequency andfor the patients with bladder hyperactivity caused byurinary incontinence have been primary. One ofchronic spinal cord injuries would likely be useful.

these reports, for subjects complaining of urinary

Incidentally, among the subjects who reported

incontinence and urgency, 11 patients with detrusor

acupuncture was effective for their symptoms after 4

hyperreflexia

astreatments, urodynamic study conducted one monthdemonstrated by urodynamic study, underwent

later, confirmed 6 people continued to showsacral acupuncture treatment and these effects wereincreased urine capacity greater than prior to

examined13).

treatments. These results suggest that treatment

The acupuncture treatment focused on the sacrum

effects continued for more than one month without

involving bi-lateral insertion at the 3rd sacralanyforamendisposablesuggested that monthly maintenance acupuncture

acupuncture needle (0.3 mm in diameter, 60 mm intherapy would be beneficial, because bladder

length). Stimulation was obtained by inserting thecapacity began to decrease slightly after just one

needle into the sacral periosteal edge directedweek cessation of the treatments. One point worth

toward the head to a depth of 60mm until a dull,

noting in the present study is that these results wereheavy sensation (dull pain) was achieved. One

the due to a combination of acupuncture andtreatment consisted of thrusting stimulation fromanticholinergic treatment. Four of 13 subjects who

this location, continued to a depth of 5 mm for 10

were taking anticholinergic agents (Oxybutynin

minutes. Following the treatment, 82% of thehydrochloride) found drug therapy by itself did not

subjects

hadproduce a desired effect, also increasing amount of

disappeared or their urinary urgency had improved.

the drug led to unpleasant side effects in these

Urodynamic study was performed before and after

refractory

the acupuncture treatment. Prior to the treatmentincontinence

maximum urine capacity was 142.5 ± 62.9 mL but

pharmacotherapy by anticholinergic agents wereafter the treatment it became 250.0 ± to 100.4 ml, amore effective than the patients without thesignificant increase ( p<0.01 ).55% of patients withpharmacotherapy. Therefore, it suggests that theoveractive bladder reported their symptoms had

usefulness of a combination therapy utilizing

disappeared. From the observed improvement ofacupuncture and the pharmacotherapy among theurinary urgency or incontinence with acupuncture

patients with bladder hyperactivity.

treatment for overactive bladder, it should be

Besides overactive bladder, we have also reported onsuggested that sacral acupuncture is a usefulthe effects of acupuncture on enuresis. We treated 15

alternative

children (average age 10 years), these subjects also

(detrusor(UB33),

reported

or

using

their

overactivity),stainlessincontinencecomplement

tostandardinfurtherurine

capacity

acupuncture

cases.

treatments.

Improved

among

the

was

rates

patients

of

also

It

was

urinary

using

the

pharmacotherapy.

received the sacral area acupuncture treatment

Similarly, 13 spinal cord injury patients with urinary

mentioned

incontinence were treated with sacral acupuncture.

Treatment results were evaluated after UB33 wasabove

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

foroveractive

bladder15).

5Volume 9, Number 4 | Winter 2014needled once a week for 4 weeks. The children in theutilized the International Prostate Symptom Score

study reported that rather than feeling pain at the(IPSS),

insertion site, there was a feeling of heaviness orenlargement and diminished bladder capacity as

dullness.

discontinued

subject criteria. Twenty-four subjects with an IPSS

treatment because they could not put up with such agreater than 8 and bladder capacity less than 30ml

sensation and no especially harmful side effects were

were accepted into the study. According to the results

observed. Urinary records were evaluated based on

obtained, it was reported that following sacral

the effects of 1 acupuncture treatment per week andacupuncture, IPSS improved significantly (p<0.001)

how this influenced urinary frequency at night.

and the parameter of maximum urinary flow andFollowing one month of Acupuncture treatments, 6

averagesubjects (40%) reported decreased urinary frequency

significantly16). As the mechanism of action in thisat night, and following 2 months of treatment, 7

study, following sacral acupuncture, the results

subjects

showed increased urine flow rate and decreased

None

(47%)

of

the

reportedpatients

theirenuresis

hadasubjective

flow

rate

measure(p<0.05)ofalso

prostate

improved

disappeared. In this study, only the subjects in theurethralacupuncture

experienced

acupuncture on urinary tract function suggest thatsignificantly greater nocturnal bladder capacity. One

this type of treatment not only impacts bladder

hypothesis about enuresis is that if the childfunction but also that of the lower urinary tract.

becomes cold while sleeping, his bladder may

In addition, we present international and domestic

contract, thereby reducing bladder capacity andevidence on the usefulness of acupuncture treatment

retention. Acupuncture is thought to counteract thisfor chronic pelvic pain syndrome17). This study

contraction, allowing the subject to maintain or

recruited 10 patients with non-inflammatory chronic

improve

pelvictheirtreatment

bladder

group

capacity,effectively

resistance.

pain

The

syndrome

results

associated

of

with

sacralpelviceliminating or reducing enuresis. Also, following

congestion syndrome. Prior to receiving acupuncture,acupuncture treatment, the subjects who reported

8 of these subjects had received pharmaceuticalmore than 50% improvement in the number times

therapy but found their symptoms unchanged as athey went to the bathroom at night were placed inresult. The Acupuncture treatment was similar to

the “effective” group. In contrast, those subjects who

previous reports, sacral acupuncture once a week forreported less than 50% improvement were placed in

4 sessions, then the patients were given the NIH

an “ineffective” group. Nocturnal bladder capacity

chronic pelvic pain symptom index (NIH-CPSI),

increased significantly in the "effective" group, andwhich is a measure of subjective symptoms. Before

showed no significant change in the "ineffective"

and after acupuncture treatment, findings from MRgroup. Additionally, it was found that most of thevenouschildren in the “effective” group were over the age ofultrasonography of pelvic vein stasis were evaluated.

10 and most of the children in the “ineffective” group

Results showed that NIH-CPSI findings for levels of

were under 10 years. From the above results, it ispain and discomfort following acupuncture were

thought that the effectiveness of acupuncture forsignificantly reduced (p<0.05) and QOL items werereducing or eliminating enuresis by increasing

significantly

bladder capacity is more significant in older children

following acupuncture treatment, it was confirmed(over 10 years).

that pelvic vein congestion and stasis was eliminated

Next, acupuncture has also been found effective forand subjective symptoms indexes were improved. On

treating enlargement of the prostate gland, a very

the other hand, these results indicated the relevanceangiography

improvedcommon complaint in geriatric men. Kitakoji et al.

6

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

and(p<0.01).

trans-rectal

Additionally,Volume 9, Number 4 | Winter 2014of this study and point to the validity of the reported

References

effectiveness18).

1) Ford

AP,

Gever

JR,

Nunn

PA,

et

al.:

Concerning the usefulness of Japanese acupuncture

Purinoceptors as therapeutic targets for lower

treatment in urology and its mechanism of action as

urinary tract dysfunction. Br J Pharmacol 147

reported so far, because many of these papers are(suppl 2): S132─S143, 2006

compilations of case studies from Japan, although

2) Chang PL: Urodynamic studies in acupuncture

they may be integrated in theory, it cannot be said

for women with frequency, urgency and dysuria.

there is a high level of evidence. For these reasons,

J Urol 140: 563─566, 1988

therefore, under the present situation, descriptions

3) Philp T, Shah PJ, Worth PH: Acupuncture in theof acupuncture as seen in typical clinical practicetreatment of bladder instability. Br J Urol 61:

cannot be equated with standard guidelines for490─493, 1988

lower urinary tract symptoms in the "over active4) Klingler HC, Pycha A, Schmidbauer J, et al.: Use

bladder treatment guidelines",19).

of peripheral neuromodulation of the S3 region

This concludes our personal research as well as aforsurveyurodynamic ─ based study. Urology 56: 766─771,

ofrelevant

researchonacupuncture

treatment for Urological conditions. As for domestic

treatmentofdetrusoroveractivity:

a

2000

or international clinical reporting of acupuncture5) Vandoninck V, Van Balken MR, Finazzi Agró E,

treatment for lower urinary tract symptoms andet al.: Posterior tibial nerve stimulation in the

success of treatment, acupuncture treatment should

treatment of urge incontinence. Neurourol

be considered one useful treatment option. However,

Urodyn 22: 17─23, 2003

many questions still remain about the detailed6) Hoebeke P, Renson C, Petillon L, et al.:mechanism of acupuncture treatment, so without

Percutaneous electrical nerve stimulation inreports of the usefulness of acupuncture performed

children with therapy resistant nonneuropathic

using large-scale randomized controlled trials in

bladder sphincter dysfunction: a pilot study. J

clinical research that yield convincing evidence, it is

Urol 168: 2605─2608, 2002

hard to say there is enough evidence. In the future,7) Abrams P, Cardozo L, Fall M, et al.: The

our greatest efforts should be organized toward

standardization of terminology of lower urinary

elucidating the mechanism and usefulness oftract function: report from the Standardisationacupuncture, integrating the evidence as recognizedSub ─ committee of the International Continencein urology and other fields and transmitting thisSociety. Neurourol Urodyn 21: 167─178, 2002

information to the medical establishment.

8) Emmons SL, Otto L: Acupuncture for overactive
bladder: a randomized controlled trial. Obstet
Gynecol 106: 138─143, 2005
9) Björkström G, Hellström AL, Andersson S:
Electro ─ acupuncture in the treatment ofchildrenwithmonosymptomatic

nocturnal

enuresis. Scand J Urol Nephrol 34: 21─26, 2000
10) Chen R, Nickel JC: Acupuncture ameliorates
symptoms in men with chronic prostatitis /chronic pelvic pain syndrome. Urology 61:1156─1159, 2003

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7

Volume 9, Number 4 | Winter 201411) Lee SH, Lee BC: Electroacupuncture relieves
pain in men with chronic prostatitis / chronic
pelvic pain syndrome: three ─ arm randomized
trial. Urology 73: 1036─1041, 200912) Lee YH, Lee WC, Chen MT, et al.: Acupuncturein the treatment of renal colic. J Urol 147: 16─18,
199213) Kitakoji Hiroshi, Terasaki Toyohiro, Honjo
Hisashi, et al.: A study on the usefulness ofacupuncture treatment for overactive bladder.
Japanese Journal of Urology 86:1514─1519,
1995
14) Honjo

H,

Naya

Acupunctureon

Y,Ukimuraclinical

O,

et

al.:

symptoms

andurodynamic measurements in spinal ─ cord
injured patients with detrusor hyperreflexia.
Urol Int 65: 190─195, 2000
15) Honjo H, Kawauchi A, Ukimura O, et al.:Treatmentofmonosymptomatic

nocturnal

enuresis by acupuncture: A preliminary study.
Int J Urol 9: 672─676, 200216) Kitakoji

Hiroshi:

Effectsofacupuncture

treatment for first stage enlarged prostate.
Bulletin of Meiji University of Oriental Medicine
24: 25─32, 199917) Honjo H, Kamoi K, Naya Y, et al : Effects ofacupuncture for chronic pelvic pain syndrome
with intrapelvic venous congestion: preliminary
results. Int J Urol 11: 607─612, 2004
18) Tugcu V, Tas S, Eren G, et al : Effectiveness ofacupuncture in patients with category IIIB
chronic pelvic pain syndrome: a report of 97
patients. Pain Med 11: 518─523, 201019) Committee of edited guidelines for overactive
bladderonJapanese

Continence

Society:guidelines for treatment of over active bladder,Blackwell Publishing Inc. Tokyo, 2005

8

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

Volume 9, Number 4 | Winter 2014

Kampo Medicine - Current Research
Clinical Applications of Kakkonto – Part 4

stiffness develops in the shoulders.”1) Additionally, in

Kampo shinryo iten, it is written : “Use [kakkonto]

Hiromichi Yasuiin cases where the mammary gland is developed andJapan Institute of TCM Researchis in a state that would normally secrete sufficient
milk but does not due to stagnation, and thereby

Kakkonto is a prescription that first appeared in
the great Chinese classic Shokanron (treatise on cold

words, kakkonto can be expected to be effective

damage) and came to be widely used in Japan fromagainst both shortage of milk production andthe latter half of the 19th century. Particularly sincelactation insufficiency.

causes stiffness in the shoulders and back.”2) In othervariousAsagiri administered kakkonto to women who

indications for the prescription, it came to be usedhave just given birth by normal delivery andwidely for a variety of diseases. In Japan, it is known

compared the efficacy of kakkonto with women in

as a representative Kampo drug and a populara control group. As a result, he reports that in theprescription that also appears in the traditional

kakkonto group, an increase in lactation was

Rakugo comic story of “Kakkonto Doctor.”

observed among women giving birth for the first

Yodo

Odai

(1799-1870)

introduced

time and those who have given birth two or moretimes, and found that kakkonto was particularly

Clinical applications (continued)
In Shokanron, indications for kakkonto are acuteinfectious diseases. However, from Japan’s more

effective in cases of milk stagnation.3)
Ishino et al. administered Tsumura kakkonto

than 150 years of experience, kakkonto is known to

extract

have an extremely wide range of indications and is

portions/day) to 20 women who have just given

today

are

birth and made a comparison with a control group

introduced below, in continuation from the previousof 20 women. The result was that on the fifth day

issue.

of childbirth, the kakkonto group had an increased

appliedtomanydiseases.

These

granules7.5g(divided

into

three

amount of lactation than the control group. They
19. Lactation insufficiency & mastitis

also report that the kakkonto group had higher

In Japan, kakkonto is used against lactation

blood PRL levels than the control group on the fifth

insufficiency by experience, and is recognized for its

day of childbirth, as well as decreased amounts ofefficacy. There are also reports that it is effective in

DHEA-S.4)

the initial stage of mastitis. The two are similar inthat they are caused by an abnormality in the

Mastitis basically has the same mechanism asmechanism of lactation, and thus share thelactationmechanism that allows kakkonto to be effective, in

involves an external pathogen.

insufficiency,

but

purulent

mastitis

In Kampo shinryo iten, it is written: “Whether for

many ways.
With regard to this point, it is written in Chuistagnant or purulent mastitis, use kakkonto plus

shohou kaisetsu (Chinese medicine prescriptions)5.0g gypsum in cases where the patient complains ofthat “when the breast does not fill and does notchills, fever, swelling, pain, or stiff shoulders in thesecrete sufficient milk, the patient should takeinitial stage.”5)

kakkonto along with foods and drinks that contain aSato et al. studied the efficacy of administering

lot of water, such as dandelion tea, milk, zenzai red-

kakkonto for milk stagnation mastitis and thebean soup with mochi, and noodles. Use kakkontotransfer of its components to breastmilk, andwhen the breast fills but does not secrete milk andreportthatnosignificant

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

differences

were

9

Volume 9, Number 4 | Winter 2014

observed between the kakkonto group and control

Kunio Matsuda, Milk deficiency, Shorei ni yoru

group with respect to increases in lactation, breast

Kampo chiryo no jissai (practical Kampo therapy by

pain and mitigation of breast swelling. With regard

disease name), p. 312, Sogensha, 1992

to the transfer of its main components tobreastmilk, ephedrine was detected in 10% of theCase 2: Stagnation mastitis

subjects and glycyrrhizin in 50%, among the

18-year-old female with no previous pregnancy or

substances that could be examined, but newborns

childbirth experience. Normal delivery of a baby girlthat consumed this milk did not display any

after 39 weeks and 2 days after pregnancy. On theclinical problems in particular.6)

morning of the second day after delivery, the feeling

Below are cases that have been reported to date.

of breast engorgement intensified and came to

They are reports of cases relating to milk deficiency,

accompany a heat sensation and pain. Thus,

milk stagnation and mastitis caused by milk

kakkonto (TJ-1) 7.5g/day was administered for two

stagnation.

days in addition to the normal breast massage. Aftertaking the prescription, the patient said the heat

Case 1: Hypogalactia

sensation and pain decreased in about half a day,36-year-old female. Famous calligrapher living inand she became much more comfortable. The feelingthe countryside.

of breast engorgement continued until the sixth day[First visit] December 1973

after delivery, but it was not painful.

[History of present illness / Present condition]

The patient had 10ml of milk secretion by the(First part omitted) The woman delivered a baby

second day of delivery, which increased to 142ml on

girl in January 1981. In June of the same year, she

the third day and 308ml on the fourth day. By the

became pregnant with her second child and gave

seventh day, the baby was fed 100% by breast milk,birth in 1982. In October 1983, she gave birth to her

and mother and child left the hospital.
(Partial omission) Kakkonto proved to be an

third child.
According to a letter I received on December 15, 1983,

effective Kampo drug that could be used for breast

her breastmilk did not flow as well as her previous

stagnation during the postpartum period without

two times, and she wished to know if something

worrying about disease pattern or about its impact

could be done about it.

on the newborn.

[Progress] Dandelion tea is said to be good for milk

Hisanori Oguri et al., A case in which kakkonto was

deficiency, but I have never used this, so I

effective for breast stagnation, Science of Kampo

administered kakkonto, considering the woman’s

Medicine, Vol. 28, No. 3, p. 33, 2004

build. I sent her kakkonto extract 5.0g (to be taken
in two portions) and instructed her to occasionallyCase 3: Mastitis

eat kuzumochi (mochi cakes made of kudzu powder)

Patient: 24-year-old female, 1 pregnancy experience

with a topping of honey.

The patient’s pregnancy showed good progress

I received a reply right away. The letter was dated

without any complications, and she gave birth to a

December 21, so she had taken the drug only for

3,250g baby boy by normal delivery. However, fromabout five days, but she wrote that “her breast milk

the third day after delivery, she began to complain ofhas begun to flow very smoothly after taking thea feeling of intense engorgement of both breasts,

prescription, and owing to that her child sleeps wellspontaneous pain, slight fever and lack of milk

and is growing healthily every day.”secretion.

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

Volume 9, Number 4 | Winter 2014

Past medical history / History of pregnancy: The

20. Acute gastroenteritis

patient has nothing in particular in her past medical

In Shokanron, it is written: “In greater yang andhistory, but with regard to pregnancy, she had anyang brightness combination disease, there will beabortion in her third month of pregnancy two years

spontaneous diarrhea. kakkonto governs this,” andago, and nothing else.

“When in greater yang and yang brightness

Present condition / Examination findings: Weightcombination disease, diarrhea is absent, only

56kg (52kg when not pregnant), height 160cm, bodyretching is present. kakkonkahangeto governs this.”

temperature 37.2°C, pulse 68/min. No anemia. Upon

The above describes conditions seen in infectious

internal examination, uterine anteversion wasenteritis, and in cases of diarrhea, it is frequently

confirmed, fist-sized and good contraction. Mostly

accompanied by a tenesmus.

normal lochia. No findings that suspect

pelvicHosono adds: “…There was an occasion to apply

infection. Blood sedimentation rate 30 (15ʹ) – 42 (60ʹ),[kakkonto] in the initial stage of dysentery and

CRP (+), Hb36%, white cell count 11,000, red cell

colitis. When kakkonto was applied in the initialcount 420 × 104. These findings were considered tostage where mucus or bloody purulent stool

indicate a normal state or minor inflammation foraccompanying tenesmus was frequently excreted

the postpartum period.

under the combined conditions of early yang and

Before taking the prescription, the patient’s breasts

middle yang diseases, some minor sweating was

were strongly tense, she experienced spontaneous

immediately followed by relief from the urge to havepain and oppressive pain, and she secreted a small

a bowel movement that had occurred at intervals ofamount of slightly bloody milk. The engorgement in

10 to 30 minutes and a significant decrease in bloody

her breasts was evident to the touch as a lump on thepurulent stool. It appears that kakkonto works evenouter sides of her breasts and on the axillary lymph

better in such cases with the addition of oren

node on the right side.

(Coptidis Rhizoma) and ogon (Scutellariae Radix).”7)

Present condition from the perspective of Oriental
medicine: Moist skin, no anemia. Dry mouth (+), stiff

Case 1: Acute enteritis

shoulders (+), nausea (-), headache from the neck to

Patient: 72-year-old female

back of the head (+).

First visit: January 4, 1993

Pulse: strong

History of present illness: On January 4, 1993, theAbdomen: tension of the abdominal rectus muscle onpatient suffered vomiting and diarrhea at around 3

both sides (+)

a.m. and took Hangeshashinto (extract), but he had

Progress: After administering kakkonto 5g/day, theserous diarrhea three times until a little past 9 a.m.

spontaneous pain became (-) on the second day, on

when he visited the clinic.

the third day, the breast engorgement clearly

Present

decreased even from an objective perspective, but

sweating. Tongue covered with a white coating andthe swelling of the axillary lymph node remained the

moist. Weak pulse, soft abdomen.

same. Milk secretion improved from the fourth day

Treatmentof taking kakkonto, and there was also sufficient

diarrhea was caused by virus-induced acute enteritis

milk ejection.

(because I did not verify it by an examination), I

Yoshiaki Sato, Cases of mastitis, Gendai no Kampo

condition:andTemperature

progress:

37.7°C,

Surmising

that

no

the

immediately administered kakkonto (extract) on thechiryo (modern Kampo therapy), p. 464, Toyo

spot.

Gakujutsu Shuppansha, 1985

kakkonkahangeto and told him to make a decoction

I

also

gave

him

a

day’s

dose

of

of it when he got home.

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

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Volume 9, Number 4 | Winter 2014

In the late afternoon, I received a call from thea loss, when Dr. Masatsugu Wada visited our office.

patient that the diarrhea has stopped. He did not

I thought he was a godsend; I explained to him my

have diarrhea the next day either, but he was given

problem and sought his help as to what I should use

orento (Shokanron) because he complained of

to cure my coughing. Dr. Wada took my pulse for a

stomach pain and loss of appetite. He recovered inwhile and said I should probably take kakkonto

two days.

after all. I was half in doubt of whether kakkonto(149)

would work after more than ten days of developing(memorandum of Kampo therapy), Journal of Kampo

a cold. However, when I took, it worked extremely

Medicine, Vol. 40, No. 5, p. 36, 1993

well, and my coughing suddenly stopped after one

Genpo

Ogata,

Kampo

shinryooboegaki

to two doses.
Ken Fujihira, Kampo rinsho note (chiryohen)

20. Bronchial asthma and coughing
In Shokeiteiijishogen, Nanyo Hara reports of acase where kakkonto improved asthma in a person(Kampo clinical notes (therapy edition)),p. 87, Sogensha, 1988

with extreme stiffness in the shoulders and back.8)
Such cases are thought to be highly rare in reality,
but the possibility is not unlikely. There have also
been reports related to coughing.

22. Meningitis and tetanus
There are various types of meningitis, andbacterial meningitis and aseptic meningitis, forexample, differ in their symptoms and prognosis, but

Case 1: Wheezing and coughing

fundamentally, they are commonly characterized by

Patient: 53-year-old female

meningeal symptoms such as a fever, headache,First visit: October 1952. The patient came down

vomiting and stiffness in the nape. Because thesewith a slight cold around five days ago. At the same

symptoms resemble the indications for kakkonto

time, she developed severe wheezing accompaniedthat are written in the Shokanron early yang disease

by coughing and received an injection of ephedrine

edition, kakkonto has come to be applied to theand other substances, but said its effect did not lastinitial stage of meningitis.

long. No fever. A clearly solid build. Pulse trended

In Sokeiteiijishogen, Nanyo Hara writes about his

toward floating and was almost tense and slightly

experience in treating a tetanus-like disorder with

rapid. The tongue was dry and absent of any coating.
excess of the early yang pattern, or a kakkonto

kakkonto.9) It was based on the following passage
contained in the Chinese classic text of Shokanron
and Kinkiyoryaku (Treatise on Cold Damage andpattern.

symptoms

Prescriptions from the Golden Cabinet): “For taiyng

considerably, and the patient was cured without

disease manifesting with an absence of sweating but

taking all seven doses as prescribed. Thereafter, forwith scant urine, qi surging upward in the chest,

30 years to today, she has not seen a recurrence.

clenched jaw, and appearing on the verge of hard

The nape and back were stiff. These indicated an
One

dose

improved

theShigenari Ogura, Journal of Kampo Medicine, Vol. 3,

tetany; kakkonto is indicated.”

No. 1, p. 23, 1956

Case 1: Aseptic meningitis
Case 2: Coughing

Patient: 37-year-old male, taxi driver

Around 12 to 13 years ago, I caught a cold, which

Chief complaint: Headache, fever

worsened to the point that severe coughing

History of present illness: In the morning of Octobercontinued for as many as ten days. I tried various

29, 1983, the patient felt a chill while driving his taxi,

remedies, but none seemed to work. I was quite atand in the afternoon, he developed a pulsatile

12

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

Volume 9, Number 4 | Winter 2014

headache in the left temporo-parietal area. The feverand neutrophils in the cerebrospinal fluid had

was minor, and the patient had no vomiting,increased considerably. The antibiotic was continued

coughing, sore throat or other such symptoms. The

even after the patient transferred departments. On

headache gradually intensified, so he visited ourNovember 10, Voltaren suppository (50mg) wasneurosurgery department on October 31. He wasadministered twice a day as an antipyretic analgesic.

diagnosed with cluster headache and given an

Voltaren is effective against headaches and lumbago,

analgesic. He went home, but the headache kept

but it was inadequate against fevers, and metilon

getting worse, and it got to the point where heintramuscular injection needed to be added.

developed a dizziness on November 1. On November

Masaaki Itasawa, kakkonto usage experience for4, the headache became intolerable and his

aseptic

temperature rose to 39°C, so he was admitted to our

examination), Vol. 4, No. 5, p. 26

meningitis,

Kampo

shinryo(Kamponeurosurgery department on a stretcher. In a lumbar
puncture performed on the next day, an increase in23.

the number of lymphocyte-predominant cells wascirrhosis

Gynecomastia

pain

accompanying

liver

confirmed. After hospitalization, the headache

In recent years, kakkonto is being experimentallyabated somewhat but increased considerably atused against the pain of gynecomastia that occurs innight, and he tended to lack sleep also because of a

relation to liver cirrhosis.

lower back pain that newly emerged. On November

Motoo et al. administered Tsumura kakkonto

7, his hearing decreased in his left hear. On

extract granules 7.5g/day against gynecomastia in

November 9, he was transferred to Internal

three patients in the compensatory period of liver

Medicine Department 1 in our clinic for medical

cirrhosis, andtreatment.

disappeared in all three patients. No significant

Conditions at the time of transfer / Progress:changes were observed in blood hormone levels

Temperature 37.2°C. No abnormality found by

before and after taking kakkonto, no shrinkage ofstethoscopy and tapping. Stiffness in nape (+).

mammary tissue was confirmed in a mammogram,

Kernig sign (-). Nystagmus in right gaze (+). Rinne

and the induration that was confirmed bytest (+) in right ear, Weber test showed lateralization

palpation had shrunk.10)

to the right. Normal tendon reflex, pathologicalAt present, only Motoo’s three cases have beenreflex (-). Aggravation of muscle tone in lower

reported to date, but it is said that additional tests

extremities.

have been performed. This shall be discussed in the

Examination findings: RBC 451 × 104; WBC 8,800;

Appendix.

reportthat

thebreast pain

Stab cells 14%; Segmented cells 66%; Monocytes 7%;
Lymphocytes

13%;

Blood

sedimentation

rate

Case 1: Gynecomastia pain

82mm/1 hour, 110mm/2 hours; CRP3 (+); α2-globulin

Patient: 45-year-old male. Compensatory period of

16.6%.

liver cirrhosis. No stiffness in nape and shoulders, no

Lumbar puncture findings: Pressure 180mm; Cell

natural sweating. Tense pulse and tongue slightly

count 864/3 (neutrophils 56, lymphocytes 748, large

covered with a white coating. Kakkonto wasmononucleosis 60); Protein 77.5 mg/dl; Sugar 54.4

administered in the first week after the patient

mg/dl.

developed gynecomastia. The pain subsided on the

The patient’s progress was as shown in Fig. 1.

third day and completely disappeared within the

Neurosurgery used an antibiotic and a γ-globulin

first week. Kakkonto was continued thereafter, but

preparation because there was strong inflammation

no recurrence was observed.

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

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Volume 9, Number 4 | Winter 2014

Yoshiharu Motoo et al., Significance of kakkonto

stiffness in her shoulders and neck. The patient was

liver

subjectively aware of the stiffness and said it wascirrhosis, Science of Kampo Medicine, Vol. 20, No. 2, pp.

painful. She also coughed and produced some15-17, 1996

phlegm. Her pulse was weak, and her blood pressure

againstgynecomastia

pain

accompanying

was around 120/80 mmHg.
The patient was given kakkonto to alleviate the24. Myasthenia gravis
A number of cases has been reported to date thatstiffness in her shoulders and back. The hospital’s

claim the efficacy of kakkonto against myasthenia

medication of Mytelase was also used in combination.

gravis.

During her visit a month later, she said her condition

hochuekkito

similarhad always worsened in the late afternoon.

prescriptions have been used for this disease. There

Previously, when she took a tablet of Mytelase in theare various views concerning how to interpret thislater afternoon, her drooping eyelids improved anddisease, and it cannot be simply attributed to theallowed to her to open her eyes wide, but her hands

lack of qi. However, while there is no denying theand legs remained weak. After taking kakkonto,

involvement of wind and dampness from the

however, she gained strength in her hands and legs

perspective of muscle paralysis, the loss of qi in theand she became able to get up freely on her own. Her

middle yang muscles is certainly a major factor.

appetite improved, and when she slept well, she

Conventionally,

andKakkonto is thought to produce an effect by

could also talk well. Her grip also improved. Thiswas because Mao (ephedra) had been increased to 4g.

addressing this condition.
Matsumoto recommends Hochuekkito combined

The patient did not come in for an examination for awith kakkonto for myasthenia gravis of the ocularwhile and simply took her medication at home,muscles.11)

because she felt well.
On January 6, 1968, she made a visit after 10

Case 1months of taking kakkonto, bringing with her her

Patient: 42-year-old female

child who had pediatric asthma. She looked so

First visit: April 1967

healthy, it was almost difficult to recognize her. She

The patient was extremely thin and lacked energy.

said she gained 4kg. She still takes a tablet of

Her face was completely devoid of expression. Three

Mytelase in the late afternoon, but where before

years ago, she came to have trouble moving her eyes,

taking kakkonto she had to support her chin withshe began to see double, her eyelids drooped, and she

her hand when drinking something and could not

choked when swallowing something. Air also leaked

take the lid off of a pot because her grip was weak,out from her nose and she could not talk. Moreover,

she has improved so much that she is now able toher hands and legs went slack so that she had

fully do the housework and even wash clothes.

difficulty walking, could not hold things in her hand

Domei Yakazu, The Journal of Traditional Sino-because her grip had weakened, and fell over fromJapanese Medicine, Vol. 7, No. 1, Special issue on

fatigue even when sitting.

“Kampo therapy for intractable diseases,” p. 130, 1986

She was diagnosed with myasthenia gravis at T
University Hospital and was recommended to have

25. Narcolepsy, post-psychotic depression (PPD), etc.

surgery of the thymus at K University Hospital. She

Kakkonto sometimes has the effect of improving

underwent the surgery but did not get better at all.

certain psychiatric symptoms such as “a fuzzy

She also received acupuncture therapy, but the effectsensation in the head” and lack of motivation.

was not apparent. An examination found severe

Focusing on this, Takahara used kakkonto on

14

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

Volume 9, Number 4 | Winter 2014

various mental disorders such as narcolepsy andthey decided to come to our clinic on the following

PPD and reports many cases in which kakkonto wasday.

effective.12) 13)

We do not perform polygraph tests at our clinic, but
we did perform a CT scan just in case. The result

Case 3: Narcolepsy

showed no abnormality, but judging from her

Patient: 1st year high school student, female

medical history, narcolepsy was suspected, so weHistory of present illness: In early November of theasked the patient about her condition in detail.

patient’s third year in junior high school, theAs expected, the following symptoms came to light.

patient had episodes such as when changing her

That is, the patient was suddenly hit by an

clothes for gym class when it was cold or before

intolerable

taking a test, where her entire body became slack

followed by a weakening of her entire bodyand felt paralyzed and she could not let out any(cataplexy), and at the same time she saw black

voice although she was consciously awake.

dots in front of her eyes (hypnagogic hallucination)

In mid-November, she fell to the floor after feelingand was overcome by a feeling of paralysis. Aftersleepy and lost her strength. She finally came tothat, she cannot recollect anything, as she had

after being shaken and nudged in the shoulders andfallenface. In December, she had cataplexy spells two towitnessed this say she had no convulsive attacks.

three times almost every day. These spells

From the time she was taken to the infirmary, it

continued thereafter

fell

took about 25 minutes for her to completely awaken,

unconscious and did not awaken even when people

become consciously aware of the situation andtried to shake her awake. She was rushed to thestand up. There were times when she came to in as

pediatric department of a public hospital in an

short as 5 or 10 minutes.

ambulance. On this occasion, she eventually came

Judging by her clinical symptoms, she wasto on her own in around 10 minutes and became

diagnosed

conscious of her surroundings, but her head felt

administered kakkonto extract granules 6g/day

fuzzy. She received an examination but neither

regardless of her “pattern” as defined by Kampo. On

electroencephalography nor CT scan found any

the day after her first visit, she suddenly felt her

abnormality. After this, there were three times

entire body weaken after gym class and sank to thewhen the patient developed a headache and felt sick,floor in a sitting position, but it was a light spell andrested a while in the infirmary and left school early.

she was able to respond when spoken to. Within the

Soon after beginning high school, the patient began

week of beginning the kakkonto medication, she

to get sleepy spells two to three times a day. This

began to feel more refreshed and gained confidence.

occurred six to seven times. In Mid-April, when

In September, she quit taking the kakkonto extract

running a marathon at school, her legs suddenly

granules.

felt heavy and she gradually became so sleepy thathypnagogic hallucination and sleep paralysis andshe lost consciousness and fell to the ground. Oneven became unconscious, but she came to in two tothis occasion, she was accompanied by her motherthree minutes, and did not trouble anyone. She

to the gynecology department of a different public

therefore resumed her medication, and by Octoberhospital, but she was told there was no abnormality,(five months after her first visit), she became

gynecology-wise. The mother and patient were nothealthy enough to take part in study presentations

convinced and gradually became so worried that

and

until

one

day

she

feeling

asleepsportsofsleepiness(sleep

with

Twice

day

paralysis).

typicalsheat(narcolepsy),

Peoplenarcolepsy,

experienced

schoolwithout

and

who

was

cataplexy,suffering

narcolepsy.

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

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Volume 9, Number 4 | Winter 2014

According to her mother, the patient continued her

27. Stress urinary incontinence

studies in good health thereafter and went on to

Shin et al. continuously administered kakkonto

university. I learned then that the patient’s

7.5g/day (to be taken in three portions) to 12 womengrandfather had this type of disease.

(average age 58.6) who complained of stress urinary

Akira Takahara, Psychiatric efficacy of kakkonto,

Oriental Medicine, Vol. 23, No. 1, 1995

incontinence after menopause, and report that theincontinence stopped after around two weeks in 11of the 12 women. Detailed questions to the women
revealed

26. Enuresis
In a round-table discussion in the Journal of

that

their

incontinence

disappeared

immediately after taking kakkonto.15)

Kampo Medicine Vol. 4 No. 4, Tokuji Yoshimura
reports that kakkonto is effective against enuresis

References

based on his experience in administering kakkonto

1)

Kobe Chuigaku Kenkyukai: Kampo shohou

to children whose enuresis is aggravated when theykaisetsu

catch a cold and successfully relieving both their coldprescriptions), p. 337, Ishiyaku Publishing,and enuresis.14) This was also verified in a follow-up

1982.

test performed by Yakazu et al. In his report,

2)

Keisetsu(interpretations

Otsuka,Domei

ofYakazu,Kampo

TotaroShimizu: Kampo shinryo iten (dictionary of

Yoshimura also notes that Maoto is just as effective.

Kampo medicine), p. 270, Nanzando, 1969.
Case 1: Enuresis

3)

Hideo Asagiri: Experience in kakkonto usage

Patient: 12-year-old girl. She had asthma since shefor postpartum milk secretion, Kampo shinryo

was small, and tended to have allergies. She no(Kampo examination)、Vol. 7, No. 2, pp. 47-79,

experienced asthma attacks, but she was told she

1988.

has allergic rhinitis, and had a tendency to sneeze.

4)

Shogo Ishino et al.: Effects of kakkonto on milk

Her mother said the girl began to wet her bed sincesecretion, Journal of Kampo Medicine, Vol. 43,

two years ago. To prevent this, the mother would try

No. 1, pp. 26-32, 1996.

to wake her up to go to the bathroom, but she would

5)

Keisetsu

Otsuka,Domei

Yakazu,Totaroremain half asleep and would not wake up. She

Shimizu: Kampo shinryo iten (dictionary oftended to urinate frequently also during the daytime

Kampo medicine), p. 271, Nanzando, 1969.

and would to go the bathroom almost every two

6)

Yoshiaki Sato et al.: Efficacy of administering

hours. She had severe stiffness in her shoulders andkakkonto for milk stagnation mastitis and thenape.

transfer of its components to breastmilk,

Focusing on the fact that the patient had stiff

kakkonto extract powder 1.5g two times. After a

Recent Progress of Kampo Medicine in
Obstetrics and Gynecology, No. 1, p. 77, 1984.
Shiro Hosono, Kakkonto Kampo igaku jikkou(Kakkonto—Lectures on Kampo medicine), pp.

month, she became much better, and was able to go

32-91, Sogensha, 1982.

shoulders and nape and would not fully wake upeven when her mother tried to wake her, I gave her

7)

to the bathroom alone. She thus no longer wets her

8)

Nanyo Hara: Sokeiteiijishogen

bed. Her shoulders, however, still remain stiff.

9)

Nanyo Hara: Sokeiteiijishogen

Domei Yakazu, Kampo chiryo hyakuwa (hundred

10) Yoshiharu

stories of Kampo therapy) Series 3, p. 126, Ido-no-

kakkonto

Nippon-Sha, 1971

accompanying liver cirrhosis, Science of Kampo

Motooagainstetal.:Significancegynecomastia

Medicine, Vol. 20, No. 2, pp. 15-17, 1996.

16

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

of

pain

Volume 9, Number 4 | Winter 201411) KatsuhikoMatsumoto:

Oriental

medicine

therapy for intractable diseases, Study on

Chinese Medicine, June 1985 edition, pp. 182189, 1985.
12) AkiraTakahara:

Psychiatricefficacyofkakkonto, Oriental Medicine, Vol. 23, No. 1, pp.
26-32, 1995
13) Akira Takahara: The Kampo, Special edition on
the Kampo Award, pp. 24-31, 1984.
14) Tokuji Yoshimura: Journal of Kampo Medicine
discussion on gynecological diseases, Vol. 4, No.
4, p. 26, 1957.
15) Sumio Shin et al: Significance of kakkonto forstress urinary incontinence, Collection ofsummaries of presentations from the 47th
annual meeting of the Japan Society for
Oriental Medicine, p. 126, 1996.

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

17

Volume 9, Number 4 | Winter 2014

Clinical Report 1 (Acupuncture)
A Case of Acute Low Back Pain that Developed in a
Severely Stressed 58-year-old Woman
Motoko Otsuka
Acupuncture and Moxibustion Care Unit
East Asian Traditional Medicine
Ehime Prefectural Central Hospitalincreased before the background of her chiefcomplaint and on October 31 she quit her job.
Overall blood stagnation developed superimposed ontheReporting the good outcome we obtained bytreating GV11 in a patient in whom acute low backpain developed under stress.

pain, heaviness); Ⓑ heaviness from the neck down
to the handunderstressful working conditions at the workplacebecame a burden and conceivably led to the onset of○ Analysis of the point locations
Congestions: neck,
Fine floating vessels, GV14, GV4, GV3

Pressure hypersensitive indurations: BL10, GB21,
BL43, BL14, right BL18, BL27, BL58, LI11, ST36,
GB34, stuffiness and rigidity below the heart○ Treatment○ Present illness:

Moxibustion points: GV11, LI11, ST36, SP6

low back pain (centrally) of

Micropuncturing: GV12, GV4, GV3, BL43, BL18

unknown origin developed. In a local orthopedic

Kampo medicine: Keikyososooushinbuto 桂姜草棗

clinic a "lumbar spondylolisthesis" was diagnosed
and healed in 2-3 days. Later, the condition Ⓑ
developed also of unknown cause. The patient wasdiagnosed with "(mild) cervical herniated disk" andtreated with hot packs and traction, which remained
ineffective. On November 7th the symptom (Ⓐ, left)developed, when the patient tried to carry somebaggage. On November 8th she received massage
treatment decreasing the pain scale score 10→7 andlater on November 11 she visited our clinic in thatcondition.
she

黄辛附湯 (decoction)○ CourseⒶ

improved day by day and regarding Ⓑ

afavorable course was observed too, so that by the
fourth treatment session the Kampo medicine wasdiscontinued. From the sixth treatment session theintervals were changed from 4 to 6 weeks.
[Discussion, conclusions]
In our clinic we use GV11 based on a restored copyof the "Hall of Brilliance Canon (Ming Tang Jiu
Jing)" as our main therapy to treat health problems○ Chronological analysis
sufferedfrom

repeated

tonsillitis and was very short-tempered. Since her
menarche she experienced menstrual pain (low backpain) and approximately from the age of 20
symptoms like shoulder stiffness and constipation
also appeared. At the age of 28 she had a trafficof the shoulders, abdomen and back originating frommental or emotional disorders. On this occasion we
added treatment of GV11 to the local treatment for
the low back pain that developed before abackground of mental burden and think, it probably
led to an interruption of a vicious circle.

accident causing hip joint and pubic bone fracturesand later led to occasional low back pain attacks. By
the age of 45 menopause was artificially induced
through a surgery for a myoma of the uterus.

18

constitution,(GV11 maximum), BL52, BL57, CV9, SP6, KI3○ Chief complaint: Ⓐ low back pain (sort of pullingchildhooddetoxication

Pressure hypersensitive depressions: GV12 – GV10

[Patient] 58-year old female

Since

original

her condition.

[Purpose]

In August X-4 Ⓐ

In X-4 the stress with her superiors at work

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

Volume 9, Number 4 | Winter 2014

Clinical Report 2 (Kampo Medicine)
Case Example of a Family whose Family Relations
Improved by Administering Kampo Medicine to a Sisterand Brother who were in a State of Rivalry

Hideaki Yamaguchi
Tosei General HospitalPresent illness: Nine months ago (autumn), thepatient’s wheezing worsened when he came downwith a fever, and was admitted to hospital.
Thereafter, he became prone to coughing, and visitedthe hospital twice a month for his wheezing. He wasreceiving treatment by inhalation and drip infusion,
but was coughing through half the month. Yet, no

Introduction
Families are shaped by the relationships of theirmembers. The relationship between mother andchildren, in particular, tends to be mutually
influenced by them both, so in cases where a childdevelops a mental or psychological disorder, otherfamily members are also included within the scopeof treatment at times, with a focus on mother-childand sibling relationships. Kampo therapy is suited
to this type of case, since Kampo medicine canflexibly address various pathological conditions.
Below is a case example of a family in which a sisterand brother were the subjects of therapy.

tic disorder
Chief complaint: Frequent blinking, coughing, biting
nails
History of present illness: The patient was diagnosed
with bronchial asthma at the age of 2, and has
controlled it with a leukotriene receptor antagonist
and inhaled steroid. From around the time her
younger brother was born two years ago, her chiefcomplaint appeared, and she tended to becomeandcausedtempertantrums.

behavior

has

becomeparticularly

Recently, he also began to experience night-crying.
He is sensitive to heat and sweats profusely, but tires
easily and tends to want to sleep.
Diagnosis: Lung defense qi deficiency, emotional
weakness
Mother: She was worried about her second child’s
wheezing aggravating, because the hospital was far
from home. Exhausted from raising the children, sheand the children now live at her parents’ house.
Treatment & progress

Case 1: Sister aged 5 years and 11 months; chronic

agitated

apparent abnormalities were found in an allergy test.

Suchconspicuousrecently. At the same time, however, the patient is aworrier and timid. She has also experienced bouts ofnight-crying.
Diagnosis: Liver qi stagnation turning into fire,emotional weakness

Case 1: Sister
Administered yokukansan (before breakfast andsupper), and kanbakudaisoto (before supper). Firstof all, the patient no longer became frightened, her
tic symptoms gradually improved, and in three
weeks her coughing practically disappeared.
Case 2: Brother
Administered ogikenchuto (before breakfast andsupper) and kanbakudaisoto (before sleep). The
patient’s

symptoms

improved

dramatically(according to the mother). He began to sleep soundly
without any night-crying, and in ten days, hiscoughing disappeared.
After 4 weeks of treatment, the mother, sister andbrother

returned

home

to

their

father.

The

treatment is planned to be continued there.

Case 2: Brother aged 1 year and 11 months,
recurrent bronchitis
Chief complaint: Susceptible to colds, frequent
coughing and wheezing
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 9, Number 4 | Winter 2014

Family structure

Grandfather

FatherGrandmother

Mother(child-raising anxiety)

Sister (5 years old)

Brother (1 year old)
Rivalry(Recurrent bronchitis)(Tic disorder)

Diagnosis: Liver qi stagnation turning
into fire, emotional weakness

Lung defense qi deficiency,
Emotional weakness

Treatment: Yokukansan,
Kanbakudaisoto

Ogikenchuto,
Kanbakudaisoto

Discussion:
The problems in this family were the mother’sanxiety

about

the

brother’s

chronic

airwayinflammation and the sister-brother rivalry overtheir mother. The sister could not satisfy her
dependency on her mother, and the anxiety andstrain stemming from that developed into tic
symptoms. The brother displayed lower respiratory
tract

symptoms

andnight-crying

that

was

considered a manifestation of his anxiety. Such
conditions of the sister and brother exacerbated themother’s anxiety and drove her to exhaustion, suchthat she was forced to return to her parents’ house.
The father was too busy to sufficiently intervene.
To address this negative spiral, it was necessary toinclude multiple family members in the scope oftreatment. The sister was given yokukansan andkanbakudaisoto as psychotropic drugs. The brotherwas given Kanbakudaisoto as a psychotropic drugand ogikenchuto as a drug for improving his chronic
inflammation. As a result, both sister and brothershowed prompt improvement, and the mother’sanxiety was also mitigated, such that the family’sfamily relations improved significantly.

20

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

Volume 9, Number 4 | Winter 2014

Conference Report
17th International Congress of Oriental Medicine
Hiromichi Yasui
Japan Institute of TCM Research

The 17th International Congress of Oriental
Medicine (17thICOM) was held over three days from
November 1, 2014 at the NTUH International
Convention Center in Taipei, Taiwan.
It turned out to be a great success owing to thetremendous efforts of the preparatory committee
working as one under the leadership of Chairman YiTsau Huang and Chairman Yong-Cheng He. An
impressive drum performance heralded the opening
ceremony, which featured greetings by many people
who support the congress, followed by a slidepresentation on the achievements of Dr. Yen Kun-Ying,
the eldest member of ISOM.
Dr. Yen Kun-Ying, who is turning 90 this year, is aprominent figure in the Pharmaceutical Society of
Taiwan. Because he has a long history of research inJapan, he has strong affection for Japanese Kampo
medicine, and has spared no effort to provide his
assistance to us Kampo practitioners in Japan. We all
wish him continued health and success for many more
years to come.
The recent conference attracted the attendance of a
total of 587 people from nine countries, including not
only Japan, Taiwan and South Korea, but also Austria,
Germany, the United States, Russia, Hong Kong andChina (official announcement).
Country

No. of people

No. of locallyregistered people

Total

Taiwan

334

11

345

Japan

111

20

131

South Korea

91

1

92

Austria101Germany

1

0

1

USA

7

0

7

Russia3

03Hong Kong

3

2

5

China

2

0

2

Total

553

34

587

There were 131 participants from Japan, the largest
number ever compared to previous conferences. ManyJapanese researchers were invited to give lectures, twosessions were offered that were related to Japan, anda wide range of studies were also featured in the poster
session.
Of the two sessions related to Japan, the session on“traditional medicine and culture” provided a
description of the characteristics of Japanese Kampo
medicine and Japanese acupuncture in an extremely
easy-to-understand manner in English, and allowed
many people to actually touch a simulation model andgain hands-on verification experience in abdominal
examination. In the session on “case examples inJapan,” four speakers presented case examples in theirfield of expertise, and engaged the floor in active
question-and-answer discussions.

Dr. Nakata, Chairman of ISOM, giving a speechat the opening ceremony

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

21

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