KAIM
T
Thhee JJoouurrnnaall ooffK
Kaammppoo,, A
Accuuppuunnccttuurree aanndd IInntteeggrraattiivvee M
Meeddiicciinnee
INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 1, Number 4 ･ Winter 2006

Foreword

The Melancholy of Acupuncture Researchers
Hiroshi Tsukayama

Japanese Acupuncture - Current Research

Clinical Practice and Studies on Acupuncture for Lumbar Disc Herniation in Japan
Hitoshi Yamashita, Shoko Masuyama, Tomoko Kurasawa, Hiroshi Tsukayama

Kampo Medicine - Current Research

Effects of Goreisan in Pediatric Acute Gastroenteritis
Hiromichi Yasui

Clinical Report 1 (Japan)

Acupuncture for Cervical Dystonia
Makiko Tani, Aya Takada, Hironori Inoue, Toshiaki Suzuki, Ikuro Wakayama, Sohei Yoshida and Toshihiko Kinoshita

Clinical Report 2 (Japan)

Two Cases for which Boiogito (Fang-Yi-Huang-Qi-Tang,防已黄耆湯) was effective for Rheumatoid Arthritis
Kazuhiko Nagasaka

Case Series

Kampo Treatment for Rheumatoid Arthritis
Kazuhiko Nagasaka

Clinical Report (Europe)

Case Report: Chronic Recurrent Diarrhea
Ulrich Eberhard

Introduction of Japanese Acupuncture
Considering the Therapist’s Hand (4)Shuichi Katai

Medical History in Japan

Japanese Acupuncture and Moxibustion under the Rule of GHQ after World War II (4)Takako Okutsu

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

The Journal of
Kampo, Acupuncture andIntegrative Medicine(KAIM)

TThhee JJoouurrnnaall ooff

K
Meeddiicciinnee
Kaammppoo,, A
Accuuppuunnccttuurree aanndd IInntteeggrraattiivvee M
Volume 1, Number 4 ･ Winter 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

TA B L E O F C O N T E N T S
1 Foreword
The Melancholy of Acupuncture Researchers

Hiroshi Tsukayama

2 Japanese Acupuncture - Current Research
Clinical Practice and Studies on Acupuncture for Lumbar Disc Herniation in Japan
Hitoshi Yamashita, Shoko Masuyama, Tomoko Kurasawa and Hiroshi Tsukayama

CA, U.S.A.

ASSOCIATE EDITORS
Shuichi Katai
Ibaraki-ken, Japan

7 Kampo Medicine - Current Research
Effects of Goreisan in Pediatric Acute Gastroenteritis
Hiromichi Yasui

Hiromichi Yasui
Tokyo, JapanEDITORIAL STAFF

Akira Shimaoka
Hiroshi Tsukayama
Hitoshi Yamashita
Naoya Ono
Noboru Mitsuhata
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

11 Clinical Report 1 (Japan)
Acupuncture for Cervical Dystonia
Makiko Tani, Aya Takada, Hironori Inoue, Toshiaki Suzuki, Ikuro Wakayama, Sohei Yoshida andToshihiko Kinoshita

18 Clinical Report 2 (Japan)
Two Cases for which Boiogito (Fang-Yi-Huang-Qi-Tang, 防已黄耆湯) was effective forRheumatoid Arthritis
Kazuhiko Nagasaka
20 Case Series
Kampo Treatment for Rheumatoid Arthritis

Kazuhiko Nagasaka

24 Clinical Report (Europe)
Case Report: Chronic Recurrent Diarrhea

Ulrich Eberhard

25 Introduction of Japanese Acupuncture
Considering the Therapist’s Hand (4)Shuichi Katai

28 Medical History in Japan
Japanese Acupuncture and Moxibustion under the Rule of GHQ after World War II (4)Shuji Goto
International Institute of Health andHuman Services, Berkeley

Takako Okutsu

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 2 | Summer 2006

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

Volume 1, Number 4 | Winter 2006

Foreword
The Melancholy of Acupuncture Researchers
In the context of modern medicine, acupuncture is often placed in the same category as
superstitions or supernatural phenomenai). The statement of the National Council Against Health
Fraudi) (NCAHF) is a typical sample of the skeptical attitude to acupuncture. One of the majorcomplaints has been that quality of clinical trials of acupuncture have been poor for proof of
specific effects of acupuncture.
In Japan there has been recognition since the early 1960s, the importance of randomized
controlled trials (RCTs) to demonstrate the effectiveness of acupuncture. Despite the early
implementation of RCT, the goal of determining specific effects has not been actively pursued.
Clinical trials began somewhat later in the West, but focused on specific effects from the
beginning of Acupuncture RCT.
Importance of randomization was recognized by both Western and Japanese researchers.
However, Western researchers developed several types of sham acupuncture method as aself-evident placebo equivalent. The suitability of the methods used is an issue that should be
addressed separately. This meant that no major adjustment of the clinical pharmacologicalresearch model was required fundamentally. Since 1975, it has been possible in those countries totest propositions regarding the specific effect of acupuncture therapy within a clinical trial
context.
In drug studies, it is relatively easy to conceal the active ingredient that provides the drug's
pharmacological effects, and to create a placebo tablet that is completely indistinguishable fromthe active drug. This is very different from the situation facing non-pharmacologic methods of
medical intervention.
There is a dogmatic view that the methodology of clinical pharmacology should be applied
to non-pharmacologic interventions as well. But it seemed that this idea be accepted a priori
without exposing to the skeptical scrutiny that was being applied to acupuncture itself. It is
impossible to gain an accurate understanding of acupuncture and moxibustion while ignoring
the physical interaction between practitioner and patient. This is particularly a problem forJapanese acupuncture and moxibustion, in which palpation play important role on diagnosis..
It may be obvious to anyone that acupuncture treatment is realized through a process ofphysical interaction between the hands of a practitioner and the patient’s skin. The concepts ofJapanese acupuncture and moxibustion have been widely discussed in Europe and America inrecent years, but Japanese acupuncture is not simply characterized by the use of finer needles
and the application of lower levels of stimulus. Emphatically, the process also builds on thephysical contact between the practitioner and the patient. We need consideration of such
relationship in order to understand concepts and practices of Japanese acupuncture.
i. National Council Against Health Fraud. Acupuncture: the position paper of the National Council Against Health Fraud. Clin J Pain.
1991:7(2):162-6

Hiroshi Tsukayama
Center for Integrative Medicine
Tsukuba University of Technology
Tsukuba, JapanThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Japanese Acupuncture - Current Research
Clinical Practice and Studies on Acupuncture for Lumbar
Disc Herniation in Japan

Hitoshi Yamashita1), Shoko Masuyama1)
Tomoko Kurasawa2), Hiroshi Tsukayama2)
1) Department of Acupuncture, Morinomiya
University of Medical Sciences, Osaka, Japan
2) Center for Integrative Medicine, Tsukuba
University of Technology, Tsukuba, Japan

1. Introduction
Our research showed that in Japan theannual utilization rate of acupuncture treatment
was 6.1%, whereas the life time utilization was32%1). Data did not show what percentage ofpatients with lumbar disc herniation (LDH) were
included among these users. It is conceivable thatsince musculoskeletal problems are generally
motivational to receive acupuncture treatment2),
the acupuncture treatment may often have beenused for this disease. In fact, we have often
performed acupuncture treatment for LDH
patients classified as within conservative
treatment.
As with
the generalization of the
Evidence-Based-Medicine (EBM) in the present
health-care arena, acupuncture treatment is no
exception. In recent years, randomized controlled
trials (RCT) have increasingly been conducted inJapan to demonstrate clinical evidence for
effectiveness and safety of acupuncture
treatments3). As for the acupuncture treatment
specific for LDH patients, sufficient clinicalstudies have not been carried out in Japan. This
report provides the summarization of the current
status of clinical studies in Japan on the use ofacupuncture for LDH and explanation of thedetailed methods of our acupuncture treatments.
Acupuncture is not a direct approach to LDH,a morphological abnormality. Rather, it is atreatment for pain in the low back or lower
extremities caused by such abnormality.
Therefore, this report presents, in the strict sense,2“acupuncture treatment for lumbar radiculopathyor sciatica due to LDH”.
2. Case series studies on acupuncture for LDH in
Japan
Although only a few RCT reports have been
published so far on acupuncture treatment onpatients with LDH4,5), RCT’s in the relevant area
have yet to be carried out in Japan. However, inJapan there are three case series studies in whichchanges in subjective symptoms and clinicalfindings before and after the acupuncture
treatment on patients with LDH were compared.
The first was the analysis performed by
Maruyama6) of 47 cases (male 29, female 18, mean
age 34.2). Acupoints were selected from BL40,
BL54, BL36, BL57, BL60, GB34, BL23, Ex36
(Huatuojiaji), Ah-shi points and others andelectroacupuncture (1-5Hz, 15-20 min per session,
2-4 times per week) were given. The treatment
results were classified in 4 grades: Excellent、Good、Fair、Poor. Fair and above or a certain
degree of improvement was observed with a rateof 72% in the single acupuncture treatment groupand 83% in the combination group of acupuncture
and conservative therapy. Patients at a younger
age, or with a shorter duration of the disorder,
tended to show favorable results, whereas
patients with a longer duration of the disorder
had a tendency to show better results by the
combination therapy. Objective findings of thereport indicated a high rate of improvement in astraight leg raising (SLR) test and a low rate of
improvementin
sensory
disorderandabnormalities in deep tendon reflex.
The second was the analysis performed by
Yamashita et al.7) of the data on 22 cases (male 14,
female 8, mean age 37. accumulated at Tsukuba
College of Technology Clinic (current Center for
Integrative Medicine, Tsukuba University ofTechnology). Points used were BL25 on theaffected side, 2cm lateral to BL25, BL26, center of

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

Volume 1, Number 4 | Winter 2006

buttocks, BL37, GB34, and electroacupuncture(1Hz, 15 minutes) and manual needling were
given. The course after the acupuncture
treatment showed a 68% improvement. In thethird week improvement was assessed with theJapanese Orthopaedic Association Score (JOA
Score)8): subjective symptoms 39%、clinical signs
31% 、 activity of daily living (ADL) 52%,
SLR-positive angle 75.5° from 59.3°, pain score
3.8 from 10 of an initial level (all are averagevalues). Patients who already had a long historyof the disorder at the initial treatment, or thepatients who had not been responsive to nerve
blocking, tended not to show favorable treatment
results.
The third was the analysis by Nakazawa9) on
29 cases (male 14, female 15, mean age 54.8),
from which data were gathered at the
Department of Oriental Medicine, Saitama
Medical School. The needling was performed in
the proximal areas of nerve root, facet joint, upper
buttocks,
andpiriform
muscleandelectroacupuncture or needle retention method
was applied. Assessments were made on the basisof pain score, visual analogue scale, sensory andmanual muscle test, pain in motion, and SLR test.
The rate of improvement after the treatment was
82.7% and the patients who reportedly had
weakness in the lower extremities or developed
the sickness after a traffic accident remained
unchanged.
The above three case series studies reveal thefollowing characteristics in the acupuncture
treatment on LDH:
1) About 70-80% of the patients showed
improvement.
2) Patients with shorter duration of the disordertended to be easily healed.
3) Younger patients showed better results.
4) Improvements in deep tendon reflex or muscle
weakness were slower than that in subjective
symptoms or ADL.

These tendencies however, may not be limited
to “the cases of acupuncture treatment” and will
generally be seen in the physical treatment orconservative treatment. Case series study is not amethod of study to prove the specific effects ofacupunctureandmoxibustion
treatment(whether getting better due to acupuncture andmoxibustion). It should be noted that the casesthat showed improvement due to natural courseor placebo effect were included. In the future,
pragmatic RCTs10) that compare effects ofdifferent treatments such as traction and drugs
should be conducted.
3. Case reports11),13)
Case 1
Age 26, Male, Height 172cm, Weight 70kg,
Pain in right lumbar and lower extremities
History: The patient was a postgraduate
student who would sit on a chair while typing his
thesis on his computer for 5-6 hours every day
before the onset. Six days ago when he sneezed ina semi-crouching position, pain in the rightlumbar and lower extremities and a sensation of
numbness appeared immediately. He was given
transcutaneous electrical nerve stimulation,
traction, and medication by his neighboring
physician(orthopedic
surgery)
andwasinstructed to wear a corset. Although the pain
was slightly relieved, dull pain and numbness
feeling remained and his first visit was made witha desire for the treatment of acupuncture andmoxibustion. In his daily life, he could neither
drive nor keep sitting on a chair for long hours
due to the pain.
Findings: In keeping the standing position /sitting position, dull pain and numbness in thelateral surface of the right lumbar / buttock,posterior and lateral surface of the right leg
became more intense. Neuralgic scoliosis wasobserved. SLR was 60˚(＋) in the right, 90˚(－) inthe left. Manual muscle testing (MMT)：Right

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Volume 1, Number 4 | Winter 2006

long extensor muscle of thumb 4、left 5. Patellar
tendon reflex (PTR) and Achilles tendon reflex(ATR) were normal without difference between
the right and left. Cutaneous sensory perception:
Hypalgia was observed in the region from thelateral surface of the right leg to the lateralsurface of the right foot (S1 region). Tenderness
was prominent in the bilateral BL23 and theright BL25.
Examination: MRI examination revealed
posterolateral lumbar disc herniation between
L4/5.
Treatment and course:
day),
Until
the
third
visit
(5th
electroacupuncture (1Hz 15 min.) was continued
on both sides of BL23 and BL25 with the needleof 60mm No. 25. After this treatment, the patient
could have almost a full day of relief. However,since the analgesic effect did not last long, thelevel of the tenderness was re-assessed on the 4th
visit or the 8th day and electroacupuncture (1Hz
15 minutes) was given in the 4 acupoints
proximal to the right BL25 where tenderness wasmost pronounced. After this treatment, the pain
subsided and only the sensation of numbness wasleft. On the 5th visit, or the 11th day, the neuralgic
scoliosis disappeared. Numbness in the footregion still existed so that the treatment wascontinued once a week on average. On the 14th
visit, or the third month, the condition returned
nearly to the one before the episode. Then thetreatment was discontinued.
Comments: Pain was relieved right after
electroacupuncture was practiced in the point of
maximum level of tenderness proximal to thesurrounding of the right BL25. Since thisexperience, I have sensitively been trying to findtenderness points surrounding BL25 in lumbar
radiculopathy cases also in an attempt to test
repeatability. I have the impression that in casetenderness is prominent at the proximity of BL25,
especially at the location slightly outward, and4

the tenderness is diffused upon pressure.
Needling into these points immediately provides
an analgesic effect, although it depends on cases.
Case 2
Age 55, Male, Height 165cm, Weight 79kg,
Pain in the left lumbar and lower extremities
History: For two weeks the patientfelt

lumbar pain without any trigger. Poultices
relieved the pain gradually. However, five days
ago, a tense sensation and pain in the left lower
extremity were added. The patient visited theorthopedic surgery department of ageneralhospital, and was diagnosed with disc space
narrowing

by

plain

roentgenographyandprescribed transcutaneous anti-inflammatory gel.
However, since no improvements in the symptoms
were obtained, the patient visited our hospital tohavetreatment

moxibustion.

The

with

acupuncture

patient

had

been

and
using

medication for high blood pressure for theprevious 10 years. For much of his working time,
he was sitting or driving.
Findings: The patient had a tense sensationin the posterior surface of the left thigh and leg
and sometimes awoke during the night time due
to pain. No numbness sensation was present.
Standing on tiptoes: Right capable, left difficult.
Standing on heels: Right and left capable. SLR
test: Right 80˚ (－), left 70˚(＋). ATR: Right (＋),
left (－). PTR: Both right and left (＋). Cutaneous
sensory perception in the lower extremities: Pain
sense and tactile sense – right and left nodifference.

MRI

examination

identified

herniation posterolateral in L5/S1.

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

discVolume 1, Number 4 | Winter 2006

Treatment and course: Electroacupuncture (1Hz 10 min.) was performed with the stainlessneedle of 60mm No. 25 at the points connecting
left BL25 and left BL26 where tenderness wasmarked; upper and lower regions of the center ofthe left buttock; and left BL37 and BL57 (Figure).

Figure:Points frequently usedin electroacupuncture
for LDH

From the initial treatment the pain score was
reducedfrom 10 to 1.
Treatment wascontinued once a week. After three weeks, pain
disappeared although a heavy sensation
remained. Standing on the left toes was enabledon the 27th day from the initiation of thetreatment or about a month after the onset ofsymptoms in the lower extremities. At the time,
the left ATR, however, was (-). On the 40th day, i.e.
the 7th visit, the patient was instructed to reduceweight and the treatment was completed.
Comments: This case can be considered as S1
radiculopathy due to LDH. Electroacupuncture at
the acupoints of the bladder meridian or thosealong with the distribution of the sciatic nerve
remarkably reduced pain. However, recovery ofobjective findings such as muscle strength(standing on toes) and ATR was slow compared tosubjective symptoms. This tendency will be thecommon course in treating radiculopathy.

Conclusions
Currently, sufficient volumes of clinicalevidence of acupuncture treatment for LDH
patients have not been presented. Evidence
confined to case series studies suggest that
acupuncture treatment can be applied at least as
an analgesic means for lumbar radiculopathy. We
have the impression that as the above two cases
typically demonstrated, acupuncture treatment ischaracterized by an analgesic effect that lasts fora certain period of time immediately after thetreatment. Although the action of pain relief does
not necessarily mean a cure of lumbar
radiculopathy, the characteristic of pain relief
effect right after the treatment merits clinicalattention when compared to other conservative
treatments. Judging from case series studies
conducted so far and case reports released, there
are sufficient reasons that more RCTs on
acupuncture for radiculopathy due to LDH need
to be conducted in Japan.
Reference
1. Yamashita H, Tsukayama H. Nippon no Seijin
Shinkyu Juryo-sha ni kansuru Zenkoku Kibo
Denwa Chosa 2005, J Jpn Soc Acupunct
Moxibust 2006; 56: 503. [Japanese]
2. Yamashita H, Tsukayama H, Sugishita C.
Popularity of complementary and alternative
medicine in Japan: a telephone survey.
Complement Ther Med 2002; 10: 84-93.
3. Tsukayama H, Yamashita H. Systematic
review of clinical trials on acupuncture in theJapanese literature. Clin Acupunct Orient
Med 2002; 3: 105-113.
4. Duplan B, Cabanel G, Piton JL, Grauer JL,
Phelip X. Acupuncture et lombosaciatique à
la phase aiguë – Etude en double aveugle detrente cas. Sem Hop Paris 1983; 59:
3109-3114.

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

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Volume 1, Number 4 | Winter 2006

5.

Wang RR & Tronnier V. Effect of acupuncture
on pain management in patients before andafter lumbar disc protrusion surgery – arandomized control study. Am J Chin Med
2000; 28: 25-33.
6.
Maruyama T. Clinical observation ofacupuncture treatment for the ruptured
lumbar disc patient – clinical observation ofacupuncture treatment in orthopaedic
surgery, 2nd report. J Jpn Soc Acupunct
Moxibust 1984; 33: 375-382. [Japanese withEnglish abstract]
7. Yamashita H, Tsukayama H, Sakai T, Nishijo K,
Amagai H. Effects of acupuncture treatment
on lumbar radiculopathy – a case series study –.
J Lumbar Spine Disord 1997; 3: 27-32.
[Japanese with English abstract]8.
Japanese
Orthopaedic
Association.
Assessment of treatment for low back pain. J
Jpn Orthop Ass 1986; 60: 391-394. [Japanesewith English abstract]
9. Nakazawa M. Touka ni okeru Youtsui
Tsuikan-ban Hernia ni taisuru Hari-chiryo
Koka. Gendai Shinkyu Gaku 2006; 6: 39-44.
[Japanese]
10. MacPherson H. Acupuncture research:time to shift from theoretical to practicalquestions. J Altern Complement Med 2006;
12: 837-839.
11. Yamashita H, Tsukayama H, Sakai T, Nishijo K.
Clinicalstudy
onacupunctureandmoxibustion therapy for pain in the low backand the lower extremities (Introduction) – acase report of lumbar disc herniation anddiscussion about methodology –. J Jpn Soc
Acupunct Moxibust 1994; 44: 128. [Japanese]
12. Yamashita H, Tsukayama H, Mimura S,
Nishijo K. Youbu Tsuikan-ban Hernia no
Hari-chiryo to Rigaku Kensa no Kaishaku.
Rinsho Shinkyu (Clin Acupunct Moxibust)
1995; 10: 32-37. [Japanese]

6

13.

Yamashita H, Tsukayama H. Youtsui
Tsuikan-ban Hernia ni Taisuru Hari-chiryo
to Sono Rinsho Kenkyu no Genjo.
Ido-no-Nippon (Jpn J Acupunct ManualTher) 2005; 741: 30-35. [Japanese]

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Kampo Medicine - Current Research

Since the early-stage disease is characterized

Effects of Goreisan in Pediatric Acute Gastroenteritis
Hiromichi Yasui
Japan Institute of TCM Research

Pediatric acute gastroenteritis is a generalterm that describes disorders in infants and smallchildren presenting the sudden onset of acutevomiting and diarrhea as primary symptoms. The
condition is most commonly due to viral infection,but occasional instances of bacterial infection andfood poisoning are also known. Although the
majority of these viral infections in infants andchildren

have

been

attributed

torotaviruses, noroviruses have also recently beenfound to be extremely common. Infection typicallyfollows a single-peak or double-peak pattern fromwinter into spring each year.
Rotavirus-induced gastroenteritis ordinarily
presents with vomiting, followed by persistentwatery diarrhea, with a fever that lasts for 1 to 3
days. Vomiting and fever are common in the earlystage of the disease, and these symptoms, alongwith the subsequent diarrhea, normally resolve
without treatment within a week. However,dehydration can develop, and if left untreated canresult in death. In addition, even after the
diarrhea resolves, several weeks can be required
for full recovery of the intestinal mucosa, and thechild's condition may be complicated by thedevelopment of secondary lactose intolerance. Asa rule, gastroenteritis due to a norovirus ischaracterizedprimarily

byvomiting,

anddiarrhea is relatively mild.
This
stopping

condition
theproblematic, making it difficult to give either
medication or fluids by mouth. Recent findings
suggest that early treatment with goreisan

Introduction

small

primarily by vomiting, oral intake can beistreatedvomiting

andprimarily
bybytreating

dehydration. The usual treatment is domperidone(Nauzelin®) by oral administration or as asuppository, together with fluid supplementation.

(Wuling san, 五苓散) can provide dramatic relief
in many cases. These findings are supported byconsiderable research and numerous case reports.
This treatment is now becoming widely acceptedin Japan.
Research done to date is introduced below,
with a summary of the methodologies used.
Research To Date

Goreisan is referenced in the classic Chinese
texts"ShangHan

Lun(DiscussionofCold-induced Disorders )" and "Jin Gui Yao Lue(Essentials from the Golden Cabinet). Mention ismade in several chapters. Specifically, Article 74of the “Shang Han Lun” states that "... when thepatient is thirsty but vomits when he or she
drinks water, the condition is termed 'Water
Reverse'. The primary treatment is goreisan."This applies to pediatric acute gastroenteritis.
Such applications have been researched for over
50 years and are used primarily in the field of
pediatric medicine.
Like other Kampo medication, goreisan isgiven primarily by oral administration. However,
because it is often prescribed for patients who arevomiting, and because of the importance of rapid
effectiveness, physicians also frequently prepare
and administer goreisan in the form of a
suppository or enema in children.
In 1987, Morishima published research on theuse of goreisan Enemas in the treatment ofpediatric vomiting where oral administration wascomplicated by vomiting or other difficulties1).
This is the first reported case of the use ofgoreisanbya

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

route

other

than

oral
7

Volume 1, Number 4 | Winter 2006

administration. Subsequently, in 1995, Koga andphysiological saline solution, and administeredcolleagues investigated the administration of

the resulting liquid by catheter as an enema. If

goreisan extract in suppository form. Of 45

the enema stopped the vomiting, the treatment

patients between 1 and 8 years of age who had

was considered to be effective. If the vomiting

acute gastroenteritis or viral gastroenteritis

continued but lessened in severity, treatment was

related diarrhea and vomiting andconsideredpresented

somewhateffective,

and

if

the

the primary complaint of vomiting (28 boys andvomiting continued to the point of dehydration

18 girls), the researchers found that goreisanrequiring supplemental i.v. fluids, the treatment

suppositories were effective in 36 patients (78.3%)

was considered to be ineffective. The overalland somewhat effective in 6 patients (13.0%).

efficacy rate for the goreisan enema was 82.9%.

During the same period and season in the

Efficacy by age range was as follows: 80.0% at 0

following year, those researchers used Western

years of age, 80.0% for 1-year-olds, 85.7% for

medicaltreatment

without

goreisan.

They

2-year-olds, 82.1% for 4-year-olds, 86.5% formonitored patient progress during both years,

5-year-olds, 88.2% for 6-year-olds, 80.0% forand reported that, in children experiencing the

7-year-olds, and 83.3% for 8-year-olds. The

same extent of vomiting, intravenous fluid

goreisan enema was effective in all treatedsupport was required 6 times more frequently

children 9 years of age or above (the number of

without

goreisan than when goreisan was

included in the treatment regimen2).

patients in this age group was very small).
The researchers also investigated the efficacy

The use of goreisan as a suppository wasof goreisan in relation to the number of times thedeveloped out of necessity because of thechild had vomited before being brought to thedifficultyoralhospital. They found that better results were

medications to patients who are prone to vomiting.

achieved in cases where fewer vomitings had

The original instructions for the treatment of

occurred. Symptoms before coming to the hospital"Water Reverse" conditions called for the oral

were vomiting in 72 cases (34.1%), and vomiting

administration of extremely small amounts ofand fever in 87 cases (41.2%). Where fever wasgoreisan liquid very gradually, in order to control

noted, it was measured at 37.5°C to 38°C in 35.6%

vomiting. However, current research indicatesof patients, 38°C to 38.5°C in 56.3%, and more

that

than

of

internal

effectively

administering

administrationcanprovide38.5°C

in

8.0%

of

cases.

Additional

equivalent effectiveness. These two studies are

symptoms included abdominal pain in 32.2%, andthe pioneering works in the field.

upper respiratory inflammation such as coughand nasal drip in 11.8% of cases.

Ongoing Research(2) Study by Yoshida4)(1) Study by Fukutomi et al.3)
Fukutomi

andcolleagues

selected211

children age 6 months to 11 years (mean 3.7 ± 2.3
years) who came to the hospital with the primary
complaint of vomiting and in whom acutegastroenteritis was suspected. The researchers
dissolved goreisan extract 2.5 g in 20 mL of warm

8

Yoshida used goreisan suppositories, alreadywidely accepted for pediatric applications by
Kampo pediatric specialists in a double-blind
randomized clinical trial (DB-RCT). For thecomparator

drug

he

used

hochuekkito(Bu-Zhong-Yi-Qi-Tnag, 補中益気湯) suppositories
prepared by the same method. Targeted subjects

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

Volume 1, Number 4 | Winter 2006

were 34 children (21 boys and 13 girls age 1 to 9

gastroenteritis. The reports show an efficacy rate

years, mean age 3.9 years) who had vomited atof 75% to 84%, proof of the usefulness of goreisan

least 3 times in the 24-hour-period before comingin treating this condition.

to the hospital, and who presented with nausea

Administration was either by suppository or

and/or vomiting. The children were treated withby enema. Since the results showed no significant

numbered suppositories using the double-blind

difference between these two methods, medical

method. Thirty minutes after administration, thepractitioners should feel free to choose thechildren were given water to drink, and themethod that is easiest for them and for theireffectiveness of treatment was evaluated on thepatients.

basis of whether or not this induced nausea
and/or vomiting.
There

was

no

statisticallysignificant

difference between the goreisan suppositorygroup of 16 children (10 boys and 6 girls) and the
Hochu-ekki-to group of 18 children (11 boys and 7
girls) with regard to age, sex, number ofvomitings, presence or absence of diarrhea, orunderlying disease. Within the goreisan group,
treatment was effective in 12 patients (75%),
somewhat effective in 2 patients, and ineffectivein 2 patients. In the Hochu-ekki-to group,
treatment was effective in 5 patients (28%),
somewhat effective in 2 patients, and ineffectivein 11 patients.

using hochuekkito as the comparator drug. Thatprescription, which is classified as a Qi Tonicprescription, is not considered to be effective intreating

diarrhea

fromconditions

such

as

infectious enteritis. This study, performed withthe consent of patients and guardians, showedthat hochuekkito was ineffective while goreisan
was highly effective, as expected. The study by
Hashimoto used prescriptions of goreisan andsaireito.

Goreisanisincluded

withintheformulation of saireito as an ingredient, so thesetwo prescriptions were essentially the same.
Results for these two prescriptions were nearly
identical, as would be expected.

(3) Study by Hashimoto5)
Hashimoto

The Yoshida study (DB-RCT) was performed

treatedacute

gastroenteritis

Closing Remarks

patients with goreisan enema (297 children) or

As long as dehydration can be prevented,

saireito enema (263 children). The mean number

pediatric acute gastroenteritis, due to rotavirus orof days before coming to the hospital was 1.2±4.2

norovirus infection, is not a particularly serious

for the goreisan group and 1.0±1.0 for the saireito

condition.

However,mostpatients

improvegroup. The study showed no significant difference

quickly if given early treatment with goreisanin the efficacy rate between the two groups

extract in the form of a suppository or enema. Out(goreisan 84.8%, saireito 85.6%). There was alsoof consideration for the child's symptoms and theno significant difference in the efficacy rate withworry and strain on the parents, it is obviously

regard to patient age, fever, or number ofimportant to relieve this condition as soon as

vomitings.

possible.

These findings indicate that goreisan can behighlyeffective

againstpediatric

acute

Additionally, in the developing nations wheremodern medical procedures such as intravenous

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

9Volume 1, Number 4 | Winter 2006

drip might be unavailable, these prescriptions
andtreatment

methods

could

provideanextremely important tool for reducing mortality.
It is our hope that this research will prove usefulto those ends.
Reference
1) Morishima A: Effectiveness of goreisan enemain the treatment of pediatric vomiting. Kampo
medical treatment 6:30-32, 1987
2) Koga M, et al.: Effectiveness of goreisan
suppository in the treatment of pediatricvomiting. Journal of the Japan ResearchGroup for Oriental Medicine 11:30-32, 1995
3) Fukutomi O, Matsuo N, Teramoto T, et al.:Study of goreisan enema in the treatment ofpediatric vomiting that accompanies acutegastroenteritis. Japanese Journal of Pediatrics
53:967-970, 2000
4) Yoshida
M:
Effectivenessofgoreisansuppository in the treatment of pediatricvomiting. Toyo Igaku 28(3) 36-38, 2000
5) Hashimoto H: Comparison of goreisan andsaireito enemas in the treatment of vomiting that
accompanies pediatric viral gastroenteritis.
Kampo Igaku 25: 73-75, 2001

10

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

Volume 1, Number 4 | Winter 2006

Clinical Report 1 (Japan)
Acupuncture for Cervical Dystonia

Makiko Tani1), Aya Takada1), Hironori Inoue1),
Toshiaki Suzuki1), Ikuro Wakayama1), Sohei Yoshida1)
and Toshihiko Kinoshita2)
1)Research Center of Neurological Diseases
Kansai University of Health Sciences2)Department of Neuropsychiatry
Kansai Medical University

promising methods in patients with cervicaldystonia.
Key words: cervical dystonia, acupuncture,electromyography, primary and secondary
disorder, needle retention method, multiple
epidermis-penetrating needle stimulation
I. Introduction
Dystonia is a diverse set of movement

Abstract
We introduce our new concept for acupuncture
therapy in patients with cervical dystonia. To
achieve satisfactory therapeutic effects, we
divided the affected muscles into two groups
using clinical evaluations and EMG findings on
motion analysis, i.e., muscles affected by aprimary disorder and those by a secondary
disorder. Abnormal hypertonus or hypotonus of
the muscles and unsustained head movement aredesignated as the primary disorder. Muscle andskin shortening were designated as the secondary
disorder. We used the needle retaining method forprimary
disordersandmultiple
epidermis-penetrating needle stimulation on
tender spots for secondary disorders. Thus, weapplied these different and specific acupuncture
treatments to each group once a week. After 10
sessions of acupuncture treatment, clinicalexamination showed improvement in 72.9% of thepatients, EMG evaluations showed improvement
in all patients, and with no side effects in any
patients. The characteristics of patients who did
not respond to our acupuncture treatment wereas follows: 1) longer duration of disease, 2) neckposture demonstrating retrocollis, 3) severe
unsustained head movement, 4) longer intervalsof treatment of more than a week, and 5) treatedby several different methods of acupuncture
previous to our treatment.
These findings suggest that acupuncture
treatment using the needle retention method
combined with multiple epidermis-penetratingneedle stimulation is one of the most effective anddisorders characterized by involuntary muscle
contractions, which may cause twisting andrepetitive

musclemovements,

orabnormalpostures. Different classifications of dystonia
have been proposed based upon the following
criteria: distribution of affected body parts, age at
onset, cause, and genetic criteria. Cervicaldystonia is one of the most common subtypes ofdystonia.
Dystonia is the least understood movement
disorderassociateddysfunction;

with

basal

gangliaa

newly

proposed

however,hypothesis to explain this disorder involves
multiple levels of the nervous system: spinal cord,basal ganglia, thalamus, somato-sensory system,
sensorimotor integration, and motor cortical
function1).
Treatment options for dystonia include drug
treatment

andsurgicalprocedures.

Drugtreatment can be subdivided into the applicationof systemically active orally administered drugs
and local botulinum toxin injections, while
surgicaltreatment

may

peripheral

denervation

surgery.

treatedWeorinvolveselectivefunctional

patients

with

brain
cervical

dystonia using acupuncture, and followed theirprogress by clinical and electromyography (EMG)
evaluations2). In this report, we introduce our new
acupuncture method and provide clinical and
EMG evaluations of the outcome.
II. Materials and Methods
To

determine

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

the

most

appropriate
11Volume 1, Number 4 | Winter 2006

acupuncture method for each patient withcervical dystonia, clinical and EMG evaluations
were performed before acupuncture treatment.
Based on these clinical and EMG evaluations,acupuncture
regimens
weredeveloped
respectively for primary or secondary disorders ofcervical dystonia. Primary disorders indicate local
muscular hypertonus, hypotonus, or unsustained
head movement due to basal ganglia dysfunction
or other causes derived from the central nervous
system. Secondary disorders indicate muscle
and/or skin shortening due to primary disorders.
Written informed consent for our acupuncture
method was obtained from each patient.
1. Clinical evaluations
Clinical evaluation included the Tsui scale
modified by Mezaki et al.3), range of motion(ROM) of the neck and visual analogue scale.
① Modified Tsui scale (Table 1)

This scale has a maximal score of 34 and assesses
the abnormality of neck posture based on theamplitude of sustained movements of the neck,duration of sustained movements of the neck,axial
distortion,andunsustainedhead
movement.
② ROM of the neck
Active and passive ROM of the neck were tested
to clarify abnormal mobility, muscle tonus,
muscle and skin shortening, and muscle
weakness.

12③ Visual analogue scale
The visual analogue scale awarded values on ascale of 0 (normal) to 10 (worst).
2. EMG evaluation
EMG evaluation using Viking Ⅳ (NICOLET)
testedthe
EMG
activityofthesternocleidomastoid muscle (SCM), the trapezius
muscle and the splenius muscle (SPL) at rest andduring actions involving 5 different movements:
neck flexion, extension, right rotation, left
rotation, and shoulder elevation in the sitting
position. To determine whether shoulder andtrunk muscles were affected, EMG activities ofthese muscles, such as the abdominal muscle anderector spinae muscle, were also tested. In
addition, neck movement was tested using
displacement transducers, built-in reel type
(KYOWA) and dynamic strain amplifiers,
DPM-601A (KYOWA), simultaneously with EMG
records
The affected muscles with clinical evaluations
showing abnormal EMG findings indicatedprimary disorders, i.e., hypertonus muscles,
hypotonus muscles, or unsustained head
movement. Affected muscles with normal EMG
findings indicated secondary disorders, i.e.,
muscle shortening. Skin shortening is also an
important secondary disorder.
3. Acupuncture methods
The needle retention method on the meridian
points for primary disorders and multiple
epidermis-penetrating needle stimulation on
tender spots for secondary disorders were applied
once a week.
Fortheneedleretention
method,pre-sterilized disposable acupuncture needles (0.2mm in diameter, 50 mm in length) were inserted
ipsilaterally into Hegu (LI4) when the SCM
muscle was affected. Also, we selected ipsilateral
Waiguan (TE5) when the trapezius was affected

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

Volume 1, Number 4 | Winter 2006

and ipsilateral Houxi (SI3) when the SPL muscle
was affected. The selection of these acupoints was
based on the meridian concept of typical distal
acupoints on the meridians running through theaffected muscles. If the affected muscles included
the trunk flexor or extensor muscles,
pre-sterilized disposable acupuncture needles
were inserted into the ipsilateral Chongyang(ST42)
andipsilateral
Kunlun(BL60),
respectively. Acupuncture needles were inserted 5
mm in depth and left in place for 5 minutes todecrease and 10 minutes to increase muscle tonus.
A retained needle on Baihui (GV20) at the top of
the head was used for treating unsustained head
movement, with needles being 5 mm in depth andleft for 10 minutes. For muscle and skinshortening, ten points in the tender area wereselected and multiple epidermis-penetratingneedle stimulation was applied to decrease thetension in the tender area.
III. Results
1. Effect of acupuncture
Among 48 patients (26 males and 22 females,mean age of 40.8 years, mean disease duration of
44.8 months; range: 3- 252 months), clinicalexamination, especially by the modified Tsui scale,showed improvement in 35 patients (72.9 %), andno change or deterioration in 13 patients (27.1%)
after 10 sessions of acupuncture treatment. EMG
evaluation showed improvement in all patients
after the acupuncture treatment. There were noside effects in any of the patients.
The characteristics of patients who did not
respond to our acupuncture treatment were as
follows: 1) longer duration of disease, 2) neckposture demonstrating retrocollis, 3) severe
unsustained head movement, 4) more than 1
week intervals between acupuncture sessions,and 5) treated by several different methods ofacupuncture previous to our treatment.

2. Case studies
Patient 1 was a 24-year-old male. He had
previously received medication and MAB (muscle
afferent block) in other hospitals, but the neckposture remained unchanged and demonstrated
left rotation and left lateral flexion. The modified
Tsui score was 14. Clinical and EMG evaluations
revealed that the main problems were increased
muscle tonus in the left SPL and decreased
muscle tonus in the left SCM. EMG activity in theleft SCM during right neck rotation was weak(Figure 1, left). Acupuncture treatment was
initially performed once a week using theretaining needle method at the left Houxi (SI3) todecrease the tonus of the left SPL and left Hegu
(LI4) to increase the tonus of the left SCM.
Multiple
epidermis-penetratingneedlestimulation was employed in the left nuchal
region before the retention needle method wasapplied. After 25 sessions using these techniques,
the abnormal neck posture with left rotation andleft lateral flexion, and EMG findings during
right neck rotation were markedly improved andthe modified Tsui score recovered to 8 (Figure 1,
right).

Figure 1

Patient 2 was a 21- year-old female. She had
previously received medication and MAB in otherhospitals, but left rotation of the neck and left
elevation of the shoulder girdle were still
prominent. The modified Tsui score was 25 andthe visual analogue scale was 10. Clinical and
EMG evaluations revealed that the main
problems were increased muscle tonus in the

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

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Volume 1, Number 4 | Winter 2006

right SCM and the left SPL, and shortened skinat the left front region of the neck. EMG activities
in the right SCM and the left SPL increased
during right neck rotation (Figure 2, left).

30

Tsui modified scale

Visual analogue scale

25
20
15
10
5
0
Before acupuncture

Figure 2

Acupuncture

treatmentwasinitially

performed once a week using the needle
retention method at the right Hegu (LI4) andleft Houxi (SI3) to decrease the tonus of the
right

SCM

and

left

SPL.

Multiple

epidermis-penetrating needle stimulation was
employed at the front neck to stretch the skinbefore the needle retention method was applied.
After 10 sessions using these techniques, theabnormal neck posture was slightly improved to

After 10 sessions ofacupuncture treatment

After 40 sessions ofacupuncture treatment

Figure 3
Patient 3 was a 47-year-old male withretrocollis and extension of the trunk. Clinicaland EMG evaluations showed that the main
problems were increased tonus in the bilateraltrunk extensor muscles and the bilateral SCM,
and decreased tonus in bilateral trunk flexor
muscles during walking (Figure 4). Acupuncture
treatment was initially performed once a week
using the needle retention method at the bilateral
Kunlun (BL60) to decrease the tonus of thebilateral trunk extensor muscles and bilateral
Chongyang (ST42) to increase the tonus of thebilateral trunk flexor muscles. Neck and trunk
posture during walking were improved withalmost normal EMG data after 24 sessions ofacupuncture treatment (Figure 4).

22 in the modified Tsui score, and 7 on the visual
analogue scale. However, elevation and flexion of
the left shoulder girdle still remained, indicating
the involvement of the levator scapulae muscle
and pectoralis major. Therefore, the needle
retention method at the left Kunlun (BL60) to
decrease the tonus of the left levator scapulae
muscle and at the left Chongyang (ST42) todecrease the tonus of the left pectoralis major

Figure 4muscle was added to the regular acupuncture
regimen. The EMG data, modified Tsui score, andIV. Discussion

visual analogue scale showed further improvement

Treatment of cervical dystonia includes several
methods such as medication, injection of
botulinum toxin, surgery, and so on, but presently,
there are no specifically effective methods.
Although acupuncture is not widely accepted as acommon method to treat this intractable

after 40 sessions of acupuncture treatment (Figure
2, left and Figure 3).

14

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

Volume 1, Number 4 | Winter 2006

neurological disease, we applied acupuncture inpatients with cervical dystonia, and developed aunique method of acupuncture treatment. Our
method employs knowledge of both modern
medical technology and ancient Chinese/Japanesetraditional medicine, particularly that of
meridians.
The following is a summary of our uniqueacupuncture method:
1) Using clinical evaluations and EMG findings on
motion analysis, we divided affected muscles into
two groups, muscles affected by primary disorderand those by secondary disorder. Thereafter, weapplied different and specific acupuncture
methods to each group.
2) For muscles with primary disorder, we used theneedle retention method on distal acupoints along
the meridian running through the affected muscle.
For muscles with secondary disorder, multiple
epidermis-penetrating needle stimulation on
tender spots was applied. In our previous study2),
EMG findings during and after acupuncture using
our method were much improved compared toother acupuncture methods, indicating thesuperiority of our method.
3) In addition, we applied the same acupuncture
method to trunk muscles, and found that it wasvery important to improve trunk function for the
successful treatment of cervical dystonia. When we
assessed patients who had both cervical and trunk
postural abnormalities, we realized that correctionof the trunk muscles positively influenced thepostural abnormality of the neck.
4) We decided the depth of retained needles to be 5
mm since the potential in the primary sensory
area during acupuncture treatment with 5 mm
depth showed a significant change in thesomatosensory evoked potential (SEP).
5) We decided the standard duration of retainedneedle treatment to be 5 minutes to decrease
muscle tonus and 10 minutes to increase it,although we changed the duration to some extent

according to the condition of the affected muscles,
determined by manual palpation in individual
cases. Importantly, techniques such as botulinum
toxin injection can only decrease muscle tonus,
whereas we found that acupuncture can produce
bidirectional effects, both increasing anddecreasing muscle tonus.
6) For multiple epidermis-penetrating stimulationon tender spots, we learned from our experiencethat we should continue stimulation until thetenderness disappears in each treatment.
7) In patients with dystonia exhibiting both primaryand secondary disorders, we found that we have totreat muscles with secondary disorders first.
Although the effectiveness by clinical evaluations
after 10 sessions was 72.9 %, there were somepatients who did not show any improvements
using our method. Therefore, we need to develop
other new techniques of acupuncture treatment for
those patients, particularly with retrocollis andunsustained head movement.
V. Conclusions
We have developed a unique method of
acupuncture treatment using knowledge ofmodern medical techniques as well as ancient
Chinese/Japanese traditional medicine. We believethat our method will become one of the mosteffective treatments for patients with cervicaldystonia.
Reference
1) Maja T: Dystonia update. Curr Opin Neurol
16:495-500, 2003
2) Suzuki

T,

et

al:

Evaluations

cliniqueetelectromyographique de l’effet de l’acupuncture surles patients souffrants de torticolis spasmodique.
MERIDIENS 115:17-26. 2000 (French)
3) Mezaki T, et al: The clinical usefulness of Botulinum
Toxin type A for spasmodic torticollis and facial spasm.
Brain and nerve 47: 749-754, 1995 (In Japanese andabstract in English)

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

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Volume 1, Number 4 | Winter 2006

Introduction of Kansai University of Health
Sciences (KUHS)
Ikuro Wakayama
Department of Acupuncture and Moxibustion
Kansai University of Health Sciences
1) General information of Kansai University
of Health Sciences
Kansai University of Health Sciences(KUHS), former Kansai College of Oriental
Medicine (KCOM), is located in southern
Osaka Prefecture near Kansai International
Airport. Access from the airport as well asfrom the railway station is very convenient.
KUHS is composed of three departments,
Department of Acupuncture and Moxibustion,
Department of Physical Therapy andGraduate School of Health Sciences. The
Department of Acupuncture and Moxibustion
includes two divisions, a program in oriental
medicine and a program in acupuncture andathletic training.
KCOM was founded in 1985 as athree-year college for training acupuncturists,then reorganized as a four-year college in
2003. On April, 2007, a four-year program forphysical therapists was added, and the nameof the institution became Kansai University
ofHealthSciences.
In
addition,apostgraduate
two-yearmasterdegreeprogram was started at the same time.
2) Educational stuffs of KUHS
The motto of KUHS is bringing up young
talent to serve the community as anacupuncturist or physical therapist. To send
fully trained professionals to the community,
KUHS provides capable teachers in the fields
of general education, basic and clinical oriental
medicine, basic and clinical western medicine,
acupuncture and moxibustion, and physicaltherapy all supported by a detailed curriculum.
3) Research works conducting in KUHS
16

Researchers actively perform investigationsin the field of basic and clinical medicine related
to acupuncture and moxibustion, and physicaltherapy. The themes of each research team arelisted below.
(1) Anatomical and biological investigation of
the mechanisms of action of acupuncture andmoxibustion(2) Investigation of the influence ofacupuncture and moxibustion on the immune
system(3) Neurobiology of acupuncture stimulation(4) Novel acupuncture treatment in patientswith cervical dystonia and related disorders(5) Study of the effect of acupuncture inpatients with hemodialysis(6) Effect of acupuncture treatment onpatients with osteoarthritis of the knee - a
randomized controlled trial(7) Changes in the autonomic systemfollowing acupuncture stimulation(8) Psychological changes in patients receiving
acupuncture and moxibustion(9) Study of the effect of ear acupuncture4) Outpatient Clinic attached to KUHS
The mission of our outpatient clinic is torender good service to the community andpatients, and to lead our students to learnclinical skills of acupuncture and moxibustion,
physical therapy, as well as skills for personalcommunication. Our outpatient clinic has 16
medical doctors working in the Divisions ofInternal Medicine, Neurology, Psychiatry,
Orthopedics,
Surgery,
Rehabilitation,
Dermatology, Gynecology and Kampo Medicine(Japanese traditional herbal medicine). The
clinic is equipped with MRI and other modern
technological instruments to establish a precise
diagnosis as well as to prepare crude drugs fromplants and animal products to provide
traditional and natural remedies.

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

Volume 1, Number 4 | Winter 2006

In addition, the clinic has an institute for
acupunctureandmoxibustion
treatment.
Presently, 21 acupuncturists work in the institutetreating patients using traditional, modern or
combined techniques. Techniques or principles
used are traditional Japanese / Chinese medicine,
Ryodoraku method, Akabane method, trigger
point techniques and so on.
In conclusion, KUHS provides good
opportunities for the students aiming to becomea knouledgeable, skillful and well trained
acupuncturist and physical therapist as well as
for patients who are eager to receive oriental
medical therapies and integrated (modern andtraditional combined) medical therapies.

Photo1: University Campus,

Photo 2: Outpatient Clinic

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Volume 1, Number 4 | Winter 2006

Clinical Report 2 (Japan)
Two Cases for which Boiogito (Fang-Yi-Huang-Qi-Tang, 防已黄耆湯) was effective for Rheumatoid Arthritis
Kazuhiko Nagasaka
Oriental Medicine Center of Suwa Chuo Hospital

Course: Treated with boiogito plus Non-prepared

Aconiti Radix 4g. After one year, treatment effects
were assessed with the results of improvement inhours of morning stiffness from 5 to 1.5 hours.
Lansbury’s index score from 168 to 15., andBoiogito is the first selective prescription for

sedimentation value to 21mm/h from 40mm/h.

degenerative rheumatoid arthritis. In this case

Edemas were alleviated with a weight reduction

study we report on two cases of advanced

by 4kg. Steinbrocker’s functional classition was

rheumatoid

have

improved to Class 3 from Class 4. At the time ofexperienced, were responsive to “boiogito plus

this report, the patient who has a 13 year history

moderate amounts of other Kampo elements”.

of hospital visits, continues to visit using a cane.

Case Report

Case Report

Age 73 , Female

Age 62, Female

arthritis

that,

as

we

Chief Complaint: Polyarticular pain
History, Family history: No particular mention
History of Pharmaceutical Adverse Reaction: Felt
sick by Salaziopyrin. Shiozol drug eruption, renal
disorder due to Rimatil, hematuria due toMethotrexate.
Present Illness: Rheumatoid arthritis occurred in
1974. Pains in nearly all joints since 1994.
Antiphlogistic analgetic and immune suppressantunable to manage pain. For

two years

had

difficulty walking and visited this department.
PSL now in use for these four years.
Findings by Wakan Medicine: Face and four limbs
swollen. Pain in all the joints, especially knee
joint pain with the accumulation of joint fluids.
Five hours of morning stiffness. Fatigable andcold limbs. Lips and gum dark red. Pigmentationin orbicularis oculus region.
Steinbrocker’s staging classification: Class 4
Pulse condition: Intermediate between floating
and deep, slightly weak, and slightly irregular.
Tongue condition: Purple and slightly swollen.
Covered with moderate furs with puncta.

Chief Complaint: Polyarticular pain
Past History: Tonsillectomy (1965), removal of
thyroid gland (1967), pregnant toxicosis (1967),
artificial joint replacement (right knee joint 1995,
left knee joint 1997).
Family History: Father - SLE
History of Pharmaceutical Adverse Reaction:
Drug eruption due to Rimatil.
Present Illness: Rheumatoid arthritis occurred in
1962. Pain in nearly all joints since 1994. Golddrug and PSL were started. Immunosuppressantbeing administered since 1997. The first visit tothis department of the hospital was May 28, 1997.
Findings by Wakan Medicine: Feels somatic
fatigue, fatigable. Sensitive to cold. The body feels
heavy and hands are stiff in the morning.
Steinbrocker’s staging classification: Class 4
Pulse condition: Slightly deep, weak andirregular.
Tongue condition: Pale white with tooth scars.
Abdominal condition: Strength – moderate.
Stuck feeling in pit of stomach and pain at sideof navel on palpation.

Abdominal condition: Strength - slightly flaccid,
stuck feeling in pit of stomach, excessive strainof abdominal muscles, and pain at side of navel
on palpation.
18

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

Volume 1, Number 4 | Winter 2006

Treatment with
Kampo started

Mar/95

Jun

Sept

Dec

Course: Fig 1 shows the course of ESR and Hb
after the treatment withboiogito plus
Non-prepared Aconiti Radix 2g. After one year, themorning stiffness disappeared and joint scores was
reduced to 13 from 40 with an improvement in
Lanbury's index to 19% from 86%. Loxoprofen and
Diclofenac suppository were no longer required.
Steinbrocker’s functional classification was Class 3
without any difference between before and after
the treatment.
Following is the record the patient wrote in her
rheumatism note.

Mar/96

Jun

Sept

Dec

Jun/96

I have experienced many cases of rheumatoid
arthritis for which boiogito was effective. Boiogito
are considered the first-line medication forrheumatoid arthritis with the main symptom ofjoints pain in the lower extremities.
If the course is prolonged, the practitioner
can increase the amounts of Sinomeni Caulis et
Rhizoma, Astragali Radix, and Atractylodis
Lanceae Rhizoma and to add moderate amountsof Aconiti Radix Processa and non-prepared
Aconiti Radix.

Since the start of Kampo medication, the body
feels light. Able to go to a supermarket for
shopping with the support of a baggage cart.
Facial swelling slightly reduced. Have become
able to wash the face as previously.
This case may be a successful example of Kampo
medication. However, her husband called to tell ofher death in 1999. (The death was not related torheumatoid arthritis.)

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Volume 1, Number 4 | Winter 2006

Case Series

effective and other results assessed as ineffective.

Kampo Treatment for Rheumatoid Arthritis
Kazuhiko Nagasaka
Oriental Medicine Center of Suwa Chuo Hospital

The results before and after the Kampo treatment
were compared using the paired t-test.
Results

Introduction

Marked effectiveness was observed in 43.5%,

Rheumatoid

arthritis

systemic

effectiveness in 15.2%, slight effectiveness in 17.4%

inflammatory disease characterized by chronic

and no effect in 23.9%. Among the 36 patients

destructive

non-suppurative

receiving western medications, 24 patients could

arthritis as its leading symptom. Even today,

either discontinue that medication or reduce thethere is no established therapy available for thisdosage. The modified Lansbury index dropped fromcondition. Here I would like to discuss the

41.7% to 19.1% (p<0.0001, Figure 1), the averageapplication of Kampo for the treatment ofClass staging fell from 2.2 to 1.8 (p<0.0001) andrheumatoid arthritis.

thus indicated a significant improvement. Other

processes

is

with

a

improvements of the CRP and γ-globulin values

Materials and Methods

were also observed (Table 1).

Over the 12 years from April 1994 until April
2006, 46 patients (7 men and 39 women) of thetotal 73 patients who consulted the Center for

Table 1 Variations in laboratory values before andafter treatment

Oriental Medicine of the Suwa Chuo Hospitalwere the subject of this study. The morbidity

Beforetreatment

Aftertreatment

duration was on the average 11.6 years and the

Leukocytes (/mm3)

8002±3469

6055±1762*

Steinbrocker function as well as the average

Eosinophils (/mm3)

5194±2784

3786±1467*

value of the disease stage classification were

Lymphocytes (/mm3)

1830±641

1629±557*

Class 2.2 and Stage 2.4 respectively. Prior to

Hemoglobin (g/dl)

12.6±1.512.7±1.6

consultation, 36 patients had been treated with

Platelets (/mm3)

31.4±10.728.1±8.6

Total protein (mg/dl)

7.5±0.6

7.0±1.3*γ-globulin (mg/dl)

1.37±0.53

1.17±0.32*

duration of the morning stiffness, articular scores,

CRP (mg/dl)

3.2±3.0

1.7±2.6*

grip power and the erythrocyte sedimentation

ESR (mm/hr)

50.6±33.5

34.2±26.5*

rate are used for the calculation of the Lansbury

CH50 (mg/dl)

42.3±3.740.2±5.3

index. Since I did not measure the grip power in*p<0.05 mean±SD CH50 had been measured in 12 patientswestern medications.
For the evaluation of the effects of Kampo
treatment I used the Lansbury index. Generally,

this study, this parameter was excluded andtherefore calculated as a modified Lansbury index.
A marked effectiveness was defined as a drop in
this modified Lansbury index to below 25% of the
pretreatment value after one year of treatment
with

Kampo

medications.

Below

50%

was

designated as effective, below 75% as slightly

20Side effects of non-prepared Aconiti Radix
were observed in 13 patients but alleviated in all
patients with a decrease in dosage (Table 2)1).
During the evaluation one year later it was foundthat 5 patients received roasted aconite, 10
patients received salt Aconiti Radix (aconite

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

Volume 1, Number 4 | Winter 2006

soaked in salt water, sprinkled with lime stone anddried) and 23 patients received non-prepared
Aconiti Radix, so that a total of 38 patients had
been treated with aconite and the maintenancedose was on the average 3.2g/day.
Table 2
Age

Sex

AconiteToxicamountSide effects of Astragali Radix were observed in
2 patients who received 20 g/day, whichcorresponds to 5-6 times the usual dosage. Yet,when treatment was switched to Hedysari Radix
the treatment could be continued2).

Side effects of aconite

Measures

OutcomePrescriptions

Initialsymptoms(g)
65

Femaleraw aconite

5.5

brewing
instructions

improvement

tokikenchuto

Numbness around
lips

28

Femaleraw aconite

5.0

aconite dosage
reduction

improvementkeishikaryojutsubuto+α

Numbness around
lips

54

Femaleraw aconite

4.0

aconite dosage
reduction

improvement

boiogito62

Male

raw aconite

1.5

aconite dosage
reduction

improvementkeishikaryojutsubuto+α

54

Male

raw aconite

3.5

aconite dosage
reduction

improvement

boiogito

Nausea63

Femaleraw aconite

5.0

switchingsalt aconite

improvement

boiogito plus aconite

Numbness around
lips

50

Femaleraw aconite

2.0

aconite dosage
reduction

improvementkeishakuchimoto

Epigastricdiscomfort

53

Femaleraw aconite

5.0

aconite dosage
reduction

improvement

bushito+α

Tingling sensationof cheeks,
insomnia

78

Femaleroastedaconite

4.5

aconite dosage
reduction

improvement

bushitoNumbness in lips,
Blackouts

56

Femaleroastedaconite1.0

discontinuing
aconiteimprovement

hochuekkito plus aconite

Stuffed nose,
headache49

Femaleroastedaconite0.7

aconite dosage
reduction

improvement

bukuryoshigyakuto

Rising bloodpressure50

Maleroastedaconite1.0

discontinuing
aconiteimprovement

boiogito

Epigastricdiscomfort

65

Femaleprocessed
aconitepowder

0.5

Discontinuing

improvement

daibofuto

Nauseato

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

Sensation ofphysicalinstability
Sensation ofphysicalinstability

21

Volume 1, Number 4 | Winter 2006

Table 3 shows the variations in the Lansbury

these descriptions rheumatoid arthritis seems toindex obtained with prescriptions that led tohave existed

slight improvements or better results. Boiogito+α

Kampo medicine.

keishikaryojutsubuto+α, bushito,
keishinieppiichito+α were most frequently
effective. When in the boiogito a higher thanusual dosage of both boiogito was used. The
followed

2,000 years ago andtreated withIn the present study, the pretreatment

by

Lansbury index of 43.5% of the patients improved
and fell below 25%, thereby verifying a certain
usefulness of Kampo medications. Yet, since thepreparations were found to be effective quite

manufacture of Kampo placebos is associatedfrequently.

withMoreover,

when

the

use

of

many

difficulties,

theevaluationofkeishikaryojutsubuto+α by itself did not produce
sufficient results, combination with boiogito often

therapeutic effects included no control group.

allowed to increase its effectiveness3). In the

not show any improvements, the eleven patients

present study a combination was used for 4 out of

in

the

ineffective, still continued to visit our clinic after

7

patients

treatedwithkeishikaryojutsubuto+α.
Table 3

Although the modified Lansbury index did
whom

the

treatment

wasassessedas

one year. Asking the patients for their reasons tocontinue the treatment, two

Effective Prescriptions

stated, it allowed

them to discontinue immunomodulators, one
statedtheabilitytodiscontinue

boiogito

13 caseskeishikaryojutsubuto+α

8 casesuzuto

3 caseskeishinieppiichito +α

3 casesfeelingdaibofuto

2 cases

improvement in the tendency to feel cold, and two

bukuryoshigyakuto

2 cases

Others4 cases

immunosuppressive drugs, three stated reductionin arthralgia, one reported the ability to walkwith a walker, one a reduction in edema andofgreater

comfort,

one

cited

an

said they were under the impression it is better totake the Kampo medicine. These 11 patients
seemed to regard the Kampo therapy as having
certain positive effects.
When the use of keishikaryojutsubuto+α by

Discussion
In the classic of Kampo therapy, "Shang Han

itself did not produce sufficient results, addition

Lun (Discussion of Cold-induced Disorders )" andof Sinomeni Caulis et Rhizoma and Astragali"Jin Gui Yao Lue (Essentials from the Golden

Radix

Cabinet), various passages such as "painful

effects of Aconiti Radix were observed in 13

suffering of bones and joints, painful suffering ofpatients (Table 3). This was probably due to theoften increased its effectiveness4 ） . Sideslightly tensed

gradual increase in the dose of Aconiti Radix until

limbs, pain of bones and joints, pain affecting thesufficient therapeutic effects were obtained. The

entire body, pain in the joints of the limbs, people

incidence

having difficulties in bending and extending their

Modifying Antirheumatic Drugs (DMARDs) is

joints, pain causing by light touch, pain in thesaid to be 60%5). Thus, the incidence of adverse

various joints and inability to bend or extend

reactions of therapeutic drugs for rheumatoid

them, inability of rolling over etc.” According toarthritis represents a problem. Often the mode of

the body, relate to22

athralgia4),ofadverseThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

reactionsof

DiseaseVolume 1, Number 4 | Winter 2006

action of Kampo medicines varies from that ofRadix, Sinomeni Caulis et Rhizoma, Astragali

western medications, but if Aconiti Radix is used

Radix etc. might enhance the pharmacologic

carefully, there should be few side effects. The

effects of the Kampo formulations.

indication for Kampo medicines also depends onthe disease stage. A combination therapy with

Referencewestern medications is possible. Rheumatoid

1)

Kazuhiko Nagasaka: Discussion of 33 cases

arthritis is considered to be one of the diseases forpresenting with aconite intoxication, Journal ofwhich Kampo medications may be expected to be

Traditional Medicines, 16 (4), 168-174, 1999
2) Kazuhiko Nagasaka, others: Investigations of sidesufficiently effective.

effects of Ogi, Kampo and Modern Therapy, 8 ( 1 )Significance of the use of Kampo formulations forrheumatism(1)

35-38, 1999
3)

Improvementofsymptoms

other

Mosaburo Kainuma, others: Significance ofprescriptions with added Sinomeni Caulis etthanarthralgia may be expected.

Rhizoma, Astragali Radix for the treatment

Kampo medicine does not simply eliminate pain,of chronic rheumatoid arthritis, Journal of

but also bestows a feeling of wellness and

The Japan Society for Oriental Medicine, 48

improves feelings of coldness etc.

(6) 91, 1998(collection of abstracts)

The symptoms of rheumatoid arthritis may

4)

The Japan Kampo Medicin Association,

improve simultaneously.

academic department: Shokanzatsubyoron,(2) Many Kampo formulations affect the immune

Toyo Gakujutsu Shuppansha, Japan, 2000
5)

system.
Some people assert that "hochuekkito

Kouichiro Ishikawa, others: Trial results of

andlong-term "Bucillamine" application for the

juzentaihoto act on the immune system, but
keishikaryojutsubuto,
boiogito,
drugs
for

treatment of chronic rheumatoid arthritis,
Inflammation, 8 (2) 169-180, 1988

overcoming blood stagnation simply alleviate thepain". However, this concept is mistaken. Whileboiogito and formulation for dissolving blood
stagnation do alleviate pain, they also improve γ-globulin and antinuclear antibody levels. Just
alleviating

the

pain

cannotexplainthis

improvement in γ -globulin and antinuclear
antibody levels. Thus, Kampo medications may beclassified as immunomodulators.
(3)

In

contrasttoimmunomodulators,

the

Kampo

delayedactivity

formulations

of

have

fast-acting properties.
Evaluation of results after one year in thisstudy revealed that if no effects appeared
between the second to fourth week, either
changing the prescription or else adding Aconiti
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

23

Volume 1, Number 4 | Winter 2006

Clinical Report (Europe)
Case Report: Chronic Recurrent Diarrhea
Ulrich Eberhard
The subject in this report was a 69-year old
retired teacher with chronic recurrent diarrhea
that continued since an acute gastrointestinal
infection two years earlier.
Findings:
Recurrent diarrhea (at least 1x/week) continuingfor 1-2 days, always starting with colicky pain,
mostly following the intake of food. Followed byadynamic defecation of liquid stools (3-4 x daily),occasionally defecation is associated withflatulence.
Previous diagnostics and therapy:
Repeated examination by gastrointestinal
specialists without findings, fecal examinations forpathogenic microorganisms repeatedly negative, colon
endoscopy revealed no pathologic findings. If
required, treatment with Perenterol forte(Saccharomyces bulardii) or Loperamid.
Other anamnestic information:
Weakness and exhaustion
Fatigue and marked need for sleep
Desire for warm beverages
In case of cold beverages or foodstuff, immediate
onset of diarrhea
Frequently abdominal pain that improves withthe application of heat.
First examination / Shô identification:
Sick appearance, weakness, underweight (46),pallor, withered face
Cold extremities, cold sensitivity
Bloodpressure 120/85 mmHg
Tongue: thin, wet, little fur
Pulse: weak, deep

Course:Acupuncture and moxibustion: Japanese meridan
school (Keiraku Chiryo 1-2 sessions/week).
Kampo prescription: North Water God Decoction(Zhen-Wu-Tang,真武湯 shimbuto) 9.86 (with Rad.
Aconiti praep 0.5).
First prescription for 7 days, well tolerated, nomarked changes, since diarrhea recurred on thethird day (as usual).
Subsequent prescription of the same formula for 14
days (with Rad. Aconiti praep. 1.0).
No diarrhea during the second and third week of
the treatment, frequency of bowel movements: once
daily, normally shaped, no colicky pain.
Subsequent prescription of the same formula for
21 days (with Rad. Aconiti praep. 1.0).
During the further course, occasional unformedstools (1x per day), yet no more diarrhea. Further
improvement of the general condition (less fatigue,
gaining strength, increase in body weight).
Acupuncture and moxibustion therapy was
discontinued.
Subsequent prescription of the same formula for 28
days (with Rad. Aconiti praep. 1.0). Treatment led
to further stabilization and shift towards longer
intervals between individual doses of the extract orapplication only if required. Over an observation
period of approximately 12 months the patient
remained free from symptoms, only occasionally
unformed stools that normalized immediately after
application of shimbuto.

Abdominal finding: "central core" extending
above and below the navel

24

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

Volume 1, Number 4 | Winter 2006

Introduction of Japanese Acupuncture

tissue, muscles, indurations and the like, as well

Considering the Therapist’s Hand (4)Shuichi Katai
3.

Establishmentofstimulation

methods

appropriately modifying responses.
It is important to establish treatment andstimulation techniques allowing the appropriate
modification of the responses ascertained throughpalpation. In other words, a system has to beestablished determining what kind of stimulation
has to be delivered in order to modify specificresponses. Since palpation naturally does notincludetreatment,

inclusionofstimulation

methodologies in the theory of palpation may
seem to be somewhat awkward. For the sake ofprogress in palpatory skills, it is essential todevelop the skills of modifying somatic responses.
The reason for this lies in the fact thatmodification of reactions literally grasped with
one's hands through stimulation (therapy) allows
for a smoother acquisition of the changes throughpalpation skills. In fact, palpation skills aretechniques to modify somatic responses (in otherwords, therapeutic techniques) and therefore
inseparable from treatment. Thus, efforts should
be made to acquire both techniques together
rather than try to acquire them separately. It goes
without saying, that during the very early stagesof the training separate explanations and practiceof each portion are easier to comprehend.
When I referred to suitable stimulation
methods,

a major portion of the decisions

regarding the intensity of the stimulation during
acupuncture

treatment

are

based

on

the

experience of the clinician. For example, and thisis always the same problem, the questions ofwhether to needle inflamed regions, or else what
degree of inflammation would still allow needling,
still have no clear answers. Moreover, questions
dealing with the conditions of skin, connective

asthe kind of stimulation appropriate forparticular situations have not been clearlysummarized. Naturally, the theories pertaining totonification and drainage of deficient and excess
states have been established, but tonification of
deficient states using moxibustion, while using
acupuncture for sedation in states of excess are
just too crude. It is possible to use moxibustion forboth tonification and sedation of deficient andexcess states and acupuncture can be used thesame way for both tonification and sedation of
deficient and excess states respectively. In thiscase it is not clear whether the pathologies here
associated with the meanings of deficient andexcess states are either identical or different,
while the differences in the meaning of themethods employed for tonification and sedation
are ill-defined.
In Japan, tonification and sedation are often
expressed as the strength of the stimulus dose. In
otherwords,

astrongstimulus

represents

reduction, while a weak stimulus represents
tonification. However, in China tonification andsedation are not infrequently expressed in form of
the changes the stimulation had brought about.
For example, there are the expressions that theburning mountain fire method is warm andtherefore tonifying, while the heaven-penetrating
cooling method is cooling and therefore sedating.
For both the burning mountain fire method andthe heaven-penetrating cooling method neither
the size of the needles, insertion depth nor
stimulus dose vary. The difference is solely
whether the needle is twisted to right or to theleft. Thus, even while using the same terms"tonification

andsedation",thetechniques

related to tonification and sedation are different
in China and Japan. In the future, the differencesin acupuncture and moxibustion between China
and Japan should be the subject of comparative

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

25

Volume 1, Number 4 | Winter 2006

practices for the acquisition of palpatory skills.

analyses and research.
Thus, one of the problems clinicians using

Since palpation is a skill, it is necessary toacupuncture and moxibustion face during theiracquire this skill through repeated instructions

daily clinical practice is that theories pertaining

and the practice of identifying somatic reactions.

to the association of particular techniques to the

However, the education methods pertaining tovarious findings on the patient's body surface arepalpation skills have not yet been established. In

not clearly defined. The needling techniques

particular the teaching of acupuncture andcannotmoxibustion itself has inherent problems. Table 3

besimplyexplained

in

terms

of

tonification and sedation for the needling andmoxibustion skills, but need to be summarized astechniques associated with specific body surface
reactions. At the same time it is also necessary todeviseandestablishasystemfortheclassification of the findings obtained throughpalpation.

summarizes these problems (Table 3).
Table 3 Problems pertaining to the teaching ofacupuncture and moxibustion1.

Insufficient2.

Dissociation between the academic andpractical

acupuncture and moxibustion.

moxibustion
3.

play

withinsummarization.

A

the

above

unifiedtheorydescribed
of

4.
5.

and

the

techniques

for

the

acupunctureandAcupuncture and moxibustion are taught
Indistinct image of the clinician to be
Insufficientteaching

time

for

the

handingclinicalpractice

palpation as well as the methods of theiridentificationof

trainedtheclassification of reactions identified throughaspects

mainly in the form of lectures

palpation plays in acupuncture and moxibustion
theories

contents

pertaining to acupuncture and moxibustion

4. The role of theorization within the theories of
It should be clearly defined what role

educational

6.

Method

for

down

of

modification of these reactions has yet to be

acupuncture and moxibustion techniques

established.

have not been established.

Only after the reactions and the methods oftheir identification, as well as the acupuncture
and moxibustion techniques with which theseAn important question among these problems
is that "teachers do not have a distinct image ofreactions are modified have been systematized,

the clinician to be trained". Since it is not clear

these

what kind of acupuncturist should be raised,

reactions

will

be

regardedastherapeutically significant reactions. If thesestudents

reactions are not modified by the acupuncture

intentions.

do

not

understandthe

relevant

and moxibustion treatment and are judged not to

The next problem is, that "methods for the

be indications for acupuncture and moxibustion

handing down of skills have not been established".

treatment, they may serve as evidence for

As opposed to the traditional model of "learning

differential diagnosis. In other words, thesethroughreactions do have a significance as rule-out items,

instructions should also be accompanied by verbal

but not for the treatment.

expressions in order to ensure the transmission of

5. Establishment of educational methods and26

observation",

repeateda minimum of technical skills.

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

technical

Volume 1, Number 4 | Winter 2006

Naturally, skills can hardly be verbalized.
Certainly, this is an area where seeing isbelieving and only actual touch will lead to a real
understanding. Yet, systemization of a minimal
degree of verbalization forms an important part of
the work of those who try to teach (transmit)
these skills. At least on the stage of basic
practical training it is necessary to systemize theverbalization of the techniques. It should be
remembered that only thanks to the systematic
writings in medical books (verbalization), at leastin the classics beginning with "Su Wen" and "Ling
Shu", the knowledge and skills of oriental
medicine could be handed down to the presentday.
All things considered, it should be noted thatthe percentage of classroom lectures in the
curricula of modern educational programs iscomparatively too high and thus disadvantageous
for a field like acupuncture and moxibustion that
centers on practical skills. This is an adverse
effect of modern education, where knowledge isconsidered to be superior to practical skills andthus can be said to represent a social
disadvantage for the field of acupuncture andmoxibustion. Yet, there are still no signs ofchanges in the social tendencies overstressing
intellectual training. On the contrary, thesetendencies seem to gain momentum. It is
important here to determine how to establish
appropriate methods of handing down technicalskills instead of being vexed by the curse ofoverstressed intellectual training.

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

27

Volume 1, Number 4 | Winter 2006

Medical History in Japan
Japanese Acupuncture and Moxibustion under the Rule of
GHQ after World War II (4)Recommendation by the Public Health andWelfare Section for the prohibition ofmoxibustion and acupuncture, and the
response of those in the moxicautery andacupuncture fields in Japan
Takako Okutsu
The advent of Law No.217 (the Law for
Business of Massage, Acupuncture, Moxa-Cautery,Judo-Orthopaedy etc.), which provided highly
desired legislated status for these occupations,
was a cause for great rejoicing in the field, andcaused acupuncturists to feel more confidence
and pride in their work. This law also provided a
starting point for a variety of reforms in the fieldof acupuncture and moxibustion. These reforms
were placed in the hands of the acupunctureindustry, since the GHQ disapproved of the
Ministry of Health and Welfare carrying out thereforms itself. The reforms were thus carriedforward with only indirect support from the
Ministry of Health and Welfare.
Reeducation of acupuncturists
The first step in reform within the industry
was the convening in Tokyo of a "Reeducation
Instructor Training Short Course", sponsored by
the
LMAMP
(LeagueofMoxa-cautery,
Acupuncture and Massage Practitioners) with thesupport of the Ministry of Health and Welfare(MHW). This short course, which lasted for 15
days (from September 12 to September 26, 1948),
was held to train the instructors who would
subsequently lead "reeducation short courses" tobe offered in cities and prefectures throughout
Japan. Participants included acupuncturists fromacross the country.
Because the GHQ had previously expresseddisapproval at participation by the Ministry of
Health and Welfare, the curriculum for the short

28

course was created by members of theacupuncture industry. Materials were drawn froma wide range of sources, not limited to theclassical Asian medicine theory of acupuncture
and moxibustion and the theory of meridians andacupoints, but also referencing topics related toWestern medicine, such as anatomy, physiology,
and sports medicine, and discussing regulations
related to the Medical Affairs Law. This
curriculum laid the foundation for modern
education in acupuncture and moxibustion.
The lecturers in each of these fields were
acupuncturists and related personnel who had
worked for the enactment of legislated status or
had been involved in responding to the "GHQtornado", and who would actively support theacupuncture industry in the future. Although the
Ministry of Health and Welfare was officiallylimited to a supporting role, individual membersof the Ministry participated as speakers in the
training short course. We can thus infer that the
MHW was cooperating in this reform of theindustry.
The reeducation program, which wasintended to improve the stature and social
standing of acupuncturists, indicates both thegreatly improved spirits within the industry as it
took on these major responsibilities for
self-reform, and also the high expectations heldby the Ministry of Health and Welfare. The
industry and the MHW cooperated on thesereforms, and attendees at the first short course
subsequently contributed to the reeducation ofacupuncturists throughout Japan by serving aspresenters in reeducation short courses aroundthe country,.
During that same time period, on September
17, the Institute of East Asian Medicine wasestablished as a corporation by a Diet member Mr.
Kobayashi, Mr. Komori of the LMAMP chairman,
Mr. Okabe and Mr. Hanada as acupuncturists,
with Dr. Takeshi Itakura as director. In the wake

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

Volume 1, Number 4 | Winter 2006of the "GHQ tornado" and the enactment of the
Law for Business of Massage, Acupuncture,Moxa-Cautery,Judo-Orthopaedy
etc.,
this
institute was established to provide scientificevidence for the effectiveness of acupuncture andto oversee educational reform. Its philosophy andideals were subsequently transferred to regional
research organs focusing on Asian medicine
across Japan.
Conclusion
Today the "GHQ tornado" is commonly
believed to have been intended to ban the practiceof acupuncture and moxibustion in Japan.
However, if we look closely at materials from thetime, we see that the GHQ "Order for theProhibition of Moxibustion and Acupuncture" wasactually a proposal for reform, rather than ablanketprohibition of acupunctureandmoxibustion.
In the process of reviewing the overallsituation in Japan, the GHQ observed thelongstanding contribution of acupuncture inmaintaining the health of the Japanese people,
noted the effectiveness of this treatment, andrecognized the undeniable importance of thisform of medical treatment for the country.
However, some issues remained to be resolved
before acupuncture could be incorporated into thenew medical system. The GHQ proposals forresolving those issues by stringent reforms wereinterpreted by the Japanese side as "prohibition".
The GHQ was willing to accept the Japanese
government's enactment of legislated status for
acupuncture and moxibustion. However, theOccupation officials did actively attempt toprohibit the visually impaired from performing
acupuncture/moxibustion therapy. This was
because there were no other countries in theworld where the visually impaired werepermitted to perform medical procedures as they
were in Japan, and to the GHQ it appeared
dangerous for visually impaired persons toperform acupuncture or moxibustion. However,the visually impaired had a surprising amount ofpolitical power, and the Order for the Prohibitionof Moxibustion and Acupuncture met with strong
resistance. If the GHQ had banned the visually
impaired from practicing acupuncture, many
visually impaired persons would have lost theirmeans of livelihood and ended up in the streets,
inviting tumult and confusion within society. This
was an outcome that the GHQ wished to avoid at
all costs, since they wanted the occupation
government to succeed in order to bolster US
credibility and prestige. It thus seems likely that
overall Occupation policy was at the root of the
GHQ decision to allow the visually impaired tocontinue working professionally in acupuncture
and moxibustion.
The problems that were perceived initially by
the GHQ were due in part to differences incultural expectations and customs between Japanand the United States. It is not an easy thing for
any nation or people to understand the culture andcustoms of another country, so it was unsurprisingthat the GHQ could not understand the traditional
medical system of acupuncture in Japan. If theJapanese side had been unable to comprehend theGHQ’s true motives of demanding evidence for thesafety and scientific foundation of acupuncture,and of requiring educational reform, and had
responded less appropriately to those demands
and requirements, then this system of medical
therapy might have truly been banned, andacupuncture in Japan would have taken a very
different path from what we see today.
The "GHQ tornado" on acupuncture epitomized
the relationship at that time between Japan andthe United States as occupied and occupying
nations. We can expect the incident to be longremembered as an interesting example of thesituation in Japanese society after World War II.

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

29

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

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Volume 1, Number 3 | Fall 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.
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Excerpted from National Park Service

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