Volume 7, Number 1 | Spring 2012

EditorialClinical Applications and Key Signs
A single Kampo medicine may be applicable to various clinical conditions and diseases. For example,goreisan (Poria Powder with Five Herbs) may be prescribed for a vast range of clinical conditions including
infectious gastroenteritis, edema diseases, and even headaches, hangovers, dizziness and abdominal pain.
The Shokanron (Treatise on Cold Damage) reveals that goreisan was also used for certain dehydration
conditions. It mentions the occurrence of post-perspiration dry mouth as a reaction to taking goreisan, andprovides instructions on drinking plenty of warm water after taking goreisan. In Japan, these conditions
are generally thought to be caused by so-called “water poisoning,” or abnormal water metabolism in thebody. As goreisan is a representative prescription for treating water poisoning, it is thus consideredeffective against the above-mentioned conditions. Most textbooks describe goreisan as being effective
against edema of the extremities, a typical symptom of water poisoning, and headaches and abdominal
pains accompanied by such symptoms as thick tongue plaque or dry mouth.
However, in actual clinical practice, there are many cases where goreisan is ineffective even if such
symptoms are observed, or conversely, cases where goreisan is effective although no signs of water
poisoning are observed. Outstanding studies that aim to solve such issues have begun to appear in recentyears. It has been found that goreisan is effective against migraine headaches that are induced by changes
in atmospheric pressure, but has no significant correlation with other signs.1)It has also been found thatabdominal pains which may be treated with goreisan are practically unrelated to other signs, and thatgoreisan is effective against abdominal pains that are induced by eating or drinking cold foods such as ice
and ice cream during the summer.2) Such findings indicate that even with goreisan alone, the signs foridentifying the responder may differ for each clinical application. It may be said that efforts to deduce thesigns for identifying the responders of actual clinical applications of Kampo prescriptions beyond thebounds of conventional practices and concepts, are necessary for the advancement of future studies ofKampo medicine and enhancement of clinical performance. Moreover, such efforts also increase thepossibility of discovering a clue to solving the essence of clinical conditions that prescriptions aim to treat.
With regard to the examples given in relation to goreisan, there emerges the possibility that headaches
occur when a drop in atmospheric pressure causes a change in pressure inside the skull and ultimately
causes a dilation of the blood vessels in the head and edema in surrounding areas.3) There is also thepossibility that abdominal pains are caused when cold foods stimulate and induce edema of the stomachlining. This writer has in fact also seen goreisan have a complete response to strong upper abdominal pains
from edema of the lining of the stomach and duodenum accompanying advanced portal hypertension.
When considering the above, it seems that goreisan acts against edema in various organizations of thehuman body. It is hoped that such mechanisms will come to be further elucidated.

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

1

Volume 7, Number 1 | Spring 2012

1) Haimoto, H. et al.: Observations pertaining to the correlation between the clinical epidemiology ofchronic headache and migratory cyclones (case-control study of patients for whom the treatment withgoreisan had been effective or ineffective). PHYTO 1:8-15, 1999.
2) Kimura, Y. et al.: Investigation of Clinical Indications of Goreisan in Patients with Epigastralgia in theSummer Season. Kampo Medicine 61:722-726, 2010.
3) Mukamal KJ et al.: Weather and air pollution as triggers of severe headaches Neurology. 2009;72:922-7

Masayuki Kashima
Department of Internal Medicine
Kumamoto Red Cross Hospital

2

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