Volume 5, Number 4 | Winter 2010

Clinical Report 2 (Japan)
A Case of Recurrent Folliculitis

Takao Namiki, M.D.,Ph.DAssociate Professor,
The Department of Japanese-Oriental (Kampo) Medicine,
Chiba University Hospitallesions on the head with oozing exudate. They wereparticular marked at the frontal hair line, the back of
the head and on the vortex (figure 1, at the first visit).

Introduction

Jizusoippo is a formula created in Japan. It iscomprised of 9 crude drugs and indicated mainly forswellings of the epidermis (to dispel dampness) andimprovement of blood flow (activate blood) and acts
to improve the skin condition (clearing heat andremoving toxins). It is often used as a formulaspecifically for skin diseases like atopic dermatitis orFigure 1: Before treatment, Rash on hairline

seborrheic dermatitis. On this occasion we would
like to present a case of recurrent folliculitis
refractory to western medical treatment, where diet,lifestyle guidance and treatment with Jizosoippo led
to improvements.
The patient was a 19-year old male.
Chief complaint: recurrent folliculitis
The anamnesis of the present illness showed, thatdying his hair in October during his third year insenior high school led to the development of a largeswelling on his head. The lesion reached the size of aFigure 2: Before treatment, tongue

golf ball and its contents was aspirated by a local

Prescription from the dermatology department:

physician. This was not a malignancy, but he wastetracycline ointment, betamethasone lotion

nevertheless referred to a university department ofSymptoms and complaints

dermatology. He was diagnosed with multiple•

dry mouth, marked spontaneous sweating

folliculitis.

•

meat centered diet•

constipation (once every few days, feeling ofAccording to his mother, the above mentioned

residual stools)

swelling developed by the time, the admission to auniversity had been settled. Later, the patient•

auniversity

departmentofdermatology

history

ofvagalreflexes,

occurrence of syncopes

tended to stay up late, indulged in an unbalanced
diet and neglected his health. Even after consulting

dizziness:•micturition: Micturition desire triggered bytension. High urinary frequency

exacerbations recurred and because the condition

Complicating factor: greasy foods (he like to eatdid not show any signs of improvement, he wasHamburgers and ice cream), constipation, stress, atreferred in August of the following year to thetime of catching cold, lack of sleep.

Department of Japanese-Oriental (Kampo) Medicine,

Kampo medical examination

Chiba University Hospital. At the time he came forconsultation there were protuberant folliculitis
22The pulse was in between the deep and superficial
layer, of intermediate size and strength.

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

Volume 5, Number 4 | Winter 2010

The tongue had a slightly dark red shade, was a

According to the patients wish the treatment waslittle enlarged, showed no teeth marks and wascontinued over half a year and then terminatedmarkedly moist with a white coat; sublingual veinsbecause of improvement.
Profile – Jizusoippo (Hodokubenkai)were slightly engorged.
Abdomen: intermediate abdominal strength, mild

The formula jizusoippo was created by Futei

tension of the rectus abdominis muscle, presence of

Fukui (birth 1725 – death 1792) and its contents

tenderness to the left and right of the umbilicus.

later slightly modified by Asada Sohaku to become

Based on the above findings of eczema above theneck, a condition between deficiency and excess,mild degree of blood and water retention andconstipation, we used only jizosoippo. During thenext visit 2 weeks later the flares had decreased toabout half their original scope and the itching
showed a decreasing tendency too.
After treatment over a period of 3 months, theforehead lesions had disappeared and a decrease in

the formula used today. Its naming suggests, that it
is a "formula to treat eczema of the skull", but todayit is used for skin diseases everywhere on the body.
It carries the nickname daikyuoto.
The formula has the following composition.
3 g of Cnidii Rhizoma
3 g of Atractylodis Lanceae Rhizoma
3 g of Forsythiae Fructus

papules on the back of the head and its vortex was

2 g of Saposhnikoviae Radix

observed (figure 2).

1 g of Glycyrrhizae Radix
1 g of Schizonepetae Spica
1 g of Carthami Flos
0.5 g of Rhei Rhizoma
2 g of Lonicerae Folium Cum Caulis[Efficacy] Expels wind and activates blood, clears
heat and remove toxins, expels dampness[Main indication] Wind -dampness, heat toxin[Explanation of the formula]

Figure 3: After 3 months, Rash on hairline

Schizonepetae Spica and Saposhnikoviae Radix
disperse wind evil; Atractylodis Lanceae Rhizoma
and Ledebouriellae radix remove dampness; Cnidii
Rhizoma activates blood and at the same time
supports the free coursing function of the liver andin conjunction with Atractylodis Lanceae Rhizoma
dispels the wind evil from the blood. Forsythia,
Lonicera japonica and Glycyrrhizae Radix clear heatand remove toxins, and together with Rhei Rhizomacool and remove heat toxin from the blood. Carthami
Flos in conjunction with Cnidii Rhizoma and Rhei

Figure 4: 3 months later, tongue

Rhizoma alleviates blood stagnation and prevents
evil from remaining in blood. The combination of theascending

properties

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

ofCnidii

Rhizomaand23

Volume 5, Number 4 | Winter 2010

descending properties of Rhei Rhizoma ensure anumber of case reports or case series studies hasbalance of the ascending and descending properties.
Clinical Application

been submitted.
Seki et al. reported a case of a 55-year old woman

This formula is used specifically for skin diseases.

with adult atopic dermatitis. By the age of 40

Originally it was used for infants with eruptions onerythematous patches associated with pruritus andthe skull, secretions, itching and eschar. While it isdesquamation developed in this woman on the facecurrently used not only for eruptions on the skull,and were treated by a local physician with topicalbut anywhere on the body, also in adults, its

steroids, but because neither this resulted inapplication is not surprisingly particularly high forcomplete recovery nor did similar treatments ineruptions on the skull or the face. It is particularly

several other clinics led to any remission and afrequently used for cases with atopic dermatitis, so

topical steroid induced rosacea-like dermatitisthat research has been carried out regarding thisdeveloped as a complication, Kampo treatment wasindication. Rhei Rhizoma in this formula may not beinitiated. After the patient had been treated withnecessary for people with daily regular bowel

shosaikoto (Xiao Chai Hu Tang) for 6 months, themovements, but the addition of a small amount ofcondition had healed almost completely2).

Rhubarb probably gives better results.
1. Atopic dermatitis

Yamamoto et al. evaluated the results after
treating 36 patients with adult atopic dermatitis

Otsuka Keisetsu (1900-1982) was the first personwith jizusoippo (7.5-15.0 g) over a period of 4 or 8

to use this formula for the treatment of atopic

weeks and reported marked improvements in 9

dermatitis. The historical record mentions that inpatients (25%), improvements in 8 patients (22.2%),

1970 this disease was rare and there were only few

mild improvements in 10 patients (27.8%) and no

refractory cases. Like for example as follows.

changes in 9 patients (25%)3).

The patient was a 5-year old boy. Shortly after

Cases where atopic dermatitis is associated withbirth eczema developed and he received various

bronchial asthma often receive a combination

treatments, but because the condition failed totherapy

improve he was brought to consultation. Most of theOtsuka mentioned that addition of Ephedra andlesions were located on the arms and neck, as well as

gyps to jizusoippo improves not only the eczema buton the medial side of the knees. He caught easily cold,also the asthma4).

withmakyokansekitoorshoseiryuto.

which then led to a congested nose and his voiceSome cases of atopic dermatitis also respond totended to get hoarse. Occasionally there were nose

Eppikajutsuto. That is because the combination ofbleedings. Appetite varied extremely and was not

Ephedra and gyps can dispel damp heat. Even inconstant. He drank plenty of water. One bowel

cases without asthma the combination of jizusoippo

movement per day. After 2 weeks of treatment withand makyokansekito can achieve similar results.

jizusoippo the skin became smooth and almost all of

Ito reported the markedly effective treatment of athe eruptions had receded. After continuing the1-year old girl with atopic dermatitis using a

medication for another 4 weeks the eruptions hadcombination of makyokansekito and jizusoippo5).

disappeared without a trace1).
Later, physicians inspired by this case used theformula for the treatment of atopic dermatitis andthus accumulated relevant clinical experience. A24

2. Seborrheic eczema

Jizusoippo has originally been developed for thetreatment of pediatric seborrheic eczema. Today

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

Volume 5, Number 4 | Winter 2010

this disease can quickly be alleviated throughreported a marked improvement in 3, improvements

topical application of steroid ointments, but inin 2 and no changes in 3 patients3).

former times there was no really good treatment.

3. Furunculosis

When Otsuka used jizusoippo for a 4-year old girlThis formula is often effective for the treatment

in whom shortly after birth erythematous lesionsof erythematous lesions of the head, regardless of thedeveloped on the head and face, who complained of

diseases causing them.

pruritus, formation of thick scabs from which serum

A dermatologist referred a middle-aged man withoozed out if they were removed only to form new

furuncles continuously developing on the head non-scabs, the pruritus was alleviated after about 10

responsive to treatment with antibiotics to Terutane

days and after about 40 days the condition hadYamada, who advised the patient to take thiscompletely been cured. Administration of the same

formula. After about 1 months of administration theformula over a period of 2 months following apatient had almost completely recovered9).

recurrence again led to a complete recovery6). ThisReferences

was in 1953.
The number of physicians using this formula for1) Otsuka K: Otsuka Keisetsu Collected Works 1980

seborrheic eczema in infants increased after the2) Seki T, Masaaki Morohashi: A case of adult atopic

publication of this report. I will cite a case reportdermatitis successfully treated with jizusoippo,

from Yakazu.

No. 13 Records of the Dermatologic Oriental

The patient was a 4-month old girl. One and a half

Medical Society, No.6, 31-38,1995

month after birth apparently itchy erythematous

3) Yamamoto I: A case of adult atopic dermatitis

lesions developed on the head, that were associatedsuccessfully treated with jizusoippo, No. 16

with copious secretions and the skin started to peel

Records of the Dermatologic Oriental Medicaloff. The regions affected gradually increased in size

Society, No. 9, 29-39, 1997

and by the time of the first consultation had spread4) Otsuka K: Otsuka Keisetsu Collected Works 1980

to the back, the entire abdomen and buttocks. At a5) Ito N: A case of atopic dermatitis in which

department of dermatology the condition was

makyokansekito and jizusoippo combination

diagnosed as pediatric seborrheic eczema andtherapytreated,Treatment Vol.13, No.8, 1994

butdidnotimprove.

administrationof

jizusoippo

half

Followingof

theerythematous lesions disappeared after about one

wasmarkedlyeffective,Kampo6) Otsuka K: Pediatric skull eczema, 30 Years of
Kampo Treatment, 378, Sogensha, 1959

month, 2 months later approximately 80% had7) Yakazu D: jizusoippo for pediatric seborrheic

healed and after 3 months the condition had healed

dermatitis, A Hundred Kampo Stories, 134

almost completely. Since the administration of theIdononipponsha 1960

drug appetite increased, the infant gained weight8) Terutane Yamada: Examination and Treatment ofKampoand got well7).
This formula is currently also used for adultMedicine[PracticalApplication],

Taniguchi Shoten

seborrheic eczema. It is indicated for erythematouslesions developing on the head and face.
Yamamoto et al. administered this formula to 10
patients (adults) with seborrheic eczema andThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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