KAIM
T
Thhee JJoouurrnnaall ooffK
Kaammppoo,, A
Accuuppuunnccttuurree aanndd IInntteeggrraattiivvee M
Meeddiicciinnee
INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 10, Number 1 ･ Spring 2015

Editorial

Integrating NBN and EBM in Kampo Medicine
Shuji Goto

Integrating Kampo and Evidence-Based Medicine (Introduction)
Four Episodes About the Integration of Kampo and Modern Medicine
Hiromichi Yasui

Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (15) – Neurology A
Ikuro Wakayama

Clinical Report 1 (Acupuncture)

A Case of Acupuncture and Moxibustion Treatment for Insufficient Lactation Following Premature BirthNaoko Maeda

Clinical Report 2 (Kampo Medicine)

A Case Where Ryokyojutsukanto was Effective for Hyperactive Bladder
Yuji Fukuma

ISSN:1559-033X

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

―

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

T
Thhee JJoouurrnnaall ooff
K
Meeddiicciinnee
Kaammppoo,, A
Accuuppuunnccttuurree aanndd IInntteeggrraattiivvee M
Volume 10, Number 1 ･ Spring 2015

EXECUTIVE EDITOR

Shuji Goto
Chairman, GOTO College ofMedical Arts & Sciences

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

Tokyo, JapanASSOCIATE EDITORS
Shuichi Katai

1 Editorial
Integrating NBN and EBM in Kampo Medicine
Shuji Goto

Ibaraki-ken, Japan

Hiromichi Yasui
Tokyo, JapanEDITORIAL STAFF

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

PUBLISHER

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

2 Integrating Kampo and Evidence-Based Medicine (Introduction)
Four Episodes About the Integration of Kampo and Modern Medicine
Hiromichi Yasui

8 Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (15) – Neurology A
Ikuro Wakayama

14 Clinical Report 1 (Acupuncture)
A Case of Acupuncture and Moxibustion Treatment for Insufficient Lactation Following
Premature BirthNaoko Maeda

21 Clinical Report 2 (Kampo Medicine)
A Case Where Ryokyojutsukanto was Effective for Hyperactive Bladder
Yuji Fukuma

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

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

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

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

Volume 10, Number 1 | Spring 2015

Editorial
Integrating NBN and EBM in Kampo Medicine
EBM is an essential concept in modern medicine. However, not all problems can be
resolved using EBM methodology. It is particularly difficult to apply to diseases andpathological conditions that are deeply associated with psychological elements. The concept of
NBM came to be widely known through Narrative Based Medicine—Dialogue and discourse inclinical practice (BMJ, 1998), edited and published by Trisha Greenhalgh and Brian Hurwitz in
1998. It introduced NBM as a complementary concept to EBM in the medical care field, andmade it known that the two concepts function as the two wheels of a cart.
With regard to a certain treatment for a certain disease, it cannot be said that “no evidence
exists unless its effectiveness is proven in a randomized controlled trial (RCT).” Yet, Kampo
medicine is placed in this precise situation. We do not have the right to abandon Kampo
prescriptions that have a history of some 1800 years for the reason that no evidence exists. Thisis because “no evidence means its effectiveness has not been proven yet, and is not the same as
being invalid.”
In Kampo medicine, physicians place importance on history taking, and make a diagnosis
and provide treatment based on the patient’s narrative. Needless to say, other examination
methods such as visual examination, auscultation, and pulse feeling are also certainly
important, but history taking, including medical history, plays an extremely important role in
Kampo medicine diagnosis, and helps determine the selection of a prescription. Patientsfrequently say that “Kampo medicine specialists listen carefully to what patients say.”
However, listening carefully to a patient’s narrative is nothing special. Kampo medicine
specialists listen carefully because doing so is necessary for making a diagnosis and providing
treatment, even if they are not aware that NBM is taking place in that process. NBM is not a
new concept in traditional medicine, but has existed from ancient times.
The series on “Integrating Kampo and Evidence Based Medicine” by Dr. Yasui, which
begins with this issue, is expected to shed light on the characteristics of Kampo medicine fromthe perspectives of both NBM and EBM. In the series, Dr. Yasui shall classify Kampo medicine
as practiced under a centralized medical system into four categories, and define the role ofKampo medicine in each category.
Shuji Goto, Ph.D.
Executive Editor
Chairman, Acupuncture and Integrative Medicine College
Berkeley, U.S.A.
Chairman, International Institute of Health and Human Services
Berkeley, U.S.A.
Chairman, GOTO College of Medical Arts & Sciences
Tokyo, JapanThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

1

Volume 10, Number 1 | Spring 2015

Integrating Kampo and Evidence-Based
Medicine (Introduction)
Four Episodes About the Integration of Kampo
and Modern Medicine

In this series, I will introduce how Kampo
medicine is being used in Japan. The information I
provide will be practical and academic, but I will
present it in narrative form to help deeper

Hiromichi Yasui
Japan Institute of TCM Researchunderstanding

of

Kampo

medicineusedbypracticing clinicians. I think it is difficult to provide
an accurate understanding of the Kampo situation

From this issue, the Journal provides this series inin Japan today, otherwise. Simultaneously, I will

narrative form to offer a better understanding

also introduce, as much as possible, evidences thatofthe captioned topic.

have been confirmed to date.

Introduction
Kampo

medicinewasintroduced

to

Japan

approximately 1,500 years ago. In approximately athousand years of history with trials and errors, it
gradually took on uniquely Japanese characteristics.
Then, Todo Yoshimasu established a style of Kampo
medicine unique to Japan in the early-18th century.
Kampo medicine was temporarily deprived of its
status as orthodox medicine during the Meiji
Restoration, but owing to the efforts of many of ourforefathers, it was established anew on thefoundation of modern medicine in the 1940s. This
movement continued even after the end of WorldWar II. In 1972, it became possible to apply healthinsurance for the use of crude drugs. From 1976, we
can prescribe Kampo extract preparations for
medicalapplications

in

the

national

healthinsurance system.
In Japan, Kampo medicine is administered undera unified system of Western medicine. Japanese
health care system is completely different from thedualistic medical system just as it is adopted in
China and South Korea. Physicians who prescribe
Kampo are educated in Western medical school andtrained in Western medicine for a period of years
after graduation, and know the natural course ofalmost all diseases. They know well how medical
conditions change when standard treatment isadministered. They also know well in what types ofsituations standard Western medical treatment andKampo medicine should be used together or when
they should be used separately.
2

Episode 1:
Let us begin with an episode that occurred to mypatient.
On a certain day in October 2011, a 70-year-oldman, my patient, climbed a famous mountain with1,500 meters in height. On his way down, he became
unable to walk because of a muscle spasm in both of
his thighs. Even after ten minutes or more, thespasm did not abate, and he remained sitting on theside of the path not knowing what to do. Then, astranger approached him and said, “Are you okay?”
He explained what happened, and the stranger told
him, “I have a good medicine for you. Here, takeone,” and disappeared.
He took the medicine, and within minutes, thespasms in his thighs subsided, and the pain was
also gone. He was so surprised for the effectivenessof the medicine. He said to me that he thought thestranger was a God. However, the stranger was
simplyan

ordinary

man

who

gave

a

shakuyakukanzoto extract to my patient. (Thestranger was a pharmacist, as I later learned.)
This episode shows that shakuyakukanzoto iscommonly used among many people as medicine formuscle spasms. It is widely known as a “silver
bullet” for leg cramps, and this Kampo formula ispopular not only as a medical prescription but also
as an over the counter (OTC) drug. It is commonlyused particularly by people who engage in sports,such as a long-distance cycling trip, hiking, and a

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

Volume 10, Number 1 | Spring 2015

back without taking goreisan. After another two

football match.
Katayama et al. sheds light on the roles of Kampo

years, all medication could be stopped.

medicine within the health care system in Japan
analyzing

This episode describes how a trigeminal neuralgia

approximately 67 million cases extracted from thepatient with facial pain gradually recovered bydata of health insurance treatment statements

taking goreisan in combination with carbamazepine.

governed by the Japanese Ministry of Health,

The administration of carbamazepine alone could

Labourfromvariousandperspectives,

Welfare1).

shakuyakukanzoto

is

the

by

They

showedthat

not adequately improve the patient’s pain, so

mostwidelyusedgoreisanwasadministeredincombination.

prescription in Japan. As a Japanese, it makes me

Therefore, carbamazepine could be lessened to theproud that such medicine is readily nearby andpoint where the pain could be controlled solely byavailable to everyone.

goreisan after a while, and a drug-free condition
was eventually achieved.
Standard Western medical treatment brings good

Episode 2:
A 75-year-old man with trigeminal neuralgia

results to patients usually, but when its effect is notcame to my clinic on September 25, 2006. In this one

enough, there are many cases helped by Kampo

month, he felt such strong pain in the right side of

medicine. As in the above, there are various forms of

his face that it was painful for him even to take atreatment. For example, initial standard treatment

bite of something or to touch his cheek. He visited a

may be combined with Kampo medicine whengeneral hospital and was diagnosed as trigeminal

satisfactory results could not be obtained. The twoR○treatments might be combined from the beginning,(carbamazepine), and his symptoms abated onceor temporarily. I hope the episode provided aafter taking the drug, but the pain recurred after

glimpse of how modern medicine and Kampo

ten days. He said the intensity of his pain varies by

medicine are integrated.

neuralgia.

the

day

He

and

was

administeredworsens

beforeTegretoltheweather
Episode 3:

deteriorates.
I administered goreisan (Polyporus Sclerotium 6g,

A 53-year old woman who was diagnosed as rectal

Alisma Rhizome 10g, Atractylodes Rhizome 6g,

cancer in January 2010 came to my clinic. Her

Poria Cocos 6g, and Cinnamon Berk 4g) with acancerprevious dose of carbamazepine. From the third day

dissemination, meaning in terminal stage, but sheof goreisan, his pain subsided largely, and he rarely

decided to undergo surgery and to seek help as

felt pain at night. By March 2007, his pain could bemuch as possible. I told her that the most I could dorelieved only with a half of tablet (50mg) ofis to lessen any damage she may incur fromcarbamazepine. Thereafter, he got better with

operative stress, and to reduce the side effects ofalternating periods of getting better and worse. On

anticancer drugs to a certain extent. Then, uponJune 16, 2010, I added another 4g of Poria Cocos ingaining her understanding, I consulted with her

consideration of the increased dampness of theattending surgeon, and started a decoction of arainy season. After continued administration of thishochuekkito-based prescription from a month before

prescription, his pain completely disappeared by thethe operation.

was

in

Stage

IV

with

peritonealend of February 2011, even without carbamazepine.

On February 17, 2010, she was performed surgery

I continued goreisan for two years thereafter on an

to remove her rectal cancer. From March 9,

intermittent basis because the pain tended to comeintravenous

injections

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

drug

3

Volume 10, Number 1 | Spring 2015

(FOLFOX) were begun. On this day, she had a CEA

family, but after her death, her friends worked forof 7.2 ng/dL and CA19-9 of 887.9 U/mL. Side effects

her as her family members. I learned later how

were expected from the surgery and administration

blessed she was to have such wonderful friends.

of the anticancer drug, she did not develop loss ofappetite,diarrhea,noraphthous

stomatitis.

Actually, her good appetite while the anticancer

Episode 4:
A 54-year-old man visited me with complaints of afever, sluggishness, and subtle pain in all his joints

drug was surprising.
On May 25, her CT scan showed hepatic

since the previous day. His fever would not go down

metastasis and peritoneal metastasis, and theeven after a day, and moreover, he said he suddenly

anticancer drug regimen was changed. From June 9,

developed lower back pain and could not walkshe began receiving an administration of irinotecan

properly. Although his lower back aches, he said hehydrochloride, but as this caused diarrhea, she wascame to my clinic seeking Kampo treatment

given hangeshashinto extract (Kracie Pharma, Ltd.,

primarily for his cold, as he is allergic toTokyo, Japan), which eased her symptoms. On June

non-steroidal anti inflammatory drugs (NSAIDs)

21, she developed aphthous stomatitis, whichandsubsided

extracttemperature was 37.7°C. He seemed to have

(Kracie Pharma, Ltd., Tokyo, Japan). Diverse

tremendous difficulty walking because of his lower

symptoms, however, gradually appeared thereafter.

back pain, and entered my office holding onto the

She showed signs of temporary recovery by using

wall.

after

shikonboreito

administeringin

unseiincombination

with

her

CalonalR○(acetaminophen).

His

body

other

He explained as follows. Last May and June, hetreatments, but passed away on September 13,

was underwent surgery for anal fistula. He took

2011.

Voltaren R○(diclofenac

sodium)and

Loxonin R○(loxoprofen) as part of his treatment, but stopped
This episode does not claim that Kampo medicine

taking those medications on the third day, as heis effective against malignant tumors. It shows thatdeveloped

Kampo medicine relieves the adverse effects fromthroughout his body. He underwent another surgery

the standard treatments against malignant tumors.

in November, and was cured of his anal fistula.

The

surgery,

Again, he was administered Loxonin, and again, he

anticancer drug treatment, or radiation therapy, butdeveloped a rash. When he caught a cold at the end

they are all invasive to the body, and the side effectsof the last year, he took an OTC drug, and again

are common.

developed a rash throughout his body. Thereafter,

standard

treatments

includeThe previous patient first received surgery to
removeherTheadministration

experiencedswelling

he developed lower back pain and went to an

Kampo

developed a rash again. After all, he wished to treat

medicine from a month before her surgery mitigated

his cold with Kampo medicine because he could notthetake NSAIDs or acetaminophen any more.

side

effectsoffollowed

andorthopedic clinic. When he took the Calonal, he

expected

immediately

rash

by

chemotherapy.

tumor,aheroffollowingchemotherapy, and allowed her to live comfortably,

I combined 2.5g of keishito extract (Kotaro

albeit temporarily, to the point where she could

Pharma, Ltd., Osaka, Japan) extract and 1.5g of

prepare herself to bring down the curtain on her life.

eppikajutsuto extract (Kotaro Pharma, Ltd., Osaka,

With the support of many friends, she passed away

Japan) extract to prepare a prescription similar to

and went to heaven surrounded by her friends. She
was alone about the fact that she did not have a4

keishinieppiichito, and told him to take it every twohours. I also told him to stop taking it when he

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

Volume 10, Number 1 | Spring 2015

begins to sweat. He took the Kampo formulas four

Kampo medicine is extremely effective against

times, sweated, and brought his fever down. The

many disease conditions that normally require thenext day, his body temperature was 36.6°C, and heuse of an antipyretic analgesic. Even if the above

said his sluggishness, sensation of heat, and joint

patient were not allergic to antipyretic analgesics, I

pains were gone.
After the episode of common cold, he wishedtreatment for his lower back pain, which has gotten
much better since the previous day but still aches. I
therefore began treating his lower back pain.

would

still

have

administered

the

above

prescription without hesitation. This is because
treatment of acute febrile illnesses is one of thegreatest specialties of Kampo medicine.
What the four episodes convey

This episode shows that Kampo medicine can beused to easily cure diseases even in a patient who is

Did you gain any new information from the above
four episodes? To those who are well versed in
Kampo medicine and Chinese medicine, they areallergic to standard treatment. As introduced above,

not particularly rare cases. Actually I introduced

he was allergic to many antipyretic analgesics. It isthem to show the roles that Kampo medicine could

disputable

areplay in medical systems that are based on modern

required for common cold or influenza that begins

medicine. Furthermore, it should be noted that they

with a chilly sensation. In Kampo medicine, iteach represent one of four types in the use of Kampo

should be avoided to adopt the medications which

medicine in daily clinical practices.

whether

antipyretic

analgesics“cool down heat” for the diseases because of “theinvasion of coldness”.

The characteristics of each type are shown in the
figure below2).

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

5

Volume 10, Number 1 | Spring 2015

Type 1: Kampo treatment is better thanstandard Western medical treatment, and is thus
1) Cases where Kampo treatment is definitely better

MTX

and

Kampo

of

antibacterials

anddaiobotampito for colonic diverticulitis
Case 5: Combination of kakkontokasenkyushin’ithan standard treatment
Case 1: yokukansan for behavioral and psychological

Case 6: Combination of inhaled steroids andCase 2: yojinkodakuto for chronic renal failure
Case 3: goreisan for headaches associated with aCase 4: goreisan for earaches that occur when

saikokeishito
recurrent

after

intra-abdominal

procedures

Case 5: shakuyakukanzoto for muscle spasms
forCase 7: Administration of daikenchuto for bowel
movement

boarding an aircraft

saikoseikanto

Kampo medicine for bronchial asthma
and COPD

decrease of atmospheric pressure

Case 6: shosaikoto,and standard treatment for purulentrhinorrhea

symptoms of dementia (BPSD)

and
upper

respiratory inflammation in children
Case 7: juzentaihoto for perianal abscess inchildrenCase 8: juzentaihoto for recurrent otitis media inchildrenType 3: The side effects of standard Western medical
treatment can be mitigated in combination with
Kampo treatment
Case 1: juzentaihoto, hochuekkito, etc. for loss ofappetite caused by anticancer drugs
Case 2: ninjin’yoeito for mitigation of the side
effects of anticancer drugs (mFOLFOX62) Cases where early healing or relief could beachieved by Kampo treatment

therapy)
Case 3: goshajinkigan for the neurotoxicity ofCase 1: A number of Kampo prescriptions for

anticancer drugs (FOLFOX therapy)

improvement of symptoms that occur

Case 4: shakuyakukanzoto for the neurotoxicity

before they are diagnosed as rheumatoidof anticancer drugs (taxane agents) andarthritis

neuralgia

Case 2: Kampo medicine represented by maotofor the early stages of influenza
anddiarrhea(mostlycausedbyrotavirus) among children
Case 4: Kampo

medicine(kakkonto,

stages of a cold

treatment

are

both

strengthened when the two are used in combination
Case 1: Combination of triptan and goshuyuto
for migraine headaches
Case 2: Combinationof(irinotecan

Case 6: ninjin’yoeito for anemia developed during
therapyfortreatmentof

Hepatitis C
Case 7: juzentaihoto for anemia during interferon+ ribavirin therapy for treatment ofType 2: The effects of standard Western medical
Kampo

drugs

hydrochloride)ribavirin

maobushisaishinto, etc.) for the earlyandCase 5: hangeshashinto for diarrhea caused by
anticancer

Case 3: goreisan for the early stages of vomiting

carbamazepine

goreisan for trigeminal neuralgia
6ofmedicine for rheumatoid arthritis
Case 4: Combination

used alone

treatment

Case 3: Combination

andHepatitis C
Case 8: saikokaryukotsuboreito

fortachycardia

caused by tocolysis (ritodrine hydrochloride)used in the treatment of threatened
miscarriage or premature delivery
Case 9: bakumondoto, etc. for dry mouth causedby the administration of psychotropic
drugs

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

Volume 10, Number 1 | Spring 2015

Types 4: Treatment is needed, but standard Western

References

medical treatment cannot be applied

1.

Katayama

K,

YoshinoT,

Munakata

K,

Case 1: Cases where standard treatment cannot

Yamaguchi R, Imoto S, Miyano S, Watanabe K.

be applied due to a drug allergy

Prescription of kampo drugs in the JapaneseCase 2: Cases where standard treatment cannot

health care insurance program. Evidence Basedbe applied due to its side effects

Complement

Case 3: Cases where standard treatment isdifficult due to age constraints
From the next issue and on, I will introduce eachof the above patterns in detail, for case examples.

Alternat

Med.

2013;

ArticleID576973, 7 pages
2.

Yasui, H. Characteristics of Kampo medicine asseen from the perspective of an integrated
medical system. FY2013 Health and Labour
Science Research Grant from MHLW (study forthe development and promotion of regional
medical foundations), “Standardization of thediagnostic method, prescription classificationand terminology of Japanese Kampo from a
global scientific perspective,” (in Japanese),2014.

[List of prescriptions]
shakuyakukanzoto: 芍薬甘草湯
goreisan: 五苓散hochuekkito: 補中益気湯
hangeshashinto: 半夏瀉心湯
unseiin: 温清飲
shikonboreito: 紫根牡蛎湯keishito: 桂枝湯
eppikajutsuto: 越婢加朮湯keishinieppiichito: 桂枝二越婢一湯

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

7

Volume 10, Number 1 | Spring 2015

Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (15) – Neurology A

Ikuro Wakayama

General Neurology
1. Acupuncture Indications in Neurological Disorders
The World Health Organization (WHO) presented
a list of 43 disorders treatable by acupuncture in 1979.
The list was amended to 49 disorders in 1996. Current
research on these disorders will be presented here.
Each neurological disorder category contained various
symptoms and diseases, such as headache, migraine,
tension-type headache, sciatic neuralgia, post-herpetic
neuralgia, and hemiplegia. However, rigorous clinical
trials have not been conducted to prove theeffectiveness of acupuncture for these conditions. The
1979 list of conditions was clearly not based on clinicalevidence. Therefore, reflection on the 1996 draft led tothe conclusion that future amendments ofacupuncture indications should be adapted based on
rigorous clinical evidence1) . Work began in 1996, andwas eventually published by the WHO in 2002 as"Acupuncture: Review and analysis of reports oncontrolled clinical trials"2). As the title of this bookindicates, clinical acupuncture research designed as
randomized controlled trials (RCT) and controlled
clinical trials (CCT) has demonstrated that 28
conditions have been shown to be effectively treatablewith acupuncture. An additional 63 conditions may beeffectively treatable but further evidence is required, 9conditions warrant clinical trials as the current
Western treatment has proven difficult, and 7
conditions seem promising but still require an
appropriate method of evaluating current clinicalresults. Even though clinical trials are the basis forthis book, it should be noted that a majority of theresearch presented is still of low quality. Since 1996,
when these results were first collared, neurologicaldisorders confirmed to be effectively treatable byacupuncture included facial pain, headaches, sciatica,
and stroke.
On the other hand, in 1997, the National
Institutes of Health (NIH) issued a Consensus
Statement that the effectiveness of acupuncture was8based on scientific evidence, and it included the relief
of nausea and vomiting caused by surgery and/or
chemotherapy, hyperemesis gravidarum, andtoothache following surgery. Also cited wereconditions related to pain, drug addiction, stroke,headache, menstrual pain, tennis elbow, fibromyalgia,
low back pain, carpal tunnel syndrome, and asthma;of these, only headache and stroke are neurologicaldisorders. Concerning the 2002 statement by the
NIH, there have been recent publications on theInternet indicating that the statement may no longer
be valid3).
Although most of the fundamental results werebased on poorly designed clinical research, the WHO
and NIH, internationally recognized agencies,
announced which conditions can be treated byacupuncture. However, very few neurologicaldisorders were mentioned. This has been thesituation regarding acupuncture therapy forneurological disorders until just recently. Concerning
the future of moxibustion therapy, high-quality,
integrated clinical trials are eagerly awaited, with it
only occasionally being reported in clinical trials at
the present time. For this reason, the current volume
focuses on acupuncture therapy.
2. Review of Acupuncture for Neurological Disorders
as Presented in the Cochrane Collaboration
The Cochrane Collaboration was founded in 1993,
and it assists people involved in health care byreferring them to online information. It currently
consists of over 4,000 Cochrane reviews, helping
patients obtain accurate information so that they canmake informed health decisions. Cochrane reviews
are based on systematic reviews of primary researchin human health care. Reviews are posted on someneurological disorders, such as stroke, Bell's palsy,
dysphagia due to stroke, epilepsy, prevention of
migraine,
restless
legs
syndrome,
strokerehabilitation, tension-type headache, and vasculardementia4).
Reviews of the results for the neurologicaldisorders are displayed in Table 11. They have yet todraw conclusions or post prospects for the future

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

Volume 10, Number 1 | Spring 2015

because most current reviews are based mostly on
low-quality clinical trials. However, reviewers
suggested that, for the prevention of migraine andtension-type headache, acupuncture treatment iseffective5, 6). In addition, for these 2 notable diseases,by adding a new clinical trial in the 2008 Edition, forwhich evidence was insufficient in 2001, reviews of
the effectiveness were verified. That is to say, thequality of clinical trials for the conditions listed inTable 11, as well as other diseases, or diseases notlisted here, will confirm the effectiveness ofacupuncture for neurological disorders once
large-scale, high-quality clinical research can be
conducted. Additionally, there are some neurologicaldisorders for which trials have not yet been
conducted but protocols for them have been
established. They are Guillain-Barre syndrome,
multiple sclerosis, Parkinson's disease, post-herpetic
neuralgia, and diabetic neuropathy.

Regarding whether or not acupuncture iseffective for specific neurological disorders, there
are currently few studies and little evidence
besides migraine and tension-type headaches.
However, this article refers to the Cochranereviews as a potential source of evidence for thevalidationofneurologicalacupuncture's
disorders:effectivenessfor

migraine,

(2)

(1)

tension-type headaches, (3) epilepsy for functional
disorders; (4) Parkinson's disease, (5) stroke, and(6) multiple sclerosis for central nervous systemdisorders; and (7) diabetic neuropathy, (8) Bell's
palsy, (9) Guillain-Barre syndrome, and (10)post-herpetic

neuralgia

forperipheral

nerve

disorders. Here, we introduce international anddomestic

research

resultsonacupuncture

treatment for these 10 conditions.

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

9Volume 10, Number 1 | Spring 2015

3. International Research on Acupuncture Treatment
for Neurological Disorders

Concerning

other

disorders,forexampleParkinson’s disease, there are 2 SR, and only one or

Most of the international clinical research on theat most 2 RCT available. Both of these Parkinson’s

above-mentioned neurological disorders, including

disease SR were presented in 2008. However, thestroke,headache,first SR reported on the significant effectiveness of

involve relatively common diseases. Regarding

acupuncture treatment. The second SR included an

stroke,migraine,theandtension-type

effectofacupunctureforstrokeRCT on scalp acupuncture within the effectiveness

in

the

Cochrane

review

wasof acupuncture therapy, and a meta-analysis

inconclusive as shown in Table 11, but later, aprovided further evidence of its efficacy, althoughsystematic review (SR) indicating acupuncture as

the overall effectiveness of acupuncture treatment

12)7, 8). In

for Parkinson's disease was not conclusive (Table

rehabilitation

effective treatment was reported (Table
addition,anSReffectiveness

of

has

been

reported

14)10, 11). Thus, at present, convincing evidence forstrokethe effectiveness of acupuncture treatment onneurological disorders is definitely lacking, but,that there is sufficient SR-based evidence for either

recently, there has been a gradual increase inacupuncture or moxibustion; however, it could be

reliable evidence.

if

more

RCT

are

for

the

rehabilitation (Table 13)9). Thus, it cannot be statedconfirmed

moxibustionon

conducted

andintegrated as SR in the near future.

10

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

Volume 10, Number 1 | Spring 2015

This concludes our overview of the results of the
Cochrane review with references to SR and RCT inforeign countries. Gradually, evidence for theeffectiveness of acupuncture in some neurologicaldiseases such as migraine and tension-type
headache has been increasing. In addition, as I
indicated in Parkinson's disease and stroke, thequality of trials improved, the scale of the trials
increased, and the SRs integrated those trials, andso the effectiveness of acupuncture will be morestrongly supported.
4. Domestic Research on Acupuncture Treatment for
Neurological disorders
a. Clinical Trials
Of the 10 conditions listed above, unfortunately,
no RCT have been from Japan. Amongcomparative studies using multiple subjects, one
report involved 38 patients suffering from diabetic
neuropathy treated with acupuncture12), andanother study treated 113 patients with peripheral
facial palalysis (Bell’s palsy or Hunt syndrome)13).
Three comparative studies reported on the clinicaleffects of acupuncture and moxibustion treatment
for stroke patients combined with rehabilitation14-16).
Also, there was a report on the n-of -1 trial method
for Parkinson's disease17). Comparative research inJapan has not been conducted for other neurologicaldisorders. Therefore, as discussed above, there arevery few comparative studies investigating
acupuncture intervention for neurological disorders
conducted in Japan.
b. Case Series
There are case series studies demonstrating theeffect of acupuncture treatment for tension-type
headache (86 patients)18) and refractory cases of
Bell’s palsy/Hunt syndrome (29 patients)19). Resultsfrom these studies showed almost or complete
clinical improvement at rates of 19.7 and 17.2%,
respectively, indicating the reliable effects ofacupuncture treatment for these conditions. Also,
successful acupuncture treatment for 48 subjects
with cervical dystonia 20) was reported. High-quality,
comparative clinical trials in the future are desirable.
c. Case Reports
As for case reports, especially treatment resultsof acupuncture interventions, it has generally been
the case that reports of these results focus primarily
on atypical treatment courses or unexpectedfavorable results. Case reports suggesting special
mechanisms of action of acupuncture that were notpreviously
reportedarealso
important.
Unfortunately, those kinds of case reports are veryrare among Japanese clinical reports; instead, mostreports merely mention that acupuncture could be
used to successfully treat the presenting symptoms.
Acupuncture case reports within the field of
neurological disorders in Japan usually focus on the

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

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Volume 10, Number 1 | Spring 2015

10 disorders addressed above. However, recently,
acupuncture treatments are being increasingly
reported for specific central nervous systemneurological disorders, such as Parkinson's diseaseand cervical dystonia in which muscle tone
increases pathologically.
d. Acupuncture
Treatment
for
Neurological
Disorders in Japan
Regarding acupuncture treatment methods inJapan for functional headache, including bothtension-type headache and migraines, thetreatment generally centers on acupoints andtender points of the neck and shoulders 18). For
Parkinson's disease, acupuncture points wereselected based on visceral pattern identification,and the acupuncture session will also include points
for local tenderness and induration21). For diabetic
neuropathy, the needle retention method orelectro-acupuncture
generally
utilizes
distal12,22). Treatment for facial
extremity acupoints
paralysis usually includes the 6 acupoints on yangchannels of the face combined with peripheral
acupoints of the upper extremities13, 19).
5. Future Perspective
With the current development of medicine, weare seeing the era of a team approach in health care.
Acupuncture was introduced from China in the 6th
Century, and later developed as Japanese
acupuncture during the Edo era; however, medical
teams integrating acupuncture and other forms of
medicine have not yet been realized. The medical
system in Japan has only recently started toemphasize the importance of a team approach.
The development of clinical research without theconsolidation of the team approach is impossible.
That is to say, for conducting good clinical research,
research team composed of more than several kindsof professionals, such as supervisor, physicians,
clinical epidemiologists, statisticians, and others,
are necessary, and good study designs are alsoneeded. This type of research system was developedin Western countries, but has not yet been fully
developed in Japan. Why have clinical trials of
12

acupuncture not been well-developed in East Asian
countries such as China, Korea, and Japan where
acupuncture originated? It is because the teamapproach as seen in Western countries has not beenpracticed. Large-scale trials of acupuncture
conducted in the West have been, as mentioned
above, extremely precise, co-authored, and carriedout by multi-talented teams of professionals fromdifferent fields. In addition, there is the possibility
that because acupuncture and moxibustion
developed gradually since ancient times in Japan,
there was never any doubt about their clinicalvalidity or effectiveness, so clinical trials did not
develop. However, as a more significant factor,
acupuncture was not considered appropriate in a
hospital setting where large-scale trials conductedby qualified research teams took place, so
acupuncture and acupuncturists were largely left
unexplored and under-utilized.
Most clinical trials of acupuncture involving
Japanese interventions include just low number andsmall-scale clinical trials on low back pain23).
Considering international clinical trials for low backpain, relatively reliable evidence for theeffectiveness of acupuncture is readily available.
However, establishing evidence may not bedesirable even for low back pain if the current
research system in Japan does not change, being
much less desirable for neurological disorders.
As mentioned above, high-quality, large-scaleclinical trials are thought to be necessary to verify
the clinical effect of acupuncture in Japan. However,
we cannot have high hopes for the relevancy ofacupuncture research in Western hospitals until anestablished system of team research develops, andacupuncture is used as a matter of course withinthat system.
References
1) Kawakita K: WHO guideline for acupuncture.
Ido-No Nippon 626 : 71-74, 1996. (In Japanese)
2) World Health Organization: Acupuncture:
Review and analysis of reports on controlled
clinical trials, 2002.

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

Volume 10, Number 1 | Spring 20153)

http://consensus.nih.gov/1997/1997acupuncture
107html.htm4) http://www2.cochrane.org/reviews/en/topics/22
reviews.html
5) Linde K, Allais G, Brinkhaus B, et al.:Acupuncture for tension-type headache. Cochrane
Database Syst Rev 21: CD007587, 2009.
6) Linde K, Allais G, Brinkhaus B, et al.:Acupuncture for migraine prophylaxis. Cochrane
Database Syst Rev 21: CD001218, 2009.
7) Kong JC, Lee MS, Shin BC, et al.: Acupuncture
for functional recovery after stroke: asystematic
reviewofsham-controlled
randomized clinical trials. CMAJ 182(16):1723-1729, 2010
8) Wu P, Mills E, Moher D, et al.: Acupuncture inpost stroke rehabilitation: a systematic review
and meta-analysis of randomized trials. Stroke
41(4): e171-179, 2010.
9) Lee MS, Shin BC, Kim JI, et al.: Moxibustion
for stroke rehabilitation: systematic review.
Stroke 41(4): 817-820, 2010.
10) Lam YC, Kum WF, Durairajan SS, et al.:Efficacy and safety of acupuncture for
idiopathic Parkinson’s disease: a systematic
review. J Altern Complement Med 14(6):663-671, 2008.
11) Lee MS, Shin BC, Kong JC, et al.: Effectivenessof acupuncture for Parkinson’s disease: asystematic review. Mov Disord 23(11):1505-1515, 2008.
12) Kasuya D: Acupuncture for painful diabetic
neuropathy.
The
JournalofKampo,
Acupuncture and Integrative Medicine 1(2):13-20, 2006.
13) Inaka Y, Okamura Y, Miyajima K et al.: Effects
of electro-acupuncture treatment on facial
paralysis. Journal of the Tokyo Women’s
Medical School 75(12): 470-476, 2005. (InJapanese)
14) Ikeoka K, Morifuji C, Chihara K et al.: Various
Approach- Synergistic effects of power
rehabilitation and acupuncture treatment.
Power Rehabilitation 6: 166-167, 2007. (InJapanese)15) Okatsu T, Kawada S, Nakayama A et al.: Effectof acupuncture on sequelae of stroke patientsStudy on effects to the ADL, QOL and mental
state Modern Acupuncture and Moxibustion
Research 7(1): 103-110, 2007. (In Japanese)
16) Shirota T: Effect of combining acupuncture
treatment with rehabilitation in post stroke
patients. Annual report of Health Medicine
Frontier Center at Gifu prefectural Gero
hospital 33: 29-34, 2006. (In Japanese)17) Masuya Y, Higashimoto Y, Wakayama I: Effectsof acupuncture treatment on Parkinson’s
disease-Clinical trials with single subject
design. Bulletin of the Kansai University of
Health Sciences 4: 67-74, 2010. (In Japanese)18) Yamaguchi S, Omata H, Arai C et al.: Effects ofacupuncture
treatmentontension-type
headache- Especially for patients referred fromother departments. Journal of the Japan
Headache Society 31(2): 126-128, 2004. (InJapanese)
19) Ebiko K, Tanba S, Kikkawa M et al.: Effect ofacupuncture on refractory Bell’s paralysis
and Hunt’s syndrome- Examination of 29
patients with a minimum ENoG of 0% andNET scale-out. Kampo Medicine 60(3):347-355, 2009. (In Japanese)20) Tani M, Takada A, Inoue H, et al.: Clinical
Report 1 (Japan) Acupuncture for cervicaldystonia. The Journal of Kampo, Acupuncture
and Integrative Medicine 1 (4): 13-18, 2006.
21) Egawa M: Acupuncture and moxibustion treatment
for Parkinson’s disease and Parkinsonism. Ido-No
Nippon 722 : 43-48, 2003. (In Japanese)
22) Ishizaki N, Yano T: A practice of complementary
medicine- Report of a patient with painful diabetic
neuropathy Ido-No Nippon 60(13): 30-35, 2001. (InJapanese)
23) Shimoichi Y, Haruki J, Wakayama I: Acupuncture
for patients with lower back pain- Systematic
review of randomized controlled trials conducted inJapan- J. Japan Society of Acupuncture andMoxibustion 64(1): 37-53, 2014. (In Japanese)

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

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Volume 10, Number 1 | Spring 2015

Clinical Report 1 (Acupuncture)
A Case of Acupuncture and Moxibustion Treatment for
Insufficient Lactation Following Premature Birthadministration of acupuncture and moxibustion
treatment made breast-rearing possible.

Naoko Maeda
1) Ayumi Acupuncture and Moxibustion Clinic2) Ayumi Midwifery Clinic3) Dept. of Health Sciences, National University
Corporation of Tsukuba University of Technology【Case】
1. Profile
The patient was a 37-year old woman, height
159cm, weight 59kg, wishing mainly to improve theinsufficient lactation after the birth of the second
child.

【Introduction】
Obstetrics and pediatrics in Japan promote

Asthmaandbuckwheatallergywerecomplications. The asthma the patient had beenissuffering from during her childhood had been

defined as the promotion of infant growth throughalleviated, but recurred after the birth of her firstbreast-feeding with breast milk (the mother feeds

child

the infant directly from her own breast). Even if

inhalation twice daily of Pulmicort. The family

only a small amount of breast milk is fed to thehistory shows that her father had hypertension andinfant, one can speak in this case of breast-rearing,her mother arrhythmia.

breast-feedingininfancy.

"Breast-rearing"

and

can

currentlybecontrolled

with

but ideally the proportion of breast milk should be

Following the 20th gestational week the patient

increased. On the other hand, "maternal feeding"took tocolytic agents 4 times a day and rested atrefers to feeding breast milk to provide nutrition

home, but on the third day of the 35th week her

where administering mother's milk in other ways

waters broke and on the 5th day of the 35th week she

than direct breast-feeding also covers the definition

gave birth to a 2210-g boy through vaginal delivery.

of maternal feeding. This feeding form is called

Both mother and child were later discharged after"maternal feeding" when the proportion of mother's

the usual length of hospitalization.

milk is higher than 80%, while at a proportion ofless than 20% it is called "artificial (bottle) feeding"and the range from 20% to 80% is labeled "mixed

2. Postpartum course
Since

directbreast-feeding

immediately

feeding". Accordingly, even if artificial feeding the

postpartum was not possible as shown in Figure 1,

proportion of mother's milk which is less than 20%

she received breast-feeding instructions 30 days

still constitutes breast-rearing1).

after delivery from the practicing midwife S and

Yet, while in the "Investigation of infant feeding

thus became able to directly breast-feed by the 42nd(2005)" conducted every 10 years by the Ministry of

day after delivery. Also, because of insufficient

Health, Labor and Welfare2) 96% of the pregnant

lactation the patient received by the 61st day a

women responded during pregnancy, that theybreast massage from the practicing midwife S, butwould like to provide maternal feeding, threesince this did not promote lactation as expected, shemonths after delivery 20% of the mothers did not

visited this clinic by the 81st day after delivery,breast-feed. Further, if the infant's suckling power

asking to promote lactation because she strongly

is weak because of premature birth, making oral

wished to provide maternal feeding.

feeding impossible, breast-rearing will become
3. Present status

difficult.
Here I will report in a case insufficient lactation
following
14

prematurebirth,

wherethe

The mother's abdomen on the whole lacked
strength, in particular the area around CV4

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

Volume 10, Number 1 | Spring 2015

appeared to be concavity, but the adequate tensionof the mother's breasts and engorgement of blood

5. EvaluationIevaluatedthefollowingparameter:(1)

vessels was not observed. Moreover, excessive

concavity around CV4 and general abdominal

tension of the neck and back muscles was observed.

tension as body surface findings, (2) improvement of

The infant on the other hand gained about 10g bodyshoulder and back muscle tension, and (3) the

weight during the week prior to the clinic visit anddevelopment of an appropriate tension of the

drank about 280ml of powdered milk, divided into 7

breasts and engorgement of the blood vessels, set

portions over the day. On an acupuncture andthe weight gain of an average infant of 25-30 g/day

moxibustion examination I judged the condition of

as a target, and (4) decreased in the amount of

the mother being a deficiency pattern and recovery

powdered milk. Further, I had the patient weigh theafter childbirth being doing poorly. Also, the weight

infant's body weight at home and report back, upongain of the infant appeared to be insufficient. The

which the amount of powdered milk was decreased

amount of powdered milk for an infant of the given

over several steps.

age of the moon of the first visit would have been
720-960ml, so that I judged the feeding to be mixed
feeding with a ratio of 29.2%-38.9% of powdered【Results】(Figure 2)
The acupuncture and moxibustion treatment
was performed a total of 5 times. Treatment intervalmilk.

was 3 days between the first and second session andafter that once a week.

4. Acupuncture and moxibustion treatment
The acupuncture and moxibustion treatment

At the first visit the same amount of powdered

had the goal to improve the deficiency pattern of themilk of 280ml was used and the number of feedings

mother, in other words recover from the fatigue ofper day decrease by 2 times from the 7 times.

delivery and increase the amount of lactation.

Since at the second visit (3 days after the first

Based on the examination of the mother and thevisit) still neither an appropriate tension of thecondition of her breasts the amount of powderedbreasts and engorgement of the blood vessels nor

milk was decreased over several steps. At first visit

any other changes in physical condition wereI treated the stiffness of neck, shoulder and backobserved, I repeated the same treatment given

muscles, using KI4, KI7, KI9, HT3, PC4, SP4, SP7,

during the first session. From the second session theinserting needles to a depth of about 5 mm andpatient realized an until that point not present

retaining them there for about 12 minutes. I used

increase in lactation resulting in permeation of

40-mm stainless steel needles with a diameter ofbreast milk into her underwear and a daily weight

0.16mm (Seirin product). To improve the concavity

increase of the infant of 35g. For those reasons thearound CV4, the lack of abdominal tension anddaily amount of powdered milk was decreased 7

promote lactation I applied moxa sticks at KI3, SP6days after the first visit to 200ml administered inand CV17 until the lack of abdominal tension andsitting. Following the 13th day after the first visit,

concavity around CV17 had disappeared. I used the

however,moxa

sticks)"administered per day was returned to 280ml,

manufactured by Senefa. Also, I instructed the

because the weight gain of the infant later fell shortpatient to apply these moxa sticks as self-care atof the expectations.

sticks"SennenQ

Bokyu

(moxa

home once or twice daily for about 5 minutes at KI3,
SP6 and CV17.

theamountofpowderedmilk

On the fourth visit (17 days after the first visit)
the concavity around CV4 had decreased in depth

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

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Volume 10, Number 1 | Spring 2015

and both a general increase in abdominal tension

highest immediately after delivery and gradually

and an appropriate tension of the breasts anddecreases after that, but each time the nipples areengorgement of the blood vessels were observed. Yet,stimulated temporarily increases again, resulting inbecause these improvements were still insufficient,thethe same treatment administered during the firstsuckling by the ninth day postpartum independent

session was continued. Also, the mother hadof the prolactin or oxytocin concentration. After aobserved her child without administering powdered

3-month postpartum period the prolactin value

milk, but since the infant's weight decreased, shesettles to the same level as in non-lactating womenadministered 21 days after the first visit 160ml ofand even after suckling increases are no longer

powdered milk per day.

observed. Promotion of sufficient lactation requires

establishmentofperiodiclactation

upon

By the fifth session (24 days after the first visit)

adequate sleep, avoidance of mental stress and thethe concavity around CV4 had disappeared, theperformance of breast massage." On the other hand,abdominal wall showed elasticity, the breast an

the Ministry of Health, Labor and Welfare reported

appropriate tension and engorgement of the blood"Examination of fluctuations in the proportion ofvessels. For this reason the treatment in this clinic

infant feeding methods (Figure 3) shows, that 1

was terminated and the patient instructed tomonth postpartum 42.5% used maternal feeding,continue the self-moxibustion at home. Even after

52.5% mixed milk feeding and 5.1% artificial

the end of the acupuncture and moxibustion

feeding. Three months postpartum the ratio oftreatment the patient reported the body weight ofmaternal feeding had decreased by 4.4% to 38.0%,

the infant and continued to adjust the amount ofwhile the ratio of mixed milk feeding had fallen bypowdered milk.

11.5% to 41.0%. However, the ratio of artificial

The amount of powdered milk per day was 38

feeding had increased by 15.9% to 21.0%. This

days after the first visit 160ml and the infant gained

indicates insufficient lactation and an increase ofabout 25g weight per day. When the amount ofmothers not feeding the infants with mother's milk.

powdered milk used per day was 140 ml the weight

It also reveals that during pregnancy mothers may

gain of the infant dropped to 18.6g, so that 52 days

wish to breast-feed their children, but during theafter the first visit the amount of powdered milk per

lactation period this may in reality not work out so

day was returned to 160ml. The weight gain of thewell.

infant stabilized as a result of feeding 160ml of

In this case the patient took tocolytic agents

powdered milk per day. I concluded that the motherduring the pregnancy, but based on the prematurewasmanagement

delivery I surmise that her body was not ready to

independently and we agreed to terminate themaintain the pregnancy until full term (from thetreatment, but she would continue to feed the infant

37th GW to less than the 42nd GW). Also, the first

powdered milk once a day.

visit for acupuncture and moxibustion treatment

capableofcontinuingthewas on the 81st day after delivery and the treatment
was completed on day 103 after delivery. The【Discussion】
Lactogenesis and lactatin are according tocondition of mother and breasts, the time of"Standard Science of Obstetrics and Gynecology"3) alactation onset had already reached the stage ofprocesses where "postpartum stimulation of the

non-lactating women, so that it can be anticipatednipples by suckling releases prolactin, which thenthat without treatment she would gradually havepromotes lactation. The prolactin secretion isswitched to artificial nutrition.

16

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

Volume 10, Number 1 | Spring 2015

Searching for reports about insufficient lactation

the mother. With the convalescence of the motherin magazines about Chinese medicine I found onlyand disappearance of the depression at CV17 the

one

while

mother started to provide maternal feeding and an

hospitalized after full-term delivery by Fujiwara etappropriate tension of the breasts and engorgemental.4).

of the blood vessels were observed. The acupuncturereportabout

supporting

lactation

Causes for insufficient lactation include (1)and moxibustion treatment promoted lactation in

decreased lactation volume because of low milkspite of the prolactin dropping to a level similar to

production, (2) sufficient production, but problems

thatwith the milk discharge, (3) poor holding of the baby,

improvement of the postpartum exhaustion of the(4) the infant cannot take hold of the nipple because

mother the treatment thus conceivably led toof inverted nipples, or (5) there is a problem of how

maternal feeding.

of

non-lactating

women.

Achieving

the infant suckles5). In the present case (1), (4) and

The first author has a license as a midwife and(5) conceivably could have caused the insufficientas such examined the condition of the mother andlactation. Again, (6) decreased suckling drive, (7)her breasts, adjusting the amount of powdered milk

suckling difficulties and (8) exhaustion of theseveral times, but as Figure 2 shows, the infant did

motherdirectnot reach the target weight gain line. Adjustment ofbreast-feeding. Suckling difficulties include (a)the amount of powdered mild, not only in thismalformation

flat,

particular case, may determine, whether thehypertrophic hypotrophic), (b) anomalies of theinfant's weight gain will reach the expected level orbreasts (breast tension, secretion), (c) medical

not. Yano recommends that pregnant women should

conditions like cleft-palate), (d) functional factors

receive appropriate guidance from a midwife

like immature infant, low-birth-weight newborn

already during pregnancy. He recommends that theand (e) medical factors8). The items (6), (8) and a., b.

guidance by the midwife should be continued

and d. applied in the present case.

postpartum and a combination with acupuncture

may

be
of

factorsthe

impeding

nipples(sunken,Tatsunami et al. reported about the effects ofand moxibustion treatment would be desirable5). As

combined Ringheaded thumbtack needles andYano already pointed out, cooperation with thebreast massage6), while Fujiki et al. reported about

midwifethe effects on lactation in a SSP treatment grouptreatment results in a still more appropriatecompared with an untreated group7), where either oftreatment. Moreover, receiving acupuncture andthese reports had been limited to a period of one

moxibustion treatment already during pregnancy

month from immediately after delivery. Yano usedhelps to prepare the expecting mother's body andthe following acupoints GV20, LU1, LU2, CV6,

may guide the women towards a normal delivery. A

CV12, CV17, ST18, ST36, SP6, LR3, SI11, BL17,

normal delivery reduces the physical burden andduringacupunctureandmoxibustion

Tatsunami et al. used LU1, CV17,

leads to a good start of the child rearing. Reducing

while Fujiki et al. listed LU1, ST18,

the physical burden associated with pregnancy,

BL18,

BL205),

ST36

etc.6),

CV17, SI11, GV12, LU107). Common acupoints aredelivery,childrearingbyacupunctureand

LU1 and CV17, but the reports did not detail themoxibustion treatment helps mothers to enjoy

reactions at the acupoints. In my case, however, I

childcare and the author would like to recommend

chose and treated CV17, because I felt a depression

using acupuncture and moxibustion treatment forthere (state of deficiency) upon palpation and also

many pregnant women.

treated this point for postpartum convalescence of

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

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Volume 10, Number 1 | Spring 2015

4. Yoko Fujiwara, Keiko Tori, Chikako Hisatomi,【Conclusion】
In a woman with insufficient lactation after giving

Akiko Uchino, Minoru Uchino: About support forprematurely birth in the 35th GW 5 acupuncture

early phase hypolactation. Journal of the Sagaand moxibustion treatments starting on the 81st day

Department of the Japan Society of Maternal

after delivery and reduction in the amount of

Health, 15(1), 25-27 2012

powdered milk made maternal feeding possible.

5. "Ladies Acupuncture and Moxibustion", Tadashi
Yano, Ishiyaku Pub,Inc., 251-257, 2006
6. Takako

References
1. Toshiaki Shimizu: The definition of maternal
feeding. Nutrition Committee – Report by the
newborn committee about the breast milk

Investigationof

Tadashi

Tsubo

Yano,

(acupoint)

ettreatment to promote lactation and its effects, Japan
Society of Maternal Health, 38:396-402, 1997
7. Akira Fujiki, et al.:. SSP treatment for patientswithSociety, 115(8):1364-1367, 2011

medicine and the pain clinic, 15:1013, 1985

3. "Standard Science of Obstetrics and Gynecology".
Takashi Okai, Takuya Ayabe, Igaku Shoin, 2011al.:,stimulation

promotion project. Journal of the Japan Pediatric
2. http://www.mhlw.go.jp/houdou/2006/06/h0629-1.html

18

Tatsunami,

postpartum

8. "Nursing
Matsubara,forhypolactation,

Maternal

MinakoFeeding",

Yamanishi,

SHUPPAN, Publishers Co., Ltd., 2003

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

Oriental
Manami
MEDICUS

Volume 10, Number 1 | Spring 2015

Body weight and amount of powdered milk from delivery until visit in thisWeight(g)Amount of milk/day(ml)30 days after delivery,
consultation with midwife

42 days after delivery,
direct breast-feeding
becomes possible

Powderedmilk

WeightFirst visit

Weight gain curvewhen weight gain

61 days after delivery,is 1 kg/monthconsultation with midwife

No. of days
after delivery

Figure 1

Present illness

Weight gain after support and amount of powdered milk per day
Weight(g)Amount of milk/day(ml)Powderedmilk

Moxibustion
at home

WeightAvg. weight gain

Targetweight gain
Acupuncture &Moxibustion treatment (5)Acupuncture &Moxibustion treatment (4)Acupuncture &Moxibustion treatment (3)Acupuncture &Moxibustion treatment (2)Acupuncture &Moxibustion treatment (1)27g/day
18.6g/day
25g/day

35g/day

10g/day

Decrease
No. of days
after elivery

No. of days

Figure 2 Course

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Volume 10, Number 1 | Spring 2015

Fluctuations feeding methods
One monthafter delivery

Maternal feeding 42.5%

Mixed feeding 52.5%

Artificial feeding 5.1%

Three months
after delivery

Source: Ministry of Health, Labor and Welfare "Investigation of infant feeding in 2005"
Figure 320

Fluctuations in infant feeding methods

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

Volume 10, Number 1 | Spring 2015

Clinical Report 2 (Kampo Medicine)
A Case Where Ryokyojutsukanto was Effectivefor Hyperactive Bladderand had a violet-red tongue with dental impressions.
Sublingual veins were only slightly engorged. The
pulse was deep and choppy. On his abdomen only a

Yuji Fukuma

Departement of Urology, Hidaka Hospital

The number of patients with hyperactive bladder,a pathological condition marked by pollakiuria andurinary urgency, is steadily rising in conjunction
with the increasingly aging population in Japan.
Therapy is based mainly on anticholinergic drugs orbeta-3 adrenergic receptor stimulants, but the effectcannot always be described as sufficient, rendering
treatment in many cases difficult. Further, while
prescription of these western medications may
cause an increase in residual urine volume aftervoiding and urinary retention, the use of Kampo
medicines has the advantage of carrying a low riskof these effects, allowing the physician to use themunworriedly.

mild degree of palpitations above the umbilicus
were observed. He complained about chilling andweariness of low back and legs and his lower legs
tended to become edematous in the evening. Basedon these signs ryokyojutsukanto was prescribed.
Without any increase in the residual urine volume
followingvoidingtheurinaryincontinence

disappeared after about one month and the OABSS
improved by 4 points. The prescription was chosen
to target not only the voiding related symptoms, butalso accessory symptoms and proved to be effectivein this one case.
Kampo medical interpretation of hyperactive
bladder allows classification by several causes.
Weakness of the pelvic floor, stagnation of pelvic
blood flow or insufficient blood flow, liver qi

On this occasion I would like to present one casedepression

andstagnation,

heart

fire,

water

difficult to treat with western medication in which

stagnation (water intoxication), chilling and stressryokyojutsukanto was effective.

are the main etiologic causes for hyperactive

The patient was a 68-year old man. He has ahistoryofdiabetes,

lipid

anomalies

andhypertension. In August of XXXX nocturia andurinary urgency developed for which he consulted
the department of urology of another hospital. The
patient was diagnosed with hyperactive bladder,but the prescribed anticholinergics (solifenacin,
propiverine) were not effective. Even just hearing
the sound of running water induced the desire tourinate. Low temperatures on November 11 of thesame year causing an aggravation of the nocturia
and urinary urgency/incontinence motivated thepatient visited our department. At the time hevisited our department he experienced urinary
urgency/incontinence 2 to 4 times a day and thevoiding frequency at night was 5 times. The
overactive bladder symptom score (OABSS) was a
total of 12 points and the residual urine volume
following voiding 59 ml. He was of slender physique

bladder and allow to understand the rationale forusing the relevant formulas. In cases of weakness ofthe pelvic floor qi supplementing formulas likehochuekkito or shikunshito are used. For stagnationof pelvic blood flow or insufficient blood flow mainly
formulas for overcoming blood stagnation likekeishibukuryogan,tokishakuyakusan
kidney-supplementingareorhachimijiogan

or

used,

else

blood

or

supplementing

formulas. When the condition is caused by liver qi
depression and stagnation Saiko preparations likeshigyakusan are used, for water stagnation (water
intoxication) goreisan or tokishakuyakusan andsimilar diuretics are used. For chilling or stressinduced conditions interior-warming formulas likeshimbuto or ryokyojutsukanto are used. It is
important not only to identify the nature ofpollakiuria and urinary urgency in cases ofhyperactive bladder during interviews with thepatient, but also focus on accessory symptoms.

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

21

Volume 10, Number 1 | Spring 2015

Both the number of patients with urologicaldiseases and the number of cases refractory towestern pharmacological therapy are expected toincrease. Skillful integration of Kampo medicines
may possibly broaden the therapeutic spectrum.
The author considers focusing not only on dysuria
and urinary incontinence, but also accessory
symptoms to be a shortcut to the selection of
appropriate formulas.

22_____________________________________________
ryokyojutsukanto: 苓姜朮甘湯
hochuekkito: 補中益気湯shikunshito: 四君子湯keishibukuryogan: 桂枝茯苓丸hachimijiogan: 八味地黄丸
tokishakuyakusan: 当帰芍薬散shigyakusan: 四逆散
goreisan: 五苓散shimbuto: 真武湯

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

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Make the most of Kampo in modern medicine

Foundation: 1905
A century of tradition ――――We are a manufacturer consistently controlling the entire process fromthe import of crude herbs to the manufacture of Kampo extracts and assuch have contributed to the development of Japanese Kampo.
We sincerely hope to continue in the future with our contribution tomodern medicine through "Kampo".

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1-1-2 Tennojicho, Minami, Abeno-Ku, Osaka, Japan
Phone: +81-6-6693-3301

The crude drugs like many other creatures on earth areraised by bountiful NATURE.
Humankind earns as well grace from Mother Natureand is blessed as a member of natural world.
PROFILE of

TOCHIMOTO

Since Tochimoto was appointed as aJapan-China friendship trading firm in
1963, we have expanded our businessoverseas, mainly with China.
We import a variety of quality-controlled
natural resources from all over the world
for maintaining wellness.

TOCHIMOTO TENKAIDO CO., LTD.
3-21 Suehiro-cho, Kita-ku, Osaka 530-0053, JAPANwww.tochimoto.co.jp