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INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 13, Number 3 ･ Fall 2018

Editorial

The Possibility of Exist of “Halo Effect” on Clinical Pearls
Hiromichi Yasui

Report from WFAS Tokyo/Tsukuba 2016

“Acupuncture and Moxibustion in Palliative Medicine”
Masaki Tsuda, Tohokai Oriental Medicine Acupuncture & Moxibustion Clinical Study Group

Type 3 Case of Yasui Classification

Effects of Kampo Medicines on Loss of Appetite and Irritation Caused by Attention Deficit Hyperactivity Disorder Medication
Kaori Kimata

Clinical Report (Acupuncture)

Acute Low Back Pain Following a Holiday
Tsuyoshi Hashimoto

ISSN:1559-033X

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

―

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

Volume 13, Number 3 ･ Fall 2018EXECUTIVE EDITOR

Shuji Goto
Chairman, GOTO College ofMedical Arts & Sciences

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

Tokyo, JapanEDITOR-IN-CHIEF

Donald Lauda, Ph.D.
Dean Emeritus, College of Health &Human Services
California State University-Long Beach

1 Editorial
The Possibility of Exist of “Halo Effect” on Clinical Pearls
Hiromichi Yasui

CA, U.S.A.

ASSOCIATE EDITORS
Shuichi Katai

2 Report from WFAS Tokyo/Tsukuba 2016
“Acupuncture and Moxibustion in Palliative Medicine”

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

Masaki Tsuda
Tohokai Oriental Medicine Acupuncture & Moxibustion Clinical Study Group9 Type 3 Case of Yasui Classification
Effects of Kampo Medicines on Loss of Appetite and Irritation Caused by Attention Deficit
Hyperactivity Disorder Medication
Kaori Kimata

14 Clinical Report (Acupuncture)
Acute Low Back Pain Following a Holiday
Tsuyoshi Hashimoto

PUBLISHER

Shuji Goto
International Institute of Health andHuman Services, Berkeley
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)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 13, Number 3 | Fall 2018

Editorial
The Possibility of Exist of “Halo Effect” on Clinical Pearls
Dr. Keisetu Otsuka (1900-1980) had begun researching Kampo medicine since the 1920s and Japanesetraditional medicine has greatly developed due to his accomplishment. He put great emphasis on“kuketsu”, the clinical pearls, which have been made and inherited by many past Kampo doctors formore than 300 years long.
Dr. Otsuka himself is also well known for making and diffusing many own clinical pearls. Let’s see
one of them.
The proportion of target patients of boiogito are higher in females than in males, more often in “a ladyof leisure” with the so-called “a flabby body”. They are increasingly obese because they do not move theirbodies, although they want to lose more weight.
They are fine to skip a meal, take a lot of tea and are hyperhidrosis. Their menstruation is irregularand menstrual blood volume is low. These kinds of females may complain of pain in the knee joint if they
became over 50 years old. Also, in the evening, edema occurs on their foot and the socks become tightfitting. Abdominal examination reveals the abdomen to be a whole fat belly without resistance ortenderness and it may be soft.
Other doctors who have referred to this clinical pearl prescribed boiogito for elderly women sufferingfrom osteoarthritis of knee. This usage has been widely spread and several clinical studies have also
supported the contents of this clinical pearl. Many doctors might think that it was enough to believe
because the clinical pearl was made by the Kampo authority Dr. Otsuka and it could be important.
However, there is a possibility of “halo effect”. The contents of this clinical pearl did not apply to all
patients and clinical studies with different conclusions also existed. Regarding this fact, Dr. Otsuka
himself was aware of it, and for the sake of later researchers he left the following words; The explanationof boiogito in medical book “Fukushokiranyoku” written about 200 years ago says “The characteristic ofboiogito’s indication is noble females who are very rich, eat delicious things with a sedentary lifestyle.
Their menstruation often stops and they are always tired.” I got a hint from this description and madethat clinical pearl. However, when others read this original text, another interpretation may come out. I
hope future researchers will do so.
In clinical reasoning, clinical pearls which form the background of System1 are very important but
we must not forget the possibility of bias. And we have to always pay attention to “halo effect”. This is
one of the important lessons from Dr. Otsuka.

Hiromichi Yasui
Japan Institute of TCM Research

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

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Volume 13, Number 3 | Fall 2018

Report from WFAS Tokyo/Tsukuba 2016
“Acupuncture and Moxibustion in Palliative Medicine”

examination methods from the oriental medical
perspective of "Qi and Blood".

Masaki Tsuda
Tohokai Oriental Medicine Acupuncture & Moxibustion
Clinical Study Group

Within palliative cancer therapy the acupuncture
and moxibustion treatment style of the Tohokai
Oriental Medicine Acupuncture & Moxibustion
Study

Group

(below:"Tohokaistyleacupuncture and moxibustion") has taken theinitiative in 1985, when Dr. Nobuko Yokokawa
introduced it in the department of anesthesiology of
the National Cancer Center (currently the Central
Hospital of the National Cancer Research Center) for
the treatment of various symptoms of cancer
patients. Relying on acupuncture and moxibustion
treatment good results were obtained for clinicalsymptoms like weariness, numbness, pain etc. andsince 1989 two acupuncturists from the Tohokai
Group were dispatched to offer Tohokai styleacupuncture and moxibustion treatment and thisarrangement still continues today.
Acupuncture and moxibustion treatment applied inpalliativecancertreatment

does

not

focus

exclusively on the treatment of symptoms, but
comprehension of the correlation between the wholebody and the site of the symptoms, based on oriental
thought

and

using

oriental

medicalspecificexamination techniques is very important.
Many cancer patients in need of palliative medicalcare suffer from exhaustion caused by the nature of
the disease, surgeries or else the side effects ofchemotherapeutics often progress into a state of
deficiency. That is why the stimulus dose of theacupuncture and moxibustion treatment has to becarefully

adjustedtoprevent overstimulation.

Essentially cancer patients and patients with otherdiseases are identical in the sense, that both present
with symptoms, and the pathology of these
symptoms can be understood by using the four

2

The Tohokai style acupuncture and moxibustion
treatment has been developed in Japan based on

Introduction

Clinical

About the Tohokai Group

interpretations of the classics and belongs to thegroup of styles called channel therapy. This channel
therapy has been proposed by Sorei Yanagiya, Sodo
Okabe, Keiri Inoue, Shinichiro Takeyama and othersin the 1930s. Channel therapy is characterized by its
concept of disease based on deficiency and excess
patterns of organs and viscera, allowing treatment
of diseases by way of adjustment of deficient andexcessive conditions. This treatment form has beensystematized based on the identification of patterns
using the four examination methods. Treatment canbe divided into treating the root in order to adjust
fundamental deficiency and excess patterns oforgans and viscera on the one hand and local andsymptomatic treatment on the other hand. Point
selection for root treatment relies mainly oninterpretations of the 69th difficult issue and selected
points are then either tonified or reduced. The
results, again, are then evaluated using mainly
pulse

diagnosis

among

the

four

examination

methods. Local and symptomatic treatment isperformed for the purpose of alleviating symptoms
and to that end take both local and generalconditions into account. In this case the treatment isperformed with the purpose of changing the local,
subjective symptoms of the patient.
Here I would like to present an organizedclassification of the needling methods used for
Tohokai Group style acupuncture and moxibustion
treatment. Needling can be classified mainly into thefollowing five types.
1. Contact needle therapy (CNT) (Contact needling)
2. Insertion needle therapy (Stabbing needle
therapy)
3. Special needle therapy

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)(Special needling techniques)Volume 13, Number 3 | Fall 2018

4. Rounded contact needle therapy(Spoon

needleimportant for determining the pattern. Once thecontact needling)

pattern has been determined, points for the

5. Qi-retained needle therapy(Qi retention needling)treatment of the root are selected based oninterpretations of the difficult issue No. 68 and 69

For contact needle therapy (contact needling) theand then used to tonify or reduce the channels. Afterneedle tip is brought only into contact with the skinthat a pulse diagnosis is performed and mainly

but not inserted, allowing to control Qi using

based on changes in pulse patterns, but facial

techniques like tonification or reduction. It is usedcomplexion, changes in expression, skin complexion,

for diseases involving Qi (psychosomatic illnesses).

the tone of the voice, changes in symptoms and otherIn case of insertion needling therapy the needle tip

information gathered using the four examination

is inserted into the body to control Blood using

methods are also taken into consideration for atechniques like tonification or reduction. It is usedgeneral evaluation of the treatment. If the effects arefor diseases involving Blood (physical illnesses).

considered to be sufficient, the treatment isSpecial needle therapy (Special needling techniques)completed. If the effects are insufficient, further

include techniques like big needle method, longcorrections will be made as far as possible, but theneedle method, moxibustion with warming needles,

stimulus dose must be matched to the physicalmicropuncture technique, intradermal needling etc.

fitness and condition of the patient.

These techniques are used, when achieving effects

This is how the treatment is administered. Here I

with contact needling or needle insertion is difficult.

would like to explain contact needle therapy (theRounded contact needle therapy (Spoon needle

method of contact needling) used so frequently forcontact needling) refers to stroking or pressing

patients in palliative care.

against the body with the tip of a comparatively

Contact needle therapy (contact needling) refers to a

thick metal rod with a rounded head called spoon

treatment form where the needles are inserted notneedle (chi zhen). It is used for infants or patientseven 1 mm deep, but only brought into contact with

who are particularly nervous, so that the use of

the target area. The movement of Qi in the channels

ordinary filiform needles may be difficult.

as well as the fluctuations of Yin and Yang are

Qi-retained needle therapy (Qi retention needling)

modifiedrefers basically to the same technique as the so-

descriptions of methods and techniques follow below.

called needle retention.

The needles used are so-called long-handle needles,

via

the

body

surface

Qi.

Concrete

which are ordinary filiform needles that have,Contact needling in palliative medical carehowever, a longer handle, with a thickness varying

In general medical practice these techniques are

between 0.18 and 0.16 mm and a length of 30-40 mm

used selectively for tonification and reduction of thefor which we recommend gold or silver as material.

channels, but in palliative care contact needle

The Tohokai Oriental Medicine Acupuncture &therapy

Moxibustion Clinical Study Group does not use(contact

needling)

constitutes

thefundamental technique.

needle tubes, not restricted to the contact needling

Treatment is performed according to the following

technique, but uses needle twirling without tube also

procedure. First, the four examination methods

for insertion of needles.

inspection, listening and smelling, asking andpalpation are performed and the general pattern is
identified.

Within

this

flow

of

examination

abdominal and pulse diagnosis are particularly

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

3

Volume 13, Number 3 | Fall 2018

Indications for the techniques of contact needle

duration.

The

selectionoftransport

andtherapy (contact needling)accumulation points depends on the disease pattern.

The contact needle therapy (contact needling

Perform palpatory massage along the channel course,

techniques) are divided into 9 types (Figure) and fora light massage as pretreatment and then determine

each of these purpose and indication are clearly

the point with the pressing hand. The pressing hand

specified.

then brings the needle body into close contact withthe skin and holds it still, maintaining an angle of 90

Transmeridian Qi tonifying therapy (Channel Qi

degrees to the skin. After holding needle body andreplenishing needling)

tip with the thumb and index finger of the pressing

Transmeridian Qi tonifying therapy (Channel Qi

hand in close contact to the skin, the needling hand

replenishing needling) is a method to replenish thethen stabilizes the needle tip. At this point it is

Qi within the channels. As a tonification technique

important to pay sufficient attention to keep theof the root treatment the channel Qi is replenished.

needle tip in light contact with the skin and do not

The tip of the needle is laid at an angle of 30 degrees

allow it to float free. Once the needle tip has been

into the direction of the channel course and fixedstabilized, apply a comfortable up and down

there with the pressing hand. The needling handpressure synchronized with your breathing to theapplies some gentle up and down pressure on theneedle tip and continue this manipulation until theneedle tip and when the coming and going of the Qi

Qi arrives. Normally the coming and going of the Qi

is detected, the needle tip is held still. With the nailusually should require about 5-6 respiratory cycles.

of the thumb of the needling hand the needle handle

When Qi has been obtained, the needle is removed.

is flicked rhythmically. Once the arrival of Qi is felt,

At this point be careful not to allow leakage of Qi andthe flicking is stopped and the needle moved away

apply simultaneously with removing the needlefromsome light massage to the acupoint as posttreatment.

the

skin

surface.

Simultaneously

withremoving the needle the needle hole is closed with
the index finger or thumb of the pressing hand and

HealthyQia gentle massage is applied to the point location.

replenishing needling)

There is a first and a second way of selecting points

Healthy

for this method to be used as root treatment, but thereplenishing needling) refers to a needling method tofirst method is used more frequently. In this case

replenish healthy Qi and is used as local andLR8 is used for liver deficiency, KI7 for kidney

symptomatic

deficiency, SP3 for spleen deficiency. LU9 for lungdeficiency, emaciation or weakness of the flesh. The

deficiency and PC7 for pericard deficiency.

used acupoints do not rely on patterns, but can beQi

tonifying
tonifyingtreatment

therapy(Healthy

Qi

therapy(Healthy

Qi

for

areas

of

markedselected as required according to the findings of
Yin-yang balancing needling therapy (Yin-yang

inspection of palpation.

balancing needling)

Application of healthy Qi tonifying therapy (healthy

The yin-yang balancing needling therapy (yin-yang

Qi replenishing needling) means applying palpatory

balancing needling techniques) utilizes the transportmassage along the channel course and thus

and accumulation points to harmonize organs andharmonizing Qi. When the point to be treated has

viscera, so that it is frequently used to treat diseases

been determined, the pressing hand fixes the needleof organs and viscera. They are used in particular forat an angel of 90 degrees to the surface of the skin.

organic diseases and where needling methods are

After holding needle body and tip with the thumbrequired that affect deeper lying disease of longer

and index finger of the pressing hand in close contact

4

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

Volume 13, Number 3 | Fall 2018

to the skin, the needling hand then stabilizes thesimultaneously with removing the needle some lightneedle tip. The pressing hand is held in close contact

massage to the point as posttreatment.

with the skin, while at the same time the needling
hand lightly applies some pressure on the needle tip.

Yin Qi tonifying therapy (Yin Qi supplementing

The needle is held still with the pressure applied andneedling)

one awaits the arrival of Qi, which usually requires

Yin Qi tonifying therapy (Yin Qi supplementing

about 3-4 respiratory cycles. When Qi has been

needling) is a needling method to replenish the yin

obtained, the needle is removed. At this point be

Qi within yin (nutritive Qi) and is used as local andcareful not to allow leakage of Qi and apply

symptomatic treatment for conditions of closed

simultaneously with removing the needle some lightinterstices, moist skin, feeling of coldness, weakness

massage to the point as posttreatment.

of the flesh, muscle tension or flaccidity. The usedacupoints do not rely on patterns, but are selected as

Yang Qi tonifying therapy (Yang Qi supplementing

required according to the findings of inspection ofneedling)

palpation.

Yang Qi tonifying therapy (Yang Qi supplementing

In the areas treated with this yin Qi tonifying

needling) is a needling method to replenish the yangtherapy (yin Qi supplementing needling technique)Qi within yang (protective Qi) and is used as local

palpatory massage is applied along the channeland symptomatic treatment for surface areas

course to harmonize Qi. When the point to be treatedshowing deficiency, conditions of numbness or

has been determined, the pressing hand fixes the

opening of the interstices. Most of the used points areneedle at an angel of 45 degrees to the surface of the

not actual acupoints but rather sites of changes onskin. After holding needle body and tip with thethe skin surface. This needling method serves thethumb and index finger of the pressing hand in close

purpose of supplementing the yang Qi of the bodycontact to the skin, the needling hand then stabilizes

surface and close the interstices.

the needle tip. The needling hand holds the needle

In the areas treated with this yang Qi tonifying

body and gently applies some pressure and holds thetherapy (yang Qi supplementing needling technique)needle for 2-3 respiratory cycles until Qi passes

palpatory massage is applied along the channel

through the yin portion within the yang. As soon ascourse to harmonize Qi. When the point to be treatedthe Qi flow swells, remove the needle. At this point

has been determined, the pressing hand fixes thebe careful not to allow leakage of Qi and apply

needle at an angel of 90 degrees to the surface of thesimultaneously with removing the needle some lightskin. After holding needle body and tip with themassage to the point as posttreatment.

thumb and index finger of the pressing hand in close
contact to the skin, the needling hand then stabilizes

Qi dispersing needlingthe needle tip. The needling hand holds the needle

Qi dispersing needling is a needling method for the

body and swiftly performs alternating half-turns todispersion of Qi depressions and is a somewhat

the left and right. Here it is important to avoid using

reducing,

force with the pressing hand and not apply too muchtechnique for local and symptomatic treatment.

pressure. One to 2 turns are the norm, but if the yang

Targets are skin areas that appear upon inspection

deficiency very marked, perform 4 or 5 half-turns. As

darker than the surrounding skin, or upon palpation

soon as the Qi flow swells, remove the needle. At thisfeel rougher. These are findings frequently observed

point be careful not to allow leakage of Qi and applyon the back and in the lumbar region. Since a major

continuously

performed

needling

characteristic of body surface Qi is its particularly

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

5

Volume 13, Number 3 | Fall 2018

marked tendency towards stagnation, the use of Qi

conventional

acupoints,butratherapplies

dispersing needling is frequently used in clinicalcontinuous needling to smooth the body surface andpractice.

is performed as a finishing or harmonizing method.

During inspection the pressing hand is used forWith a slightly supplementing effect it is combined

palpation and determines the scope in which the Qi

with the slightly reducing effect of Qi dispersing

dispersing needling is to be applied, when Qi

needling.

depression has been found. The pressing hand is not

The body surface is palpated with the pressing hand

held fixed on the body and the needle body is notand the scope of the area to be treated determined.

brought into close contact. The contact is more like

The pressing hand is not held fixed on the body andlight touch to protect the needle, the hands keep

the needle body is not brought into close contact. The

moving while needling and at the same time

contact is more like light touch to protect the needle

constantly check, whether the Qi is dispersed or not.

and the hands keep moving while needling, at theHold the junction of needle handle and body gently

same time constantly observing whether the bodywith the finger pulps of thumb and index finger ofsurface is moistening. Hold the junction of needle

the needling hand. Beware not to exert any force via

handle and body gently with the finger pulps of

the joints of the fingers and arms and learn how tothumb and index finger of the needling hand.

apply light pressing and withdrawing movements

Beware not to exert any force via the joints of thethrough snapping motions of the needling hand. The

fingers and arms and learn how to apply lightneedle is brought into contact with the areas of Qi

pressing and withdrawing movements throughstagnation and at once quickly withdrawn. The

snapping motions of the needling hand. The needle

needle should have an angle towards the skin of

tip is swiftly withdrawn almost simultaneously with

about 60 degrees. Be careful not to drag the needle

bringing it into contact with the skin. The needle

tip during the manipulation. Once the first needlingshould have an angle towards the skin of about 30

is completed, slide to the next treatment point anddegrees. Be careful not to drag the needle tip during

repeat the procedure. Perform this techniquethe manipulation. Once the first needling isconsecutively for a third, fourth and fifth timecompleted, slide to the next treatment point andwithout any intervals in between. After the needlingrepeat the procedure. Perform this techniquepalpate the skin and stop the treatment when theconsecutively for a third, fourth and fifth time. The

roughness of the skin has decreased, or the moistureneedle is brought into contact with the skin with aof the areas of Qi stagnation seems to have increased.

frequency of about 3-4 times per second. After theCare is required, since with this technique theneedling palpate the skin and stop the treatment

stimulus dose may easily increase. The needle iswhen the skin has become smoother and moister.

brought into contact with the skin with a frequency
Qi drawing needlingof about 3-4 times per second.

Qi drawing needling is a technique that through
Smoothing Qi needling

remotely guiding healthy Qi disperses the evil Qi in

Smoothing Qi needling is a needling technique used,

the affected area. It is a supplementing needlingwhen in conditions other than Qi stagnation (Qitechnique and used for local and symptomatic

dispersing needling), yang Qi deficiency (yang Qi

treatment on all parts of the body, employing

supplementing needling), or closure of the interstices

acupoints. The point selection depends on the naturea disharmony of smoothness and moistness of theof the disease and usually traditionally well-known

skin surface is present. It does not rely on

acupoints are selected.

6

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

Volume 13, Number 3 | Fall 2018

Qi drawing needling is performed, holding thethe point location and hold it at an angle towards theconcept of "drawing Qi" in mind. The channels areskin of about 60 degrees. The direction is chosen

palpated along the channel course and a lightbased on the principle of the directional reducing-massage is applied to the point locations. Bring thereinforcing method. The needling hand gently

thumb of the pressing hand into close contact withapplies some pressure on the needle tip and performs

the needle body and thereby fix it. At this time the2-3 times an up-and-down movement. After this up-

needle should have an angle towards the skin of 45

and-down movement is finished, the needle isdegrees. After grasping needle body and needle tip

quickly removed from the point location and thefirmly with thumb and index finger of the pressing

pressing hand leaves the needle hole without closing

hand, the needling hand stabilizes the needle. Bringit.

the needle tip lightly into contact with the point

When employed as local and symptomatic treatment

location and hold it there for about 4-5 respiratory

palpate the region feeling warm (the site of pathogen

cycles. Immediately after the Qi arrives, remove theexcess) with the pressing hand to determine theneedle from the point location. Simultaneously withscope of the local needling. Hold the needle gently atremoving the needle the point location is closed by

the junction between the long needle handle andlightly pressing it.

body gently with the finger pulps of thumb and index
finger of the needling hand. Swiftly bring the needle

Clear excess therapy (Pathogen draining needling)

tip into contact with the area of warmth andClear excess therapy (Pathogen draining needling) isimmediately remove it. At this time the needle

a needling technique to drain pathogen (in particularshould be at an angle of about 90 degrees towards

yang

and

the skin. After completion of the first pathogen

symptomatic treatment. As systemic and generaldraining needling move slightly sideways to the next

treatment the command points on arms and legs areneedling site and repeat the procedure. Perform thisused to drain the pathogenic Qi accumulated in thetechnique consecutively for a third, fourth and fifthchannels. As local and symptomatic treatment it istime without any intervals in between. The

employed to treat heat associated with wind evil,

movement should be performed at a speed of 5-6

bruises or else in the presence of pain due to swelling

times per second. The pressing hand is not held fixedand distension at sites of pathogen accumulation.

on the body surface and moves together with theApplied as systemic and general treatment theneedle, constantly checking whether the feeling of

connecting and cleft points of the channel presenting

warmth is fading of not as well as assessing the statewith excess are used. The proper use of these cleftof sweating. When the pressing hand senses

and connecting points depends on whether thesweating in the area of warmth and fading of thecondition is due to external pathogens or not. In caseheat sensation, it is time to discontinue theof external pathogens the cleft points, or based ontreatment.

the exterior and interior correlation and in case of

The above described contact needle therapy (contact

excess of flourishing Qi the connecting points areneedling techniques) are used to treat cancer

used.

patients in palliative care.

pathogens)andappliedaslocal

First, locate the points to be needled. Hold thejunction between needle handle and body gently

Conclusions

with the finger pulps of thumb and index finger ofCancer patients in palliative medical care present

the needling hand. Form the shape of the pressing

with pulse patterns showing exhaustion and suffer

hand, bring the needle tip lightly into contact withfrom the characteristics of their disease as well as

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

7

Volume 13, Number 3 | Fall 2018the side-effects of various treatments, so that thepulse is often very thin and weak. Contact needle
therapy (contact needling techniques) are optimalfor these patients. During the treatment it isimportant to carefully observe the pulse, skincondition and changes in indurations.
Contact

needletherapy(contact

needling

techniques) have the advantage that they are safe,
painless and not associated with the risk of infection.
Also, for patients afraid of needles contact needle
therapy (contact needling) is easier to accept than
the typical treatment using needle insertion.
I believe wide application of contact needle therapy(contact needling techniques) can be an effective
treatment for many patients in palliative medical care.

8

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

Volume 13, Number 3 | Fall 2018

Type 3 Case of Yasui Classification
Effects of Kampo Medicines on Loss of Appetite
and Irritation Caused by Attention Deficit
Hyperactivity Disorder Medication

chemotherapy3)4). In this study, we examined theeffects of Kampo medicines administered to treat
loss

Kaori Kimata

ofappetiteandirritability

due

to

the

administration of MPH and ATX.

Kawashima Family Clinic

Patients and Methods
Patients included 20 pediatric males who visited

Abstractsustained-

our developmental outpatient clinic during the 4

release tablets and atomoxetine hydrochloride are

years between January 2014 and May 2017 and werepreferred drug treatments for attention deficit

prescribed MPH or ATX. They exhibited loss of

hyperactivity disorder (ADHD), but both drugs often

appetite and irritability, for which Kampo drugs

cause loss of appetite or irritability. In this study, wewere additionally prescribed. The patients were all

examined the effects of shikunshito and rikkunshito

males and between 6 and 14 years of age at the timeadministered to alleviate these adverse effects.

of Kampo medicines administration. Six patients

Although

had comorbid autistic spectrum disorder.

Methylphenidate

therehydrochloride

were

cases

in

which

oral

administration was not possible due to the taste or

ADHD medication doses were ATX 50 mg/day (nof= 1), MPH 18 mg/day (n = 8), MPH 18 mg/day (n = 1),

appetite improved in 1–2 months. Because patients

ATX 10 mg/day (n = 1), and MPH 27 mg/day (n = 10)with ADHD are often “inattentive,” missed doses did(Table 1). Loss of appetite, as a consequence of MPH

occur; however, it was considered that patientsadministration, tended to increase in severity with

continued taking Kampo because they felt it was

the dose. It often appeared from the day theeffective. Many children with ADHD experience

medication was administered. We attempted tostress related to their condition and may have low

prevent a significant decrease in daily intake byself-esteem. Considering such condition of children

reducing the amount of school lunch that thewith ADHD as “qi-kyo (qi deficiency),” shikunshito

children consumed for the first 1–2 weeks afterand rikkunshito improved gastrointestinal motility

starting the medication, while increasing theand sustained patient motivation.

number of snacks and amount of food served atformulation,

following

administration,

loss

dinner. If loss of appetite persisted for ≥1 month or
Keywords: attention deficit hyperactivity disorder,worsened due to environmental changes, Kampo

loss of appetite, shikunshito, rikkunshito

medicines were added.

Rikkunshito extract granules (Tsumura & Co.,Tokyo, Japan) at 5.0 g/day or shikunshito extract

Introduction
Drug treatment for attention deficit hyperactivity

tablets (Osugi & Co., Osaka, Japan) at 12 tablets/day

methylphenidate

were administered before breakfast and dinner totablets(MPH),

combat loss of appetite. We explained the taste andcovered by health insurance for children since 2007,

formulations of the drugs to the patients and theirand atomoxetine hydrochloride (ATX), covered sinceparents or guardians. In cases where the patient2009. As both drugs sometimes cause loss of appetite

could only tolerate the granulated formulation,

disorder(ADHD)hydrochloride

includessustained-release

discontinued prior to achieving their optimal effects.

rikkunshito extract granules were prescribed. If thepatient preferred tablets, we prescribed shikunshito

Reports indicate that rikkunshito is an effective

extract tablets.

as a side effect1)2), these medications are often

treatment for loss of appetite in patients undergoing

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

9Volume 13, Number 3 | Fall 2018

In terms of response evaluation, we considered

Three cases exhibited irritability and frequent

the drugs to be effective if consumption of foodepisodes of crying in addition to loss of appetite;

increased by more than half at school lunch. The

therefore, we added 2.5 g/day of kanbakutaisouto

medications were considered ineffective if loss of(Tsumura & Co., Tokyo, Japan) before dinner. In 3

appetite persisted, or if the dose of MPH or ATX hadcases with continuous irritability and agitation,toconsidered unknown if oral administration could not

shikunshito was discontinued and switched todaisaikoto extract tablets (Osugi & Co., Osaka,

be continued or evaluation was difficult due to poor

Japan)

medication compliance.

switching Kampo medicines, the patients withbe

reduced.

The

medication

effectswereat 6 tablets/day before breakfast. After

irritability showed improvement in symptoms. The
Results

following

Kampo

medicines

wereadditionallyThe results of this investigation are depicted inprescribed: hangekobokuto for severe anxiety (n = 1);

Table 1. Of the 20 patients, 2 took rikkunshito
extract granules, and 18 patients took shikunshito

shokenchuto for repeated abdominal pain (n = 2);
goreisan for nausea (n = 1); and hangeshashinto for

extract tablets. Many of the patients were sensitive

sustained diarrhea (n = 1). Due to the small sample

to the drug formulation, smell, or taste and therefore

size, individual examinations of each side effect wererefused the granular formulation or could not

not performed.

continue to take the granular formulation because oftime constraints. In those cases, shikunshito extract

Case presentationtablets, with similar crude products and indications

Case 10: A 10-year-old 5th grade male student.

as rikkunshito, were prescribed so that the patients

At first consultation: The patient was in 3rd grade.

could continue to take the medication.

He visited the clinic accompanied by his mother.

We found that patients often forgot to take theChief complaint: The patient was advised by his

drugs before dinner. Twelve patients took theirclassroom teacher to consult a developmental

medication only once in the morning, and 8 patients

outpatient clinic for his poor conduct in the

took their medications twice per day, every morningclassroom.

and evening. Appetite stimulation effects were “good”

Patient’s complaints: difficulty in listening to others,

in 16 cases, had “no effect” in 3 cases, and were

often spilling drinks; often getting lost during early“unknown” in 1 case. Ten patients out of the 16 thatchildhood, restlessness at home, and frequent

exhibited a “good” response to the drug discontinued

movement.

the medication within 2 months. In 14 cases,

Parental

administration of Kampo medicines was started

patient’s condition, the mother requested thatbetween July and November, indicating that more

pharmacologicalpatients appeared to experience loss of appetite

patient’s mother also wanted to better understandduring summer or at the start of sports day practice.

the patient’s psychological status.

There was no case in which drug therapy for

Perinatal period: Unremarkable.

concerns:

If

medicine

treatmentbeimproved
initiated.

the
The

ADHD was discontinued due to sustained loss ofDevelopmental history: During early infancy, theappetite. In 1 case, the dose was reduced due to loss

patient was sensitive to sound and was a shallow

of appetite and nausea, and in another case, the dose

sleeper. He did not exhibit stranger anxiety.

was reduced because the patient’s ADHD symptoms

At 1 year of age, the patient started running as soon

improved.

as he started walking. Patient had delayed speech
and began speaking words at the age of 22 months.

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

Volume 13, Number 3 | Fall 2018

At 2 years of age, he had difficulty understanding,some extent. MPH (CONCERTA®) was started foreven when auditory information was repeatedly

hyperactivity and impulse control. The patientpresented. He liked to climb to high places and wasstarted taking MPH at 18 mg/day during therestless, with frequent movement. At 3 years of age,summer vacation prior to the 3rd grade, and loss ofhe frequently misbehaved, despite warnings, andappetite appeared on the first day of drug

was restless. He showed great interest in letters andadministration. Starting in September, we reduced

numbers. At 4 years of age, he showed no avoidance

the amount of food served during school lunch byof dangerous activities and required repeatedhalf and increased the amounts of snacks and dinner.

redirection. He talked about many things, but did

When sports day practice started in early

not understand the feelings or positions of others. He

September, he also experienced loss of appetite in thewas obsessed with winning and losing and had

evening and his daily intake decreased to about halftrouble maintaining friendships. Additionally, heof pre-medication levels. Because the patient wasoften forgot his belongings.

unable to take the granulated formation, we[ADHD checklist (behavioral questionnaire) forprescribed shikunshito extract tablets at 12 tablets

children aged ≥6 years]/day before breakfast and dinner. Although theInattention (7 points): does not pay attention topatient was actually taking shikunshito only before

details while studying; has difficulty focusing on

breakfast, his appetite improved about 1 week after

activities; cannot listen to instructions to the end;

starting the medication. At this time, the patient

avoids tasks; often gets distracted; has difficulty

was eating half of his school lunch and all of hislearning tasks and activities in order; does not seemdinner each day. After the sports day ended into hear when being spoken to.

October, he started to eat the full amount of school

Hyperactive/impulsive (5 points): restless andkeeps moving; cannot keep still; talkative; answers
questions without listening to the end; leaves seatlunch. After 1 month, his appetite improved, andshikunshito was discontinued.
After starting MPH at 18 mg/day, he could remain

when required to be seated.

calm in class for longer periods and required less

Treatment course:

frequent redirection by the classroom teacher.

We encouraged the family, especially the mother,and the classroom teacher to understand thedevelopmental

characteristics

discussed

following

hours.

ADHD

andIn the 4th grade, he started to receive special

recommendations:(1)

guidance, in addition to his general classwork. At our

adjustment of the environment, such as reducing

clinic, we started to provide social skill training withwall hangings that may be distracting; (2) how to

the help of a psychotherapist and separately

talk to the patient, such as giving instructions

interviewed the patient and his mother. Whenseparately for each item, and sending a signal to pay

practice for the sports day started in September, theattention; and (3) how to support the patient when

patient found it difficult to focus and participate

he gets in trouble. We had an individual interview

during class. He continued to be absentminded andwith the patient once a month, where we observed

spent

the patient could not help touching whatever he saw,

disconnected from class activities. Then MPH dose

frequently turned around in his chair, switched fromwas increased to 27 mg/day. While the patient was

one topic to another during conversations, andunder observation, his appetite decreased, and heconstantly moved around during games, indicating

was barely able to eat school lunch. Beginning in

the

of

However, while learning at home, he often cried fortime

playing

alone

with

his

hands,

an inability to complete a conversation or a game to

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

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Volume 13, Number 3 | Fall 2018

November, we prescribed shikunshito extract tablets

report describes the effects of rikkunshito for stress-

at 6 tablets/day before breakfast.

related loss of appetite, focusing on serotonergic

After taking Kampo medicines, his appetite

neurons involved in eating behavior4).

calm and participated in class while at school, andShikunshito consists of Ginseng Radix,
Atractylodis Rhizoma, Poria, Glyzirrhizae Radix,
Zingiber Rhizoma, and Zizyphi Fructus. A
combination of Ginseng Radix, Atractylodis Rhizoma,
Poria, and Glyzirrhizae Radix are the crude productsof ninjinto, to which Poria is added instead of Zizyphi

he was more easily able to complete his homework.

Fructus. Its diuretic effects are enhanced, and it is

At present, the patient has been taking MPH at 27

more effective for phlegm-dampness pattern than for

mg/day for 6 months along with shikunshito.

ninjinto. This formulation tonifies qi and is used toreturned to the same level as when he was taking 18
mg/day of MPH, and he was once again able to eat
half of his school lunch. After

increasing MPH doseto 27 mg, he was able to listen to instructions ingroup settings and throughout the day. He remained

treat impaired digestion and absorption (weakness
Discussionof the stomach and spleen)5). The difference between

hallmark symptoms of ADHD, by activating the

rikkunshinto and shikunshito is that shikunshito
contains neither Pinelliae Tuber, which suppresses

dopaminergic nervous system. MPH also suppresses

nausea and vomiting due to gastric fluid retention,eating behaviors, which can lead to a loss of

nor Citri unshiu Pericarpium, which removes

appetite1)2). Loss of appetite is generally self-limiting

phlegm; thus, shikunshito has no effect on nausea.

and improves within 2–3 weeks, but if it does not
improve, this adverse effect can alleviate by

Rikkunshito extract granules at 5.0 g/day or
shikunshito extract tablets at 12 tablets/day before

withdrawing the drug during weekends or reducing

breakfast and dinner were prescribed for loss ofthe drug dosage. There have been reports on theappetite secondary to ADHD treatment drugs. In

effects of rikkunshito on loss of appetite duringcases in which oral administration was continued,

chemotherapy3),4), and we hypothesized that Kampo

the effects of rikkunshito and shikunshito appeared

medicines would have similar effects on loss ofin 1–2 months. A patient who could barely eat school

appetite caused by MPH or ATX.

lunch was soon able to eat more than half with

MPH suppresses hyperactivity and impulsivity,

The crude products of rikkunshito are ginseng,

improvement in appetite. Once patients adapted to

Atractylodis Rhizoma, Poria, licorice, Pinelliae Tuber,
citrus unshiu peel, ginger, and Zizyphi Fructus, and
it is combined with shikunshito and nichinto. In

the environmental changes and the temperature
discontinue

Kampo

medicine

and

those

addition to the digestion and food absorption effects

frequently

forgottotheirmedicationof shikunshito, rikkunshito has the effects of

discontinued use within 2 months. The 3 patients

Pinelliae Tuber and therefore suppresses nausea

who continued Kampo medication for 4–10 months

and vomiting due to fluid retention in the stomach

continued to eat smaller school lunches, as did

and the effects of Citri Unshiu Pericarpium, which

patients who were picky eaters. In these individuals,

reduces gastric fluid retention and sputum. Similar

Kampo was continued over time. One patient

to shikunshito, rikkunshito also tonifies qi. It is used

continued taking shikunshito for 9 months. In thisto treat fatigue, nausea, loss of appetite, chronic

case, his appetite completely recovered to the extent

gastritis, and symptoms of gastroptosis. rikkunshitothat he consumed more than 1 serving of school

enhances appetite and gastrointestinal motility bylunch, but because Kampo medication helped him

became cooler, those patients who wanted toits antagonistic effects on serotonin 2 receptors. A

12

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

take

who

Volume 13, Number 3 | Fall 2018

stay calm, administration was continued. Soon after

Summary
When

that, his MPH dose was reduced.

rikkunshito

shikunshito

or

was

Regarding the time when Kampo medicines wereadministered for loss of appetite secondary toinitiated, 14 cases (70%) started during summer ortreatment with ADHD medicine, 16 out of 20 cases

fall when practices for field day were being held. In

showed improvement. In addition, among the 16

these cases, loss of appetite may have been caused

cases that showed improvement, 10 cases were able

by

and

to finish taking Kampo medicines within 2 months.

increased humidity as well as deterioration of ADHD

There was no case in which ADHD medicine had tosymptoms due to changes in school–life rhythm.

be discontinued due to persistent loss of appetite.

higherenvironmental

temperatures

There were many cases in which continuing
medication was difficult due to the developmental

The abstract of this paper was presented at the 45th

characteristic of “inattention.” In 12 cases (60%),

Japan Pediatric Oriental Medicine Society Annual

despite being instructed to take medication twice per

Meeting (Nagoya, 2017).

day, before breakfast and dinner, patients wereactually taking only 1 dose per day in the morning.

References

However, they were able to continue taking Kampo

1)

Miyajima Y., Pharmacotherapy of attention

medicines every day because they experienced an

deficit hyperactivity disorder (ADHD), J.

effect from the medication. If continuously taken

Pediatr. Pract. 77:866–869, 2014.

twice per day in the morning and evening, theappetite-stimulating

effects

can

be

2)

increased.

Negoro H., Kyo M., Treatment of loss ofappetite

appeared

duringADHD

Therefore, medication counseling is necessary in thepharmacotherapy in children; Effect of

future. Children with ADHD are often cautioned andmosapride citrate sustained release tablets

restricted in their behaviors due to developmental

on methlphenidate hydrochloride sustained-characteristics, and they are under continual life

releasestressors. If we consider the condition of these

Clinical Psychiatry 17:669–676, 2010.

children, whose self-esteem declines by repeated3)tablet-induced

loss

of

appetite,Ohno T., Mochiki E., Kuwano H., Side effects

failures due to inattention, as “qi deficiency”,

of chemotherapy and traditional Chinese

rikkunshito

enhance

medicine, Loss of appetite-rikkunshito ．

motivation in addition to improving gastrointestinal

Journal of Clinical Surgery 68:1340−1344,

motility.

2013.

and

shikunshito

canAmong the 6 cases that showed worsened

4)

irritability and agitation during the administration
of

ADHD

medication,

kanbakutaisoto

Yakabu Y., Action mechanisms of traditional
Chinesemedicine(1)

rikkunshito

andextract

appetite control mechanisms mediated by

granules were added in 3 cases, and the medication

ghrelin, Clinical Gastroenterology 28:221–

was switched to daisaikoto extract tablets in the230, 2013.

other 3 cases. In both groups, irritability improved,
indicatingthat the medication was effective;

5)

Inaki

M.,

Fundamentals

guidance-Important

Kampo

and

practical

Prescription

however, the sample size was small, and future

Manual 25, Shikunshito. Kampo Practicestudies with more cases are necessary.

13:15–18, 1994.

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

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Volume 13, Number 3 | Fall 2018

Clinical Report (Acupuncture)
Acute Low Back Pain Following a Holiday
Tsuyoshi Hashimoto
Association
Iwanami Acupuncture and Moxibustion Clinic
Tokyo Medical Welfare Vocational School
Departement of Education for Acupuncture,
Moxibustion and Massage Instructors

fatigue and stiffness of neck and shoulders due todesk work and used to come for treatment once every
two months complaining of low back pain.
Past history
Acute low back pain [an MRI taken about 15 years
ago showed a herniated disk at L4-5]
Life history: no drinking and smoking, little exercise
Current condition: height 180 cm, weight 90 kg,

Introduction

blood pressure 156/90 mmHg, pulse rate 92/min

I have learned the acupuncture and moxibustion

Examination findings:

skills from late Mr. Meiyu Okada and Mr. Akizo

The SLR could not be performed because the patient

Okada. These masters used pulse diagnosis andwas too afraid. Chilling of the lower legs and feet +,pattern based treatment, treating the entire bodywithout

using channel therapy. Also, at the pedagogic

numbness of the lower legs (-) and no obvious

institution where I am employed, I strive to clarify

differences in the circumference of the lower legs.

the foundations of channel therapy through lectures

NRS (Numerical Rating Scale): 9

and research and I am trying to apply these during

Inspection

my ordinary clinical practice. Low back pain is a

Little facial expression with a dark complexion

symptom of one region of the body, but its treatment(examination of the skin of the medial forearm

essentially requires the comprehension of findings

revealed dark skin and the patient had in general afrom the entire body in order to determine how tonaturally dark skin) and a tendency toward dry skin.

proceed with the treatment. Using this case report I

The patient was large body build and a great

present here the use of channels in diagnostics andabdominal circumference. He walked cautiously

treatment.

bend forward while holding his hand to his back. The

differences

betweenleft

andright,

soles of his feet showed erythematous patches but
Day of treatment: Year XX, May X

the plantar arch area was white.

Patient: male, 44 years

Audio-olfactory examination

Chief complaint: low back pain, left gluteal painHe was almost reticent and when he answered, his

Present illness

voice was quiet, without force and slightly high-On the 6th of X (during the May holidays) the patient

pitched.

started experiencing low back discomfort and on theInquiry

fourth of X severe pain developed when he went toRecently he tended to be unusually thirsty andwork. He could not think, however, of any triggering

drank much water, micturition frequency slightly

event. In the morning on the third of X he could notincreased (10 times/day), bowel movements (once per

get out of bed and called the company reporting heday) of slightly soft consistency without abdominal

will take a day off. Even during bed rest he sufferedpain. Reportedly a high stress level at the workplace.

from pain radiating from the lumbar region down

Channel palpation

into the left gluteal region and then visited our clinic

The body in general was tense and hard. Due to highbecause these symptoms interfered with his daily

tension spontaneous sweating was observed on thelife.

face, back, lower legs, palms, and soles of the feet.

Two years earlier he had visited our clinic because of

Chilling of the abdomen and lower legs, while chest

chronic low back pain. Later complained about

and head felt feverish, indicating a marked

14

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

Volume 13, Number 3 | Fall 2018

differences in hot and cold feelings between thewith abundant heat in the chest, while the pulse

upper and lower parts of the body.

characteristics indicated insufficient dispersion of

Hands

heart heat.

Taiyin lung channel of hand indentation at LU7:

Pattern:tenderness at LU5, indentation at LU8

Kidney deficiency heat pattern, deficiency heat

Yangming

large

intestine

channelofhand:affecting the gallbladder channel, heart heat.

tenderness at LI11, LI10 and LI4
Juejin pericard channel of hand: tenderness at PC6,

Treatment

PC8

Needling:

Shaoyang sanjiao channel of hand: tenderness at

For "floating pulse" mostly shallow needling, for

TE5, TE6"deficient pulse" reinforcement, in case of a "floating,

Shaoyin heart channel of hand: tenderness at HT5,

large and deficient" pattern reinforce the deficiency

HT6, HT7 and HT8

first and later drain the excess.

Taiyang small intestine channel of hand: pinching

The primary treatment channel is the kidney

pain at SI3, left > rightchannel, but on this occasion it was a disease pattern

Feetof the gallbladder and bladder channels. I also used

Taiyin spleen channel of foot: indentation at SP9,

the small intestine channel to drain the heart heat,tenderness at SP8

and used the lung and large intestine channels as

Yangming stomach channel of foot：tenderness at

well

ST36 and ST44, left > rightreinforcement of the kidney channel.

Jueyin liver channel of foot: tenderness at LR8, LR3,Supine position:left > right

GB5, GV20 (needle retention), VC12, ST25, CV15 ~Shaoyang gallbladder channel of foot: tenderness at

hypochondrial

GB34, GB38, GB39 and GB41, left > rightscattered short pricking), LU8, LI11, SI3, TE3, ST37,

Shaoyin kidney channel of foot: indentations at KI10,

KI9, KI7 (singular insertion, reinforcement), SP8,

KI9, KI7 and KI3, left > rightGB38 (singular insertion, draining)

Taiyang bladder channel of foot: tenderness at BL55,

Prone position:

BL58

Scattered short pricking in the interscapular region,

Abdominal diagnosis:

BL14, BL15, BL43, BL17, BL18, BL22, BL23, BL52,* Discomfort in the hypochondrial region

BL26, left BL53, left BL54, BL55, BL58, BL60

* Lower abdominal weakness, lateral abdominal(needle retention + far infrared irradiation for 25

tensionminutes),

Pulse diagnosis:

insertion)

Floating,

large

and

deficient,

left

chi

pulse

as

the

left

spleenregionGB39,

channelto(singular

BL10,

supportinsertion

GB20

the

and

(singular

Sitting position:intermediate, floating, deficient, right cun pulse

Scattered short pricking along the ridge of theslightly floating and deficient, left cun and right cun

shoulder.

pulses slightly excessive
Pathology:

Results

A yin deficiency of the kidney channel led to a kidney

At the beginning of the treatment the patientchannel qi deficiency, the deficiency heat of thereported pain even upon lying down and turning in

bladder channel affected the gallbladder channel

bed, but after the treatment the pain rating

leading to upper excess and lower deficiency anddecreased from NRS 9→6. In a sitting posture there

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

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Volume 13, Number 3 | Fall 2018

was tenderness at GB39 on the gallbladder channel

Discussion

in the lower leg area. Attaching Pyonex 0.3 mm

In the past this patient had been diagnosed with aneedles decreased the NRS to 5, but due to the low

herniated intervertebral disk, but in the absence ofback pain the slow movements did not change. Facialnumbness of the lower leg, no difference in theexpressions

thecircumference of the calf and no atrophy, thepretreatment condition and dressing and walking

condition was considered to be a non-specific low

remained somewhat awkward.

back pain. He usually was performing desk work andimproved

ascomparedtoalthough feelings of fatigue and heaviness indicatedCoursea chronic condition, he could not think of any

Second session (+2 days)

triggering events that might have caused a low backOn the day following the treatment the low backpain severe enough to interfere with his social

NRS score dropped to 4. Today he visited our clinic

activities. Studies conducted in recent years indicate

after work and the NRS score has currently beena correlation between

alleviated to 3. However, there is still no change indepressive mood among possible sociopsychological

the slow movements and the patient keeps worrying

factors" and low back pain in cases of prolonged low

about the condition of his low back. Channel

back pain1). The symptoms of the low back pain that

palpation showed that the lower legs have become

developed in this patient during a string of

warmer and the generalized tension is decreasing.

consecutive holidays were characterized in that they

The 12 channels still showed the same tendencies,

aggravated after returning to work so much, that

but the tenderness at PC6, PC8 has decreased and I

they prevented him from leading his normal social

palpated a deficiency at ST36 a deficiency as well as

life. While treatment alleviated the low back pain, he

an excess at ST40.

could not help being worried about the activities ofPulse:

daily life, suggesting the presence of a mild degree of

Floating, slightly large and deficient, left chi pulse

depressive mood.

was intermediate, slightly floating and deficient, theThe patient had a disposition with a tendencyright cun pulse was slightly floating and deficient,towards kidney deficiency and "fear" as an emotion

the right guan also slightly floating.

associated with the kidney was unstable. Anxiety

Pattern:

actually developed during daily life, preventing him

Kidney deficiency heat pattern, the channel heatfrom taking audacious actions, suggesting theaffecting the gallbladder and stomach channels.

burden on the lower back had increased.

Treatment

Inspection showed a type of dark and dry skin that

Same treatment as during the previous session,

has been mentioned in Chapter 10 of the Jing Mai,

exempting the small intestine channel, reinforced

On Channels in the "Ling Shu", where the disease

and reduced the stomach channel and added 5 cones

produced by the liver channel being referred to as 'Zuof heat penetrating moxibustion at BL23 and BL26.

jue yin gan jing shi dong bing zheng' is characterized"psychological distress,by "non-lustrous complexion as if the face is dusted".
Results

In case the work related stress leads to a tendency

The patient reported "the moxa stimulation seems totowards depression, heat builds up within the chest

have been most effective" and the pain had beingthat may then be difficult to disperse. This does notalmost completely alleviated, so that the treatment

only suggest that the kidney deficiency and heart

was terminated.

heat form an exterior-interior unity, but it is also
possible to view this as a "vexation and fullness"

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

Volume 13, Number 3 | Fall 2018

associated with the liver channel 'Zu jue yin gan jing

Conclusions

Suo sheng bing zheng'. Since the patient requires

The objective findings were rather scant in spite oftime to lie down and worries about turning in bed,

the marked subjective symptoms reported by thethis may be interpreted as a disease produced by thepatient, so that I based the decision whether or not

liver channel described as "low back pain andto proceed with channel therapy mainly on the pulse

difficulty in moving the body" as well as the related

diagnosis and channel palpation. I performed a pulse

diseasechanneldiagnosis at the three bilateral radial pulses anddescribed as "pain in the subcostal region, inability

based my judgment of a "heat pattern" on theto turn the body".

evaluation of the classified pulses. Heat was the

Although in this case the predominant emotion wascentral feature of the disease pattern, but in case of"fear", it is easily conceivable that an insufficiently

reduction of the heat through shallow needling I

smooth dispersion of "anger" may have led to thedecided to "first reinforce the deficiency and later

onset of an acute low back pain as a disease of the

reduce the excess". Based on diagnosis of the pulse

gallbladder channel.

differences between the sided the kidney channel

Mr. Meiyu Okada said, that "the effective use of

was the primary treatment channel, but I decided

command points and local needling is sufficient tothat the changes in the gallbladder and bladderachieve recovery from acute but mild conditions

channels too have contributed to the development odepending on the pulse condition"2).

the low back pain. This is a channel combination

The author interprets the denotation of "acute andfrequently encountered in patients with low backmild" as referring to an "acute low back pain, but

pain. Combined with anxiety or tension the

without any signs of neurologic impairments". Mr.

inspection of the patients complexion and the results

Okada mentioned that in this case the "use ofof channel palpation the pulse reveals a close

command points depending on the pulse condition"correlation with the kidney channel, so that theand "local needling" should be sufficient. This

treatment of the kidney channel had in this patient

remark of him is serves as an important suggestion

marked general effects.

producedbythegallbladderregarding the standard treatment guide for low backin channel therapy.
In this case I initially applied comparatively shallow
needling for the yin deficiency heat pathology3,4), but
the pulse condition indicated the need for somewhat
greater insertion depth. In general it is important todiscern the deficiency-excess and cold-heat condition,
perform meticulous channel palpation. After that it
is possible to proceed with the appropriate treatment
based on an evaluation of the responses observed
during the channel palpation as well as thepathology surmised from the pulse condition
regarding yin-yang deficiency-excess.

References
1) Low Back Pain Clinical Practice Guideline 2012:supervision

by

The

Japanese

Orthopedic

Association, Japan Low Back Pain Association(Fourth Edition), Nankodo 2013
2) Meiyu Okada: Three cases of low back pain,
channel therapy, Channel Therapy Study Group,
1968
3) Motoaki
Japanese

Okabe,

Masakazu

Acupuncture

andIkeda,

others:Moxibustion

Medicine, Channel Therapy, Basics, Traditional
Japanese Medicine, 1997
4) Motoaki
Japanese

Okabe,

Masakazu

Acupuncture

andIkeda,

others:Moxibustion

Medicine, Channel Therapy, Clinics, Traditional
Japanese Medicine, 1997

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

17

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