KAIM
T
Thhee JJoouurrnnaall ooffK
Kaammppoo,, A
Accuuppuunnccttuurree aanndd IInntteeggrraattiivvee M
Meeddiicciinnee
INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 4, Number 4 ･ Winter 2009

Editorial

Wish to Progress “Clinical Pharmacognosy” in Japan
Toshiaki Makino

Japanese Acupuncture - Current Research

Sinusitis – Nasal Congestion / Effect of Acupuncture Stimulation on Nasal Secretion –Takeshi Kusumi

Kampo Medicine - Current Research
Effect of Goreisan on Cerbral Infarction
Hiroshi Kimoto

Clinical Report 1 (Japan)

Acupuncture and Moxibustion Treatment – Case Report
Introduction to Kuretake School of Integrative Medicine
Hironori Hatakeyama

Clinical Report 2 (Japan)

Kamishoyosan + Goshuyuto for Migraines before Menstruation
Mitsuyuki Takamura and Hiromichi Yasui

Clinical Report 3 (Japan)
Menstrual Cramps
Yang Cholsong

Kampo Dermatology – Clinical Studies
Vrticaria / Hives (8)Fumino Ninomiya

Medical History in Japan

Sotetsu Ishizaka’s “Shinkyu Chiyo Ichigen” (4)Kenji Kobayachi

ISSN:1559-033X

Volume 1, Number 1 | Spring 2006

A good motive creates a selfless devotion.
“I just want my customers to feel better, body and soul. Just to see
their faces light up with hope and happiness, I’d do anything,”
remarks Masao Tsuji, President of Ominedo Pharmaceutical Industry
Company. He visits various sites where raw herbs and substances foruse in their Kampo products are picked. And he believes this is the
tradition Ominedo had maintained for over a century now since thecompany was founded in 1900.
The same philosophy is applied in handling the numerous
high-quality formulas created at their labs where highly advanced
scientific and pharmacological researches are conducted. The
company’s state-of-the-art facilities that comply with GMP standards
turn out various extracts to be incorporated into their pride products.
“Every merchandise is the by-product of our sincere devotion todelivering a lineup of products that not only work for the customers’
body, but also bringing peace of mind as well,” Tsuji concludes,“delivering the right product to customers who appreciate ourknowledge and devotion is our ultimate goal.”

Ominedo Pharmaceutical Industry Co., Ltd.
574, Nenarigaki, Yamatotakada-City, Nara 635-0051, Japan
URL: www.ominedo.co.jp
Contact: info@ominedo.co.jp
FAX (81) 745-23-2540

The Journal of
Kampo, Acupuncture andIntegrative Medicine(KAIM)

T
Thhee JJoouurrnnaall ooff
K
Meeddiicciinnee
Kaammppoo,, A
Accuuppuunnccttuurree aanndd IInntteeggrraattiivvee M

Research on Theory, Practice and Integration

EXECUTIVE EDITOR

Shuji Goto
Chairman, GOTO College ofMedical Arts & Sciences
Tokyo, JapanEDITOR-IN-CHIEF

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

Volume 4, Number 4 ･ Winter 2009

TA B L E O F C O N T E N T S
1 Editorial
Wish to Progress “Clinical Pharmacognosy” in Japan
Toshiaki Makino

2 Japanese Acupuncture - Current Research
Sinusitis – Nasal Congestion/Effect of Acupuncture Stimulation on Nasal Secretion –Takeshi Kusumi

ASSOCIATE EDITORS
Shuichi Katai
Ibaraki-ken, Japan

Hiromichi Yasui
Tokyo, JapanEDITORIAL STAFF

8 Kampo Medicine - Current Research
Effect of Goreisan on Cerbral Infarction
Hiroshi Kimoto

Akira Shimaoka
Hiroshi Tsukayama
Hitoshi Yamashita
Naoya Ono
Noboru Mitsuhata
Yoshiro Sahashi

12 Clinical Report 1 (Japan)
Acupuncture and Moxibustion Treatment – Case Report
Introduction to Kuretake School of Integrative Medicine

EDITORIAL BOARD

17 Clinical Report 2 (Japan)
Kamishoyosan + Goshuyuto for Migraines before Menstruation

Denmei Shuto
Hajime Haimoto
Hideaki Yamaguchi
Hidemi Takahashi
Katsutoshi Terasawa
Kazushi Nishijo
Keigo Nakata
Keishi Yoshikawa
Koji Ebe
Shohachi Tanzawa
Tadashi Yano
Takahisa Ushiroyama
Tomomasa Moriyama
Toshihiko Hanawa
Yoichiro Ebe
Yoshiharu Motoo
Yoshiro Yase

PUBLISHER

Hironori Hatakeyama

Mitsuyuki Takamura and Hiromichi Yasui

18 Clinical Report 3 (Japan)
Menstrual Cramps
Yang Cholsong

19 Kampo Dermatology – Clinical Studies
Urticaria/Hives (8)Fumino Ninomiya

21 Medical History in Japan
Sotetsu Ishizaka’s “Shinkyu Chiyo Ichigen” (4)Kenji Kobayashi

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)

Volume 1, Number 2 | Summer 2006

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

Volume 4, Number 4 | Winter 2009

Editorial
Wish to Progress “Clinical Pharmacognosy” in Japan"Pharmacognosy" is one of research fields in pharmaceutical science.
But thecharacteristics of pharmacognosy are slightly different between United States and Japan. In
Japan, crude drugs such as medicinal plants, minerals or fossils, named "natural medicines",
have been used as the component of traditional medicines. Since crude drugs are "medicines",
their quality control is necessary, and the pharmacognosy has been developed to make thequality control of crude drugs more efficient by employing microscopic histology, quantifying
the contents of marker compounds, or identifying the genes of the plants, etc. In the UnitedStates, crude drugs have not been recognized as "medicines" from more than 100 years ago.
Since they are "crude", the only active ingredients containing in crude drugs, that are usually
explained as pure substances or chemical compounds, have been considered as "medicine".
Therefore, the techniques for quality control of crude drugs have been no need, and the isolationof chemical compounds from crude drugs has been developed in the pharmacognosy in UnitedStates. Until now, a lot of useful chemical compounds are isolated from crude drugs, and morethan 70% of medicines have been developed from natural sources with or without chemical
modification.
Over the past several years in the United States, crude drugs are recognized as dietary
supplements, and have come to contribute to the public health. Crude drugs that haverelatively strong pharmacological activity and are recognized as drastic medicine in Japan are
also commercially available as functional food in the market in US. Since dietary supplements
are not "medicine" but food, and are only regulated under the quality control for food sanitation,coarse products are sometimes distributed in the market, e.g. the products using wrong plantmaterials, containing or foreign substances or no active ingredients, exhibiting highly variation
among lot-to-lot, etc. These problems have been already settled in Japanese market for crude
drugs, where these materials are regulated as "medicine".
It is considered that theJapanese-style pharmacognosy is now getting more important to use crude drugs as dietary
supplements in United States.
On the other hand, "clinical pharmacognosy" is slightly behind in Japan. In United States,
the principle "clinical pharmacy" is enormously ingrained in hospitals and pharmacies, and since
many patients are actually using crude drugs as dietary supplements, physicians andpharmacists have to handle them in order to make their beneficial evidences by clinical trials or
to protect patients from their adverse effects. A workshop on clinical pharmacognosy was heldin the meeting of American Society of Pharmacognosy in 2007, and they have discussed to solve
above problems for crude drugs. The culture of clinical pharmacy has recently been become
popular in Japan, and the several approaches are just now being conducted for chemical drugsby trials and errors. Japanese physicians and pharmacists have to learn and develop clinicalpharmacognosy from United States, since they have more excellent techniques for the quality
control of crude drugs.
Toshiaki Makino, Ph.D.
Associate Professor, Department of Pharmacognosy
Graduate School of Pharmaceutical Sciences
Nagoya City University, Nagoya, JapanThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

1

Volume 4, Number 4 | Winter 2009

Japanese Acupuncture - Current Research
Sinusitis – Nasal Congestion/Effect of Acupuncture
Stimulation on Nasal Secretion –Takeshi Kusumi
University of Human Arts and Sciences

1. Nosediseaseandtreatment
withacupuncture
Acupuncture treatment in the field ofotorhinolaryngology in Japan started when thenews was reported in 1974 that acupuncture
anesthesia was used in China for ahearing-impaired individual. Since then, theacupuncture anesthesia has been practiced inJapan based on the Chinese methods.
Acupuncture treatment of sinusitis is also basedon the one of their methods. The acupuncture of
the time was performed not for the purpose oftreatment but was handled as acupuncture
anesthesia for the surgery of sinusitis. Various
books about acupuncture treatment forotorhinolaryngological diseases have been
written by a well-known clinical practitioner inJapan, introducing acupuncture treatment forsuch as hearing loss, buzzing in the ear,dizziness, rhinitis, heaviness of the head,neuralgia, and nerve paralysis. The contents ofthe books, however, are not based on medical
rationales and only provide the general
information of diseases and acupuncture points
used for the treatment of respective diseases. By
contrast, what the university hospital needed
was the information of scientifically grounded
acupunctured effects. Earlier studies on
acupuncture treatment of sinusitis were lack ofscientific reasoning and did not serve as usefulreferences.
This report is not written from the standpointof how to “cure” sinusitis. The purpose is to givean account of nose diseases, especially theconnection of nose diseases with the autonomic
nervous system on the basis of the relationshipbetween nose symptoms and acupuncture2

stimulation. Therefore, this report will not be
useful for the therapists who expect or seek
information about treatment of certain diseases.
So I hope this report will be utilized not only for
acupuncture treatment of sinusitis but as a guidefor supportive or preventive measures of sinusitis
treatment with reference to the relationshipbetween autonomic nerve symptoms of the nasal
mucous membranes ad acupuncture stimulation.
2. General information of chronic sinusitis
There are few reports published on
acupuncture treatment of chronic sinusitis. Thismay be due to a wide gap between themechanisms of acupuncture efficacy, causes andpathological conditions. So, firstly a brief
explanation of sinusitis will be given.
Chronic sinusitis is caused by individual’s
constitution, allergies, bacterial and viral
infections. If appropriate procedures were nottaken in the acute phase, it may lead to chronic
problems. The symptoms differ depending on the
combination of affected paranasal cavities.
However, subjective symptoms commonly seen
include rhinorrhea (nasal discharge), nasal
congestion, headache/feeling of top heaviness,and decreased mental function. Furthermore,nasal obstruction and inflammation of the nasal
mucous membranes may cause anosmia, a
reduced sense of smell. The type of nasal
discharge in chronic sinusitis is mucous andpurulent, which is different from the watersoluble thin type in allergic rhinitis. In the case ofsinusitis, the nasal discharge more often gives thesensation of dropping downward through theposterior nasal aperture as posterior nasal drop
rather than through the anterior nasal aperture.
In modern medicine, there are two types ofsinusitis treatment – conservative treatment inwhich antibiotics and/or antiphlogistics are used,
and operative treatment1)2).
It is difficult to treat sinusitis presenting these

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

Volume 4, Number 4 | Winter 2009

conditions with acupuncture and such sinusitis isoften handled as a disease to which acupuncture
is not applicable. Even so, it cannot be said that
acupuncture treatment is completely helpless.
This report is not intended to provide the way ofhandling chronic sinusitis for a radical cure but isintended to provide the way of thinking about
acupuncture treatment based on the relationshipbetween the nasal mucous membranes andautonomic nerves for the people who complain ofsinusitis.

A nasal discharge is secreted from the nasal
glands in the nasal mucosa. The secretion of nasal
discharge occurs when parasympathetic nerves
become hyperactive. We have also verified thisphenomenon by our clinical study using
autonomic drugs and autonomic blocking
drugs5)6).
Symptoms relating to the nasal mucosa
include those caused by the involvement of theautonomic nerves and those developed by the
involvement of the sensory nerves innervating

3. Typical nasal symptoms
Sneezing, nasal congestion, and nasal
discharge
are
known
as
three
major
characteristics of nasal allergy. These symptoms
are also typical conditions that are associatedwith other nasal disorders1)2).
Nasal congestion is caused by nasal septum
deviations, nasal polyps, nasal tumors, or otherstructural anomalies of the nose. If there is no
structural anomaly, swollen mucus membranes in
the nose is often the cause. The swelling of thenasal mucous membrane is due to the structure ofabundant blood vessels in the nasal mucous
membranes and the degree of the swelling isaffected by the activities of cervical sympathetic
nerves that innervate the blood vessels in thenasal mucous membrane. If the activities of thecervical sympathetic nerves are enhanced, theblood vessels of the nasal mucous membranes
contract and the nasal congestion improve. The
connection of the blood vessels of the nasal
mucous membranes to cervical sympathetic
nerves has been elucidated from the anatomicaland physiological viewpoint, and the connection
has also been verified from clinical effects of astellate ganglion block3)4), stellate ganglion
stimulation, and adrenaline nasal spray5)6). The
blood vessels of the nasal mucous membranes are
influenced only by sympathetic nerves but
parasympathetic nerves have no action on the
blood vessels of the nasal mucous membranes.

the nasal mucosa. Sneezing happens by the
involvement of the sensory nerves. Nasal allergicsneezing

happenedbyallergen-induced

simulation is triggered by the stimulation of thesensory nerves distributed over the nasal mucosa.
4. Nerve innervations of the nose
The nasal mucous membranes function by thesensory nerves responsible for processing sensory
information such as smell and pain and theautonomic nerves innervating the blood vessels of
the nasal mucosa and nasal glands. This section
presents

anoverviewofautonomic

nerve

innervations (Figure 1).

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

Figure 13Volume 4, Number 4 | Winter 2009

The blood vessels of the nasal mucosa receive

nasal mucosa) needs 15 minutes. The influence ofcontrol of the cervical sympathetic nerves. As

acupuncture stimulation given in this way on theshown in the Figure, preganglionic fibers coming

nasal mucosa is characteristically more effectivefrom the upper thoracic spinal cords form

compared to that in the recumbent position.

synapses,

and

then

pass

throughthepterygopalatine ganglion to control the blood

6.

vessels of the nasal mucous membranes. The

acupuncture stimulation

control is ipsilateral, and vascular contraction

1) Influence on nasal congestionand dilation occur depending on the control

Relationship between nasal symptoms andNasalcongestion

improvesbyactivity status. As with other peripheral vessels,

electro-acupuncture stimulation to one hand.

this function is not subject to parasympathetic

However, the degrees of the improvement are

nerve control.

subjective, so assessing improvements is difficult.

The nasal glands are innervated by the greater
petrosal nerve responsible for parasympathetic
functions of the facial nerve. After the greater
petrosal nerve has formed synapses in thepterygopalatine

ganglion,thepostganglionicfibers innervate the nasal glands. The control isalso ipsilateral. When activities increase, nasal
discharge is secreted. Nasal discharge is notaffected by sympathetic activities.
The autonomic nerves innervating the nasal
mucosa do not have dual and antagonistic control
characteristic of autonomic nerves.

Therefore, we used a rhinomanometer to measure
the nasal airway resistance to objectively assessthe degrees of nasal congestion.
The nasal airway resistance decreased withinone

minutewiththe

The acupuncture points to apply stimulationelectro-acupuncture stimulation to one hand,showing an improvement in nasal congestion8).
Electro-acupuncture

stimulation

inserted in these acupuncture points

at the same time. This result indicates that
acupuncture stimulation to one hand worked onsides, resulting in an improvement in the nasal
congestion of the opposite side (Figure 2).

7).

The

stimulation conditions are for 15 minutes with 1
Hz with the stimulation intensity that causesslight muscle contractions and with which
patients do not subjectively feel painful. The
similar

to

that

of

acupuncture anesthesia except for the points thatsimulation is given to one hand while sitting andthat acupuncture anesthesia needs longer hoursof stimulation whereas acupuncture stimulation
for nasal symptoms (autonomic nerves in the4thewell as contralateral nose to the stimulated handcurrents are applied to the needles as electrodesislowerednasal airway resistance of the ipsilateral nose as

are hegu and neiguan on one hand. Electric

methodofthe blood vessels of the nasal mucosa on both

5. Methods of applying acupuncture stimulation

stimulation

application

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

Figure 2

Volume 4, Number 4 | Winter 2009This phenomenon was observed both when air is

In the group of pilocarpine alone, the patients

inhaled and when air is exhaled in nasal breathing.

with nasal allergy had evidently higher secretion

Electro-acupuncture

stimulations, however,

did not have effects on congestions occurred in the
decubitus

position6)

andphysiologicalnasal

volumesofnasal

discharge

thanhealthy

volunteers. On the other hand, in the combination
group

of

pilocarpine

andacupuncture

congestions induced by the pressure on the chest

stimulation, the patients with nasal allergy andside9) and nasal congestions occurred due tohealthy volunteers had similar levels of secretion

stellate ganglion blocking 8).

volumes to those of healthy volunteers (used as
the base) in the group of pilocarpine alone. As the2) Influence on nasal discharge
Electro-acupuncture stimulation applied in thesimilar manners reduces the secretion volume ofnasal discharge. As it is difficult to compare thesecretion volumes before and after applying
stimulation, an induction test 8) was conductedwith patients and healthy volunteers with the useofaerosolspraysofpilocarpine(aparasympathetic nerve stimulant) into the nasal
cavities to compare results (Figure 3). The uppergraphs of Fig. 3 show the results of healthy
volunteers and the lower graphs are for the
results of the patients with nasal allergy. The
upper and lower graphs on the left side show theresults of pilocarpine alone, while those on theright show the results of the simultaneousadministrationofpilocarpine

electro-acupuncture stimulation.

andresults showed, electro-acupuncture stimulation
was unable to block or inhibit the drug efficacy of
pilocarpine in either healthy volunteers or thepatients with nasal allergy, but the stimulation
reduced the secretion volumes of the patientswith nasal allergy to the levels of healthy
individuals. This phenomenon may have beencaused by the sensitivity of nasal mucous
membranes

or

their

responsivenessbeing

inhibited by electro-acupuncture stimulation.
3) Influence on sneezing
From a separate experiment, it is known thatnasal congestion or nasal discharge occurred in
the nasal provocation test using allergen extracts
could

be

inhibitedbyelectro-acupuncture

stimulation. Sneezes happened by allergens
stimulating the nasal mucosa could not be
inhibited by electro-acupuncture stimulation. It
could

be

assumed

from

the

above

that

electro-acupuncture stimulation may not haveinfluence on sensory thresholds of the nasal
mucosa8).
7. Commentary
The subject of this report is effects ofacupuncture

treatmentforsinusitis.

As

mentioned at the beginning of the report, I
consider sinusitis treatment with acupuncture to
Figure 3

aim for a cure is difficult. As stated above, I
consider that in view of the influence on

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

5

Volume 4, Number 4 | Winter 2009acupuncture stimulation on nasal symptoms,

nasal congestions improved by acupuncture

acupuncture treatment can yield some practicalstimulation. Like this, the relationship of theeffect as a symptomatic treatment for sinusitis.

nasal functions with the Large Intestine

For instance, improving nasal congestion has

Meridian of Arm Yang Brightness can besome sort of potential positive influence on

considered from the author’s experiences andventilation of the paranasal sinuses. Purulent

experiments,

nasal discharge is a symptom resulted fromstimulation to the acupuncture point of hegu

inflammation, and acupuncture stimulation has

are conveyed to the central nerves systeminfluence on the secretion volume of nasal

throughdischarge through the mediation of the autonomic

mediate the autonomic nerves through thenerves. Although there are many reports released

efferent

on immunoreactions in the nasal mucosa, I expect

acupuncturestudies will be promoted on autonomic nervous

functional relation with the nasal mucosa

functions of the nasal mucosa as well as

through the pathway of neural reflex. On theanti-inflammatorytransfer

effects

occurring

by

the

the

that

signals

afferent

pathway.
point

point

of

inducedpathway,

It

means

stimulation

this

and

by

then

that
have

pathway,

the
a

the

acupuncture point of dazhui that has a deep

stimulation of peripheral nerves.
There are many indications for acupuncture.

connection with cervical sympathetic nerves

In the symptoms associated with sinusitis such as

may be located at the seventh cervical vertebra

headache, top heavy feeling, and deteriorated(Figure 4).

mentalfunctions,

some

are

apparently

susceptible to treat with acupuncture. To provide
acupuncture treatment for respective associatedsymptoms to enhance the QOL of patients is oneof important purposes of acupuncture treatment.
However, if treatment cannot achieve a radical
cure,treating

respective

symptoms

isnotbeneficial to patients. Therefore, the provision of
integrative medicine is required for the benefit ofpatients.
Lastly, I will mention about the relationshipbetween the Large Intestine Meridian of Arm

Figure 4

Yang Brightness (Yangming) 10) and the nose.
The acupuncture point of yingxiang (whichIn

futureacupunctureandmoxibustionmeans meeting flavors) is located at the end of

medicine, the combination of modern medicine,the Large Intestine Meridian of Arm Yanganatomical physiology, and classical concept ofBrightness. It could be assumed that thismeridians and acupuncture points will further

acupuncture point was named as yingxian

deepen the way of thinking toward acupuncture(meeting flavors) by ancient people who hadtreatment and enhance the clinical significance ofobserved respiratory anosmia resulted fromacupuncture.

6

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

Volume 4, Number 4 | Winter 2009

8. References
1)

KirikaeIchiro,NomuraYasuya:Shin

Jibiinkou Kagaku. Nanzando, Tokyo, 2004.
2)

Suzuki Jyunichi, Nakano Yoshiaki, Hirano
Minoru:HyoujunJibiinkou

Kagaku.

Igakushoin, Tokyo, 1083.
3)

Wakasugi

Bunkichi:Seijyoushinkeisetu

Hana-Allergy
Block

no

Ryouhou.

Igakunoayumi, 136: 668 – 671, 1986.
4)

Masuda Yutaka: Hana-Allergy no Seijyoushinkeisetu
Block Ryouhou – Sugi-Kafunshou wo Chuushin ni –.
Igakunoayumi, 136: 673 - 676, 1986.

5)

Ishizaki Fumio: Bibu Hifuon to Bikuu-Tsuukido
tono Kankei nitsuite. Nichijibi, 90: 547 - 554,
1987

6)

KusumiTakeshi,

Sokugai

Michinari:

de

Okoru

Binenmaku-Kekkan-HannouniTaisuru

Katatebari-Tsuuden

Shigekino

Eikyou.

JournalJapanese

SocietyofBalneology,
Medicine,
7)

OkamotoThe

Climatology

and

of

Physical53 (3): 153 – 158, 1990.

Kusumi Takeshi: Hari-Tsuuden Shigeki ni
yoru Biheikan oyobi Bibu-Hifuon no Henka
ni Tsuite. Igaku/Seibutsugaku Thermography,
1: 115 – 117, 1981.

8)

Kusumi Takeshi, Ishizaki Fumuo: Bishoujyou(Bihei,Bijyuu)ni

Taisuru

Katatebari-Tsuuden Shigeki no Eikyou. JIBIINKOKA TEMBO, 23 – 41, Tokyo, 1988.
9)

Sakamoto

Maki,

KusumiTakeshi:

Sokukyoubu Appaku de Okoru Bihei ni
Taisuru Harishigekino Eikyou. Journal of
Japan

College

Associationof

Oriental

Toyo

Igaku.

Medicine, 19, 38 – 43. 1995.
10) Shirota

Fumihiko:

GAKKEN

ZusetsuCo., Ltd. 1979.

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

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Volume 4, Number 4 | Winter 2009

Kampo Medicine - Current Research
Effect of Goreisan on Cerbral Infarction－From the Goreisan Symposium 2010”－
Hiroshi Kimoto, Internist
Saito Clinic, Medical Corporation Eizukai

Introduction
Goreisan, whose source is “shang han lun”, haslong been known as a common agent in Chinese
herbal medicine. It is considered to be an
aquaretic drug and alleviates aqueous moisturemetabolic abnormality. Using this medicine totreat headaches has recently come to light in(1)
Japan. In this paper, we review the indications
for goreisan on cerebral infarction, a pathologic
condition in cerebral stroke. At present, its
application for cerebral infarction is being
conducted only by the author, and there is a(3)
clinical comparison
with the 2002 Japan(2)
Standard Stroke Registry Study (JSSRS), as
described later.
Background
Acute cerebral infarction is a disease that isclassified into types of cerebral stroke and itself is
a risk factor in elderly persons. A guideline forthe treatment of cerebral stroke has been
published by the Cerebral Stroke Joint Guideline
Committee (the Committee), starting in 2003 and(4)continuing in 2003, 2004, and 2009. At each of
those times, treatment based on scientificfoundations was recommended. In the process,various drugs such as thrombolytics and radical
scavengers have been developed, which has
resulted in a greater number of patients withfavorable prognoses. On the other hand,statistically, many patients have residual
disabilities such as paralysis, which reduces apatient’s quality of life (QOL) and causes social
problems such as patient care. Thus, further
development of drugs and treatment for the
disease has been desired.
In Japan, the use of Chinese herbal medicines

8

for cerebral stroke has been described in various
(5)
While
daisaikoto,historicalliterature.
san’oshashinto, and zokumeito, etc., are indicatedfor treatment at the acute stage, a record of theuse of goreisan has not been found. The reason ispresumed to be because its diagnostic findings in
Chinese medicine varied historically due to alarge number of hemorrhagic pathologic
conditions such as cerebral hemorrhage, whichmight result in various prescriptions of Chinese
herbal medicines; it was also impossible tounderstand the lesions in the brain in detail as
can now be done by CT or MRI, etc., andconsequently, it was impossible to detect cerebral
edema, a pathologic condition induced by cerebral
stroke in many cases.
In cerebral infarction, signals are detected on
diffusion images of MRI at the initial stage orlater after onset, and thus the local pathologic
condition of cerebral edema at the lesion appears.
It is expected that controlling the edematous
condition will enable protection from necrosis of
cerebral nervous tissue induced by the infarction,
which indicates the great contribution to aprognosis. However, only edaravone, which isavailable as a cerebral protector, has a certain
effect, but it is not a cure-all.
Process till application of goreisan
In 2000, the author reported a case of a patientwith external hydrocephalus secondary totraumatic subarachnoid hemorrhage and theprognosis could be controlled favorably byadministration of aquaretic drugs such as
inchingoreisan and shinbuto. In addition,
aquaretic drugs of Chinese herbal medicine wereapplicable for an edematous pathologic condition(6)
in the cranium.
Taking these findings and the above-describedpathologic conditions of cerebral infarction into
consideration, the author devised a method inwhich Western drugs and Chinese herbal

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

Volume 4, Number 4 | Winter 2009
(7–9)

medicines were combined
and the treatment
was described in case reports during the period
from 2001 to 2002. The outline of the method is asfollows:
A small dose of argatroban (10 mg/day; aprescribed dose is 60 mg/day for the first two daysand 20 mg/day for the subsequent five days) andgoreisan extract (7.5 mg/day) were combined for
all cases, and for abdominal symptoms,
saikokeishito, san’oshashinto, orengedokuto, etc.,
were added (see reference for details). The
functional prognoses after discharge were
sufficiently satisfactory.
Comparison with the 2002 Japan Standard
Stroke Registry Study
Based on the above-described case report, theauthor describes a comparative study of theseverity at admission and findings in follow-up
observations after discharge of 14 inpatients withlacunar and atherothrombosis cerebral infarction
who were treated by a combined therapy with
Chinese herbal medicines at the author’s clinic
during the period from October 2000 to October
2002, and those findings were compared withthose in the 2002 Japan Standard Stroke(2,3)
Registry Study (JSSRS).
The subjects were 14 patients (seven males
and seven females aged 68–99; mean age,
78.0±9.1), of whom 9 had a lacunar type disease, 4
had an atherothrombotic type disease, and 1 was
unknown. The time until consultation at theclinic ranged from one to 84 hours after onset(mean time, 19.3±26.6 hours).
In diagnosing the disease, except for one case,the infarct site becoming a culprit lesion wasdetermined by neurological symptoms anddetectable lesion sites on diffusion images of MRI
performed two to three hours after onset. The
severity at admission was evaluated according to
the Japan Stroke Scale (JSS), the clinicalevaluation at discharge was determined by the
degree of neurological improvement on the JSS,

and the degree of recapitulative functional
improvement was evaluated based on the
Modified Rankin Scale.
The results obtained could not undergo a testof significant difference between both sets of data
because the number of cases was insufficient andindividual data in JSSRS were not available. In
the group treated with combined Chinese herbal
medicines, the ages of the subjects were higher(78.0±9.1 years vs. 68.0±11.4 in JSSRS lacunar
type and 68.0±10.2 in JSSRS atherothrombotictype), and the period (days) of hospitalization was
shorter (29±18 vs. 33±25 in JSSRS lacunar typeand 36±23 in JSSRS atherothrombotic type). The
JSS at admission was higher (8.9±5.9 vs. 2.1±3.5
in JSSRS lacunar type and 4.9±6.5 in JSSRS
atherothrombotic type), indicating a severer
condition, and the JSS at discharge was lower(0.3±1.2 vs. 1.3±4.1 in JSSRS lacunar type and3.6±6.6 in JSSRS atherothrombotic type),
indicating a neurological improvement. As for the
Modified Rankin Scale at discharge, theproportion of the scores of 0 or 1 that indicatesnormal or very slight pathologic condition without
any clinical problem, was 93% versus 67% in
JSSRS lacunar type and 45% in JSSRS
atherothrombotic
type,
which
is
an
unquestionably favorable outcome. As for theclinical results from the different treatment
methods, the variation in JSS was 8.6±6.20 in thegroup treated with combined Chinese herbal
medicines versus 2.7±6.11 in the group treatedwith argatroban in JSSRS and 1.7±4.44 in thegroup with ozagrel in JSSRS, which was a morefavorable result than the groups treated witheach single Western drug. As for safety, no side
effect or harmful event was found in thetreatment with combined Chinese herbal
medicines.
Subsequent reports
Based on a search of the literature, no clinicalstudies appear to have been published after the

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

9Volume 4, Number 4 | Winter 2009

above-described report. However, the author
presented a report at the end of 2003, in which amechanism for the effect related to the above(10)
The report was about aresults is indicated.
patient with atherothrombotic cerebral infarctionin the anterior cerebral arterial region, where thevariations in the lesion on an MRI three hours
and seven days after onset were compared. The
results revealed that the extent of the infarctlesion seven days after onset was far less than the
expected range in an untreated case, whichstrongly indicates a cerebral protective action of
the combined Chinese herbal medicines. The
author also presented data (in this journal) from acomparison of variations in urinary volume
during treatment with goreisan administered topatients with other diseases such as vertigo.
According to the report, the urinary volume
increased significantly with the treatment for
cerebral infarction, which strongly indicates acause and effect relationship between thetreatment effect and the administration of anaquaretic drug, namely goreisan, for cerebral
infarction.
The author hasn’t presented further clinicalstudies and similar additional reports about
cerebral infarction have also not been presented.
Therefore, further studies are required.
Viewpoint of current medicine for cerebral edema
In 2004–2005, Nagai et al. from Kumamoto
University and Isohama et al. presented thetreatment effects of goreisan on fatal cerebral
edema induced by water intoxication in rats,
reporting that the mechanism for this is due tothe active inhibition of aquaporin 4, and the basisof the inhibitors of aquaporin 4 were mineralcomponents such as manganese contained incang-shu and zhu-ling, both of which areconstituent crude drugs of goreisan (see reference11). Subsequently, the relationship between
cerebral edema with various pathologic
conditions and the pharmacokinetics of aquaporin

10

(12)

Although the
4 was studied and reported.
mechanism cannot always be explained only by
the action of aquaporin 4, clinically, evidence ofthe effects of Western drugs such as glyceol on
cerebral edema have not been apparent and therole of goreisan as an anti-cerebroedema drug isthus anticipated.
Summary
Although no additional reports have currently
been presented with respect to cerebral infarction,
there have been clinical reports on cerebral
edemas induced by chronic intradural hematoma,(13–15)
As such,dialysis uneven syndrome, etc.
recently, the efficacy of goreisan on various
cerebral edemas has been strongly indicated byclinical reports and animal experiments fromindependent facilities. Accordingly, goreisan is
now considered to be effective for treatment of
edematous pathologic conditions accompanying
various cerebral diseases. There is currently noeffective Western drug for the treatment of
cerebral edema, but the clinical applications forgoreisan have been strongly indicated and they
therefore remain to be clarified by future studies.
References(1)

Yasui H.: Efficacy of “Goreisan” to the
Headache. The Journal of KAIM, Vol. 1 No.
1 pp. 8–12, 2006

(2)

Kobayashi S. et al.: A Study on Structure of
Database of Patients with Acute Cerebral
Stroke, 1999, Welfare Science Research
Grant. 2000 report of Health Science
Integrated Research Project, 2002

(3)

Kimoto H.: A Study on 14 Cases of Combined
ChineseHerbalMedicines

for

Acute

Cerebral Infarction: Japan Standard Stroke
Registry Study; Mainly comparing with
(JSSRS). Journal of Japanese and Chinese
Medicine, Vol. 20 No. 2 pp. 68–73, 2003

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

Volume 4, Number 4 | Winter 2009(4)

Shinohara Y. et al.: Edition: 2009 Guideline fortreatment of cerebral stroke. Kyowa Project,
2009

(5)

Otsuka K. et al.: Practice of Diagnosis in
Chinese Medicine. Nanzando pp. 616–655,
1954

(6)

Kimoto H.: An Experience of External
Hydrocephaly Treated mainly by Chinese
Therapy.

Clinical

PracticeofChinese

Medicine, Vol. 47 No. 12 pp. 36–42, 2000
(7)

Kimoto H.: An Experiment of Chinese
HerbalPreparation

in

Acute

Cerebral

Infarction. Clinical Practice of Chinese
Medicine Vol. 48 No. 2 pp. 37–44, 2001
(8)(13) Matsumura M. et al.: Effect of goreisan on
Chronic Intradural Hematoma in Highly
Elderly People. Neurosurgery, Vol. 33 pp.
965–969, 2005
(14) Shii J. et al.: Prioperative Management for
Hemorrhagic Cerebrovascular Impairment
in Patients with Chronic Renal Failure/Caseof Medical History of Abdominal Surgery.
Surgery of Cerebral Stroke, Vol. 28 pp.
393–396, 2005(15) Hayashi A.: Clinical Effect of goreisan on
Cerebral Edema accompanying Intracranial
Malignant Tumor. Chinese Medicine andLatest Treatment, Vol. 17 No. 3 pp. 226–231,
2008

Kimoto H.: Three Treatment Cases by
Combined Chinese Herbal Preparation for
Acute Central Nervous Infarction. Clinical
Practice of Chinese Medicine, Vol. 48 No. 6
pp. 31–41, 2001

(9)

Kimoto H.: Experience of Combined Chinese
HerbalMedicines

Infarction

in

Acute

Cerebral(Additional

Cases).

Clinical

Practice of Chinese Medicine, Vol. 49 No. 3
pp. 27–39, 2002(10) Kimoto H.: Possibility of Organ-Protection
by Combined Therapy with Chinese Herbal
Medicines, mainly goreisan, in Acute
Cerebral Infarction (Certain indicativedata). Clinical Practice of Chinese Medicine,Vol. 50 No. 9 pp. 1233–1238, 2003
(11) Gihama Y.: Aquaretic Action of Chinese
Herbal Medicine and Aquaporin. Accessible
Chinese Medical Treatment for PediatricDiseases (Record Book of 10th Meeting ofJapan Pediatric Chinese Medicine), No. 9 pp.
8–31, 2010(12) Sato S.: Role of Aquaporin 4 in Cerebral
Edema and Cerebral Water Balance.
Neurological Advance Vol. 50 No. 2 pp.
183–189, 2006

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Volume 4, Number 4 | Winter 2009

Clinical Report 1 (Japan)
Acupuncture and Moxibustion Treatment – Case Report
Hironori Hatakeyama
Kuretake School of Integrative Medicine

1. Introduction
This case reports describes the observed courseof a patient with lumbar spinal canal stenosis
referred to this clinic from the Kuretake Medical
Clinic (below abbreviated KMC) affiliated withthis school, who was treated a total of 7 times.
2. CasePatient: 64 years, male, runs an opticians store,height: 165 cm, weight: 62 kg
First visit: January 27, 2011
Chief Complaint: low back pain, numbness
extending from the right buttock down theright leg, pain in the buttocks upon sitting
down.
Present illness: At the beginning of December
2010 the patient felt while walking a sudden
pain in the right knee and on the right side of
the waist that quickly disappeared at that time,
but later he occasionally experienced pain, also
during walking, on the right side of the low
back. On December 31 the low back started tohurt on both sides and he went to a groceries
store to purchase and use a low back pain belt
to reduce the pain. On the next day (January 1,2011) upon rising a sharp pain and numbness
in the right lumbar area occurred when he put
his foot on the floor and since then he felt
numbness on the outside of the right leg.
On January 6 of the same year he consulted
the department of orthopedics at the KMC and
was diagnosed with stenosis of the lumbar
spinal canal. Until January 8 of the same year
he had to use a taxi to commute to the KMC,
which is located in his neighborhood, because
he had difficulties walking. At the KMC thetreatment was performed from the day of thefirst visit in the department of rehabilitation

12

and included application of heat, traction, lowfrequency current therapy and was alsoprescribed oral drugs (anti-inflammatory
analgesics, muscle relaxants, PG derivatives,
drugs for peptic ulcers). By January 16 of thesame year he had recovered so far, that hecould come walking to the clinic. At this time
he tended to drag the right leg when starting
to walk but still commuted every day. After the
rehabilitation the dragging sensation of theright leg was somewhat relieved.
When he learned of the parallel establishmentof this facility acupuncture treatment was
initiated. Although this was going to be his
first acupuncture treatment, he had noconcerns about the treatment nor felt any
resistance to it and was thus referred to the
KMC based on his wish to achieve any possible
relief of the symptoms (the form requestingtreatment was received on January 24 of thatyear) and thus started to visit this clinic.
The pain and numbness on the outside of theright lower extremity is particularly strong
upon rising and slightly alleviated by warming
the leg. Since the development of thesymptoms the patients thought that heavy
objects might generate stress and thus does
not carry weights any longer. These last 2-3
days pain started to developed upon sitting ina chair. From his injury until now he had not
had any pain anywhere in his body. Now hecannot sit for a prolonged time during work.
He consumes a moderate amount of alcohol
once a week.
Past history: 22 years ago he was diagnosed withDM (currently he is on therapeutic
medication).
Family history: nothing particularly noteworthy
Personal history: Played soccer from elementary
to high school. Used to walk since thediagnosis of the DM (a course of approximately
3.5 km, requiring 45 minutes)

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

Volume 4, Number 4 | Winter 2009

Findings: blood pressure: 162/80mmHg, pulse
rate 64 (no arrhythmia), body temperature
36.2℃, no scoliosis, slightly decreased lumbar
lordosis, no stepwise deformation.
The motion of the lumbar area is normal, but
movement elicited pain around the insertion of
the erector spinae muscles of the lumbar
region and numbness/pain of the outside of theright lower extremity.
Negative Kemp sign, patellar tendon reflex
normal, Achilles tendon reflex diminished on
the right side, plantar and dorsal flexion of the
big toe were both reduced, the right L5/S1 area
showed positive signs of esthesiodermia(described as the appearance of numbness), theSLR test was negative, so was the Katayama's
Bonnet test.
The region of the lumbar erector spinae
muscles (BL24 (Kikaiyu, Qihaishu), BL25
(Daichoyu, Dachangshu), BL26 (Kangenyu,
Guanyuanshu) / muscle tension of the gluteal
region (left ≒ right), right mid-back (BL18(Kanyu, Ganshu) – BL20 (Hiyu, Pishu)) muscle
tension.
Assessment of the pathologic condition: The KMC
physician diagnosed a stenosis of the lumbar
spinal canal. Based on the diminished lordosis
the presence of age dependent degenerativechanges can be surmised. It cannot be
definitely stated that only walking is directly
responsible for the development of the present
condition, but an accumulation of daily muscle
fatique, including the portion caused bywalking, may have possibly triggered theonset.
Treatment plan: Needling was performed in anarea from the lumbo-gluteal region down to theright lower extremity in order to achieve asedation of the nervous symptoms throughraising the pain threshold and attempts atrelieving the muscle tension. I expected an
improvement of the lordosis through relievingof the muscle tension. From the next time

modification of the point selection for theneedling depending on the lower extremity
symptoms were also considered.
Treatment: For the needling disposable needles
manufactured by SEIRIN were used.
Needling sites and needles sizes were: 30 mm#16 needles placed at BL18 (Kanyu, Ganshu),
BL20 (Hiyu, Pishu), BL37 (Inmon, Yinmen),
GB34 (Yoryosen, Yanglingquan), GB35 (Yoko,
Yangjiao) (all bilaterally, inserted to a depth ofapproximately 7 mm), 40 mm #16 needles
placed at right BL24 (Kikaiyu, Qihaishu), right
BL25 (Daichoyu, Dachangshu), right BL26
(Kangenyu, Guanyuanshu), right gluteal
tender point (inserted to a depth between 25
and 30 mm), right external BL53 (Hoko,
Baohuang), right BL52 (Shishitu, Zhishi), left
BL24
(Kikaiyu,
Qihaishu), left
BL26
(Kangenyu, Guanyuanshu) (inserted to a depth
between 15 and 25 mm). All needles wereretained after insertion for 5 minutes.
Course: Slight improvement of the subjective
symptoms after the treatment.
Second treatment (February 3): After the lasttreatment there was during the 10-minute
walk home no dragging sensation in the rightleg. The numbness, however, reappeared by
the following day. After that the patient wasbarely aware of any lower extremity symptoms
during walking and there were no
aggravations. He felt the numbness at rest or
while sitting.
On the day of the treatment muscle tension
was relieved, but by the following day thetension in the lumbar and gluteal had returned.
The tension was worst in the morning andrelieved by warming.
The lumbar motion did not induce any changes
in the degree of numbness and pain. Postive
right Kemp sign, normal tiptoe and heel gait(tensing the muscles in the right lower
extremity was not possible and the patient had
difficulties in balancing), other positive

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Volume 4, Number 4 | Winter 2009

findings observed during the examination wereabout the same as those observed during thefirst session. Same treatment as during thefirst session.
Third treatment (February 10): Alleviation oflumbar tension after the last treatment, bodyweight could be more easily shifted onto theright leg, but no improvement in the numbness.
There was still a vague sensation of numbness
in the foot, but now tended on concentrate on
the region around the third digit. Tension of
the hip in the moving was unchanged.
The lumbar motion did not induce any changes
in the degree of numbness and pain. Negative
right Kemp sign (pain in the right buttock),other positive findings observed during theexamination were about the same as thoseobserved during the first session. Sametreatment as during the first session.
Fourth treatment (February 17): On the day of
the treatment the patient felt fine. When thepatient put both feet together on the nextmorning and scoop up water to wash his face,numbness and pain developed in the rightbuttock and along the outside of the right leg(down to the lateral malleolus), so that he had
to wash his face with one hand in a posturewith the right leg drawn backwards. During
this week the constant sensation of numbness
disappeared and if it occurred, the size of theaffected area had started to decrease.
No changes in the lumbar motion induced
numbness and pain. Negative right Kemp sign
(only pain in the right buttock andexamination revealed the same positive
findings that were also found during the firstexamination. Right BL58 (Hiyo, Feiyang),right BL60 (Konron, Kunlun) were added tothe initial treatment menu.
Fifth treatment (February 24): No changes in thepain in both buttocks during sitting in themorning and the numbness during washing14

the face in the right buttock and outside of theleg. Likely appearance of numbness after 20-25
minutes when the patients takes a walk.
The lumbar motion induced numbness andpain were the same except during left rotation.
Negative right Kemp sign (disappearance of
pain in the right buttock) while examination
revealed the same positive findings that werealso found during the first examination. Right
BL58 (Hiyo, Feiyang) was added to the initial
treatment menu.
Sixth treatment (March 3): When going for a walkeven after 30 minutes he did not feel numbness
or pain in the right leg any longer. The area of
the numbness now covered the region from thelateral malleolus to the foot. The pain in both
buttocks during sitting in the morning had
slightly improved.
The lumbar motion induced numbness andpain occurred only during retroflexion.
Negative right Kemp sign while examination
revealed the same positive findings that werealso found during the first examination. Reliefof the lumbar muscle tension. Right BL58
(Hiyo, Feiyang) was added to the initial
treatment menu.
Seventh treatment (March 10): The patient
became able to wash his face with both hands
and both feet put together (disappearance ofsymptoms in the right buttock and leg) and thefrequency with which he noted the numbness
and pain in the area from the lateral malleolus
to the foot decreased. The sensation ofdragging the feet during walking had almost
disappeared. The pain in both buttocks during
sitting in the morning had been significantly
alleviated. He also felt that the awareness oflumbar muscle tension had decreased. The
sensation of muscle fatique of the leg too
decreased and he felt a tendency toward
increasing power.

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Volume 4, Number 4 | Winter 2009

The lumbar motion induced numbness andpain occurred only during retroflexion. Normal
tiptoe and heel gait (no staggering), negative
right Kemp sign (right buttock felt slightly
heavy), right Achilles tendon reflex normal,
plantar flexion and dorsal extension of the big
toe were both weakened on the right side, in
the right L5/S1 region disturbance of the senseof touch. Relief of the lumbar muscle tension.
Right BL58 (Hiyo, Feiyang) was added to theinitial treatment menu.
* After the treatment the chief complaint of thepatient presented during the first examination
had almost completely be alleviated and thepatient
therefore
requested
temporarydiscontinuation of acupuncture treatment,
while integrating the exercise therapy at the
department of rehabilitation previously
proposed by the physician of the KMC andsimultaneously increasing the frequency ofgoing out.

therapeutic results.
Normally acupuncture and moxibustion
treatment for stenosis of the lumbar spinal
canal cannot directly be administered within
the spinal canal, but in this case we were able
to achieve alleviation of the symptoms after ashort period of time. This suggests that a clear
identification of the pathologic condition
allowed to obtain an appropriately informed
consent regarding the treatment plan from thepatient.
4. Conclusion:
Examination of western medical physicalfindings by acupuncturists allows to accurately
identify the pathologic condition and correctly
communicate with physicians. The result is,that confirmation of the symptoms is easily
comprehensible for the patient too, helps to
obtain an informed consent for setting goals
and is also considered to improve therapeutic
results.

3. Discussion:
This patient presented with clinically common
degeneration induced symptoms. In thisfacility
weendeavor
toimmediately
communicate information about patientsreferred from the KMC, so that we could visit
the department of orthopedics of the KMC
promptly after the first treatment andinquired about the basis for the diagnosis ofstenosis of the lumbar spinal canal whilereferring to the diagnostic images. Also, by
routinely obtaining the western medical
physical examination items determined by theclinic we were probably also able to compare
our findings with the information from the
KMC and thus provide an environment for atreatment that was each time finely adjusted
to the patient's symptoms. This also made thesymptoms easier to comprehend for the patient,
had the advantage of facilitating the setting ofgoals and thus probably led to improved
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Volume 4, Number 4 | Winter 2009

Introduction to Kuretake School of Integrative
Medicine
Kuretake School of Integrative Medicine was
openedinOmiya-ku,
Saitama-shi,
Saitama-prefecture in April 2009 as the third
school of Kuretake College of Medical Arts andSciences. Kuretake College of Medical Arts andSciences founded in 1926 has dedicated itself over
85 years to the education of Japanese traditional
massage, massage, finger pressure, acupuncture,
moxibustion, and Judo-orthopaedics and grownas an institution of systematic practical education
for traditional medicine.
Taking full advantage of educational
techniques developed and built up by all its
existing schools, Kuretake School of Integrative
Medicine proactively tries anything new ordifficult that we deem to be necessary for training
human resources required by the modern age. It
is absolutely imperative that acupuncture andmoxibustion in this day and age have acooperative relationship with Western medicine.
And, views and speculations from the perspectiveof Western medicine are the most important. In
order to put a great deal of effort in fostering
human resources most appropriate and requiredin the field of such medical care, we adopt the fulltime system for daytime classes. For individuals
who work and study for the national certification,nighttime classes are also offered, responding to
the needs of the local community.
Furthermore, we have established thetreatment centers attached to the school as partof the follow-up system where training courses
are offered to the graduates for further
improvement of their techniques, as well as
students, who can experience clinical sites
through the trainings of clinical practice. Thus,
we provide practical education with our main
focus on fostering practitioners of acupuncture
and moxibustion who will contribute to society.
16

We have also established Kuretake Medical
Clinic in the school facilities, where community
healthcare is being provided in close coordination
with each of the treatment centers for
acupunctureandmoxibustion,andJudo-orthopedics. The clinic complete withstate-of-the art apparatus for medical testing has
different Departments of Internal Medicine,
Kampo
Internal
Medicine,
Orthopedics,
Rehabilitation, and Gynecology allowing patientsto receive healthcare they want from many
options made available to them throughcooperation among all departments andtreatment centers. The staff members of the clinic
and treatment centers have regular workshops
for the purposes of their better and mutual
understanding of medical matters such as
diagnosing, procedures, and treatment methods
and interacting with physicians, co-medical staff
members, and practitioners/teachers. We are also
putting lots of efforts to reflect the know-how thus
accumulated in the clinical exercises and optionalclasses to further enhance the quality of thelessons.

Kuretake School of Integrative Medicine

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

Volume 4, Number 4 | Winter 2009

Clinical Report 2 (Japan)
Kamishoyosan + Goshuyuto for Migraines before
Menstruation
Mitsuyuki Takamura
Mie University Occupational Health Research Project

Hiromichi Yasui
Japan Institute of TCM Research

Case: Female of 45 years old
Initial visit: October 11 of year X
Chief complaint: Migraine attacks
Current medical history: The patient had been
suffering from headaches with stiff shoulders forseveral years. Separately from the headache, athrobbing pain appeared sometimes in thetemples and became exacerbated especially before
the period. The pain was not associated with theweather. Analgesics hardly worked, and the use of
the medicine caused her stomach troubles.
Stiffness in the shoulders became worse
especially in recent days. Massages had effect tosome extent, but the effect lasted only for one day.
Menstruation became irregular 1-2 years ago. It
came earlier or late and the cycle was not stable.
She had menstrual cramps. Her limbs were cold.
She got hot and sweaty. She was irritable. The
lips became chapped.
Appetite: Ordinary
Sleep: Good
Defecation: twice/day
Urination: 15 times/day
Present conditions: 158cm/58kg
Pulse: Deep
Tongue: Slightly red with small amounts offurs
Diagnosis: Qi stagnation and blood stasis/cold of
liver and stomach
Prescription: Extract of kamishoyosan 6.0g +Extract of goshuyuto 2.5g divided into 3 equal
doses
Course: The patient’s re-visit was 2 weeks later.
The frequency of headaches decreased and thelimbs became warm. Stiff shoulders were relieved
and a headache developed only once in a while. In

14 weeks, the headache disappeared completely
and she often forgot to take the medicine. As aprecautionary measure, however, the medication
was continued. On March 4 of year X+1, theheadache recurred and became worse. So theExtract of goshuyuto was increased to 5g,
resulting in a relief of the pain. On May 30 when
the patient made a hospital visit, she complainedof intense stiffness in the region from theshoulders to the back, involving the exacerbationof the headache. For these symptoms, kakkonto
7.5g was added, which relieved stiff shoulders
and the headache.
Consideration: In the patient’s case, tension-type
headache and migraine coexisted. Irregularmenstruation, or the unstable cycle of the periodcoming earlier or late, and irritability prompted
the author to assume liver Qi stagnation while it
was assumed that menstrual cramps caused
blood stasis. The conditions of cold limbs andsuddenly becoming hot and sweaty were causedby the simultaneous presence of heat in the upper
body and cold in the lower body. These symptoms
are indications of kamishoyosan, which is also
supported by her getting close to the age ofmenopause and similar signs and symptoms tothose of menopausal syndrome. The headache,however, was triggered by cold, so the applicationof goshuyuto was also possible. Thus, these two
formulations were administered at the same time.
After qi stagnation and blood stasis were
improved, the reason the headache became
intense again was, I considered, because theseason was changing to the cold one and thereby
the conditions of cold of liver and stomach were
aggravated. And so, the volume of goshuyuto wasincreased and the symptoms were resolved.
Subsequently, as tension-type headaches became
noticeable, kakkonto was used in combination.
Then all problems were solved.
hen all problems were solved.

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Volume 4, Number 4 | Winter 2009

Clinical Report 3 (Japan)
Menstrual Cramps
Yang Cholsong
Yang Herb Clinic
Case: Female of 36 years old
Chief complaints: Headache and menstrual
crampsCurrent medical history: The patient had been
suffering from headaches, menstrual pains,and daily sleeplessness. Stretching-like pains
appeared 2-3 times a week from the occipitalregion to the temporal regions and the pain
lasted for tens of minutes to several hours. On
the first day of each period, stab-like intense
pains developed in the lower abdomen. Bloodclots were heavy and when they were shed, thepain disappeared.
Present conditions: Medium built
Headaches,
menstrual
pains,
andsleeplessness brought intense frustrations or
irritability.
Pulse: Deep and string-like pulse. Tongue:
Deep red with small amounts of white furs
Sho: Liver depression and qi stagnation/bloodstasisTreatment method: To sooth the liver andregulate qi, and to activate blood and resolve
stasisPrescriptions: Extract of kamishoyosan 9g/3 ＋
Extract of keishibukuryogan 7.5g/3
Course: In 4 weeks, headache and menstrual pain
markedly improved. During the period of 2
months, headache occurred twice, no
menstrual pains were experienced, anddifficulty
falling
asleepimproved.
Subsequently, the doses were adjusted toExtract of kamishoyosan 7.5g/2 ＋ Extract ofkeishibukuryogan 6g/2. Then, the symptoms
did not recur.

18

Commentary
The swollen-like pain in the temporal regions,
intense frustrations/irritability, and string-like
pulse were the conditions of liver depression andqi stagnation. I consider that sleeplessness was
also caused by liver depression. The stab-like
pain in the lower abdomen that went away after
blood clots were shed was menstrual cramps
caused by blood stasis. Liver depression and qi
stagnation in women are often associated withblood sticks. For menstrual cramps caused byliver depression and qi stagnation, kamishoyosanis usually used. As blood stasis coexisted in thepatient case, keishibukuryogan was used in
combination.

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

Volume 4, Number 4 | Winter 2009

Kampo Dermatology – Clinical Studies
Urticaria/Hives (8)Fumino Ninomiya
Aoki Clinic

Case 1: Urticaria, oversensitivity
Male of 51 years old
Current medical history: Urticaria had been
persistent for 15 years. The patient hadreceived treatment of various kinds but no cure
was attained.
Present conditions: Edemas and erythmas

Treatment and course
Inchingoreisan 5.0g, keigairengyoto 6.0g, andLoratadine 1 tablet were administered for 14 dys.
Formulations were changed to shigyakusan
5.0g and tsudosan 5.0g. Claritin 1 tablet wascontinued. The medication was maintained.
One year later, the conditions became mostly
improved.
Sweat test
Before treatment

Sweat

Chronic urticaria (more commonly known ashives) is unexpectedly one of intractable disorders
in our every day life. Many cases of acuteurticaria have known causes so that it can easily
be cured. In many cases, urticaria appearing
repeatedly for a long period has an unknown
cause. The skin condition of urticaria can often be
improved by Kampo medicines selected based on
the overall condition.
Urticaria is a raised, bumpy red wheal thatappears anywhere on the body. The wheals can be
the size of a grain of rice enlarging in a map-like
form. Generally, acute urticaria will fade withinseveral hours whereas chronic urticaria will lastmore than a month, sometimes persist several
years to more than 10 years.
Causes are certain foods, drugs, focal infection,and the direct physical stimulation of the skin.
Urticaria, however, is often caused by
IgE-mediated allergies. For chronic urticaria, no
definite cause can be identified.
Urticaria often causes red erythmas andelevated patches (wheals) – it is basically due to theabnormality of water damp. Therefore, to treat thissho, medicines to induce diuresis and medicines toclear heat are appropriately combined.
Basic two prescriptions are inchingoreisan andeppikajutsuto. And adjustments will be
determined depending on whether or not there issweat, cold sensation, or blood stasis.

covering the entire body with intense itching.
Pigmentation
andmoistnesscoexisted.
Dermographism (＋＋). Highly irritable due tooversensitivity. Had difficulty falling asleep
and getting up in the morning. Cold feet (＋＋),
constipation (＋), and lose stool.
Feeling thirsty (＋). Blood pressure 128/80
Abdominal sho: Tension of abdominal rectus
muscles on both sides, a bloated feeling in thechest and hypochondriac region, andtenderness in the lower abdomen.
Examination findings: Table 1 (attached)

Right
hand
Left
hand
Right
hand
Left
hand

After
treatment

Beforestressapplication

After
stressapplication

Beforestressapplication

After
stressapplication

37.9

40.8

26.1

32.6

38.5

44.1

26.6

37.5

39.5

45.8

35.2

49.0

34.5

40.6

37.9

36.9

* Sweat test is a simple test that shows the levels ofstress felt by the patient. The patient is requested tosubtract 7 from 100, and to keep subtracting fromthe result. And then, the volume of palmar sweating
is measured. The table indicates that patient’s
stress levels are dropping.

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

19

Volume 4, Number 4 | Winter 2009

Before treatment

Before treatment

After treatment

Before treatment

After treatment

Case 1: Examination findings<Biochemistry>

Before treatment

After treatment

Total protein

6.6g/dl

6.6g/dl

UA

91mg/dl

8.1mg/dl

TC

227mg/dl

180mg/dl

TG

183mg/dl

65mg/dl

CPK (peripheral blood)

236

178

<Hematological value>

Before treatment

After treatment

Erythrocytes

538×10/ul

479×l0/ul

Leukocytes

9.3↑

9.0↑

Lymphocytes

16.1%

21.0%

Neutrophils

69.8%

71.9%

Acidocytes

7.4%

1.7%

IgG 830mg/dl

20

IgA 87 mg/dl↓

IgE 244 Cedar (＋＋＋)↑The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 4, Number 4 | Winter 2009

Medical History in Japan
Sotetsu Ishizaka’s “Shinkyu Chiyo Ichigen (4)Kenji Kobayashi
Guest researcher of Medical History Research Dept.
Kitazato University Oriental Medicine Research Center[Part 4 of this series]
On March 9 of the year Bunsei 8 (1825) I
received through the official interpreter in
Nagasaki Sakusaburo Nakayama a letter4) fromDr. Siebold along with a present of two sword
needles (hishin = pi zhen), one retention needle,
and some first grade Dutch opium. The text of theletter follows below. (Since it was in a foreign
language, I had the Han physician Tsuyama,
Shinsai Udagawa translate it.)To the care of Sotetsu Ishizaka, Edo acupuncturist
From: Dr. von Siebold, Dutch National Medical
Instructor, in Dejima February 1825

Acupuncture is a medical technique not knownin Europe, but for some time some knowledge
about acupuncture and moxibustion has spread.
Fortunately, on this occasion, I had theopportunity to look at master Ishizaka's book("Chiyo Ichigen" – Essentials in a word).
Up to now I have been employed in Nagasaki
and wanted to get in touch with master Ishizaki,
but so far was not able to fulfill this wish. Now I
was so fortunate as to be blessed with a chance toperuse one of his books. I wish to maintaincontact with the master through letters andwould be very much obliged, if I could ask him for
instructions. It would be extremely beneficial forme, if that wish could be granted. With yourpermission, but I believe my knowledge about
surgery would probably prove to be very
beneficial for the master too.
I would like to ask you to please contact me in
the future.
Among my students is a person called Junzo
Mima, who studies very enthusiastically. He

translated your book into Dutch and explained its
contents to me. In the future I would like to meet
you directly and ask a few questions.
Currently I am considering to translate yourbook in greater detail into Dutch.
So far the content of the letter in Dutch, but I
would be very happy, if you could have translated
this and would read it.
**********************************************
4) In the archives of the library of Waseda University
there is the title "Translated Writings of Siebold"
translated by Junzo Mima for Sotetsu, in which itsays "I am very happy about the treatise on
acupuncture that was given to me, since it isexplains a subject still little known in our country
Europe." The 12-page text translated by Shinsai
Udagawa is probably identical with the original.
Currently

published

via

the

internet.

http://www.wul.waseda.ac.jp/kotenseki/html/bunko08/bu
nko08_a0223/index.htm

There are two drafts, one of which has been once
written by Junzo Mima and appears to have laterbe edited, so that there are some doubts regardingwhether this is really Mima's own handwriting.

**********************************************As an expression of gratitude for the masters
books he send us two lancets5), a clamp and eightmomme (8 x 3.75 g = 30 g) of Dutch opium. Eachof which he will take with him on his visit to Edo
next. Please take care of him on that occasion.
Please take good care of yourself in this weather

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

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Volume 4, Number 4 | Winter 2009

In the spring of year Bunsei 9 (1826) Dr.
Siebold accompanied the head of the Dutch
trading post Mr. Sturler to Edo. During ourmeeting Dr. Siebold stated:[Illustration 11][Illustration 11] Translated by Siebold's pupil
Ryosai (Seikai) Totsuka and others "Kyuho
Ryakusetu" (Brief Explanation of Moxibustion)[Illustration 12][Illustration 12] Translated by Siebold's deciple
Ryosai (Seikai) Totsuka and others "Kyuho
Ryakusetu" (Brief Explanation of Moxibustion)
As a response to this letter I sent a letter to theinterpreter Sakusaburo Nakayama. In addition I
had 7 needles ranging from gauge No. 1 to No. 7
manufactured by Genzo Kobe and sent them as a
gift to Dr. Siebold.

22" I made some notes in "Chiyo Ichigen" andsent it to my home country.
Once I have comprehended the deeper
meanings of the filiform needles, I would like topromote the spread of this book throughout thevarious European countries. When the techniqueof the filiform needling provides relief from
diseases and suffering, it will be all your merit."
When I finished my commentaries to Dr.
Siebold's 12 questions, he said he would like towitness an actual performance of acupuncture
and moxibustion. I demonstrated by needling on
one of my disciples, whereupon he requested to beneedled directly himself.
Since that is what he wanted, I needled Dr.
Siebold and thus conveyed also things, that are
difficult to express in words.
On this occasion I feel extremely proud of
being able to contribute to the spread ofacupuncture and moxibustion, which I consider
my calling, abroad. If acupuncture andmoxibustion should be generally accepted insociety, I believe the long years of studying thefiliform needling techniques may provide an
opportunity of opening up the passage for theonce lost 2,000-year old art and teachings ofacupuncture and moxibustion to Europe. I
exhaustively wrote down the innermost secrets ofthe fine needles, not even holding back family
traditions, and would like to convey thisknowledge to future generations6).
**********************************************
5) Lancet. Dutch. A kind of knife used for vaccination
against smallpox and phlebotomy.
Flat, double-edged blades pointed at the tip.

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

Volume 4, Number 4 | Winter 20096) Copied translations of the reference "Shifukuta
Sensei Bunken Shukei" = original title: "vertaald
door O. Kenkai" (published in 1935, including"Kyuho Ryakusetu" (Brief Explanation of
Moxibustion)) referring to Dr. Siebold in Japan andsimilar materials provide an opportunity of glancesat the acupuncture and moxibustion techniques Dr.
Siebold learned from Sotetsu.
Currently on display on the digital archive website
of Kyushu University.
http://record.museum.kyushu-u.ac.jp/siebold/[ Dutch translation of a treatise by one of Siebold's
pupils ]http://record.museum.kyushu-u.ac.jp/siebold307/
Nr. 1.307.000
Totsuka Ryōsai et al., [Vier Abhandlungen überAkupunktur und Kinderkrankheiten.]"Kyuho Ryakusetu" (Brief Explanation of
Moxibustion) translated Ryosai (Seikai) Totsuka
and others

May of year Bunsei 9 (1826)
Signed court physician Hogan Sotetsu Ishizaka

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

23

Volume 1, Number 1 | Spring 2006

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

35

Volume 1, Number 3 | Fall 2006

Kanebo Pharmaceutical, Ltd.
Like the cherry trees along Potomac River, Kanebo wishes
to play a role of the bridge for friendship and healthbetween Japan and U.S.A.

History of the Cherry Trees in Washington, D.C.
The plantings of cherry trees originated in 1912 as gift of friendship to the United Statesfrom the people of Japan. In Japan, the flowering cherry tree or “Sakura”, as it is called by
the Japanese people, is one of the most exalted flowering plants. The beauty of the cherry
blossom is a potent symbol equated with evanescence of human life and epitomizes thetransformations Japanese Culture has undergone through the ages.
2

Excerpted from National Park Service

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