KAIM
T
Thhee JJoouurrnnaall ooffK
Kaammppoo,, A
Accuuppuunnccttuurree aanndd IInntteeggrraattiivvee M
Meeddiicciinnee
INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 9, Number 3 ･ Fall 2014

Editorial

Genetic Resources and Traditional Knowledge of Traditional Medicine
Naoya Ono

Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (13) – Pediatrics
Tomofumi Ozaki

Kampo Medicine - Current Research
Clinical Applications of Kakkonto – Part 3
Hiromichi Yasui

Clinical Report 1 (Acupuncture)

One Case in which Moxibustion Applied at GV12 and BL17 Seemed to have been Markedly Effective for Headaches and Physical Fatigue
Aggravating after High School Entrance Examinations
Akio Manabe

Clinical Report 2 (Kampo Medicine)

A Case in Which Psychogenic Abdominal Pain in a 6-year-old Girl was Improved by Shokenchuto
Hideaki Yamaguchi

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 9, Number 3 ･ Fall 2014

EXECUTIVE EDITOR

Shuji Goto
Chairman, GOTO College ofMedical Arts & Sciences

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

Tokyo, JapanASSOCIATE EDITORS
Shuichi Katai

1 Editorial
Genetic Resources and Traditional Knowledge of Traditional Medicine
Naoya Ono

Ibaraki-ken, Japan

Hiromichi Yasui
Tokyo, JapanEDITORIAL STAFF

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

PUBLISHER

3 Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (13) – Pediatrics
Tomofumi Ozaki

10 Kampo Medicine - Current Research
Clinical Applications of Kakkonto – Part 3
Hiromichi Yasui

20 Clinical Report 1 (Acupuncture)
One Case in Which Moxibustion Applied at GV12 and Bl17 Seemed to have been Markedly
Effective for Headaches and Physical Fatigue Aggravating after High School Entrance
Examinations

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

Akio Manabe

23 Clinical Report 2 (Kampo Medicine)
A Case in Which Psychogenic Abdominal Pain in a 6-year-old Girl was Improved by
Shokenchuto
Hideaki Yamaguchi

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 9, Number 3 | Fall 2014

Editorial
Genetic Resources and Traditional Knowledge of Traditional Medicine
Most traditional medicines make frequent use of drugs made from plants, animals and minerals thatexist in the natural world. In most cases, the majority of these ingredients are dependent on each country’s
specific generic resources that are a product of Earth’s biodiversity. Genetic resources that are relevant totraditional medicine have the potential to bring about a profit as intellectual properties, and are thus
posing an international issue regarding ownership today.
For example, India and its neighboring countries are attempting to formulate basic rules on accessrights and profits gained from genetic resources that are used in traditional medicine in their countries.
From an industrial aspect, China is working on the International Organization for Standardization (ISO)to promote the international standardization of Chinese medicine. Additionally, in South Korea, Dongui
Bogam, a traditional book on traditional medicine in South Korea, has been inscribed on UNESCO’s
Memory of the World Register in 2009, and in China, Chinese acupuncture and moxibustion has been
inscribed as an Intangible Cultural Heritage in November 2010, following the country’s declaration of
intent in September 2010. These movements are part of the countries’ important cultural strategy topreserve and disseminate their national culture to the world. At the same time, they are movements thatregard traditional medicine not only as a medical resource but also a cultural resource. As such, they aim
to protect traditional medicine as an industrial resource based on a national strategy concerning
intellectual properties, and to precedently secure national ownership of traditional medicine at the sametime. Not only traditional medicine, but modern Western medicine also faces the same issue. According
to a certain survey, more than half (52%) of all new chemical entities (NCE) contained in the 1,031 Western
pharmaceuticals that were approved between 1981 and 2002 were derived from a natural product. In
other words, in modern Western medicine, as in traditional medicine, genetic resources and traditional
knowledge are indispensable for the development of new drugs.
However, issues in genetic resources and traditional knowledge surrounding traditional medicine
and modern Western medicine are discussed today from a vertical “silo approach” by institutions andconventions related to the environment, culture, agriculture, industry, trade, intellectual property, andmedicine. These include the United Nations Environment Programme (UNEP), the Convention on
Biological Diversity (CBD), the United Nations Educational, Scientific and Cultural Organization(UNESCO), the Food and Agriculture Organization of the United Nations (FAO), International
Organization for Standardization (ISO), World Trade Organization (WTO), the Agreement on TradeRelated Aspects of Intellectual Property Rights (TRIPs), the World Intellectual Property Organization(WIPO), and the World Health Organization (WHO). Yet, matters that pertain to a wide range of fields
are intricately intertwined, such that they are no longer matters that could possibly be solved by any
single institution alone. Moreover, with the constant bargaining and fighting between resource-richcountries (mainly developing countries) and resource-using countries (mainly industrialized countries),
the issue is taking on the aspects of a North-South issue.

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

1

Volume 9, Number 3 | Fall 2014

It is time we address the diverse issues in traditional medicine in each country from thecomprehensive and organic perspective of genetic resources and traditional knowledge. From thestandpoint of each country’s national interests, issues revolving around the genetic resources andtraditional knowledge of traditional medicine pose an unavoidable economic dispute among countries in
the international community. However, in the interests of humanity beyond all national interests,
traditional medicine in all its forms must not harbor any possibility of being threatened from existence
and disappearing. This is because the disappearance of traditional medicine means the disappearance ofa wisdom of humanity, which would limit humanity’s diverse choices and possibilities for surviving an
uncharted future and would also go against human interests. There will come a time when we have no
choice but to explore, examine and realize “sustainable medicine for society” not at the national level, but
on a global scale. When that time comes, the guarantee and safeguarding of the diversity of traditional
medicine will play a part in expanding humanity’s future choices and possibilities for surviving an
uncharted future. It is essential that each country address the issues of genetic resources and traditional
knowledge of traditional medicine in the light of national interests as based on the interests of humanity.

Naoya Ono
Center for Lifenhance in 22nd Century
Institute for Future Engineering

2

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

Volume 9, Number 3 | Fall 2014

Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (13) – Pediatrics

remained the central historical hub of these

Tomofumi Ozaki

specialties since them. Currently, numerous clinics

Associate Professor of Faculty of Health Sciences

specialize in “children`s acupuncture” and theMorinomiya University of Medical Sciences,
Vice-principal of
Morinomiya Academy of Medical Sciences

Pediatric acupuncture methods (Shonishin) are
unique from filiform acupuncture because they rely
primarily on gently stimulating the surface of theskin without inserting needles. This treatment
method is appropriate for infants through school age
children. Compared to adults, the delicate methods
employed are especially effective for these agegroups who have extremely sensitive and reactive
skin. Very slight stimulation and delicate methods
characterize pediatric acupuncture and are safe andhighly effective for these young children. Pediatricacupuncture is practiced all over Japan with anespecially rich cultural tradition emanating from theKansai area1-3). Recently, as the number of Japanesebirths continues to decline, there has been a
proportionate

decreaseinnational

healthcare

revenue covering free or low-cost infant and childtreatments, so the number of children receiving
pediatric acupuncture has also decreased. Especiallyfor conditions like pediatric neurological conditions,which lack effective low-cost treatments and moregeneralduring the Edo period and the Kansai Area haswellnessmanagementcare,

pediatric

acupuncture represents a meaningful treatment
modality. Below, we provide an overview of pediatricacupuncture.

expressions describing these traditions are quite
varied, however most clinics treat all commonchildhood conditions. Most notably, the pediatric“Kanmushi” treatment refers to assisting the childdevelop strong nervous, digestive and immune
systems4, 5).
1. The history of Pediatric Acupuncture
There is scarce historical data clarifying the early
use of pediatric acupuncture6).
Early records pertaining to pediatric acupuncture(Shonishin) go back to Nakano village (Hari Nakano)of the mid-Edo period7, 8). During the late Edo period
the technique apparently gained popularity inOsaka and became established there during the
Meiji period as a form of childcare culture. The
situation became to be assessed even as: "It would
not be an exaggeration to say, that there are no
indigenous households in Osaka not treating theirchildren with Shonishin9)." After the Taisho period
Shonishin spread throughout the country throughthe education in vocational schools for acupuncture
and moxibustion, books and lectures10-12).
A 200 year-old map of Kawachi Hiranogo Townshipreportedly

lists

a

"Nakanovillage

Pediatric

acupuncture clinic”. Even today, the station name,“Harinakano” remains in use. Another interesting
pediatric acupuncture “heirloom” is reflected in[A] An Overview of Pediatric Acupuncture
Shonishin (pediatric acupuncture) is acupunctureusing particular tools for infants and children andrefers to the methods used for these patients.
Distinct from acupuncture for adults, it is anacupuncture method that primarily stimulates theskin surface. Pediatric acupuncture developed

many clinic names inherited from this tradition:
Okajima’s rabbit acupuncture, Daruma acupuncture,
Turtle acupuncture etc. These names refer tofamiliar children`s words and playthings, reassuring
them and their parents. It is generally accepted that
pediatric acupuncture was initially incorporated into
Japanese acupuncture during the Taisho period.

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

3

Volume 9, Number 3 | Fall 2014

2. Appropriate ages for pediatric Acupunctureof a doctor or a specialist of acupuncture is required

patients

for fevers over 38℃(104 F), acute abdominal pain,

Infants age 2 weeks up through elementary school

acute spinal injuries, fractures, dehydration, etc.

aged children receive pediatric acupuncture. Thereis generally a peak around ages 3-4 with a pattern of

5.

Classification

andtechniquesofPediatricchildren gradually migrating to filiform acupuncture

acupuncture

as they get older.

Pediatric acupuncture involves gently stimulating
the skin in very specific locations using various tools,

3. Pediatric Acupuncture treatment (appropriatetechniques and methods. In general, the mostconditions)

important types of stimulation are contact needling

Generally

speaking,

pediatric

acupunctureisclassified as useful for health management andand friction type needling.
a. Types of contact needling: Spring-loaded ordisease treatment. Health management includes

seven star plum blossom type tools

common symptoms associated with “Kanmushi” a[Method] Lightly contacting the skin (commonlyJapanese term referring to night terrors, sleep

used in pediatric acupuncture).

difficulties, moodiness, fussiness, making strange[Adjusting the amount of stimulation] Controllingnoises, poor appetite, biting etc. that is to say

the length of the needle tip and how it contacts thesymptoms tend to be associated with childhood

skin.

neurological conditions. On the other hand, treatingb. Types of friction type needling: friction typecommon childhood diseases includes sinusitis,

needle, long sword shape needle (naginata needle),

tonsillitis, laryngitis, asthma and other respiratory

rolling tool (kuruma needle)

diseases, digestive disorders, such as poor appetite,[Method] lightly touching the skin with a needle or

stomatitis, constipation, diarrhea, eye diseases, such

instrument that is horizontal to the surface andas nearsightedness and eye strain. Additionally,

gently stroking using specific techniques.

more difficult conditions such as enuresis, epilepsy[Adjusting the amount of stimulation] Appropriately

and cerebral palsy are also treated. It should betouching the skin (perpendicularly, at an angle, etc.)

noted that while treating children with theseand adjusting the speed of the horizontal needle.

conditions the practitioner is primarily treating the

Figure 8 shows examples of pediatric acupuncture.

child’s QOL by improving sleep, appetite, digestion

The needle shown in the upper part of the photo isandstiffness,called Daishi pediatric needle. From the left in theheadaches, nervous ticks, stutters, skin conditions

lower part Seirin disposable needles, Yoneyama

such as dermatitis, developmental challenges,

pediatric

learning disorders have been increasing13). Further,needles, and roller needles etc. are presented.

elimination.

Recently,

shoulderneedles,

health tune-ups before and after sports events,
vacations, examinations and recitals assist children
adjust physically, mentally and emotionally to thestresses felt during these events.
4.

Maladaptation

andContraindications

forPediatric Acupuncture
Maladaptation and contraindications for children
are very similar to adults. Requesting the assistance

4

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

scraping

needles,

shakableVolume 9, Number 3 | Fall 2014

Figure 8 Classification of pediatric acupunctureneedlesFigure 9 Fundamental diagnoses of young children

6. Pediatric acupuncture treatment areas
and amounts of stimulation for each
Fundamental areas include the head, neck,upper back, chest, abdomen and legs.
Specifically, for throat and tonsillitis theanterior neck and jaw will be used. For
vision disturbances and near sightedness
points on the cheek and temple are used (TaiYang, GB5). For enuresis, points on thelower abdomen and sacrum are used.

Contact needling on the back

Friction type needling on the backFigure 10 Fundamental treatment methods for pediatric acupuncture

7. Pediatric acupuncture approach and attitude

8. Amount of stimulation and treatment interval

Figure 9 shows a 5 year old boy receiving a

Treatment usually takes under 5 minutes, a positive

Yoneyama style treatment on his back. The left

reaction is indicated by reddening of the skin andback depicts contact needling and the right showsslight sweating. Generally, good results are expected

friction type needling. This photograph clearlyin pediatric acupuncture with extremely slightshows the needle tip contacting the skin. However,stimulation.

actually the needle tip only lightly contacts the skincomplains are usually once a month for a period of 3

and is then withdrawn in a careful in and out

consecutive days. More complicated cases may

motion that controls the amount of stimulation

require 4-5 consecutive days before the symptoms

delivered to the area. Figure 11 on the upper left,

abate and the child returns to their naturally calmshows a 10 month old baby boy receiving treatment.

level of health. Best results are seen if the

For such young children, it is common for thetreatments can be repeated once a month. In the caseparent to hold the child during treatment toof acute asthma attacks, while maintaining active

reassure the child and learn some of the techniques.

communication with the medical doctor, the child

Additionally, contact needling is performed on the

may be seen 2-3 times a day. Further, in the case of

back, left lower leg and right arm (Figure 11)

enuresis, the child may be seen for three consecutive

Treatmentintervalsforcommondays and then depending on the child`s progress,
every other day, then twice a week, once a week,
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

5

Volume 9, Number 3 | Fall 2014

twice a month gradually extending the interval as
the child shows consistent signs of improvement.
[B] Routine physical examination for children
The symptoms of the child patients may include
serious infectious conditions and diseases. In thecase of newborns, because they are unable tocommunicate using words, open communication
with the parent is necessary to help the practitioner
grasp the nature of the symptoms and judge whether
the child`s condition warrants prompt emergencycare.
(1) Visual inspection requires observing the facial
appearance. So called Kanmushi presents with

Figure 11: Pediatric needles for infantparticular symptoms including eyelid and lateral[C] Case Study13)

nostril redness, engorgement of a subcutaneous vein

1. Case study for a frail body typeobservable on the forehead and a pale complexion)

Subject: 3 year old boy(2) Appearance of the eyes: eyes may be red with[Complaints]The boy`s body is delicate and he often

inflamed conjunctiva but the overall condition iscatches colds.

anemic or pale (Figure 11 upper left)[Medical History]Since birth the child`s body has(3) Neck and facial appearance: special attention

been weak, he often gets sick, stays home from day

must be given to the lymph nodes in the neck (Figurecare, is picky about his food and does not eat much.

11 Upper right)

He was hospitalized one month ago for pneumonia(4) Intraoral inspection: redness of tonsils, posterior

and was released just last week. His mother broughtwall of the pharynx and presence of pustules or

him to the clinic hoping to strengthen his body.

Koplik spots (Figure 11 bottom left)[Physical findings]The boy is thin, his conjunctiva(5) Listening inspection: the purpose is to confirm

are red, lymph glands in the neck area are swollen

presence of wheezing, rattling or other signs of lightand painful to light palpation, tonsils are enlarged

asthma or bronchitis (Figure 11 Lower right)

and the back of his pharynx is red, lung sounds are(6) Thermometry (temperature measurement): it isnormal, weak musculature, poor appetite, bowel

very common for young children and toddlers tomovement once every 2 days and the amount is small.

develop fevers so temperature must be measured

He squirms and is unsettled at night.

when the child is in a feverish condition.

[Treatment]Pediatric acupuncture. The parents andchild preferred the treatment be conducted in theirhome (Du12). Treatments were continued on a
weekly basis and gradually the interval was
extended. There were some ups and downs but if hecaught a cold it resolved quickly and was lighter
than before. His appetite increased and his pickinessdiminished. His sleep improved. Eventually his
mother began to complain that he was so healthy he
was hard to manage.

6

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

Volume 9, Number 3 | Fall 2014

2. Case study for enuresis

known as Kanmushi in Japanese). Additionally,

Subject: 9 year old boy, 3rd grade in elementary

respiratory, digestive or ophthalmological conditions

school.

are often included. More complicated conditions such

[Complaints] (1) Enuresis, (2) Stuffy nose.

as epilepsy are treated not so much for the disease[Medical history] (1) Enuresis started about the timeitself, but regular pediatric acupuncture helps to

he entered elementary school. The time was variablereduce the physical and mental fatigue thatbut he wet his bed every night, and sometimes twice

naturally drains the child`s vitality, keeping him ina night. When the boy was examined by his medical

good condition. Most patients experience lighter

doctor, no abnormalities were found. They came toseizures and a reduction in frequency. Recently

our clinic on the advice of an acquaintance. The boy

reported treatment effects, include improvements inappeared sheepish and lacked vigor.

developmental disabilities, learning disabilities and[Other medical history] Nothing of note.

Asperger's syndrome14). That is to say, pediatric[Physical findings] Picky eater, regular bowel

acupuncture

movements (once daily), regular sleep cycle.

providing both relief of symptoms and improved[General Inspection] Average temperature 36.5 ℃

overall(97.7°F), swollen lymph glands under the jaw (+),

maintain health and prevent disease.

includeshealthso

safe

delicate

regulartechnique,administrationcanvery red nasal mucous membranes (2+), Pharyngeallaryngeal mucosal redness (+), enlarged tonsils (-),

2. Positive effects of the spread of pediatric

no abdominal tenderness, induration or masses.

acupuncture[Therapy and treatment] The family had developed

Especially around Osaka and Western regions of thea negative cycle of scolding the boy when he wet his

Kansaibed. The boy felt stress and had lost his confidence.

acupuncturists

The first priority was to encourage the family to see

acupuncture in their practice. Over the past several

the problem from the boy perspective, get them todecades, 20-30% out of all visiting patients were theencourage rather than discourage him. Pediatricchild

acupuncture treatments focused on treating the

Recently the birthrate has been decreasing in Japan

lower abdomen and low back as a means to treating

and there has been a decrease in the overall number

the whole body.

of acupuncture child patients. However, the overall[Progress] treatments were conducted 1 or 2 times anumber of children receiving pediatric acupuncture

weeks a total of 23 times. Gradually the frequency ofhas been increasing which bodes well for the long

bed wetting decreased. Six month following theterm future of the profession. One point about this

discontinuation of the treatments, the family

type of treatment is the short treatment time. Gentle

reported only occasional wet nights. Updates thestimulation to the skin takes about 5 minutes andfollowing year reported almost no episodes. The boy

rarely more than 10, so the number of children

had become very healthy and happy.

coming and going from the clinic will increase givingarea,

patients

it

is

who

said
do

seeking

that

not

there

includepediatricarenopediatric

acupuncture.

the appearance of a booming practice. As thechildren grow and develop they become accustomed[D] Considerations

to this type of treatment and usually lose any

1. Pediatric acupuncture treatment

resistance to acupuncture and moxibustion. Of

Relevant

conditionsforpediatric

acupuncture

course, there are the members of the child`s family,

include night crying, night terrors, making strange

parents, grandparents, siblings who accompany thesounds etc. (childhood neurological symptoms,child to their treatment—they begin to understand

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

7

Volume 9, Number 3 | Fall 2014

the treatment style and often become patients

References

themselves. In this way, as pediatric acupuncture

1) Hirohisa Yoneyama, Hidetaro Mori: Pediatricpatients

increase,regularacupunctureandacupuncture methodologies, Ido no Nippon,
Inc.1980

moxibustion patients increase as well.

2) Masanori Tanioka: User friendly pediatricacupuncture, Genso-sha, 1998

3. Challenges of pediatric acupuncture
We are often asked why pediatric acupuncture is3) Mitsuko Nagasawa, Shin Suzuki, Naomichi

effective, currently there are 4 published theories:

Shimizu et al.: Clinical pediatric acupuncture.

(1) Control of the autonomic nervous system in

Shinkyu Osaka 14─1: 12─26, 1998

system4) Isao Okuda: Pediatric acupuncture: methods andenhancement, (3) Regulation of growth hormone andgeneral information. Shinkyu Osaka 14─1:

adrenal cortical hormone, (4) Improved blood

34─38,1998

childhooddevelopment,(2)

Immune5) Shin Suzuki: Pediatric acupuncture methodology,

circulation.
Harlow HF reported, in an experiment using

Pediatric acupuncture- practice, effects andmonkeys, that skin stimulation is important forclinical management, pp2─20, Ido no Nippon,

normal development15). The normal healthy emotion

Inc, 2006

cannot be developed without the skin stimulation

6) Hitoshi Nagano: The origin of the Pediatricreceived while being held by the mother or similar

acupuncture – birth of a pediatric acupuncturist

stimulation.

Field16)and its historical background─. Journal of thereported that skin stimulation is critical for normal

Japanese Society for the History of Medicine

physical and emotional development and went

56─3 : 387─414, 2010

Further,

Schanberg

andfurther to state that beyond the early years of life,7) Sesshu Hirano Map, Horeki year 13 (1763)

tactile stimuli and physical contact plays an8) Shinkyu Soku (Acupuncture and Moxibustion

essential role in emotional and physiological health

Rules*), published Meiwa year 4 (1767)and development. Unfortunately, little research on9) Shoni Yoiku no Kokoroe (Guidelines for Bringing

pediatric acupuncture has been performed. In 1929,

up Children*), Enlarged 2nd Edition, by Sokitsu

Fujii et al. investigated changes in blood pressure,

Nagahama, Meiji year 39 (1906, August)respiration, body temperature and peristalsis among10) On the Origins of Shonishin The emergence ofyoung children and rabbits. They reported that

pediatric

pediatric acupuncture provided one type of skinbackground, Hitoshi Nagano, Yutaka Takaoka,

stimulation capable of modulating sympathetic

Journal of the Japanese Society for the History

nervous system tension. Further, Katai et al.

of Medicine, 56 (3), 2010acupuncturists

and

its

historicalinvestigated the effects of pediatric acupuncture on11) Catalog of Reference Materials on the History ofhealthy adult males and found reduction in heart

Japanese Shonishin, Authorship, Modern Edition

rate and reported that this stimulation had a(Vol. 1 / Vol. 2), Hitoshi Nagano, 2011. 1-2

definitive effect on the autonomic nervous system. In

12) Outline of the History of Japanese Shonishin,

the future, they are hoping that additional research(Vol. 1, 2, 3), Hitoshi Nagano, Ido no Nippon, Inc.

on the effects of pediatric acupuncture will be

2011.12, 1012. 1-2

conducted.

13) Tomofumi

Ozaki:

Examplesofsuccessfultreatment for nocturnal enuresis treatmentusing Pediatric acupuncture. Shinkyu Osaka
14─1, 1998

8

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

Volume 9, Number 3 | Fall 201414) Shigeyuki

Hirose,Yasuji

Nonoi,

MitsukoNagasawa et al.: Pediatric acupuncture andmoxibustion treatment. Shinkyu Osaka 94:
10─32, 200915) Tadashi

Yano:

Fundamentals

ofclinicalAcupuncture and Moxibustion medicine. The
human science of Oriental medicine IV, Waseda
University, Department of Human Sciences, 96:
116─119, 1995
16) Yuko Sato: Neurophysiology of acupuncture ─astudy on the mechanism of acupuncture in
recent years─. The Japan Conference of ClinicalAcupuncture and Moxibustion 11─1: 1─15, 1966

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

9Volume 9, Number 3 | Fall 2014

Kampo Medicine - Current Research
Clinical Applications of Kakkonto – Part 3

Case 1: Stiff shoulders
Patient: 53-year-old male teacher

Hiromichi Yasui
Japan Institute of TCM Research

Chief complaint: Stiff shoulders, dizziness
Past medical history: None in particular
History of present illness: From about a month ago,

Kakkonto is a prescription that first appeared in
the great Chinese classic Shokanron (treatise on cold
damage) and came to be widely used in Japan fromthe latter half of the 19th century. Particularly since
Yodo

Odai

(1799-1870)

introduced

variousindications for the prescription, it came to be usedwidely for a variety of diseases. In Japan, it is known
as a representative Kampo drug and a popularprescription that also appears in the traditional

the patient developed a stiffness from his shoulders
to the scapular region. He also felt as though his
body were floating at times, and experienced
dizziness and a ringing in his ears.
Condition at the time of hospitalization: Height
160cm, weight 58kg. Medium build and muscular,
good complexion. Recently, his stomach has felt
heavy after eating due to poor gastrointestinal
condition, but he showed no tendency of hot flashes,

Rakugo comic story of “Kakkonto Doctor.”

chills or sweating.

Clinical applications (continued)

no objective findings other than the tenderness in his

His cervical spine had good mobility, and there were

In Shokanron, indications for kakkonto are acuteinfectious diseases. However, from Japan’s morethan 150 years of experience, kakkonto is known tohave an extremely wide range of indications and is
today

appliedtomanydiseases.

These

are

introduced below, in continuation from the previous

shoulders and scapular region. X-ray images showeda narrowing and osteophyte formation in theintervertebral space between the C5-C6 spinal
segment.
His pulse was floating and excessive, and his tongue
was covered with a rather moist white coating. His

issue.

abdominal muscles were moderately tense, and

11. Stiff shoulders

paraumbilical resistance or tenderness, there was a

while

Shokanron paragraph 31 contains the passage, “Ingreater yang disease with a stretched stiff nape andback, absence of sweating, and aversion to wind,kakkonto

governs…”

Based

on

a

broad

interpretation of this passage, kakkonto is also
applied to stiff shoulders that are not caused by aninvasion of external pathogens.
Needless to say, there are various causes of stiffshoulders, and only some of them are indications for

kakkonto.
However, kakkonto is frequently used for stiffshoulders in daily practice. Its effect may appear inseveral hours or may not appear for several days.
Kitanami et al. have presented many cases inwhich kakkonto was used on an as-needed basis forstiffness in the neck, with good results.1) 2)

10

there

was

no

chest

side

painfulness,slight splashing sound in the epigastric region.

Kakkonto plus bukuryo (Poria) and byakujutsu(Atractylodis Rhizoma) was administered in thiscase, and good progress was observed over six weeks
without applying cervical traction.
Yoshihiro Fukuda, The Journal of Traditional Sino-

Japanese Medicine, Vol. 3, No. 4, p. 16, 1982
Case 2: Stiff shoulders accompanied by obesity andallergic rhinitis
Patient: 49-year-old female
Chief complaint: Stiffness in left shoulder
As a child, the patient was pale, thin and tall. Her
family feared tuberculosis and had her receive chest
X-ray and a blood sedimentation test once every year,
but she has never suffered a severe illness. She gave

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

Volume 9, Number 3 | Fall 2014

birth to two children at the ages of 29 and 31. From

was thus first attempted, but it was not all thataround the age of 40, her weight began to increase.

effective against the pain in the outer shoulder point.

At the time of her first visit, she weighed 54kg andFrom

November

of

this

year,

I

began

was 154cm tall. She found it troublesome to sit down

administering kakkonto extract in the place ofdeeply or to climb up and down the stairs. She had acervical traction. The patient took the preparation

darkish complexion with spots that stood out. She

for 16 days during the year and a total of 132 days

tended to get hot easily and sometimes slept with her

during the following year. In the beginning, the effectarms and legs sticking out from the blanket. She also

was not readily apparent, but she gradually began toexperienced spontaneous sweating. She had thirst,

stop experiencing any severe stiffness in theand frequently quenched her thirst with small sips

shoulder, and unexpectedly, she gradually lostof green tea. She passed urine 4 to 5 times a day andweight and became 44kg by the end of the following

had regular bowel movement every day. She had ayear after shedding 10kg. Furthermore, before she

normal appetite, but liked sweets and ate a cakerealized it, the fits of allergic rhinitis that she

during the day and a daifuku rice cake at night.

suffered since she was young had stopped.

The stiffness in her shoulder began afterHeartened by the effect of Kampo, she took thechildbirth and persisted for 20 years. The outer

preparation for 126 days during the following year

shoulder point of her left shoulder was stiff andand another 182 days during yet the year after that.

caused pain throughout the year. When it got bad,

By winter of the year, any stiffness in her shoulder

the pain traveled up from the attached branch of thewas almost negligible, but a tenderness still

inner upper margin of the left scapula and theremained in her outer shoulder point. Her weight“gyokuchin(BL9)” of the left occipital lobe andincreased slightly thereafter but was basicallydeveloped into a headache on the left side. Further

maintained at the 46kg level. Her fits of allergic

aggravation caused pain at the back of the left eye

rhinitis also disappeared.

and eventually caused her to throw up gastric juices.

Kensuke

Nakamura,Kampo

gyuhoroku(23)

When this happened, she could neither eat nor drink(detailed accounts of Kampo), Journal of Kampo

anything. If she were to receive an intravenous drip

Medicine, Vol. 30, No. 2, p. 24, 1983

for fear of dehydration, her vomiting would havebegun again perhaps due to gastric juices collecting

12.

in her stomach, so she could not receive an

syndrome

intravenous drip. All she could do was to burrow her

Cervicalspondylosis

andcervicobrachial

In Kampo shinryo iten, it is written as follows

head in the pillow and remain quietly still. Afterregardingcervicobrachialabout two days of neither eating nor drinking, the[kakkonto]fornausea would subside, and she would suck on anumbness from their shoulder to arm. Aim tosmall piece of ice. If this went down well, she would

improve the tension in the pulse and muscles in thegradually try something else to eat, but if not, she

initial stage of development. yokuinin (Coicis

would continue “fasting” and let her body dry up.

Semen) may also be added in some cases.”3)

patients

who

syndrome:

“Use

have

and

pain

When this happened, she did not even pass urine.

Fumio Nishina administered kakkonto to a total

Such terrible spells occurred four to five times a year,of 78 patients, including 41 patients with cervicalall triggered by fatigue.

spondylosis, 31 patients with cervicobrachial

An X-ray showed a narrowing in the intervertebral

syndrome, 3 patients with trauma, and 3 patients

space between a spinal segment and osteophyteof other disorders and reports that it was effective

formation toward the nerve root. Cervical traction

in two-thirds of the patients based on two

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

11

Volume 9, Number 3 | Fall 2014

criteria—(1) they have an moderate or higher levelto her right shoulder, I prescribed 5g/day of kakkontoof physical strength and have pain in the neck inin addition to NSAIDs. After commencing Kampo

the acute stage or the exacerbation stage oftherapy, the neck pain abated from the second week,

symptoms, and (2) they have a pulse that isand because an improvement was seen where

floating and strong. It was similarly effective inpreviously she could not walk to go shopping in her

patients who tested positive (weak pulse) whenneighborhood because her neck would hurt andpressure was applied to the nerves and blood

make her feel nauseous, NSAIDs was reduced to two

vessels in their neck and upper chest, but the rate

to three times a week on an as-needed basis. Fromof efficacy was a low 50% among young andthe fourth week, she no longer felt pain when she

middle-aged women and particularly among

was at home, and her objective symptoms improved

patients who also had abnormal tendon andto approximately one-tenth, with a headache

periosteum reflexes in their upper extremity.4)

occurring only once in a while after making an outing.

The following are cases that have been reported toHersymptoms

subsided

kakkonto

fourmonthsafter

date. Cases 1 and 2 show the effect of kakkonto alone,commencing

but most cases require a blending of sojutsuprescription was terminated. (Observations omitted)(Atractylodis Lancea Rhizome) and hobushi (Aconiti

Kosuke Tajima, Science of Kampo Medicine, Vol. 29,

treatment,

and

the

Radix Processa).

No. 1, p. 39, 2005

Case 1: A case in which kakkonto had a marked

Case 2: Cervical spondylosis

effect on neck pain that had not improved for a long

Patient: 52-year-old maletime

Chief complaint: Numbness and pain in the rightPatient: 82-year-old female

handEight years ago, the patient visited a nearby

First visit / Present illness: The patient visited ourinternal medicine clinic chiefly complaining ofclinic on June 19, 1995. He said that when he wasposterior neck pain and difficulty in walking due toswinging a golf club, his nape began to hurt, and his

the pain. She was told to take NSAIDs, but this had

right hand became so numb that he could not evenno effect, so in April 2000 she was introduced to ourhold his chopsticks properly. Judging from theclinic.

findings of a neck X-ray, he was diagnosed with

The patient complained of pain that felt as thoughbrachial neuralgia caused by cervical spondylosis.

she had slats pasted on the area from the back of her

He was prescribed an anti-inflammatory analgesic

head to her right shoulder. A simple X-ray image

and vitamins B1 and B12, and physical therapy wasshowed cervical spondylosis mainly in the lower

also begun.

cervical vertebrae, but no neurological abnormalities

A week later, the pain showed signs of abating andwere found, so she was prescribed NSAIDs in thegood progress was thus expected, but the patient stillsame manner as before. Physical therapy was also

complained of numbness in his right thumb andbegun, including traction of the neck. However, thebegan to say that it had exacerbated such that hepatient continued her visit without her symptoms

could not even hold a pencil. When his sensations

improving whatsoever.

were examined, areas of hypersensitivity and

In February 2004, I examined the patient, andhypoesthesia were found from said thumb to the

because she hardly perspired due to a medium

back of his hand. No eruption was observed, but pain

pattern of deficiency and excess and complained of

caused by herpes zoster was suspected. Treatment

strong pain and stiffness from the back of her neckmainly by Western drugs was continued until July

12

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

Volume 9, Number 3 | Fall 2014

26, but because no improvement was seen, thePresent

Western drugs were switched to kakkonto extract

Adequate sleep. Stiffness in nape and shoulder.

(Tsumura 7.5g/day). A week later on August 1, theCold-sensitive legs and hip. Bowel movement: once apatient said the pain subsided for the first time.

day (smooth defecation). Urination: wakes up once

After taking the prescription for two weeks or so, theduring the night. Menstruation: menopause at age

pain decreased to 40%, and after a little more than

53. Predilection for fruits.

three weeks, it was down to 20%. The patient took

Tongue was covered with light-brown coating andthe prescription for a total of 33 days and stopped

was moist. Pulse was sunken and weak. Abdominal

coming to the clinic on September 5.

region was weak. Moderate degree of subcutaneous

Kensuke

Nakamura,Kampo

gyuhoroku(138)

illness:

Mediumbuild.

Easilytired.

fat. Umbilical pain.

Shushitsu no yonrei (detailed accounts of Kampo (138)

Treatment / Progress: Kakkonkajutsubuto was

Four cases of finger and hand pains), Journal of Kampo

administered. After taking the prescription for 14

Medicine, Vol. 42, No. 11, p. 44, 1995

days, the patient’s pain significantly abated. She wascured after taking it for another 18 days.

13. Shoulder periarthritis

Genpo

In Kampo shinryo iten, it is written as follows
regarding the indications for kakkonto in shoulder

Ogata,

Kampo

shinryooboegaki(126)(Memorandum of Kampo therapy), Journal of Kampo

Medicine, Vol. 37, No. 12, p. 32, 1990

periarthritis: “Use [kakkonto] in the relatively earlystage of development of the disease, for patients who

Case 2: Kakkontokasojutsuyokuinin for shoulder

exhibit a strong pulse, good tension in the muscles

periarthritis of the left shoulder

and a strong digestive system.”5) Byomei Kampo

Patient: 27-year-old female; pianist

chiryo no jissai recommends Kakkonkajutsubuto forFirst visit: November 18, 1976

stiff shoulders and shoulder periarthritis. In these

History of present illness: From November 15, 1986,

diseases, the pain in the shoulder joint andthe patient felt pain in her left shoulder joint

surrounding organization is frequently accompanied

whenever she raised her left arm. She received aby edema, so it notes that sojutsu (Atractylodis

doctor’s treatment, but she saw no improvement.

Lanceae Rhizome) and hobushi (Aconiti Radix

However, she strongly desired to perform at a

Processa) that have the effect of removing edema

concert that was scheduled in four days’ time.

should be added to kakkonto, which has an analgesic

Present condition: Medium build, but slightly thin.

effect, and used as kakkonkajutsubuto. In extract

Adequate

form, the preparation blends kakkonto, extract +Stiffness in nape and shoulder. Bowel movement

ryokeijutsukanto

once a day, regular stool, smooth defecation.

+

powderofAconitiRadix

sleep,

goodcomplexion.

Red

eyes.

Predilection for fruits and sweets.

Processa.6)
The following are cases that have been reported todate. They contain sojutsu and hobushi.

Her tongue was covered with a thin white coating,slightly dry. Pulse appeared sunken and strong but
disappeared when pressure was applied. Soft andCase 1: Shoulder periarthritis

weak abdomen.

Patient: 57-year-old female

Local findings: When engaging in exercise to raise

History of present illness: The patient began

the left shoulder joint, the patient complainedcomplaining of pain in her right shoulder joint onstrongly of pain when pressure was applied to theexertion since the beginning of March.

upper one-fourth region of the humerus. The armraising exercise itself also caused her pain.

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

13

Volume 9, Number 3 | Fall 2014

Treatment / Progress: Because the patient had justdeveloped the disease, kakkonto+sojutsu+yokuinin

Keisetsu Otsuka, 30 Years of Kanpo, p. 118, Sogensha,
1959

was administered for three days with the thoughtthat it should be sufficient to cure the disease. When

Case 2: Lumbago

the patient made a visit three days later, her pain

This is about my own recent experience. My lower

had disappeared as expected, but she was given

back began to hurt, even though I had no conscious

seven more days of the preparation, to be certain.

awareness of having done anything to become tired.

Genpo Ogata, Kampo chiryo shorei senshu 1

I ignored it at first, thinking it would go away in two(Collection of selected cases of Kampo therapy 1), p. 248,

to three days, but the pain gradually increased to the

Gendai Shuppan Planning, 1988

point that it became difficult to stand or sit. I
therefore blended and drank Hachimigan. I drankthis for two to three days, but to no avail. It seems I

14. Lumbago and sciatica

Kakkonto has been reported to cure not only neckdid not have the pattern for Hachimigan. Not onlyand shoulder pains, but also lumbago, as shown in

did my lower back hurt, but my whole body also felt

the cases below. There has also been a report inheavy, and my shoulders were stiff. I thought maybe

which lumbago was coincidentally cured when

I had a cold. When I felt my pulse, it was floating andkakkonto was taken for a different reason.

strong. Therefore, I thought that kakkonto mightwork. I took a dose and my body became light, andCase 1: A strong man with lumbago

after taking kakkonto for a day, the pain in my lower

The patient was a heavyset 38-year-old male. He hadback subsided.

lumbago for several months and received an
injection

among

other

treatment,

but

no

Keisetsu Otsuka, 30 Years of Kanpo, p. 119, Sogensha,
1959

improvement was seen.
His first visit was on June 5, 1933. He had a floating

Case 3: Sciatica

and strong pulse and tense muscles. The lumbago

Patient: 60-year-old housewife

was not exacerbated by pressure, but he experienced

Past medical history: The patient developed goitera pain that felt like something was pulling at his

7 years ago. She was prescribed Shakanzoto at mylower back when he bent and stretched his back. No

clinic, and the swelling subsided considerably. Her

abnormality was observed in his spine.

minimal blood pressure was high, but she was not

In Shokanron, kakkonto is used for tension in thetaking any medication for it.

nape and back. As the lower back is part of the back,History of present illness: The patient began to feelI regarded the lumbago as a symptom of nape andpain in the area from her left hip to the foot. She wasback tension, and thus administered kakkonto.

told she has sciatica at a local clinic and took aWithin a few days, the pain disappeared completely,

medication, but because it was not effective, she

and I was highly appreciated by the patient.

visited our clinic.

kakkonto worked well with this patient because he

There was extreme pain from the left hip to the foot.

had good tension in his muscles and his pulse was

It worsened in the early evening and caused extreme

floating and strong. For patients whose pulse ispain. The patient was sensitive to cold, especially inweak and muscles are relaxed, kakkonto would not

her feet and hips. Normal bowel movement. Passed

only be non-effective, but it could even exacerbate

urine twice during the night.

the symptoms.

Present condition: Height 156cm, weight 46kg. Bloodpressure 144/94.

14

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

Volume 9, Number 3 | Fall 2014

She had a pale complexion and her pulse was

Her tongue was covered with a thick, light-yellow

scrambled. Her tongue showed no abnormality.

coating and was dry. Pulse was sunken and tense.

An abdominal examination found nothing in

The abdominal region displayed a light-brownish

particular.

skin color and was generally weak. Umbilical pain.

Progress: She was first given Hointo. She took thisTreatment / Progress: The patient had a deficiency

for a month, but to no avail. She began to complain

pattern, but because she also had umbilical pain, shethat even her back has begun to hurt, and she felt a

was given kakkonkajutsubuto. By the time she took

stiffness in her nape.

the prescription for approximately 30 days, most of

Around this time, the patient came down with a cold,

the pain disappeared. However, she said her

so I gave her kakkonto. During the time she was

symptoms worsened when she ate the fig from thetaking kakkonto, she said her hip and feet did nottree in her yard. Before commencing Kampo therapy,

hurt so much.

she was instructed not to eat raw vegetables andI therefore changed her prescription to 5.0g eachfruits because they bring dampness inside the body.

kakkonto+sojutsu (Atractylodis Lanceae Rhizoma)
and toki (Angelicae Acutilobae Radix), and her

When she came in for a visit on October 4, 1980, hersciatica began to improve quickly. By a month later,

Genpo Ogata, Kampo chiryo shorei senshu 1

her pain mostly disappeared. After a month of taking(Collection of selected cases of Kampo therapy 1), p. 269,

the prescription, it was terminated, with the patient

Gendai Shuppan Planning, 1988

joint pain and muscle pain had disappeared.

saying that she was surprised that the pain that was
so intense disappeared without taking any other

Case 2: Muscle pain of unknown cause and namemedication.

11-year-old boy. The patient had the tendency of

Kunio Matsuda, Shorei ni yoru Kampo chiryo no

autointoxication when he was small, but he did notjissai (practical Kampo therapy by disease name), p.

know of any other ailment. From around six months

213, Sogensha, 1992

ago, he began complaining of pain in his back andthigh and could not go to school. Even at home, the15. Joint pain and muscle pain

pain bothered him, and he could not study at all.

Kakkonto has the effect of curing pain related toThree months ago, his right arm also began to hurt.

muscle tension in the nape and back, but there have

Various treatments were applied, but to no avail.

been reports of cases where kakkonto cured the pain

Recently, his doctor said the pain was a matter ofin joints and muscles other than in the nape, backnerves, and that it was not a problem.

and shoulders.

He had an ordinary build and good nutrition. His

Case 1: Arthralgia in all four extremities

pulse was floating, large and rapid, and had

Patient: 51-year-old housewife

palpitations. This was perhaps because the patient

History of present illness: About a year ago, thewas slightly nervous about his first visit to our clinic.

patient began to complain of joint pain and muscle

The pain was in the muscles on the right side of thepain in all four extremities. She had been receiving

interscapular region, the right forearm, and thetreatment from a doctor but saw no improvement.

inner side of his left and right thighs. An abdominal

Present condition: Medium build. Stiffness in theexamination found slight tension in the abdominalback and nape. Frequent bowel movement andrectus muscle is his left abdomen but no otherurination. Menopause (end of 1979). Good appetite,significant findings. I used kakkontokayokuinin forlikes warm foods. Favorite foods: fruits, meat, fish,

this. After taking the prescription for two weeks, thecoffee, Japanese sake.

patient was able to go to school without giving any

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

15

Volume 9, Number 3 | Fall 2014

thought to his disease, and was completely cured

Ephedrae Herba and Gypsum Fibrosum releases thethereafter.

heat accumulated in the triple energizer to outside

Keisetsu Otsuka, Shukindo chikenroku (3) (Records
of clinical trials at Shukindo (3)), Journal of Kampo

Medicine, Vol. 11, No. 4, p. 16, 1964

the body.
In Kampo shinryo iten, it is written as follows:“[kakkonto] is generally used in the initial stage,
when the patient feels cold or has a temperature and

16. Rheumatoid arthritis (RA)the skin is red, hard, widely swollen and itchy. In

Kakkonto is rarely used for rheumatoid arthritis.
However, in Kampo shinryo iten, it is written as
follows: “Use [kakkonto] in the initial stage of RA

case of a high temperature, add 5.0g Gypsum

when symptoms are light. It works well for chronic

the symptoms may temporarily worsen after taking

RA at the level where several joints of the finger are

the preparation, but this is not a concern.”8)

Fibrosum. In cases where the patient tends to beconstipated, add 1.0g Rhei Radix. As it is a sudorific,

swollen and hurt in the morning when waking up,
but the pain is mitigated after a while.”7) The

Case 1: Kakkonto extract for urticaria

following is a case reported by Keisetsu Otsuka.

Patient: 39-year-old female, skinny
Past medical history: Nothing in particularCase 1: Rheumatoid arthritis

History of present illness: About three months ago,

18-year-old male. Around two weeks ago, he began

the patient began to develop urticaria in the late

to feel pain in his back and joints of his hands andafternoons.

feet when waking up in the morning, but the pain

Progress: The patient’s child had atopic dermatitis

would lighten when he began working. The affected

when she was little, but the symptoms improved byparts showed hardly any conspicuous swelling. He
had a regular appetite. He sometimes felt a chill, andjumihaidokuto and had not recurred.
Therefore, I prescribed jumihaidokuto to the patient,

his body temperature would increase to up to 37.7-

thinking that she has the same physical constitution

37.8°C. The pain was strongest in his nape and back.

as her child. However, three days of taking theI gave him kakkonto, three days’ dose three times.

prescription did not improve the patient’s condition.

After a total of nine days of taking kakkonto, theNext, I prescribed Kososan, but also to no avail. Thus,

patient was fully cured. After about two months, he

I prescribed kakkonto extract. When the patient took

had a recurrence of the previous symptom, but thiskakkonto at the first sign of urticaria, the rash

was fully cured by taking kakkonto again for three

disappeared. However, it reappeared after the effectdays. Kakkonto was used for this patient because theof kakkonto wore off in several hours. Therefore, thepain was strongest in his back.

patient needed to take the prescription three to four

Keisetsu Otsuka, 30 Years of Kanpo, p.120, Sogensha,takingtimes a day, but the frequency of the rash gradually
decreased,

1959

and

her

frequencyoftakingtheprescription also decreased.
17. Urticaria, eczema and other skin diseases
There are several causes of urticaria, including

Hiroki Mizobe, Journal of Kampo Medicine, Vol. 49,
No. 6, p. 25, 2002

those that are indications for kakkonto. For
symptoms that include insomnia, edginess andCase 2: Urticaria in a child

restlessness, Gypsum Fibrosum needs to be added

Just after the previous experience, I was consulted

for kakkonto to have an effect. This is because by

by a certain person. According to that person, a childadding Gypsum Fibrosum, the combination ofof one of his employees living in the same

16

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

Volume 9, Number 3 | Fall 2014neighborhood had urticaria that kept the child fromfloating and quick. His tongue was normal, his

sleeping even at night because of the severe itchiness.

abdomen was well-fleshed, and his upper abdomen

A local doctor gave the child a shot about ten days

was swollen but not an indication of chest sideago, but the itchiness did not subside, so he asked me

painfulness. No other abnormalities were found. I

if there was something I could do.

therefore prescribed jumihaidokuto for a week as a

The patient was a five-year-old boy whom I had

means of detoxification. However, when the patient

examined once before when he had the common cold.

made a visit again in a week, he said his symptom

In Ruijuhokogi (interpretations of the classified

had not improved. I thought again. The patient had

assemblage of prescriptions), it is written thata strong itching sensation on his skin but showed no

kakkonto “cures pediatric erysipelas” and thatkakkonkajutsubuto “cures rubella, pyemid andrash whatsoever. This resembled a previous casesevere pruritus.” Therefore, I regarded the patient’s

interpreted his rather floating pulse as an exterior

symptoms as a pattern for kakkonto, and also

pattern of the disease, and according to precedent,

thought to add gypsum, thinking that the itchyprescribed kakkonto+sekko (GypsinFibrosum) for asensation that kept the patient awake at night was

week.

a

sign

of

dysphoria,

andprescribedkakkontokasekko for three days.

where jumihaidokuto was noneffective. I therefore

After about ten days, I received a phone call fromthe patient. “This time, the itching stopped when I

I received a message after a while. It said the childtook the prescription. When I ran out, I became itchy

showed a strong dislike for the preparation andagain, so please send me more,” he said. I thus send

refused to take it, but he somehow took a day’s dose

him ten more days’ dose. I have not heard from thein two days. By the time he finished taking the dose,patient thereafter, so I assume he has recovered.

the itching that was so severe suddenly stopped, andTerutane Yamada, Clinical trials of urticaria andhe became able to sleep well at night. It seemed

athlete’s food using Kakkonto, Journal of Kampo

enough, but to make sure there was no recurrence,

Medicine, Vol. 6, No. 11, p. 17, 1959

the child was somehow coaxed to take two more days’
dose in five days and was fully cured during thisCase 4: Urticaria
I administered kakkon+kabokusoku (Quercus

period.
Terutane Yamada, Clinical trials of urticaria andCortex) and yokuinin (Coicis Semen) to a 44-year-old

athlete’s food using Kakkonto, Journal of Kampo

male who complained of urticaria every winter for

Medicine, Vol. 6, No. 11, p. 16, 1959

the past 25 years ago, with good results. kakkontoalone may have sufficed for this patient, but I added

47-year-old male. Every summer, the skin of his

bokusoku, mostly for my own reassurance. I am notcertain whether or not bokusoku had an effect, but I

entire body became itchy, and the itchiness worsened

made this decision because the patient complained

when he perspired. This year, the itchiness wasof nose congestion at night, which resembled a caseparticularly severe, and he sought medical attention.

where a patient with empyema and urticaria was

However, nothing changed, and he had left it at that.

cured by using kakkonto+bokusoku. Bokusoku

He was of medium build and relatively well-(Quercus Cortex) is a different name for kunugi

fleshed and solid. No abnormality was seen in his(Quercus acutissima). I also added yokuinin (Coicis

skin, but rubbing the inside of his forearm caused a

Semen) because the patient had a wart near the

reddening. This was a sign of dermographism. It

hyakue (GV20) point on his head.

Case 3: Urticaria

might also have been urticaria. His pulse was rather

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

17

Volume 9, Number 3 | Fall 2014

The patient developed urticaria in the winter, but

prescription to be certain, before terminating it. The

the rash disappeared in about 5 minutes after

diagnosis was confirmed by comparing the herpes

drinking water. The rash did not appear when hevirus antibody titer on the day of the patient’s first

had a fever. However, three years ago, he began tovisit and two weeks later.

feel a discomfort in his throat as though fish scales
were attached. He was told it was neurosis, or other

Katsutoshi Terasawa, Wakan shinryogaku (Japaneseoriental medicine), p. 120, Igakushoin, 1990

times that it was nasopharyngitis. He visited a noseand ear doctor for a year but did not get better.

Case 3: Ramsay Hunt’s syndrome

kakkonto+bokusoku(Quercus Cortex) and yokuinin (Coisis Semen), theWhenIadministered

The patient is a 35-year-old female.
Last year, the patient sought medical attention for

urticaria decreased and appeared only at times whenstomach pain, and received a surgery after a large

it was especially cold. From around the twentiethovarianday, the dry sensation in the patient’s nose became

examination. This time, she said she began to feel annegligible, and around the thirtieth day, the wart

unpleasant tingling sensation on her skin on the left

disappeared.

side of her face and forehead two days ago. There

cyst

was

found

in

an

ultrasoundKeisetsu Otsuka, Shoko ni yoru Kampo chiryo no

was a rash accompanied by minor blistera vesicles

jissai (practical Kampo therapy by symptom), p. 553,

from the left external auditory canal to the auricle.

Nanzando, 1963

The left parotid lymph node was also swollen. There
was no apparent facial paralysis yet, but the patient

18. Herpes zoster

said the left half of her face felt heavy. She also felt

Kampo shinryo iten notes the following about theindications for kakkonto in patients with herpes
zoster: “[kakkonto] may be used at the prodromal

her ears ringing and a cold sensation in her ear.

stage, when the patient has a fever and shows early

She was dark-skinned and had a paunch. Because

signs of blistera vesicles.”9) Generally, kakkonto does

she was overweight, her pulse was sunken yet strong,

not have an effect past the initial stage, in most cases.

and not rapid. She had a slightly cold sensation and

These were symptoms of Ramsay Hunt’s syndrome.
The patient was well-built and weighed some 80kg.

tension in her nape and back. Blood pressure 110-70.
Bowel movement (+). Fever (-). Sweating (-).

Case 1: Herpes zoster
72-year-old male. The day before, he noticed an

Considering her build, she appeared to be sensitive

unpleasant tingling sensation whenever he touched

to cold. Prone to developing ovarian cyst, she had

his hair on the right temporo-frontal area. In thewatermorning,

eruptionskakkonkajutsubuto extract 9g (regular dose 4.5g)

appeared on his right forehead. There was a sense of

was used. She said drinking this preparation

photophobia in his right eye. His pulse was excessive,

warmed and relaxed her body and lightened her stiffand he had a slight stiffness at the back of his head.

shoulders. Three days later, the cold sensation in her

He had no tendency of natural sweating. I prescribed

ear and ear ache also disappeared. The blistera

kakkonto, judging it to be herpes zoster in the earlyvesicles in the external auditory canal also began toyang phase. In around 30 minutes of taking the

dry up. This disease sometimes causes facial palsy

prescription, the pain from the rash decreased byabout two to three later, so she was prescribed thehalf, and after three days, the sense of photophobia

preparation for another two weeks. Naturally, there

in the patient’s eye and rash both disappeared. The

were no aftereffects thereafter.

patient

18

severalwaspainfuladministereddiscrete

for

more

days

poisoningof

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

andcoldness,

so

Sanwa

Volume 9, Number 3 | Fall 2014

Isao Iwasaki, Rinshorei (clinical trials), Journal of7)

Keisetsu

Otsuka,Domei

Yakazu,TotaroShimizu: Kampo shinryo iten (dictionary of

Kampo Medicine, Vol. 32, No. 10, p. 19, 1985

Kampo medicine), p. 153, Nanzando, 1969.
Case 3: Aftereffects of herpes zoster

8)

Otsuka,Domei

Yakazu,TotaroShimizu: Kampo shinryo iten (dictionary of

A man born in 1904. Herpes between his right ribs
had been causing him pain for a year and a half, but
said he had no other symptoms. At a glance, he

Keisetsu

Kampo medicine), p. 301, Nanzando, 1969.
9)

Keisetsu

Otsuka,Domei

Yakazu,Totaroappeared to be solidly built. He had a reddish face,

Shimizu: Kampo shinryo iten (dictionary of

had regular bowel movement, was not choosy about

Kampo medicine), p. 321, Nanzando, 1969.

what he eats, and liked tea. His pulse was sunken,
rapid, and very intermittent possibly because he has

To be continued in the next issue

a bad heart. An abdominal examination revealedtension in both the left and right hypochondrium.
Therefore, he was given kakkonkajutsubuto, and his
progress was decided to be monitored. Two weeks
later, the patient himself said he has become
extremely comfortable.
Kazuo Matsumoto, Toyodo keikenroku, daiisshu(Toyodo records of experience, Series 1), p. 568,
Taniguchi Shoten, 1993

References
1)

Akira Kitanami et al.: A case in which kakkonto
per request was effective against stiffness in thenape and neck (First report), Journal of Kampo

Medicine, Vol. 29, No. 7, pp. 3-9, 1982.
2)

Akira Kitanami et al.: A case in which kakkonto
per request was effective against stiffness in theneck (Third report), Journal of Kampo Medicine,Vol. 30, No. 1, pp. 15-21, 1983.

3)

Keisetsu

Otsuka,Domei

Yakazu,TotaroShimizu: Kampo shinryo iten (dictionary of
Kampo medicine), p. 158, Nanzando, 1969.
4)

Fumio Nishina: A kakkonto onto and pulses inorthopedic diseases, Kampo shinryo (Kampo
examination), Vol. 4, No. 3, pp. 48-50, 1985.

5)

Keisetsu

Otsuka,Domei

Yakazu,TotaroShimizu: Kampo shinryo iten (dictionary of
Kampo medicine), p. 155, Nanzando, 1969.
6)

Shozo Bando: Byomei Kampo chiryo no jissai(practical Kampo therapy by disease name),
Medical Yukon Publishing, p. 320, 2002.

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

19

Volume 9, Number 3 | Fall 2014

Clinical Report 1 (Acupuncture)
One Case in Which Moxibustion Applied at GV12 andBl17 Seemed to have been Markedly Effective for
Headaches and Physical Fatigue Aggravating after HighSchool Entrance Examinations

patient expressed her wish to try it if possible andAkio Manabe

needle was forced through (difficult to express in

Acupuncture Department ofwords). She was constantly uncomfortable andEhime Prefectural Central Hospital

influenced by the weather (rain and humidity had anthus visited the acupuncture and moxibustion
section of the department of Kampo internal
medicine in this clinic.
The had strong parietal headaches that felt like aaggravating tendency). Severe headaches werePatient: 17-year old girl, first-year high schoolaccompanied by nausea.

student

Currently she feels shooting pain whenever she

Chief complaint: headaches, general physical fatigue

moves her head and in association with that

Past history:

develops mild nausea. Moving is painful.

From the age of 13 she started to suffer from

General physical fatigue developed from about theheadache attacks once or twice a month. When shesame time the headache attacks started and areattended a training camp of her high school club atcurrently so trying that commuting to school is not

the age of 16, she developed a high fever. After thatpossible.

the frequency of the headaches increased so that she

In the department of pediatrics in hospital N avisited pain clinic T, where she was diagnosed withcombination

migraine without aura and prescribed sodium"Keishikajutsubuto"

valproate and ibuprofen, but the frequency ofindication of the formula "Keikyososooushinbuto".

of"Maobushisaishinto"

and

was

the

prescribedforheadaches increased still further. Due to the weakeffects of ibuprofen, she visited in August of X-1 theCurrent condition: 163 cm,

60 kg

headache center of hospital T. There too an

Tonguepurple;aggravationindentations; thin white coat; varicose veins present.

of

the

nausea,vomiting,

diagnosis:

light

minor

teeth

hypersensitivity to light and sound was observed,

Pulse diagnosis: deep, slightly rapid.

was also diagnosed with migraine without aura and

Abdominal diagnosis: abdominal wall tone 4/5; mildprescribed a triptane preparation. Based on a 49-

feeling of pressure below the heart; mild degree ofpoint score using a self-evaluation diary for

rigidity and fullness in the lower abdomen on the

depressive mood, she was diagnosed as being "mildlyleft; mild degree of hypochondrial fullness anddepressive".

tenderness.

However,

since

no

improvement(decrease) in the frequency of the headaches was

Skin: many bruises; on the back many skin eruptions.

achieved in this headache center, she consulted in

Chilling: objectively the feet are very cold from below

January of X-year the department of pychosomatics

the ankles, but subjectively the patient does notin hospital N. Yet, even there the conditions

complain of cold feet.

improved only very little, so that the physician in

Meridian point diagnosis:

charge of the psychosomatic ambulance referred thetender depressions: GV12, GV4

patient to physician U of the pediatric department.

tender indurations: BL17, KI2

Based on the Kampo treatment initiated byfine floating vessels: in the vicinity of GV12

physicianedema: parietal region

there

was

improvement,butphysicianUacupunctureandmoxibustion

treatment.

20

U

a

tendency

towardrecommended

Time-series analysis and treatment planThe

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

Volume 9, Number 3 | Fall 2014

Based on the time-series analysis, a past history ofIn the acupuncture and moxibustion treatment

chronic paranasal sinusitis, irritability and quick-section the moxibustion treatment was continued,

tempered character traits conceivably indicates afine floating vessels in the interscapular region wereclassification as detoxication constitution according

punctured, and moxa needling at GV12, BL17 andto the "Ikkando medical view". Since she had her

GV4 added to the treatment regimen.

menarche at the age of 10 and after that experienced

Dr. Kakuto of the department of Kampo internal

abdominal pain, headaches, dizziness as symptoms

medicine added GB40.

of menstrual pain, she may also be considered to

Fifth visit (X, 9, 13)suffer from a stagnant blood constitution.

While

Also,

she

still

had

difficulties

gettingup,

while she is already 17 years old, she gives ancommuting to school became possible. She reported

immature impression, so that the use of GV12 anda decreased frequency of the headaches.

GV4 said to be highly effective for infants according

The acupuncture and moxibustion treatment wasto the Sawada style moxibustion was considered,

the same as during the previous session.

presuming the liver to be the viscera mainly affected

Sixth visit (X, 10, 21)

and thus the conceived treatment plan based on the

Schoolconcept of relieving blood stagnation (improving

headaches had reportedly decreased.

circulation)

The acupuncture and moxibustion treatment wasandimprovingthedetoxication

constitution, helping to improve the circulation of qi.

attendance

possible;frequencyofthethe same as during the previous session.
Course evaluation questionnaire
Headaches ・・・・・・・ B (have improved, but are

Courseoccasionally bad)First visit (X, 6, 21)
Moxibustion: at GV12, BL17, GV4, SP6, KI2

Generalized fatigue ・・・ B (has improved, but isoccasionally bad)Second visit (X, 7, 7)
Headache relieved from 10→3
Physician U at hospital N changed the prescription
from goreisan to nichinto.

Menstrual pain ・・・・・・ B (has improved, but isoccasionally bad)
Easy irritability ・・・・・・・ B (has improved, but

Addition of GB21 and GV9 to the initial moxibustion
points and warming moxibustion on the lower

is occasionally bad)
Quick temper ・ ・ ・ ・ B (has improved, but isoccasionally bad)abdomen.
Third visit (X, 7, 28)Seventh visit (X, 11, 25)

The patient apparently suffered since July 25 from a

She reported still having headaches, but wasright-sided temporal headache that felt, like she had

nevertheless able to attend school and classes.

been beaten.

The acupuncture and moxibustion treatment was

Physician U at hospital N changed the prescription

continued.

to keishininjinto.

Physician U at hospital N prescribed shinbuto andIn our clinic the moxibustion treatment was

bushi (aconiti tuber).

continued.

Through the treatment by Dr. Kakuto of the

Fourth visit (X, 8, 16)

department

The headache apparently peaked upon getting up in

developed more energy and recovered to the degree,

the morning, by 1 o'clock in the afternoon andthat she became motivated to study.

around 6 o'clock in the evening.

Eighth visit (X, 12, 21)

of

Kampo

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

internal

medicineshe

21Volume 9, Number 3 | Fall 2014

She reported still having headaches, but wastrend.

Using

moxibustion

nevertheless able to attend school and classes.

symptoms and relieves stress, but by relying on

The acupuncture and moxibustion treatment wasparents for support we would like to see, even if thiscontinued.

is still a premature conclusion, a reduction in theBased on information from Physician U at hospitalsuicide rate.

N, currently only shinbuto is prescribed.
Nineth visit (X+1, 1, 27)
VAS assessment
Headache：10→3.5

Generalized fatigue：10→4
She

was

able

to

performdaily

moxibustion

treatment at home. She also reported having theimpression shinbuto was effective. The frequency ofthe headaches as her chief complaint

decreased

and the migraine without aura showed a tendency
towards improvement. The generalized fatigue also
improved.
Discussion
Blood stagnation being considered to be the main
pathology in this patient the, we used the meeting
point of the blood BL17. Again, according to the
Ikkando classification we thought, we were dealing
with a detoxication constitution and thus applied
moxibustion at KI2 to improve this constitution. We
also used GV12 to regulate the flow of qi. This
treatment seemed to have been markedly effective inthis patient. In this case the compliance regarding
moxa treatment at home was almost 100%, showing
the potential of care by the parents.
Conclusions
This patient gave the impression, that her visiting
our clinic was like she would clutch even at straws
considering her background of severe headaches
caused by migraine without aura, which had forced
her to repeat a year in high school.
Recently many teenage children have visited ourclinic, revealing a glimpse at the magnitude of thestressfulenvironment

of

these

children.

The

Japanese Cabinet too has pointed out, that thesuicide rate among teenagers shows an increasing

22

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

not

only

improves

Volume 9, Number 3 | Fall 2014

Clinical Report 2 (Kampo Medicine)
A Case in Which Psychogenic Abdominal Pain in a 6-yearold Girl was Improved by Shokenchuto

Hideaki Yamaguchi
Tosei General Hospital

Case: 6-year-old girl with psychogenic abdominal
pain

disappeared, and after 2 weeks, she no longer
needed to be accompanied to school. Thereafter,
there was no abdominal pain, and the patient was
able

to

commutetoschoolregularly.

The

prescription was terminated in 4 months.
(Shared impression by the mother and homeroom
teacher: It worried them that the patient wasexcessively quiet since entering primary school,

Chief complaint: Abdominal pain
Past medical history: The patient exhibited
normal growth and development, but suffered
night terrors at the age of 3. She developed a fever
easily and had a small appetite.
History of present illness: In preschool, she was
accustomed to having a bowel movement after
returning home, but from after entering primaryschool, she could not reach home by that time, andhad to suppress her urge to have a bowel
movement. She tried to have a bowel movement in
the morning, but from around mid-May, she began
to complain of stomach aches in the morning andwent to the bathroom 2 to 4 times. The stomachache caused her to miss school only on around 3
occasions, but perhaps due to a feeling of anxiety,she had to be accompanied by her mother whengoing to school. Night terrors also appeared
around this time. Therefore, the patient visited

but she suddenly perked up after commencing
treatment.)
Observation: It is thought that the patient hadcongenital dormant spleen qi deficiency (digestive
function decline). Her environment changed after
entering school, and combined with the issue ofher bowel movement time, she entered a state ofmental strain, which reflected on her digestive
tract and developed into a pathological condition
resembling irritable bowel syndrome. Because

shokenchuto has the effect of relieving excessive
tension in the digestive tract, the patient’s
abdominal pain disappeared and she came to havesmooth bowel movement after its use. It is thoughtthat her anxiety also declined at the same time.
Furthermore, as her innate spleen qi deficiency
gradually improved, it is thought that she became
more active thereafter.

our department on June 15.
Diagnosis:

Psychogenic

abdominal

pain(pathological condition resembling irritable bowel
syndrome)
In terms of Kampo, “liver qi attacking the stomach”(digestive function decline caused by stressinduced tension)
Treatment policy: To relieve tension and improvethe digestive function
Prescription: Shokenchuto extract 3 times/day
Progress: After a week of taking the prescription,
the patient’s abdominal pain, frequent bowel
movement

and

night

terrorpractically

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

23

Global Tech Communications
streamlines communication among
our client companies by linking with the
projects and generating returned profits.
Translation and Localization Services
Our mission is simply to help our clients grow their globalizing businessand gain profits by providing high quality translation deliverables andadded values with our unconventional and creative ideas. Our highly
competent and experienced staff and our qualified freelance translators
together provide the best solution to satisfy our clients’ expectation in areaof Information Technology, Financial market, Medical & Pharmaceuticalmarket, Automobile, Legal, Patents, etc.
Our language pairs cover more than 50 languages for our clients.

Consultation Services
We offer the focused consulting services that meet the need of each clientcompany for their business development in the borderless markets.
Our clients vary in size and field, and are offered with various consultation
proposals. We search the issues and the opportunities that confront ourclients, and provide the best support in developing business systems thatgenerate the profit to our clients. We further extend our consulting
services in various markets as we started in Asian countries.

Global Tech Communications, Inc.
Nakano SUNPLAZA 9F
4-1-1 Nakano, Nakano-ku, Tokyo 164-8512, JAPANTEL: +813-5942-3038 FAX: +813-5942-3601
URL: www.globaltech.jp

Make the most of Kampo in modern medicine

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

OHSUGI Pharmaceutical Co., Ltd.

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

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

TOCHIMOTO

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

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