Volume 10, Number 1 | Spring 2015

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

Departement of Urology, Hidaka Hospital

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

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

theurinary

incontinence

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

On this occasion I would like to present one casedepression

andstagnation,

heart

fire,

water

difficult to treat with western medication in which

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

are the main etiologic causes for hyperactive

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

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

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

orused,else

bloodorsupplementing

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

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

21

Volume 10, Number 1 | Spring 2015

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

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

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