KAIM
T
Thhee JJoouurrnnaall ooffK
Kaammppoo,, A
Accuuppuunnccttuurree aanndd IInntteeggrraattiivvee M
Meeddiicciinnee
INTERNATIONAL INSTITUTE OF HEALTH AND HUMAN SERVICES,
BERKELEY
Volume 8, Number 2 ･ Summer 2013

Editorial

An Aged Society and Traditional Medicine
Naoya Ono

Japanese Acupuncture - Current Research

Japanese Traditional Medicine Text (8) – Acupuncture in the Areas of Otorhinolaryngology
Kazuo Sasaki

Kampo Medicine - Current Research
Irritable Bowel Syndrome
Shinji Nishida

Clinical Report 1 (Acupuncture)

A Case of Quick Relief from Persistent, Blood Stagnation Related Stiffness of the Interscapular Region
Toyoji Sakamoto

Clinical Report 2 (Kampo Medicine)
A Case of Irritable Bowel Syndrome
Shinji Nishida

Clinical Report 3 (Kampo Medicine)

A Case in Which a Recurrent Tonisillitis in a Six-year-old Girl Suspected of PFAPA Was Resolved by Ogikenchuto and Shosaikoto
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 8, Number 2 ･ Summer 2013

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
An Aged Society and 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

2 Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (8) – Acupuncture in the Areas of Otorhinolaryngology
Kazuo Sasaki
6 Kampo Medicine - Current Research
Irritable Bowel Syndrome
Shinji Nishida

9 Clinical Report 1 (Acupuncture)

A Case of Quick Relief from Persistent, Blood Stagnation Related Stiffnessof the Interscapular Region
Toyoji Sakamoto

PUBLISHER

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

18 Clinical Report 2 (Kampo Medicine)
A Case of Irritable Bowel Syndrome
Shinji Nishida

19 Clinical Report 3 (Kampo Medicine)
A Case in Which a Recurrent Tonsillitis in a Six-year-old Girl Suspected of PFAPA Was
Resolved by Ogikenchuto and Shosaikoto
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 8, Number 2 | Summer 2013

Editorial
An Aged Society and Traditional Medicine
Predicting what future society will be like requires a collection of data from various fields. Most
important among them all is data on the demographic estimation of each country. Demographic
estimation is essential to predicting the future of society, as it never lies, as long as there is no catastrophic
disaster or war.
Today in the 21st century, Japan is daily renewing its own record in leading the world as an ultraaged society with a declining birthrate and population. Until the 20th century, Japan was a young society
with an increasing birthrate and population. Patients were also young, and required “efficient,” “curative
medicine.” Modern Western medicine was thus the mainstream. In today’s ultra-aged society with adeclining birthrate and population, however, a large proportion of patients are old. Given that people
cannot escape the cycle of “birth-old age-illness-death,” these patients require “inefficient,” “watchful
medicine,” and the focus of treatment must necessarily be placed on this type of medicine. To Japan today,the 21st century marks a century of “defeatist medicine,” which are irrelevant to the concepts and valuesof the previous century, already transcends the bounds of “medicine,” and cannot provide cures.
Nevertheless, ageing is an issue not only in Japan, but in other countries in Asia, as well. China willfind itself in the same situation as today’s ageing population in Japan in twenty years. The South Korean
population will hereafter age at an accelerated rate and even more rapidly than Japan. The ASEAN
countries and India will also experience an ageing of society, and the Asian countries as a whole will growold. This phenomenon is not only common to the Asian countries, but even to Western developed
countries. In other words, all of humanity will grow old.
Until now, traditional medicine was practiced, researched, and evaluated from the perspective of“efficient,” “curative medicine” mainly of the West. However, it is hereafter necessary to practice,research, and evaluate traditional medicine from the perspective of “inefficient,” “watchful medicine.”
Can traditional medicine respond to this shift? The true value of traditional medicine in an aged society
will be questioned hereafter, and demonstrating this will provide evidence of the significance oftraditional medicine in future society.

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

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

1

Volume 8, Number 2 | Summer 2013

Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (8) – Acupuncture in
the Area of Otorhinolaryngology

1990’s and the remaining reports were prior to that.

Kazuo Sasaki

randomized, placebo-controlled trial of manual andProfessor, Department of Acupuncture and Moxibustion

electrical acupuncture for the treatment of tinnitus”.

Suzuka University of Medical Science

Subjects were 50 patients with tinnitus were divided

Most recently (2010), Wang K, Bugge J et al. of
Denmark

publishedsingle-blinded

RCTs

”A

into three trial groups, 1) an electro-acupuncture
In this section we will discuss, Otolaryngology
diseases (ears, nose and throat), especially thosesuited to treatment by acupuncture and moxibustion
therapy such astinnitus, dizziness (vertigo) andsudden deafness.
Conditions if the eyes, ears and throat, especiallywith respect to Acupuncture and Moxibustion
Treatment, are considered imbalances within theFang Fu system of organs as Kidney, Liver typediseases. Further, external influences of winddampness and phlegm fire are thought to have astrong connection to these external orifices, so
treatment of these conditions must focus on thesepathogenic processes.
In 1996, the WHO published a list of 49 diseases
effectively treated with acupuncture. Diseases of theear, nose and throat included tinnitus, hearing loss
and Meniere disease. Indications on this list are notbased on evidence obtained through rigorous clinical
trials and, dominated by subjective symptoms, suchas tinnitus and vertigo, so making an objective
evaluation based on the degree of symptoms very
difficult. Because these conditions are not dealt witheffectively by modern medical treatment provided by
medical institutions, patients with these symptoms
tend to seek acupuncture treatment. For thesereasons, Otolaryngology specialty hospitals in Japan
may often offer acupuncture treatment room.
1. Present Status of Foreign Clinical Researcha) Tinnitus
Using Pub Med, we limited our keyword search to[Acupuncture] [hearing disorder] and found 91
references, 8 of which were RCTs. Of those, 4 reports
were published after 2000, 2 reports were from the2group, 2) manual acupuncture group, and 3) a nonacupuncture treatment group. Groups 1 and 2
received acupuncture at intervals of 6 times a week
for one month, after which they completed a survey
concerning the frequency, volume and quality of
their tinnitus and remarked about their subjective
evaluation of the treatment and their progress.
Resultsofthesepost-treatment

subjective

evaluations showed that, compared to the nontreatment baseline levels, manual acupuncture
produced significant improvements and compared tomanual stimulation, electro-acupuncture produced
relatively

moresignificant

improvements.

Frequency and volume of tinnitus was significantly
reduced in the electro-acupuncture group and it was
concluded that, as for tinnitus, electro-acupuncture
was especially effective.
b) Vertigo
Performing a Pub Med search using key thewords [Acupuncture], [Dizziness], [Vertigo], 23
reports were collected, 3 of which were RCTs.
Aigner N et al. published “Adjuvant laser
acupuncture in the treatment of whiplash injuries: aprospective, randomized placebo ─ controlled trial”
for vertigo resulting from whiplash injuries (45subjects). The subjects were divided into 2 groups, 1)
pharmaceutical treatment combined with laser
acupuncture and2) laser acupuncture with nopharmaceuticals

as

the

placebotestgroup.

Comparing results from these two groups revealed
that both groups improved but there was no
significant difference between the results.
Heikkilä

H,

et

al.,

published“Effects

ofacupuncture, cervical manipulation and NSAID
therapyon

dizziness

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

andimpairedheadVolume 8, Number 2 | Summer 2013

repositioning of suspected cervical origin: a pilot

to initial evaluation scores, he experienced 50%

study”. They discussed vertigo and its relationship toimprovement in his Patulous Eustachian Tube

disorders of the neck. They performed trials using

symptoms and this improvement was maintained

acupuncture,

followingcervicalmanipulation

and

non-

the

treatment

period.

Wu

et

al.

steroidal anti-inflammatory drugs to confirm efficacy.

published ”Acupuncture Treatment for Labyrinthine

Cervical manipulation was found to be the mostTinnitus”. Having recruited 65 subjects, they wereeffective method for reducing the amount of timescreened and divided into deficiency, excessive andpatients suffered dizziness and vertigo. However,intermediate

according to post treatment VAS scores, acupuncture

acupuncture treatment. Before and after thewas found to be very effective for relieving thetreatments subjects were asked to evaluate theirvarious pains experienced by these patients.

subjective scores for [tinnitus expression] andUsing a Pub Med search including the key words[Acupuncture] and [sudden deafness], we found 4
reports, none of which were RCTs. Yin CS et al. wasprimaryAllsubjects

received[tinnitus loudness]. Analyzing the data from 65c) Sudden Deafness

thetypes.

researcher

for

these

reports.

Requirements for entrance into the study were thatthe symptom had continued for more than 3 weeks

subjects showed that, compared to the deficient andintermediate types, the excessive type subjects
showed the greatest reaction to acupuncture
treatments.
b) Vertigo
We performed a web search using jamas.or.jp andand that Western treatments had failed to correct

includingthe condition. Seventeen subjects with obstinate[Moxibustion] and [Vertigo]. We retrieved 98 reports,

deafness joined the study. A specific type of sham

49 of which were case studies and 43 included

acupuncture was used (舎岩鍼法) as the control andresearch commentary. Kadokura et al., recruited 7

manual acupuncture was used as the treatment.

subjects with peripheral (??) vertigo who had not had

After 70.4 days, improvement rates were measured

experienced relief with Western Medical Treatments

at 47.1% (8 of the initial 17 had improved hearing).

(1 male, 6 females).Acupuncture and moxibustion
treatments

thekeywords

involved

retention[Acupuncture],

needling

and

2. Present Status of Clinical Studies in Japan (fromcomfortably warm moxa that did not leave a scar or

2001 to 2012)

blistering. Treatment was continued for between 6-a) Tinnitus

15 months. A QOL questionnaire was collected toUsing an online search engine, jamas.or.jp, we

evaluate the effectiveness of the treatments: 1

used [Acupuncture], [Moxibustion] and [Tinnitus] as

subject reported complete recovery, 5 reported a

the keywords. Retrieving 57 reports, we are

reduction in symptoms and 1 reported no changes forreviewing 32 of those here, although none of thesean overall improvement rate of 85%. Further,were RCTs. Muranaka et al. published ”Efficacy of

Sakuraba et al. reported improvement in vertigo, an

Acupuncture

Patulous

accompanying symptom experienced by patients

Eustachian Tube symptoms” having recruited a 43

receiving hemodialysis. Specifically, 18 hemodialysis

year old male subject. Needling was performed in thepatients were divided into Group A (10 hemodialysis

area of the Trigeminal nerve using acu-points at thepatients (2 males and 8 females, average age 62.4)

back of the head on the neck. He was treated once aand Group B (5 males and 3 females, average age

week for 25 weeks and the results of his treatments

67.5). The groups were treated with acupuncture,

were reported as follows. ANRS (Numerical Rating

alternately

Scale) was used to evaluate his progress. Comparedtreatment method). Acu-points were selected using

andMoxibustion

for

for

12

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)-weeksessions(cross-over3Volume 8, Number 2 | Summer 2013

an M-test and embedded needles were then applied.

References

Following the treatments, group A’s VAS scores for

1)

Masanori

Takashi:

Dialectical

Theoryitchiness decreased significantly from 52.2 to 18.5.

Treating

Vertigowith

Acupuncture.

Further, slight decreases were reported for general

Acupuncture and Moxibustion OSAKA (22)2:

stiffness, irritability, a sense of dull heaviness, and139-144, 2006
2 ） Xiaoxiang Z, et al.: Jinger moxibustion forvertigo.

treatment of cervical vertigo ─ a report of 40c) Sudden Deafness
Using an online search engine, jamas.or.jp,
includingthekeywords,[acupuncture],cases. J Tradit Chin Med 26(1): 17─18, 2006
3） Aigner N, Fialka C, Radda C, et al.: Adjuvant
laser acupuncture in the treatment of whiplash[moxibustion] and [sudden deafness] we retrieved 23

injuries: a prospective, randomized placebo ─reports, one of which was original research, 15 were

controlledcase reviews and 7 were research commentaries.
Additionally, we found no RCTs. Sudden deafness
has been studied by Yamamoto and Takenouchi who

Klin

Wochenschr

Effects of acupuncture, cervical manipulation
and NSAID therapy on dizziness and impaired
head repositioning of suspected cervical origin :body acupuncture treatments, using particularly
Four of the subject (26.7%) reported their treatments

Wien4） Heikkilä H, Johansson M, Wenngren BI, et al.:15 patients for 6 years, providing systematic whole
points around the ears and auricular acupuncture.

trial.

118(3─4): 95─99, 2006

researched classical texts. Since 1981, they followed

a pilot study. Man Ther 5(3): 151─157, 2000
5） Yin CS, Park HJ, Nam HJ, et al.: Acupuncture
for refractory cases of sudden sensorineural

were effective.

hearing loss. J Altern Complement Med 16(9):3. Perspectives and views for the future ofacupunctureandmoxibustion
therapyofOtolaryngology
As noted earlier, modern medical treatment for

973─978, 2010
6)

these types of symptoms are often based on

7)well as gastric discomfort, menstrual cramps,
insomnia, or exercise with fibromyalgia should also
be tracked in future clinical research models.

patients

who

complainof

Manta So, Lawrence C ─ L Huang et al.:Concerning the usefulness of clinical researchacupuncture for Labyrinthine Tinnitus using
the "Nakanishi medical combined treatment".
Journal of the Japan Society of Acupunctureon their results from a University Hospital setting,hearing evaluation, symptoms such as dizziness asfor420-424, 2011

treatment is complicated. Kadokura et al. reported

include balance tests, MRI and sensory neural

Narushima,

Society of Acupuncture and Moxibustion 61(4):difficult so we have to conclude that this area ofsuch serious symptoms as intractable Vertigo should

Tomomi

Patulous Eustachian Tube. Journal of the Japansubjective observations, treatment evaluation can besuggesting that special consideration for patients

Nakamura,

Treatment

necessarily get positive results. In many cases, evenafter a successful acupuncture treatment, because

Ryota

Masanori Tojo et al.: Case Study: Acupuncture

patients with Otolaryngology diseases do not

4ofand Moxibustion 58(4): 626-641, 20088)

Yo Sakuraba, Kenta Sawasaki, H. Takeuchi etal.: Effects of Acupuncture treatments aimed atmaintaining QOL of hemodialysis patients andimproving implementation (the practice ofacupuncture treatment for itching associatedwith hemodialysis)). Kidney 30(2): 167-174,
2007

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

Volume 8, Number 2 | Summer 20139)

Yoshiyuki

Kadokura,

Ryou

Ishida,IchiroYagitani et al.: Effects of Ac puncture andMoxibustion Treatment for Vertigo. Journal of
the Japan Oriental Medicine Journal 59(2): 291295, 2008
10) Kouki Yamamoto, Shinsao Takenouchi, Sanshi
Takenouchi

et

al.:

Acupuncture

andMoxibustion for Sudden Deafness and Tinnitus.
Journal of the Japan Society of Acupunctureand Moxibustion Therapy 40(2): 184-187, 1990

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

5

Volume 8, Number 2 | Summer 2013

Kampo Medicine - Current Research
Irritable Bowel Syndrome

to be ineffective and in case of severe abdominal pain,
or in the presence of strong depressive symptoms,

Shinji Nishida
Department of Psychosomatic Medicine
Japan Red Cross Wakayama Medical Center

antidepressants or anti-anxiety drugs may be added
and psychotherapy administered.
Table1 Irritable Bowel Syndrome (Rome III)

Summary
Abdominal pain or abdominal discomfort occurringin conjunction with bowel movements, but wherecolonoscopy etc. cannot demonstrate any organic
lesions are called irritable bowel syndrome (IBS）.
The Roma III criteria (Table 1) are used as
diagnostic

criteria

for

IBS.

Based

on

the

predominant symptoms the condition is further
classified into the four disease types constipation,
diarrhea, mixed and an unclassified varied type1).
Moreover,thedefinitionof"abdominal

paindecreases with bowel movement" is important andconstipationofabdominal

pain

diarrheaisnotassociatedclassified

as

with

functional

constipation or diarrhea, while the independent
symptom of abdominal distension is classified asfunctional

abdominal

distension.

Similartofunctional dyspepsia (FD) IBS too has a highprevalence and is a disease severely impairing the
QOL, but society in general often dismisses it.
Similar to FD the three major factors related to thepathology of IBS are anomalies of gastrointestinal
motility, visceral hyperesthesia and psychologicalfactors. Moreover, there are also patients developing
IBS following infections of the intestinal tract, so
that

the

influenceofminimalintestinal

inflammation, cytokines and intestinal bacteria arealso considered as etiologic factors.
Western

medicaltherapy

of

IBS

uses

improving intestinal motility on a foundation of
guidanceanddietary

improvements.

Depending on the disease type 5HT3 receptor
antagonists,

Lactobacillus

preparations,anticholinergics and cathartics are combined withaforementioned measures. If these measures prove
6

Recurrent abdominal pain or discomfort** atleast 3 days/month in the last 3 months
associated with two or more of the following:
1. Improvement with defecation
2. Onset associated with a change in frequency ofstool
3. Onset associated with a change in form
(appearance) of stool* Criterion fulfilled for the lastmonths withsymptom onset at least 6 months prior to
diagnosis**“Discomfort”

means

an

uncomfortablesensation not described as pain.
In pathophysiology research and clinical trials, apain/discomfort frequency of at least 2 days aweekduringscreening

evaluation

isrecommended for subject eligibility.
IBS classification based on bowel movement
condition
1. Constipational type IBS (IBS-C): hard or
scybala-like stools (a) in more than 25%, soft(mushy) or watery stools (b) in less than 25%, (c)2. Diarrhetic type IBS (IBS-D): soft (mushy) or
watery stools (a) in more than 25%, (b) hard or
scybala-like stools in less than 25%, (c)3. Mixed type IBS (IBS-M): hard or scybala-likemacromolecular polymer preparations and drugs
lifestyle

Diagnostic criterion*

stools (a) in more than 25%, soft (mushy) or
watery stools (b) also in more than 25%, (c)4. Unclassified IBS: stool anomalies do not meetthe characteristics of either IBS-C, IBS-D or
IBS-Ma) Bristol Stool Chart 1-2b) Bristol Stool Chart 6-7c) not using any antidiarrheal agents, laxatives

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

Volume 8, Number 2 | Summer 2013

Treatment

EBM

In Chinese medicine diarrhea is called 'fu xie' or 'xie

In Japan the formula keishikashakuyakuto is usedxie (loose stools and diarrhea)', while constipation ismost frequently, but there are also reports about

called 'pi yue' (the restrained spleen, constipation

saireito, keihito, heiisan, daikenchuto etc.2).

due to deficiency of circulatory fluids) or 'da bian nan'

In a DB-RCT Sasaki et al. investigated the effects of(constipation). The causes leading to diarrhea

keishikashakuyakuto3). The study showed that

includeamong the total of 232 patients with IBS (122external

cold,

food

includeddamage,stagnation and sluggishness of liver Qi, Qi deficiency,

patients

Yang

for

constipational type, 53 patients with an alternating

constipation include heat bind, Qi stagnation, Qi

type presenting with diarrhea and 19 patients with

deficiency, Yang deficiency, Blood deficiency, Yinan alternating type presenting with constipation

deficiency etc. In Chinese medicine IBS is often

effects were observed in the normal dose group (1)classified into the subtypes of liver depression andtreated for more than 4 but less than 8 weeks withspleen deficiency, cold-heat complex, intestinal

keishikashakuyakuto and the low dose group (2)liquid depletion, combined with spleen/stomach

receiving 1/20 of the normal dose. These results

deficiency and weakness, but based on the concept

showed that 1) the degree of final improvement (thethat IBS is a disease influenced by mental stress,

ratio of a more than moderate improvement) for all

liver depression and spleen deficiency can be

IBS patients was: (1) 50.9%, 47.9% (n.s.). Classified

considered to be the underlying condition to whichby disease type this ratio was for diarrhetic type: (1)the other factors are added.

54.4%, (2) 48.2% (n.s.), constipational type: (1) 63.6%,

deficiency

etc.,

while

the

causeswithdiarrhetic

type,

38

patients

57.9% (n.s.), alternating diarrhea type: (1) 39.4%,
Diarrhetic, constipational and mixed types can all be

40.0% (n.s.), alternating constipational type: (1)found within the condition of liver depression and spleen

57.1%, (2) 37.5% (n.s.). 2. The degree of improvement

deficiency, for which in China the formula ｔsushayoho

of bowel movements and intestinal organ symptoms:(痛瀉要方 tong xie yao fang) is used for the diarrhetic(n.s.). 3. Improvement classified by disease type

type. In Japan shigyakusan is the first choice, but(ratio of more than moderate improvement) was forkamishoyosan is occasionally used too. Also, viewed asa liver-spleen disharmony keishikashakuyakuto or
keishikashakuyakudaioto as well as shokenchuto

the diarrhetic type: (1) 57.9%, (2) 37.0% (p=0.037). 4．

are used. For cold-heat complex Ubaigan is used in

where

China, while in Japan hangeshashinto is used. A

movements and intestinal organ symptoms wereconstipational type of IBS is interpreted in China as

observed for the diarrhetic type of IBS.

intestinal

liquiddepletionandtreatedThe usefulness for all IBS patients (ratio of being
more than useful) was: (1) 46.2%, (2) 44.7% (n.s.),significant

improvements

of

bowel

with

ikkansen, while in Japan mashiningan or junchouto
are used. A diarrhetic form of IBS is considered to bekeihito, saireito,
keishikashakuyakuto, heiisan, daikenchuto havea spleen and stomach deficiency and weakness andreportedly been effective.

treated in China with jinryobyakujutsusan, but inRegarding reports from abroad there is the DB-RCT

Japan the similar formula keihito is used. In

by Bensoussan et al.4). In this study 116 IBS patients

particular, for the pathology caused by spleen andwere divided into 3 groups: (1) a group receiving

stomach deficiency and weakness ninjito or shinbuto

individual

are used.

identification, (2) a group receiving a standardIn

cumulative

formulacasestudiesprescriptions(Codonopsii

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

based

Radix,

onpattern

Pogostemi Herba,

7Volume 8, Number 2 | Summer 2013

Saposhnikoviae Radix, Coicis Semen, Bupleuri
Radix, Artemisiae Capillaris Flos, Atractylodis
Rhizoma, Magnoliae Cortex, Citri Unshiu
Pericarpium, Zingiberis Rhizoma Processum,
Fraxini Cortex, Poria, Angelicae Dahuricae Radix,
Plantaginis
Semen,
Phellodendri
Cortex,Glycyrrhizae Radix Praeparata, Paeoniae Radix,
Saussuerae Radix, Coptidis Rhizoma, Schisandrae
Fructus) and (3) a placebo group that were alltreated over a period of 16 weeks. After that (1), (2)and (3) were compared to each other and asignificant improvement of the IBS symptoms
observed that continued in group (1) even beyond theend of the administration period. Moreover, thereport by Wai K. et al.5) describes the inclusion of 133
patients with diarrhetic IBS, who were divided intoa (1) regular prescription group (Atractylodis
Rhizoma, Astragali Radix, Angelicae Dahuricae
Radix, Atractylodis Lanceae Rhizoma, Bupleuri
Radix, Citri Unshiu Pericarpium, Saposhnikoviae

Granati Cortex, Murrayae Folium etCacumen, Portulacae Herba, Coptidis Rhizoma) andRadix,

References
1) Drossman DA. The functional gastrointestinal
disorders

and

the

Rome

III

process.

Gastroenterology. 130:1377-1390. 2006
2) Shinji Nishida and others: Evidence for Kampo
treatment of psychosomatic and stress-relateddiseases, (6) Irritable bowel syndrome; Journal ofJapanese Association of Oriental Psychosomatic
Medicine; 23:90-92, 2008
3) Daisuke Sasaki, Satoru Uehara, Masayoshi
Namiki: Clinical effects of keishikashakuyakuto
in the treatment of irritable bowel syndrome – ajoint multicenter randomized allocation groupcomparison clinical trial – The Japanese Journalof Clinical and Experimental Medicine; 75: 11361152, 1998
4) Bensoussan A, Tally NJ, Hing M,et al.: Treatmentof irritable bowel syndrome with Chinese herbal
medicine: a randomized controlled trial. JAMA.
280:1585-1589,1998
5) Wai K. et al: Treatment of Diarrhea-Predominant(2) a placebo group and treated correspondingly. Yet,

Irritable

Bowel

Syndromewith

Traditionalno significant differences between the groups

ChineseHerbalMedicine:A

Randomized

regarding the QOL score regarding the SF36 were

Placebo-Controlled Trial. Am J. Gastroenterology.

observed. Otherwise the pain and diarrhea formula
has frequently been examined in cumulative casestudies.

8

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

Volume 8, Number 2 | Summer 2013

Clinical Report 1 (Acupuncture)
A Case of Quick Relief from Persistent, Blood Stagnation
Related Stiffness of the Interscapular Region

were accompanied by chills. The attacks

Toyoji Sakamoto

years earlier her first child was born throughDepartment of Health Sciences ofthe Moriyama University of Medical Sciences

cesarean section and the second child three

Case: 65 years, female; occupation: housewife andpart-time employee; first visit: Sep. 7, 2013
Chief complaint: #1 stiffness of the interscapularregion, pain (R>L), #2 paroxysmal sweating; #3
tinnitus#1 She has been working with leather products for
30 years, working Mondays to Saturdays from9:00 AM to 5:00 PM, but experiences stiffness in
the interscapular region during work, which
may occasionally progress to pain. Previously
she used to feel fine on her days off, but recently
she is even on holidays often under distress. She
herself thinks, that the poor posture she
assumes when sitting almost the entire day forher work is responsible. Relieving factors
include taking a walk in the park, sleeping,bathing (she sits in the bath tub for only about
5 minutes, but feels fine after the bath) andmassaging. However, the effect does not last
very long and the affected region soon becomes
the source for distress again. Three days ago thestiffness became so severe, it was almost painful.
(NRS10)#2 The sweating phenomenon started around theage of 48. There was no dizziness, but eventhough hands and feet were even in the summer
cold, she suffered from paroxysmal sweating.
has

minutes, lasting for 3 to 5 minutes. Forty-one

years later was also delivered through cesarean
section. She regular menses, but menopause
occurred at the age of 48. (NRS10)#3 Tinnitus started 20 years ago as a cicada
chirping sound heard daily on the right ear. It
gets worse when she is tired. Otolaryngologic
examination revealed low frequency range

Present illness:Sheoccurred with a frequency of once every 40

beentreatedwithhormonepreparations for 10 years, which led to somerelief, but the symptoms recurred during thelast few years, so that she was sweating without
any triggering factors from spring, when theweather starts to get warmer, until the cold of
the winter mainly on the back of her hands, thehearing impairment, but a clear cause could not
be identified, so that the physician explained thesymptom as an aging related phenomenon.
(NRS10) Vertigo, autophonia, no feeling of ear
obstruction.
General condition
Appetite: She does not want to eat, butnevertheless has three meals per day. After
meals she often experiences gastric upset.
Brushing teeth easily causes gum bleeding.
Bowel movements: slightly soft but regular andalmost daily. Micturition: cold causes increased
urinary frequency. She does not really feelthirsty, but ingests small amounts of warm
water because of a bitter taste in the mouth.
Sleep: She goes to be before midnight, but has
difficulties falling asleep. Dreams a lot. Often
has scary dreams in which she is being pursued.
No night sweats. At 4:30 she wakes up and at
5:30 she gets up and wants to have breakfast.
Approximately twice a month she experiences
after a night of poor sleep headaches that feellike compression of the temples. Fatigue isparticularly strong in the morning. However,from the evening into the night she feels
weariness from the waist down into the legs.
This weariness is particularly marked in thecalves. She easily develops eye strains (has been
diagnosed

with

dry

eye).

She

does

not

forearms and her face. Sometimes these attacks
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

9Volume 8, Number 2 | Summer 2013

experience palpitation or shortness of breathof TH3-6 (R>L), where pressure on theduring walking, climbing or descending stairs.

tendernessisassociatedwithpleasure.

Observation shows a mild degree of a stoop anda mild degree of winging of the right scapula.

Past history
her

Deep reflexes: active in all four extremities.

twentieth) that is currently well controlled.

Hoffmann reflex, Trömner's reflex were both

Periodontal

Familiar

hypercholesterolemia(since(sinceher

twentieth),absent. No thickening of the Achilles tendon.

climacteric disorders (17

years

ago),

NeitherdiseaselowIobserveany

palpebralfrequency range hearing impairment (before thexanthomatas. Weber test lateralized towards

age of 20), reflux esophagitis (5-6 years ago).

the healthy side. Rinne test was negative, on theright affected side the time was slightly

Family history

shortened as compared to the left healthy side.

Lives with her husband in a 2-person household,where the husband is treated over the past 7-8<Oriental medical findings>

years because of liver cirrhosis induced poor

1)

Facial color: black, yellow. Tongue: dark red, redtip, thin white fur, little fluid, slightly dry.

physical condition.

Venous

Personal history
30 years as a non-regular employee. Two births,

engorgementisobserved

ontheunderside of the tongue.

Housewife who married 43 years ago. Works for2)

Pulse diagnosis: deep, empty, slightly choppy,
right guan pulse is wiry and full. Spleen

two daughters (married).

deficiency pulse, liver repletion.

Medication: Rosuvastatin Calcium 2.5 mg tablets(familiar hypercholesterolemia).

Alendronate

3)

Abdominal diagnosis: operational scar from

Sodium Hydrate, 3.5 mg tablets, for the

below the naval down to the pubic bone. The

prevention of osteoporosis. Myslee, 5 mg tablets,

lower abdomen is cool. Left lateral abdomen isfor sleep disturbances. Omeprazole, 10 mgvery tense. There is mild resistance extending

tablets, for reflux esophagitis.

from the epigastric region to CV12.

<Findings during first examination>

4)

Source point diagnosis: chilling of the feet is

Height: 150 cm; weight: 45 kg. Blood pressure

objectively not very, but subjectively apparently

154/86 mmHg, after deep breathing load 140/80

marked. Left and right SP3 soft and weak.

mmHg. Tends to rise when tense. Pulse: 60 bpm,

Depression at the left and right KI3 associatedregular. Neck ROM is almost normal, but shewith coolness. Left LR3 is deficient. Right LR3feels a certain tension in the region of the rightis replete. At the left GB41 there is tenderness

mastoid process upon rotation to the left. Heartand a replete reaction. The left and right TE4

sounds: second heart sound left parasternaland SI4 there is sweating and chilling.

slightly enhanced but no audible murmurs.

right LU9 there is also sweating.

Percussion of lung-liver border is normal. The

10

did

5)

At theOn the spine, along the governing vessel

region from the epigastric region to the left

tenderness was observed at GV20, GV11, GV10,

hypochondriac region is tympanic.

GV9, GV7. In the shoulder and neck region

The range of motion of the shoulder joint isthere was mainly around the trapezius muscle

normal, but with 170° of abduction on the left

superficial tension (R>L). At the right TE17,

and 165° on the right slightly different. Palpable

BL10, GB20, GB21 and SI14 slight reactions

difference in rhomboideus muscle tension R>L.

with a tendency towards excess (R>L) could be

Palpable deep indurations 1 to 2 fingers lateralpalpated. In the interscapular region on the

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

Volume 8, Number 2 | Summer 2013

right side from BL13 to BL16 the superficial

blood stagnation as a basis for her condition,

layer was soft and weak, while in the deep layer

where the continuous burden from her work anda continuous band of induration could be

the stress load probably led to the development

palpated. Pressure there elicited uncomfortableof the blood stagnation type stiffness (almost

pain. On the left side a similar finding was

painfulobserved only at BL15. On the lower back aninterscapularexcess reaction was observed at right BL17,

combination of a lack of appetite induced by theright BL18, left BL18, left BL19 and both BL20.

ingestion of several medications, decreased foodA deficient reaction was observed on both atintake and a lack of exercise and various similar

BL23.

factors probably enhanced the symptoms.

continuous

stiffness)region.

intheAdditionally,the#2 Regarding the paroxysmal sweating: Similar[Assessment of the condition at the first visit]#1 The stiffness and pain (R>L) the patient

symptoms did develop since her menopause, thecomplains about in her interscapular region

properties of the sweat, the sweating condition

could

etc. suggesting a climacteric disturbance of thebereferred

pain

from

lesionsofcardiovascular, respiratory organs or also upper

autonomic nervous system.

digestive organs, but based on the general#3 Tinnitus: The accurate cause is unknown. Since

condition of the patient and the physicalan otorhinologist pointed out a low frequency

findings a strong correlation seemed rather

range hearing impairment, I assumed theunlikely. The most likely cause is probably thecondition to be a tinnitus associated with a low

working posturefrequency hearing impairment.

thepatient herself also

recognizes as such, so that the continued
maintenance of this working posture was

Based on the above described modern medical

assumed to be the main reason for an imbalance

assessment of the condition the possibility of anof the muscles in the shoulder girdle1,2,3).

unfavorable prognosis was considered low andFindings obtained during the first examinationaccording to past experiences6) I assumed it to be an

include a mild degree of winging of the rightindication

scapula, that was considered to support thetreatment. Moreover, oriental medical findings

above mentioned assumption4). Moreover, theindicated an inherited weakness of the spleen andillness of her husband, financial problems etc.

stomach,represent other mental and social stresspredisposing her for suffering from decreased

factors5) and observation of her entries in the

movement and transformation function. This kind of

medical record showed very meticulous entries

spleenrelating to name, address, prescriptions etc.,

responsible for the necessity for delivery throughthus suggesting her having a fastidious,

cesarean sections and the two operations then led tomentally very tense, with "liver dominated"the formation of stagnant blood. Also, prolonged

character. These personality traits also add towork requiring intense concentration can lead tothe stress, conceivably facilitating a tendency

injury of the kidney qi, so that at a time when the

towards an easy development of stiffness.

kidney qi is naturally declining, a kidney deficiency

Constitutionally there is a genetic disposition

associatedwithregarding the familiar hypercholesterolemia

personality

traitsand the necessity for birth through cesareandevelopment of liver disease, with the sevensections etc., contributing to the development ofemotions causing internal damage, deteriorating theforacupuncture

givingthedeficiency

andpatient

constitution

tinnitus

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

isamoxibustionawasdeveloped.
factordisposition

probablyAnd

herfavoringthe11Volume 8, Number 2 | Summer 2013

free flow of liver qi and thereby building theinterscapular regions and found that the deep

foundationinduration above and below the right BL15 could

of

blood

stagnation,

which

then

aggravated the shoulder stiffness. Regarding thenow be palpated in a superficial position.

sweating there was no paroxysmal sweating during
daytime activities, no feeling of warmth or strong

2) Treatment in prone position

upsurging, and since it was associated with chills, it

Retaining 30-mm long, 0.14 mm thick needles at

represents a yang deficiency sweating caused by theright BL15, right BL18, left BL20, both BL23 for 7

spleen deficiency. Combining the above describedminutes. Box moxibustion at BL23 (the box

symptoms with the findings of abdominal and pulse

moxibustion of the lumbar region was continued

diagnosis I identified a spleen deficiency liver

after that). For the tension in the superficial layers

repletionof neck and on the top of the shoulders I inserted 30-

pattern7)

andstartedtherapeutic

mm long, 0.14 mm thick needles and performedintervention.

scattered short pricking. At the end I attached a[Treatment and course]

Seirin made PYONEX 2-mm press needle at TE17 to1) Treatment in supine position:finish the first treatment.

According to the root treatment principle the left

Second session (9/12) The patient returned 5 daysside was chosen as the indication side and 40-mm #1

later. She could now sleep better than at the time ofsilver needles used at left SP3, left LR3 to performthe first visit. (NRS8) However, on the day following

contact non-penetrating needling for tonification.

the treatment she felt somewhat tired. #1 Regarding

The right guan pulse became balanced, but although

the stiffness and pain in the interscapular region

the wiry, full left guan pulse loosened, it was still(R>L), she had no pain for 3 days, although thisstrong, so that I used a 40-mm #3 stainless steel

returned later to a level of NRS2. The other day theneedle at GB37 to perform reducing non-penetratinglevel rose to NSR4, but there was no pain, only aneedling. This decreased the fullness of the left guanfeeling of heaviness. (NSR4) Palpation of thepulse still further. However, the tension at the leftinterscapular region showed that the induration at

GB26 still remained. Therefore, based on belt vessel

the left BL15 had disappeared and while indurations

pattern according to the 'Miyawaki Extraordinary

could be palpated at the right BL14 and BL15, but

Vessel Abdominal Diagnosis'8) I attached the southpressure did not elicit discomfort any longer. The

pole of the tester magnet to GB41 and its north polewinging of the right scapula was less obvious than

to the right TE5. The tension around GB26 in the left

the last time. #2 No changes in paroxysmal sweating

lateral abdominal region abated and the abdominal(NSR10); #3 the sound intensity of the tinnitus had

pattern changed, to that I applied three half-riceslightly decreased. (NSR8)

grain sized cones of moxa and let them burn 90%

Changes in other symptoms: The subjective feelingdown at the left GB41, similarly 2 cones to the rightof coldness of the toes had not changed, but theTE5 and repeated this moxa treatment three times.

objective finding of coldness remitted. (NSR10) The

During the extraordinary vessel moxibustion I

subjective feeling of tiredness of the gastrocnemial

retained a 0.14 mm 15 mm long needle at EX-3.

muscle region had been slightly alleviated. Meals are

Through the extraordinary vessel moxibustion thestill not perceived as tasty and the patient has noleft lateral abdominal tension decreased further andappetite, but the bitter taste in her mouth has

softened to the degree, that it equaled the right

improved. (NSR10)

abdominal region. At this point I observed changes

Since abdominal diagnosis did not show tension inof the stiffness in the neck, upper shoulder andthe left lateral abdominal region, I did not add the12

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

Volume 8, Number 2 | Summer 2013previous extraordinary vessel treatment. Pulse

The subjective chilling of the toes decreased. (NSR9)

diagnosis did not show the left guan wiry pulse any

Sleep tended to improve. (NSR8)

longer and because the left deep chi pulse wasTreatment: The mild resistance extending from thedifficult to palpate, I restricted myself to kidney

epigastric region to CV12 found during themeridian tonifying root treatment.

abdominal diagnosis made at the first visit had

Treatment in supine position: I chose the left side as

decreased, but nevertheless still persisted. Because

the indication side and used 40-mm 0.16 mm silver

the three bilateral radial pulses showed bothneedles at the left KI7 to perform tonification

weakened spleen and kidneys, I identified thethrough non-penetrating needling. Next I applied 5

pattern as spleen/kidney five phase restraining andhalf-rice grain sized moxa cones each at both KI3

performed the relevant systemic and generaland ST36 that were burnt down 90% and added

treatment. After the systemic and general treatment

application of moxa roll on the abdominal CV4.

I also repeated the extraordinary vessel treatment.

Treatment in prone position: On the back I added

Systemic and general treatment (use of silver

skin piercing needle retention at the right BL14 toneedles for non-penetrating needling): For thethe last treatment. Otherwise the treatment was thetreatment of the root I tonified the left GB34 and left

same. After the treatment the legs grew warmer andKI10. The force of both the right guan pulse and thetheregionleft chi pulse had increased and was more easily

disappeared, so that I recommended the patient

palpable, but in the superficial position of both guan

applies moxibustion herself at home at both KI3 andpulse I could still feel evil properties. I added someST36. Also similar to the last treatment I attached agentle reducing at ST40 and GB37. Extraordinary

Seirin made PYONEX 2-mm press needle at TE17. I

vessel treatment: I checked with a tester based on

also instructed her how to do stretch exercises tothe Miyawaki style extraordinary vessel abdominal

improve the balance of the muscles of the shoulder

diagnosis8) and thus identified a yin linking vessel

girdle and muscle strengthening exercises mainly forpattern. As moxibustion treatment I applied a set ofthe rhomboideus muscle to be done both at work andeach 3 half-rice grain sized cones of moxa at the left

at home.

PC6 and 2 cones at the right SP4, burnt down to 90%,

Third session (9/21) Good physical condition sincerepeating the set three times.

last treatment.

The#1 Regarding the stiffness and pain in theapproximately the same.

interscapular region (R>L): she experienced pain in

Fourth session (10, 5)

the interscapular region 1 or 2 times. But the#1 Regarding the stiffness and pain in the

stiffness had improved to a NRS level of about 3-2.

interscapular region (R>L): there was no pain and#2 Whether the treatment for paroxysmal sweating

the stiffness improved to a level of NSR 3-2. Last

had been effective or the slightly cooler weather was

week there was very little stress, so that she

responsible is unclear, but the symptom had

experienced no stiffness at all. However, from thedecreased. (NSR7) #3 The tinnitus sometimes

other day she again experienced some heaviness.

disappeared on turning the face to the left. (NSR6)(NSR2) Examination showed, that indurations could

Changes in other symptoms: There was a tendency

not be felt, but at the right BL14, BL15 a thin strand

towards improvement of the stomach upset. There isof increased muscle tone could be palpated. Winging

still no appetite, but the bitter taste in the mouthof the right scapula (-). #2 Paroxysmal sweating did

had disappeared at some time unnoticed. (NSR9)

not occur any longer. The symptom disappeared 1

heavinessoftheinterscapulartreatment

in

the

prone

positionwasmonth earlier than in previous years. (NSR0) #3 She

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

13

Volume 8, Number 2 | Summer 2013

was very happy, because she experienced now days,

occasionallystrong,during which the tinnitus did not bother her at all.

alleviated. (NSR3)(NSR4)

Treatment:

Treating

but

generally

the

has

been

fundamental

andStopped using

extraordinary vessel treatment were the same, but I

hypnagogues. It took her about 20 minutes to fall

shallowly inserted a 30-mm 0.16 mm needle at GV20

asleep. Wakes up twice during the night. (NSR4) She

and retained it for 3 minutes.

experiences times when she does not have tinnitus.

* Because of the favorable course I widened the(NSR4) The other day she felt tired from the calvestreatment intervals to once a month.

down into the soles of the feet. Maybe the

Sixth session (11/9) Good physical condition.

moxibustion performed at home had started to take

#1 Stiffness and pain in the interscapular region

effect, but the feeling of an upset stomach remitted(R>L): There is occasionally some stiffness, but it isand she gradually developed an appetite. (NSR4)

not very distressing. (NSR1)

The bitterness in the mouth had disappeared.

#2 Sweating has stopped completely. #3 There is

Chilling of the feet had been relieved. (NSR5)

some tinnitus, but it does not bother the patient.

Abdominal diagnosis: The resistance in the vicinity

Changes in other symptoms: The occasions whereof CV12 had disappeared, but the resistance in theshe falls asleep quickly and does not wake up during

epigastric region still remained. The pulse still

the night have become more frequent. (NSR2)

showed weakness of both the spleen and kidney. The

Although she experiences some chilling of the feet, it

color of the tongue had grown lighter as compared tohas become less marked. (NSR3) Eye strain has

the first visit, but the edges are still dark red and thedecreased to a degree, where she experiences onlyveins on its underside remain engorged. Dryness had

occasionally some mild eye fatigue. The number ofsignificantly improved.

days on which she has appetite and enjoys her food

Changes in other symptoms:andhas increased. Yet, when she thinks, she might haveextraordinary vessel treatment were the same as

eaten a little too much, she later experiences

during the previous session, but I added 5 cones ofstomach upset. (NSR4)

moxa burned 90% at SP6. * Will undergo a

Abdominal diagnosis: The tension of the epigastricgastroscopic examination on October 16.

region decreased but still remains. Pulse diagnosis

Fifth session (10/19) The gastroscopic examination

showed a balanced spleen on the right guan pulse,

revealed a mild inflammation. The test for HP

but the left chi pulse was floating and the kidney stillbacteria was negative.

weak. However, the dryness has resolved and#1 Regarding the stiffness and pain in theinstead some moistness is beginning to show. Theinterscapular region (R>L): She did not feel any pain

tongue has a thin white coating. The dark red edges

or stiffness in the interscapular region. (NRS0) #2

of the tongue have grown lighter in color and theParoxysmal sweating did not occur any more. #3

venous engorgement on the underside of the tongue

Tinnitus was the same as as during the previous

has decreased.

session. (NRS4)

Treatment:

Changes in other symptoms: She fell quicker asleep.

extraordinary vessel treatment were the same. As

Waking up twice. (NRS2) The other day shetreatment of the incidental I performed the same

experienced heaviness from the calves to the soles oftreatment on the back as before.

her feet. The feeling of stomach upset decreased and

The course after one month is still good. Therefore I

she started to enjoy her food. (NSR2) The bitterness

recommended the patient continues the moxibustion

Treatment:

Treatingthefundamental

Treating

in the mouth had disappeared. Chilling of the feet is

14

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

thefundamentalandVolume 8, Number 2 | Summer 2013

treatment at home and comes once a month for

fatigue may then further increase the sympathetic

health management and she agreed to this proposal.

nerve excitation, again leading to the contraction ofarterioles and increased excitation of muscles, which[Discussion]then results in stagnation within the venous system.

Regarding the stiffness of the interscapular region

If still more algogenic substances are produced, thisinspection during the first visit showed a mild degree

will enhance the sympathetic nerve excitation andof a stooping and a mild degree of winging of thethus establish a viscous cycle."right scapula, thus suggesting that the prolonged

Moreover, it has been said, that "when the activity ofmaintenance of the working posture was the main

the α-motor neurons is increased via excitation of γ-

cause leading to a disruption of the muscle balance

motor neurons outside the sympathetic nervous

in the shoulder girdle 1,2,3,4). For that reason I

system muscle tone also increases, resulting in the

instructed the patient to do stretch exercises todevelopment of the same kind of viscous circle

regain the balance of the shoulder girdle muscle

triggered by circulatory insufficiency, consequently

group in addition to the acupuncture treatment andleading to shoulder stiffness."11) In this case too themuscle strengthening exercises mainly for theacupuncture treatment relieved the sympathetic

rhomboid muscle to be done at home9).

nervous bias and thus conceivably interrupted thisThe earnest adherence to this exercise program byviscousthe patient led to improvements of the imbalance of

sympathetic

the

the

parasympathetic nerves to normal functioning anddisappearance of winging of the right scapula. The

thus probably improves gastrointestinal function.

above described general results contributed to the

The regulation of the autonomic nervous systemalleviation of the almost painful distress caused byprobably also led to an early alleviation of thethe stiffness. Moreover, before a background of theabnormal sweating, but the possibility that thepatient's earnest and fastidious character traits, thecoming of the cold season resulted in a spontaneous

illness of her husband, financial problems etc.

remission cannot be ruled out. Although the tinnitus

represented other mental and social stress factors

didand the mental tension exacerbated sympathetic

acupuncture and moxibustion invention, it improved

activity, resulting in a sympathetic bias (increased

so much, that it did not bother the patient any longer.

myotactic reflexes and extrafusal muscle tone due toThis is presumably due the influence of the

an increased activity of the sympathetic nerves),

therapeutic

causing the muscle tone to increase and thereby

intervention via some sort of mechanism affecting

probably aggravating the shoulder stiffness10).

the inner ear or the pathways of the auditory area.

Ogawa et al.11) too stated, that "regardless ofFrom an oriental medical point of view the patientwhether the mechanism for the shoulder stiffness is

had basically a constitution marked by a weak

idiopathic or symptomatic, an increased activity of

spleen and stomach. In this context the delivery of

the sympathetic nerves always play an important

two children through cesarean section led to bloodrole". In other words, "since the sympathetic nerves

stagnation and the daily stress caused seven

do not only control blood vessels, but also both extra-

emotions induced internal damage, resulting in liverand intrafusal fibers, their excitation results in

qi depression and stagnation

contraction of blood vessels and increase muscle tone.

aggravating the blood stagnation and thus leading to

The accumulation of algogenic substances etc.

the development of the condition "interscapular pain

induced by increased mental tension or muscle

and stiffness". In other words, I assumed theshouldergirdlemuscle

group

and

not

cycle12).

Also,

nerve

disappear

reduction
excitation

completely

acupuncture

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

and

of

excessive

restoresfollowing

the

the

moxibustion

and thereby

15Volume 8, Number 2 | Summer 2013

condition to be a spleen deficiency liver repletion

Conclusions

pattern where Qi stagnation was added to blood

Because this patient, who presented at the first visit

stagnation. Moreover, relieving factors for thewith a chief complaint of almost painful, persistentshoulder stiffness suggested that the healthy qi wasstiffness of the interscapular region (R>L) associatednot severely weakened, providing sufficient potential

withfor recovery from the condition. Actually, throughparoxysmal sweating and tinnitus, I expected a

the acupuncture and moxibustion intervention andprolonged therapy would be necessary and madeqi regulation the spleen deficiency liver repletion

appropriate plans. However, not only the chief

was corrected, qi stagnation improved and ancomplaint improved more quickly than I expected

improving tendency in the blood stagnation observed.

after only a few treatments, the accessory symptoms

This resulted in the relief of the "interscapular

did so too. Moreover, the gastrointestinal symptoms

shoulder stiffness". Again, spleen and stomach

were also alleviated. This is because I did notfunction inhibited by the liver qi recovered, thereby

concentrate on just one symptom, but rather based

improving appetite and presumably contributed to

my treatment plan on a holistic view and the results

the reduction of drug side effects. Adjustment of theshowed, that this treatment seems to have been

restraining five phases between spleen and kidneylargely correct.

long-standing

accessory

symptomsofled to a recovery of the kidney qi, which is probably
why an improving tendency was observed for thetinnitus.

Course of this case
Chief complaint

16

1st time

2nd time

3rd time

4th time

5th time

6th time

Stiffness of the interscapular retion

10

4

2

2

0

1

Pain of the interscapular region

10

0

2

0

0

0

Sweating

10

10

7

0

0

0

Tinnitus

10

9

6

4

4

1

Stomach upset

10

10

9

4

4

4

Lack of appetite

10

10

10

5

2

2

Sleep disorder

10

8

8

4

2

2

Chilling of feet

10

10

9

5

3

3

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

Volume 8, Number 2 | Summer 2013

<Complaints in this case and overview of the course>
Graph title
15
10
5
0
1st time

2nd time

3rd time

Pain of the interscapular region

Sweating

Tinnitus

Stomach upset

Lack of appetite

Sleep disorder

Chilling of feet

4)5)

Hiromichi

Fukushima:

Adjustment

of

the

restraining five phases, essentials of meridian

originating from the cervical vertebrae; All Japan

therapy; Secretariat of the Toyo Hari Medical

Hospital Publication Society; 2008:19-15.

Association; 1984:274-269

ofshoulderJunichiro Hamada: Cultural background of

8)

KazutoMiyawaki:Easilyunderstandable

shoulder stiffness as well as examination andextraordinary vessel treatment; extraordinary

treatment of primary shoulder stiffness; Practicalvessel abdominal diagnosis; Taniguchi Shoten;

examination of shoulder stiffness and pain; All2005:81-63
9)

Norio Hayashi: The mechanisms of shoulder

Tetsuya Shinozaki, Kenji Takagishi: Pathology

stiffness seen from the point of view ofand symptoms of shoulder stiffness, MBOrtho

physiotherapists;

p19(4) 2006:1-5

shoulder stiffness and pain; All Japan Hospital

Shogo Takama, Kunihiro Kato: Kinesiologic

Publication Society; 2008:41-34.

Practical

examinationofapproach to shoulder stiffness and pain;

10) Sakae Yoneyama: Modern medical explanation

Practical examination of shoulder stiffness andof shoulder stiffness – interpretation based on thepain; All Japan Hospital Publication Society;myofascial (tendinous) system; The Japanese

2008:96-85

JournalShinichi

Kinoshita:

Examinationofpsychological and social stress induced shoulder

6)

7)

stiffness/pain

treatment

Japan Hospital Publication Society; 2008: 47-42.
3)

6th time

THE PAIN CLlNIC; 2013.55-46.

Yoshiharu Kawaguchi, Yumiko Abe: Diagnosis
and2)

5th time

Stiffness of the interscapular retion

References
1)

4th timeofJapanese

Acupuncture

andMoxibustion Therapies; Ido no Nippon; 2006:2229.

stiffness; Clinical acupuncture and moxibustion,11) Atsushi Yoshida, Kiyohisa Ogawa: Examination

Vol. 21, No.2; The Japan Conference of Clinicalof shoulder stiffness; JOURNAL OF CLINICAL

Acupuncture and Moxibustion; 2007.111-91.
Toyotsugu Sakamoto: Examination of shoulder

REHABILITATION. 1996:5:1126-1129.
12) Kazuro Sasaki: Research into shoulder stiffness

stiffness / pain and acupuncture and moxibustion

and acupuncture and moxibustion treatment;

treatment; Oriental Medicine and Pain Clinic,

Ishiyaku Pub, Inc.; 2001:109-132

Vol. 4, No.3/4; ORIENTAL MEDICINE AND
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

17

Volume 8, Number 2 | Summer 2013

Clinical Report 2 (Kampo Medicine)
A Case of Irritable Bowel Syndrome

Progress: I prescribed 6 packages of shokenchuto, 3
times a day.

Shinji Nishida
Department of Psychosomatic Medicine
Japan Red Cross Wakayama Medical CenterFebruary; the abdominal pain has improved. He
went to school without a break during the exam.
March; He had felt abdomen better and stool was

Case : Constipational type IBS

normal. He did not fail at that grade.

Patient: 19-year-old male

April; good condition.

Chief complaint: abdominal pain

November: He did not visit for a while because he
had

was in good condition. However, when the medicine

abdominal pain in the winter since he was in thirdran out, his symptoms of the abdomen became thegrade of middle school. His abdominal pain has been

worst. He felt embarrassing to take medicine atpresent even from October X-1 and he wasschool. He did not eat breakfast because ofhangeshashinto by gastroenterology

abdominal pain, and after a lunch he ate not muchinternal medicine clinic, but because of no effect hebecause he would get tired. I prescribed him 6

visited to my clinic in February X .

packages of shokenchuto to take after morning andPast medical history: He took pranlukast hydrate fordinner.

bronchial asthma and inhaled Fluticasone.

December; Not very good. It was hard to drink

Family history：His mother is getting treatment tobecause of the large amount of Kampo medicines forpsychiatry because of bipolar disorder.

him . There was also a lot of mental stress from the

Present status: Blood Pressure:110/59mmHg, pulse

mother. I changed the prescription from shokenchuto

96/minto keishikashakuyakudaioto every 3 times after

Symptoms: He go to the toilet for abdominal pain

meals.

and sensation of defecation, with or without bowel

January X+1; somewhat constipated, but in good

movements. The stool is diarrhea or ordinary. The

condition. I instructed for 2 packages in the morning

abdominal pain is relieved by defecation, but there

and 1 package in the evening for shokenchuto, and 1

is a feeling of remaining stool after defecation and it

package in the evening for keishikashakuyakudaioto.

is not comfortable. He had previously taken

March; all right. There is also a good bowel

trimebutine

movement and he could attend school.

Historyofprescribedpresent

illness:

maleate,The

patient

polycarbophil,andbutylscopolamine, but none had any effect.

May; new semester no problem. shokenchuto 2

Observations from the perspective of Eastern

packets

medicine:keishikashakuyakudaioto

Tonguepattern-

white

coating,thorn-likemorning

and1

packetevening,
when

constipated.

protrusions

August; He had taken medicine not so often, and wasPulse pattern - sunken pulse

in good condition, so that finished taking medication.

Abdominal pattern - a little bit strong power, stuckfeeling in pit of stomach, Kyokyo-kuman, execessive
strain of abdominal muscles, and tickle feeling bytouching
18

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

Volume 8, Number 2 | Summer 2013

Clinical Report 3 (Kampo Medicine)
A Case in which a Recurrent Tonsillitis in a Six-year-old
Girl Suspected of PFAPA Was Resolved by Ogikenchuto
and Shosaikotofunction was related to the immunoregulatory
function, so ogikenchuto was also used.
This type of condition has been thought to symbolize
an infectious disease, but in recent years, it isHideaki Yamaguchi

frequently classified as an abnormality of the innate

Tosei General Hospital

immune system caused by PFAPA. This implies that
inflammation resembling an infection occurs andabates naturally.

Case: Six-year-old girl with recurrent tonsillitisThe

patientbegan

todeveloptonsillitis

repeatedly from the age of three. It occurred at a

Reference 1: PFAPA (Syndrome of periodic fever,frequency of almost once a month, accompanied

aphthous stomatitis, pharyngitis, and adenitis)by a fever that would last three to six days. It

A medical condition which starts in young

required her to be hospitalized three times. The

children below the age of five, in which a fever

patient had no other problems except for theoccurs regularly and is accompanied by stomatitis,

tonsillitis, but she developed a fever easily andadenoiditis or cervical lymphadenitis. It is not an

was frequently absent from school. Recurrent

infectious

tonsillitis was suspected, and a tonsillectomy was

however. No symptoms are evident during theconsidered, but the patient’s family requested

interval stage, and growth and development are

Kampo therapy.

unaffected. It is a disease with a good prognosis,

diseaseorautoimmune

disease,and resolves in about four to five years in mostInterview and observations
The patient had a small appetite from earlycases. It is classified as an autoinflammatory

childhood, and complained of poor physicaldisease in the broad sense.

strength and a tendency to become tired easily.

The fever is treated with a steroid, and prevention

Cervical lymph nodes of small-finger thickness

is achieved by tonsillectomy.

were felt, with the result that her tonsil displayed
second-degree hypertrophy. The tongue, pulse,

Reference 2: Autoinflammatory disease

and abdomen were normal.

Definition:A

diseaseinwhichsystemic

inflammation (fever, arthritis, rash, etc.) occurs

Therapy and course
Heat accumulation in the liver meridian and qi

repeatedly. It is not caused by an infection or

deficiency in the spleen were suspected, so the

autoimmune disease, but is considered an

combineduseofshosaikoto

extract

andabnormality of the innate immune process.

ogikenchuto extract were begun.

Classification - Genetic: Familial Mediterranean

Episodes of fever thereafter occurred for one tofever, TRAPS, hyper-IgD syndrome, etc.

two days in three months, and disappeared afterNon-genetic: PFAPA, systemic JRA, Crohn's

six months. The prescription was terminated after

disease,a year and six months. In terms of Western
medicine, this case corresponded to the definition
PFAPA.
Observation
In Japan, shosaikoto has conventionally beenused for children with recurrent tonsillitis. In thiscase, it was thought that the decrease in digestive

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

19

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Make the most of Kampo in modern medicine

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

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The crude drugs like many other creatures on earth areraised by bountiful NATURE.
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PROFILE of

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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