Volume 1, Number 2 | Summer 2006

Clinical Report 4 (Japan)

syndrome. Nothing remarkable in the family history.

Treatment of Both Mother and Child withYokukansan
Shinji Nishida, et al.
Department of Kampo Medicine
Osaka University Graduate School of Medicine

Yokukansan is a preparation intended to calm anofliver

Qiandtheclassics

contain

instructions to treat “both mother and child” (use thepreparation for both the mother and the child). In thisstudy we observed a case of improvement induced bytreating the mother with yokukansan. Later, the childstarted to crave the mother's Kampo medicine, so that
we had no choice but to accept the mother's request forconsultation. Observation of the child revealed night
crying, fretfulness and other symptoms suggestingthat yokukansan would be effective. For this reason,
both the mother and that child were treatedsimultaneously with yokukansan upon which weobserved improvements in both of them. This is anextremely interesting case, since the child apparently
had expressed its interest in the treatment with
Kampo medicine by herself. We report this experience
here as an example of treating both mother and child.

complaint:

depressivemood,irritation,insomnia, shoulder stiffness etc.
Present illness: At the age of 23 the stress at workand love affair related problems led to a loss ofappetite and the development of depressive moods.
The patient consulted a psychiatric outpatient clinic,
receiving a prescription of psychotropic agents basedon the diagnosis of depression, but discontinued thetreatment after about one year due to developing sideeffects. She married at the age of 26, became pregnant
the following year and delivered her first child by
caesarean section. Since then, the depressive moods
and irritation grew worse. The patient consulted ourclinic because she was looking for a treatment otherthan the psychotropic agents.
Anamnesis: At the age of 19 years Guillan-Barré26

and percussion: no anomalies.
Results of laboratory studies: peripheral bloodcount,biochemicalandgeneralurologicalKampo medical findings: The tongue body was offaint red color and had a thin white fur. Sublingualveins were engorged. The pulse was thin and wiry. The
abdominal pattern showed an intermediate abdominal
tension, increased resistance and tenderness in theepigastric region, left-sided fullness, tenderness ordiscomfort of the hypochondrium, tense abdominal
skin,supraumbilicalpulsation,paraumbilicaltenderness and pressure pain in the ileocecal area.
Oriental medical findings: Cold hands and feet,general malaise, vertigo, dizziness, stiff shoulders,
palpitations, anxiety, anorexia, edema of hands andfeet, irritation, depression, bitter taste in the mouth,
insomnia (difficulties falling asleep and profusedreaming),

constipation,

menstruation(irregular,associated with strong pain), copious mentrual flow,abundant fluor genitalis).
Observation of the course
Initial visit: Deficiency of both Qi and blood,

1. Mother: 28 years
Chief

47kg, blood pressure 110/70 mmHg, chest auscultation

examinations were all normal.

Introduction
upsurge

Western medical findings: Height 160cm, weightassociated with stagnation and sluggishness of liver Qi
and blood stagnation were considered and therefore
7.5g of yokukansankachimpihange extract (dividedinto 3 portions) administered.
Two weeks later: There was some improvement in
the irritation, but constipation and abdominal bloating
worsened, so that a Lactobacillus preparation andmagnesium oxide were added to the prescription.
Four weeks later: There was some improvement in
the irritation, but now constipation and diarrhea
occurredalternatingly.

Forthisreason,

theLactobacillus preparation and magnesium oxide werediscontinued and the prescription switched to 6.0g ofyokukansan, 4.5g of Cassia Twig Decoction plus Peony+ 3.0g of daiokanzoto (mixture, administered divided
into three portions).
Six weeks later: Improvement in mental status andThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Number 2 | Summer 2006

bowel movements. At this time we were consulted about"Bao-Ying Cuo-Yao" (Essentials for the Care of

the female child. According to that consultation, theInfants; 1555). This text states: "yokukansan heals

child grows angry and develops a hot-red face when it

deficiency-heat of liver meridian, the occurrence ofdoes not like certain things, so that the parents are notconvulsions, or development of fever with grinding theable to control it. The question was whether thisteeth,

situation could somehow be improved with Kampo

irritability manifests in the form of chills and fever, ormedicine. Since the child was eager to take the mother's

else a condition where wood overcontrols earth and theKampo medicine, it was given a mouthful to try and didpatient discharges phlegm and saliva, the abdomen is

not show any aversion at all. Rather on the contrary,distended, the patient eats little and has difficulties

the child seemed to crave the drug.

with sleep. Use 5 fen (about 1.9g) of soft Bupleurum

orpalpitations

withanxiety;clinically

Eight weeks later: Improvement of the symptoms

root (Saiko), 8 fen (about 3.0g) of Cnidium rhizome

continued. The child accompanied the mother during(Senkyu), 1 qian (about 3.8g) of Chinese Angelica root

her visits.

(Toki), Largehead Atractyrodes rhizome (Byakujutsu),
Tuckahoe (Bukuryo), Gambirplant Hooked Stems and

2. Child: 1 year 8 months, female
Symptoms: Once she started to cry, she began tothrow things around, hit things and could not becontrolled. She fell easily asleep, but on days in which
she encountered certain things or situations she didBranch (Chotoko) each and 5 fen (about 1.9g) ofLicorice root (Kanzo) prepared in water. This decoction
was given simultaneously to both mother and child."

Yokukansan contains the following ingredients andnot like, she started crying at night like she wastheirscreaming. She had an active character and did not*ingredients (action)

show any fear of strangers. She tended to beconstipated and in particular would not have any
bowel movements when away from home. She had anDevelopment: Since she was in a breech position,
wasdelivered

actions

aredetailed

below.

* Uncariae Uncis cum Ramulus(Calmes the Liver and Extinguishes the ”Wind”)*Bupleuri Radix(Spreads Liver qi and relieves constraint)

aversion to heat.
she

respective

throughceasarean

section*Cnidii rhizoma(Invigorates the blood)(2800g). Fed on artificial milk. Examinations did not* Angelicae Acutilobae Radix

reveal any anomalities. Her height was 80cm and(Nourishes the Liver)

her weight 11kg.

(Tonifies the blood)First visit and course: Prescription of 2.0g of*Poria(Calm the spirit)

yokukansan.
Two weeks later: The crying at night stopped from(Promotes urination)

the day she started taking the medicine. She did not* Atractyrodis Rhizoma

get sleepy during the day. The drug was mixed with(Promotes urination)

milk or administered during meals dissoloved in warm
water which she drank with pleasure instead of tea.
Later, the course was favorable and she visited ourclinic regularly. After the child entered Kindergarten
at the age of 4 year, gradually tapering the drug did
not lead to any problems, so the therapy of bothmother and child was discontinued.

Discussion
The original text describing yokukansan was the* Glycyrrhizae Radix(Harmonizes the other herbs)
A modified form with added Citri Unshiu
Pericarpium and Pinellia tuber is used for worse
conditions where the loss of gastric and splenic
functions leads to the formation of phlegm. Tokaku
Wada (1744-1803) frequently used yokukansan, notonly for children, but applied it also to adults. For
example, in the "Shoso-Hoi-Kai (Medical Formulary

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

27

Volume 1, Number 2 | Summer 2006

written beside the window shows through BashoTree)" he exerts: "Cures severe symptoms of excessive
anger, insomnia, rash and impatient nature. Thesesymptoms are signs of an upsurging liver Qi. (Thatmeans, severe forms of getting easily angry and being
irritated because of poor sleep etc. represent the mainsymptoms. These symptoms are caused by an upsurgeof liver Qi.) Moreover, Sohaku Asada (1814-1894)
wrote in his "Hutsugo-Yakushitu-Hokan-Kuketsu(Knack of the Formularies of “Don’t mistake thePharmacy” Chamber), "Inquire about anger. When
there is anger, this preparation never fails to beeffective. (Ask questions as to whether the patient iseasily angered. If he/she is, it is unlikely that thisformula will work)." Generally speaking, this formula
is effective for mental and physical symptoms
associated with anger and irritation, night crying,
fretfulness not only in infants, but it is also widely
effective in adults with neuroses, depression,
headache, chronic pain, hemiplegia, demented
aggressive elderly and the elderly adult population ingeneral.
In the "Bao-Ying Cuo-Yao (Essential for the Care ofInfants)" (1555) it says: “In the care of the infant,treat the nurse as long as diseases have not yet
developed, but once the child has already fallen ill,
carefully examine and treat the child. Furthermore, itwould be best, if both mother and child were treated
together.” Generally, it is common practice that "themother is also treated for the purpose of treating thechild", but in this case rather the reverse situation
applied. Moreover, since the child described in thiscase report strongly disliked vegetables, we expected
the formula to be difficult to administer, because
yokukansan has a distinct smell of Senkyu(resembling the smell of celery). Yet, in spite of thissmell the child even tried to take the medicine from its
mother, which makes the case very intriguing.
The mechanisms of action when treating bothmother and child include first direct effects and secondeffects induced through the mother's milk. Thatmeans, there are conceivably two psychological effects.
Regarding the direct effects, there are the following
two well-known case reports in the section on infantdiseases of the "Wan Bing Hui Chun (Restoration of28

Health from Myriad Diseases); 1587, Vol. 7.
“When small children of less than one monthdevelop convulsions and nasal obstruction, that means
they are suffering from common cold. Use therikkunshito with added Platycodi Radix and Asiasari
Radix and administer this to both mother and child.
( … omission …) It will clear the nose and stop theconvulsions.""When an infant of less than a month develops
convulsions, vomits milk, has a distended abdomenand diarrhea, the cause is adverse effects of milk on
the spleen and stomach. Use the gomiikosan(Miraculous Effect Powder with Five Herbs), add
Raponticum uniflorum Radix and give this to themother. Administration of the drug to the child with achildren's spoon eventually leads to a cure."
The mechanisms responsible for improvement in
the child when both mother and child are treated, areconsidered in case of common cold or mastitis, thetransfer of antibiotic components through the mother's
milk. In case of yokukansan, there are naturally direct
effects, but the psychological effect of "relaxation of thechild through relaxation of the mother" is probablyalso of major importance. The synergism with thispsychological effect does not only apply to parent-childrelationships, but could probably also be applied tomarried couples or the relationship between caregiverand the person being cared for. Yokukansan has fewerside effects when compared to western psychotropic
agents and thus could conceivably find wide
application in our modern, so-called "stressed society".

Summary
When a mother complaining of irritation wastreated with yokukansan, alleviation of the symptoms
had been observed. Moreover, when the child cravedto take the mother's medicine, treatment of the infant
with the drug improved symptoms of night crying.
Since even in the original text describing yokukansan
treatment of both mother and child is recommended,this was a highly intriguing case.

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

Volume 1, Number 2 | Summer 2006

ReferenceAuthors:

1) Yakazu D.: yokukansan ．Explanation of ClinicalApplicationofKampo
Medicines,
Sogen
Publishing, Osaka, 599-605, 1966
2) Miyazaki Z.: Simultaneous Effective Treatment ofMother and Child with kachinpihange, ClinicalKampo 42: 333-336, 1995
3) Mori Y.: Illustrated Composition and Applicationsof Kampo Preparations; Ishiyaku Publishing,Tokyo, pp. 156-157, 1985

Shinji Nishida1), Yuki Kishida1), Takaya Inoue1),
Hideki Yoshikawa1) 2)
1) Department

ofKampoMedicine,Osaka

University Medical School2) Department of Orthopaedic Medicine, Osaka
University Medical School
Address: 2-2, Yamadaoka, Suta-city, Osaka, Japan
Tel: +81-6-6879-3968, Fax: +81-6-6879-3969
E-mail: nishida@kanpou.med.osaka-u.ac.jp

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

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