The abdominal diagnosis plays an essential role in Japanese Kampo medicine. Moreover, this diagnostic method is a characteristic practice in Kampo medicine. The conventional method of abdominal diagnosis is performed with the patient in a supine position. However, the author has found that several patients have presented with tenderness of the epigastrium or hypochondrium in a standing position, which was not detected in a conventional supine position. This paper is intended to announce the significance of a new method of abdominal diagnosis named “Ritsuishin”. In this paper, the author describes the utility of this method via a case of saikokeishikankyoto and of hontonto (Chugoho).

Modern Kampo medicine is mainly based on a restoration of ancient Chinese medicine which occurred in the Edo period in Japan. This historical event rose under the influence of a Confucian renaissance, resulting the exclusion of metaphysics. This report intends to clarify the correlation between these two new cultural movements, and to outline the characteristics of Kampo medicine from a historical perspective.

Keijyuro Wada's Ikaino-tettsui (The Iron Hammer of the Medical World) was first published in 1910, just a hundred years ago. This book admonishes against the influence of modern Western medicine, which is based on the theory of element reductionism. Wada insisted that a reevaluation of Kampo medicine was essential to create a holistic medical system. Immediately after the book was published, Dr. Ryuken Hirade proposed a bitter criticism of it in a medical journal. Dr. Hirade, at that time, was leader of a well-respected medical society in Nagoya. His bitter criticism is very meaningful for us who engaged in Kampo medicine today. There is a conflict betweenthe two different paradigms of Western and Eastern medicine. This lecture intends to discuss our challenges facing Kampo medicine based on Ryuken Hirade's opinions.

The abdominal sign “shinkashiketsu” (lump of the epigastrium) is an important sign for the choice saikokeishito. However, an understanding of this symptom has been not defined in concrete terms. The author has found that this symptom can be recognized as a small painful point lying median to the xiphiod process and navel. This specific painful point is described equally in the textbook Shokanron and others. And the senior physician Kenzo Okuda has interpreted the suitability of their prescriptions as being decided by clinical results. Thus, the author has confidence that this painful point is an important indicator for saikokeishito.

In the daily practice of Kampo medicine, a small string in the midline of the abdominal wall called the seichushin can be recognized. This paper intends to clarify anatomical aspects of this string by means of MRI or CT imaging. As a result of this study, this string's position distal of umbilicus was detected as the urachal remnant, and the proximal position was detected as the Lig. teres hepatis. The relationship between signs of the shofukufujin and seichushin has been not clear in some textbooks. The result of this study indicated that seichushin was detectable under the prerequisite condition of shofukufujin. That is, seichushin was inclusive special sign of shofukufujin, as has been already reported. On the other hand, the proximal seichushin was detectable under the condition of very weak tonus of the abdominal wall.

In the previous article, the author reported on the relationship between shinkahiko and transport points. However, acupuncture manipulation to these points never diminished fullness in the chest and hypochondrium (kyokyokuman). Thus the author searched a new lump of back muscles and finally discovered that the infraspinatus muscle is a critical point which is closely rerated with kyokyokuman. The author also discovered that this point improves hiccup. It is well known that this lump is present in patients with shoulder stiffness and so on. Some patients with kyokyokuman present this lump simultaneously. This report intends to clarify a kyokyokuman that appears related tense condition of diaphragm, by means of both two concrete clinical cases and fifteen cases discussing to the pathophysiological background of this phenomenon.

In Kampo Medicine, abdominal manipulation is a very important diagnostic procedure. This is because some abdominal signs appearing in the abdominal wall indicate a specific group of Kampo formulations. Recently the author revealed that distension and tenderness in the epigastrium (shinkahiko) was closely related with transport points of the back meridian root. It was also revealed in 28 cases that relaxation of this cluster of the transport points by means of acupuncuture needle brought immediate elimination of distension and tenderness in epigastrium. This new knowledge suggests two facts : that a mutual origin expresses both tenderness of epigastrium and the cluster of transport points, and secondly that some unknown reflective system inhibits the vagal afferent signal which originates in the upper digestive tract, by means of acupunctural procedure to the transport points of the back. And also the results of this study suggest that the existence of a vagosympathetic reflex system lies behind shinkahiko. This new evidence may break-through in two different paradigms, i.e. Kampo and acupuncture, and proposes a new means of traditional medicine for the future.

In 1963, Keisetsu Otsuka reported painful groin as a typical abdominal sign for tokishigyakukagoshuyushokyoto (TSG) sho (indication). In 1974, he also reported Senki syndrome type A. However, this useful abdominal sign was not described as a ‘painful groin' medical term by him. By investigation his pupil's descriptions, the author revealed that this ‘painful groin' term was commonly used in their articles. The author has recently found that inguinal pain accompanies muscle contraction and hyperalgesia in this region clinically. Thus, these sign in the groin should be considered as noted in the diagnosis of TSG sho.

It is well known that an abdominal sign of painful groin indicates an appropriate condition for choosing the Kampo formulation tokishigyakukagoshuyushokyoto (TSG). This evidence was found by Keisetsu Otsuka in 1963. He thought that this sign is correlated with the liver meridian.
However, the pathophysiological background for this sign has been unknown. Recently, the author made clear that this sign disappears by acupunctural procedure at the Hikon (ExB4) meridian point. According to this clinical evidence, the author proposes a new hypothesis for this abdominal sign in that it closely relates to a homeostatic mechanism. In the cold environment, sympathetic drive to the femoral arteries occurs in order to guard from radiation heat loss in the lower extremities. This drive also causes a reduction of blood supply to the pelvic viscera. The acupunctural procedure at the Hikon (ExB4) meridian point may release both the induration of the iliocostal muscle and the contraction of IOM simultaneously. TGS disconnects the vicious cycle which exist between the pelvic viscera and sympathetic ganglion, and improves various signs that correlates with ischemia of the pelvic viscera.

It is well known that a painful lump around para-naval, ileo-cecal and sigmoid regions are correlated with oketsu syndrome, although, the physiological mechanism for these signs is still unknown. Recently, the author made clear that these signs disappear by acupunctural procedure at the meridian points Hikon (ExB4), Kekkai (SP10) and/or the lump itself. And also the author found out that these abdominal lumps are located in the most peripheral position of the superior or inferior epigastric artery. This evidence may indicate that abdominal lumps are brought by diminished blood flow of the superior or inferior epigastric artery, and acupunctural input from a meridian point or lump itself inhibits not only the excited gamma and alpha motor-neuron in the thoracic 11 and 12 segment of spinal cord but also excites sympathetic neurons. The author speculates that the initial noxious stimuli occur with stagnation of the pelvic vein associated with homeostatic inflammation.