Japanese Kampo Weight Loss Experience: Application of Fangfeng Tongsheng San and Fangji Huangqi Tang for Excess and Deficiency Syndromes

IV. Japanese Experience with Weight Loss Using Traditional Chinese Medicine

In recent years, Japanese scholars have found that traditional Chinese medicine (TCM) treatment for obesity has yielded better results than conventional Western medicine. Therefore, they have adopted a modified version of basic TCM formulas, emphasizing the effective use of classic formulas from the *Shanghan Zabing Lun* (Treatise on Febrile and Miscellaneous Diseases). They categorize Japanese patients into three types based on their constitution: excess, deficiency, and a combination of both. Prescriptions are then tailored to each category. Their experience is described below:

1. Fangfeng Tongsheng Powder

The formula, containing rhubarb, Glauber's salt, and licorice, is a flavoring of Chengqi Decoction, possessing a purgative effect. Saposhnikovia root, ephedra, schizonepeta, ginger, and mint have diaphoretic properties, allowing pathogens to be expelled through the skin via sweat. Forsythia, scutellaria, platycodon, gardenia, and gypsum have heat-clearing, detoxifying, and dampness-drying effects. Atractylodes and licorice strengthen the spleen and stomach. Through this combination, pathogens are expelled through the skin and urination, achieving the effect of clearing heat and detoxifying.

This formula is most commonly used for patients with obesity of the actual type, also known as stroke-prone constitution. Abdominal palpation reveals fullness and thickening centered around the navel, often accompanied by constipation, and the pulse and abdomen are firm and strong.

2. Da Chai Hu Tang (Major Bupleurum Decoction)

This formula is applicable to cases of actual obesity. It describes individuals who are obese or have a robust physique, with a thick abdominal wall, an obtuse angle in the upper abdomen, tension and tenderness below the costal margin, and significant fullness and discomfort in the chest and hypochondrium-the so-called "real obesity." It is commonly seen in middle-aged individuals who overeat fatty and sweet foods and lack exercise, leading to subcutaneous fat deposition. It is often accompanied by constipation and a deep, slow, and forceful pulse. Adding Job's tears can enhance diuresis and help eliminate fat.

3. Fangji Huangqi Decoction

It is suitable for deficiency syndromes and intermediate deficiency-excess syndromes. Symptoms include pale skin, excessive sweating, muscle weakness, knee pain, or edema. It is not accompanied by constipation, which is the so-called "bloated obesity".

4. Peach Kernel Decoction for Relieving Inflammation

Applicable to empirical cases. Symptoms include good physical strength, facial flushing, constipation, menstrual irregularities, lower abdominal congestion, and abdominal distension. Abdominal palpation often reveals a cord-like structure in the left lower quadrant, which is tender to the touch.

5. Guizhi Fuling Wan (Cinnamon Twig and Poria Pill)

This formula is suitable for cases of excess or intermediate between excess and deficiency. It is milder than Taohua Chengqi Decoction and can be used for patients with a ruddy complexion, good physical strength, abnormal menstruation, and blood stasis in the lower abdomen, but without abdominal distension.

6. Major Purgative Decoction

This formula is applicable to cases of actual illness. It is a strong purgative and is suitable for those with abdominal obesity, a strong pulse, and severe constipation.

According to Kazuo Yumoto, a combination of Da Chengqi Tang and Tao He Chengqi Tang (15 grams each of Glauber's salt and rhubarb) plus Huang Jie Wan was effective in treating obesity. He believed that blood stasis exists throughout the body, and the combined formula, with the help of the medicinal power of Da Chengqi Tang, could achieve a better therapeutic effect.

7. Bupleurum and Dragon Bone & Oyster Shell Soup

It is applicable to intermediate syndromes of deficiency and excess, as well as excess syndromes. Symptoms include fullness and discomfort in the chest and hypochondrium, palpitations above the navel, irritability, insomnia, and decreased libido.

8. Nine-Ingredient Pinellia Decoction

This formula is suitable for cases of intermediate symptoms between deficiency and excess. It is often used for obesity in middle-aged and older adults, presenting with facial flushing, dizziness, or fluid retention. Fluid retention is mostly caused by water metabolism disorders and water retention leading to obesity, so red beans, which promote urination, can be added.

9. Wu Ling San combined with Jiu Wei Bing Lang Tang

It is suitable for deficiency syndromes. Symptoms include obesity, heaviness in the body, easy fatigue, easy edema, and beriberi-like symptoms.

Although the above-mentioned traditional Chinese medicine preparations (Fangfeng Tongsheng San and Fangji Huangqi Tang) still have issues regarding the criteria for judging efficacy, based on the existing clinical evaluations and studies on lipid and electrolyte metabolism, they have achieved certain therapeutic effects.

Some researchers, including Di Zi, used Fangfeng Tongsheng San and Fangji Huangqi Tang, administering extracts alone or in combination. Based on a 10% weight loss and a significant reduction in chest and waist circumference, they inferred that the drug may have little effect on protein and mainly manifests as a fat-decomposing effect. However, since only four cases have been reported, further observation of more cases is expected.

According to Takayuki Hirai, four obese women were given Fangfeng Tongsheng San and Fangji Huangqi Tang extract, along with dietary control. After 5 to 6 months, the effects were observed, leading him to conclude that it is feasible as an adjunct treatment for simple obesity.

Narita et al. administered Fangji Huangqi Decoction and Fangfeng Tongsheng Powder extract to 68 obese women. For a small number of patients with menstrual abnormalities and blood stasis, Guizhi Fuling Pill and Taohe Chengqi Decoction extract were given. After 8 to 12 weeks, about one-third of the women lost weight.

In summary, Japanese scholars focus on using original prescriptions from classical Chinese medicine to treat obesity, and mainly use extracts, which differs from traditional Chinese medicine's approach to obesity and is worth learning from.

See Foreign Medical Sciences (Traditional Chinese Medicine and Materia Medica), 1987(3), 21-23. Kampo treatment for obesity: Momosuke (Japan).