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At the 71st Annual Meeting of the Japan Society for Oriental Medicine held in August 2021, we conducted a special program focusing on Kampo medicine education, “Pre-graduation post-graduation Kampo medicine education for the next generation.” The following is a summary report on the practical training in Kampo medicine at each educational facility where the project was conducted. We recorded videos with explanations of topics in advance : “Four examinations,” “Decoction and crude drugs,” and “Acupuncture and moxibustion.” The report on the hands-on training in Kampo medicine was viewed 501 times by medical students, educators, and the society members across the country. This initiative was the first nationwide educational activity of the society.
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Although it is not yet common, certified Kampo (traditional Japanese medicine) doctors and acupuncturists are cooperating with each other to provide traditional medical treatment for patients in some general hospitals in Japan. In other hospitals, however, Kampo and acupuncture-moxibustion have not been introduced, and doctors only treat patients using modern Western medicine. Many doctors must already be aware that modern Western medicine is not the only approach for the treatment of patients, but they do not make any efforts to improve the situation by adopting traditional medicine. Here, we give some examples of hospitals in which acupuncture treatments are routinely provided, having a favorable effect on both patients as well as the hospitals themselves. We believe that these examples give us a good opportunity to consider the future of an ideal medical system in which modern Western medicine and traditional Japanese medicine are successfully integrated.
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[Objective] We report a successfully treated case by a combined therapy of acupuncture and Kampo medicine for a patient with lower limb pain associated with Guillain-Barre syndrome (GBS).[Case] The patient was a 74-year-old man whose chief complaints were severe lower limb pain, gait difficulty, and hyposthenia. Clinical history: In late September in X year, the patient had a cold infection. On October 14, he became aware of weakness in his lower limbs on both sides, difficulty in walking, and severe pain in his lower limbs. He visited our hospital's general internal medicine department and was diagnosed with GBS. The patient was hospitalized and started to receive intravenous immunoglobulin therapy for GBS. Since pain in the lower limbs continued after treatment, he received analgesics, which was not effective. Therefore, acupuncture treatment was started on October 30 aiming to alleviate lower limb pain. Evaluation: Pain and burning sensation were evaluated using a numerical rating scale (NRS), and Hughes' function grade scale (FG) as an objective evaluation. [Acupuncture treatment] The acupuncture treatment was based on Chinese medicine. The basic combination of meridian points for treatment of the case were LR3 (Taichong), LI4 (Hegu), KI6 (Zhaohai), KI3 (Taixi), ST36 (Zusanli), PC6 (Neiguan), and SI8 (Xiaohai). The patient received acupuncture treatments once a day for 12 weeks.[Progress] The first evaluation of the patient's pain in his lower limbs on both sides was 10 points in NRS and 4 units in FG. Pain was alleviated immediately after acupuncture treatment was started, and a significant improvement in pain was observed by the seventh acupuncture treatment. However, the patient started to complain of burning sensation on his soles. Therefore, the combined use of Kampo medicine (Choutousan, Rokumijiougan) were introduced in addition to the acupuncture treatment, and his burning sensation disappeared. Since then, rehabilitation was enhanced, and after three months from the start of acupuncture treatment, he was discharged since the FG was improved to 2 units. [Discussion] Lower limb pain and burning sensation in this case were considered to be neuropathic pain associated with GBS, and conventional analgesics were only temporarily effective. In contrast, the combined use of acupuncture and Kampo medicine alleviated the pain and burning sensation, and ADL was improved. Acupuncture and Kampo medicine were effective for lower limb pain and burning sensation from GBS.
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We report a case of a 71 year-old woman treated for diffuse panbronchiolitis (DPB). She received home oxygen therapy and was administered erythromycin ; however, sputum production, cough and respiratory distress worsened. After hospitalization, she was treated with keishikyoshakuyakukasokyoto and acupuncture. After 30 days, respiratory distress, respiratory resistance measured with the pulseoscillation technique and the distance walked in the 6-minute walk test improved. Thus, combination therapy comprising keishikyoshakuyakukasokyoto and acupuncture seemed to be a beneficial therapy for an advanced case of DPB.
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Objective: This study investigated the association between use of sedatives in terminal cancer patients near death who were receiving home care and the home care period. Methods: We conducted a retrospective review of the medical records for 1032 cancer patients who received home palliative care from 17 specialized home care clinics between June and November 2013. We checked the use of sedatives within 48 hours before death at home, and we compared the home care period between patients with and without sedation. Results: The sedatives used were diazepam (n, %: 100, 52%), flunitrazepam (29, 15%), bromazepam (27, 14%), midazolam (26, 13%), and phenobarbital (20, 10%). The median home care period (median [quartiles]) was 26 [13, 63] days and 25 [10, 64] days (Adj p=0.79) for the patients with and without sedatives, respectively. Conclusion: Among terminal cancer patients near death receiving home care, 24% were administered sedatives, with more than half of those patients receiving diazepam. There was no association between use of sedatives and the home care period.
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A 48-year-old man presented with knee pain and general fatigue. He had been diagnosed with sarcoidosis 15 years previously. Prednisolone was administered, but the pain and fatigue persisted. Morphine, fentanyl, and a tramadol/acetaminophen combination were then administered, but their effects were not sufficient. Finally, the patient was treated with sekiganryo, uzuto, uzukeishito, and daiuzusen, all of which contained uzu (aconite root without processing). His pain and fatigue improved after administration of these drugs, and he became able to perform various activities of daily living. In this case, uzu alleviated knee pain and general fatigue in a patient with sarcoidosis.
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Purpose: This study was performed to compare the characteristics of home palliative care for elderly patients with cancer between age groups. Methods: The clinical records of 1,032 patients with cancer who received home medical care from June to November 2013 were reviewed retrospectively. Patients were classified as non-elderly (<65 years old), young-old (65-74 years), old-old (75-84 years), or oldest-old (≥85 years), and these groups were compared with respect to demographic characteristics, patient/family problems, outcomes, and medical care and services provided. Results: There was a higher percentage of patients with no caregiver in the oldest-old group than in the other groups (18%, p=0.014), while the young-old and oldest-old groups had a higher percentage of problems related to caregiving such as caregiver burden or absence of a caregiver (32% and 33%, p=0.002, respectively). In addition, the percentage of patients who required visiting nurses and care was higher in the old-old group (86% and 30%, respectively) and oldest-old group (89% and 35%, respectively) compared with the other two groups. Conclusion: Problems related to caregiving, such as caregiver burden or absence of a caregiver, were greater in the old-old and oldest-old groups, and a higher percentage of patients required visiting nurses and care in those two groups.
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Purpose: This study investigated the current state of medical care and palliative care provided at home and the factors influencing death at home for terminally ill cancer patients living in single-person households. Methods: We conducted a retrospective questionnaire study of 1032 cancer patients living in single-person households who received home palliative care from 17 specialized home care clinics and finished home care between June and November 2013. We compared patient background factors, outcomes, home care services, and medical care between these patients and others not living in single-person households to investigate factors influencing death at home. Results: Compared with patients not living in single-person households, the patients living in single-person households were older, had a better performance status at initiation of home palliative care, showed a lower preference for dying at home, and received more frequent social hospitalization. Among the subjects from single-person households, factors influencing death at home were a family preference for dying at home (odds ratio (OR)=14.0), poor performance status at initiation of home palliative care (OR=4.0), and no hospitalization during home palliative care (OR=16.6). Conclusion: We found that death at home for terminally ill cancer patients living in single-person households and receiving home medical care and palliative care was influenced by family preference, the performance status at initiation of home palliative care, and hospitalization during home palliative care.
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<p>Otsujito is a well-known Kampo medicine for treatment of hemorrhoidal diseases. In the current report, we present end results for a case of enterocutaneous fistula treated with Kampo medicine in accordance with traditional “sho” indications.<br>An 81 year-old female developed abdominal wall-intestinal fistula right immediately following partial colectomy due to ischemic sigmoid colic perforation 12 years previously. Two years later, she had a fistulectomy and repair using intraperitoneal mesh for abdominal recruitment. Eight years after repair of the enterocutaneous fistula, she had peritonitis caused by the tardive intraperitoneal mesh infection. Since then, she has had frequent repeated ileus and received conservative treatment for two years. Several local operations and abdominal drainages were performed after transfer to Aizu Medical Center. Kigikenchuto was provided for wound healing for approximately 1 year, and one fistula was finally identified. Otsujito dramatically decreased the leakage of intestinal juice and closed her enterocutaneous fistula.<br>Angelicae Radix as an anti-inflammatory agent, and Cimicifugae Rhizoma as originally indicated, may have played pivotal roles in this case with Otsujito.</p>
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<p>In 2013, we prescribed daiuzusen for 3 patients with intractable pain; pain from complex regional pain syndrome, colic pain of unknown origin after an abdominal operation, and colic pain from advanced colon cancer and ileus. A dose of daiuzusen (containing uzu 0.5-2 g) quickly relieved their pain in several minutes. Another common symptom was “cold” in their bowel or extremities when they were feeling pain. Aconite levels in drugs and patients' serum after taking daiuzusen were analyzed by liquid chromatography tandem mass spectrometry. Daiuzusen per 1 g of uzu contained aconitine 1.28 μg, mesaconitine 2.31 μg, and hypaconitine 92.89 μg, while jesaconitine was not detected; this was about 5 to 35 times the level of tsumyakushigyakuto per 1 g of uzu. Serum concentrations of hypaconitine peaked in the study at 1.11 ng/mL after about an hour of taking daiuzusen (1 g of uzu). We posit that the immediate effect after taking daiuzusen was due to transmucosal absorption of uzu components. However serum hypaconitine, which we are now able to monitor, is at least one practical way of indicating the use of uzu or bushi containing prescriptions.</p>
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Purpose: This study investigated the current state of critical hemorrhage during home palliative care for terminally ill cancer patients. Methods: We conducted a retrospective medical chart review of 7 cancer patients (1.4%) who received home palliative care from our clinic and died of critical hemorrhage at home from October 2007 to December 2014. Results: Four patients were male, the mean age was 70±11 years, and underlying diseases were different. None of the patients were accompanied by medical staff at the onset of bleeding. Six patients died at home and one patient was admitted to hospital for hemostasis. Six patients had a pre-hemorrhage episode more than 24 hours before critical hemorrhage occurred from the same site. One patient was administered a hemostatic agent, hemostasis was attempted in one, and one was given sedation. Six patients wanted to die at home, and did die at home. Discussion: If terminally ill cancer patients have critical hemorrhage at home, our options are limited. The results of this study suggest the importance of hemorrhage risk assessment and advance care planning.
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A 45-year-old woman had been suffering from fibromyalgia, chronic fatigue syndrome, and complex regional pain syndrome (CRPS) for 2 years before admission. Non-steroidal anti-inflammatory agents, selective serotonin reuptake inhibitors and pregabalin did not affect the various symptoms. A severe feeling of Coldness, the widespread systemic pain and the severe fatigue were decreased by tsumyakushigyakuto (glycyrrihza 4 g, processed ginger 9 g, aconite root 6 g). Attacks of CRPS were relieved by a dose of daiuzusen (aconite root 1 g, honey 10 g). The CRPS attacks presented mainly on the left heart meridian and the small intestine meridian where we treated them with electroacupuncture with reference to the <i>Shigoryuchu </i>(子午流注) methods. Acupuncture and electroacupuncture decreased the frequency of pain attacks, and alleviated the muscles stiffness caused by the CRPS. Thus, the combination of Kampo medicine and acupuncture were effective for the severe pain and other symptoms associated with fibromyalgia, chronic pain syndrome and CRPS.
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<b>Objectives:</b>To determine the factors influencing death or the cessation of palliative care in home-based setting among patients with cancer.<b> Methods:</b>We included 352 terminally ill patients with cancer who received home-based palliative care from six specialized palliative care clinics. We reviewed the medical charts when patients died at home or chose to stop home care.<b> Results:</b>A total of 82％ of participants died at home, and 18％ chose to stop home care. Multiple logistic regression analysis revealed five independent factors that affected cessation of home-based palliative care:patient and informal caregiver preferences for the place of death not to be at home［odds ratio, 10.1（95％ Confidential interval, 2.5-40.9）and 51.9（11.9-226.6）, respectively］or uncertain preferences［5.0（1.3-19.4）, 10.8（2.3-50.5）］;anxiety and depression among informal caregiver［4.1（1.2-13.9）］;lower frequency of informal care［6.8（2.0-23.4）］;and history of admittance to hospital during home care［11.6（4.0-33.9）］. <b>Conclusion:</b>We revealed independent factors influencing death or the cessation of palliative care in home-based settings among patients with cancer. Our findings suggest the importance of providing support for decision making about the place of death and hospital admission, and psychosocial support for informal caregiver to ensure home death consistent with patient preference.
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<b>Purpose：</b>This study investigated the current state of medical care and home palliative care for terminally ill cancer patients in Japan. <b>Methods：</b>We conducted a retrospective questionnaire study of 352 cancer patients who received home palliative care from 6 specialized home care clinics and discontinued home care or died from January to June in 2012. <b>Results：</b>The questionnaire was answered by 290 patients〔165 men（57％）, mean age：72±13 years〕who started home palliative care after completing cancer treatment. Home visits from nurses were used by 238 patients（98％）and 95 patients（39％）used home care workers. Within a month before discontinuation of home care or death, 72 patients（30％）received fluid therapy and 127 patients（52％）received strong opioids. The outcome of home palliative care was death at home in 242 patients（83％）and discontinuation of home care in 48 patients（17％）. The reason for discontinuation was family physical and mental problems or physical problems of the patient. <b>Conclusion：</b>This study demonstrated the current state of home palliative care by specialized home care clinics.
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Tricuspid valve myxoma is extremely rare. A 33-year-old woman who had undergone clipping of a cerebral aneurysm, had a cardiac tumor pointed out incidentally while undergoing echocardiography. Echocardiography showed a mobile and solid round mass (14×12 mm) attached by a short stalk. We suspected a right ventricular tumor. Once the diagnosis of cardiac tumor has been established, prompt excision is essential to prevent complications, as well as syncope or collapse due to the transient occlusion of the tricuspid or pulmonary valves with embolization by the thrombus or fragments of the tumor tissue. Surgery was performed under cardiopulmonary bypass. The tumor was attached to the anterior papillary muscle and chordae of the tricuspid valve. The tumor was extirpated along with a piece of the papillary muscle and chordae. We performed tricuspid chordoplasty with artificial chordae. The histopathologic diagnosis was myxoma. The postoperative course was uneventful and the patient was discharged on the 15th day after the operation. While the patient has done well with no recurrence of the tumor during the five years that have passed since her operation, we will continue to observe her closely in the future because there have been some reports of recurrence after complete excision of cardiac myxoma and there are no long-term follow-up results of artificial chordae in the tricuspid position.
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[Introduction]Insomnia and anxiety are major symptoms of depression and severely limit the daily activities of depressed patients. We report the case of a depressed patient who had developed liver dysfunction caused by medication and whose depression was successfully managed by acupuncture after discontinuation of antidepressants. <BR>[Case]A 37 years-old male had been taking noradrenergic and specific serotonergic antidepressant (NaSSA) and Chai Fu Jia Long Gu Mu Li Tang Jia Wei Gui pi Tang for insomnia and anxiety due to depression. Although his symptoms had improved by the medication, abnormalities in his liver functions were found after 3months of medication. After he was diagnosed as having drug-induced liver damage, he was admitted to Meiji University's Integrative Medicine Hospital and all medication was replaced by Glycyrrhizin and Glutathione. Consequently his depression and symptoms returned. We then tried to relieve his symptoms by applying acupuncture, which was prescribed according to traditional Chinese medical diagnosis (TCM diagnosis, Heart Yin Deficiency , Liver Qi Stagnation , and Kidney Yin Deficiency ). <BR>[Results]After 4 acupuncture treatments, the patient's duration and depth of sleep considerably improved compared with that before the acupuncture sessions, and comparable results were maintained until discharge. Beck Depression Inventory (BDI) scores were also markedly improved from 'moderate depression'(24 points) at the beginning of treatment to 'minimal depression'(8 points) at the end (9th treatment, 16 days from the first session).<BR>[Conclusion]The results of this case suggest that acupuncture treatment may be an effective alternative for anti-depressants when there is a limitation to administer those drugs.
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A 51-year-old man was referred to us because of upper extremity hypertension and vascular claudication of the lower extremities. He underwent extraanatomic ascending aorta-abdominal aorta bypass with vascular graft under a median sternotomy and a midline laparotomy incision without cardiopulmonary bypass. The postoperative course was uneventful. Upper extremity hypertension and vascular claudication were completely resolved. Although the patient has done well in the three years since his operation, we continue to observe him closely. The etiology of atypical coarctation may be related to Takayasu arteritis because of the angiographic findings and positive specific alleles such as HLA-B5201 and DRB1 1502.
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[Background]Functional abdominal pain syndrome (FAPS) represents a chronic pain disorder localized in the abdomen and the symptoms largely are unrelated to food intake and defecation, which differ from other painful functional gastrointestinal disorders.<BR>We report a case of FAPS whose symptom was successfully improved by acupuncture.<BR>[Case Report]A 75-year-old female had been hospitalized at Meiji University of Integrative Medicine Hospital because of left lower abdominal pain from which she had repeatedly suffered for more than 2 years. Despite strict medication, her symptom had not been improved. After admission to the hospital, according to recommendation by her physician, acupuncture treatment was started. The patient received TCM-based acupuncture treatments five times a week over 13weeks. Primary acupuncture points used for the patient were LV3(Taichong), SP6 (Sanyinjiao), ST36 (Zusanli) and PC6 (Neiguan). Evaluation of the left lower abdominal pain was carried out with a Visual Analogue Scale (VAS). The Gastrointestinal Symptom Rating Scale (GSRS) was used to evaluate QOL related to the digestive symptoms. VAS for the left lower abdominal pain showed a remarkable decrease immediately after the initial acupuncture session. The symptom disappeared within 4 weeks after commencement of the treatment and never appeared during her hospitalization. GSRS was also improved and it was maintained during hospitalization.<BR>[Conclusion]We suggested that acupuncture treatment might be one of the useful, non-pharmacological alternatives for symptoms of FAPS.
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BACKGROUND: In recent years, various studies have analyzed the concepts of “good death” and “quality of dying and death” in the world. The objective of this study was to compare community residents and physicians regarding their perceptions of “good death” in a terminal cancer setting in Fukushima, Japan.<BR>METHODS: One thousand residents of Fukushima City (40 years or older) were randomly selected for comparison to the 483 physicians working in the same city. A self-administered questionnaire was used to query residents and physicians on 52 items about “good death.”<BR>RESULTS: The response rate was 73.6% for the residents and 53.0% for the physicians. The concept of “good death” was composed of 14 factors for both groups. We elucidated the structure of the concept of “good death” in the general population and physicians in Japan, and only the third factor, “religion and spiritual beliefs, ” was the same between the general population and physician.<BR>CONCLUSION: The data offers useful information pertaining to palliative care education for medical providers. Specifically, physicians should understand the differences between concepts held by the general population and physicians. For example, some same items were included in factor X (continuance of one's lifestyle) for citizen and factor II for physician. But contribution ratios of factor X for citizen and factor II for physician were different. This should lead to the better palliative care provision.
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<b>Purpose</b>: To clarify factors associated with the Japanese perception of whether they can live at home until death with the inclusion of knowledge and beliefs about end-of-life. <b>Methods</b>: A questionnaire survey was conducted on the Japanese general population who participated in a lecture meeting about palliative home care (N=61, effective response rate, 100%). <b>Results</b>: Ten (16%) responded they could live at home until death. Barriers to end-of-life home care were "Home care would burden my family (80%)," " Family and I are anxious about emergency care when I get worse (59%)" and "Family and I are anxious about whether I can enter a hospital emergently when I get worse (52%)" in that order. From the multivariate logistic regression model, respondents who expressed "Opioids cause addiction (OR, 95% confidential interval (CI):0.29, 0.09-0.99)" and "Artificial hydration and nutrition should be continued as the minimum standard until death (OR, 95%CI:0.39, 0.16-0.95)" were more likely to perceive that they could live at home until death. <b>Conclusion</b>: The empowerment activity for the general population regarding correct knowledge about palliative care, benefit and disadvantage of life-sustaining treatment, and correct knowledge about home care is important for the end-of-life patients who want to live at home until death to achieve their wish.