The History and Current Situation of Medicinal Plants and Crude Drug Production in Tohoku Region / 日本東洋医学雑誌

Ninety percent of the crude drugs consumed in Japan depend on imports. Recently, the Japanese government has been promoting the domestic production of crude drugs. We investigated the history and current situation of the cultivation of medicinal plants and the production of crude drugs in the Tohoku region, where the 71st annual meeting of the Japan Society for Oriental Medicine was held in August 2021. In the Tohoku region, the cultivation of medicinal plants expanded after the Kyoho era of the Edo period. Several medicinal plants in this region have been successfully cultivated and distributed as local specialty products and are being preserved (e.g., Panax ginseng in Aizu, Carthamus tinctorius in Dewa). In some other areas, cultivation has just begun. In each cultivation area, a contractual relationship was established in which local governments, cultivation experts, farmers, Kampo-related associations, and pharmaceutical companies collaborated to continue and expand the cultivation business. To generate revenue, they have been trying to find sales channels not only for crude drugs but also for foods, cosmetics, textiles, and processed products. Although many issues remain to be solved in the distribution of medicinal plants as the source of crude drugs, this survey clarified the ingenuity of medicinal plant cultivation in various areas of the Tohoku region. The results of the investigation are available as videos on the website for members of the Japan Society for Oriental Medicine.

Report of the 71st Annual Meeting of the Japan Society for Oriental Medicine Special Program 1—“Pre-and Post-Graduate Kampo Medicine Education for the Next Generation”: Symposium on Model Core Curriculum in Medicine, Dentistry, Pharmacy and Nursing, and the Current Status of Kampo Education / 日本東洋医学雑誌

At the 71st Annual Meeting of the Japan Society for Oriental Medicine in August 2021, we conducted a special program focusing on education in Kampo medicine, “Pre-graduate and post-graduate Kampo medicine education for the next generation.” As part of this project, we directed a symposium on the model core curriculum (core curriculum) in medicine, dentistry, pharmacy and nursing. The core curriculum in these fields includes Kampo education. Each institution shall promote education in accordance with the core curriculum, considering the characteristics of the field and the circumstances of the educational institution. We introduced the core curriculum in each field, and summarized and reported the current status of Kampo education in the field, points to note and suggestions for multidisciplinary cooperation, issues related to clinical practice and lack of educators, and future prospects.

Report of the 71st Annual Meeting of the Japan Society for Oriental Medicine Special Program1 — “Pre-and Post-Graduation Education of Kampo Medicine for the Next Generation”: Clinical Practice on Kampo Medicine / 日本東洋医学雑誌

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.

Report of the 71st Annual Meeting of the Japan Society for Oriental Medicine Special Program 1-“Pre-and Post-Graduation Education of Kampo Medicine for the Next Generation”: Standard Lecture on Kampo Medicine / 日本東洋医学雑誌

At the 71st Annual Meeting of the Japan Society for Oriental Medicine held in August 2021, we conducted a special program, “Pre-graduation and post-graduation Kampo medical education for the next generation,” focusing on Kampo medical education. We summarize and report a mock lecture on standard Kampo medicine conducted jointly with the Japan Council for Kampo Medical Education (JCKME) for the purpose of faculty development. The lecture contents were based on the “Basic Curriculum for Pre-Graduate Education in Kampo Medicine 2016” established by the JCKME, and the common model slides prepared by the JCKME were used. The lectures were pre-recorded for 240 minutes on the “History of Kampo medicine,” “basic theory of Kampo medicine,” “physical examination of Kampo medicine,” “composition and effects of typical Kampo medicines, effects and side effects of typical herbal medicines,” “usefulness of Kampo and clinical cases that were effective,” and “overview of acupuncture and moxibustion treatment,” and were delivered from seven days before to seven days after the annual meeting. This was the first nationwide educational activity for the general meeting of the society. These lectures were viewed 1,017 times nationwide, by medical students, educators, and members of the society.

Three Cases in which Kampo Therapy was Effective in the Long Term for Menstrual Symptoms in Patients with Mental Illness / 日本東洋医学雑誌

We report three cases of patients with mental illness suffering from symptoms associated with menstruation, which were improved with Kampo treatment. Case1: A 39-year-old female had been in a depressive state after delivery and diagnosed with persistent mood disorder in the Neuropsychiatry Department of Fukushima Medical University (FMU). During treatment for the disorder, she developed premenstrual dysphoric disorder (PMDD) and was immediately hospitalized. After she was introduced to the Obstetrics/Gynecology Department, we treated her with Kampo medicine such as tokakujokito considering the meaning of the pattern (sho), and then she recovered from PMDD. Case2: A 29-year-old female with schizophrenic disorder treated in the Neuropsychiatry Department of FMU was referred to the Obstetrics/Gynecology Department due to PMDD. We administered Kampo medicine such as kamishoyosan, nyosinsan and saikozai when yang pattern was observed, and ninjinto and daikenchuto in yin sho. Then, her condition then gradually improved. Case3: A 37-year-old female diagnosed with borderline personality disorder and attention deficit hyperactivity disorder was hospitalized in the Neuropsychiatry Department of FMU. She was introduced to the Obstetrics/Gynecology department due to dysmenorrhea and PMS. After she was treated with keishibukuryogan and hangekobokuto, her symptoms improved. In conclusion, Kampo treatment appears to be effective for symptoms associated with menstruation in women with mental illness.

Pain and burning sensation of bilateral lower limbs successfully treated using acupuncture combined with herbal medicine (Kampo medicine) in patient with Guillain-Barre syndrome / 全日本鍼灸学会雑誌

[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.

Solution Proposal for 5 Challenges to be Resolved in Formalizing the Logical Format of Kampo-Based Diagnosis by Building Consensus Among 6 Medical Institutions Specialized in Kampo Herbal Medicine / 日本東洋医学雑誌

We are planning a study focused on the gathering of clinical data for the purpose of formalizing diagnostic logic at 6 institutions specialized in Kampo-based medical examinations. However, during the planning stage, it has been recognized that there are a large number of Kampo formulas to be studied, and differences among faculties and individuals exist regarding how to identify each Kampo formula, methods of gathering findings, and the evaluation of efficacy. Here we report the solution proposal reached after building consensus among all participating faculties on these issues. After raising the issues, conferences were held for each of them, until a unanimous consensus was obtained. As a result, the following conclusions were reached. Thirty-three Kampo formulas were selected as targets for the formalization of diagnostic logic. In addition, the range of dosage forms, crude drug ingredients, and permissible dosages for each Kampo formula were determined. Regarding clinical findings for these Kampo medicines, the items to be collected and evaluation criteria were also established. The criteria for evaluating the validity and safety of each Kampo medicine were decided, together with the grading and timing of evaluation. We hope that our solution proposal reached after building consensus becomes the basis for Kampo research in the future.

Assessment of Patients Treated with Kampo Decoctions Containing Aconite Root Before Processing (uzu) / 日本東洋医学雑誌

We examined 57 patients treated with Kampo decoctions containing uzu for 5 years and 3 months from September 2013. Sekiganryo, which was administered to 32 patients, was the most commonly used decoction. The value of uzu dosage and duration of administration were spread widely and the medians (ranges) are 8.0 (1.0-41.0)g/day and 180 (3-1700) days, respectively. Complete recovery, partial recovery, no recovery, and deterioration in terms of the chief complaint, were observed in 36, 11, 9, and 1 patients, respectively. The number of patients exhibiting complete or partial recovery was higher than that of patients showing no recovery or deterioration when the duration of uzu administration was more than one month and the dosage was higher than 4 g/day (p < 0.05). The patients treated with uzu more than 20 g/day were all sekiganryo administrated ones. Side effects were observed in three patients. Thus, under careful observation, uzu was safely used over a long term and at high doses.uzu: aconite root before processing

A Patient with Diffuse Panbronchiolitis Treated with a Combination of Keishikyoshakuyakukasokyoto and Acupuncture / 日本東洋医学雑誌

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.

A Case of Uncontrolled Cancerous Ascites Reduced by Sekiganryo / 日本東洋医学雑誌

Abdominal pain and marked coldness were observed in a 56-year-old male with cancerous ascites associated with cancer of unknown primary, and the patient was treated with sekiganryo. The abdominal pain resolved from day 2 after the initiation of sekiganryo administration, and the ascites markedly decreased with an increase in the urine volume on day 3. Although the mechanism of the effect of sekiganryo on cancerous ascites was unclear, it was considered that the improvement of coldness promoted the metabolism and subsequently promoted diuresis. No case of the improvement of cancerous ascites by sekiganryo has been reported to date. We report this case along with a literature review.

A Case in Which Byakujutsubushito Responded to Extremity Pain / 日本東洋医学雑誌

The patient was an 84-­year-­old woman living in a nursing home. Her chief complaint was difficulty in mov­ing her body due to extreme pain. She could not lie down especially in a supine position because of severe un­identified somatic pain from left side of lower chest to flank. According to her family, she had been taking 2-­3 L of water daily at her nursing home to avoid dehydration even in the wintertime. Therefore she urinated fre­quently, but she also had constipation for several days. Since NSAIDs had been not effective, byakujutsu­bushito was administered from the first day of her hospitalization. Accordingly, her constipation improved and her pain quickly faded away. We inferred that her pain resulted from “fluid disturbance” caused by massive in­take of water in the wintertime in Aizu region. We believe that byakujutsubushito is a useful Kampo medicine for the treatment of pain resulting from “wind-­dampness” along with keishibushito and kanzobushito.

A Case of Sarcoidosis Complicated by Knee Pain and Fatigue Successfully Treated with Uzu / 日本東洋医学雑誌

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.

<b>Otsujito Found Effective in Enterocutaneous Fistula after Trying Other Kampo T</b><b>reatments</b> / 日本東洋医学雑誌

<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>

<b>Three Cases with Intractable Pain Treated with a Dose of Daiuzusen, and an Analysis of Aconite Concentrations in Prescriptions and Patientsʼ </b><b>Serum</b> / 日本東洋医学雑誌

<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>

<b>Sansoninto (Containing Zizyphi Spinosa Semen) Alleviates Multiple Joint and Muscle Pains More Effectively than Insomnia : a Report on two Cases</b> / 日本東洋医学雑誌

<p>Case 1 : A 56-year-old woman had been suffering from insomnia for 10 years, and multiple joint pains on her shoulders, wrists and fingers for 2 years. She complained of headache, dizziness, heart palpitations, and irritable bowel syndromes. Case 2 : A 72-year-old woman presented with cold and painful feeling in her legs that she had had for 10 years, as well as insomnia, excessive sweating, alopecia and pollakiuria that she had had for two years. In both cases, organic diseases of the joints or muscles were ruled out by several doctors, and the patients had been suffering from malaise and insomnia for which they had been taking brotizolam for several years. Consequently, the patients consulted our department of traditional Japanese medicine (Kampo). Medical interviews revealed that they had been under a lot of stress for a long time because of family problems. Sansoninto (roasted Zizyphi spinosa semen 15 g, Poria 3 g, Cnidii Rhizoma 3 g, Anemarrhenae Rhizoma 3 g,Glycyrrhizae Radix 1.5 g) was prescribed, which reduced the pain in their joints and muscles, and their other complaints, in several weeks. Sansoninto seemed not to alleviate insomnia as effectively as it did the pain and other multi complaints, because the patients were not able to discontinue brotizolam. Patients with multiple complaints including insomnia with fatigue induced by long-term stressful lifestyle may sometimes possibly express non-organic joint or muscle pain. Sansoninto may be an effective prescription for non-organic joint and muscle pain.</p>

<b>A Case of Fibromyalgia Complicated by Chronic Fatigue Syndrome and Complex Regional Pain Syndrome Successfully Treated with a Combination of Kampo Treatments Including Uzu and Acupuncture </b> / 日本東洋医学雑誌

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.

<b>A Successful Case of Pseudo-Obstruction After Femoral Hernia Radical Operation Treated with Chukenchutokatoki </b> / 日本東洋医学雑誌

A 54-year-old female had left femoral incarcerated hernia. One month later, she received a radical operation for it, but was admitted to our hospital twice because of ileus. Various tests showed no mechanical intestinal obstruction, but small-intestinal edema. She was transferred to our department to receive Kampo medicine. She could not eat any food and her weight decreased from 47 to 37.5 kg. We therefore administered intravenous hyperalimentation. She had a cold sweat on her face and was prone to bed rest because of severe abdominal pain as if in labor, and general fatigue. Her skin was dry, her radial pulse was weak and her abdominal tonus was weak. In addition, lower abdominal tension was more intense than upper and we could observe bowel movements from her skin. At first, we administered bushikobeito, but it had no effect. Referring to her abdominal findings, we considered that daikenchuto and tokikenchuto were compatible in her case, and after changing to chukenchutokatoki her abdominal pain disappeared in 5 days. Thus, Kampo medicine was effective for post-operative pseudo-obstruction.

<b>Two Cases of Abdominal Pain Improved by Kanbakutaisoto</b> / 日本東洋医学雑誌

In general, keishikashakuyakuto or shokenchuto is used to treat abdominal pain. We experienced 2 cases that kanbakutaisoto were effective in treating abdominal pain, however keishikashakuyakuto and shokenchuto did not have any favorable effect on these cases. Case 1 : A 17-year-old female who consulted us because of abdominal distension and pain. We treated her with keishikashakuyakuto and shokenchuto, but they had no effect on her. As the abdominal pain was increased by anxiety, we prescribed for kanbakutaisoto to her and her symptoms disappeared after one and half months. Case 2 : A 13-year-old male who visited our clinic complaining of upper abdominal pain. He was treated with shokenchuto, but it had no favorable effect. As we knew that he had some anxiety over his club activities and school life, we changed the prescription to kanbakutaisoto, and he recovered after about 1 month. When keishikashakuyakuto or shokenchuto has no effect against abdominal pain, we posit that kanbakutaisoto is useful for the symptom if the patient has psychological problems.

<b>A Case of Diabetic Foot Syndrome Successfully Treated with </b><b>Combination Kampo Medicine </b> / 日本東洋医学雑誌

This case involved a 58-year-old male with diabetic foot syndrome complicated with osteomyelitis. He had been diagnosed with diabetes mellitus type 2 twenty years previously, but had ignored it and developed diabetic foot syndrome and diabetic triopathy. His HbA 1 c (NGSP) was 11.2%. Twelve days after diabetic foot onset, he was transferred to our hospital to receive Kampo medicine. His whole right leg was edematous and there were two ulcers on the dorsum (5 × 4 cm in size) and between the fourth and fifth toes (7 × 4 cm in size).We used antibiotics, insulin, and prostaglandin formulation in combination with Kampo medicine, involving hachimijioganryo because of lower abdominal numbness. Simultaneously, we used keishibukuryogan at high dosage (personalized formula, 2 g × 24 pills) for 7 days to improve blood stasis. Seven days after hospitalization, we changed the initial hachimijioganryo to hachimijiogan (personalized formula, 2.3 g × 9 pills) and kigikenchuto (astragalus root, 20 g) to accelerate ulcer granulation. We also decreased the high dose keishibukuryogan gradually. Although the bone of the DIP joint in the fifth toe was exposed, the ulcer dimensions decreased and reached 2.5 × 1.8 cm at the time of discharge (50 days after onset). Two months after onset, the ulcer had epithelialized and medical dressings were unnecessary. Four months after onset, it had completely healed. We propose that Kampo medicine is effective for diabetic foot syndrome when combined with conventional therapy, and that healing occurs earlier than with conventional therapy alone.

<b>2 Cases of Children Successfully Administered Kampo Formulae that Included Bushi or Uzu </b> / 日本東洋医学雑誌

We administered a Kampo decoction containing bushi (prepared aconiti tuber) or uzu (un-prepared aconiti tuber) to two children in Aso Iizuka hospital. Case 1 was a thirteen year-old girl with atopic dermatitis that worsened after her topical steroid was stopped. When her itching sensation was reduced following a bath, we considered that she was suffering from coldness. Therefore we administered a half dose of bukuryoshigyakuto.The next morning her old skin flaked off and her skin appeared healthy. We administered bukuryoshigyakuto before every meal and there was rapid improvement in her dermatitis. Case 2 was a twelve year-old girl with orthostatic dysregulation who was unable to attend school. She had become aware of coldness the previous autumn and had not been able to go to school, nor even sit up, since the previous winter because of severe fatigue. We diagnosed her with severe coldness and so started sekiganryo administration, and included 2 g of uzu. We gradually increased the uzu. At a result, her severe fatigue improved to the extent that she could eat breakfast and go to school inside the hospital. Children may have severe coldness if they suffer from a long-term illness. Moreover, particular attention should be given to toxicity caused by aconiti tuber.