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.

<b>Japanese Literature Survey of Tongue Findings for the Purpose of Creating a Unified Multicenter Description of Clinical Tongue Diagnoses</b> / 日本東洋医学雑誌

In Kampo medicine, a tongue examination, whereby the shape and color of the tongue is observed, is thought to reveal the constitution and condition of the patient. In Japan, numerous books on this tongue examination have been published. However, tongue findings are expressed differently in these books, and a standard description for such findings has yet to be established. A standard description would be useful when examining the tongue, and when educating students of Kampo medicine. We therefore compared how tongue colors and shapes were expressed in the Japanese literature on tongue examinations (12 publications).<br>Using these results, we have arrived at a standardized description for tongue findings in accordance with Kampo specialists of tongue diagnoses at many facilities. In the process, we focused on easily recognizable findings that can be noted with short clinical examination times, and that can also be understood by beginners.

Questionnaire Survey on Kampo Medicines for Patients Under 19 Years Old / 日本東洋医学雑誌

To investigate the difficulties of taking Japanese traditional (Kampo) medicines, questionnaires were filled out by patients under 19 years old or their families.Forty-six questionnaires were valid for analysis. The mean age of the patients was 9.7 &qlusmn; 5.3 years old (2 to 19 years old) and the percentage of male patients was high (65%). They took extract granules (n = 40) or decoction (n = 6) and most of the patients (n = 38, 83%) took medicines twice a day. Though 69% of patients under 5 years old needed direct assistance from their family to take medicines, none of over 6 years of age needed any help except to dissolve medicines in hot water, while notably 77% of the patients over 13 years old took their medicines un-aided. It was found that patients' families gave them the concrete explanations on the necessity of their medicines regardless of patients' age, so it is important for pharmacist to guide not only families but also patients themselves. Furthermore, pharmacists should understand the taste and the constituent crude drugs of Kampo medicines to improve patients' adherence in taking medicines.

Incidence of Lactose Intolerance Caused by Administration of Granulated Kampo Extracts / 日本東洋医学雑誌

We consecutively enrolled all patients who visited our Kampo clinic from October 2004 to September 2008, and examined whether or not milk drinking causes abdominal fullness, pain or diarrhea in the patients. Among 3,175 patients enrolled, 35 patients (1.1%) complained of symptoms of milk intolerance. Granulated Kampo extracts containing lactose were administered to 20 patients among the 35 patients, but these Kampo extracts did not cause symptoms of lactose intolerance in 13 patients among the 20 patients. The true incidence of lactose intolerance caused by granulated Kampo extracts may be smaller than 1% at most.

Six Cases with \lqHonton\rq Disease Successfully Treated with Combination of Goshuyuto Extract and Ryokeijutsukanto Extract / 日本東洋医学雑誌

We report six cases with honton disease successfully treated with a combination of goshuyuto extract and ryokeijutsukanto extract. Five of the cases were diagnosed as panic disorder, and the remaining case as generalized anxiety disorder. All six cases complained of palpitation, nausea, dizziness, headache and anxiety attacks. We diagnosed them as a hontonto (Zhouhou fang) indication. Their various complaints disappeared after combination therapy with those extracts. Furthermore, efficacy of the combination therapy was proven to be equal to hontonto. These cases suggest that the combination therapy with goshuyuto extract and ryokeijutsukanto extract is useful in place of hontonto.

Two Cases of Complaints after Abdominal Operation Successfully Treated with Kososanryo / 日本東洋医学雑誌

Although a laparotomy itself may be successful, various complaints, whose organic causes are not definite, occasionally arise afterwards. We report two cases of complaints after abdominal operations successfully treated with kososanryo. The chief complaints were anorexia in Case 1, and anxiety in Case 2. We treated the pathological states in these cases as qi stagnation, or qi obstruction in Japanese-oriental medicine sense. The symptoms in these cases improved soon after administration of kososanryo, which is traditionally used for qi stagnation. On closer investigation, we first report that kososanryo is useful for complaints after abdominal operations. Complaints after various operations lower quality of life and, what is even worse, may cause unreliability of medical treatment. The present cases suggest that Japanese-oriental medicine has therapeutic utility in the therapy of complaints after various operations.

The Revealing of Problems Concerning about Treatment of Kampo Formulae in Hospitalization / 日本東洋医学雑誌

Aims : To clarify any difficulties that pharmacists and nurses may have when prescribing Kampo medicines to newly-admitted patients with a survey questionnaire at a local hospital ward.Methods : Questions for pharmacists on the handling of Kampo herbs, any perceived risks in the preparation of Kampo formulae powder extracts/pills, or in explaining Kampo medicines, based on their experiences. Also questions for nurses on the handling of Kampo medicines, as compared to western medicines, and any perceived risks in their administration at their ward.Result : All 7 pharmacists and 14 out of the 16 nurses surveyed completed their questionnaires. The pharmacists pointed out that Kampo preparation takes more time, although none perceived an increased risk with Kampo medicines, as compared to western medicines. Only 1 pharmacist had ever had experience explaining Kampo medicines to patients. The nurses, on the other hand, felt that Kampo treatments were somewhat more difficult to use, and perceived similar risk in their administration to patients.Conclusion : Both the pharmacists and nurses surveyed believed that the handling of herb medicines was somewhat difficult, but that these difficulties could be overcome with risk management. This suggests that pharmacist, nurse and office personnel education would be useful before Kampo medicines are administered to newly-admitted hospital patients.

Six Cases with 'Honton' Disease Successfully Treated with Combination of Goshuyuto Extract and Ryokeijutsukanto Extract / 日本東洋医学雑誌

We report six cases with <I>honton</I> disease successfully treated with a combination of goshuyuto extract and ryokeijutsukanto extract. Five of the cases were diagnosed as panic disorder, and the remaining case as generalized anxiety disorder. All six cases complained of palpitation, nausea, dizziness, headache and anxiety attacks. We diagnosed them as a hontonto (<I>Zhouhou fang</I>) indication. Their various complaints disappeared after combination therapy with those extracts. Furthermore, efficacy of the combination therapy was proven to be equal to hontonto. These cases suggest that the combination therapy with goshuyuto extract and ryokeijutsukanto extract is useful in place of hontonto.

Six Cases with 'Honton' Disease Successfully Treated with Combination of Goshuyuto Extract and Ryokeijutsukanto Extract / 日本東洋医学雑誌

We report six cases with <I>honton</I> disease successfully treated with a combination of goshuyuto extract and ryokeijutsukanto extract. Five of the cases were diagnosed as panic disorder, and the remaining case as generalized anxiety disorder. All six cases complained of palpitation, nausea, dizziness, headache and anxiety attacks. We diagnosed them as a hontonto (<I>Zhouhou fang</I>) indication. Their various complaints disappeared after combination therapy with those extracts. Furthermore, efficacy of the combination therapy was proven to be equal to hontonto. These cases suggest that the combination therapy with goshuyuto extract and ryokeijutsukanto extract is useful in place of hontonto.

Six Cases with ‘Honton’ Disease Successfully Treated with Combination of Goshuyuto Extract and Ryokeijutsukanto Extract / 日本東洋医学雑誌

We report six cases with honton disease successfully treated with a combination of goshuyuto extract and ryokeijutsukanto extract. Five of the cases were diagnosed as panic disorder, and the remaining case as generalized anxiety disorder. All six cases complained of palpitation, nausea, dizziness, headache and anxiety attacks. We diagnosed them as a hontonto (Zhouhou fang) indication. Their various complaints disappeared after combination therapy with those extracts. Furthermore, efficacy of the combination therapy was proven to be equal to hontonto. These cases suggest that the combination therapy with goshuyuto extract and ryokeijutsukanto extract is useful in place of hontonto.

One Case of Imatinib Mesylate-Associated Diarrhea Successfully Treated with HANGESHASHINTO / 日本東洋医学雑誌

Imatinib mesylate, a specific inhibitor of BCR-ABL tyrosine kinase, has been mainly used for the management of chronic myeloid leukemia (CML). Common side effects of imatinib include hematologic toxicity, liver dysfunction, edema, fluid retention, gastrointestinal symptoms, and skin rashes among others. We experienced a patient with imatinib-associated diarrhea, who was successfully treated with hangeshashinto. The patient was 61 year-old female, who first consulted our clinic in June, 2005. Her complaint was frequent diarrhea(4 or 5 times a day) which occurred after the introduction of imatinib. Four weeks after hangeshashinto was administered, her bowel movement improved from watery diarrhea to loose stool twice a day. Eight weeks later, her symptom disappeared. It is generally accepted that imatinib should be administered continuously to obtain a complete clinical remission of CML. From the viewpoint of eastern and western medicine integration, it is significant that a Kampo medicine contributed to continuous therapy with imatinib.

Consideration to Clinical Indication of Boiogito / 日本東洋医学雑誌

Boiogito, which has been used for obesity, edema and arthritis by using flabby constitution as a clinical indication, is mentioned in Jin Kui Yao Lue (Synopsis of the Golden Chamber). We experienced five cases of wind-wetness syndrome or edema caused by the pathogen Wind successfully treated with boiogito. There were common findings in these cases, i.e., heavy sweating or perspiration while sleeping, chilly feelings and worsening of the evening subjective symptoms and pulse diagnoses, such as floating, string-like and congested pulse in objective findings. On the basis of these cases, we investigated the efficacy of boiogito extract in 10 patients having the all of common findings mentioned above. As a result, boiogito improved symptoms in 8 patients. This suggests that medical examination by interview and distinctive pulsation are important in deciding the Kampo diagnosis for boiogito.

Clinical Application of Juzentaihoto for Skin Diseases and its Possible Mechanism / 日本東洋医学雑誌

We report three cases of skin disease successfully treated with juzentaihoto. Juzentaihoto has been used traditionally for deficiency of both Ki and Ketsu, and, at present, clinically for the treatment of various skin diseases. Toll-like receptors (TLRs) have recently been characterized as the receptors of innate immunity, which are mainly expressed on antigen-presenting cells. We previously reported that juzentaihoto enhanced interleukin-12 (IL-12) and interferon-γ (IFN-γ) production through modulation of TLR4signaling pathways in murine peritoneal exudative macrophages. Since Langerhans cells, a kind of the antigen-presenting cell, are known to exist in epidermis, we speculate that juzentaihoto improves T helper1and 2 (Th 1/2) balance through modulation of TLR signaling pathways in Langerhans cells. Our cases suggest that influence to acquired immunity through the innate immune signaling is assumed to be one of the mechanisms of juzentaihoto for controlling morbid states of the skin.

The Evaluation of Handy Objective Indicator of Skin Moisture and Its Clinical Usefulness in Kampo Medicine / 日本東洋医学雑誌

Objects : The purpose of this study is to evaluate objective measurements of skin moisture and its usefulness in the Kampo clinic.Methods : We measured the skin moisture of 6 male volunteers using a sensor twice, in a one to two week interval, and calculated the correlation of both data sets at 66 points. Secondly, we compared the skin moisture data at 10 regions in 81 patients without any skin disease, in a wide age range from 30 s to early 70 s. The ten regions measured were : face, chest, back, abdomen, leg and 4 forearm points, i.e. the inside and outside of the bilateral center forearm, and palm.Results : The correlation of two successively measured data sets showed excellent relation (r=0.716, p<0.0001). The sensor measurement of skin moisture was quite reliable. Measurements of the face, chest and back showed them to be significantly wetter than the abdomen, leg or any of the 4 forearm points. Palm measurements indicated a wetter tendency than for any forearm measurements. Back and abdomen measurements in males were significantly wetter than those in females. There were no significant differences among the data sets, with regards to age. Therefore, any forearm points are clinically useful for the standard measurement of skin moisture. We also demonstrated a case in which skin moisture measurements with a sensor were useful in prescribing and observing the effects of shigyakusan.Conclusion : Utilizing this method may be helpful in acquiring much more objective measurements for Kampo medicine.

Importance of \lq\lqQuestion and Answer\rq\rq about Psychological Background in Cases of Chronic Urticaria Successfully Treated with Kampo Therapy / 日本東洋医学雑誌

We experienced four cases of urticaria (two patients with cholinergic urticaria, one patient with chronic idiopathic urticaria and one patient with cold urticaria) successfully treated with Kampo therapy. The factors for outbreak or aggravation of urticaria were stress of looking after the father in law and hysterectomy in the first case, psychological stress due to familial trouble in the second case, panic disorder like episode in the third case, and solicitude and anxiety for family in the fourth case. The effective Kampo formulae that improved the dermatological symptom were keishibukuryogan, hangekobokuto, yokukansankachimpihange and kamishoyosan, respectively. It was helpful that to clarify the psychological background affecting the dermatological symptom in the determination of Kampo formulae. It would be useful that careful and repetitious question and answer about psychological background in the treatment of intractable urticaria.

For Universal Understanding of Kampo Medicine in which Context is a Keyword / 日本東洋医学雑誌

In order to have a more “universal understanding” of Kampo medicine, it helps to explain the “fundamental concepts” and the “theoretical framework” of Kampo medicine, in latest life science knowledge with a key word “context.”Ki, Ketsu and Sui are the three elements which compose the cellular environment (context), and shoulder the maintenance of life's activities, which are dependent on metabolic changes and information flow. The function and structure of the living body are normally led by Ki, Ketsu and Sui.The five parenchymatous viscera (lungs, heart, liver, spleen, kidneys) are not only organs which maintain the cellular environment, they also act as higher control systems which control organ activities. These five viscera as higher control systems create conditions (context) throughout the body and control the life activities of each organ in an integrated manner.In a sick person, these organ life activities take on a kind of “fighting style” which can change from moment to moment, with natural disease progression and/or treatment intervention. The classic text Shokanron describes these changes in fighting style as the “six stages of disease”, and indicates formulation choices based on variations in the body's fighting style.From the viewpoint of a connection with Western medicine and a dialog with traditional Chinese medicine, explaining Kampo medicine in ways which anyone can understand by creating a universal understanding of its fundamental concepts and theoretical framework, is our mission for the 21st Century.

Practical Application of Yokukansankachimpihange for Prevention of Chronic Headache / 日本東洋医学雑誌

Yokukansankachimpihange has been applied to practical use for some indications such as irritability, excitability, anxiety and insomnia. We report 6 cases of chronic headache patients (tension-type headache [1], migraine [2] and mixed-type headache [3]) with the significant pulsation at pit of stomach and navel, who were successfully treated with Yoku-kan-san-ka-chimpi-hange for prophylaxis. These findings suggest that Yokukansankachimpihange might be useful for not only tension-type headache but also migraine and mixed-type headache.

Importance of "Question and Answer" about Psychological Background in Cases of Chronic Urticaria Successfully Treated with Kampo Therapy / 日本東洋医学雑誌

We experienced four cases of urticaria (two patients with cholinergic urticaria, one patient with chronic idiopathic urticaria and one patient with cold urticaria) successfully treated with Kampo therapy. The factors for outbreak or aggravation of urticaria were stress of looking after the father in law and hysterectomy in the first case, psychological stress due to familial trouble in the second case, panic disorder like episode in the third case, and solicitude and anxiety for family in the fourth case. The effective Kampo formulae that improved the dermatological symptom were keishibukuryogan, hangekobokuto, yokukansankachimpihange and kamishoyosan, respectively. It was helpful that to clarify the psychological background affecting the dermatological symptom in the determination of Kampo formulae. It would be useful that careful and repetitious question and answer about psychological background in the treatment of intractable urticaria.

Investigation of Clinical Indications of Choyoto based on 9 Effective Cases / 日本東洋医学雑誌

Choyo-to, which has long been used for acute and chronic intestinal disease, dermatological disorders and pulmonary abscess, is attributed to the writings of 7th Century physician Sun Simiao, known as the “Qian-jinyao-fang”. We have also successfully treated nine different patients suffering from various diseases, using Choyo-to. In most of these cases, patients complained of constipation. Thus far, our modern experience suggests that Choyo-to may be indicated for not only right-side pain upon naval palpitation, pressure sensation at the ileocecum and excessive strain of abdominal muscles, but also for cases of dry skin, edematous skin and tendency of normal tongue color.

Clinical Indications of Kumibinroto / 日本東洋医学雑誌

Kumibinroto is a Kampo formulation which was first produced by Sohaku Asada (1815-1894) and which has since been used for patients with stasis of body fluids presenting beriberi like symptoms. Previously, we reported that tympanic sounds on right side of the abdomen might be an indication for the use of kumibinroto. In this study, having both symptoms with stasis of body fluids, and tympanic sounds on right side of the abdomen were used as a target when prescribing kumibinroto. To the best our knowledge, the present study was the first to demonstrate that the effects of kumibinroto give significant improvement in dermatological disorders such as chronic prurigo, cutaneous pruritis and chronic urticaria, and susceptibility to chills. These findings suggest that tympanic sounds on right side of the abdomen may an extremely useful indicator for kumibinroto, and position it for practical use for various disorders, for which it has not been formerly used.