Kampo Medicine in the 21st Century / 日本東洋医学雑誌

As the 21st century advances, evidence-based medicine (EBM) has come to be regarded as essential in all field of medical sciences and practical medicine. Creating medicines have been searching for based on EBM and development of new medicine has been carried out.In Japan the number of diabetic patients has increased to 129% during recent 10 years. The number of diabetic complications has also increased and hemodyalysis has been introduced in approximately 16,000 patients/year with diabetic nephropathy in Japan in 2008.Additinally many diabetic patients are suffering from numbness, cold sensation and pains in extremities derived from diabetic neuropathy. Therefore reduction of diabetic complications is one of the most important considerations in the field of diabetic patient care.Diabetes mellitus is equivalent to wasting-thirst in Jomgiiyaolue.We have reported the effectiveness of Goshajinkigan (GJG) for the treatment of nembness associated with diabetic neuropathy for the first time in Japan in 1984.In controlled comparative study, GJG showed significantly higher rates of improvement of this symptom versus mechobalamin.Insulin resistance has an important role on the occurrence of type 2 diabetes and metabolic syndrome.We have studies the effects of Kampo medicine on the insulin resistance using the euglycemic clamp and molecular biological techniques.1) Animal experimental studies: The improvement of insulin resistance in STZ rats by the administration of GJG might be via NO pathway and due, at least in part, to correct in the abnormal early steps of insulin signaling pathway in skeletal muscle.2) Clinical Studies: Effects of GJG on insulin resistance in patients with type 2 diabetes were investigated. HOMA-R was significantly decreased after GJG treatment (P=0.019). On the other hand, HOMA-R in the control group did not show significant difference. HOMA-R returned to the pre GJG treatment level1month after GJG discontinuation (P=0.018). The high-dose clamp resulted in a significantly increased insulin action (MCR levels) after GJG treatment.These animal experimental and clinical studies suggest that GJG might be effective for improving insulin resistance in the patients with type 2 diabetes.Kampo formulations might be useful not only for the prevention and the treatment of diabetic complications but also effective for the prevention and treatment of type 2 diabetes.In conclusion GJG has been used for the treatment of numbness and dysnuria since the statement in Yanshijishengfang. We have found the effectiveness of GJG on the treatment of diabetic neuropathy and on the prevention and the treatment of type 2 diabetes. We would like to continue these scientific activities.

Analysis of risk factors for dental caries in infants: a comparison between urban and rural areas

<p><b>OBJECTIVES</b>This study investigated the incidence of caries in infants and explored the risk factors related to noteworthy variations between urban and rural areas.</p><p><b>METHODS</b>Subjects were 232 infants (111 males and 121 females) aged 1.6 and 3 years born in "N" town between the fiscal years of 1997 and 2001. Infants aged 1.6 and 3 years had 99.6 and 100% participation in health checkups, respectively. Of the total, 148 and 84 infants were living in the urban and rural areas, respectively, of "N" town.</p><p><b>RESULTS</b>Caries incidence and the average number of carious teeth (decayed/missing/filled teeth, dmft) for infants aged 1.6 years were significantly higher in the rural area than in the urban area, indicating that environmental factors that predispose infants to develop dental caries exist in the rural area. In addition, logistic regression analysis for infants in each of the two areas revealed that risk factors of the child-care environment, for example living with grandparents and brushing by parents, stood in marked contrast with each other. Moreover, the odds ratio of the risk factor dozing off while drinking showed a marked difference between the areas, although this risk factor was common in both areas.</p><p><b>CONCLUSIONS</b>The results of this study indicated that several factors of the child-care environment, for example the daytime caring person, are related with caries development. Scientific elucidation of the risk factors that give rise to high prevalence of caries in specific regions and access to the whole picture of the disease mechanism may have great potential to lead to the development of effective countermeasures and to contribute to the reduction of dental caries in preschool children.</p>

Relationship between the Metabolic Syndrome and Abdominal Tension / 日本東洋医学雑誌

Metabolic syndrome develops because of an accumulation of intra-abdominal fat. In Kampo medicine, an abdominal examination is commonly performed for the diagnosis of diseases. Thus, we examined the relationship between metabolic syndrome and abdominal tension. Our subjects were 999 people (619 males and 380 females) who underwent regular physical check-ups. Metabolic syndrome was diagnosed in 14.5% (21.3% of males and 3.4% of females) and the prevalence rate of subjects with metabolic and pre-metabolic syndromes was 40.8% (55.9% of males and 16.3% of females). In addition, abdominal examinations detected 19.1% of hyperfunction, 64.6% of intermediate function, and 16.3% of hypofunction. Almost subjects with abdominal hyperfunction were classified as metabolic or pre-metabolic syndrome, and neither metabolic nor pre-metabolic syndrome was present in subjects with abdominal hypofunction. In conclusion, assessment of abdominal tension may become an additional valuable screening method for metabolic syndrome.

Cumulative fatigue symptoms among caregivers in Japan

<p><b>OBJECTIVE</b>To investigate the relationship of cumulative fatigue symptoms among caregivers in Japan with work environment issues and lifestyle behaviors.</p><p><b>METHODS</b>The subjects were 376 women (mean age, 54 years) attending professional seminars for caregivers held between 1999 and 2002. After obtaining informed consent, a survey was conducted to ascertain work environment issues, lifestyle behaviors and fatigue levels. Fatigue was quantitatively assessed using the Cumulative Fatigue Symptoms Index (CFSI) developed by Kosugoh et al. Factors related to caregiver fatigue were identified using Pearson's correlation coefficient, the Mann-Whitney U-test and multiple regression analysis.</p><p><b>RESULTS</b>Caregivers who felt an xiety or concern regarding care techniques, care content, personal relationships, work conditions, and physical fitness showed higher CFSI scores, while caregivers who exercised regularly and had proper eating behavior displayed lower CFSI scores. Anxiety/concern regarding physical fitness and proper eating behaviors were identified as significant predictors for all CFSI category scores (P<0.001). Regular exercise behavior (P<0.001), age (P<0.001), and years of work experience (P<0.001) also represented significant independent variables for some CFSI categories.</p><p><b>CONCLUSION</b>Our results suggest that upgrading the knowledge and skills of care and nursing and modifying lifestyle behaviors could reduce the level of fatigue experienced by caregivers.</p>

The Treatment Strategy for Diabetes Mellitus by Kampo Medicine / 日本東洋医学雑誌

Recently in Japan, the numbers of diabetic patients have been increased to 7.4 million and to 16.2 millions if the subjects of impaired glucose tolerance are added. Most Japanese diabetic patients are type 2 (non-insulin dependent). Decreased secretion of insulin and insulin resistance play important roles on the occurrence and progression of type 2 diabetes.<br>Long-established systems of traditional medicine have evolved from systematic recordings of human evidence for more than 3 thousands years. In addition the traditional Chinese medicinal philosophy is one of the oldest medical sciences in the world and has a long-standing history in the usage of herbal medicinals. Nowadays the use of complementary/alternative medicine and especially the consumption of botanicals has been increasing rapidly worldwide.<br>1. Clinical Studies<br>The management of diabetic neuropathy is one of the most difficult clinical problems. Among 65 patients with diabetic neuropathy who suffered from numbness of lower extremities 43 (66.2%) experienced some degree of improvement after oral administration of Goshajinkigan (GJG). Following our first report, more than 10 papers were published in Japan and almost same results were obtained. In a well-controlled comparative study, the efficacy of GJG and mecobalamin in diabetic neuropathy was estimated. After oral administration of GJG, the general improvement rate was 80.0%, while it was 48.1% in mecobalamin. The difference between the two groups was statistically significant (P<0.01). These results suggested that GJG is a useful medicine for amelioration of numbness due to diabetic neuropathy.<br>2. Animal experimental studies<br>Regular physical training has been known to be beneficial in the prevention and the treatment of life-style related diseases such as type 2 diabetes. However, it is very difficult for diabetic patients to continue physical exercise training for a long time. Troglitazone has insulin-sensitizing actions but it withdrew because of severe fatal hepato-toxic actions. Therefore development of insulin-sensitizing medicine without significant side-effects have been expected.<br>Chinese herbal medicine has less frequent side effects when compared to modern western medicine.<br>In the present study, the effect of GJG on insulin resistance in streptozotocin (STZ, 50mg kg^-1 BW, ivy.)-induced diabetic rats was examined by means of the euglycemic clamp procedure.<br>The improvement of impaired insulin action in STZ-diabetic rats by single and repeated administration of GJG may be due, at least in part, to enhance insulin signaling, and subsequent ameliorated production of NO. In conclusion, <br>(1) Diagnosis and primary treatment to reduce blood glucose including diet, exercise, oral hypoglycemic agents and insulin should be practiced by western style medical sciences. (2) Kampo medication is useful for the prevention and treatment of diabetic complications. (3) Kampo medicine has the possibility of prevention of type 2 diabetes.

Cumulative Fatigue Symptoms among Caregivers in Japan

Objective: To investigate the relationship of cumulative fatigue symptoms among caregivers in Japan with work environment issues and lifestyle behaviors. Methods: The subjects were 376 women (mean age, 54 years) attending professional seminars for caregivers held between 1999 and 2002. After obtaining informed consent, a survey was conducted to ascertain work environment issues, lifestyle behaviors and fatigue levels. Fatigue was quantitatively assessed using the Cumulative Fatigue Symptoms Index (CFSI) developed by Kosugoh et al. Factors related to caregiver fatigue were identified using Pearson’s correlation coefficient, the Mann-Whitney U-test and multiple regression analysis. Results: Caregivers who felt anxiety or concern regarding care techniques, care content, personal relationships, work conditions, and physical fitness showed higher CFSI scores, while caregivers who exercised regularly and had proper eating behavior displayed lower CFSI scores. Anxiety/concern regarding physical fitness and proper eating behaviors were identified as significant predictors for all CFSI category scores (P<0.001). Regular exercise behavior (P<0.001), age (P<0.001), and years of work experience (P<0.001) also represented significant independent variables for some CFSI categories. Conclusion: Our results suggest that upgrading the knowledge and skills of care and nursing and modifying lifestyle behaviors could reduce the level of fatigue experienced by caregivers.

Associations between physical strength, cerebral function and mental health in independent-living elderly Japanese women

<p><b>OBJECTIVES</b>To evaluate the physical strength, cerebral function, and mental health conditions in elderly persons, and to examine the correlation between these functions.</p><p><b>METHODS</b>The subjects were 151 independent-living elderly Japanese women, mean age 70 +/-5 years (+/-SD; range, 60 to 80 years), with normal abilities in daily life. The health check-up was conducted from April to May 1997. Physical strength was estimated by measuring seven activities. Cerebral functions were assessed by six sub-tests of the General Aptitude Test Battery (GATB). Their mental health status was measured by four sub-scales of the General Health Questionnaire (GHQ)-28.</p><p><b>RESULTS</b>The physical strenght and almost all of the cerebral functions decreased with age. Social dysfunction and severe depression on the GHQ sub-scales also worsened with age. Physical strength was strongly correlated with cerebral functions after adjusting for the confounding effect of aging. There were also interrelations between physical strength and mental health.</p><p><b>CONCLUSIONS</b>This study provided important information on the correlation between physical and mental status in elderly women. Future longitudinal studies with the intervention of physical training are required to determine whether a causal relationship exists between these factors.</p>

Associations between Physical Strength, Cerebral Function and Mental Health in Independent-Living Elderly Japanese Women

Objectives: To evaluate the physical strength, cerebral function, and mental health conditions in elderly persons, and to examine the correlation between these functions. Methods: The subjects were 151 independent-living elderly Japanese women, mean age 70 +/− 5 years (+/− SD; range, 60 to 80 years), with normal abilities in daily life. The health check-up was conducted from April to May 1997. Physical strength was estimated by measuring seven activities. Cerebral functions were assessed by six sub-tests of the General Aptitude Test Battery (GATB). Their mental health status was measured by four sub-scales of the General Health Questionnaire (GHQ)-28. Results: The physical strength and almost all of the cerebral functions decreased with age. Social dysfunction and severe depression on the GHQ sub-scales also worsened with age. Physical strength was strongly correlated with cerebral functions after adjusting for the confounding effect of aging. There were also interrelations between physical strength and mental health. Conclusions: This study provided important information on the correlation between physical and mental status in elderly women. Future longitudinal studies with the intervention of physical training are required to determine whether a causal relationship exists between these factors.

The Effect of Daily Walking on Body Fat Distribution

The effect of daily walking on body fat distribution was investigated using an electronic pedometer and ultrasonography. Subjects were 77 women, aged 31 to 72 years. They were divided into four groups according to the average number of steps they walked per day(I<7, 500, 7, 500≤II<10, 000, 10, 000≤III<12, 500, 12, 500≤IV). Subcutaneous fat in the trunk and limbs, and the minimum thickness of subcutaneous fat(Smin) and the maximum thickness of preperitoneal fat(Pmax) below the xiphoid process were measured by ultrasonography. Abdominal wall fat index (AFI) reflecting the intra−abdominal fat accumulation was obtained by dividing Pmax by Smin. Fat distribution was analyzed by ANCOVA, controlled for age, body mass index(BMI), percent body fat, and menopausal status. Energy and macronutrient intake were obtained through a nutritional survey. There were no significant differences in anthropometric variables, energy and macronutrient intake, and subcutaneous fat thickness in trunk and limbs. Pmax of Group I was significantly higher than Group IV. Furthermore. Group I showed significantly higher AFI than the other three Groups (II, III, IV). The results of this study suggested that women who walked less than 7, 500 steps per day tend to have significantly increased intra−abdominal fat accumulation.

Effects of a single period of low-intensity exercise on serum lipoprotein triacylglycerol after an oral fat load / 体力科学

From the viewpoint of atherosclerosis prevention, it is important to examine the effects of exercise on the lipoprotein fraction in the postprandial state. The purpose of this study was to investigate the effects of a single period of low-intensity exercise on serum lipoprotein triacylglycerol (TG) after an oral fat load (50g/body surface area) as exogenous TG. Seven normolipidemic men aged 23.1±1.1 years (mean ± SEM) took part in two trials. The subjects were all young students at a university graduate school. In the exercise trial (Ex), they exercised for 1.5 h on a bicycle ergometer at 35-40% of their maximal oxygen uptake, starting 2 h after ingestion of the fat, and then rested for a further 2 h. In the control trial (Co), they rested for 5.5 h after ingestion of the fat. Lipoprotein and lipid levels were measured in venous blood taken during the fasted state and at different intervals between the two trials for 5.5 h after the fat load. Serum total TG and high-density lipoprotein (HDL) TG decreased significantly in Ex from 3.5 to 5.5h (p<0.05, p<0.01) in comparison with Co. These results indicate that a single period of low-intensity exercise reduces exogenous serum total TG and HDL-TG.

Component elements of daily walking activities among the residents of a care-house for female aged people / 体力科学

The purpose of this study was to clarify various components of walking activities among the high aged people, in relation with physique and heart rates at rest and post exercise recovery period. Subjects are 53 female residents of a care house in Hyogo Prefecture, whose average age being 78.9±0.9 years were tested in various parameters that are relevant to the study, such as height, weight, BMI, resting heart rate, total amount of weekly walking steps (recorded twice, i, e., in September and in October), walking velocity, walking stride, time length for climbing 15 step stairs and self-rate health. the major findings are summarized as follows<BR>(1) Various physical functions that are related to daily activities and therefore related to muscular strength and neuromuscular coordination, were found to decrease significantly upon aging, such as walking velocity and time length for climbing stairs.<BR>(2) The result of multiple correlation regression analysis, taking total amount of weekly walking steps with self-rated health, time length spent for 15 steps of climbing stairs and age were existent.<BR>(3) Walking velocity, walking steps size and stair climbing velocity of good walkers (upper 25% in total amount of weekly walking steps) and it was found that the good walkers walked faster with greater steps size and climbed the stairs faster than the less walking subjects.<BR>(4) The total amount of daily walking steps of various days of the week were compared each other and it was found that the good walkers recorded significantly less amount of walking steps on Thursday than others days. the fact that a large scale shopping center which is located near by the care-house closes on Thursday every week suggests that the amount of walking steps are influenced by social factors, such as shopping behavior.<BR>(5) In terms of the going out behavior outside of care-house, visiting the large scale shopping center (40% of subjects), and hospitals and alike (25%) were recognized. The results suggest that there are certain common elements in the motivation and behavior of out-of- care-house activities.<BR>The above results suggest that the study of walking behavior of the high aged people would be extremely variable not only in assessing the fitness level and physical function of the residents, but also in possible evaluation of efficiencies of the care-house location.

Relationship of health and physical fitness in middle-aged elderly men and women / 体力科学

This study was carried out to determine the relationship between health status and physical fitness, and the contribution of each element of physical fitness to the health status of middle-aged and elderly men and women. The subjects were 889 males and females aged 30 to 69 years. Physical fitness tests and medical check ups were performed. According to health status, the subjects were divided into two groups ; the healthy group (HG, n=348) and the unhealthy group (UG, n=207) . Multiple discriminant analysis was applied to the multivariate data. Correct discriminant probabilities of multiple discriminant functions to discriminate the HG and UG were 70.2% and 68.2% for men and women, respectively. These results suggested that there was a relatively strong relationship between health status and the level of physical fitness in both men and women. The contribution of each element of physical fitness to health status was evaluated by correlation coefficients between the discriminant score representing health status, and performance on each element of the physical fitness test and age. Age and muscle endurance contributed significantly to health status in both men and women. In addition, close relationship was seen between health status and elements of cardiorespiratory endurance, balance, and muscle strength in men, while change in physique correlated with health status in women. From these findings, it was concluded that exercise programs for health promotion in middle-aged and elderly people should be provided separately with consideration of the degree to which these specific elements contribute to health status.

Effects of Rapid Weight Reduction on Protein Metabolism in Boxing Players / 体力科学

The purpose of the present study is to investigate protein metabolism during rapid weight reduction. Six male boxing players put on a restricted diet of their own accord for two weeks. Body weight changes were observed and a biochemical analysis was made of their urine and blood. The initial body weight of 66.1±3.0kg (mean±SE) decreased to 63.6±3.2 kg after two weeks (P<0.01) . The changes in lean body mass (LBM) by weight reduction were not significant, but the LBM tended to decrease after two weeks. The mean caloric intake was 2, 791±728 kcal before the study and 1, 643±548 kcal after two weeks. The reduction of carbohydrate consumption is much more than that of fat and protein consumption. The 3-Me/Cr in urine increased significantly after two weeks (348.1 ± 37.0 μol/g to 508.1 f 45.6 μmol/g, P<0.01) and the increase of Urea-N/Cr in urine (8.4±0.5mg/mg creatinine to 13.7±1.3mg/mg creatinine, P<0.01) was also significant after two weeks. Urine volume decreased significantly after two weeks (P<0.01) . There was no significant difference in the blood components during the weight reduction period. These results might suggest that rapid weight reduction and massive decrease of carbohydrate intake accelerate protein catabolism.

Effects of different types of physical training on insulin action in human peripheral tissues. Use of the euglycemic clamp technique / 体力科学

Physical training has been shown to improve glucose tolerance and insulin action in peripheral tissues. In the present study, regular (R) and high (H) -dose euglycemic clamp procedures were performed to determine the effects of different types of physical training on insulin action (sensitivity/responsiveness) in 10 long-distance runners (LR), 10 weight-lifters (WL) and 12 healthy controls (HC), The amount of infused glucose (glucose metabolism, GM) during euglycemic clamping is a measure of the peripheral tissue sensitivity and/or responsiveness to insulin. For R clamping, when GM was calculated per unit body weight (BW), GM in LR (11.92±1.22 mg/kg BW·min) and WL (9.28±0.63 mg/kg BW·min) was significantly (P<0.05) higher than that in HC (7.44±0.39 mg/kg BW·min) . When calculated per unit lean body mass (LBM), LR (15.07±1.56 mg/kg LBM·min) differed from HC (9, 15±0.59 mg/kg LBM·min, P<0.05), whereas the value in WL (11.50±0.93mg/kg LBM·min) was identical to that in HC. For H clamping, there was no significant change in these three groups when GM was calculated per unit BW or LBM. These results suggest that enhancement of insulin action by physical training is due to an increase in insulin sensitivity, rather than to an increase in insulin responsiveness, and that aerobic exercise, for example long-distance running, is more effective for the improvement of decreased sensitivity to insulin, which is observed in patients with simple obesity and diabetes, than anaerobic exercise such as weight-lifting.

Serum lipid levels in female handball players / 体力科学

Serum lipid levels in female handball players were studied. A group of well trained female handball players, in comparison with a group of less active females, had a significantly lower level of triglyceride, higher levels of HDL-cholesterol and HDL<SUB>2</SUB>-Cholesterol subfractions, and higher apolipoprotein A-I and LCAT activities. The ratio of apolipoprotein B/apolipoprotein A-I, as an atherogenic index, was also significantly lower in the handball players. These results suggest that prolonged regular exercise such as handball training may produce favorable changes in serum lipids, thus helping to prevent and reduce the incidence of atherosclerosis.

Studies on the relationship between physical training and immunity. (I). Effect of acute physical exercise on immunity of untrained subjects / 体力科学

In order to clarify the relationship between acute physical exercise and immunity, the numbers of overall leucocytes, lymphocytes and neutrophils, the concentrations of immunoglo-bulins and complements, the ratios of lymphocyte subsets (OKT 3, 4, 8, Leu 7, OKIa 1) and the levels of lymphocyte transformation response to PHA were measured in nine untrained male subjects (18-22 years old) before, immediately after, along with 24 and 72 hours after acute physical exercise at 50% of VO<SUB>2</SUB>max for 2 hours. Before exercise all components were within normal range. Exercise produced a significant rise in the number of leucocytes and neutrophils overall. The response of lymphocytes to PHA immediately after exercise was significantly lower than before, or 24 hours or 72 hours after exercise.<BR>There was no change in the number of lymphocytes, or in the concentration of immunoglo-bulins and complements before and after exercise. Likewise the ratios of lymphocyte subsets also remained unchanged.<BR>From these results, it can be concluded that acute physical exercise by untrained subjects is one kind of physical stressor and can contribute to T cell dysfunction.

Improvement of high glucose toxicity-induced insulin desensitivity by nitric oxide in diabetic rats / 中华内分泌代谢杂志

Objective To observe whether nitric oxide (NO) improves high glucose toxicity induced insulin resistance in streptozotocin (STZ) induced diabetic rats. Methods The changes of metabolic clearance rate for glucose (MCR), as the index of insulin effect, were observed in 24 STZ induced diabetic rats and 24 normal rats in awake condition treated by sodium nitroprusside (SNP), N G monomethyl L arginine (LNMMA), adenosine or saline duringeuglycemichyperinsulinemiaclampprocedure.Results MCR in saline treated diabetic rats 〔(7.2?0.8)ml?kg -1 ?min -1 〕 wassignificantlylowerthanthat in normol control rats 〔(18.0?1.8)ml?kg -1 ?min -1 , P