Reflux-related Extraesophageal Symptoms Until Proven Otherwise: A Direct Measurement of Abnormal Proximal Exposure Based on Hypopharyngeal Multichannel Intraluminal Impedance as a Reliable Indicator for Successful Treatment Outcomes

Background/Aims@#The Lyon Consensus defined parameters based on upper endoscopy and 24-hour combined multichannel intraluminal impedancepH (MII-pH), that conclusively establish the presence of gastroesophageal reflux disease (GERD). However, the true role of upper endoscopy and MII-pH to evaluate patients with extraesophageal symptoms (EES) has not been well established. Hypopharyngeal MII (HMII), which directly measures laryngopharyngeal reflux (LPR) events, has been utilized to evaluate patients with EES suggestive of LPR. @*Methods@#This was a retrospective study involving patients with EES for > 12 weeks despite proton pump inhibitor therapy, and had no endoscopic confirmatory evidence for GERD and negative MII-pH. All patients were subsequently referred for further evaluation of EES with “unknown” etiology and underwent laryngoscopy and HMII. Based on HMII, abnormal proximal exposure (APE) was defined as LPR ≥ 1/day and/or full column reflux (reflux 2 cm distal to the upper esophageal sphincter) > 4/day. Patients with APE were offered antireflux surgery (ARS) and the outcome of ARS was objectively assessed using Reflux Symptom Index. @*Results@#Of 21 patients with EES which was thought to be GERD-unrelated based on endoscopy and MII-pH, 17 patients (81%) had APE. Eight patients with APE who had undergone ARS had significant symptomatic improvement in the Reflux Symptom Index score (19.6 ± 4.9 pre-ARS to 5.8 ± 1.4 post-ARS, P = 0.008). @*Conclusions@#A conventional diagnostic approach using endoscopy and MII-pH may not be sufficient to evaluate patients with EES suggestive of LPR. HMII is essential to evaluate patients with EES, and APE could be a reliable indicator for successful treatment outcomes.

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.

Clinical Characteristics of Esophageal Motility Disorders in Patients With Heartburn

Background/Aims@#Esophageal motility disorders (EMDs) contribute to the pathophysiology of gastroesophageal reflux disease. However, the causes of EMDs and their impact on gastroesophageal reflux disease-associated symptoms remain unknown. This study aims to elucidate clinical features associated with various types of EMDs in patients with heartburn symptoms. @*Methods@#Of the 511 patients who underwent high-resolution manometry, 394 who were evaluated for heartburn symptoms were examined. Patients subjected to high-resolution manometry were classified into 4 groups: outflow obstruction group, hypermotility group, hypomotility group, and normal motility group. Symptoms were evaluated using 3 questionnaires. Patient characteristics and symptoms for each EMD type were compared with those of the normal motility group. @*Results@#Of the 394 patients, 193 (48.9%) were diagnosed with EMDs, including 71 with outflow obstruction, 15 with hypermotility, and 107 with hypomotility. The mean dysphagia score was significantly higher in each of the 3 EMD groups compared with those with normal motility. The mean acid reflux and dyspepsia scores were significantly lower in the outflow obstruction group (P < 0.05). The mean body mass index and median Brinkman index were significantly higher in the hypermotility group (P = 0.001 and P = 0.018, respectively), whereas the mean diarrhea and constipation scores were significantly lower in the hypomotility group (P < 0.05). @*Conclusions@#The results of our study indicate that different EMDs have distinct characteristics. Cigarette smoking and high body mass index were associated with esophageal hypermotility. Assessment of the dysphagia symptom scores may help identify patients with EMDs.

Clinical Characteristics of Esophageal Motility Disorders in Patients With Heartburn

Background/Aims@#Esophageal motility disorders (EMDs) contribute to the pathophysiology of gastroesophageal reflux disease. However, the causes of EMDs and their impact on gastroesophageal reflux disease-associated symptoms remain unknown. This study aims to elucidate clinical features associated with various types of EMDs in patients with heartburn symptoms. @*Methods@#Of the 511 patients who underwent high-resolution manometry, 394 who were evaluated for heartburn symptoms were examined. Patients subjected to high-resolution manometry were classified into 4 groups: outflow obstruction group, hypermotility group, hypomotility group, and normal motility group. Symptoms were evaluated using 3 questionnaires. Patient characteristics and symptoms for each EMD type were compared with those of the normal motility group. @*Results@#Of the 394 patients, 193 (48.9%) were diagnosed with EMDs, including 71 with outflow obstruction, 15 with hypermotility, and 107 with hypomotility. The mean dysphagia score was significantly higher in each of the 3 EMD groups compared with those with normal motility. The mean acid reflux and dyspepsia scores were significantly lower in the outflow obstruction group (P < 0.05). The mean body mass index and median Brinkman index were significantly higher in the hypermotility group (P = 0.001 and P = 0.018, respectively), whereas the mean diarrhea and constipation scores were significantly lower in the hypomotility group (P < 0.05). @*Conclusions@#The results of our study indicate that different EMDs have distinct characteristics. Cigarette smoking and high body mass index were associated with esophageal hypermotility. Assessment of the dysphagia symptom scores may help identify patients with EMDs.

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.

Switching to systemic therapy after locoregionaltreatment failure: Definition and best timing

In patients with unresectable hepatocellular carcinoma (HCC) without both macrovascular invasion and extrahepatic metastasis, the initial treatment choice recommended is transarterial chemoembolization (TACE). Before sorafenib came into wide use, TACE had been pointlessly carried out repeatedly. It was in the early 2010s that the concept of TACE refractory was advocated. Two retrospective studies from Japan indicated that conversion from TACE to sorafenib the day after patients were deemed as TACE refractory improved overall survival compared with continued TACE, according to the definition by the Japan Society of Hepatology. Nowadays, phase 3 trials have shown clinical benefits of several novel molecular target agents. Compared with the era of sorafenib, sequential treatments with these molecular target agents have gradually prolonged patients’ survival and have become major strategies in patients with HCC. Taking these together, conversion from TACE to systemic therapies at the time of TACE refractory, compared with before, may have a greater impact on survival and may be considered deeper in the decisions-making process in patients with unresectable HCC who are candidate for TACE. Up-to-date information on the concept of TACE refractory is summarized in this review. We believe that the survival of patients with unresectable HCC without both macrovascular invasion and extrahepatic metastasis may be dramatically improved by optimal timing of TACE refractory and switching to systemic therapies.

Effectiveness of Subcutaneous Suture in Prevention of Surgical Site Infection after Pancreaticduodenectomy / 日本農村医学会雑誌

　　[Purpose] We introduced subcutaneous suture with a synthetic absorption thread and examined its efficacy on surgical site infection after pancreaticduodenectomy (PD). [Method] In hour hospitals, PD was performed in a total of 69 cases from March 2006 through March 2014. They was divided into two groups-one consisting of 31 cases in which the skin wounds with staplers (non-subcutaneous suture group), and the other consisting of 38 cases in which surgical wounds were closed with subcutaneous sutures (subcutaneous suture group), and the incidence of surgical site infection (SSI) were compared between the two groups. [Result] Incidence of surface SSI occurred in eight cases (21.0%) in the non- subcutaneous suture group and three cases (9.7%) in the subcutaneous suture group (p＝0.17). The incidence of SSI was decreased in the subcutaneous suture group than in the non-subcutaneous suture group, but no statistically significant difference was observed between the two groups. However, taking into account the advantages such as the reduction of patient’s medical expenses, and the burden of ward duties, further examination with an additional number of patients was thought to be necessary.

Current Status of Kampo Medicine in Community Health Care / General Medicine

<b>Background:</b> Kampo medicine is the traditional form of medicine practiced in Japan, based on ancient Chinese medicine. Kampo medicine includes acupuncture and moxibustion, as well as herbal medicine. Physicians are allowed to prescribe ethical Kampo extract granules used in various formulae and practice acupuncture and moxibustion as acupuncturists and moxibustionists. However, medical schools do not offer many classes in traditional medicine. This study aims to analyze the use of Kampo formulae and practice of acupuncture and moxibustion in contemporary community health care.<br><b>Methods:</b> The subjects (1538 clinicians) were graduates of Jichi Medical University on or after 1978, affiliated with a clinic or hospital with 300 beds or less on July 2010, and surveyed by postal questionnaire in October 2010.<br><b>Results:</b> The effective response rate across Japan was 44% (n=679). Of these responders, 30%, 45%, and 22% were found to prescribe Kampo formulae regularly, occasionally, and rarely, respectively, in daily clinical care. Frequently prescribed formulae included shakuyakukanzoto, daikenchuto, kakkonto, rikkunshito, and hochuekkito. The reasons for using Kampo formulae given by 61% and 58% of the responders were, respectively, applicability for common diseases and ease of use for unidentified complaints and psychosomatic disease. Among the reasons for unlikely use, unclear applicability was chosen by 34% of the responders; difficulty stocking many formulations by 33%; and insufficient evidence of efficacy by 30%. Practitioners of acupuncture and moxibustion accounted for 4% of the responders. The main indications for acupuncture and moxibustion included low back pain and shoulder stiffness.<br><b>Conclusions:</b> A large number of primary care physicians use Kampo formulae, implying their usefulness. However, one out of three physicians complains of unclear applicability and insufficient evidence of efficacy for Kampo formulae. In the future, appropriate education and research will be needed to clarify these issues.

A Case of Ulcerative Colitis with Recurrent Attacks of Melena that Required Changing in Prescription during Medical Treatment / 日本東洋医学雑誌

We report the case of a 33-year old man with ulcerative colitis and attacks of melena who responded positively to a change in prescription, in accordance with change in his disease state. His melena developed in May of the year XXXX. He was diagnosed with ulcerative colitis (proctitis) after a thorough evaluation at another medical institution, administration of 5-ASA, steroid suppositories and an antidiarrheal agent had brought no relief, and he consequently sought Kampo treatment at our institution. Saireito (9.0g/day) and kyukikyogaito(9.0g/day) extract granules were initially administered for two weeks in addition to the aforementioned drug therapy, which resulted in improvement of his melena. However, the same Kampo formulations prescribed later, when his attacks recurred, failed to effectively halt rectal bleeding. These recurrent attacks differed from his first, in that blood was seen after the elimination of feces (feces first, blood later), and as “feces-first, blood-later” conditions are described in the Synopsis of the Golden Chamber as “enketsu” indications for odoto decoction, his prescription was changed to odoto. After odoto administration for 2 months, his melena gradually resolved, and active rectal inflammatory change was improved as seen with colonoscopy. His melena then lessened after 1 month's administration, and symptoms of melena had almost completely disappeared after 2 month's administration. Amelioration of active rectal inflammatory change was also confirmed with colonoscopy findings. This was an interesting case where the progression of a clinical condition required a corresponding change in prescription for effective management of symptoms.

Epidemiologic Survey of Subjective Symptoms based on Kampo Medicine in Hase Village, Nagano / 日本東洋医学雑誌

The purpose of this study was to verify the concept of Kampo medicine epidemiologically and demonstrate the objective bases of the Kampo treatment. For this purpose, a population based survey of subjective symptoms based on Kampo medicine was conducted among 1,486 residents of Hase village, Nagano prefecture, ages 20 and older. The completion rate was 80.7% and 1,199 residents provided favorable responses. An investigation of gender differences showed a higher rate of blood deficiency among female residents, while spleen and qi deficiency were more common in males. Considering age differences, symptoms related to blood deficiency and water-dampness affected younger females, symptoms related to qi deficiency primarily affected younger males, and symptoms of liver afflictions were common in younger both genders. Among the elderly residents, symptoms of kidney deficiency were overwhelmingly predominant in both genders. Though younger people with subjective sense of health had few diseases in western medicine, most of the elderly with perceived health actually had some kind of diseases for medical treatment. Physical symptoms in the chest area such as shortness of breath correlated positively with the perception not to be healthy, and these may be regarded as both the manifestation and factors contributing to ill health. Approximately 1 out of 12 residents reported currently receiving the treatment of oriental medicine or demonstrated the potential to benefit from such intervention. These results may clinically be useful as the objective bases to perform the Kampo treatment.

Review of an experimental program for fundamental education about kampo herbal medicine / 医学教育

A model core curriculum proposed by the government in 2001 outlined the core structure for undergraduate medical education, in which a kampo medicine educational program was established to teach holistic medicine. Eighty Japanese medical schools have attempted to implement this program. We presented lectures on kampo herbal medicine as part of practical training in kampo focusing on clinical pharmacology and using a team-based format. This experience-based program aims to promote active learning of kampo herbal medicine among students. 1) After 116 4th-year students at Tokai Medical University had listened to 6 units of general lectures on the basic theory of kampo medicine, they received practical training comprising 3 units of kampo medical practice, acupuncture, and kampo herbal medicines in small groups of approximately 13 students (12 students, 3 groups; 13 students, 4 groups; and 14 students, 2 groups).2)For experience-based learning about kampo herbal medicine, each group was divided into 2 teams of students who practiced and worked on assignments so that they could understand herbal medicine from the viewpoints of both physicians and patients.3) By preparing keishito using Cinnamomi Cortex, whose production areas and quality differ, students learned the fundamental mechanism of kampo medicine through team discussions of their subjective sensory assessment of the herbal medicine keishito and the objective analysis of the main ingredients of Cinnamomi Cortex. 4) Group A (40 students, 6 teams) took the examination 2 days after the practice, and group B (76 students, 12 teams) took the exam before the practice. Group A did not show any correlation between examination results and interest levels in kampo herbal medicine, and all students but 1 correctly answered 60% or less of the questions. Group B showed a positive correlation between interest levels and examination results, and 6 students correctly answered less than 60% of the questions.5)The present practice could be effective in motivating students in kampo medicine.

Educational Problems Associated with Kampo Medicine Lectures as an Elective at Tokai University School of Medicine / 日本東洋医学雑誌

Kampo medicine lectures at Tokai University School of Medicine are an elective subject this year. In order to evaluate student acceptance of this elective, we performed a questionnaire investigation prior to lectures for all fourth-year medical students (n=96). Among the 76 students who provided effective answers, 47 considered attending the Kampo medicine lectures, and 35 of these did attend them. Ten could not attend though they had wanted to. Three could not attend because applicant numbers surpassed class quotas, and 6 reported that other elective subjects were of greater interest to them. Regarding a new model core curriculum for medical education, 6 students (8%) knew that questions about Kampo medicine might be included in a medical state examination, and only 3 (4%) knew that Kampo medicine was included as a specific behavioral objective (SBO). Regarding attitudes toward Kampo medicine, 64 students (84%) were interested in it, while 47 (57%) had a good image of it. However, about two-thirds of students had skeptical or negative images of Kampo medicine citing phrases such as “lack of evidence, ” “mysterious, ” “unscientific, ” “difficult to understand, ” “doubtful” and “works slowly.” These findings suggest that a minimal knowledge of Kampo medicine should be taught to all medical students as a required subject. Furthermore, establishment of advanced programs should be considered as well, since medical students have great interest in, and expectations of Kampo medicine.

Impact of Kampo Therapy on the Second Derivative of the Photoplethysmogram (SDPTG) / 日本東洋医学雑誌

The effect of Kampo therapy (Japanese traditional herbal medicine) on the second derivative of the photoplethysmogram (SDPTG) was investigated. The SDPTG is the second derivative of the fingertip photoplethysmogram (PTG), which expresses the characteristics of the vascular system, the properties of peripheral vessels, and the state of blood flow. The subjects comprised 13 normal volunteers, 101 patients (21 males and 80 females; mean age 53±11 years) with 1 month of Kampo therapy, and 19 patients (4 males and 15 females; mean age 60±9 years) with 3 months of medication. Control subjects showed no significant changes in their vascular age after 1 month. Patients with a higher vascular age than expected before therapy showed improvement of their vascular age, after treatment for 1 month and 3 months. The difference between the vascular age and calendar age decreased from about 10 to 7 years after 1 month of therapy (n=65. p<0.001), and from about 9 to 4 years, after 3 months (n=11, p<0.01). Vascular age not only reflects organic vessel wall sclerosis due to arteriosclerosis, but also a vascular wall tone that is closely related to the autonomic nervous system. The change of vascular age within a relatively short period suggested a functional change rather than an organic change of the vessels.

Patient-Based Evaluation of Kampo Therapy-Introduction of a Clinical Information Database for Patient-Based Assessment- / 日本東洋医学雑誌

Patients often complaint about their health, even if nothing is wrong with them upon concise objective examination. The complaints often imply the symptoms reflect more than one organ. Kampo treatment has the advantage of curing several symptoms at the same time, with only one or a few medicines. Kampo medicines comprise Chinese herbal formulations individually tailored to the patient. Therefore, symptom reduction is one of the most essential outcome parameters in Kampo treatment. However, how these subjective symptoms should be quantified, is controversial. The purpose of the current paper is to introduce an evaluation system for subjective symptoms. The system is referred to as Tokyo Women's Medical University Oriental Medicine Research Active Support System (TOMRASS). Apart from subjective symptoms, this database contains physical examination, laboratory data, clinical diagnosis and prescribed medicines, etc. In this study, 2 cases are shown as examples of practical use with TOMRASS use. One is a case with many complaints, which is effective with one medicine, Toki-shigyaku-ka-goshuyu-shokyo-to. The other is a case, which reveals unexpected outcomes with Sho-seiryu-to.<br>The new approach enables us not only to give more consideration to the patient's perspective, but also to differentiate therapeutic implications. The investigation between the subjective quality of life and therapeutic relationship may contribute to further understanding of Kampo treatment.

Three Cases of Palindromic Rheumatism Effectively Treated with Kampo Medicine. Consideration of Kampo Treatment in Palindromic Rheumatism / 日本東洋医学雑誌

We examined three cases where Kampo medicine had effects on palindromic rheumatism. All the patients are men with arthralgia accompanied by redness, fever, and swelling. All cases are RF negative. Cases 2 and 3 are brothers. Case 1: A 58-year-old patient with recurrent arthralgia on shoulders, hands, and legs for 30 years. Eppi-ka-jutsu-to was administrated for arthralgia. When discomfort of the hypochondrium (Kyokyokuman) was noted, the administration of Sho-Saiko-to reduced the symptom.<br>Case 2: A 40-year-old patient with recurrent arthralgia on shoulders, hands and legs for nine years. Eppi-ka-jutsu-to was administrated for arthralgia. When discomfort of the hypochondrium (Kyokyokuman) and contraction of the abdominal muscles (Fukuhikokyu) was noted, the administration of Eppi-ka-jutsu-to-go-Shigyaku-san-ryo was replaced, which reduced the symptoms.<br>Case 3: A 46-year-old patient with recurrent arthralgia on knees and fingers, and pain in hip joints. Eppi-ka-jutsu-to was administrated for arthralgia. When discomfort of the hypochondrium (Kyokyokuman) and contraction of the abdominal muscles (Fukuhikokyu) were noted, the administration of Shigyaku-san reduced the symptoms.<br>All cases were typical palindromic rheumatism, and Eppi-ka-jutsu-to was effective to a certain degree. Kampo diagnosis of Saiko (Saiko-sho) was made and additional Saiko-drugs (Saiko-zai) reduced the frequency, the degree, and the length of the period of symptoms.

A Case of Systemic Lupus Erythematodes (SLE) Treated with Sho-saiko-to-go-Oren-gedoku-to-ka-Yokuinin, Whose Antinuclear Antibody Became Negative with the Improvement of the Skin Symptom / 日本東洋医学雑誌

A 26-year-old woman who was diagnosed with mild SLE came to our hospital with the complaints about cutaneous eruptions on her face, head and back, as well as alopecia. We treated her with Sho-saiko-to-go-Oren-gedoku-to-ka-Yokuinin. After that, skin symptoms such as erythema, alopecia and photosensitivity disappeared, and an antinuclear antibody, which had shown 640 times at the first medical examination, became negative about two years later. In addition, the skin symptoms did not relapse and the antinuclear antibody rose very little even though the patient received no further medication for the next year. Our reseach found no other case reports of SLE whose antinuclear antibodies became negative only by Kampo treatment and who was treated with Sho-saiko-to-go-Oren-gedoku-to or its modified formulations.<br>Overall, it seemed to be an interesting case, and it suggests that Kampo medicine may be valuable in treating some cases of mild SLE, and may make steroid treatments unnecessary in the early stages of SLE before the diagnosis has been established.

A Study of the Origins of the Oriental Medical Term "Half Exterior Half Interior" / 日本東洋医学雑誌

The term “half exterior half interior” is not found in the Oriental Medical Classic, the ‘<i>Shang Han Lun</i>’. Rather, the phrase “half outside and half inside” appears. It was Cheng Wu Ji that first used the term “half exterior half interior” in the phrase “Those in whom the disease-causing agent is half in the exterior and half in the interior are considered to be of the fever manifestation-type” appearing in his ‘<i>Shang Han Ming Li Lun</i>’. In the ‘<i>Zhu Jie Shang Han Lun</i>’ which Cheng Wu Ji wrote shortly afterwards, he explains that the phrase “half outside and half inside” found in the ‘<i>Shang Han Lun</i>’ means half exterior and half interior. Since this commentary on the ‘<i>Shang Han Lun</i>’ was more frequently published and more widely circulated than the original text, it is thought to be this explanation that accounts for the popularization of the term “half exterior half interior”.

A Case of Congestive Heart Failure Controlled by the Addition of Sairei-to / 日本東洋医学雑誌

A 82-year-old patient with congestive heart failure visited our hospital complaining of dyspnea and orthopnea. Initially, treatment was given based on the western medicine. She responded very well to a diuretic, with her congestive heart failure improving in a relatively short period of time. However, she could not adhere to the restriction of water intake she was supposed to follow was hospitalized repeatedly. While she was in hospital, just rest and water restriction alone improved dyspnea. Although she was discharged from hospital and was given increased doses of a diuretic and a vasodilator, congestive heart failure recurred. Since there was moderate discomfort of the hypochondrium and disturbance of the body's fluid metabolism, we added Sairei-to to her treatment. Six weeks later, the discomfort of the hypochondrium cleared. Her appetite started to improve and she had less severe dryness of the mouth. she was therefore gradually able to follow the water restriction and has not had recurrence of heart failure since then. Although Moku-boi-to is frequently used in the treatment of heart failure, it is assumed that a formulation with a diuretic action such as Gorei-san was effective because heart failure represents a disturbance of the body's fluid metabolism.

An Investigation into the Relief of the Pain Accompanying with Colonoscopy with Shakuyaku-kanzo-to / 日本東洋医学雑誌

In order to relieve the pain accompanying colonoscopy, we gave patients “Tsumura Shakuyaku-kanzo-to extract” 5.0g 30 minutes before their examination, and investigated its effect.<br>We were unable to find a statistical difference in the increase in systolic blood pressure and heart rate during the examination between the group prescribed Shakuyaku-kanzo-to (n=18) and the control group (n=20). However, the mean for visual pain score, by which we estimated the pain, was 4.89±0.42 in the group prescribed Shakuyaku-kanzo-to and 6.20±0.34 in the control group. This difference was statistically significant.<br>These results suggest that Shakuyaku-kanzo-to is effective as a premedication for relieving the pain accompanying colonoscopy. From the literature, we assume that this is caused mainly by the sedative effect resulting from suppression of the nerve center.