Internet survey on the provision of complementary and alternative medicine in Japanese private clinics: a cross-sectional study / 中西医结合学报

OBJECTIVE@#Although the use of complementary and alternative medicine (CAM) by the general population has been surveyed previously, the provision of CAM by Japanese physicians in private clinics has not been studied. Universal health insurance system was established in Japan in 1961, and most CAMs are not on the drug tariff. We aimed to clarify the current status of CAM provided by physicians at private clinics in Japan.@*METHODS@#We conducted an internet survey on 400 directors/physicians of private clinics nationwide on the provision of CAM from February 6 to February 10, 2017. Survey items included attributes of subjects, presence/absence of sections or facilities for provision of CAM, proportions of health insurance coverage for medical practices, and source of information. Private clinic was defined as a clinic run by one physician, with less than 20 beds.@*RESULTS@#Commonly provided CAMs were Kampo (traditional Japanese herbal) medicines (34.8%) and supplements/health foods (19.3%). CAMs on the drug tariff were provided in 46.5% of cases at the clinics, but only 16.5% of cases were provided CAMs which were not on the drug tariff, at different neighboring facilities. Among different specialties, Kampo medicines were prescribed at obstetrics/gynecology (54.0%), orthopedics (44.4%), and dermatology (43.0%). Clinics not providing any CAM accounted for 53.5%. With regard to health insurance coverage, 96.8% of the clinics provided only or mainly health services on the universal national health insurance tariff (29.8% and 67.0%, respectively).@*CONCLUSION@#Kampo medicines represent the most commonly used CAM in private clinics in Japan, and universal national health insurance coverage is considered to be the reason for the high rate of their use.

Standards of Reporting Kampo Products (STORK) in research articles / 中西医结合学报

There had been no standardized rules for citing ethical Kampo products used in clinical trials in journal articles. Although the name of a Kampo manufacturer was described in 77.9% of research articles, the name and ratios of crude drug components of Kampo formulas were not described in 77.5% of these papers. Considering the importance of proper characterization of interventions in the Consolidated Standards of Reporting Trials (CONSORT) checklist, we hereby propose the use of the Standards of Reporting Kampo Products (STORK) website, http://mpdb.nibiohn.go.jp/stork, as a reference for Kampo products. This will provide an official source on the internet for verified information on individual Kampo formulations for citation purposes in clinical research articles.

Effect of Saikokeishito, a Kampo medicine, on hydrogen peroxide-induced premature senescence of normal human dermal fibroblasts / 中西医结合学报

<p><b>OBJECTIVE</b>Saikokeishito (TJ-10) is a Kampo (traditional Japanese herbal) medicine, clinically used for hundreds of years in East Asia. Among its various mechanisms elucidated so far, TJ-10 inhibits the production of transforming growth factor-β1 (TGF-β1) and development of pancreatic fibrosis in vivo. Oxidative damage of normal human dermal fibroblasts (NHDFs) in the corium is a cause of human dermal senescence. Our aim was to determine whether TJ-10 protects NHDFs from premature senescence by hydrogen peroxide (H₂O₂).</p><p><b>METHODS</b>Premature senescence was induced in NHDFs by 200 μmol/L H₂O₂ for 4 h. Cell viability and the expressions of p53, AMP-activated protein kinase α1 (AMPKα1), AMPKα2, and 14-3-3 protein sigma (14-3-3 σ) were measured in NHDFs treated with TJ-10 for 48 h before exposure to H₂O₂for 4 h.</p><p><b>RESULTS</b>Cell viability after treatment with 200 μmol/L H₂O₂ for 4 h was similar (about 80%) to after pre-treatment with TJ-10. Ascorbic acid as a control did not protect NHDFs from damage by 200 μmol/L H₂O₂. Treatment with 200 μmol/L H₂O₂tended to up-regulate p53 and to down-regulate SIRT1 and AMPKα1, but had no effect on AMPKα2 and 14-3-3 σ expression. Pretreatment with TJ-10 inhibited H₂O₂-induced up-regulation of p53 and enhanced AMPKα1 expression.</p><p><b>CONCLUSION</b>It is suggested that Saikokeishito has a protective effect on oxidative stress-induced senescence of NHDFs.</p>

<b>Successful Treatment of Post-influenza Chronic Fatigue Syndrome </b><b>with Kampo Medicine : a Case Report</b> / 日本東洋医学雑誌

A main symptom of chronic fatigue syndrome (CFS) is fatigue which continues for more than 6 months and does not improve with rest, leading to a marked decrease in quality of life. Other problems include fever, sleep disorder, and headache. Etiologically, a preceding viral infection, immunological disorder, and changes in the central nervous system, especially in hippocampus have been reported. However, the precise pathogenesis of CFS has not been elucidated, and neither diagnostic markers nor effective treatments have yet to be discovered. Here, we report a case of CFS, successfully treated with Kampo medicines.<br>The patient was a 16-year-old high school student, who had received medical therapy for one year under the diagnosis of CFS. His chief complaint was a continuing fever and strong malaise after influenza infection. At his visit to our outpatient clinic, we confirmed that his symptoms met the criteria for CFS. A combination treatment with Kampo medicine (sanoshashinto) and duloxetine improved his malaise and fatigue in 4 weeks, but fever and anorexia remained. The addition of hochuekkito to the combination dramatically ameliorated his symptoms. This case suggests that Kampo medicines would contribute to the effective treatment of CFS, which is refractory to Western medicines.

Effect of Saikokeishito, a Kampo medicine, on hydrogen peroxide-induced premature senescence of normal human dermal fibroblasts / 中西医结合学报

Saikokeishito (TJ-10) is a Kampo (traditional Japanese herbal) medicine, clinically used for hundreds of years in East Asia. Among its various mechanisms elucidated so far, TJ-10 inhibits the production of transforming growth factor-β1 (TGF-β1) and development of pancreatic fibrosis in vivo. Oxidative damage of normal human dermal fibroblasts (NHDFs) in the corium is a cause of human dermal senescence. Our aim was to determine whether TJ-10 protects NHDFs from premature senescence by hydrogen peroxide (H₂O₂).

Traditional Japanese medicine, Kampo: its history and current status / 中国结合医学杂志

Traditional Japanese medicine, Kampo, is used by over 80% of medical doctors in Japan. Owing to its high quality and safety, Kampo has been integrated into modern medicine, and there are 345 randomized controlled trials using Kampo in Japan as of 2010. Although there are a number of articles in top journals about basic science research, we can find only small numbers of high-quality clinical evidence. Since undergraduate education on Kampo has been established, integrative approach with the balanced combination of modern medicine and Kampo is expected to generate good clinical evidence in the near future.

Effectiveness of Goshajinkigan on the Cold Sensation and Dysthesia in A Case of Nodular Multiple Angiitis / 日本東洋医学雑誌

A 70 year-old male with nodular multiple angiitis visited our outpatient clinic because of cold sensation and dysthesia. Although the vascular disease went into remission with steroid and immunosuppressant use, dysthesia continued. An improvement in subjective symptoms was evaluated with a visual analogue scale, after Gosha jinki-gan extract was administered on the basis of Kampo diagnosis. Furthermore, this beneficial effect increased when Syuchibushi matsu administration was added. Thus far, there are no such reports on Goshajinkigan as being useful for nodular multiple angiitis. Although the direct effect was not seen on the peripheral nerve conduction velocity, Goshajinkigan might be useful for the treatment of subjective cold sensation and dysthesia symptoms, in patients with nodular multiple angiitis. The mechanism of the above effect is considered to be similar to that in diabetic peripheral neuropathy.

Is it Possible to Develop Global Clinical Practice Guidelines for Traditional Medicine? / 日本東洋医学雑誌

Since 2004, the World Health Organization Regional Office for the Western Pacific (WHO/WPRO) has been in the process of developing international clinical practice guidelines (CPU), for the use of traditional medicines. There are, however, major differences in the medical licensing, drug approval and health insurance systems among nations within this Region. Furthermore, there is yet not enough evidence to develop reliable CPU. It is highly possible that any such CPU could cause legal and administrative, as well as healthcare problems. Japan should approach this issue with caution.

Effects of Chinese herbal medicines on spontaneous chronic pancreatitis in rats and the pathological relationships between formulas and syndromes / 中西医结合学报

OBJECTIVE: To investigate the effects of Guizhi Decoction, Chaihu Guizhi Decoction, Xiaochaihu Decoction and camostat on rat spontaneous chronic pancreatitis and the pathological relationships between formulas and syndromes. METHODS: Fifty-seven male WBN/Kob rats at age of 4 weeks were divided into five groups: untreated group (n=18), Guizhi Decoction-treated group (n=9), Chaihu Guizhi Decoction-treated group (n=9), Xiaochaihu Decoction-treated group (n=9) and camostat-treated group (n=12). The rats in each group were fed with corresponding drugs for 12 weeks. The pancreatic wet weight and histopathological changes of pancreatic tissue were observed every four weeks. Meanwhile, the expression level of pancreatitis-associated protein (PAP) in pancreas was detected by RT-PCR technique and immunohistochemical method. RESULTS: In the untreated group, the histopathological changes in pancreas were observed in rats at 12-week age, while such changes were absent in the Guizhi Decoction-treated group. The histopathological changes in pancreas were quite remarkable in rats at 16-week age in both the Xiaochaihu Decoction-treated and the camostat-treated groups. The expression level of PAP mRNA was lower in the Guizhi Decoction-treated group than those in the other groups. The PAP expressions were absent in rats at 12-week age in the Guizhi Decoction-treated and the Chaihu Guizhi Decocion-treated groups. CONCLUSION: Guizhi Decoction, Chaihu Guizhi Decoction, Xiaochaihu Decoction and camostat are all beneficial to prevention and cure of chronic pancreatitis, and Guizhi Decoction is the most effective one. It is speculated that Taiyang exterior syndrome may be the pathogenesis of basic syndrome may be the pathogenesis of basic syndrome of spontaneous chronic pancreatitis, and the expression of PAP may be its pathological basis.