A Case of Pleural Effusion Due to Bacterial Pleurisy Markedly Reduced by Treatment with Saikanto / 日本東洋医学雑誌

Although saikanto has often been used for infectious pleuritis, there are few reports on the usefulness of it in recent years. We experienced a patient successfully treated with saikanto, who was suffering from bacterial pleuritis with residual pleural effusion, which was difficult to drain and treat with antibacterial drugs. Kampo treatment including saikanto should be used for pleuritis that is not sufficiently improved by Western medical treatment alone.

Medical Safety Committee Report :Medical Accident Information and Minor Incidents from Medical Institutions Related to Kampo Products / 日本東洋医学雑誌

The Medical Safety Committee analyzed the case reports of minor incidents from the pharmacies last time as part of an activity to promote patient safety in Japanese traditional Kampo medicine. This time, we analyzed the case reports of medical accidents and minor incidents from the medical institutions. We extracted 626 reports related to Kampo products from the public database, which the Japan Council for Quality Health Care has established based on the collected information related to the medical accidents and minor incidents. The medical accident information includes case reports related to drug-induced liver injury. The minor incident reports include prescribing error due to misinterpretation related to the quantity of one sachet of Kampo extract product, dispensing error due to similarity of product appearance, number or name, and administration error due to judging the medicine only by Kanji characters or product company names without checking the Kampo formula name. Additionally, the minor incidents were often discovered by people belonging to different professions or patients themselves. In order to promote patient safety, knowledge about these incidents should be shared among the people involved in the same or different professions.

Effectiveness of Kampo Medicines Against Intractable Stomatitis: A Mini-Review

Intractable stomatitis is a chronic inflammatory disease of oral mucosa, with unclear etiopathogenesis. Kampo Medicines (KMs), i.e., Japanese herbal medicines, effectively treat stomatitis. The precise effects of KMs on intractable stomatitis are not established. We present the details of several patients with intractable stomatitis who were well-treated with KMs (i.e., Inchinkoto, Orento, Goreisan, and Byakkokaninjinto). We also review the literature on the link between intractable stomatitis and KMs. KM-related anti-inflammatory and antioxidant activity may suppress intractable stomatitis. KMs may also facilitate wound healing through increased saliva secretion. KMs may therefore be useful for the treatment of intractable stomatitis.

Efficacy of Kampo Medicine for Migraine in Children and Childhood Periodic Syndromes / 日本東洋医学雑誌

In the Guideline for treatment of chronic headache published by Japanese Headache Society, Ibuprofen and Acetaminophen are proposed for the acute treatment of migraine in children. But prophylactic treatment of pediatric migraine is not established. We report the efficacy of Kampo medicine for preventing migraine in children and childhood periodic syndromes. We use a variety of Kampo medicine for 9 pediatric migraine and periodic syndromes patients from 8 to 15 years old. All 9 patients improve their headache and associated symptoms including abdominal pain, vertigo, nausea and vomiting. After treatment the mean average of Headache Impact Test-6 (HIT-6) improve from 63.66 points to 45.77 points. Kampo medicines is effective for migraine in children and childhood periodic syndromes.

Renewed Thoughts on What is Being Required of Kampo / 日本東洋医学雑誌

At present, some 70% of physicians prescribe Kampo medicines in our country, and most medical departments and medical universities hold courses in Kampo. This was quite unthinkable just a half century ago. Be that as it may, Kampo now stands at a crossroads. EBM, RCT and scientification are being required of Kampo, while moreover it is being threatened by the tempest of globalization. Then there is the problem of crude drug resources. Without a proper response to these threats, Kampo will be swallowed up by modern medicine, left behind, and fade away. I, a simple private practitioner, do not hold the key to any solutions. Just from having been long involved with Kampo, however, I have my own thoughts and feelings, and I have shared them. And one thing I can saw with certainly is that Kampo should not lose sight of its origins, and should hold them dear. I have stated that “Kampo medicines essential treat the diseased, not diseases”. I have also touched on the word-of-mouth esotericism of Kampo, commented on the role of private practitioners, and, would very much like The Japan Society for Oriental Medicine to continue to be a place where we local practitioners too can speak out openly and with confidence.

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.

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.

One Case of Wells' Syndrome Successfully Treated with Kampo Medicines / 日本東洋医学雑誌

Wells' syndrome (eosinophilic cellulitis), whose etiology is idiopathic, is clinically characterized by solitary or multiple cellulitis-like eruptions which occur on the extremities and trunk. Corticosteroids are usually used for palliative treatment, but relapses are often observed. We observed an 8 year-old patient with Wells' syndrome successfully treated with Kampo medicines. In 2001, skin eruptions appeared on his extremities. In 2002, a histopathologic examination determined his disease to be Wells' syndrome, and corticosteroids were subsequently used for treatment. In January 2007, his skin eruptions worsened, and he first visited our outpatient clinic in May. After oral administration with keigairengyoto, his skin eruptions were slightly improved, but afterwards, they again worsened. In June, jumihaidokuto was administered instead of the former prescription, and the skin conditions had begun to improve. Because dry skin appeared in November, keigairengyoto was again added. With these treatments, his skin eruptions stably improved. In previous reports, Kampo medicines had not been used for the treatment of Wells' syndrome. This case, however, suggests that Kampo medicines are a candidate for the treatment of Wells' syndrome.

Practice and Perspective of Clinical Research on Kampo Medicine / 日本東洋医学雑誌

I will illustrate our research, which elucidate the efficacy of Kampo medicines for “Ki”.In order to compare hangekobokuto with kososan, we assessed them by binocular infrared video pupillography. The results revealed that sympathetic nerve activity was inhibited by taking hangekobokuto in the patients belonging to sympathetic dominant group, while it was stimulated by taking kososan in the patients belonging to parasympathetic dominant group.Administration of hangekobokuto has decreased the value of brachial-ankle pulse wave velocity. This result suggests that hangekobokuto ameliorates the elasticity of vascular wall, which is closely related to autonomic nervous system.The gastric emptying rate, which was evaluated by ultrasonographic method in FD patients, showed its significant increase after administration of hangekobokuto.Global gene expression analysis using a DNA chip has shown the pharmacological actions of kososan.In the animal study using depression-like model mice, we have found that kososan decreased the suppression of neurogenesis.

The Kampo Medicine of Dr. Sakaguchi, my Teacher / 日本東洋医学雑誌

Dr. Sakaguchi, who has succeeded to the “Asada-style” of Dr. Hosono's Kampo Medicine, has been long studied the dietary theories of Sakurazawa, acupuncture, moxibustion, and homeopathy based on Hosono Kampo Medicine.<br>Dr. Sakaguchi has made great contributions, along with Dr. Shiro Hosono, the reconstruction of Showa Era (1926-1989) Kampo medicine through pharmacological studies of Kampo formulae, and development of their extracts. One remarkable characteristic of Dr. Sakaguchi, as a clinician, is that he attaches importance to “the treatment of minus one-year-olds”, i. e. the treatment by Kampo medicine for a pregnant woman.

The Analysis of New Patients in Oriental Medicine Research Center of the Kitasato Institute and its Application to Medical Care / 日本東洋医学雑誌

In general hospitals or clinics, medical treatment and instruction in medical therapies and nursing are carried out by the medical staff (doctors, pharmacists and nurses) on hand. It is necessary to understand overall trends in patient illness, in addition to personal information, in order to practice medical care comprehensively. For these reasons we analyzed popular medicines, patient make up, and major disease distributions at our own Kampo clinic institute, for patients admitted since 2001.<br>34% of our patients were male and 66% were female. The majority of these patients were between 20 to 30 years old or, 50 to 70 years old. There were few patients, either male or female, in their 40s. As for major disease distribution, atopic dermatitis was most common among both males and females. Next in line were cold sensations and endometriosis, for females, while respiratory organ diseases such as bronchial asthma or nasal inflammation, and Alzheimer's disease were most common, for males.<br>Among major disease types, atopic dermatitis was treated with Oren-gedoku-to (JTDN: Japanese Traditional Drug Name) and Ogi-kenchu-to (JTDN), while diabetes was treated with Hachi-mi-gan (JTDN) and Seishin-renshi-in (JTDN). Cold sensations were treated with Toki-shigyaku-ka-goshuyu-shokyo-to (JTDN) and Toki-shakuyaku-san (JTDN), while hypertension was treated with Cho-to-san and Saiko-ka-ryukotsu-borei-to (JTDN).<br>The present report contains information useful for diagnosis with Kampo medicines, as well as instruction in the nursing and use of these medications by doctors, pharmacists and nursing staff. This report may be utilized in order to administer appropriate medical care for patients.

Seeking Contact Point for Crude Drugs and Clinical Application of Kampo Medicine / 日本東洋医学雑誌

A quarter century has passed since the implementation of the complete health insurance coverage of Kampo medicines in 1976. This drastic change has led to the wide use of this type of medications in the clinical setting. During this period, based on the myth “Kampo medicines have no adverse reaction” and the indoctrination “Kampo medicines are effective for various pathophysiological conditions that cannot be managed by Western medicine”, there was a transient, but dramatic increase in the use of Kampo medicines. It is certainly true that Kampo medicine has been beneficial in many patients. However, the expectation that Kampo medicines have been truly accepted by doctors who have properly managed their patients according to the principle of Western medicine is doubtful. This is partly because, based on the idea that it is firstly needed to make the use of Kampo formulations more easy in the hands of clinicians, Kampo medicines have been dealt with as if they were single components although they are actually complex entities. Due to such misunderstanding, prescribing physicians have lost their interest toward the contents (component crude drugs) of Kampo medicines. Numbered extracts are certainly convenient for clinicians who use Kampo medicines according to the concept of Westem medicine. Let me introduce Mashinin-gan (No. 126) as an example. Unfortunately, doctors use this Kampo medicine just to improve bowel movement. I think that we can understand the true worth of Joki-to formulae, which used to play an active role in the treatment of <i>yang ming bing</i>, a condition once thought as refractory, only if we recognize that Mashinin-gan is a modified formulation of Sho-joki-to (immature orange, magnolia bank, Rhubarb Rhizome) and then pursue its use differentiating from Juncho-to (No. 51), Dai-joki-to (No. 133) and Tsu-do-san (No. 105). Upon such consideration, we understand that to learn the principle of <i>Shang han lun</i> [a treatise on <i>Shang han</i> (a form of an acute infectious disease)] is to place importance on the Chinese classic. I think that, in the past, at the meetings of the Japan Society for Oriental Medicine, more attention was paid to the origin of crude drugs as well as the efficacy of Kampo formulations. “What is the origin of Rhubarb Rhizome you used?” or “Is bupleurum root you mentioned <i>Bupleurum falcatum</i> Willd or <i>Bupleurum falcatum</i> Linné?” Of course, we must not stick to this aspect too much, but we will have trouble if we pay absolutely no consideration to the components of Kampo medicines we actually use, even when we use extracts. This is an era of evidence-based medicine (EBM). When we clinicians treat patients with Kampo medicines that cannot be characterized by single chemical formulae, we can value their clinical efficacy only if we stick to the quality of crude drugs to the extent possible. The man subject of this meeting is “To Get Handfuls of Blessings of Great Nature.” At this meeting, I would like to describe the current clinical application of Kampo medicines and actual efforts made by farmers who engage in the cultivation and gathering of well-known crude drugs. I hope that my lecture will help to make clinicians aware of the characteristics of each crude drug for the clinical application of Kampo medicines.

Effects of Red Ginseng on Osteopenia in Ovariectomized Rats / 日本東洋医学雑誌

The effects of Red Ginseng on osteopenia were investigated in ovariectomized rats. Eight-week-old female Wistar rats were used. Sham operating and ovariectomized control (OVX Cont) rats were given the vehicle. Korean Red Ginseng extract powder (0.1g/kg/day p. o.) was administered to another ovariectomized group (OVX RG). After 12 weeks, blood was drawn, and jejunum and tibia were removed. Histologial parameters in bone and intestinal villi were measured. Biochemical and endocrinological parameters were also measured. Although ovariectomy significantly increased body weight of rats, there was no significant difference between OVX Cont and OVX RG in body weight gain. Bone volume in OVX Cont was significantly lower than in sham operating rats. Administration of Red Ginseng significantly increased the bone volume of tibia in ovariectomized rats. Intestinal villous height in OVX Cont was significantly lower than in sham operating rats. There was a tendency towards increasing intestinal villous height in OVX RG. Administration of Red Ginseng significantly decreased the frequencies of abnormally shaped villi in ovariectomized rats. This experimental study showed that Red Ginseng was effective in inhibiting osteopenia in ovariectomized rats, and it appears that the effect on bone is related to that on intestinal villi.

Studies on Diagnostic Methods to Detect Drug Allergies to Kampo Medicines. (I): Preliminary Analysis of Antigens from Crude Drugs and Antigen-Specific Antibodies using Shosaiko-to Extracts / 日本東洋医学雑誌

Recently, there has been an increase in reports of allergic reactions to Kampo medicines. In order to elucidate the mechanisms of these so-called Kampo allergies, suitable methods are necessary to detect allergens in crude drugs and allergenspecific antibodies in sensitized individuals. In this study, methodology and sensitivity were studied using enzyme-linked immunosorbent assay and Western blot analysis. The antigens used were haptenized baicalin and high-molecular-weight components of Ginseng Radix, both derived from Shosaiko-to extract.<br>Attempts were also made to further identify antigens from Shosaiko-to and detect antigenspecific antibodies in immunized rabbits.

Kampo Treatment of Patients with Common Cold Syndrome Associated with Fever / 日本東洋医学雑誌

Suppression of fever with antipyretics has been reported to increase mortality in animals experimentally infected with various viruses. To study the adverse effects of antipyretics, 80 patients with the common cold (students of this school) who were previously untreated were enrolled in this study. The author compared the therapeutic effects of fenoprofen (1200mg/day) as an antipyretic (P group) with Kampo formulas (K group). Of the various Kampo formulas, “Hozai” were selected, according to each patient's Sho (pattern of symptoms assessed by Kampo diagnosis. Each “Hozai” chosen had been pharmacologically proven to have no direct antipyretic effect.<br>Statistical analysis of the 45 patients of the P group and 35 patients of the K group that exhibited fevers over 37 degrees. The background as to sex, sge, time elapsed after symptom onset, place of oirgin, the length of the period between highschool graduation and admission to this university and the conditions under which daily meals were taken were analyzed and no statistical differences were found between the two groups. The duration of fever after treatment was 2.6±1.7 days in the P group and 1.5±0.8 days in the K group (p<0.001) respectively, and the incidence of rebound of the fever was higher in the P group (11.1%) than in the K group (0%). The time elapsed before all symptoms disappeared, such as sore throat, nasal discharge, or cough was 6.6±3.6 days in the P group, and 5.1±1.9 days in the K group (p<0.05).<br>It was concluded that treatment using Kampo was more beneficial than the use of antipyretics, and that the fever associated with the common cold is a positive response of the body, suppression of which is undesirable.