Somatic symptoms with psychogenic or psychiatric background: Characteristics and pitfalls.

INTRODUCTION: The characteristics of somatic symptoms seen at the first hospital visit in patients with psychogenic backgrounds remain poorly elucidated till date. METHODOLOGY: A total of 277 patients who visited the Department of General Medicine at a single university hospital with somatic symptoms were prospectively enrolled in this study. The eventual definite diagnoses were classified into the following three groups: non-psychogenic disease (n = 128), psychogenic symptoms (n = 131), and mental illness (n = 18). Subsequently, the chief complaints and other background information of the patient obtained at the first visit were compared among the three groups. RESULTS: More than half of the patient with non-psychogenic diseases (60.2%) presented with a single complaint at their first hospital visit; contrarily, less than half of the patients with psychogenic symptoms (23.7%) or mental illnesses (22.2%) presented with a single complaint at the first visit. Approximately, <10% of the patients with non-psychogenic diseases had four or more multisystemic presentations at the first visit. The results of the receiver operating characteristic curve analysis revealed a fair discriminatory ability of the number of complaints to identify patients with psychogenic diseases or psychiatric backgrounds. Almost half of the non-psychogenic patients with four or more multisystemic presentations were eventually diagnosed with autoimmune-related disorders, such as Sjögren's syndrome or Behçet's disease. In conclusion, the general notion that patients with psychogenic somatic symptoms are likely to present with more complaints than patients with non-psychogenic diseases is correct. However, not a few patients who present with multiple indefinite complaints would certainly have organic diseases such as autoimmune-related disorders or neuromuscular diseases. A careful diagnostic process is required in such patients before attributing their symptoms to psychogenic or psychiatric factors.

Characteristics and course of patients treated with Kampo Medicine in the Department of General Medicine.

BACKGROUND: A recent investigation reported that 92.7% Japanese family physicians have prescribed Kampo medicine (KM). KM can treat a wide variety of conditions from mental disorders to physical weaknesses. However, the characteristics and course of patients treated with KM at the Department of General Medicine remain unclear. AIMS: To investigate the characteristics and course of patients treated with KM in our hospital. METHODS: Data on medical history, complaints, course after Kampo treatment, and Hamilton Depression Rating Scale (HAM-D) scores were retrogradely collected. The background of patients who received Kampo treatment was compared to that of patients who did not. RESULT: Of 362 patients, 51 were treated with KM. Symptoms for which KM was prescribed included pain, general malaise, or sensory disturbance of extremities. All patients treated with KM were screened and initially diagnosed with a functional disorder or noncritical condition. KM including a crude drug of saiko such as hochuekkito, shigyakusan, shosaikoto, and yokukansan, was frequently prescribed for patients. Subjective symptoms showed improvement (53%) and no change (47%), while worsening was not observed in any patient. HAM-D scores showed that patients treated with KM had higher anxiety levels and related symptoms as well as a higher frequency of mental disorders prior to presenting at the hospital. CONCLUSION: Most complaints of the patients treated with KM were pain, general malaise, and sensory disturbance. KM is more likely to be prescribed in patients with health-related anxiety or a history of mental disorders.

Successful Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome with Chronic Febricula Using the Traditional Japanese Medicine Shosaikoto.

We herein report the case of a 14-year-old girl who had been experiencing chronic fatigue, febricula, and social withdrawal for 20 months. No notable abnormalities were identified during routine checkups at a general pediatric hospital; symptomatic treatments did not affect her condition. She was diagnosed with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Based on the concepts of Japanese traditional medicine, she was administered shosaikoto-based treatment. After several weeks of treatment, all of the symptoms had been dramatically alleviated, consequently resolving the issue of non-attendance at school. Shosaikoto-based medication may be a therapeutic option for treating ME/CFS in patients presenting with chronic febricula.

Responder Analysis of Daikenchuto Treatment for Constipation in Poststroke Patients: A Subanalysis of a Randomized Control Trial.

A traditional Japanese medicine, daikenchuto (DKT), is used for treating abdominal bloating and pain with coldness. In modern medicine, it is used to treat postoperative intestinal dysfunction and ileus. We previously showed the effective improvement in functional constipation with DKT in poststroke patients. However, response prediction for the treatment has not been elucidated. We investigated the data from the prior trial (UMIN000007393) to predict the DKT treatment response. We assessed the efficacy of DKT for chronic constipation in poststroke patients. Neurogenic bowel dysfunction score (NBDS) and the Gastrointestinal Symptom Rating Scale-constipation subscale (GSRS-C) score were newly analyzed comparing the pre- and postintervention data after intake of 15 g of DKT extract granule daily for 4 weeks. Single and multiple regression analyses were performed to examine the correlations between the changes in NBDS, GSRS-C score, patient characteristics, clinical symptom score, gas volume in the gut, and serum calcitonin gene-related peptide level. The total NBDS and GSRS-C score were significantly reduced after DKT administration. The total NBDS, GSRS-C score, and gas volume score at baseline were significantly correlated with the change in these scores. Higher NBDS and GSRS-C scores and more gas volume in the gut may be possible predictors of response to DKT when treating constipation.

Spontaneous Regression of Recurrent Undifferentiated Carcinoma of the Endometrium.

We herein report a very rare case of spontaneous regression of recurrent undifferentiated carcinoma of the endometrium. An 80-year-old woman had undergone total hysterectomy with bilateral adnexectomy for undifferentiated carcinoma of the endometrium. The cancer recurred locally 10 months after surgery and then metastasized to the lung and liver. After she and her family elected to receive supportive care without active treatment, the local recurrences dramatically decreased, and the metastases of the lung, liver, and peritoneum also disappeared. This case showed that spontaneous regression can occur even with malignant tumors showing an extremely poor prognosis, such as undifferentiated carcinoma of the endometrium.

Literature Review: Herbal Medicine Treatment after Large-Scale Disasters.

Large-scale natural disasters, such as earthquakes, tsunamis, volcanic eruptions, and typhoons, occur worldwide. After the Great East Japan earthquake and tsunami, our medical support operation's experiences suggested that traditional medicine might be useful for treating the various symptoms of the survivors. However, little information is available regarding herbal medicine treatment in such situations. Considering that further disasters will occur, we performed a literature review and summarized the traditional medicine approaches for treatment after large-scale disasters. We searched PubMed and Cochrane Library for articles written in English, and Ichushi for those written in Japanese. Articles published before 31 March 2016 were included. Keywords "disaster" and "herbal medicine" were used in our search. Among studies involving herbal medicine after a disaster, we found two randomized controlled trials investigating post-traumatic stress disorder (PTSD), three retrospective investigations of trauma or common diseases, and seven case series or case reports of dizziness, pain, and psychosomatic symptoms. In conclusion, herbal medicine has been used to treat trauma, PTSD, and other symptoms after disasters. However, few articles have been published, likely due to the difficulty in designing high quality studies in such situations. Further study will be needed to clarify the usefulness of herbal medicine after disasters.

Recommendation of Repeated Ammonia Tests for Intrahepatic Portal-Systemic Shunt Without Cirrhosis in Elderly Patients With Psychiatric Symptoms.

We report an elderly male patient with hyperammonemia induced by intrahepatic portal-systemic shunt without cirrhosis (IPSSwoC). The occasional emergence of his erratic behaviors was misdiagnosed as a psychiatric disorder. Regardless of his uneven symptoms, IPSSwoC was suspected due to his hyperammonemia. The contrast computed tomography of the abdomen revealed a congenital type of IPSSwoC. As blood ammonia levels are inconstant, repeated blood tests are recommended when this disease is suspected in elderly patients with psychiatric symptoms.

Improving the Quality of Postgraduate Education in Traditional Japanese Kampo Medicine for Junior Residents: An Exploratory Survey Conducted in Five Institutions in the Tohoku Area.

Traditional Japanese (Kampo) medicine has been widely applied in general medicine in Japan. In 2001, the model core curriculum for Japanese medical education was revised to include Kampo medicine. Since 2007, all 80 Japanese medical schools have incorporated it within their programs. However, postgraduate training or instruction of Kampo medicine has not been recognized as a goal for the clinical training of junior residents by Japan's Ministry of Health, Labour and Welfare; little is known about postgraduate Kampo medicine education. This exploratory study investigated attitudes about Kampo medicine among junior residents in Japanese postgraduate training programs. A questionnaire survey was administered to junior residents at five institutions in the Tohoku area of Japan. Questions evaluated residents' experiences of prescribing Kampo medicines and their expectations for postgraduate Kampo education and training. As a result, 121 residents responded (response rate = 74%). About 96% of participants had previously received Kampo medicine education at their pre-graduate medical schools and 64% had prescribed Kampo medications. Specifically, daikenchuto was prescribed to prevent ileus and constipation after abdominal surgery and yokukansan was prescribed to treat delirium in the elderly. Residents received on-the-job instruction by attending doctors. Over 70% of participants indicated that there was a need for postgraduate Kampo medicine education opportunities and expected lectures and instruction on how to use it to treat common diseases. In conclusion, we have revealed that junior residents require Kampo medicine education in Japanese postgraduate training programs. The programs for comprehensive pre-graduate and postgraduate Kampo education are expected.

Questionnaire-Based Development of an Educational Program of Traditional Japanese Kampo Medicine.

Traditional Japanese Kampo medicine has been widely used in clinical practice in Japan. Though it is a compulsory subject in Japanese medical schools, a standard educational program in Kampo medicine does not exist. Tohoku University has incorporated Kampo medicine into clinical education via didactic lectures since 2003; however, student evaluations have been lower for Kampo than for all other clinical specialties. We administered a questionnaire about a Kampo medicine course for fifth-year students from 2009 to 2012 and developed an educational program based on feedback obtained. The questionnaire consisted of nine questions (a clear training plan; opportunities for learning, practice, and patient contact; acquisition of medical knowledge and physical examination; learning professionalism; understanding the specialty; overall assessment) that were rated on a 5-point Likert scale along with open-ended questions about the course's strengths and weaknesses. The students responded to the questionnaire after clinical practice in Kampo medicine and other clinical specialty courses. Scores for Kampo medicine and the average of other clinical specialties were compared. All 389 students who participated in Kampo clinical practice answered the questionnaire. In 2009, scores for Kampo medicine for nine questions were lower than for the average of the other clinical specialties. After curriculum reformation involving hands-on training in 2012, all scores except "opportunities to learn about clinical cases" and "opportunities to practice involvement" were higher than the average of all other clinical specialties. In conclusion, we have successfully developed a Kampo medicine educational program for our university through this survey study.

The Pilot Study of Evaluating Fluctuation in the Blood Flow Volume of the Radial Artery, a Site for Traditional Pulse Diagnosis.

BACKGROUND: Radial artery (RA) pulse diagnosis has been used in traditional Asian medicine. Blood pressure (BP) and pulse rate related to heart rate variability (HRV) can be monitored via the RA. The fluctuation in these parameters has been assessed using fast Fourier transform (FFT) analytical methods that calculate power spectra. METHODS: We measured blood flow volume (Volume) in the RA and evaluated its fluctuations. Normal participants (n = 34) were enrolled. We measured the hemodynamics of the right RA for approximately 50 s using ultrasonography. RESULTS: The parameters showed the center frequency (CF) of the power spectrum at low frequency (LF) and high frequency (HF). More than one spectral component indicated that there were fluctuations. The CF at LF for Volume was significantly different from that for vessel diameter (VD); however, it was significantly correlated with blood flow velocity (Velocity). On the other hand, the CF at HF for Volume was significantly different from that for Velocity; however, it was significantly correlated with VD. CONCLUSION: It is suggested that fluctuation in the Volume at LF of RA is influenced by the fluctuation in Velocity; on the other hand, fluctuation in the Volume at HF is influenced by the fluctuation in VD.

Traditional Japanese medicine daikenchuto improves functional constipation in poststroke patients.

Poststroke patients with functional constipation, assessed by the Rome III criteria, from 6 hospitals were recruited in a study on the effects of the traditional Japanese medicine Daikenchuto (DKT) on constipation. Thirty-four patients (17 men and 17 women; mean age: 78.1 ± 11.6 years) were randomly assigned to 2 groups; all patients received conventional therapy for constipation, and patients in the DKT group received 15 g/day of DKT for 4 weeks. Constipation scoring system (CSS) points and the gas volume score (GVS) (the measure of the intestinal gas volume calculated from plain abdominal radiographs) were recorded before and after a 4-week observation period. The total score on the CSS improved significantly in the DKT group compared to the control (P < 0.01). In addition, scores for some CSS subcategories (frequency of bowel movements, feeling of incomplete evacuation, and need for enema/disimpaction) significantly improved in the DKT group (P < 0.01, P = 0.049, and P = 0.03, resp.). The GVS was also significantly reduced in the DKT group compared to the control (P = 0.03). DKT in addition to conventional therapy is effective in treating functional constipation in poststroke patients. This study was a randomized controlled trial and was registered in the UMIN Clinical Trial Registry (no. UMIN000007393).

The traditional kampo medicine tokishakuyakusan increases ocular blood flow in healthy subjects.

The aim of this study was to examine the effects of oral administration of kampo medical formulas on ocular blood flow (OBF). A crossover protocol was used to randomly administer five grams of yokukansan, tokishakuyakusan (TSS), keishibukuryogan, or hachimijiogan to 13 healthy blinded subjects (mean age: 37.3 ± 12.3 years). The mean blur rate, a quantitative OBF index obtained with laser speckle flowgraphy, was measured at the optic nerve head before and 30 minutes after administration. Blood pressure (BP) and intraocular pressure (IOP) were also recorded. No significant changes were observed in mean BP or IOP after the administration of any of the kampo medical formulas. There was a significant increase in OBF 30 minutes after administration of TSS (100% to 103.6 ± 6.9%, P < 0.01). Next, TSS was administered to 19 healthy subjects (mean age: 32.0 ± 11.0 years) and OBF was measured before and 15, 30, 45, and 60 minutes after administration. Plain water was used as a control. OBF increased significantly after TSS administration compared to control (P < 0.01) and also increased from 30 to 60 minutes after administration compared to baseline (P < 0.05). These results suggest that TSS can increase OBF without affecting BP or IOP in healthy subjects.

The role of integrative medicine and Kampo treatment in an aging society: experience with Kampo treatment during a natural disaster.

BACKGROUND AND OBJECTIVES: After the Great East Japan Earthquake, elderly individuals, who are particularly vulnerable during natural disasters, experienced difficulty while evacuating the area. This report discusses the Kampo treatments provided to elderly individuals in the disaster areas, and the role of integrative medicine and Kampo treatment. METHODS: The changes in symptoms and Kampo treatment contents were summarized using the medical records of treatments provided in the evacuation centers until 10 weeks after the earthquake. RESULTS: Infectious diseases, the common cold and hypothermia were frequently observed in most patients for first two weeks after the disaster. Allergies increased two weeks later, and mental distress was commonly observed six weeks later. We prescribed several Kampo formulas to treat the individual symptoms. DISCUSSION: Many elderly individuals were treated using Western medications, but the symptoms persisted; however, after Kampo formulas were included in the treatment, the symptoms of many patients improved. Unlike Western medications, Kampo formulas warmed the bodies of elderly individuals who often had a reduced basal metabolism and low body temperatures due to exposure to the cold tsunami waters. Therefore, the Kampo formulas may have improved the immunity of those who were under psychological and physical stress because they had spent several days in the evacuation centers. CONCLUSION: Many studies have reported the effectiveness of Kampo formulas. Therefore, the combined usage of both Western and Kampo medicine may be used in a mutually complementary manner, and these combination treatments may play an important role in preserving the victims overall health after natural disasters.

Treatment of posttraumatic stress disorder using the traditional Japanese herbal medicine saikokeishikankyoto: a randomized, observer-blinded, controlled trial in survivors of the great East Japan earthquake and tsunami.

The Great East Japan earthquake and tsunami caused immense damage over a wide area of eastern Japan. Hence, many survivors are at high risk for posttraumatic stress disorder (PTSD). This randomized, observer-blinded, controlled trial examined the efficacy and safety of the traditional Japanese herbal formula saikokeishikankyoto (SKK) in the treatment of PTSD among survivors of this disaster. Forty-three participants with an Impact of Event Scale-Revised (IES-R) score ≥ 25 were randomized into SKK (n = 21) and control (n = 22) groups. The primary endpoint was the change in IES-R scores from baseline till after 2 weeks of treatment. Intergroup statistical comparisons were performed. The magnitude of changes in total IES-R scores differed significantly between the two groups (P < 0.001). Post hoc analysis showed that the total IES-R score improved significantly in the SKK group from 49.6 ± 11.9 to 25.5 ± 17.0 (P < 0.001). Subscale scores improved significantly in the SKK group (avoidance, P = 0.003; hyperarousal, P < 0.001; intrusion, P < 0.001). Two-week treatment with SKK significantly improved IES-R scores among PTSD patients. This traditional medicine may be a valid choice for the treatment of psychological and physical symptoms in PTSD patients.

Food intake and the risk of endometrial endometrioid adenocarcinoma in Japanese women.

The present study examined the association between food intake and endometrial cancer restricted to endometrial endometrioid adenocarcinoma (EEA) using a case-control study in Japanese women. One hundred sixty-one cases and 380 controls who completed a questionnaire regarding demographic, lifestyle, and food frequency questionnaire were analyzed. Odds ratio (OR) between selected food intakes and EEA were calculated by logistic regression analysis. After adjustment putative confounding factors, the higher intakes of vegetables [odds ratio (OR) = 0.47, 95% confidence interval (CI) = 0.26-0.83], peanuts (OR = 0.48, CI = 0.27-0.86), fish (OR = 0.52, CI = 0.29-0.93), boiled egg (OR = 0.24, CI = 0.33-0.92), instant noodles (OR = 1.94, CI = 1.12-3.34), instant food items (OR = 2.21, CI = 1.31-3.74), and deep-fried foods (OR = 2.87, CI = 1.58-5.21) were associated with a risk for EEA. The inverse association with a risk of EEA was also seen in higher intakes (g/1000 kcal) for vegetables (0.45, CI = 0.25-0.81) and fish (0.53, CI = 0.30-0.94) as compare to lower intake. Higher intake of vegetables, peanuts, fish, and boiled egg was associated with a reduced risk for EEA, whereas instant noodles, instant food items, and deep-fried foods was associated with an increased risk for EAA as compared to lower levels of intake.

Heart rate variability and hemodynamic change in the superior mesenteric artery by acupuncture stimulation of lower limb points: a randomized crossover trial.

Objective. We investigated the relationship between superior mesenteric artery blood flow volume (SMA BFV) and autonomic nerve activity in acupuncture stimulation of lower limb points through heart rate variability (HRV) evaluations. Methods. Twenty-six healthy volunteers underwent crossover applications of bilateral manual acupuncture stimulation at ST36 or LR3 or no stimulation. Heart rate, blood pressure, cardiac index, systemic vascular resistance index, SMA BFV, and HRV at rest and 30 min after the intervention were analyzed. Results. SMA BFV showed a significant increase after ST36 stimulation (0% to 14.1% ± 23.4%, P = 0.007); very low frequency (VLF), high frequency (HF), low frequency (LF), and LF/HF were significantly greater than those at rest (0% to 479.4% ± 1185.6%, P = 0.045; 0% to 78.9% ± 197.6%, P = 0.048; 0% to 123.9% ± 217.1%, P = 0.006; 0% to 71.5% ± 171.1%, P = 0.039). Changes in HF and LF also differed significantly from those resulting from LR3 stimulation (HF: 78.9% ± 197.6% versus -18.2% ± 35.8%, P = 0.015; LF: 123.9% ± 217.1% versus 10.6% ± 70.6%, P = 0.013). Conclusion. Increased vagus nerve activity after ST36 stimulation resulted in increased SMA BFV. This partly explains the mechanism of acupuncture-induced BFV changes.

Report on disaster medical operations with acupuncture/massage therapy after the great East Japan earthquake.

The Great East Japan Earthquake inflicted immense damage over a wide area of eastern Japan with the consequent tsunami. Department of Traditional Asian Medicine, Tohoku University, started providing medical assistance to the disaster-stricken regions mainly employing traditional Asian therapies.We visited seven evacuation centers in Miyagi and Fukushima Prefecture and provided acupuncture/massage therapy. While massage therapy was performed manually, filiform needles and press tack needles were used to administer acupuncture. In total, 553 people were treated (mean age, 54.0 years; 206 men, 347 women). Assessment by interview showed that the most common complaint was shoulder/back stiffness. The rate of therapy satisfaction was 92.3%. Many people answered that they experienced not only physical but also psychological relief.At the time of the disaster, acupuncture/massage therapy, which has both mental and physical soothing effects, may be a therapeutic approach that can be effectively used in combination with Western medical practices.