Oriental medicine encompasses various areas including Kampo medicine, and alternative treatments such as acupuncture and massage. Special knowledge of statistics is not necessary to understand in oriental medicine, for which it is sufficient to master general statistics. This review describes statistic fundamentals and important issues for submitting an original article. It describes statistical thinking, data collection, study design, special considerations related to oriental medicine, fundamental statistical methods, multivariate analysis, and statistical software. In particular, it deals with the concept of sample variation, observational and experimental studies, rationale for randomization, sample size determination, t-tests, chi-square tests, paired tests, nonparametric methods, P-values, correlation coefficients, multiple regression, and logistic regression.

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It is important to treat patients with spleen qi deficiency not only with formulations for their deficiency, but also with formulations to improve qi stagnation. Rikkunshito plus Cyperi Rhizoma, Amomi Semen and Agastache rugosa, which improve qi circulation, was effective in cases 1 and 2 herein. We examined when and how to prescribe kososan with formulations for spleen qi deficiency, with reference to kosharikkunshito. Kososan and rikkunshito were effective in cases 3 and 4. Based on rikkunshito indication, a patient with weaker constitution was prescribed shikunshito (case 8), a patient with diarrhea and vertigo was prescribed shinbuto (cases 5 and 6), and a patient with severe coldness was prescribed ninjinto (case 7). Kososan played a supplementary role in treatment, and can be prescribed with other medicines. Not only gastrointestinal symptoms, but also various other complaints were improved by adding kososan to prescriptions for spleen qi deficiency.

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We report 5 patients with polymyalgia rheumatica (PMR) successfully treated with Kampo medicines. In total, we investigated 10 patients with PMR, including the 5 patients here treated in our department. Results showed that Kampo medicine was effective in 6 cases. One of the 6 refused steroid drug administration, and tapering dosage steroid was difficult in the other 5 patients due to myalgia or inflammation. Except for one case, C-reactive protein in most of the effective cases was below 3.0 mg/dl. On the other hand, the non-effective cases had severe inflammation levels and needed steroid therapy. The effective cases were treated with sokeikakketsuto, tokakujokito, keishibukuryogan, choyotokasyakuyaku, yokuibushihaishosan and tokishakuyakusan, which have the effect of improving oketsu states. Thus, it was considered that Kampo medicine has the potential for treatments in PMR patients who have difficulty tapering steroid dosage and mild inflammation. Moreover, this suggests Kampo medicines that improve oketsu state are useful for PMR treatment.

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We report a case of a 35-year-old woman with fibromyalgia who was successfully treated with acupuncture only after identification of syndromes using the Four Examinations. After working hard for years, she suffered from severe chest and back pain, fever and insomnia. At one hospital, no abnormality was found after detailed examinations. The pain gradually worsened and she was eventually diagnosed with fibromyalgia at a university hospital. She wanted to be treated with Kampo medicine and consulted us. We identified her symptoms as liver qi stagnation, qi stagnation causing blood stasis and qi stagnation damage to yin, and treated with acupuncture mainly using only two shendao (GV 11) and zhaohai (KI 6) points. Pain was relieved by 30% after her 37 th treatment. Her fever also disappeared. Almost no pain was reported by the 91st treatment. A Fibromyalgia Impact Questionnaire score of 78 at her first examination had improved to 23 by the 82 nd treatment at 17 months, indicating that her QOL had improved.

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Reitakutsukito is a Kampo formulation that is applied for the treatment of olfaction disorder. There have been some reports that reitakutsukito improves nasal obstructions such as allergic rhinitis and chronic sinusitis, but none have reported a neurogenic olfaction disorder successfully treated with this formulation. We report a case of olfaction disorder that was neurogenic, successfully treated with reitakutsukito. The patient was a 43-year-old male. After being bruised on the head, he presented with olfaction disorder. He went to the otorhinolaryngology department at a university hospital and received a diagnosis of neurogenic olfaction disorder. However, he did not show any improvement. Fourteen months after the head trauma, he consulted our institution. We prescribed reitakutsukito for four weeks, and his subjective symptoms improved. Treatment with reitakutsukito for almost two years then resolved his symptoms. This case suggests that reitakutsukito could be a useful formulation for the treatment of not only respiratory olfaction disorder, but also neurogenic disorder.

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Teian Azai classically described that summer heat was caused by humidity in addition to hot weather. It may occur after becoming chilled while asleep, enjoying the evening cool, and taking cold foods and drinks. Humidity and high temperature prevent qi circulation in the stomach. Therefore, he insisted that goreisan, a formula improving water circulation, could be applied for diverse symptoms caused by summer heat. We present two cases of patients with epigastralgia caused by cold foods and drinks in air-conditioned environments, whose symptoms were improved by goreisan. In prior treatment, anchusan in case1, and rikkunshito in case 2 were not effective for their epigastralgia. Nineteen cases of epigastralgia after taking cold foods and drinks in summer, including these two cases, revealed that goreisan was efficacious against summer epigastralgia with white fur on the tongue and a stuck feeling in the pit of the stomach. Abdominal fluid congestion is a major abdominal sign for an indication of goreisan, but a stuck feeling in the pit of the stomach presented in some effective cases with goreisan. We concluded that epigastralgia caused by cold foods and drinks with white fur on the tongue and a stuck feeling in the pit of the stomach could be a target for the application for goreisan.

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Chronic fatigue is a common symptom in primary health care and caused by various organic and functional diseases. Although improvement is attained by controlling underlying organic disease, it is sometimes difficult to relieve fatigue in patients with chronic fatigue syndrome or dysthymia. We have encountered patients with idiopathic chronic fatigue (ICF) successfully treated with sansonintokagen. A 62-year-old female complained of chronic fatigue several years after menopause, and had normal status in routine blood and image analyses at a nearby hospital. Her condition was diagnosed as ICF with sleeplessness. Treatment with sansonintoaogibakumondo for 8 weeks improved her chronic fatigue and sleeplessness, and enabled her to continue housekeeping. This observation suggests that this kampo formula may be a useful agent for ICF.

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A 51-year-old male with cyclic neutropenia, on whom we previously reported, was admitted to our hospital with severe abdominal pain and diarrhea four years and seven months after his last hospitalization. Since then, he has received Kampo treatment at our hospital every three weeks, with good clinical results. This time, he was at first treated with Kampo daikenchuto combined with bushikobeito, which had been effective during his last hospitalization, although this time the remedy had no effect. From the viewpoint of Japanese traditional (Kampo) medicine, it was considered that the patient had severe cold syndrome. He was given uzukeishito three times a day (at 10.00, 15.00 and 20.00 hours). The dose of uzu in uzukeishito was gradually increased. Daiuzusen, in which the dose of uzu (an aconite) was 1g or 2g, was also administered five times a day due to the patient's very severe abdominal pain. On the fourth day of uzukeishito administration, the patient felt very hot and still had severe abdominal pain, although this pain was different from the previous pain, thirty minutes after daiuzusen (with 2g dose of uzu) was administered. This reaction can better be explained as mengen rather than uzu poisoning. Very soon he had a good appetite, his abdominal pain was reduced and the cycle of neutropenia was normalized. The case suggests that in cases of very severe cold syndrome, frequent and high-dose administration of aconite component medicine can be effective.

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Dang Gui Liu Huang Tang (in the Lan Shi Mi Cang written by Li Dong-yuan) is a common medicine for treating night sweats. We describe its historical development and therapeutic uses. The use of Huan qi (Radix Astragali sen Hedysari) is based on the Han-Sui dynasty medical principle that night sweats are mainly caused by Deficiency of Yang. Herbs to enrich the lood and Yin, Dang gui (Radix Angelicae Sinesis), Seng di huang (Radix Remannia), Shu di huang Radix Rehmannia preparata) were later added because Son dynasty physicians mentioned that Yin deficiency caused night sweats. The addition of heat-reducing herbs, such as Huang lian (Rhizoma Coptidis), was based on the Song dynasty theory that night sweats are caused by pathologic heat in the body, which forces body fluid out of the skin. In the same period, the herbal medicine called Da Jin Hua Wan created by Liu Wansu, and this greatly influenced the principles for treating night sweats. The clearest explanation can be found in the medical treaties Huang Di Nei Jing Su Wen, and Xuan Ming Lun. This medical combination was based on medical theories from a number of historical periods, which may explain its effectiveness. Dang Gui Liu Huang Tang is not effective against types of weak heat (Dan xin xin fa), severe vital Qi Deficiency (Zhang shi yang), or serious deficiency of Yin (Yi xue xin wu). It sometimes hurts Pi and Wei (digestive system). It is useful in the treatment of spontaneous perspiration (Yi xue zheng zhuang, Jin xue quan shu). In summary, this medicine is most effective when the seriousness of heat and Yin deficiency are almost equal and a slight Qi Deficiency exists, or in cases of spontaneous perspiration.

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Healthcare in Japan is approaching a crossroads. Birth rates are lowering, and various problems associated with a rapidly increasing elderly population are erupting. To turn around regional medical care, a complete rethinking on the part of physicians and the citizenry alike is called for. Physicians need to understand not only the latest clinical resources, but also what role medical care plays in everyday life. And we should reassess our regional medical care to gain a better understanding of its value and meaning.
In an aging society, we need to build communities able to extend the helping hand of care to the elderly, whatever position they may be in. As science and technology advance, great changes in medical care are coming about. We see home healthcare becoming more high-tech. And it would be best for us to build a healthcare system that links the functionality of various medical institutions from the most advanced hospitals to more common private infirmaries. Answering the question of how the increasing number of women doctors would best provide medical care throughout life will also provide a breakthrough to our shortage of doctors. This is an age in which both patients and healthcare providers can move forward together. And we are counting on the nation to put forth its best efforts.

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