Two experiments were conducted to determine effects of Juzen-taiho-to on endometrial carcinogenesis in mice. In the first experiment, Juzen-taiho-to treatment (2 weeks) decreased the levels of estradiol-17 β (E₂)-stimulated expression of c-fos/jun mRNA and their oncoproteins, determined by reverse transcription-polymerase chain reaction and Southern blot analysis, and immunohistochemical method, in the uteri of ovarectomized mice. For the second experiment, 93 female ICR mice were given N-methyl-N-nitrsourea (MNU) solution (1mg/100g body wt.) and normal saline (as controls) into their left and right uterine corpora, respectively, and were divided into four groups. Group 1 was given 0.2% Juzen-taiho-to and 5 ppm E₂-containing diet. Group 2 was given 5ppm E₂-containing diet alone. Group 3 was exposed to 0.2% Juzen-taiho-to containing diet alone. Group 4 was kept on the basal diet alone and treated as a control. Juzen-taiho-to treatment significantly decreased incidences of the uterine endometrial atypical (P<0.01), complex (P<0.05) and simple hyperplasias (P<0.01), under estrogenic stimulation. It is suggested that Juzen-taiho-to has an inhibitory effect on E₂-related endometrial carcinogenesis in mice, relevantly through suppression of estrogeninduced c-fos/jun-expression.

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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 yang ming bing, 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 Shang han lun [a treatise on Shang han (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 Bupleurum falcatum Willd or Bupleurum falcatum 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.

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The Idan medical monograph was originally written by Yoshimasu Todo (1702-73). Tsuruta Gen'itsu (1727-56), Todo's student, edited the first version. And after his death, his fellow student, Nakanishi Shinsai (1724-1803), revised and expanded the work, publishing it in 1759. Nakanishi claimed that this was the pioneering medical treatise penned by Todo, argued that it represented Todo's “original teachings, ” with playing up its sensational character.
There years after this book was published, Hata Kozan (1721-1804) wrote Seki-idan, severely criticizing Todo and Tsuruta's Idan. It ignited a raging debate, which divided the Edo period medical community in two. One side upheld Todo's Tenmeisetsu theory, which argued that the human life span was decided by the gods, while the other side opposed this premise. Horie Dogen's Ben-idan, Tanaka Eishin's Ben-seki-idan, Obata Hakuei's Ben-idan-hyosetsu, and Kaya Kyoan's Zoku-idan were published during the middle of this deflate. Here, I focus on the Idan and Seki-idan debate, and place this debate in the larger context of Edo period medical history.

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Myelodysplastic syndrome (MDS) is very difficult to treat, especially in case requiring blood transfusion therapy. Kami-kihi-to (Jia-Wei-Gui-Pi-Tang) was reported to have had a hematological effect on a case of idiopathic thrombocytopenic purpura. As it is well known that Kami-kihi-to improves anemia, we tried Kami-kihi-to for a case of MDS needing frequent blood transfusion, and analyzed its hematological and systemic effects. A 74-year-old man with MDS suffered from appetite loss and general fatigue-probably due to hemochromatosis with liver dysfunction after chemotherapy with prednisolone, metenolone and blood transfusion-for about eight years. Kami-kihi-to was administered to the patient, and two months later, his leukocyte and platelet count of peripheral blood increased, while the red cell count did not increase. Bone marrow findings remained constant before and after Kami-kihi-to therapy. The appetite loss and general fatigue improved after six weeks of this treatment. Kami-kihi-to is an appropriate treatment option for MDS with hemochromatosis that induces appetite loss or general fatigue.

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For many patients with trigeminal neuralgia, oral administration of carbamazepine is highly effective. Micro decompression surgery (Jannetta's operation) is also considered a fundamental treatment. However, there are patients who do not respond to carbamazepine and who hesitate to have surgery. Here, we report 14 cases whose pain was relieved solely by Kampo (7 cases) or by a combination of Kampo and carbamazepine (7 cases). The Kampo formulations used were Goshuyu-to (2 cases), Gorei-san (9 cases), Saiko-keishi-to (1 case), Toki-shigyaku-ka-goshuyu-shokyo-to (1 case) or Mao-bushi-saishin-to (1 case), depending on the “Zheng” of each patient. In trigeminal neuralgia, the nerve root is compressed or adhered to surrounding vessels, such as the superior cerebellar artery. It is highly possible that localized edema at the point of compression is responsible for the pain. The diuretic action of the Kampo may diminish the localized edema around the trigeminal nerve root.

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We report a case of rheumatoid arthritis (RA) that showed improvement after treatment with Daiseiryu-to-kadaiou. The patient was a 77-year-old woman diagnosed with RA in 1988. She had been visiting our department regularly since 1994. Oral steroids were used for two weeks in May 1994, but were discontinued due to a bacterial infection of the artificial femoral head. Thereafter, treatment was continued with bucillamine, nonsteroidal anti-inflammatory drugs, and various Kampo medicines. Joint pain worsened in November 2001. She was hospitalized on **********, as the CRP level had elevated to 15.2mg/dl. She had been taking bucillamine for seven years, but it had already been assessed as ineffective. It was discontinued upon hospitalization, and treatment with Daiseiryu-to-kadaiou was immediately begun. By ******, the patient judged the pain in both knees to have improved by about 50 percent. Moreover, the CRP level decreased to 2.4mg/dl by *******. The Lansbury index also improved from 100 percent to 69 percent during her hospitalization, and she was discharged on *******. Based on this experience, it is suggested that the prescription of Daiseiryu-to-kadaiou be considered in the treatment of RA patients.

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