The modern medicine in Japan made a remarkable progress according to development of Western medicine and further studies made it possible to understand almost of all diseases as cell and gene abnormalities using scientific approach such as imaging diagnosis or blood biochemistry. Kampo medicine, on the other hand, developed especially in Japan and is defined as holistic medicine because many diseases can be induced by responses of whole body against various causes instead of cell or organ abnormalities.
Recently EBM (Evidence based medicine) is required in the clinical field.
Though the evidence cannot be obtained easily in the clinical field, the concept of EBM seems to be important in achieving clinical practice even from the stand view point of cost-benefit and many trials began to accept this EBM in the field of Western medicine.
On the other hand, usefulness of Kampo medicine on various diseases was elucidated by means of Western analysis such as double blind test and the “Shou”, unique diagnostic method for Kampo medicine, turned out not to be necessary in all cases for the best treatment. Doctors engaging in Kampo medicine began to change their attitude to accept EBM by their newly considered method including conventional “Shou”
Both medicines, Western and Kampo medicine, have various features and merits or demerits for the treatment of diseases respectively. Therefore, a trial to combine Kampo and Western medicine should be taken into consideration, to improve the clinical practice.

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Women with undefined climacteric period complaints often have multiple symptoms. To identify the characteristics of and to provide treatment tailored to each patient, Sho diagnosis based on an eight-principle pattern of identification is needed. Furthermore, identification of abnormalities in Ki, Ketsu and Sui, which are the basic elements of all physiological activity, are of great importance in clinical practice.
We determined identification rates of these principles in women with climacteric symptoms using Kampo medicine. Eight hundred and ninety-nine climacteric patients, aged 43-58 years: 52.1±2.4yr, were recruited for this study. We detected heat-or cold-syndrome, and hyper-or hypofunction patterns using the eight-principles with conventional, traditional Japanese Kampo medicine diagnostic procedures as well as disorders of Ki, Ketsu, and Sui metabolism according to the Terasawa score, in retrospective fashion. Ketsu stagnation (36.5%) was found to be the most frequent condition. Ki regurgitation (25.9%) and Ki stagnation (24.8%) were found to be relatively frequent pathological conditions. In women with headache, hot flushes, and dizziness as the principal menopausal symptom, disorders of the Sui metabolism (48.8%), Ketsu stagnation (48.1%), and disorders of the Sui metabolism (48.0%) were the most frequent conditions, respectively.
These results indicate that although climacteric symptoms are diverse in nature, identification of Ki-Ketsu-Sui patterns often makes it possible to obtain a coherent diagnostic picture, leading to a better understanding of the conditions seen in climacteric women. When dealing with climacteric women with undefined complaints, it seems particularly important for physicians to be able to prescribe Kampo preparations precisely for Ketsu stagnation (the most frequently observed) so that the health of these women can be restored. It is also important that physicians perform Sho diagnosis carefully, bearing in mind the finding that Ki-Ketsu-Sui patterns were complex in patients exhibiting hot flushes (one of the main symptoms), although half of these presented with Ketsu stagnation. Incorporating Kampo medicine into therapeutic approaches to the treatment of such patients therefore seems advisable.

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Kyo-kyo-kuman has not been analyzed with modern medicine methods. We hypothesize that Kyo-kyo-kuman reflects the severity of somatization symptoms. Thus we investigated the correlation of Kyo-kyo-kuman with somatization symptoms, using Keio's Kyo-kyo-kuman scale (K-scale) and the Screener for Somatoform Disorders (SSD). One hundred and fifty patients (38 males, 112 females, mean age 40.69±17.56 years) were evaluated for their Kyo-kyo-kuman levels, using the K-scale and the number of somatization symptoms according to the SSD. On the right, the K-scale scores correlated significantly with the number of present somatization symptoms (R=0.440, p<0.0001) and the number of somatization symptoms within one year (R=0.476, p<0.0001). On the left, the K-scale scores correlated significantly with the number of somatization symptoms lasting for more than three months (R=0.450, p<0.0001), the number of present somatization symptom (R=0.597, p<0.0001) and the number of somatization symptoms within one year (R=0.586, p<0.0001).
In conclusion, patients having Kyo-kyo-kuman tended to complain of many kinds of somatization symptoms. We suggest that Kyo-kyo-kuman correlates well with these symptoms.

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Aconitum carmichaeli debeaux is an essential herbal medicine that possess anti-inflammatory, analgesic, and cardiotonic effects. Five hundred ninety-three subjects were treated with Shuchi-bushi (a powder type of this aconiti tuber that has been autoclaved) added to Kampo extract granules, between the years 1996 and 2002. The patient population consisted of 153 men and 440 women with an average age of 54.5 years. Four patients showed adverse reactions such as hypertension, nausea and hot flashes with Shuchi-bushi. There were no serious adverse effects, and the toxic symptoms disappeared quickly by reducing the Shuchi-bushi dosage, or cessation.
Shuchi-bushi has been used in small quantities because of its highly toxic alkaloids. However, this study indicates that Shuchi-bushi can be used more actively.

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Hangekobokuto is a “kizai” (psychoactivity modulating drug), which is often used for “inchu-sharen” (feeling that something is obstructing the throat). Many previous papers have pointed out its importance when treating abdominal symptoms, especially “chukan-himan” (feeling of fullness/stomach mid-segment obstruction).
We administered an extract or decoction of Hangekobokuto, to the patients with oppressive “chukan” pain and discomfort, and examined their chief complaints, subjective symptoms and abdominal symptoms, especially the state of their “chukan” and the change of that “chukan” after administration. We found “inchu-sharen” (66.7%), sense of cold (55.6%), moderate abdominal strength (77.8%), changes in the epigastrium (38.9%), clapotage (11.1%).
We showed that in terms of the state of “chukan, ”, oppressive pain was eliminated or reduced in 69.2% of the patients except omission.

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A 22-year old man was referred for mental retardation, refractory epilepsy, and chronic renal failure due to congenital anomalies of the kidney and urinary tract since he was an infant. Although hemodialysis was introduced both 3 years and 8 months ago, neither its appropriate safe management nor good quality of life were obtained, because of polyhydruria, psychogenic polydipsia, and his aggressive disruptive behavior in refusing any proper direction. After the fourth making of a shunt vessel with an artificial material, we gave him Orengedokuto to reduce his insomnia, itching, and other indefinite complaints.
As a result, his complaints and behaviors improved and he stopped taking too much water on the days before hemodialysis; which then began to work preferably with the proper amount of water exclusion. Moreover, we could reduce the amount of carbamazepine and methylphenidate hydrochloride he required. This case demonstrates that Orengedokuto may have an effect on the central nervous system to improve behavioral problems stemming from developmental disorders in children, or adolescents.

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[Purpose]
The purpose of this study was to demonstrate the effectiveness of Kampo medicines, from the aspect of cost effectiveness. We obtained judgment criteria by analyzing past published papers and implemented our study according to criteria about the kinds of formulations and diseases that were suitable for pharmacoeconomic analysis.
[Method]
First, we extracted the original, clinical, and NHI price listed formulations (EA) from each published paper, by searching for Japanese key words such as “_??__??_ (Kampo)” or “_??__??_ (economic)” in the databases of “Igaku Chuo Zasshi” and “Institute for Health Economics and Policy.” Considering the importance establishing a controlled treatment method in pharmacoeconomic analysis, we defined papers with a comparative control (Comp) as one judgment criterion (1), then extracted these data; and analyzed how target (diseases and formulations), controlled formulation, measurement outcomes, and “Sho” (patterns or syndromes) were handled in each paper. Secondly, we defined those formulations which had been referred to many times in the EA as our second judgment criterion (2), because we thought they had abundant and clear outcomes, and then implemented an outcome analysis of them.
[Results and Discussion]
Judgment criterion (1): The number of formulations, and the total number of papers referring to a Comp (38 articles) were 25 and 41 (Shoseiryuto [4], Shosaikoto [4], Kyukichoketsuin [3] in descending order) respectively. Approximately two-thirds of target illnesses covered in these papers were gastrointestinal diseases, infectious diseases, ear nose and throat diseases; and in women, pregnancy or delivery-related diseases. Concerning outcomes, only 10.5% of the papers measured human outcomes such as quality of life (QOL), which might suggest that the implementation of cost effectiveness analysis was difficult. The results of analyzing how to handle “Sho” suggested that Kyo-sho or Vacuity-sho patient formulations tended to exert their treatment effects relatively, even without consideration for “Sho”.
Judgment criterion (2): Using EA prices, we expedientially defined frequently referred formulations as those referred to in 15 or more of the total research paper number, and then extracted them. As the result of this extraction, 6 formulations (Hochuekkito, Keishibukuryogan, Shishihakuhito, and etc.) were obtained. Among these formulations, Shishihakuhito had high rates (88.2%) for achieving treatment goals, including the improvement of skin symptoms such as erythema and pruritus.
[In Conclusion]
A comparison between Kampo and Western medicines was not simply applicable, due to large differences between their mechanisms of action, and the ways they exert their effect, even if their ultimate effects are the same. We would need to create a study plan which would cover human outcomes when making a further pharmacoeconomic study, because Kampo medicines do have a good chance of improving QOL. We would even say that Vacuity-sho formulations given to patients could easily work, without consideration for “Sho”.

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