Physical examination in Kampo medicine are Inspection, Listening, Interview, Palpitation, and examining it make the core of “Inspection” the diagnosis of tongue. A character of “Inspection” is hieroglyphic formation of the state that even a tiptoe watches the distance of a person. In other Words, not a viewpoint of “analysis”, you must perform it for an idea to “grasp the whole” to the last. Medical examination and treatment begins at the moment when a patient entered a consulting room, and it is it with a key whether, with that in mind, “grasping the whole” is possible. Laennec (1781-1826) created a stethoscope states that “all the medicine begins with observation”, but a meaning to have of “Inspection” is deep. Examining it divide it into “Shin, color, form and state” and observe it, but this “Shin” is “energy” and gathers up a whole body state of a patient generally, and a tongue is important when I guess convalescence of illness an importance. It is thought that a tongue reflects development of a condition, Yin and Yang/Kyo and Jitsu of the condition of a patient, balance of Qi, Ketsu and Sui, but there is not such a change for views, and even a physically unimpaired person can watch a native change though there is serious illness in one. In other words it is a premise to watch quality of tongue and a change of fur as a partial phenomenon and an accompanying symptom of the condition of a patient generally without being seized with only views of a part.

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I have been an ordinary surgeon. But, for about eight years, I have frequently been prescribing Kampo drugs. So, at first, I'd like to tell my story about how to learn Kampo and how to improve my Kampo skill. In this part, I introduce my interesting career, my character and my favorite Kampo books and masters (lecturers). Then, in my experience, I try to clear the property of Kampo, and show the key points of the Kampo therapy. At last, I refer to my attitude of the daily Kampo therapy.

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The practice of Chinese medicine has continued for more than 2,000 years, based on its long record of effectiveness. In this regard, Kampo medicine has also been used successfully for these many years, and it is still equally effective today, reflecting the fact that humans have changed little during that duration. In fact, it is said that humans have not undergone much evolutionary change in the last four million years. In contrast to this, however, are the ongoing changes in our environment and surroundings, which are giving rise to a host of new diseases, including many that are allergy-related.
In the Japanese system of Kampo medicine, the pathophysiological diagnosis (Sho) and treatment are decided on the basis of two venerable texts, Shokanron and Kinkiyoryaku. There is, as a matter of fact, a prevailing, and possibly too extreme, opinion among Kampo practitioners that Kampo methods and medications not found in these two manuals are not to be applied. However, it is thought that changes had already been made to these texts in 1065-1066 by Rinoku et al., and possibly also by others earlier during the Song Dynasty (960-1279). Furthermore, two other texts, Ishimpo and Taiheiseikeiho, present many points that differ from those found in Shokanron. Thus, it is highly likely that Sho is also based on other revisions possibly carried out on these texts (originally authored by Cho Chukei) before Rinoku et al., if not on their own revised versions. From this, it must be realized that revision itself is not a bad process, and rather that the changes for which Rinoku et al. were responsible are quite in harmony with the present age.
We must not be afraid to break with an old style. From the early days of Kampo medicine, Sho was assessed on the basis of the four available examination methods (visual examination, examination according to hearing and smell, questions and answers, and palpation). The field of medicine has since undergone some remarkable transitions, and its current state is one of tremendous development. As part of these newly acquired abilities, elevated levels of leucocytes and CRP as reflecting the state of the disease, for example, can be incorporated into the assessment of Sho. In this sense, Kampo practitioners should adopt and apply useful methods also originating from Western medicine. As a matter of fact, this is in line with the preface of Shokanron, which states that useful medications and methods should be gathered as broadly as possible ( ?? ).

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Chinese herbal remedy (KAMPO) is no longer an out-of-date medicine. It is now transforming into a new medical care system that attracts world-wide attention. The therapeutic system of Oriental Medicine is different in various aspects from that of Occidental Medicine. In this regard, appropriate harmonization of East and West (Oriental Medicine and Occidental Medicine) by comparison with merits and demerits in the understanding of diseases, methods of consultation, usage of drugs, etc. is expected to improve the quality of medical care. Considering that most of the drugs used in the Occidental Medicine are based on “single effective ingredient” that is artificially synthesized while herbal drugs are produced by combining crude drugs that contain various ingredients, the method of administration should naturally be changed.
Such stance of Kampo medicine is based on the “respect for and understanding of individual constitution and disposition while paying attention to the gender difference and individuality” with the patient as the protagonist (treatment that is centered on client) and is also based on understanding and respecting the gender difference and individuality that are the basis of so-called “Science and Art” of practical medicine.

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In order to have a more “universal understanding” of Kampo medicine, it helps to explain the “fundamental concepts” and the “theoretical framework” of Kampo medicine, in latest life science knowledge with a key word “context.”
Ki, Ketsu and Sui are the three elements which compose the cellular environment (context), and shoulder the maintenance of life's activities, which are dependent on metabolic changes and information flow. The function and structure of the living body are normally led by Ki, Ketsu and Sui.
The five parenchymatous viscera (lungs, heart, liver, spleen, kidneys) are not only organs which maintain the cellular environment, they also act as higher control systems which control organ activities. These five viscera as higher control systems create conditions (context) throughout the body and control the life activities of each organ in an integrated manner.
In a sick person, these organ life activities take on a kind of “fighting style” which can change from moment to moment, with natural disease progression and/or treatment intervention. The classic text Shokanron describes these changes in fighting style as the “six stages of disease”, and indicates formulation choices based on variations in the body's fighting style.
From the viewpoint of a connection with Western medicine and a dialog with traditional Chinese medicine, explaining Kampo medicine in ways which anyone can understand by creating a universal understanding of its fundamental concepts and theoretical framework, is our mission for the 21^st Century.

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We experienced four cases of urticaria (two patients with cholinergic urticaria, one patient with chronic idiopathic urticaria and one patient with cold urticaria) successfully treated with Kampo therapy. The factors for outbreak or aggravation of urticaria were stress of looking after the father in law and hysterectomy in the first case, psychological stress due to familial trouble in the second case, panic disorder like episode in the third case, and solicitude and anxiety for family in the fourth case. The effective Kampo formulae that improved the dermatological symptom were keishibukuryogan, hangekobokuto, yokukansankachimpihange and kamishoyosan, respectively. It was helpful that to clarify the psychological background affecting the dermatological symptom in the determination of Kampo formulae. It would be useful that careful and repetitious question and answer about psychological background in the treatment of intractable urticaria.

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I report two cases of subchorionic hematoma successfully treated with Tokishakuyakusan. They had genital bleeding due to subchorionic hematoma in the second trimester of pregnancy. I prescribed Tokishakuyakusan, and their genital bleeding improved within a week after the administration. The hematoma disappeared in less than two weeks after the administration, and they delivered infants of 2470g and 3324g respectively at 39 weeks pregnant by vaginal delivery. I found Ketsu stagnation, Sui disturbance and coldness of extremities in two cases. Although several studies suggested that the presence of subchorionic hematoma might be associated with adverse pregnancy outcome, there is no effective treatment for subchorionic hematoma in western medicine. The present cases suggest that Tokishakuyakusan may be useful in the treatment of subchorionic hematoma.

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We report a case of 87-year-old female with somatoform autonomic dysfunction whose complaint of oppression ranging from the left chest to the epigastrium was successfully treated with shimbuto, in whom neither antidepressants nor anxiolytic drugs had been effective. Since weak abdominal power, bilateral kyokyokuman and pulsation in the upper navel region were observed, saikokeishikankyoto was initiated, but satisfactory effect was not obtained. Thus, we re-estimated her conditions and judged as the stage of Shao yin based on symptoms such as bedridden tendency, coldness of the limbs and indigestible diarrhea, although a weak and surface pulse was noted. Shimbuto was then administered, and various symptoms including chest oppression were improved rapidly and dramatically. We speculated that her chest oppression might occur due to kiutsu (depression of ki) secondary to suitai (accumulation of sui) rather than kigyaku (regurgitation of ki), and that the improvement of suitai by shimbuto might result in the disappearance of kiutsu. Although shimbuto is not popularly used for the treatment of somatoform disorder having chest symptoms, our case suggests that there should be a certain case in which shimbuto is so effective. Also it is suggested that shimbuto might be applicable even when deep pulse or excessive strain of abdominal muscles is not necessarily observed.

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