We evaluated body constituent patterns of 130 consecutive patients with symptomatic acute cerebral infarction. They comprise lacunar infarction (n = 47), atherothrombotic infarction (n = 70), cardiogenic embolism (n = 11), and other type of infarction (n = 2). We compared body constituent patterns between them and 93 consecutive patients with other neurological diseases of the same age. We used qi-ketsu-sui scores to evaluate body constituent patterns in all cases. Qi-ketsu-sui scores measure six factors : qi deficiency (kikyo), qi stagnation (kiutsu), qi counterflow (kigyaku), blood deficiency (kekkyo), blood stasis (oketsu), and fluid retention (suitai). As a result of multivariate model analysis, symptomatic acute cerebral infarction had the largest weight of blood stasis and an adjusted odds ratio (95% confidence interval) was 4.6 (2.45-8.91). Even when gender as a confounding factor was adjusted by stratified analysis, adjusted odds ratios of blood stasis (95% confidence interval) were 7.46 (3.02-20.25) for males and 2.63 (1.02-7.11) for females, and those were maximum. The point (median, interquartile range) of blood stasis was more severe in acute cerebral infarction (24 points, 18-33 points) than other neurological diseases (16 points, 9-23 points). We examined relationships between body constituent patterns and clinical disease type, severity at hospitalization, and sex in patients with symptomatic acute cerebral infarction. Ratio of blood stasis was the largest in any clinical disease type, severity and sex. Blood stasis seemed to be the most important factor in symptomatic acute cerebral infarction.

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We investigated the number of drugs and pharmaceutical cost among 159 patients prescribed Western medicine and hospitalized from August 2006 to August 2015 in the Department of Oriental (Kampo) Medicine at Chiba University Hospital. The number of drugs used in Western medicine among improved patients significantly decreased from 5.6 ± 3.6 at hospitalization to 5.3 ± 3.5 at discharge, but the number of Kampo medicine drugs was not changed. The total number of drugs including both Western medicine and Kampo medicine significantly decreased from 7.0 ± 3.8 to 6.7 ± 3.6. The number of drugs used in Western medicine among nochanged patients decreased from 5.1 ± 3.4 at hospitalization to 5.0 ± 3.7 at discharge, but the number of Kampo medicine drugs significantly increased from 1.0 ± 0.0 at hospitalization to 1.3 ± 0.5. The total number of drugs including both Western medicine and Kampo medicine increased from 6.1 ± 3.4 to 6.3 ± 3.9. We thus conclude that a combination of Kampo medicine with Western medicine can be useful for reducing the number of drugs related to polypharmacy. To achieve these results, it is essential to use the concept of sho (a way of pattern recognition of a patient's symptoms in Kampo medicine).

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The decoctions of unprocessed aconite root (uzu) were prepared with the tap water samples collected in Tianjin and Shanghai in China, and the contents of alkaloids in the decoctions were compared to those prepared with purified water or with tap water collected in Niigata, Japan. The contents of aconitine-type diester alkaloids (ADA) in the decoctions prepared with tap water collected in China were significantly lower than those with purified water or tap water in Niigata. It was speculated that this difference appeared by buffering effect of bicarbonic anion in tap water in China to decline pH of the decoction. When uzu was decocted with glycyrrhiza, ginger, or jujube, the contents of ADA in the decoctions exhibited the tendency to have higher levels than those prepared using unprocessed aconite root singly, and also this tendency was observed more remarkably when the decoctions were prepared with tap water collected in China. It was suggested that even the decocting period was fixed, unexpected change of the contents of ADAs might be induced by the differences in the properties of water used for decoction or the crude drugs decocted with aconite root. The physicians in the era when “Songban Shanghanlun” had established may have adjusted the contents of ADA in the decoction by carefully choosing the crude drugs combined to aconite root.

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Urinary tract infection (UTI) is a common disease, and administration of antibiotics should be the first choice for UTI. However, it often recurs, and recurrent UTI is generally treated with antibiotics. Many reports describe the use of choreito for the treatment of lower urinary tract symptoms and ureteral stones, but only a few reports are dedicated to the treatment of recurrent UTI with choreito. An 84-year-old woman had a UTI that recurred 4 times, and every time she was hospitalized. Although we treated her condition with an antibiotic and α 1-blocker for neurogenic bladder, and provided her home-care advice, her UTI recurred 4 times. Thus, we gave her choreito, which successfully treated her recurrent UTI. Before the treatment, she was hospitalized 4 times within 2 months. However, in the recent 7 months after the treatment with choreito, she did not need to be hospitalized. She is currently visiting a hospital once every 2 months. The present case indicates that choreito is beneficial in terms of health economics.

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We experienced 8 cases of children who presented with somatic complaints and found it difficult to attend school successfully treated with Kampo medicine. We evaluated them objectively by using the evaluation scale in the guideline for medical care of school refusal. Four cases were orthostatic dysregulation, 2 cases were migraine, 1 case was involuntary movement in upper abdomen and the other case was autonomic dysfunction. Kampo medicines were selected according to conventional method, so-called sho. Among 8 cases, 5 cases had a major response, 2 cases had a minor response and one case had no beneficial response. These results suggest that Kampo therapy can be effective therapeutic means. Kampo therapy is quite personalized and beneficial especially for children who find it difficult to attend school and need individualized care. This is the first report evaluating many cases objectively by using the evaluation scale and there have been no reports similar to ours. We have to continue to enlighten general pediatricians about the effectiveness of Kampo therapy.

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Allergic rhinitis is an allergic disease affecting the nasal mucous membrane, and is aggravated by many kinds of factors. Here we describe 4 cases of allergic rhinitis successfully treated with tokishakuyakusan. Case 1 was a 31-year-old woman who suffered from coldness and irregular menstruation. We administered tokishakuyakusan, and her allergic rhinitis improved. When she stopped taking tokishakuyakusan, her allergic rhinitis recurred. Case 2 was a 40-year-old woman who suffered from seasonal pollenosis every year. Her pollenosis did not respond to keishibukuryogankayokuinin, administered for uterine myoma, but when we switched to tokishakuyakusan, her pollenosis improved. Case 3 was a 49-year-old woman who suffered from allergic rhinitis. She had not responded to many herbal medicines, but when we administered tokishakuyakusan, her allergic rhinitis rapidly improved. Case 4 was a 65-year-old woman who suffered from allergic rhinitis. She did not respond to kakkontokasenkyushin'i, but when tokishakuyakusan was added, her allergic rhinitis improved. Efficacy of tokishakuyakusan for rhinitis is not described in the classic literature. Our results suggest that tokishakuyakusan could be a suitable herbal medicine for asthenic, cold constitution of patients with allergic rhinitis caused by blood stagnation and blood deficiency as well as water disturbance.

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Calf cramps is a complication that can arise in dialysis patients. Shakuyakukanzoto is a useful medicine that is administered at appropriate doses for calf cramps. However, this medicine has been effective at the beginning, with a subsequent progressive decrease in its effect. We came to experience invalidity cases. In five phases theory, calf cramps were recognized as a disorder of the liver, and we administered saikokeishito, including saiko and shakuyaku, which regulate the liver function. We report on 9 dialysis patients with calf cramps who were successfully treated with saikokeishito. Calf cramps were considered to occur by the ataxia of organization of lesser yang pattern resulted in periodic attack, and the ataxia of auto nervous system as the symptom of yin yang disconnection. Saikokeishito is prepared using shosaikoto which regulates the lesser yang pattern and keishito which modulates the yin yang balance. Saikokeishito has the properties of both of these medicines. Thus, it may be a suitable medicine for calf cramps that occur owing to life style in dialysis patients.

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Shiunko, topical herbal ointment, has been used in Japan for hemorrhoid and skin wound such as scratch, incision and burn. We report two cases of radiation dermatitis with erosion, which have a good outcome after treatment with shiunko. Case 1 was 72-year-old man with radiation dermatitis of bilateral inguinal region caused by postoperative irradiation for bilateral inguinal lymph node metastases from penile cancer. Re-epithelization was observed in erosion on the 10^th day after applying shiunko. It showed earlier recovery from radiation dermatitis than the cases treated with topical external medicine of azulene and/or steroid. Case 2 was 60-year-old man with the perianal radiation dermatitis with pain caused by pelvic radiotherapy for recurrence of advanced rectal cancer after chemotherapy. Shiunko gave rapid relief from anal pain and the patients felt no pain on the day subsequent to applying shiunko. Shiunko hastens analgesic effectiveness and improvement of wound caused by radiotherapy.

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Soshikokito has long been used to treat cough in frail patients with cold sensation in their feet, based on the Japanese traditional Kampo textbook “Iryo-Shuhou-Kiku”. In many old documents including “Wazai-Kyokuho,” where soshikokito was first described, it is suggested that airways obstructed by a large quantity of watery expectoration should be the proper indication for the use of this formula. However, in the five cases that we successfully treated, the quantity of sputum was relatively small. To determine the practical indications for this, we examined their abdominal strength and the presence or absence of “cold feet” sensation. In addition, we investigated the nature of sputum in the past clinical reports in which successful treatment using soshikokito was described. It has become clear that we can prescribe soshikokito as an antitussive regardless of the patients' physical fitness as deduced from the abdominal strength. The “cold feet” sensation was not an essential symptom and was regarded as one of the symptoms of qi counterflow. Regarding the properties of sputum, it was viscous and small in quantity. In the cases where soshikokito was effective, it was speculated that viscous sputum would result in airway obstruction, coughing, and wheezing. These conditions will be ameliorated by the antitussive and expectorant effect of this formula, which improves qi counterflow and mildly tonifies water. In the treatment of cough with respiratory distress, “sputum with high viscosity and hard to discharge” is considered to be the targeted symptom in the practical usage of soshikokito.

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A 59 year-old woman with rashes of forehead and chest visited our hospital in hope of treatment with Kampo medicine. The rashes had occurred at the age of 50 years old and gradually spread. She had been diagnosed with psoriasis vulgaris by a nearby dermatologist. Though she had been treated with the steroid ointment, the symptom had repeated exacerbation and remission for nine years. At the first examination, her exanthems were damp, concentrated on frontlet and was seen in posterior cervical region, precordial region, upper and lower limb. Jizusoippo was prescribed, and the exanthem improved significantly in 4 months. In conclusion, jizusoippo can be effective in cases of psoriasis that the exanthems are damp and concentrate on head.

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Postsurgical persistent pain, once entrenched, may be resistant to western medical treatments. A 39-year-old man who underwent thoracic repair with blood vessel prosthesis for dissecting aneurysm was presented to our pain clinic due to postoperative persistent pain. He complained his pain mainly around the sternum on which skin became keloid scar and presented tactile allodynia. Initially, we treated the patient with pregabalin, duloxetine and tramadol/acetaminophen fixed-dose combination tablets, leading to no pain relief. Then, we started the treatments with Kampo medicine as well as Yamamoto New Scalp Acupuncture and Unblocking acupuncture. We initially treated him with keishibukuryogan (TJ-23 ; Tsumura ^®, Japan) and saikokeishito (TJ-10 ;Tsumura ^®, Japan) based on the signs of blood stasis, hypochondrial resistance and pain, but no relief of pain was obtained. Thus, we administered ogikeishigomotsuto in addition to the above Kampo formulas. His pain was gradually decreased with increasing doses of ogi from 3 to 10 g/day and aconite tuber from 1.5 to 6 g/day due to cold sensation, and finally disappeared at 20 months since the start of Kampo treatments. The duration of effectiveness for relieving his pain with acupuncture was gradually increased in proportion to his pain relief. Our experiences suggest that ogikeishigomotsuto with aconite tuber as well as acupuncture may be optimal treatments for the patients with cold sensation suffering from postsurgical persistent pain.

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The education of Kampo medicine is performed in a very small portion of the field of nursing education. The questionnaire survey which related to Kampo medicine was carried out for the female nursing student who received the training of motherly nursing. As a result, 86% of the students did not know about the fellow of the Japan Society for Oriental Medicine. However, 70% of the students thought that a lecture of Kampo medicine was necessary for nursing student, and 78% of them thought that Kampo medicine was necessary for medical treatment. Furthermore, after reading a collection of slides about Kampo medicine, the number of student who thought that a lecture of Kampo medicine was necessary for nursing students and that Kampo medicine was necessary for medical treatments, was increased.

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Our institute performs retained acupuncture for cold-related symptoms using planar electric heaters. After placing retained acupuncture needles at 8 points on the lower back, the site is covered with a planar electric heater and heated for 20 minutes, with the 6-channel dial of the device set at 5, the second highest temperature. Using this method, we treat and examine patients with cold-related symptoms. If patients feel discomfort during the heating process, the procedure is continued when heat is used for treatment and immediately terminated in the case of examination. On examining related adverse events in 75 cases (224 sessions) within the 8-month period between March and October 2016, there was soreness/irritation of the skin surface in 5 (2.2%), itching in 3 (1.3%), and physical deconditioning in 1 (0.4%). However, all of these events were mild and temporary, supporting the safety of the method. As a future challenge, it may be necessary to expand this study to clinical research on traditional Chinese medicine and acupuncture/moxibustion.

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The Koho school has a high regard for formulation corresponding to sho uniquely developed as a conspicuous feature of Kampo medicine, and Ruihobunrui (the classification of formulae based on the main crude drug : CF) has played an important role in structuring the foundation of this development in the Koho school. CF is a classification method used to express the adaptation and characteristics of formulae in the Koho school, and is useful for research on drug compositions. Therefore, CF can be used effectively in both clinical practice and education. CF has shown little development in China after the appearance of Xu Ling Tai ; however, in Japan the development of CF centered on such influential figures as Todo Yoshimasu of the Koho school, and Naohiro Kitamura of the Kosho school. Kenzo Okuda and Keisetsu Otsuka used CF for clinical practice and education during the revival stage of Kampo medicine in the Showa era ; moreover, CF had a large effect on structuring the foundation of clinical application by formulating Kampo extracts for prescriptions. Thus, CF has played an important role in Kampo medicine. However, the research has been stopped in the present circumstances of Japan. We focus here on CF of the Koho school in Edo and Showa eras, and carried out considerations of CF to establish one of the characteristics of Kampo medicine that places importance on Shang Han Za Bing Lun.

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