Objective : To evaluate the clinical usefulness of gargling with hangeshashinto (HST) for treatment of oral mucositis (OM) caused by sunitinib in patients with metastatic renal cancer.
Patients and methods : The study included 22 patients with sunitinib-induced OM. Among them, 12 patients were instructed to gargle with 2.5 g of HST for 30 seconds after each meal, 3 times a day, and to refrain from eating and drinking afterward (gargling group). The remaining 10 patients were treated without gargling (non-gargling group). The changes in the following outcome measures after treatment were analyzed and compared between the two groups : the Karnofsky Performance Status (KPS), OM grade, body weight, albumin (Alb) levels, hemoglobin (Hb) levels, and eating status.
Results : In the non-gargling group, the OM grade and eating status were not well improved, and KPS, body weight, Alb and Hb levels decreased. In the gargling group, despite a decrease in KPS, both OM grade and eating status improved from the day after the start of gargling, while no significant decreases were observed in body weight, Alb levels, or Hb levels after treatment. The gargling group showed better responses in all measures than the non-gargling group.
Discussion : OM associated with cancer chemotherapy interferes with treatment completion. HST is a typical Kampo medicine belonging to the shashinto group, gargling with HST is also effective for treating OM. It appears that gargling with HST improves earlier stage of OM and eating status, thereby suppressing a decrease in KPS, body weight, Alb, and Hb levels.

Objective : To examine how to treat patients suffering from electromagnetic hypersensitivity (EHS) combined with multiple chemical sensitivities (MCS) with herbal medicines.
Methods : The patient was diagnosed as having blood stagnation (血瘀), yang deficiency (陽虚) and spleen qi deficiency (脾気虚) based on the traditional Chinese medicine (TCM) theory. Hoyokangoto which had been applied to patients with hemiplegia for a long time in China, was prescribed with cinnamon and processed aconite root. For her persistent diarrhea, ogikenchuto was administered.
Results : Headache, sense of exhaustion, insomnia, and various symptoms debasing her quality of life (QOL) were shortly decreased, which made her lead a normal life.
Discussion : The administration of hoyokangoto combined with cinnamon and processed aconite root added qi (気), removed blood stagnation and accelerated blood circulation and collateral channels, implying that elimination is the first (先瀉). The administration of ogikenchuto for diarrhea (spleen qi deficiency) means that tonic is the second (後補), which improved her symptoms of EHS combined with MCS. Herbal medicines may be one of the choices for treating degraded QOL of patients with EHS and/or MCS.

We experienced a refractory case of respiratory failure with CO₂ narcosis after respiratory tract infection successfully treated with daikenchuto, ninjinyoeito, and bushimatsu. The patient was an 88-year-old woman with pulmonary tuberculosis sequelae and chronic obstructive pulmonary disease for which she had been receiving tiotropium, a budesonide inhalation suspension, and tulobuterol patches. She developed a fever and persistent dyspnea and was taken to our hospital by ambulance. Initially, artificial respiration was recommended because she had CO₂ narcosis, but this intervention was rejected because of her advanced age. She showed persistent dyspnea and mild consciousness disturbance. Therefore, treatments by daikenchuto, ninjinyoeito, and bushimatsu were gradually introduced. As a result, her dyspnea, constipation, anorexia, and decreased consciousness improved, and the CO₂ concentrations in arterial blood decreased with normalization of pH level. Artificial respiration management is the first-choice treatment for aggravated chronic respiratory failure with CO₂ narcosis. However, when such medical management is not feasible, as in the present case, Kampo medicines may contribute to alleviating symptoms of respiratory failure.

In female patients with migraine, the triggering or exacerbating factors for migraine including stress, menstruation and fatigue, should be treated intensively in addition to treatment for headache. Patients with coldness and weak constitution become a state of qi and blood deficiency in terms of Kampo medicine under the circumstances of severe fatigue, lack of sleep and menopausal symptoms. They tend to suffer from migraine at around the 4th or 5th day of menstrual period after rather heavy menstrual bleeding on the 2nd or 3rd day. We experienced 4 patients with headache during the late period of menstruation whose symptoms were successfully treated by juzentaihoto known to improve qi and blood. In Case 1, daily prescription was changed from unkeito to juzentaihoto. In Case 2, during the 7 days of menstrual period, juzentaihoto was added to tokishigyakukagoshuyushokyoto, while juzentaihoto was substituted for tokishakuyakusan in Case 3 and Case 4.
In 9 cases of headache, including these 4 cases, juzentaihoto was efficacious against migraine headache during the late period of menstruation with coldness (9/9 cases), fatigability (9/9 cases) and dryness symptoms (7/ 9 cases).
These results indicate that juzentaihoto is effective for migraine during the late period of menstruation, especially in patients with fatigue after menstrual bleeding. The administration period of juzentaihoto should be individualized for each patient depending on the severity of qi and blood deficiency.

Number of chronic obstructive pulmonary disease (COPD) patients tend to increase in middle and older aged people. They have shown a certain degree of improvement with various Western medicine treatments including smoking cessation guidance, rehabilitation, home oxygen therapy, inhalation therapy and so on. However, it is a clinical problem that some elderly people have acute exacerbations frequently due to infectious diseases and have poor prognoses. This time, we experienced an elderly COPD patient with type II respiratory failure. He was repeatedly hospitalized and needed treatment with a ventilator temporarily. We conducted Kampo medical examination on him, and diagnosed that he had cold state in the lungs. So, we administered ryokankyomishingeninto to him. As a result, he recovered dramatically, and he was never hospitalized again due to respiratory failure for a long time. It is suggested that ryokankyomishingeninto may be effective for some COPD patients who have cold state in the lungs.

We report three patients with acute lumbago who did not respond to nonsteroidal anti-inflammatory drugs (NSAIDs), but were treated successfully with daiobotampito and shimotsuto. Case 1 (86-year-old man) and Case 2 (56-year-old woman) were diagnosed with acute lumbago. Case 3 (69-year-old man) was diagnosed with acute lumbago and mild left sciatica. All three patients were initially administered orally NSAIDs, but this treatment was ineffective. Therefore, daiobotampito and shimotsuto were administered after choeikatsurakuto according to “Manbyokaishun.” Following this treatment, the patients' acute lumbago and sciatica resolved within 1-2 weeks. In conclusion, daiobotampito in combination with shimotsuto seems to be a useful Kampo medicine for treatment of lumbago.

We evaluated the effect of gosyajinkigan in 30 cases of anticholinergic agent or α-1 blockers resistant nocturia with a sign of jinkyo which is the hypofunction of the kidney organ unit at Kampo medicine. As to subjective outcomes, storage symptoms and quality of life (QOL) of International Prostate Symptom Score, and sleep and energy items of King's Health Questionnaire and Nocturia QOL Questionnaire were statistically much improved. Concerning objective outcomes, nocturnal frequency of urination, nocturnal polyuria index and hours of undisturbed sleep by means of frequency volume chart, and total body water by body composition analyser were also statistically much improved. This study might demonstrate that normalization of body composition leads to reduce nocturnal urinary volume and improve nocturia.

Iron deficiency anemia is the most frequently experienced anemia in common daily practice. It is often difficult to treat due to gastrointestinal side effects of iron drugs. We report a difficult case of iron-deficiency anemia with intolerance to oral iron supplementation, which was resolved by concomitant use of Kampo.
Thirty-five-year-old woman visited us because of menoxenia continuing since she was 17 years old. Although tokishakuyakusan with kakobushimatsu (processed aconite root powder) had been administered, remarkable anemia such a low hemoglobin (Hb) level (7.8 g/dL) was observed. After we added an oral iron agent for 5 months, the hemoglobin level increased to 12.8 g/dL, and epigastric discomfort appeared. Therefore, we discontinued iron agent and switched to Kampo monotherapy, but anemia gradually worsened again. Following intravenous iron infusions could not improve the iron deficiency state.
Then we administered ryokeijutsukanto with kojinmatsu (ginseng powder) and lower dose of oral iron agent than before, with reference to sinshato described in “Sokeitei Ijishogen” written by Nan'yo Hara. After administration, Hb and serum ferritin level improved from 11.6 g/dL and 4.0 ng/mL to 12.3 g/dL and 32.0 ng/mL, respectively. After that, the iron metabolism marker kept stable, although the oral iron agent had been further reduced.
The main indications of sinshato are palpitation, shortness of breath, dizziness and edema according to the original text. These symptoms can be interpreted as ones related to anemia. In our case, it was suggested that prescription composition of sinshato promoted iron absorption and improved anemia.

It is theoretically thought that Paeoniae Radix (shakuyaku) has a sour taste and astringent action in traditional Chinese medicine. To examine the practical taste of shakuyaku, 12 volunteers sampled the decoction of Paeoniae Radix Rubra (sekishaku) and Paeoniae Radix Alba (byakushaku). Each volunteer determined how sekishaku and byakushaku taste among “five tastes” : sweet, salty, bitter, sour, or spicy. Most volunteers chose bitter taste and none of them chose sour taste as the foremost taste of shakuyaku. At least in the modern age, shakuyaku may have little sour taste. In this article we discussed the astringent action and the muscle relaxant action of shakuyaku with reference to the sour taste.

The term “sansho” is an element of six entrails in Kampo medicine. The correspondence of “sansho” with any organ in human body was described in “Seikenshu” written by Narikiyo Yamada at first, and Kazuo Otomo declared that “sansho” corresponds to visceral peritoneum and mesentery. Recently, “The Lancet” published a review on the mesentery in which mesentery should be recognized as an organ. This report aims to discuss the accuracy of Otomo's doctrine, which was published in 1980, from the view point of the new anatomical knowledge.

The mind-body unity is a fundamental doctrine in Kampo medicine. In this report, the author tried to consider oketsu syndrome as a concrete object because this syndrome consists of both emotional and physical disorders. The oketsu syndrome has been recognized as blood stagnation in the microcirculatory vessels. On the other hand, the emotional aspect of this syndrome correlates with anger or aggressive affection. It is well known that emotional disorders are brought by very complicated neural circuit in the cerebral limbic system, so that this report referenced suitable articles among numerous scientific evidences, and discussed about mindbody unity.

Berberine-containing goldenseal root has been classified into Group 2B (possibly carcinogenic to humans) by International Agency for Research on Cancer based on evidence of carcinogenicity in experimental animals. It was also confirmed that ultrahigh concentration berberine can induce DNA damage in cultured cells. Thus, two articles in Journal of Japan Medical Association advocated carcinogenicity and reproductive toxicity of oren, obaku, and daio considering that ingredients of daio and berberine contained in oren and obaku can cause DNA damage. However, many fallacies and arbitrary descriptions are observed in the two articles. The concentration of berberine that caused toxicity in the experiments is extremely higher than the possible concentration in humans taking Kampo medicine. Although no studies have shown carcinogenicity and reproductive toxicity of oren or obaku, the advocates in the articles were played up by a weekly magazine causing unreasonable anxiety to patients. Here, we present scientific counterarguments against the fallacies of the articles.

We have developed and operated a browser-based questionnaire system for Kampo medicine based on conventional questionnaires and review of systems to reveal implicit Kampo wisdom both in patients' questionnaire data and in some Kampo specialists' examination data. However, the questionnaire data were found to be inaccurate because too many questions were included and cumbersome input steps were required. The purpose of the present study was to solve these problems and to develop a new patient-centered questionnaire system with fewer questions and an easier input method. After analyzing inquiry database from collaborating institutes and hospitals, we deleted, combined, and added questions. We changed the evaluation method of symptoms from a visual analogue scale to a simple staged evaluation, and introduced another method to evaluate the main symptoms in each time of visit using a visual analogue scale. At the same time, a tool for predicting Kampo pattern diagnoses based on the questionnaire data was implemented. We have already started collecting more accurate and reliable data using the new questionnaire system. It is expected to support routine practices and facilitate more precise clinical research on Kampo medicine.

The number of acupuncturists and moxibustion therapists has rapidly increased since around 2000. If they can be regarded as new healthcare resource investments, it is of great significance to evaluate their social impact. Here, we conducted a regional correlation study in different prefectures by using the extension of average life expectancy as an evaluation index. The results revealed an increase in “acupuncturists (human healthcare resources)” and in “facilities for performing acupuncture and moxibustion therapy (physical healthcare resources)” to show a weak but statistically significant positive correlation with the extension of average life expectancy for elderly men. Due to methodological limitations, however, this study cannot confirm a causal relationship between them. The author strongly hopes that public service corporations involved in the provision of acupuncture and moxibustion will henceforth serve as a bridge to allow researchers, acupuncturists, and moxibustion therapists to collaborate and conduct multicenter joint studies, in order to create an even greater social impact of acupuncture and moxibustion.