We conducted a factfinding survey about the difficulties of handling the telephone consultations at a Kampo medicine outpatient clinic. We extracted the details of consultations that could not be handled by an outpatient nurse alone from the descriptive data of the telephone responses described by the nurses in the survey. We, then, identified the factors that were involved in the difficulties encountered in these consultations, and countermeasures were established and implemented. One year later, we compared and examined the status of telephone consultations between before and after the fact-finding survey. We classified the telephone consultations that were difficult for the outpatient nurses to handle alone into four categories : (1) consultation about a physical disorder, (2) questions about prescribed Kampo medicines, (3) reports and questions based on the patient's own judgment, and (4) questions about treatment and hospitalization. Some of the questions about Kampo medicines included the continued use of the medicine and drug interactions, and the main topics of the survey's nurse self-judgment reports were dose reductions and changes in Kampo medicine regimens. As a result of the introduction of guidelines prepared by the nurses together with physicians at the clinics, the outpatient nurses became able to handle telephone consultations about frequently asked questions (FAQs). At 1 year after the survey, the number of cases of difficulties in handling telephone consultations decreased to less than half the original value, and no telephone consultations were made within 1 week after the patients' first visits to the outpatient clinic.
Disorder of venous circulation is a common cause of skin ulcers in the lower leg. Increased vascular permeability inhibits normal healing of the skin and often prolongs the course. We observed a 75 year-old woman who developed intractable leg ulcer caused by traumatic injury. In spite of the routine medical therapy of Western medicine, the ulcer got worse. She came to us when her doctor recommended surgical intervention. After initial treatment with boiogito extract with shiunko ointment for 2 weeks, no improvement was observed. Then the prescription was changed to eppikajutsuto extract and bushi powder with shiunko ointment, which resulted in increased urine volume and healing of the ulcer after 2 months. Although we usually use hozai such as ogikenchuto for the treatment of skin ulcers, eppikajutsuto might be a choice for the difficult cases like this caused by circulation disorder.
The number of patients with taste disorder and halitosis has recently increased in Japan. Some of these patients have no abnormalities identified in blood tests and no apparent dental problems, so they are diagnosed with unidentified complaints. In this paper, we report 2 patients who were diagnosed with psychogenic taste disorder and pseudohalitosis. Kampo medical examination found their symptoms to be related to qi deficiency. They were prescribed 5g of hochuekkito extract per day, and their symptoms were relieved. These results suggest that hochuekkito is effective against unidentified complaints such as psychogenic taste disorder and pseudohalitosis.
We administered Kampo medicine to 40 patients whose lower urinary tract symptoms worsened in winter and examined the changes in their lower urinary tract symptoms and coldness symptoms. The effectiveness was evaluated by International Prostate Symptom Score (IPSS), Overactive Bladder Symptom score (OABSS),and the interview of coldness symptom. IPSS scores were significantly improved in 30 cases (75.0%), and OABSS scores were significantly improved in 26 cases (65.0%). The number of the night-time frequency of urination significantly decreased from 2.5 times to 2.0. The symptoms of coldness were improved in 21 of 29 cases (72.5%). Moreover, in the group of 21 cases whose coldness symptoms were improved total OABSS were significantly improved compared to the group of 8 cases with no change of coldness symptoms. Appropriate administration of Kampo medicine was considered to be one of the effective measures that could improve lower urinary tract symptoms due to cold stress as well as coldness symptoms.
Chronic sciatica is one of the neuropathic pains which assumed to be effective for pregabalin. However, a recent double-blind placebo-controlled trial reported that pregabalin was no more effective than placebo in patients with acute or chronic sciatica. We retrospectively investigated the effect of Kampo medicine including makyoyokukanto extracts combined with powdered cinnamon bark and processed aconite root (makyoyokukanto plus) which were administered to 14 cases with chronic sciatica in the past year. The efficacy of Kampo medicine for lower leg pain relief was assessed using NRS (numerical rating scale). It was effective in 11 of 14 cases (79%, 6 males and 5 females, the mean age : 69), and not effective in 3 of 14 cases (21%, 2 males and 1 female, the mean age : 77). In 7 of 9 cases, who were given pregabalin before prescribing makyoyokukanto plus, makyoyokukanto plus was more effective than pregabalin. Furthermore, we have continued to observe 10 cases for over a year. Two of 10 cases were completely cured even if makyoyokukanto plus was discontinued. In 5 cases we switched from makyoyokukanto plus to yokuininto extracts combined with powdered cinnamon bark and processed aconite root, which was comparable to makyoyokukanto plus in its effect. Makyoyokukanto or yokuininto extracts combined with powdered cinnamon bark and processed aconite root were effective for chronic sciatica.
Heberden's and Bouchard's nodes are clinical manifestations of osteoarthritis of the interphalangeal joints. Heberden's nodes typically affect the distal interphalangeal (DIP) and Bouchard's nodes, the proximal interphalangeal (PIP) joints of a fingers in patients with osteoarthritis. We describe osteoarthritis of the interphalangeal joints in 3 women who were successfully treated with sokeikakketsuto. Case 1 : A 58-year-old woman presented with pain in the DIP joint of her left middle finger and was diagnosed with a Heberden's node. Case 2 : A 60-year-old woman presented with pain in the DIP joint of her left ring finger and was diagnosed with a Heberden's node. Case 3 : A 37-year-old woman presented with pain in PIP joint of her left ring finger and was diagnosed with a Bouchard's node. All women were successfully treated with sokeikakketsuto. In conclusion, sokeikakketsuto is a useful Kampo medication to treat mild-to-moderate pain secondary to bone, joint, or spinal conditions, as well as non-steroidal antiinflammatory drugs.
Carpal tunnel syndrome is a common condition caused by compression of the median nerve. Patients usually present with numbness and pain along the distribution of the median nerve in the hand. We report 2 cases of carpal tunnel syndrome successfully treated with kakkonto after their pattern diagnosis. We treated a 57-year-old women and a 59-year-old man. Two patients presented with hand pain and numbness and were diagnosed with carpal tunnel syndrome. Kakkonto treatment was successfully in two cases. We observed that median nerve compression persisted in these patients even after disappearance of numbness and pain ; therefore, we recommended operative management. The 2 patients underwent an operation for carpal tunnel syndrome. Kakkonto can be considered useful palliative treatment before considering operative management for numbness and pain in the patients with carpal tunnel syndrome.
Keishibukuryogankayokuinin (KBGY) is a Kampo formulation that is well known as being suitable for patients with blood and water stagnation. In this study, we retrospectively investigated the efficacy of KBGY for tinnitus patients. The total number of patients was 9 (5 males, 4 females). The average age was 67 years (range : 54-81 years, the median age : 65 years). The progression of 9 patients was cure (1), amelioration (6), no change (2), and deterioration (0). The important pathophysiology of tinnitus in Kampo medicine includes blood stagnation and water stagnation. In these cases, KBGY can single-handedly improve both blood and water stagnation. We recommend KBGY for the treatment of tinnitus caused by the coexistence of blood and water stagnation.
The patient was an 80-year-old woman who had been suffering from paroxysmal vomiting with diarrhea about twice a month for 3 years. She had these symptoms at around 11:00 am every time and got over them after a rest for about 20 minutes. Though no abnormality was detected by the inspections in the gastroenterology and the cardiology, the interval of her attacks became short. These symptoms were treated with ryokeijutsukanto. We conclude that the pathogeneses of this case were excessive accumulation of fluids in epigastrium caused by the lack of stomach qi, and that these were ameliorated by the effect of ryokeijutsukanto mainly in nourishing stomach qi and cleaning away excessive accumulation of water. There is a report that the stuffiness and rigidity below the heart shows the presence of excessive accumulation of fluids in epigastrium, and this case suggests the possibility that this symptom of abdominal diagnosis by palpation is seen only during an attack.
The low back pain is often intractable and leads to the drop of the daily living activity. These symptoms are good indications of Kampo medicine. We report 5 cases of low back pain that saikokaryukotsuboreito treatment succeeded regardless of psychogenetic presence. These patients complained of low back pain and lower melagra or numbness of limbs. Four of 5 cases did not have any psychogenetic presence. After administration of saikokaryukotsuboreito, their pain decreased and walking distance was improved in to 4 weeks and analgesics were not required. Generally, saikokaryukotsuboreito is prescribed for patients with psychogenetic symptoms, but these treatments based on abdominal patterns were effective even if they do not have subjective psychogenetic symptoms. Saikokaryukotsuboreito may be the differential prescription for such low back pain cases.
Case 1 was a 28-year-old female who had epigastric discomfort and epigastralgia for three months. These symptoms were accompanied with dizziness, faintness and hot flush. Right after taking ryokeijutsukanto, her dizziness, faintness and chillness of foot disappeared with improvement of gastrointestinal symptoms after two weeks. Case 2 was a 40-year-old female who presented prolonged nausea and epigastralgia for eight months. She also complained of dizziness and strong globus sensation when taking meals. After taking ryokeijutsukanto, her appetite improved in a week and gastrointestinal symptoms improved in 3 weeks. Case 3 was a 15-year-old female whose complaints were nausea, epigastric discomfort, palpitation, dizziness and globus sensation consequent to swaying feeling after riding a roller coaster. These symptoms including nausea improved after taking ryokeijutsukanto with 3g of magnolia bark for a week. Case 4 was a 28-year-old male who presented severe appetite loss and epigastric discomfort when he got tired. He also complained of faintness. His faintness disappeared after taking ryokeijutsukanto for 2 weeks. His appetite also improved after four weeks. Clinical courses of these cases suggest that ryokeijutsukanto may be useful for the treatment of upper gastrointestinal symptoms including functional dyspepsia, i.e. fluid retention with qi-counterflow.
Ikki-Ryo was a moxibustion clinic established as part of a national project facility that belonged to the Uchihara Training Camp (1938-1945) for the Japanese Youth Volunteer Brigade for Reclamation of Manchuria and Mongolia. Since such a case is extremely rare in the modern medical history of Japan, this article summarizes the information on Ikki-Ryo obtained through documents collection and analysis, interviews, and fieldwork investigation. Ikki-Ryo was proposed by acupuncturists Bunshi Shirota and Kyohei Tanaka, and was established under the directorship of Kanji Kato. It played a role in the clinical practice and training of moxibustion techniques. The data suggests that Ikki-Ryo provided advantageous clinical effects in the promotion of good health and in the treatment of some diseases (e.g. enuresis, suspected tuberculosis) for the trainees, while it is indicated that this clinic had a certain geographical, organizational, and emotional distance from other medical or healthcare departments at the camp. Although the role of moxibustion has changed throughout history, the concept and activities of Ikki-Ryo are still thought-provoking from the perspective of the diversity, versatility, complementarity, and sustainability of healthcare tools.
The Japan society of oriental medicine created a committee of medical safety in 2017. The first activity was to summarize the representative side effects of Kampo medicine and to enlighten members of our society about them. In this report, we documented the knowledge to keep in mind at present on pseudoaldosteronism, drug-induced liver injury, and drug-induced lung injury. Since these three major side effects may cause clinically severe conditions, it is very important to detect them early and take appropriate measures. Therefore, proper examinations at the right time are necessary while taking Kampo medicine.
We experienced a patient whose trigeminal neuralgia disappeared after treatment with keishikaryojutsubuto and maobushisaishinto. A 77-year-old man developed excruciating pain by a cold wave. The patient received Kampo medicine classified for treating coldness in addition to pregabalin. Ten days later, the patient was relieved of the excruciating pain. It was suggested that the synergistic effect between Kampo medicine and Pregabalin could relieve the pain.
Various measures are being undertaken all over the world to control the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Artificial respirators and extracorporeal membrane oxygenators (ECMO) have been introduced for severely ill patients, and antiviral pharmacotherapy has been attempted. However, in the current situation, it is not feasible to wait for evidence-based effective treatments, and it is imperative to deal with daily situations. It would be very helpful to retrospectively evaluate the doctors who worked during the Spanish flu pandemic without access to medical devices such as ventilators, or drugs including antibacterial and antiviral agents. Based on the fact that Kampo medicine was used to treat patients with the Spanish flu, this article demonstrates the high pathogenicity of the Spanish flu virus, the mechanism of action of antiviral drugs, and clinical evidence. As one of the measures against the COVID-19 pandemic, we propose the role of Kampo medicine, which has relative clinical safety with few side effects, and can be expected to induce antiviral action by autoimmune activation.
We are planning a study focused on the gathering of clinical data for the purpose of formalizing diagnostic logic at 6 institutions specialized in Kampo-based medical examinations. However, during the planning stage, it has been recognized that there are a large number of Kampo formulas to be studied, and differences among faculties and individuals exist regarding how to identify each Kampo formula, methods of gathering findings, and the evaluation of efficacy. Here we report the solution proposal reached after building consensus among all participating faculties on these issues. After raising the issues, conferences were held for each of them, until a unanimous consensus was obtained. As a result, the following conclusions were reached. Thirty-three Kampo formulas were selected as targets for the formalization of diagnostic logic. In addition, the range of dosage forms, crude drug ingredients, and permissible dosages for each Kampo formula were determined. Regarding clinical findings for these Kampo medicines, the items to be collected and evaluation criteria were also established. The criteria for evaluating the validity and safety of each Kampo medicine were decided, together with the grading and timing of evaluation. We hope that our solution proposal reached after building consensus becomes the basis for Kampo research in the future.