We evaluated the effects of self­care with indirect moxibustion (moxibustion group : MG) on hiesho (cold disorder) in mature females in a prospective multicenter randomized controlled trial using leg warmers (leg warmers group : LG) as a control. Subjects were 49 women aged 18 to 39 years who were judged to suffer from hiesho as measured by the hiesho sensation scale (Kusumi and Emori). Subjects were sorted by age and block-­randomized at each of the four facilities. Before going to bed, subjects in the MG (N = 25) performed two moxibustions on both sides of kI 1, SP 6, and ST 36. Subjects in the LG (N = 24) wore leg warmers while sleeping. Each intervention lasted for one month. The primary endpoint was the degree of hiesho by visual analogue scale (VAS) ; secondary endpoints were mainly suffering scores for comorbid symptoms and body temperature difference between forehead and peripheries. Two subjects in the LG dropped out due to preg­nancy and skin pruritus, respectively. The change in VAS and suffering scores was larger in the MG, showing small ES in VAS and medium ES in suffering scores. Body temperature difference between the forehead and LI 4 on both sides was reduced in the MG, and medium ES was observed. It was suggested that self-care of indirect moxibustion for hiesho in mature females could reduce the degree of hiesho and comorbid symptoms, and could suppress the expansion of body temperature difference between forehead and peripheries compared to wearing leg warmers.

Eruption as a dermatological disease is often localized, which is not fully explained by Western medicine. However, localization of eruption is interpreted in Kampo medicine according to meridian and collateral theo­ries, and here, we report two cases of successful treatment with Kampo medicine. Case 1 was of a 32-year-old woman who visited our clinic because of localized eruption around her mouth and was diagnosed with acne vulgaris. She was administered rikkunshito effectively. Case 2 was of a 37-year-old man who visited our clinic because of localized eruption in the anterior portion of the neck and was diagnosed with atopic dermatitis. He was administered shin'iseihaito effectively. Rikkunshito and shin'iseihaito are generally not adapted for dermatological diseases but were effective. After treatment we considered meridian and collateral theories. These two cases are depended on stomach meridian of foot-yangming and large intestine meridians of hand­-yangming, rikkunshito and shin'iseihaito were consisted of herbs concerning with spleen and lung meridians. Two cases were successfully treated through spleen meridian of greater yin and hand great yin lung meridian, which make exterior and interior with stomach meridian of foot-yangming and large intestine meridians of hand-yangming. Kampo medicine was effective for treating these diseases based on meridian and collateral theories.

Infectious epidermal cyst (IEC) is one of the most common cutaneous cysts. It sometimes causes severe bacterial infection and requires incisional drainage under local anesthesia. We reviewed the short-term outcome of the severe IEC patients with the Japanese traditional medicine, hainosankyuto, instead of surgical drainage. We retrospectively examined 125 patients of IEC (52 males and 73 females) administered hainosankyuto (HST). No recurrence for a year after the inflammatory symptoms disappeared was defined as short-term cure. We compared the cure rate and the internal use period by gender, age, affected area, premedication of antibiotics, and complications of immunosuppressive therapy. Overall, 88 cases (70%) were short-term cured and the average oral administration was 14.6 days. There was no gender difference. In age-related analysis, the cure rate tended to be lower in the 30s-50s because of many dropouts. In the examination by site, the cure rate was significantly higher in the other site group (63/78 cases : 80%) than back and buttock group. The average oral administration period was longer in the back and buttock group, respectively. The cure rate was higher in the antibiotic premedication group. The average oral administration period was significantly shorter in the no premedication group. In immunosuppressive group, 21 of 24 patients (87.5%) were cured, which was significantly higher than normal group. There was no difference in average oral administration period between the two groups. Hainosankyuto treatment was beneficial for short-term cure of severe IEC.

We aimed to clarify the significance of using Kampo therapy centered on kamishoyosan and tokishakuyakusan together with general infertility treatment. The subjects were 41 women who visited a Kampo outpatient clinic for infertility and received general infertility treatment with Kampo therapy (Kampo group). The control group was 781 women who received only general infertility treatment at the same time (non-Kampo group). In comparing both groups, we conducted a retrospective survey on the pregnancy rate by cycle and the pregnancy rate by prescription. The pregnancy rate in the first cycle was 24.4% in the Kampo group and 8.5% in the non-Kampo group, and the pregnancy rate was higher in the Kampo group (P = 0.003). There was no difference in pregnancy rates after the second cycle. The pregnancy rate by prescription was 26.7% for kamishoyosan, 22.2% for tokishakuyakusan, and 8.5% for the non-Kampo group. In the comparison between the first cycle pregnant group and the non-pregnant group, the qi counter flow score was clearly higher in the first cycle pregnant group (P = 0.012). It is suggested that combined use of Kampo therapy including kamishoyosan and tokishakuyakusan may be effective from an early stage. Meanwhile, if pregnancy does not occur even after the combined use of Kamp therapy, it would be an opportunity to consider stepping up as Western medical therapy.

The indications of hachimijiogan formulation include lower limb pain, low back pain, edema, fatigue, coldness, and accompanying symptoms of hypertension. In this study, hachimijiogan was administered to patients who complained of symptoms of coldness, pain, etc., and the subsequent blood pressure was observed. Changes in hachimijiogan, a powder pill formulation of crude drugs, were observed in 12 patients aged 45 years or older, with an average age of 71 years. Various symptoms of jinkyo, blood pressure, and laboratory findings were examined. Coldness and pain improved significantly after 3 months. Of the 9 patients who wanted to take hachimijiogan for more than 9 months, 8 were treated with antihypertensive drugs. Among them, 4 underwent an antihypertensive dose reduction by 9 months, and 3 received angiotensin receptor antagonists, and 1 received a Ca antagonist. The systolic pressure before treatment with hachimijiogan averaged 127 mmHg, and after 9 months it was stable at 128 mmHg despite drug dose reduction. In patients with antihypertensive drugs, the long-term use of hachimijiogan may facilitate dose reduction and protection of the vascular endothelium protection. The usefulness of hachimijiogan in the aging society was suggested.

Tokishakuyakusan is well-known to be useful in infertility. We report 3 cases of infertility that resulted in pregnancy and childbirth due to oral administration of tokishakuyakusan after being led to tokishakuyakusan pattern by symptomatic treatment resolving blood stasis or regulating qi. Case 1 was a 39-year-old woman with unexplained infertility. She visited our hospital because of irritability and was initially administered keishibukuryogankayokuinin and yokukansankachinpihange, and then tokishakuyakusan. After a month of treatment, she conceived. Case 2 was a 33-year-old woman who was diagnosed with ovarian dysfunction and received ovarian stimulation. To support infertility therapy she was administered keishibukuryogan, and subsequently, tokishakuyakusan based on her pattern. After 3 months of treatment, she conceived. Case 3 was a 37-year-old woman who was diagnosed with unexplained infertility and was administered kamishoyosan and hochuekkito for premenstrual syndrome at another hospital. She visited our hospital because of sensitivity to cold and fatigability. The previous treatment was discontinued, and she was administered tokishakuyakusan based on her pattern. After 2 months of treatment, she conceived. All 3 patients continued tokishakuyakusan treatment during pregnancy and successfully delivered live babies. These 3 cases initially received other Kampo medicines and then, tokishakuyakusan, according to the changed Kampo medical pattern. It is important to administer tokishakuyakusan to patients with infertility, following administration of appropriate Kampo medicine to correct their imbalance of qi, blood and fluid and after further confirming the abdominal signs suitable for tokishakuyakusan.

A 70-year-old woman was diagnosed with peripheral T-cell lymphoma and received chemotherapy. She developed chemotherapy-induced peripheral neuropathy (CIPN), and her chief complaint was numbness of her fingertips and toes. However, the symptoms did not change even 9 months after the chemotherapy was completed. Our Kampo diagnosis was dual deficiency of qi (ki) and blood. Hence, we applied pedestal moxibustions to the following acupuncture points : SP 6 (Sanyinjiao), Ex-LE 10 (Bafeng), Ex-UE 9 (Baxie), CV 4 (Guanyuan). Her symptoms improved rapidly after moxibustion treatment. There were neither adverse events nor relapse of the numbness. Moxibustion treatment might reduce symptoms of CIPN.

We report the case of a 60-years-old man who complained fever and left knee pain. Fever and arthralgia appear once a month, and these symptoms disappear spontaneously in 3 days. The patient came to our hospital to receive Kampo treatment, because the patient experienced improving these symptoms by Kampo medicine about 20 years ago. I judged the arthralgia as kanshippi, because the arthralgia improved when the patient warmed the joint. We prescribed keishikajutsubuto 7.5 g/day. Arthralgia improved after administration of keishikajutsubuto, but the attack appeared every month. We prescribed maobushisaishinto 5 g/day in addition to keishikajutsubuto 5 g/day for further improvement of arthralgia. The frequency of fever and arthralgia attack was dramatically decreased after we prescribed keishikajutsubuto 5 g/day and maobushisaishinto 5 g/day. We considered the possibility of palindromic rheumatism based on clinical symptoms, X-ray in other clinic and blood test results in our hospital. We report an effective case of keishikajutsubuto and maobushisaishinto on arthritis attacks with fever that resolved spontaneously in a short time.

A questionnaire survey was conducted on the actual state of manufacturing homemade pill preparations. Of the 14 facilities that responded, there were 4 pharmacies producing pills of only one type and 4 pharmacies producing more than 11 types. There were 7 facilities for handmade, manufacturing, 5 facilities for machinery manufacturing, and 2 facilities for handmade and/or machinery. The manufacturing process consists of about 9 steps, and it is possible to do it in 2-3 hours if considering just the time to make the pills, but it requires several days or more including preparation, machine cleaning, maintenance, etc. Based on the above, it seems that the current technical fees for pill manufacturing are extremely low.

Following the Chinese-led global standardization of Chinese medicine, the 9 th edition of the European Pharmacopoeia, published in 2016, listed 66 kinds of crude drugs that are used in traditional Chinese medicine. By the spread of dietary supplements in the United States, the number of herbal medicines listed in United States Pharmacopoeia is tended to be increasing. In this article, we compare the names and origins of crude drugs listed in the European and American Pharmacopoeias and used in ethical Kampo extract formulation with those described in the pharmacopoeias of Japan, China, Taiwan, and South Korea. There were 4 crude drugs that had the same origins and names in the pharmacopoeia of these 6 countries, but only Coix Seed had the same English name. The pharmacopoeia of the 5 countries except the United States had 19 crude drugs with the same origin, but only Platycodon Root and Eucommia Bark had the same English and Latin names. For other crude drugs, the names and origins in the pharmacopoeia of each country were different. When scientists in each country disseminate the information about crude drugs used in their own countries to the world, it is necessary for them to describe the original plant scientific names and their medicinal parts that are unified by International Code of Nomenclature for plants instead of English or Latin names of crude drugs.

Prior to the current pandemic caused by Coronavirus disease 2019 (COVID-19), there was a worldwide pandemic of H1N1 subtype influenza during 1918-1920. One of the most notable records of treatment in Japan is the story of Hiroaki Kimura in Tokyo. He used a formula including saikatsugekito and no patients died. The case was a 31-year-old woman testing positive for COVID-19 was treated with kakkonto (ge-gen-tang) and shosaikotokakikyosekko as an approximate prescription for saikatsugekito for one week from the first day of follow-up at the hotel. On the first day of treatment, the patient had severe headache, decreased oxygen saturation, increased heart rate and shortness of breath at rest as well as during physical activity, and the next day, smell and taste disorders appeared. However, by the time she left the hotel, these symptoms almost completely disappeared. This suggests the efficacy of combination of kakkonto and shosaikotokakikyosekko. Since COVID-19 often presents with symptoms of the interior organs from the early stage of the disease, combination of kakkonto and shosaikotokakikyosekko is considered to be one of the options of Kampo treatment for COVID-19.

Japanese traditional (Kampo) medicine saved many lives during the Spanish influenza pandemic of 1918-­20. In Japan, acute viral respiratory infections represented by influenza have been called shokan (cold damage), and so on since ancient times. These infections were treated by prescriptions that were adopted from Chinese classical texts including “Shanghan lun (Treatise on Cold Damage Diseases),” “Xiaopin fāng (Prescriptions of Sketch),” “Tai ping hui min he jì ju fang (Formulary of the Bureau of Taiping People's Welfare Pharmacy),” and “Wan bing hui chun (Restoration of Health from Myriad Diseases).” Additional materials include (but are not limited to) “Ishimpo (Prescriptions of Medical Sprit),” “Ton-­i-­sho (Abstract of Medical Enlightenment),” and the diaries of some Muromachi aristocrats. In the Edo period (1603-1868), treatment with Kampo medi­cines developed uniquely in Japan, but due to medical and economic disparities, many patients could not be treated by Kampo experts. Ephedra herb, a key drug for treating shokan (cold damage), has shown major problems in terms of quality, because it has been confused with plants of the genus horsetail since at least the 8 th century ; its medicinal effects may therefore have been underestimated. The effectiveness of Kampo medicine against the novel influenza/coronavirus pandemic is anticipated, however, in order to fully exploit its potential, it is important that physicians with sufficient knowledge of Kampo should use Kampo medications properly.

Yang diseases of the Shanghanlun (shōkanron) list the Three Yangs in the order of early yang stage pattern (taiyōbyō), middle yang stage pattern (yōmeibyō) and late yang stage pattern (shōyōbyō). However, in Japan, the order is early yang stage pattern, late yang stage pattern, and middle yang stage pattern. A survey of Japanese disease history revealed that by the Edo period smallpox, measles, and influenza were infectious, febrile, and highly lethal. Furthermore, these diseases exhibited bimodal fever. We investigated and examined how Kampo doctors viewed the order of the Three Yangs in the Shōkanron from the literature of the Edo period, and found that the epidemic period of these three diseases coincided with the increase in the number of doctors advocating late yang stage pattern. It is thought that the Three Yangs in Japan came to be recognized in the order of early yang stage pattern, late yang stage pattern, and middle yang stage pattern through these three dis­eases that became prevalent from around 1700.

A commemorative lecture meeting on the inclusion of a new chapter of traditional medicine in ICD­-11 was held in Tokyo in February 2020. The head of the Collaborating Centre for WHO­-FIC in Japan explained the process of the project, which started in 2006 to increase WHO's data collection from developing countries and expressed gratitude to the concerned persons who made efforts to obtain consensus with China and Korea. WHO promoted integrated coding between traditional medicine and Western medicine. In the field of acu­puncture, meridian and collateral patterns proposed by Japan were adopted and research activities have begun. In the field of Kampo medicine, the prescription content is often used in a fixed form as a representative for­mula pattern in Japan, so clinically high­-level research will be possible under this new classification. In the field of medical information, it has been pointed out that there are high hurdles for medical information man­agers to understand traditional medicine. It is expected that the progress of mutual understanding of both medi­cines. From now on, activities in research, translation, education and dissemination of this new classification should be promoted.