The Japan Society for Oriental Medicine (JSOM) has made various efforts against coronavirus disease (COVID-19) to build evidence. JSOM has launched an academic society-led clinical research project on COVID-19 based on the concept and characteristics of Kampo medicine, including (1) prevention of disease by activating the immune system to regulate body conditions (pre-symptomatic stage of illness), (2) symptom alleviation in the mild and moderate stage and prevention of aggravation (acute to subacute stage of illness), and (3) early recovery and improvement of prolonged symptoms (late stage of illness). Since the declaration of the pandemic, the special working group has conducted the following activities : enlightening academic members, lobbying other academic societies, preparing research protocols, establishing research groups, conducting ethical reviews, responding to the research disclosure system, preparing protocol papers and review articles as the basis for the research, reporting research progress, soliciting case reports, warning against Chinese medicine use, requesting for research support funding, and revising the JSOM website. We also discuss the interpretation of COVID-19 from the perspective of Kampo medicine and the direction of the selection of Kampo formulas in this report.

“Shanghanlun” describes 6 stages patterns of disease. Among them, late yin stage pattern is the most difficult to understand including its pathology, symptoms, and treatment. In other words, late yin stage pattern manifests as various symptoms, such as alternating heat and cold symptoms (tangled cold and heat), heat symptoms in the upper body and cold symptoms in the lower body (upper heat and lower cold), or cold symptoms alone. Therefore, its pathology may not have been clearly understood. In this paper, I tried to classify late yin stage pattern into several disease types based on these symptoms and to explain these disease types from the texts and formulas of “Shanghanlun.”

There are few reports on the effects for children using the diagnostic method of Kampo medicine (called sho : pattern diagnosis). Therefore, we investigated the effects of combination therapy with Kampo medicines prescribed by specialists in this ancient form of medicine to children who were refractory to modern medicine. This was a retrospective observational study of 98 children (pre-school children (PS ; n = 21), elementary school students (ES ; n = 37) and junior high school students (JS ; n = 40)) younger than 16 years old at the first visit to our department of Chiba University hospital between April 2007 and April 2017. We collected the following information from their medical records : background, chief complaint, referral source, and efficacy of Kampo medicines. We evaluated efficacy for Kampo medicine as follows : Higher improvement (HI) (symptoms improved by 2/3 or more) ; Improvement (I) (symptoms improved by 1/3-2/3) ; Mild improvement (MI) (symptoms improved by 1/3 or less) ; constant ; aggravated ; and unknown or first visit only. Positive response (HI, I, and MI) due to Kampo medicines was observed in 76% (75/98) of patients. No aggravations were observed. The chief complaint by age was skin diseases in PS, digestive diseases in ES, and cardiovascular diseases in JS. Pediatrics was the primary referral in all ages, while 30% of JS were referred from psychiatry. Kampo medicine was significantly more effective for those in PS and ES compared to those in JS (p = 0.025). Combined use of Kampo medicine and modern medicine therapy is useful for children refractory to modern medicine.

The usage of Kampo medicine has been expanding in hospitals and pharmacies, and the systematic education on Kampo medicines and their components is urgently needed. Although the efficacies of Kampo formulations are approved at the national level, those of the composing crude drugs are not approved individually except for some cases. Consequently, the efficacy description of individual crude drug in textbooks differs much depending on the authors. To clarify this situation, we suggested the standardized description of the efficacy of crude drugs used in ethical Kampo formulation using terms of modern Western medicine in the previous study. In this study, we reviewed the descriptions of efficacies using the terms of Kampo medicine in the books published in Japan from the 17 century to the present to explore the possibility of standardizing the crude drug efficacies using the terms of Kampo medicine. The proposal for standardized description of the efficacy of crude drugs was based on the high frequency of appearance of the terms in successive books.

The current study involved 70 patients with atopic dermatitis who were treated with herbal medicine at this hospital’s Oriental Medicine department. This study examined a total of 237 prescriptions with Kampo diagnosis used to treat those patients. Patients who no longer needed to use a steroid ointment preparation were defined as “complete responders” and both these patients and patients whose use of a steroid ointment preparation decreased 50% or more from the level prior to use of herbal medicine were defined as “responders.” The complete response rate was the percentage of complete responders and efficacy rate was the percentage of responders. Among all patients, efficacy was 56.3% for unseiin > 50.0% for tokiinshi > 41.0% for Keigairengyoto > others. The complete response rate was 25.0% for unseiin > 16.7% for tokiinshi > 15.8% for shishihakuhito > 13.1% for Keigairengyoto > others. Among patients with “reddish” atopic dermatitis, unseiin had the highest efficacy and resulted in the highest complete response rate, followed by shishihakuhito and then keigairengyoto. Among patients with “wet” atopic dermatitis, unseiin had the highest efficacy and resulted in the highest complete response rate, followed by shofusan. When Kampo diagnosis is equivocal and herbal medicines are urgently needed, unseiin should be the prescription of first choice. Based on the condition of the skin, shofusan, shishihakuhito, or tokiinshi should be the second-best option.

Venipuncture pain is rare complication. The underlying pathophysiology of venipuncture pain is incompletely solved and there is no standard treatment. Though most venipuncture pain is accepted as neuropathic pain, some venipuncture pain does not meet neuropathic pain criteria. Case 1 was a woman punctured dorsal vein for blood sampling. She visited pain clinic 9 days after injury because of residual pain and numbness. Case 2 was a woman punctured dorsal vein for intravenous line and radial artery for artery line at the time of operation. She visited pain clinic 16 days after injury because of residual pain. Case 3 was a woman punctured median cutaneous vein for blood sampling. She visited pain clinic 6 days after injury because of residual pain. We thought internal hemorrhage, local pain and tenderness as static blood and prescribed jidabokuippou for all 3 patients. All their pain improved. This report describes 3 cases of venipuncture pain successfully treated with jidabokuippou that shows the excellent analgesic action to nociceptive pain.

We investigated the efficacy of choreitogoshimotsuto for radiation hemorrhagic cystitis. Of the 11 patients who could be followed up, hematuria disappeared in 8 cases. The median time to disappearance of gross hematuria was 74 days. There was no recurrence. Of the 3 ineffective patients, one had urinary diversion, and two had transurethral electrocoagulation and hyperbaric oxygen therapy. There were no adverse events associated with the use of choreitogoshimotsuto. Choreitogoshimotsuto might be effective for radiation hemorrhagic cystitis.

Usually, chronic pain is difficult to treat because this is often accompanied by none-organic factors such as psychiatric symptoms, which complicate the pathological condition. For this reason, the guidelines also call for coping with peripheral symptoms except pain. This time, we report that facial pain as well as peripheral symptoms such as mental anxiety gradually improved by a combination of decoction extract and acupuncture and moxibustion. The case was a man in his 60s, who received all kinds of treatments such as taking Western medicines and blocking trigger points for chronic facial pain of unknown cause with mental anxiety. However, even after one year the side effects were strong and the treatment was ineffective. Acupuncturists and Kampo specialists made the diagnosis and treatment based on a common concept of Kampo medicine. Treatment focused on shin abnormalities and oketsu suppressed the vicious cycle of pain and improved psychiatric symptoms and QOL. It was suggested that Kampo medicine based on the idea “the same in mind and body” is effective for chronic pain in which various symptoms are intricately intertwined.

We report a case of obstructive sleep apnea improved with the treatment both of Kampo medicine and Western medicine. The patient aged 52 years old was struggling with daytime drowsiness. Through the sleep test, he was diagnosed as severe obstructive sleep apnea (OSA) and was received a continuous positive airway pressure therapy (CPAP). Generally, positive air from CPAP applies through the nose and usage reports were recorded in the device. If having nasal congestion, it may be hard to continue CPAP. In this case he had a severe nasal congestion, and he nearly became CPAP failure. It was clear from the poor usage reports. Using Eppikajutsuto for nasal congestion, he felt decrease of nasal congestion. By switching to Shoseiryuto or kakkontokasenkyusin’i from Eppikajutsuto with reference to CPAP usage and nasal CT images, CPAP was continued effectively. Eventually, his daytime sleepiness disappeared.

To continue CPAP, which is one of Western medicine, Kampo medicine was useful. On the other hand, to evaluate the effectiveness of Kampo medicine, Western medicine was necessary. CPAP reports and nasal CT images, which are Western medicine, contributed to the switch to Kampo medicine. This case showed the worth of the combined therapy of Kampo medicine with Western medicine.

The cause of dizziness is often phlegm-rheum, and most of them are treated with drugs, which eliminate excessive fluids. However, in recent years, the causes of dizziness have become diversified and complicated, and in some cases it is difficult to treat with general-purpose agents. This time, we present a case of chronic refractory dizziness successfully treated with goshakusan. The patient was a 70-year-old woman. She had wobbled while walking for 2 years, and consulted nearby doctors. No particular abnormality was pointed out, and oral treatment was performed, but there was no improvement. In our department, ryokeijutsukanto, hangebyakujutsutenmato, goreisan, hochuekkito, kamishoyosan, chotosan, and shinbuto were prescribed by the doctor at the first visit. However, there was no improvement, and the author took over the charge. We diagnosed her with orthostatic dysregulation and prescribed tofisopam, but her dizziness did not improve. We conducted oriental medical examination, and diagnosed that phlegm-rheum associated with food accumulation was the main pathological condition, and that qi stagnation and blood stasis were combined. After 16 weeks of administration of goshakusan, her dizziness improved.

A 65-year-old man, with a history of surgery for esophagogastric junction cancer in X-3, was admitted to the Department of Internal Medicine in our hospital in March for anorexia that had developed since January X. The patient was diagnosed with adhesive small bowel obstruction, and underwent surgery to relieve the obstruction in early May. However, his symptoms did not improve, and he was referred to our department in mid-June. His drooling was considered to be due to “excessive saliva secretion.” He started taking a decoction of bushirichuto for epigastric discomfort and resistance and coldness of the hands and feet. On the 5th day, he started to feel more energetic, and on the 8th day, his saliva production decreased. Furthermore, on the 12th day, his sense of taste and appetite improved. As the oral intake increased, tube feeding could be reduced and rehabilitation progressed ; from an almost bedridden state, he was able to walk continuously for 150 m with a cane. On the 29th day, he was transferred to a chronic care hospital. His weight increased from 34.1 kg, when he was referred to our department, to 39.7 kg at the discharge time. Anorexia and drooling, which had otherwise continued for 5 months, were improved within a short period of time by using bushirichuto.

In response to the increasing numbers of patients with long-term effects of coronavirus disease 2019 (COVID-19), we started using Kampo (traditional Japanese) medicine for some outpatients. We analyzed the patients' characteristics and the treatments used in each case. Our subjects were 9 patients who visited our clinic between May and September 2021. All subjects provided their written informed consent and were followed for several months. Decoctions or extract formulations were prescribed for treatment based on pattern identification, and general guidance related to lifestyle habits based on traditional thought was also provided. Fatigue, lifestyle of intemperance (due to excessive amounts of cold foods and drinks), and mental/physical stress were present in each patient. Some patients also felt strong anxiety about the lack of any established Western medical treatment and insufficient follow-up systems for patients with long-term effects of COVID-19 (long COVID). Tonic formulas and formulas of involving Bupleuri radix were often used. All 9 patients showed a tendency to improve their symptoms within 4 or 5 weeks of treatment. Our impression is that the prompt effect of Kampo medicine was achieved by combining the use of Kampo medicines with instructions to stop eating excessive amounts of cold foods and/or drinks. Further study is needed in the future. For long COVID, no Western medical treatment has yet been established. On the other hand, in our experience with these patients, Kampo medicine based on the concept of mind-body unity was useful.

In this article, we focus on Japanese traditional (Kampo) medicine for the 1889 “Russian flu (Osome cold)”. The influenza pandemic arrived in Japan in 1890 (Meiji 23), and returned in waves over the next several years. The Kampo medicine at that time is described in “Ryukokanbo Setsu (Influenza Editorial)” by Sohaku Asada and “Tenkojikikanbo Zeisetsu (Epidemic Disorder Editorial)” by Masaharu Okada, in “Wakan Irin Shinshi (New Journal of Japanese-Chinese traditional medicine)”. There are prescriptions in “Shang Han Lun (Treatise on Cold Damage Diseases)” for both daiseiryuto and keishinieppito, as well as for formulas of Gosei School, such as gekito, saikogedokuto, shoyosankato, kyushikososan, wageto, jusshinto and kososan. As candidates to cause this pandemic, both the novel influenzavirus-H3 and the novel coronavirus-OC43 are considered. In contrast to Western medicine, which must deal with each virus, Kampo medicine was as effective for the Russian flu, as it was for the Spanish flu.