At the 71st Annual Meeting of the Japan Society for Oriental Medicine held in August 2021, we conducted a special program, “Pre-graduation and post-graduation Kampo medical education for the next generation,” focusing on Kampo medical education. We summarize and report a mock lecture on standard Kampo medicine conducted jointly with the Japan Council for Kampo Medical Education (JCKME) for the purpose of faculty development. The lecture contents were based on the “Basic Curriculum for Pre-Graduate Education in Kampo Medicine 2016” established by the JCKME, and the common model slides prepared by the JCKME were used. The lectures were pre-recorded for 240 minutes on the “History of Kampo medicine,” “basic theory of Kampo medicine,” “physical examination of Kampo medicine,” “composition and effects of typical Kampo medicines, effects and side effects of typical herbal medicines,” “usefulness of Kampo and clinical cases that were effective,” and “overview of acupuncture and moxibustion treatment,” and were delivered from seven days before to seven days after the annual meeting. This was the first nationwide educational activity for the general meeting of the society. These lectures were viewed 1,017 times nationwide, by medical students, educators, and members of the society.

At the 71st Annual Meeting of the Japan Society for Oriental Medicine held in August 2021, we conducted a special program focusing on Kampo medicine education, “Pre-graduation post-graduation Kampo medicine education for the next generation.” The following is a summary report on the practical training in Kampo medicine at each educational facility where the project was conducted. We recorded videos with explanations of topics in advance : “Four examinations,” “Decoction and crude drugs,” and “Acupuncture and moxibustion.” The report on the hands-on training in Kampo medicine was viewed 501 times by medical students, educators, and the society members across the country. This initiative was the first nationwide educational activity of the society.

Carpal tunnel syndrome is a common orthopedic disease. Western medicine treatments for carpal tunnel syndrome include conservative drug treatments, temporary external fixations, and operative treatments. Cases of patients being treated with Kampo medicine have been reported. The patient was an 80-year-old woman, who visited our clinic because of numbness in her right hand. She was diagnosed with carpal tunnel syndrome. She was administrated with a Kampo medicine, keishito. After 7 days, her symptoms were relieved, and after 14 days her symptoms had resolved. We could not find any reports showing that keishito was effective in treating carpal tunnel syndrome. We believe that her symptoms of carpal tunnel syndrome were caused by eiefuwa (nutrient-defense disharmony) and were successfully treated with keishito.

Sleep disorders may be involved in unexplained dizziness. This time, we report 2 cases of dizziness with sleep disorders improved with keishikaryukotsuboreito. Case 1 is a 67-year-old woman. She had had vertigo attacks for 4 years, was very anxious about the attacks, had trouble falling asleep, and was aware of dizziness even between the attacks. After 4 weeks of administration of keishikaryukotsuboreito, her anxiety disappeared and she was able to sleep soundly. After 10 weeks, the lightheadedness disappeared and the medication was terminated at 17 weeks. Case 2 is a 38-year-old woman. She was exhausted because she had a personnel change in her workplace 3 months ago and she was concerned about many things. From 2 months ago, she had trouble falling asleep at night. After 2 weeks of administration of keishikaryukotsuboreito, she was able to sleep soundly. The dizziness disappeared after 6 weeks, and the medication was terminated at 10 weeks.

In cases of pulsatile tinnitus, the presence of organic disease should be suspected, and many of them can be treated once the cause is identified. However, there are idiopathic cases in which the cause cannot be identified, and there is no established treatment for them. Here, we report 2 cases in which Kampo medicine was effective for idiopathic pulsatile tinnitus. Case 1 was a 50-year-old man. He had been stressed for half a year due to the change of job title in his workplace, and he had left pulsatile tinnitus a month ago. We administered saikokaryukotsuboreito, and his tinnitus disappeared in a week. Case 2 was a 30-year-old woman. She gave birth 4 months ago, and after giving birth, she had less sleep and was tired and stressed. She started to notice right pulsatile tinnitus and dizziness from a month ago. We administered nyoshinsan, and her tinnitus and dizziness disappeared in 2 months. In both cases, they were aware of hot flashed on their face as a symptom of qi counterflow, and Kampo treatment improved the symptom together with pulsatile tinnitus. It is possible that blood flow in the head increased with qi counterflow, causing relative stenosis of the blood vessels in the head, leading to turbulence in the lumen of the blood vessels, and hearing pulsatile tinnitus.

A 71-year-old woman was referred to our hospital with complaints of gross hematuria. She had been administered 50mg/day of cyclophosphamide for 13 years to treat idiopathic thrombocytopenic purpura (ITP). Cystoscopy revealed irregular surface of bladder mucosa. On suspicion of bladder cancer, we performed transurethral resection of bladder tumor (TURBT). The pathological examination showed polypoid cyst, and we diagnosed hemorrhagic cystitis. Two months after the operation, gross hematuria was observed again. Although we administered choreitogoshimotsuto and then saireito, both were ineffective. Then we administered kamikihito, considering the findings of deficiency of ki (qi) and ketsu (blood) in Kampo diagnosis and the underlying disease ITP. One month after administering kamikihito, gross hematuria disappeared, urinary sediment test showed RBC 1-4/HPF. After one year of follow-up, bladder tumor was suspected by cystoscopy, but the pathological result of the second TUR-BT was inflammatory change. Since then, kamikihito was continued during the 44-month observation period, and no gross hematuria was observed.

We describe 3 cases of easy fatigability successfully treated with hangekobokuto. Case 1 was a 44-year-old woman who had been experiencing fatigue for a long time due to her busy work schedule. Juzentaihoto was ineffective, and she felt abdominal swelling and showed epigastric resistance upon abdominal examination. Case 2 was a 13-year-old woman who became easily tired, had palpitations, felt uneasy, and showed epigastric resistance upon abdominal examination, after moving from overseas to Japan. Case 3 was an 18-year-old woman who became easily tired under the pressure of her studies after entering university, felt uneasy, felt abdominal swelling, and showed epigastric resistance upon abdominal examination. Hangekobokuto relieved these symptoms. In Case 2 and Case 3, there were obvious stressors, and qi stagnation was strongly suspected. In Case 1, although the patient did not complain of obvious stress, she did not respond well to juzentaihoto, which compensates for qi deficiency, so we also considered qi stagnation. For symptoms such as “get tired easily,” qi-tonifying formulas are often used, but qi-regulating formulas including hangekobokuto may also be effective. It is also important to focus on the patient’s mental state and living environment.

I report two cases in which chikujountanto was effective for psychiatric symptoms after acute infection. Case 1 was a patient with depression after the common cold, which did not respond to the standard treatment with Western medicines using antidepressants, and was cured by honchiho with Kampo medicine. Case 2 was a patient with delirium after influenza, and kinds of untanto were highly effective. There is a neuroinflammatory hypothesis in the etiology of depression, and there are reports examining the clinical application of NSAIDS for neural inflammation, but the development of new pharmacotherapeutic drugs for targeting neuroinflammation has just only begun. On the other hand, it was found that the constituent crude drugs of Kampo medicine have anti-inflammatory effects, which is considered to be one of the factors leading to a cure. It was suggested that chikujountanto might be one of the differential prescriptions for psychiatric symptoms after suffering from the new coronavirus infection (COVID-19).

We report a case of loss of consciousness multiple times with and without focal to bilateral tonic-clonic seizure-like episodes that we diagnosed as psychogenic non-epileptic seizures, and successfully treated with shigyakusan and hangebyakujutsutemmato. The patient did not have fullness and discomfort in the chest and hypochondrium (kyokyokuman), nor spasmodic bilateral rectus abdominis in an interictal state. On the other hand, she had extremely cold limbs, especially feet and hands, with fingers being flexion and rigid under the status of loss of consciousness even without tonic-clonic seizure-like episodes in the ictal state. After being warmed and loosened, her consciousness level slowly recovered. She had headaches frequently in a non-ictal state, too. We identified that she had qi deficiency (kikyo), qi depression (kiutsu), fluid retention (suitai) and qi counter flow (kigyaku) in the interictal state, while kiutsu and kigyaku were extremely strong in the ictal state. In this case, the combined use of shigyakusan and hangebyakujutsutemmato was useful, considering that the patient had two different locations of disease (byoi) that required treatment.

We had a female patient who had stagnation of qi and recovered not only by adjusting qi but also by warming interior cold. A 67-year-old woman visited our clinic for generalized anxiety disorder and whole body overstrain on the basis of domestic problems. She had taken anxiolytic, which brought about some relief. She also suffered from uterine cancer, and had operation of uterine resection. After operation, she took radiation therapy, which caused ileus. Although she took daikenchuto, ileus sometimes recurred. At first, we diagnosed her condition as stagnation of liver qi and deficiency of liver blood according to Kampo medical findings, and prescribed yokukansankachimpihange. However, she felt little effectiveness. We focused on her condition as spleen-stomach deficiency cold, and switched to anchusan, which gradually improved her symptom and led to discontinuation of daikenchuto and anxiolytic. She continued to take it for 7 years, and gradually reduced. She stopped taking medication 2 years later, and has had no recurrence ever since. It suggests that anchusan was effective in warming her latent severe interior cold. We should consider anchusan as a therapeutic candidate for stagnation of qi and interior cold, although it is well known Kampo medicine that is suitable for stomach pain.

We report a case in which daibofuto was effective for knee osteoarthritis in the elderly. The case was an 84-year-old woman, who tried various drugs for right knee pain at multiple hospitals, but the effect was insufficient, so she visited the hospital hoping for Kampo treatment. Although no qi deficiency was observed systemically, joint swelling and mild heat sensation were observed locally. Additionally, in plain X-ray findings, severe knee osteoarthritis including joint space narrowing, osteophyte formation, and osteosclerosis was observed. We administered sokeikakketsuto and hachimigan, but no effect was obtained. Since daibofuto was effective to some extent, we changed to a decoction and increased the amount of crude drug, and then sufficient effect was obtained. Daibofuto has an effect on qi deficiency, and it is frequently used for rheumatoid arthritis with mild synovitis. Daibofuto was also effective for knee osteoarthritis in the elderly ; therefore we believe that both diseases have a common pathological condition.

The patients with foreign body sensation in the throat often visit the hospital. However, they have no problem in Western medicine and may be prescribed with anxiolytics. In Kampo medicine, hangekobokuto is effective in most cases for the symptom of qi stagnation. This time, we report that 2 cases, in which hangekobokuto was ineffective, responded to the combination of ryokeijutsukanto and goshuyuto. The combination, which is a mixture of hontonto (Zhouhou fang), bukuryo, jutsu, and taiso, excluding hange, was effective in these 2 cases as running piglet.

Many patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) complain of respiratory distress, chest pain, and arthralgia even after their recovery. We tried to give saibokuto to a 61-year-old man who has suffered from those symptoms as after effects of COVID-19 for more than 2 months. We report that after administration of saibokuto, almost all symptoms have disappeared within 3 weeks.

We report a case of post coronavirus disease 2019 (COVID-19) condition, in which the patient suffered from a severe sense of fatigue and brain fog that was successfully treated with Kampo therapy. The patient was a 21-year-old man. He had been diagnosed with COVID-19 and hospitalized for follow-up examinations. He recovered without any complications and was discharged from the hospital, but continued to suffer from a severe sense of fatigue, coldness, dizziness, and a loss of concentration. Because of these symptoms, he had to spend most of the day lying down. One month later, he was hospitalized to receive Kampo therapy. We administered bukuryoshigyakuto for 2 weeks referring to his severe coldness and fatigue and then changed to renjuin for his fluid disturbance and blood deficiency. After starting Kampo therapy, his fatigue and dizziness gradually improved. He was discharged after 3 weeks of hospitalization and received Kampo therapy as an outpatient. One month later, he reported a dull feeling in his stomach and depression. We switched to kamikihitogohangekobokuto and added hachimigan. His activities of daily living improved and he could take 4.5-kilometer walk. He could return to work 4 months later. Kampo therapy may be useful for post COVID-19 condition that causes a sense of fatigue and brain fog.

Two cases of hair loss due to coronavirus disease 2019 (COVID-19) sequelae as known as Long COVID were successfully treated with ninjin’yoeito. Case 1 was a 45-year-old woman who complained of hair loss about 2 months after COVID-19 (moderate II in Japanese criteria). Case 2 was a 50-year-old woman who complained of hair loss about 2 months after COVID-19 (mild). In all cases, hair loss stopped next month after treatment with ninjin’yoeito. And their hair began to grow 2 months later administration, the depression caused by hair loss improved as the symptoms improved. Hair loss is one of the symptoms with blood [TM1] deficiency, and patients suffering from Long COVID are also with qi deficiency. We gave ninjinʼyoeito for pattern of both qi and blood [TM1] deficiency with reference to traditional key of treatment, and it contributed to the improvement of symptoms.