To investigate the difficulties of taking Japanese traditional (Kampo) medicines, questionnaires were filled out by patients under 19 years old or their families.Forty-six questionnaires were valid for analysis. The mean age of the patients was 9.7 &qlusmn; 5.3 years old (2 to 19 years old) and the percentage of male patients was high (65%). They took extract granules (n = 40) or decoction (n = 6) and most of the patients (n = 38, 83%) took medicines twice a day. Though 69% of patients under 5 years old needed direct assistance from their family to take medicines, none of over 6 years of age needed any help except to dissolve medicines in hot water, while notably 77% of the patients over 13 years old took their medicines un-aided. It was found that patients' families gave them the concrete explanations on the necessity of their medicines regardless of patients' age, so it is important for pharmacist to guide not only families but also patients themselves. Furthermore, pharmacists should understand the taste and the constituent crude drugs of Kampo medicines to improve patients' adherence in taking medicines.

We consecutively enrolled all patients who visited our Kampo clinic from October 2004 to September 2008, and examined whether or not milk drinking causes abdominal fullness, pain or diarrhea in the patients. Among 3,175 patients enrolled, 35 patients (1.1%) complained of symptoms of milk intolerance. Granulated Kampo extracts containing lactose were administered to 20 patients among the 35 patients, but these Kampo extracts did not cause symptoms of lactose intolerance in 13 patients among the 20 patients. The true incidence of lactose intolerance caused by granulated Kampo extracts may be smaller than 1% at most.

A 45-year-old woman had been suffering from fibromyalgia, chronic fatigue syndrome, and complex regional pain syndrome (CRPS) for 2 years before admission. Non-steroidal anti-inflammatory agents, selective serotonin reuptake inhibitors and pregabalin did not affect the various symptoms. A severe feeling of Coldness, the widespread systemic pain and the severe fatigue were decreased by tsumyakushigyakuto (glycyrrihza 4 g, processed ginger 9 g, aconite root 6 g). Attacks of CRPS were relieved by a dose of daiuzusen (aconite root 1 g, honey 10 g). The CRPS attacks presented mainly on the left heart meridian and the small intestine meridian where we treated them with electroacupuncture with reference to the Shigoryuchu (子午流注) methods. Acupuncture and electroacupuncture decreased the frequency of pain attacks, and alleviated the muscles stiffness caused by the CRPS. Thus, the combination of Kampo medicine and acupuncture were effective for the severe pain and other symptoms associated with fibromyalgia, chronic pain syndrome and CRPS.

In 2013, we prescribed daiuzusen for 3 patients with intractable pain; pain from complex regional pain syndrome, colic pain of unknown origin after an abdominal operation, and colic pain from advanced colon cancer and ileus. A dose of daiuzusen (containing uzu 0.5-2 g) quickly relieved their pain in several minutes. Another common symptom was “cold” in their bowel or extremities when they were feeling pain. Aconite levels in drugs and patients' serum after taking daiuzusen were analyzed by liquid chromatography tandem mass spectrometry. Daiuzusen per 1 g of uzu contained aconitine 1.28 μg, mesaconitine 2.31 μg, and hypaconitine 92.89 μg, while jesaconitine was not detected; this was about 5 to 35 times the level of tsumyakushigyakuto per 1 g of uzu. Serum concentrations of hypaconitine peaked in the study at 1.11 ng/mL after about an hour of taking daiuzusen (1 g of uzu). We posit that the immediate effect after taking daiuzusen was due to transmucosal absorption of uzu components. However serum hypaconitine, which we are now able to monitor, is at least one practical way of indicating the use of uzu or bushi containing prescriptions.

Otsujito is a well-known Kampo medicine for treatment of hemorrhoidal diseases. In the current report, we present end results for a case of enterocutaneous fistula treated with Kampo medicine in accordance with traditional “sho” indications.
An 81 year-old female developed abdominal wall-intestinal fistula right immediately following partial colectomy due to ischemic sigmoid colic perforation 12 years previously. Two years later, she had a fistulectomy and repair using intraperitoneal mesh for abdominal recruitment. Eight years after repair of the enterocutaneous fistula, she had peritonitis caused by the tardive intraperitoneal mesh infection. Since then, she has had frequent repeated ileus and received conservative treatment for two years. Several local operations and abdominal drainages were performed after transfer to Aizu Medical Center. Kigikenchuto was provided for wound healing for approximately 1 year, and one fistula was finally identified. Otsujito dramatically decreased the leakage of intestinal juice and closed her enterocutaneous fistula.
Angelicae Radix as an anti-inflammatory agent, and Cimicifugae Rhizoma as originally indicated, may have played pivotal roles in this case with Otsujito.