In 1963, Keisetsu Otsuka reported painful groin as a typical abdominal sign for tokishigyakukagoshuyushokyoto (TSG) sho (indication). In 1974, he also reported Senki syndrome type A. However, this useful abdominal sign was not described as a ‘painful groin' medical term by him. By investigation his pupil's descriptions, the author revealed that this ‘painful groin' term was commonly used in their articles. The author has recently found that inguinal pain accompanies muscle contraction and hyperalgesia in this region clinically. Thus, these sign in the groin should be considered as noted in the diagnosis of TSG sho.

It is well known that an abdominal sign of painful groin indicates an appropriate condition for choosing the Kampo formulation tokishigyakukagoshuyushokyoto (TSG). This evidence was found by Keisetsu Otsuka in 1963. He thought that this sign is correlated with the liver meridian.
However, the pathophysiological background for this sign has been unknown. Recently, the author made clear that this sign disappears by acupunctural procedure at the Hikon (ExB4) meridian point. According to this clinical evidence, the author proposes a new hypothesis for this abdominal sign in that it closely relates to a homeostatic mechanism. In the cold environment, sympathetic drive to the femoral arteries occurs in order to guard from radiation heat loss in the lower extremities. This drive also causes a reduction of blood supply to the pelvic viscera. The acupunctural procedure at the Hikon (ExB4) meridian point may release both the induration of the iliocostal muscle and the contraction of IOM simultaneously. TGS disconnects the vicious cycle which exist between the pelvic viscera and sympathetic ganglion, and improves various signs that correlates with ischemia of the pelvic viscera.

It is well known that a painful lump around para-naval, ileo-cecal and sigmoid regions are correlated with oketsu syndrome, although, the physiological mechanism for these signs is still unknown. Recently, the author made clear that these signs disappear by acupunctural procedure at the meridian points Hikon (ExB4), Kekkai (SP10) and/or the lump itself. And also the author found out that these abdominal lumps are located in the most peripheral position of the superior or inferior epigastric artery. This evidence may indicate that abdominal lumps are brought by diminished blood flow of the superior or inferior epigastric artery, and acupunctural input from a meridian point or lump itself inhibits not only the excited gamma and alpha motor-neuron in the thoracic 11 and 12 segment of spinal cord but also excites sympathetic neurons. The author speculates that the initial noxious stimuli occur with stagnation of the pelvic vein associated with homeostatic inflammation.

A sign of palpitation above the umbilicus is an important piece of information which means a disorder of Ki circulation in the Kampo medicine. This study revealed that the amplitude of this palpitation observed in the abdominal wall was about 4 mm. The author has been speculated for a long time that this sign should accompany significant change of the diameter of abdominal aorta. But this speculation was denied by MRA study, which showed at most 1.5 mm change of the diameter of abdominal aorta. The ultrasonic studies of abdominal aorta showed that the amplitude of diameter of the aorta changed about 1.5 mm. The discrepancy between the amplitude of abdominal wall (4 mm) and that of ultrasonic image (1.5 mm) could be explained by assuming the impulse force toward the abdominal aorta wall. Concerning the generated powerful impulse, the author considered three factors including increased pulse velocity, reaction force by the spine and the sound pressure generated in the heart.

Chilblains is one indication for the use of an ethical Kampo formulation, i.e. tokishigyakukagoshuyushokyoto. This disease is a very common disorder which occurs in cold circumstances. It has been noted that this disorder correlates with diminished peripheral blood flow. However, the inflammatory mechanism associated with this disorder are still unknown. The author's intention is to speculate on the mechanism behind this disorder from the view point of homeostatic inflammation, as proposed by recent immunology. To wit, chilblains may occur via cytokines which are released from ischemic vessels of the microcirculation and/or cells associated with micro-coagulation in the post-capillary venula.

The outline of COE program at University of Toyama entitled “Advanced Approach to Personalized Medicine Based on Oriental Philosophy” was presented. This program consists of two parts, i.e., basic research group and clinical research group. On the basic researches, we performed field work for natural resources of medicinal plants both in Mongolia and China. And we revealed the differences of the chemical ingredients in rhubarb family. Furthermore, we developped a new DNA microarray to detect the panax ginseng family. In this paper, we also reported that the chemical ingredients of medicinal herbs convert new substances by the action of intestinal bacterias. In the clinical research group, we revealed that the characteristic protein pattern of “blood stagnant (Oketsu) syndrome” in Kampo medicine by means of protein chip array system. We showed the result of the midway evaluation by Japan Society for the Promotion of Science.
Universities ; basic research ; seconds ; Chemical compound, NOS ; Proteins

The abdominal diagnosis plays an essential role in Japanese Kampo medicine. Moreover, this diagnostic method is a characteristic practice in Kampo medicine. The conventional method of abdominal diagnosis is performed with the patient in a supine position. However, the author has found that several patients have presented with tenderness of the epigastrium or hypochondrium in a standing position, which was not detected in a conventional supine position. This paper is intended to announce the significance of a new method of abdominal diagnosis named “Ritsuishin”. In this paper, the author describes the utility of this method via a case of saikokeishikankyoto and of hontonto (Chugoho).

Modern Kampo medicine is mainly based on a restoration of ancient Chinese medicine which occurred in the Edo period in Japan. This historical event rose under the influence of a Confucian renaissance, resulting the exclusion of metaphysics. This report intends to clarify the correlation between these two new cultural movements, and to outline the characteristics of Kampo medicine from a historical perspective.

Keijyuro Wada's Ikaino-tettsui (The Iron Hammer of the Medical World) was first published in 1910, just a hundred years ago. This book admonishes against the influence of modern Western medicine, which is based on the theory of element reductionism. Wada insisted that a reevaluation of Kampo medicine was essential to create a holistic medical system. Immediately after the book was published, Dr. Ryuken Hirade proposed a bitter criticism of it in a medical journal. Dr. Hirade, at that time, was leader of a well-respected medical society in Nagoya. His bitter criticism is very meaningful for us who engaged in Kampo medicine today. There is a conflict betweenthe two different paradigms of Western and Eastern medicine. This lecture intends to discuss our challenges facing Kampo medicine based on Ryuken Hirade's opinions.

The abdominal sign “shinkashiketsu” (lump of the epigastrium) is an important sign for the choice saikokeishito. However, an understanding of this symptom has been not defined in concrete terms. The author has found that this symptom can be recognized as a small painful point lying median to the xiphiod process and navel. This specific painful point is described equally in the textbook Shokanron and others. And the senior physician Kenzo Okuda has interpreted the suitability of their prescriptions as being decided by clinical results. Thus, the author has confidence that this painful point is an important indicator for saikokeishito.