Physical examination in Kampo medicine are Inspection, Listening, Interview, Palpitation, and examining it make the core of “Inspection” the diagnosis of tongue. A character of “Inspection” is hieroglyphic formation of the state that even a tiptoe watches the distance of a person. In other Words, not a viewpoint of “analysis”, you must perform it for an idea to “grasp the whole” to the last. Medical examination and treatment begins at the moment when a patient entered a consulting room, and it is it with a key whether, with that in mind, “grasping the whole” is possible. Laennec (1781-1826) created a stethoscope states that “all the medicine begins with observation”, but a meaning to have of “Inspection” is deep. Examining it divide it into “Shin, color, form and state” and observe it, but this “Shin” is “energy” and gathers up a whole body state of a patient generally, and a tongue is important when I guess convalescence of illness an importance. It is thought that a tongue reflects development of a condition, Yin and Yang/Kyo and Jitsu of the condition of a patient, balance of Qi, Ketsu and Sui, but there is not such a change for views, and even a physically unimpaired person can watch a native change though there is serious illness in one. In other words it is a premise to watch quality of tongue and a change of fur as a partial phenomenon and an accompanying symptom of the condition of a patient generally without being seized with only views of a part.
Inspection, NOS ; Tongue ; Patients ; Diagnosis ; Medicine, Kampo

A quarter century has passed since the implementation of the complete health insurance coverage of Kampo medicines in 1976. This drastic change has led to the wide use of this type of medications in the clinical setting. During this period, based on the myth “Kampo medicines have no adverse reaction” and the indoctrination “Kampo medicines are effective for various pathophysiological conditions that cannot be managed by Western medicine”, there was a transient, but dramatic increase in the use of Kampo medicines. It is certainly true that Kampo medicine has been beneficial in many patients. However, the expectation that Kampo medicines have been truly accepted by doctors who have properly managed their patients according to the principle of Western medicine is doubtful. This is partly because, based on the idea that it is firstly needed to make the use of Kampo formulations more easy in the hands of clinicians, Kampo medicines have been dealt with as if they were single components although they are actually complex entities. Due to such misunderstanding, prescribing physicians have lost their interest toward the contents (component crude drugs) of Kampo medicines. Numbered extracts are certainly convenient for clinicians who use Kampo medicines according to the concept of Westem medicine. Let me introduce Mashinin-gan (No. 126) as an example. Unfortunately, doctors use this Kampo medicine just to improve bowel movement. I think that we can understand the true worth of Joki-to formulae, which used to play an active role in the treatment of yang ming bing, a condition once thought as refractory, only if we recognize that Mashinin-gan is a modified formulation of Sho-joki-to (immature orange, magnolia bank, Rhubarb Rhizome) and then pursue its use differentiating from Juncho-to (No. 51), Dai-joki-to (No. 133) and Tsu-do-san (No. 105). Upon such consideration, we understand that to learn the principle of Shang han lun [a treatise on Shang han (a form of an acute infectious disease)] is to place importance on the Chinese classic. I think that, in the past, at the meetings of the Japan Society for Oriental Medicine, more attention was paid to the origin of crude drugs as well as the efficacy of Kampo formulations. “What is the origin of Rhubarb Rhizome you used?” or “Is bupleurum root you mentioned Bupleurum falcatum Willd or Bupleurum falcatum Linné?” Of course, we must not stick to this aspect too much, but we will have trouble if we pay absolutely no consideration to the components of Kampo medicines we actually use, even when we use extracts. This is an era of evidence-based medicine (EBM). When we clinicians treat patients with Kampo medicines that cannot be characterized by single chemical formulae, we can value their clinical efficacy only if we stick to the quality of crude drugs to the extent possible. The man subject of this meeting is “To Get Handfuls of Blessings of Great Nature.” At this meeting, I would like to describe the current clinical application of Kampo medicines and actual efforts made by farmers who engage in the cultivation and gathering of well-known crude drugs. I hope that my lecture will help to make clinicians aware of the characteristics of each crude drug for the clinical application of Kampo medicines.

Medicine, Kampo ; Metabolic ; Therapeutic procedure ; Syndrome

Vulvodynia is defined as vulvar pain of at least three months duration without a clearly identifiable cause. Currently, there are few established treatments. We report two cases of vulvodynia treated successfully with relief of insomnia, using Japanese herbal medicine including saiko. Case 1: A 29-year-old female had been in a poor physical condition for two years. Initially, she had vulvar itching, which gradually became vulvar pain. At the first consultation, she complained of not only vulvar pain but also insomnia and feeling cold. Additional symptoms included severe fatigue, constipation, frustration, stiff shoulder, and heart palpitations. There were no abnormal findings in the genital region. We began treating the insomnia and coldness using saikokeishikankyoto. By the time of the second consultation two weeks later, her insomnia and coldness completely resolved, vulvar pain disappeared, and other symptoms improved. Case 2: A 46-year-old female experienced vulvar pain two months before the first visit to the hospital. The pain increased gradually and she awakened every 30 minutes in the night with severe vulvar pain. However, there were no abnormal findings in the genital region. We used saikokaryukotsuboreito, an antidepressant and a sleeping pill. Her insomnia improved gradually, and vulvodynia resolved two weeks after the improvement of the insomnia. These results suggest that saiko is effective on vulvodynia with insomnia.

Kampo medicine is widely used in Japan for neuro-otologic disease (e.g. tinnitus, dizziness, hearing loss). Some patients with these diseases suffer from comorbidity of other non-otologic symptoms. We reviewed typical Kampo medicine formulations for neuro-otologic disease. Kampo extracts have indications not only the neuro-otologic but also other systemic diseases. Kampo medicine would facilitate the care of patients with both neuro-otologic diseases and comorbid symptoms.

The consumption and sales of Kampo products, as well as the crude drugs that make up the products, have been increasing recently. However, the Kampo industry has been exhibiting a long-term decline due to the rise in price of imported crude drugs and reduction in standard prices of crude drugs by the Japanese National Health Insurance scheme. As the production of crude drug in Japan has been decreasing for the past thirty years, efforts have been made to improve the situation. Although the production of Aizu Ginseng decreased from 153 metric tons to 8 metric tons in Fukushima, university research institutes have initiated research on expansion of the farm field for Ginseng and reduction in a cultivation term. In Nara, farmers, pharmaceutical and food manufacturers, and university research institutes, aiming to develop new products using Yamato Angelica root, organized a joint council and have been working together to establish integrated systems from cultivation to sales. The Ministry of Agriculture, Forestry and Fisheries, the Ministry of Health, Labour and Welfare, and Japan Kampo Medicines Manufacturers Association have held local meetings with farmers and pharmaceutical companies in different areas throughout Japan over the past three years from fiscal year 2013. In order to reduce national healthcare costs by Kampo medicine, it is necessary to upgrade the health care system where not only Kampo extract products but also medicinal plants as raw materials including decoctions can be used. Discussions on measures to cover the costs of domestic production of crude drugs should be required.