An 8-year-old girl was admitted with vision loss. She had no history of amblyopia or other eye diseases. On examination, both eyes showed vision loss and uncorrected myopia, regardless of visual acuity correction by glasses. Her symptoms were considered exacerbated by fatigue. We diagnosed tonic accommodation because a regulatory paralysis agent provided relief. The patient had been treated with tropicamide methyl sulfate and neostigmine, but her visual acuity did not change. Based on a Kampo diagnosis, she was prescribed Shokenchuto. After 4 months' administration, her uncorrected vision improved by 1.2 in both eyes, and her visual acuity was maintained even when fatigued. Kampo medicine can be a treatment option for tonic accommodation in cases where standard treatments are ineffective.

A total of 147 subjects presenting with common colds were discussed in the context of traditional Japanese medicine. Using diagnoses and treatment based on traditional Japanese medicine, the subjects were divided into three groups, including wind-cold and wind-heat, and were prescribed herbal medicines. The subjects were compared in terms of time-of-onset, complaints, subjective and objective symptoms, and constitution.1) Wind-cold was observed in 42.9% of their cases, mostly treated with kakkonto/keishito. This type of common cold occurred frequently during winter but was less common in summer. Many patients were found to have a weak stomach and/or an excessive sensitivity to cold. Typical symptoms were chills (often the chief complaint) and cold sensations in the limbs, both of which are external cold symptoms. There were no objective symptoms other than a floating pulse. 2) The percentage of wind-heat colds was 46.3%. Gingyosan was frequently used. This type of common cold occurred more frequently in spring, but was also seen in autumn. Slightly more subjects were sensitive to heat and/or had a healthy constitution. Symptoms were extensive, including external/internal heat symptoms, such as pharyngeal pain (often the chief complaint), redness of the pharynx, hot sensation, feverishness, dry mouth favoring cold water, and dryness symptoms and, less often, cold state symptoms. 3) The remaining subjects, accounting for 10.9%, were regarded as a complex of cold and heat states, and were treated with kufugedokuto.

A 54-year-old female had cesarean sections at ages 26 and 29, a left salpingophrectomy for left ovarian cyst at age 31, and a total abdominal hysterectomy for fibroids at age 41. After total abdominal hysterectomy, she had repeated bouts of ileus and started taking daikenchuto (DKT), which is commonly used to prevent ileus. At age 54, she visited our hospital when DKT failed to relieve her constipation and lower abdominal pain and had occasional heat flash above her neck. Tongue examination revealed pale red tongue and fissured tongue signs with yellow fur and dilation of the sublingual collateral vessels. Kampo diagnosis was blood stasis and excess heat, for which keishibukuryogan was prescribed to be taken daily and with which her symptoms dissipated after 7 days. Despite the popular use of DKT, its potential to cause excess heat after long-term use is not as well known. It is extremely important to warn clinicians who prescribe Kampo not to focus solely on a disease-to-prescription model but also to be learned of the discipline and to take measures to prevent adverse long-term effects and complications.

Objective: To quickly collect and provide information on package insert revisions, packaging changes, discontinuation of drug manufacturing and distribution, and other information without fail.
Methods: Information was collected with the use of a drug information service site (SAFE DI) managed by an organization formed by 15 pharmaceutical wholesalers (SAFE Co., Ltd.).  The information obtained was processed into a house journal and provided to the department of pharmacy and other hospital personnel via an employees-only website (hospital LAN).
Results: Before the introduction of the SAFE DI, incomplete or delayed information collection sometimes forced personnel to urgently cope with packaging changes or discontinuation of drug manufacturing and distribution and assume a heavy workload.  Introduction of the system allowed quick collection and dissemination of such information without fail.
Conclusion: The recently introduced SAFE DI contributes to qualitative improvement in collection and dissemination of information.  Introduction of such a system may also be useful in other hospitals.

The IPCD (Immersing Powdered Crude Drugs) method, inspired by the “zhu san fa” which was widely used in the Song period of China, has been developed to prepare Kampo decoctions quickly and easily, with highyield extract from crude drugs. One trouble with the IPCD method occurs when separating the decoction from the muddy residue of the crude drug powder. When powdered ephedra herb is packed in a nonwoven fabric bag and immersed in hot water, yield of the marker compounds is much lower than that obtained when ephedra herb powder is dispersed freely in hot water without a nonwoven fabric bag. Thus the use of a nonwoven fabric bag was shown to be unsuitable with the IPCD method. In investigating an easy and more efficient separation method, we tried decanting with a commercially available wine carafe to separate the decoction and residue. With IPCD followed by decantation using the wine carafe, yields of about 80% decoction volume were obtained as compared with those when cut crude drugs are decocted and filtered using a tea strainer, in 6 of the 7 formulas tried. We find that decantation using a wine carafe is a more practical way of separation in the IPCD method.

Objective: At Kitasato Institute Hospital, Kitasato University (henceforth, the hospital), the first edition of an antimicrobial use guidebook (henceforth, the guidebook) was produced in 2000.  This time, the Pharmaceutical Department’s members on the hospital’s Infection Control Committee (ICC) took the lead and revised the guidebook so that it better conforms to clinical conditions and assessed the guidebook they created.
Methods: A Working Group (WG) consisting of two ICC Pharmaceutical Department members and two members of the Medical Products Information Office staff examined the items to be listed in the guidebook.  These items were approved by the ICC and then assigned to physicians and pharmacists to be written up.  A questionnaire survey was conducted on the physicians and pharmacists in the hospital as to their assessment of the content and the conditions of use of the guidebook created.
Results: In the revised edition, “Antimicrobials PK/PD,” “TDM,” “Empiric Therapy for Infections in Each Department,” etc. have been added, the physicians wrote “Empiric Therapy for Infections in Each Department” and everything else was written by the WG.  The return rate of the questionnaire was 65.7% (N=99), and the guidebook utilization rate was 75.4%.  Frequently viewed items were “List of Antimicrobials Used In-Hospital,” “How to Administer Medication during Decreased Renal Function,” “Empiric Therapy for Infections in Each Department,” etc. by the internal medicine physicians, “List of Antimicrobials Used In-Hospital” and “How to Administer Medication during Decreased Renal Function,” etc. by the surgeons, and “Classification of Antimicrobials,” “List of Antimicrobials Used In-Hospital,” “When Renal Function is Decreased,” “TDM,” and “Empiric Therapy for Infections in Each Department,” etc. by the residents.  Furthermore, there were no items deemed “not necessary for inclusion” for a clear reason.  As to be expected in this guidebook, 72.3% of all respondents mentioned it was “a source of information on basic antimicrobial use” and next, “a source of information for treating infections outside one’s area of specialty.”
Conclusion: The items listed in the guidebook are thought to be appropriate, and its usage conditions are also good.  As they are specialists on antimicrobials, the pharmacists playing a central role while cooperating with the physicians on the ICC led to the creation of a highly useful guidebook.

Dang Gui Liu Huang Tang (in the Lan Shi Mi Cang written by Li Dong-yuan) is a common medicine for treating night sweats. We describe its historical development and therapeutic uses. The use of Huan qi (Radix Astragali sen Hedysari) is based on the Han-Sui dynasty medical principle that night sweats are mainly caused by Deficiency of Yang. Herbs to enrich the lood and Yin, Dang gui (Radix Angelicae Sinesis), Seng di huang (Radix Remannia), Shu di huang Radix Rehmannia preparata) were later added because Son dynasty physicians mentioned that Yin deficiency caused night sweats. The addition of heat-reducing herbs, such as Huang lian (Rhizoma Coptidis), was based on the Song dynasty theory that night sweats are caused by pathologic heat in the body, which forces body fluid out of the skin. In the same period, the herbal medicine called Da Jin Hua Wan created by Liu Wansu, and this greatly influenced the principles for treating night sweats. The clearest explanation can be found in the medical treaties Huang Di Nei Jing Su Wen, and Xuan Ming Lun. This medical combination was based on medical theories from a number of historical periods, which may explain its effectiveness. Dang Gui Liu Huang Tang is not effective against types of weak heat (Dan xin xin fa), severe vital Qi Deficiency (Zhang shi yang), or serious deficiency of Yin (Yi xue xin wu). It sometimes hurts Pi and Wei (digestive system). It is useful in the treatment of spontaneous perspiration (Yi xue zheng zhuang, Jin xue quan shu). In summary, this medicine is most effective when the seriousness of heat and Yin deficiency are almost equal and a slight Qi Deficiency exists, or in cases of spontaneous perspiration.

Until the Sui Dynasty in China, night sweat and spontaneous perspiration had been thought to be caused by same pathophysiology, that is, lowered superficial resistance by deficiency of Qi.In the Tang Dynasty, these were considered to have different pathophysiologies and a new principle indicated that pathogenic heat caused night sweat.In the Song and Jing Dynasties, deficiency of blood and pathogenic heat by deficiency of Yin was also considered to cause night sweat.In the Jing Dynasty, exogenous pathogens, such as Cold were considered to cause night sweat, which indicated the principle that not only the deficiency syndrome but also the excess syndrome caused night sweat.In the beginning of the Yuan and Ming Dynasties, it was concluded that the deficiency of Yin caused night sweat and the deficiency of Yang caused spontaneous perspiration.In the middle of the Ming Dynasty, another new theory indicated that deficiency of Yang also possibly caused night sweat; therefore we should diagnose abnormal sweat depending on the pathophysiology in each case.In the Qing Dynasty, new theories were established stating that not only exogenous pathogens but also Damp-heat, undigested food and stagnation of blood, all of which are included in excess syndrome, cause night sweat, and that based on which part of the body sweats occurred we might understand pathophysiology of night sweat. The night sweat by Warm-heat, which is different from the one by Wind-cold, was considered to be caused with deficiency of Yin.Thus we conclude that the theories of night sweat developed over time, based on Chinese medical classics.

OBJECTIVE: The aim of this study was to explore the factor structure of a novel, 10-item rating scale, the Targeted Inventory on Problems in Schizophrenia (TIP-Sz). Determining the factor structure will be useful in the brief evaluation of medication and non-medication treatment of the disease. METHODS: An exploratory factor analysis was performed on TIP-Sz scores obtained from 100 patients who met the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for schizophrenia. RESULTS: The factor analysis extracted four factors that were deemed clinically pertinent, which we labeled: disorganization, social cooperativeness, functional capacity, and emotional state. The items exhibited cross-loadings on the first three factors (i.e., some items loaded on more than one factor). In particular, the 'behavioral dyscontrol and disorganization,' 'insight and reality testing,' and 'overall prognostic impression' items had comparable cross-loadings on all of the first three factors. The emotional state factor was distinct from the other factors in that the items loading on it did not cross-load on other factors. CONCLUSION: The TIP-Sz scale comprises factors that are associated with the psychosocial functioning and emotional state of patients, which are important outcome parameters for successful treatment of the disease.
Anomie ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Schizophrenia

Tenmin NAMIKAWA (並河天民) thought the Shanghanlun (傷寒論) was an important text. He also taught his pupils the importance of prescribing Zhongjing ZHANG's (張仲景) medicines. Ryokyu ARIMA (有馬凉及) was a physician-teacher, who prescribed Chengqitang (承気湯) for the emperor without conferring with other doctors. His chengqitang formulary was derived from medical texts by Zhongjing ZHANG. Kyugo GODA (合田求吾) on the other hand, was a pupil of Ikkannsai MATSUBARA (松原一閑斎), who wrote in the Idokikigaki (医道聞書) : theKoho (古方) school started by Ryokyu ARIMA. He was a hero who was punished by the Goseiin (後西院) emperor. He taught Koho to Tenmin. This therefore reveals that Ryokyu ARIMA was a teacher who taught the importance of the Shanghanlun.