[Introduction] We consider that the missions of acupuncture medicine are : 1) cooperation with other departments, 2) treatments of subclinical diseases, and 3) palliative care, and we have been actively persuing all of the above. We conducted an acupuncture trial in the Palliative Care Unit (PCU) in Kawasaki General Care Center.
[Subjects] We studied 74 cancer patients who were hospitalized in PCU between June 1999 and March 2001. There were 36 male patients and 38 female patients, and their average age was 63.9 ± 11.8 years old.
[Methods] We treated the patients using appliance moxibustion with warming acupuncture (CS-2000). Nurses in charge treated the patients according to an association of points chosen with differentiation of syndromes.
[Results] Of 74 cases, 51.4% received effective palliation. Among 58 cases who complained of pains, 55.2% received effective palliation. Treatments were most effective for patients who complained of “dull persistent pain”, “severe dull pain”, “heavy throbbing pain”, “bulging pain” and “penetrating pain” in order of effectiveness.
[Discussion] Appliance Moxibustion with warming acupuncture is expected to relieve 1) pain not controllable with painkiller, 2) cancer pain (pain originating from cancer) or pain from combatting the disease, and 3) pain unrelated to cancer. Such pain is considered to be dull pain (indescribable pain).
This is not based on data, but we were also able to play the following roles. One is spiritual care resulting from sharing common time and space with patients, and the other is providing nurses and doctors with meaningful information obtained from close communication with patients. (This is a part in teamwork medicine.) :
[Conclusion] By participating in palliative care, we found out that we were able to contribute to caring to remove physical pain (and other symptoms) which is part of holistic pain. Especially, we found out that our care is meaningfully effective in removing pain.

[Introduction]Patients express various symptoms that reflect their physical, mental and psychological conditions. Thus, traditional Chinese medicine (TCM) emphasizes the relationship between physical and mental states. In the clinical practice of acupuncture and moxibustion, however, many patients chiefly cite physical complaints, and are often treated without a full discussion of their mental and psychological conditions. In TCM, feelings are divided into five categories:anger, happiness, concern, sadness, and fear. The relationship between these feelings and symptoms of disease of the five viscera is not clearly defined, so we attempted to clarify the correlations. This report describes the results of a survey on the characteristics and nature of anger and depression in terms of the five viscera.
[Methods]After obtaining informed consent, 102 students from a vocational school and our university (60 men and 42 women, average age 25 ± 8) were recruited for this study. Three survey sheets were used:Oriental Medicine Health Questionnaire 57 (OHQ57) for understanding the condition of the five viscera; 24 of the 34 items of the State-Trait Anger Expression Inventory (STAXI) for understanding the state of anger;and Beck Depression Inventory (BDI) for assessing depression. The survey was conducted from June to July in 2012.
[Results]The average scores in OHQ57 were 5.1 ± 3.1 for kan (liver), 4.6 ± 3.2 for shin (heart), 5.2 ± 3.1 for hi (spleen), 3.8 ± 3.3for hai (lung), and 3.9 ± 2.7 for jin (kidney). The average scores in STAXI were 23.0 ± 5.1 for State of Anger, 18.8 ±.1 for Anger-Expression, 20.8 ± 3.8 for Anger-Suppression, and 18.9 ± 3.5 for Anger Control. The average score in BDI was 12.4 ± 8.0. Significant correlations were found between State of Anger and kan:Anger-Expression and han/shin/hai in STAXI, and between depression and shin/hi in BDI.
[Conclusion]The Suwen ("Basic Questions,"the oldest Chinese medical text) and other TCM literatures report that anger and depression are related to kan, and the results of this study confirmed the relationship between anger and kan. Based on factor analyses, scores of Anger State (intensity of anger) revealed that groups suspected of having diseases of kan tended to get angry easily and Anger-Expression (expression of anger) showed that these groups displayed both aggressive behavior and verbal assertion. On the other hand, latent factors of depression, possibly caused by diseases of kan, were not revealed in factor analyses, although depression was significantly correlated with shin and hi.

Kampo medicine lectures at Tokai University School of Medicine are an elective subject this year. In order to evaluate student acceptance of this elective, we performed a questionnaire investigation prior to lectures for all fourth-year medical students (n=96). Among the 76 students who provided effective answers, 47 considered attending the Kampo medicine lectures, and 35 of these did attend them. Ten could not attend though they had wanted to. Three could not attend because applicant numbers surpassed class quotas, and 6 reported that other elective subjects were of greater interest to them. Regarding a new model core curriculum for medical education, 6 students (8%) knew that questions about Kampo medicine might be included in a medical state examination, and only 3 (4%) knew that Kampo medicine was included as a specific behavioral objective (SBO). Regarding attitudes toward Kampo medicine, 64 students (84%) were interested in it, while 47 (57%) had a good image of it. However, about two-thirds of students had skeptical or negative images of Kampo medicine citing phrases such as “lack of evidence, ” “mysterious, ” “unscientific, ” “difficult to understand, ” “doubtful” and “works slowly.” These findings suggest that a minimal knowledge of Kampo medicine should be taught to all medical students as a required subject. Furthermore, establishment of advanced programs should be considered as well, since medical students have great interest in, and expectations of Kampo medicine.

To investigate the effect of amifostine, we administered amifostine, a radioprotective agent, 30 minutes before exposing the maxillary region of mice, including the parotid gland, to 5 Gy or 10 Gy X-ray irradiation. The survival rate was recorded, and changes in the parotid gland morphology were investigated by examining the hematoxylin and eosin (HE)-stained specimens and light microscope autoradiography (LMARG) images obtained 30 days after irradiation. A survival rate of 100% was not observed in any group administered 200 mg/kg amifostine with or without irradiation. Among the groups irradiated with 10 Gy X-rays, the survival rate was higher and the survival period was longer in the 100 mg/kg amifostine group than in the no amifostine group. The histological findings in the group that received 5 Gy irradiation without amifostine were as follows: auxetic growth of acinar cells, nuclei of all sizes, cells in the mitotic phase, and cells undergoing apoptosis. Further, the treated groups were compared with the no amifostine and no irradiation group (untreated control). LMRG imaging revealed that the number of reduced silver grains per mm² of acinar cells after 30 min of ³H-leucine administration was higher than that after 120 min in mice treated with 100 mg/kg amifostine with or without 5 Gy irradiation. This observation was similar to that in the untreated control.This finding suggests that although amifostine administration reduces the adverse effects of irradiation on the parotid gland, higher doses of amifostine may be fatal.

At the request of the gynecology deparment, ten patients who were suffering from edema of the legs after undergoing radical operative hysterectomy and radiotherapy were treated with a combination of Oriental medical therapies, namely acupuncture, moxibustion and ‘Toeki’ (a form of internal treatment more commonly known as Kampo formulas, or decoctions of combinations of crude drugs). The average patient age was 54±3.7 years of age and the average morbid period was 180 days.
Although this therapy did not appear to produce any remarkable change in the leg diameter (measured at the thigh, largest diameter of the crus and leg joints), relief from subjective symptoms such as pain associated with the swelling (swelling pain), muscle stiffness and improved bowel function were evident.
These findings indicate that Oriental medical treatment has therapeutic value for alleviating the patients' discomfort and improving the quality of life.

We did Oriental medical treatment to intractable atopic dermatitis patients. The number of cases is twenty. We divided them into two groups, namely the group of the combined treatment of acupuncture and “Toeki” (internal remedy), the “Toeki” treatment group, and compared the effective rates of the two. The combined treatment of acupuncture and “Toeki” is effective in seven cases out of eirht, and the effective rate is 88%, while the “Toeki” treatment is effective in eight out of twelve, and the effective rate is 67%. We think that both of the combined treatment of acupuncture and “Toeki” and “Toeki” treatment are both effective, but that the former is more effective than the latter.

We assessed the late aortic reoperation after surgery for type A acute aortic dissection (AAAD). Subjects were 108 consecutive patients with AAAD who underwent surgery by routine aortic arch replacement using geratin-resorcin-formalin-glutaraldehyde (GRF) glue between January 1996 and December 2010. Seven of the 94 patients who were discharged after the initial repair of AAAD required reoperation for the residual aorta. Reoperations included 4 procedures on the distal aorta and 3 procedures on the proximal aorta (aortic root or ascending aorta) at a mean interval of 6.1±3.5 (0.9∼13.7) years after initial surgery. There were no hospital reoperation-related deaths. Freedom from reoperation was 96% and 89% at 5 and 10 years. In conclusion, the use of GRF glue may influence the risk of reoperation after surgery for AAAD, but our results showed that there were very few of such cases. Furthermore, routine aortic arch replacement for AAAD may reduce late aortic reoperations after surgery by eliminating possible risks of residual tear at the transverse arch.

The present study investigated an effective method of eliciting medium and long latency cutaneous reflexes in normal human subjects. The effect of changes in stimulus conditions (number of pulse train, duration of electrical pulse and inter-stimulus interval) on cutaneous reflexes in the first dorsal interosseous muscle (FDI) following non-noxious electrical stimulation to the hand digits (digit 1 ; D1, digit 2 ; D2 and digit 5 ; D5) were investigated in seven healthy volunteers. Cutaneous reflexes were elicited while the subjects performed isolated isometric contraction of FDI (D2 abduction). Under all experimental conditions, the level of muscle contraction was set at 10% of the maximal EMG amplitude, which was determined during maximal voluntary contraction. Intensity of the electrical stimulation was set at 2.0 times the perceptual threshold under all experimental conditions.Although the amplitude of E2 (excitatory response, peak latency ∼60∼90 ms) was independent of the number of pulses (1, 2, 3, and 5 pulses, pulse frequency at 333 Hz), that of I1 (inhibitory response, ∼45∼60 ms), I2 (inhibitory response, ∼90∼120 ms) and E3 (excitatory response, ∼120∼180 ms) was significantly increased depending on the number of pulses (p<0.001). Amplitudes of E2 and I2 were significantly affected by the digit stimulated (p<0.01). For all four components of the cutaneous reflexes, there were no significant differences in magnitude even by alternating both the inter-stimulus interval (fixed at 1, 2 and 3 Hz and random between at 0.7 and 2 Hz) and the duration (0.1, 0.5 and 1 ms) of the electrical stimulation.These findings suggest that the susceptibility of responsible interneurons impinging on each reflex pathway to temporal summation of the test impulse differs depending on the digit stimulated. It is also likely that almost the same population of the cutaneous afferent fibers were activated by test stimulation with different durations as far as the same stimulus intensity was utilized. As a practical application, double or more pulses up to 3 Hz without causing pain is recommended to effectively evoke medium and long latency cutaneous reflexes in FDI, which would reduce possible effects arising from fatigue.

It has recently demonstrated that central fatigue during sustained maximal voluntary contraction (MVC) progresses faster in the presence of delayed onset muscle soreness due to eccentric contractions than in normal states (Endoh et al., 2005). However, it remains to be clarified whether these findings are related to muscle damage or muscle pain induced by eccentric contractions. The present study investigated which factor plays a more critical role in the earlier onset of central fatigue during sustained MVC with muscle pain induced by injecting hypertonic saline. Ten healthy male right-handed subjects (age, 21~32 yrs.) were asked to perform brief MVCs (~3 sec) before and after injection of isotonic saline (0.9%, 1.0 ml, ISO) or hypertonic saline (5.25%, 1.0 ml, HYP) into the left biceps brachii. The subjects then performed 1 min MVC (fatigue test) with isometric elbow flexion was done in ISO or HYP condition or intact control condition (CON). During these contractions, transcranial magnetic stimulation was delivered to the contralateral motor cortex to evaluate voluntary activation (VA), the motor evoked potential (MEP) and electromyographic (EMG) silent period (SP). Ratio of root mean square of the EMG and elbow flexion force (EMGrms/F) was also measured.The peak pain induced by the injection of HYP was significantly higher than that of ISO (p<0.01). There was no significant difference in either the maximum size of the M response or the twitch force between ISO and HYP (p>0.05). However, during the brief MVCs, both maximal force (p<0.01) and VA (p<0.05) for HYP were significantly decreased compared to those for ISO. During the fatigue test, although MVC, VA, MEP and SP were significantly altered (p<0.05~0.01), there was no significant difference among CON, ISO and HYP (p>0.05). There was no significant difference in EMGrms during the fatigue test (p>0.05).These results suggest that peripheral force-producing capacity remained intact after the injection of ISO and HYP during sustained MVC, and that progression of central fatigue during sustained MVC was less affected by the increased group III and IV afferent activity induced by HYP.

A model core curriculum proposed by the government in 2001 outlined the core structure for undergraduate medical education, in which a kampo medicine educational program was established to teach holistic medicine. Eighty Japanese medical schools have attempted to implement this program. We presented lectures on kampo herbal medicine as part of practical training in kampo focusing on clinical pharmacology and using a team-based format. This experience-based program aims to promote active learning of kampo herbal medicine among students. 1) After 116 4th-year students at Tokai Medical University had listened to 6 units of general lectures on the basic theory of kampo medicine, they received practical training comprising 3 units of kampo medical practice, acupuncture, and kampo herbal medicines in small groups of approximately 13 students (12 students, 3 groups; 13 students, 4 groups; and 14 students, 2 groups).2)For experience-based learning about kampo herbal medicine, each group was divided into 2 teams of students who practiced and worked on assignments so that they could understand herbal medicine from the viewpoints of both physicians and patients.3) By preparing keishito using Cinnamomi Cortex, whose production areas and quality differ, students learned the fundamental mechanism of kampo medicine through team discussions of their subjective sensory assessment of the herbal medicine keishito and the objective analysis of the main ingredients of Cinnamomi Cortex. 4) Group A (40 students, 6 teams) took the examination 2 days after the practice, and group B (76 students, 12 teams) took the exam before the practice. Group A did not show any correlation between examination results and interest levels in kampo herbal medicine, and all students but 1 correctly answered 60% or less of the questions. Group B showed a positive correlation between interest levels and examination results, and 6 students correctly answered less than 60% of the questions.5)The present practice could be effective in motivating students in kampo medicine.