It is well known that aconitine-alkaloids is effective for treatment of rheumatoid arthritis (RA). However, the clinical use is limited in part because of its side effects. In this study we examined the therapeutic effects of newly processed “bushi” (Shujibushi) in which the contents of original forms of aconitines were reduced to aboid their undesirable effects. The effectiveness of the “Shujibushi” was recognized in 65.8% (45/67) for clinical and definite RA and in 80.7% (21/26) for probable RA. There were not any adverse side effects.
In order to obtain possible explanations for the high effectiveness of the “Shujibushi”, we analized ingredients of the “Shujibushi” in comparison with “Uzu” another type of aconitine-alkaloids medicine. The “Shujibushi” contained the significantly larger amounts of total alkaloids compared with “Uzu”. The satisfactory effectiveness of the “Shujibushi” might be brought on by the high content of total alkaloids which seem to be composed of aconitine-metabolites and its original forms.

In order to reduce the side effects of aconitine alkaloids, various types of processed Aconitine Tuber have been developed. We have been using 2 types of processed materials: the “Shujibushi” and the “Uzu” for the treatment of rheumatoid arthritis.
Original forms of aconitines (aconitine, hypaconitine and mesaconitine) and total alkaloids of these processed materials were analyzed. Hypaconitine content was 4.9 times larger in the “Uzu” than in the “Shujibushi”. In contrast, the content of total alkaloids was significantly larger in the “Shujibushi” than in the “Uzu”. Accordingly, the amount of total alkaloids eluted to the decoction was 1.3-1.8 times larger in the “Shujibushi” than in the “Uzu”.
Our data indicate that 1) The effectiveness of the processed Aconiti Tuber may depend on the contents of the total alkaloids as well as the original forms of aconitines; 2) Elution rates of total alkaloids to the decoction vary among the types of herb complex resulting in the difference of their clinical effectiveness and reduction of side effects.

OBJECTIVE: Although the use of complementary and alternative medicine (CAM) by the general population has been surveyed previously, the provision of CAM by Japanese physicians in private clinics has not been studied. Universal health insurance system was established in Japan in 1961, and most CAMs are not on the drug tariff. We aimed to clarify the current status of CAM provided by physicians at private clinics in Japan. METHODS: We conducted an internet survey on 400 directors/physicians of private clinics nationwide on the provision of CAM from February 6 to February 10, 2017. Survey items included attributes of subjects, presence/absence of sections or facilities for provision of CAM, proportions of health insurance coverage for medical practices, and source of information. Private clinic was defined as a clinic run by one physician, with less than 20 beds. RESULTS: Commonly provided CAMs were Kampo (traditional Japanese herbal) medicines (34.8%) and supplements/health foods (19.3%). CAMs on the drug tariff were provided in 46.5% of cases at the clinics, but only 16.5% of cases were provided CAMs which were not on the drug tariff, at different neighboring facilities. Among different specialties, Kampo medicines were prescribed at obstetrics/gynecology (54.0%), orthopedics (44.4%), and dermatology (43.0%). Clinics not providing any CAM accounted for 53.5%. With regard to health insurance coverage, 96.8% of the clinics provided only or mainly health services on the universal national health insurance tariff (29.8% and 67.0%, respectively). CONCLUSION Kampo medicines represent the most commonly used CAM in private clinics in Japan, and universal national health insurance coverage is considered to be the reason for the high rate of their use.

There had been no standardized rules for citing ethical Kampo products used in clinical trials in journal articles. Although the name of a Kampo manufacturer was described in 77.9% of research articles, the name and ratios of crude drug components of Kampo formulas were not described in 77.5% of these papers. Considering the importance of proper characterization of interventions in the Consolidated Standards of Reporting Trials (CONSORT) checklist, we hereby propose the use of the Standards of Reporting Kampo Products (STORK) website, http://mpdb.nibiohn.go.jp/stork, as a reference for Kampo products. This will provide an official source on the internet for verified information on individual Kampo formulations for citation purposes in clinical research articles.