In China, the roots of several species of Paeonia plants in the Paeoniaceae family have been used as crude drugs under the names of Ji-shao-yao, or the red peony, and Bai-shao-yao, or the white peony, since olden times. While in Japan, the simply dried root of Paeonia lactiflora Pallas has been used as the Chinese crude drug Shao-yao, or Shakuyaku in Japanese. As for the origins of the modern “red” and “white” peony names, there have been a variety of theories, e.g. the names were perhaps derived from differences in their root or flower colors, or whether they were wild or cultivated. Based on our herbological study, we have concluded that the dried root with a cork surface was named the red peony, and those peeled cork layers, the white peony. During the Ming Dynasty, in China, the root of wild peonies such as Paeonia veiitchii and P. obovata, whose flowers are reddish, were processed into the red peony, while cultivated peony root of the white flowered variety, P. lactiflora, was processed into the white peony drug. Because of this coincidence in flower color and name of the processed product, red flowered varieties or wild plants came to be called the plant origin of the red peony, while the white flowered varieties or cultivated plants came to be called the white peony.
Red color ; Plant Roots ; Peony ; Paeonia ; Chinese People

Currently, the international environment surrounding traditional medicine, including acupuncture and moxibustion, is changing faster than we can imagine. In recent years there are some Far East Asian countries that have registered the classical medical books of traditional medicine and a part of traditional medicines in their own countries to the Memory of the World and the Intangible Cultural Heritage in UNESCO. In addition, preparations to include traditional medicine in ICD-11 have been carried out with revision of ICD-10 in WHO. Furthermore, the working of international standardization of traditional medicine of Far East Asia is underway in ISO. Also WFAS is working on the international standardization of acupuncture and moxibustion in an official relationship with WHO. Furthermore, genetic resources and traditional knowledge related to traditional medicine have been discussed in CBD. The matters concerning traditional medicine have been discussed separately elsewhere in a wide variety of international organizations such as WIPO, WTO/TRIPS and FAO.
In this panel discussion, firstly, we outlined the main points about the protection of traditional knowledge by CBD and the Nagoya Protocol, clarified the current status of discussions in WIPO about traditional medicine and registration of traditional knowledge under the Intangible Cultural Heritage in UNESCO, and examined future protection of traditional knowledge of acupuncture and moxibustion. Secondly, we summarized the current status and progress of the international standardization of acupuncture and moxibustion driven by WFAS as commissioned by WHO, clarified the viewpoint of JSAM about problems with the efforts of WFAS for the international standardization of acupuncture and moxibustion, and discussed the relationship of the international standardization of acupuncture and moxibustion in WFAS and ISO. Finally, we summarized the progress of the international standardization of acupuncture and moxibustion from the 1980s when international standardization of acupuncture and moxibustion was first initiated by WHO up until the present when international standardization of acupuncture and moxibustion is included in ISO/TC249, surveyed the present situation of the international standardization of traditional medicine in the countries that are leading the international standardization of acupuncture and moxibustion, and discussed about the aspects of the struggle for supremacy lurking behind the international standardization of traditional medicine and the issues associated with the future of the international standardization of traditional medicine.

The results of pulmonary function tests (PFTs) given to those inhabitants in the western part of Kanagawa Prefecture who visited our hospital for medical examinations between April 1991 and March 1992 were studied comparatively, with their occupation, age, sex, environmental factors and smoking habits taken into account. For this purpose, the subjects totaling 1, 322 were classified into three groups-those who live in the hilly area, those who live in the suburban area and those who live in the coastal area. In the present study, the results of the four PFT items-FVC, FEV 1.0%, FVC and FEV 1.0%-were checked. Careful examination brought into relief the startling fact that many aged people, non-farmers and nonsmokers in the suburban subject group have impaired pulmonary function. It is said that because of the Tokyo-Nagoya expressway and many other motorways, the air in the suburban area is fouled up with exhaust gas to a greater extent than in the other two areas. Although our finding alone could not identify the cause of impaired pulmonary function definitely, air pollution was thought to be a culprit. Further investigation should be made into the living conditions of the examinees. Moreover, environmental monitoring and data analysis have to be carried out in the future.

Early detection and treatment decrease the mortality rate associated with gastric cancer (GC). However, the natural history of GC remains unclear. An 85-year-old woman was referred to our hospital for evaluation of a gastric tumor. Esophagogastroduodenoscopy identified a 6 mm, flat-elevated lesion at the lesser curvature of the antrum. A biopsy specimen showed a well-differentiated tubular adenocarcinoma. The depth of the lesion was estimated to be intramucosal. Although the lesion met the indications for endoscopic resection, periodic endoscopic follow-up was performed due to the patient's advanced age and comorbidities. The mucosal GC invaded into the submucosa 3 years later, and finally progressed to advanced cancer 5 years after the initial examination. The patient died of tumor hemorrhage 6.4 years after the initial examination. In this case, mucosal GC progressed to advanced GC, eventually leading to the patient's death from GC. Early and appropriate treatment is required to prevent GC-related death.
Adenocarcinoma ; Aged, 80 and over ; Biopsy ; Comorbidity ; Endoscopy, Digestive System ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Mortality ; Natural History* ; Stomach Neoplasms*

PURPOSE: The aim of this study was to evaluate the validity and reliability of the Seattle Angina Questionnaire, Japanese version (SAQ-J) as a disease-specific health outcome scale in patients with coronary artery disease. METHODS: Patients with coronary artery disease were recruited from a university hospital in Tokyo. The patients completed self-administered questionnaires, and medical information was obtained from the subjects' medical records. Face validity, concurrent validity evaluated using Short Form 36 (SF-36), known group differences, internal consistency, and test-retest reliability were statistically analyzed. RESULTS: A total of 354 patients gave informed consent, and 331 of them responded (93.5%). The concurrent validity was mostly supported by the pattern of association between SAQ-J and SF-36. The patients without chest symptoms showed significantly higher SAQ-J scores than did the patients with chest symptoms in 4 domains. Cronbach's alpha ranged from .51 to .96, meaning that internal consistency was confirmed to a certain extent. The intraclass correlation coefficient of most domains was higher than the recommended value of 0.70. The weighted kappa ranged from .24 to .57, and it was greater than .4 for 14 of the 19 items. CONCLUSIONS: The SAQ-J could be a valid and reliable disease-specific scale in some part for measuring health outcomes in patients with coronary artery disease, and requires cautious use.
Asian Continental Ancestry Group ; Coronary Artery Disease ; Coronary Vessels ; Humans ; Informed Consent ; Medical Records ; Reproducibility of Results ; Thorax ; Tokyo ; Surveys and Questionnaires

BACKGROUND/AIMS: To compare the diagnostic yield of 20-gauge forward-bevel core biopsy needle (CBN) and 22-gauge needle for endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) of solid pancreatic masses. METHODS: The use of 20-gauge CBN was prospectively evaluated for 50 patients who underwent EUS-FNA from June 2016 to December 2016. Data were compared with those obtained by a retrospective study of 50 consecutive patients who underwent EUS-FNA using standard 22-gauge needles between December 2016 and April 2017. At least two punctures were performed for each patient; the sample from the first pass was used for cytology with or without histology and that from the second pass was used for histology. Sample quantity was evaluated using the sample obtained from the second pass. RESULTS: There was no significant difference in the diagnostic accuracy rate between the first and second passes (20-gauge CBN: 96% [48/50]; standard 22-gauge needle: 88% [44/50]). Samples >10× power fields in length were obtained from 90% (43/48) and 60% (30/50) of patients using the 20-gauge CBN and standard 22-gauge needle, respectively (p=0.01). Technical failure occurred for two patients with the 20-gauge CBN. CONCLUSIONS: Diagnostic accuracy of the 20-gauge CBN was comparable to that of the 22-gauge needle. However, two passes with the 20-gauge CBN yielded a correct diagnosis for 100% of patients when technically feasible. Moreover, the 20-gauge CBN yielded core tissue for 90% patients, which was a performance superior to that of the 22-gauge needle.
Biopsy ; Biopsy, Fine-Needle ; Diagnosis ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Humans ; Needles ; Pancreas ; Prospective Studies ; Punctures ; Retrospective Studies ; Ultrasonography

Prediction of histology by endoscopic examination is important in the clinical management of non-ampullary duodenal epithelial tumors (NADETs), including adenoma and adenocarcinoma. The use of a simple scoring system based on the findings of white-light endoscopy or magnified endoscopy with narrow-band imaging is useful to differentiate between Vienna category 3 (C3) and C4/5 lesions. Less invasive endoscopic resection procedures, such as cold snare polypectomy, are quick to perform and convenient for small (<10 mm) C3 lesions. Neoplasms with higher grade histology, such as C4/5 lesions, should be treated by endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), or surgery. Although EMR often requires piecemeal resection, the complication rate is acceptable. Excellent complete resection rates could be achieved by ESD; however, it remains a challenging method considering the high risk of complications. Shielding or closure of the ulcer after ESD is effective at decreasing the risk of delayed bleeding and perforation. Laparoscopic endoscopic cooperative surgery is an ideal treatment with a high rate of en bloc resection and a low rate of complications, although it is limited to high-volume centers. Patients with NADETs could benefit from a multidisciplinary approach to stratify the optimal treatment based on endoscopic diagnoses.