In oriental medicine, the state in which blood is stagnant is called "oketsu, (Yu xie)"meaning preceding state or symptomatic of sickness. However, the pathological detail and mechanism of "oketsu"is not clear. Therefore we attempt to clarify the meaning of "oketsu"with Western medical knowledge and methods. The relationship between "oketsu"and blood fluidity (BF) was studied in human studies and the influence of several kinds of stress, "anti-oketsu"herbal medicine, electro-acupuncture stimulation (ACU), adrenoceptor agonist and antagonist on BF, platelet aggregation (PA), plasma ATP level, reactive oxygen metabolites level (d-ROM) and biological anti-oxidant potential level (BAP) were studied in animal studies using male Wistar rats. BF and PA were examined using a Micro Channel Array Flow Analyzer (MC-FAN) and a laser scattering platelet aggregometer (PA-20), respectively. D-ROM and BAP levels were studied using a Free Radical Elective Evaluator. In ACU study, 1Hz, 3-5 V stimulation was applied to the acupoints for 15 or 60 minutes. Stimulated acupoints were as follows:ZuSanli (ST-36), Sanyinjiao (SP-6), Hegu (L-I4), Neiguan (P-6) and Shenshu (BL-23). A significant decrease of BF was observed in "oketsu"patients compared to the "non-oketsu"patients in human studies. In the animal study, restrained and electrical shock stress applied to rats results in a quick decrease of BF, increase of PA, increase of plasma ATP level, increase of d-ROM level and decrease of BAP level. ACU applied to ST-36, SP-6 and L-14 revealed significant increases in BF, while PA activity decreased. The effect was observed even with 15 min stimulation. However, no significant changes were observed when ACU was applied to P-6 and BL-23. Furthermore, ACU applied to ST-36 represented a significant reduction to the stress induced blood changes such as BF, PA, plasma ATP level, d-ROM, and BAP level. These data suggest the close relation of BF with the "Oketsu"and that sympathetic nervous system activity and plasma ATP level have important roles in the changes of blood fluidity. Acupoints may have some role in the result that ACU affects BF depending on the stimulation loci. ACU has an immediate effect on BF since 15 min stimulation shows a significant effect. PA decrease by ACU suggests that an increase of BF is mainly associated with PA ability. The result that ACU reduced the stress induced BF and other changes of blood properties may imply that ACU has anti-stress activity.

The Oriental medical therapies are increasingly used in medical treatment in conjunction with the Western medical health care system in our country. As Oriental medicine and Western medicine are based on different scientific systems, there is no curriculum of Oriental medicine in Western medical school education. In 1996, we investigated opinions about Oriental medicine among medical students and teachers at Showa University. A mini follow-up survey was done in 1999 and 2000. Awareness of Oriental medicine was still limited, but those surveyed were remarkably interested in Oriental medicine. Moreover, they recognized Oriental medicine as an important and useful tool for the care of illnesses that do not respond to Western medicine. About 40% of the medical doctors at Showa University hospitals used Oriental medicine with their patients in 1996, and traditional knowledge was learned in its own way. According to the pharmaceutical department of Showa University, both the number and variety of Kampo prescriptions increased between 1996 and 2000. These results suggest that it is necessary to properly learn Oriental medicine from the foundations during medical school. More research on Oriental medicine in terms of clinical and basic science is necessary, and the opportunity to exchange information about Oriental medical diagnosis and treatments should be included in postgraduate curricula.

Scientific elucidation of “oketsu (blood stasis)” states is very important to understanding the diagnostic methods of oriental medicine. We investigated the correlation of blood fluidity to oketsu states, by micro channel array flow analyzer (MC-FAN). Twenty-seven female patients were divided into three groups: a non-oketsu group, a mildly affected group, and a severely affected group according to the diagnostic criteria of their oketsu syndrome. Immediately after collecting their venous blood, whole blood passage time was measured by MC-FAN. And we compared and investigated the correlation with degree of oketsu state, diagnostic criteria and changes of whole blood passage time after the administration of ku-oketsu drugs. As a result, whole-blood passage time of the mildly affected group and the severely affected group were significantly longer than that of the non-oketsu group, while the [an] improvement of blood fluidity was observed after medication. This study confirms that reduced blood fluidity is seen using MC-FAN in oketsu states, and that ku-oketsu drugs are able to improve these states.

The influence of exercise on the endogenous levels of both β-endorphin (BE) and corticosteroid (CS) in the hypothalamus and plasma was examined in rats. F344 male rats, five weeks of age, were divided into three groups: involuntary exercised (IE), non-exercised (NE) and control (C) groups. Rats in the IE group were exercised every day for one hour at the speed of 20 m mm n for 7 to 28 days. After training, the hypothalamus and plasma were obtained from rats. BE levels in water soluble extracts of hypothalamus were examined by rat BE ELISA test kits; and CS contents in plasma was examined by RIA. The amount of BE in the hypothalamus obtained from rats in the IE group was much higher than that in the NE and C groups. Although there was no significant difference between rats exercised for 7, 14, and 21 days, BE levels in the hypothalamus from rats exercised for 28 days was significantly higher than for 7 days. The amount of BE in the hypothalamus of NE rats was nearly identical to that of C rats. On the other hand, there were no significant changes in plasma CS levels. These results may suggest that exercise, especially running, causes on increase in BE levels in the hypothalamus.

The influence of exercise on the endogenous levels of both β-endorphin (BE) and corticosteroid (CS) in the hypothalamus and plasma was examined in rats. F344 male rats, five weeks of age, were divided into three groups: involuntary exercised (IE), non-exercised (NE) and control (C) groups. Rats in the IE group were exercised every day for one hour at the speed of 20 m mm n for 7 to 28 days. After training, the hypothalamus and plasma were obtained from rats. BE levels in water soluble extracts of hypothalamus were examined by rat BE ELISA test kits; and CS contents in plasma was examined by RIA. The amount of BE in the hypothalamus obtained from rats in the IE group was much higher than that in the NE and C groups. Although there was no significant difference between rats exercised for 7, 14, and 21 days, BE levels in the hypothalamus from rats exercised for 28 days was significantly higher than for 7 days. The amount of BE in the hypothalamus of NE rats was nearly identical to that of C rats. On the other hand, there were no significant changes in plasma CS levels. These results may suggest that exercise, especially running, causes on increase in BE levels in the hypothalamus.

Collagen-induced arthritis (CIA) in DBA/1J mice is an autoimmune model driven by the combination of humoral and cellular immunity against cartilage type II collagen. It has been proven to be a useful model for human rheumatoid arthritis (RA). This study was designed to obtain experimental evidence of Kampo medicine Dokkatsu-kisei-to (DKT) in the treatment of RA by using mouse CIA. As positive control, prednisolone was given. The significant suppressive effect of DKT as measured by arthritis score persisted upon cessation of treatment on day 42 and remained until the termination of the experiment on day 63. The amelioration of inflammatory articular lesions was confirmed by radiological and histo-pathological findings. We also observed significantly decreased concentrations of serum TNF-α on day 28 and levels of serum IgG antibody against bovine type II collagen on day 49. These results suggest that DKT has important effects on immuno-inflammatory response and may be useful in the prevention of the onset and severity of arthritis.

[Objective] Physical exercises raise more or less body temperature. A body temperature is regulated constantly generally by homeostasis mechanism. Perspiration is only heat radiation mechanism under high temperature environments. And sudoriferous water is supplied from blood. Blood flow is determined by blood fluidity, blood volume and the cardiovascular system. It was reported that strong stress decreased blood fluidity.In this experiment, we investigated the relation between blood fluidity and water supply in rats loaded with forced exercise in high temperature environment.[Methods] SPF male Wistar rats weighing 150 g were used. All animals were put in high temperature environment (Wet Bulb Globe Temperature; WBGT: 28°C) through whole experimental period. In a group of water supply, distilled water was served before and later exercise by sonde forcibly. The rats were divided into five groups randomly; Rest-Non water intake (RN), Rest-Water intake (RW), Exercise-Non water intake (EN), Exercise-Water intake (EW) and Baseline (B). The blood was collected before or later of exercise and blood fluidity or platelet aggregation was measured.[Results] In the EN, platelet aggregation, lactic acid and corticosterone increased while blood fluidity were decreased significantly compared with the RN, RW and EW. In addition, the hematocrit did not increase even if water equivalent to 8 % of body weight lost it.[Conclusion] We speculate that exercise in high temperature environment decreases blood fluidity. However, the water supply that does not completely make up for quantity of depletion in exercise may improve blood fluidity.

[Objective] Perspiration is almost only heat radiation mechanism under high temperature environments. And sudoriferous water is supplied from blood. Blood flow is determined by blood fluidity, blood volume and the cardiovascular system. It was reported that strong stress decreased blood fluidity.In this experiment, we investigated the relation between blood fluidity and water supply in rats loaded with forced exercise in high temperature environment.[Methods] SPF male Wistar rats weighing 250g were used. All animals were put in high temperature environment (Wet Bulb Globe Temperature; WBGT: 28°C) through whole experimental period. The rats were divided into four groups randomly; Suitable temperature environment-Exercise-Non water intake (SEN), High temperature environment-Exercise-Non water intake (HEN), High temperature environment-Exercise-Water intake (HEW) and Baseline (BL). In a group of water supply, distilled water was served before and later exercise by sonde forcibly. The blood was collected before or later of exercise and blood and erythrocyte suspension fluidity were measured.[Results] In the HEN, hydroperoxides, blood sodium, lactic acid and adrenaline increased while blood and erythrocyte suspension fluidity were decreased significantly compared with the BL. In addition, the hematocrit did not increase even if water equivalent to 4% of body weight lost it.[Conclusion] We speculate that exercise in high temperature environment decreases blood fluidity. However, the water supply in exercise that might not be sufficiently improve blood fluidity.

Swelling and pain appear when blood flow is delayed in states of “oketsu.” Until now “oketsu” as a circulatory disturbance has been studied from profiles of vascular resistance characteristics and blood fluidity. Blood fluidity is influenced by blood cell function, plasma ingredients and reactive oxygen. In this study, we administered the various Chinese herbal medicines, tokishakuyakusan, saikokaryukotsuboreito, tokakujokito, keishibukuryogan and juzentaihoto to determine the effect of these medicines on “oketsu” by observing reactive oxygen dynamics and blood fluidity in rats.SPF male Wistar rats weighing 200 g were used. Each experimental group was given feed containing 3% extract of one Chinese herbal medicine for1week. Blood samples were mixed with heparin, EDTA-2K or sodium citrate to block coagulation. Blood fluidity was measured with a Micro Channel Array Flow Analyzer (MC-FAN). A PA-20 examined platelet aggregation by the reaction to ADP, which activates platelet aggregation. Reactive oxygen dynamics were measured with a Free Radical Elective Evaluator (FREE).As a result, anti-oxidative ability and blood fluidity increased in all Chinese herbal medicine-administered groups. Furthermore, an inverse correlation between the fluidity of erythrocyte suspensions and anti-oxidative ability was shown. We speculate that an anti-oxidative influence of Chinese herbal medicines affected erythroid deformability or stickiness. In addition, tokishakuyakusan, tokakujokito and keishibukuryogan decreased platelet aggregation ability.This study shows that “oketsu” improves blood properties and suggests that Chinese herbal medicine improves decrease in blood fluidity, the causes of conditions such as thrombosis or embolism.

This study was designed to evaluate the myocardial protection with observation of the monophasic action potential (MAP) which was recorded by suction electrode. Using the isolated working rabbit hearts, amplitude, duration of MAP at 50% repolarization level (MAPD₅₀), aortic flow and heart rate were measured after reperfusion. The comparative study obtained for all five groups under the following various conditions of the aortic cross clamping are stated as follows. Myocardial temperature were maintained at 20°C during aortic cross clamping. Group I was treated with St. Thomas' Hospital cardioplegic solution. The cardioplegic solution was infused every 20min during ischemia and kept at 20°C. The hearts of group I was divided into four sub-groups, all of which were infused with different concentration of diltiazem (D) in cardioplegia: group Ia D=0μg/ml (n=10), group Ib D=1μg/ml (n=5), group Ic D=5μg/ml (n=5). group Id D=10μg/ml (n=5), and in group II cardioplegic solution was not used. The amplitude of MAP following 30min working mode of reperfusion in group I showed a significantly higher recovery compared to those in group II. The MAPD₅₀ of MAP following 30min working mode of reperfusion in group I showed a significantly lower recovery compared to those in group II, and 10min Langendorff mode in group I a showed a significantly higher recovery compared to those in group Ib, group Ic and group Id. 20min working mode in group Ia and group Ib showed a significantly higher recovery compared to those in group Ic and group Id. The heart rate following 30min working mode of reperfusion in group Ia and group Ib showed a significantly higher recovery compared to those in group Ic and group Id. The aortic flow following 30min working mode of reperfusion in group Ia and group Ib showed a significantly higher recovery compared to those in group Ic, group Id and group II. We would like to conclude that the permeability of large amount of calcium across myocardial cell membrane seems to be depressed by diltiazem added to cardioplegia. But when the concentrations of diltiazem in cardioplegia was over 5μg/ml, it showed negative inotropic action and negative chronotropic action.