At present numerous Kampo formulae are used in Japan, and how we classify Kampo formulae into groups has become an important issue. Nevertheless, in recent-year Kampo formularies or prescription manuals, there is almost no comprehensive classification of all Kampo formulae covered by the older Koho or Goseihou schools, or recent Chinese Medicine. Furthermore no research has been performed on Kampo formulae classi fications. From a historical point of view, however, many classifications were made in formularies and prescription manuals of the Edo period then the early Showa period.
Kenzo Okuda, who belonged to the Koho School, was a Kampo physician in the early Showa period who attempted to make classifications of Kampo formulae. In this review, we researched his classifications as based on Ruihou-classifications, in other words the systematic collecting Kampo formulae by points of similarity between herb formations. Then we also studied the history of Ruihou-classifications preceding Okuda’s, and considered problems lying ahead for classifications of Kampo formulations in Japan.

For its 1993 activity, the Data base Subcommittee, Editorial Committee, the Japan Society for Oriental Medicine (JSOM) made a survey of: (1) the starting year of publication; (2) the starting year of indexing; and (3) the number of articles in the 54 serials indexed in JMEDICINE. (The names, pablication Codes, etc are reported in the Nihon Toyo Igaku Zasshi, 45: 571-575, 1993, as the 1992 activity of the Subcommittee's A general picture of the period covered and the number of articles indexed in JMEDICINE were revealed in the survey. In view of the recent improvement in the accessibility to JMEDICINE, further use of it in research and clinical work is recommended.

A survey was done of the serials from the countries/areas in the Han-character-using sphere that are indexed in MEDLINE, the global medical data base created by National Library of Medicine of the United States of America. One hundred eighty serials were found to be from eight different countries/areas, which are, in alphabetical order: China (32 periodicals), Hong Kong (2), Japan (124), Republic of Korea (6), Malaysia (2), Singapore (4), Taiwan (8) and Thailand (3). Of these, 28 of the serials from China are in the Chinese language (88%), 66 of the Japanese serials are in Japanese (53%), one of the serials from Republic of Korea is in Korean (17%) and five of the serials from Taiwan are in Chinese (63%). As for traditional medical serials only China had three such publications. In order to correctly transmit the Oriental Medicine of Japan, efforts are needed to have this serials, Nihon Toyo Igaku Zasshi (Japanese Journal of Oriental Medicine), indexed in MEDLINE.

The practical use of abdominal examination is a major characteristic of Kampo medicine. Although most Kampo medical texts describe an abdominal examination for a Kampo formula, comparative studies between texts have not contributed to any standardized descriptions for such examinations. We investigated descriptions of 147 prescription Kampo extract formulations in Kampo texts written after the Showa Era, and obtained the following results. Abdominal examinations were described differently by authors, even for the same prescription. Additionally, we examined the descriptions for anchusan (安中散) and kososan (香蘇散), which are called the Gosei school formulae (後世方). Descriptions of abdominal examinations for these drugs were not quoted from an original Chinese medical text, but were empirically constituted in Japan. As knowledge was accumulated, these various descriptions were created through limited personal connections, and/or the opinions of particular authorities. We suggest that a consensus on abdominal examinations would further studies on the viability of traditional medicines, and better characterize Kampo medicine.

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.

Enterovaginal fistula, which causes uncontrollable symptoms such as gas release, vaginal defecation, perineal erosion, and vaginitis, markedly reduces patients' quality of life. In this report, we present a case of successful treatment for enterovaginal fistula with Kampo medicine.
A 62 year-old female who had ileoanal canal anastomosis for ulcerative colitis developed symptoms of gas release and defecation from the vagina. Although these symptoms had disappeared with conventional medicine previously, they recurred 7 years later. There was no medical indication for surgery because the fistula could not be located by barium enema or endoscopic examination. She, therefore, visited our outpatient clinic 1 and a half years after all conventional management had ended in vain.
Her symptoms were slightly improved by the administration of ifutokaogi, a Kampo formula, although they persisted. Three months after switching her prescription to another Kampo formula, goreisan, her symptoms completely disappeared.
In recent years, there has been no report on goreisan for the successful treatment of enterovaginal fistulae. Our case suggests that Kampo medicine can be an option for the treatment of enterovaginal fistula refractory to conventional treatments.

We reported a case of a 69-year-old male who had been diagnosed with left eye glaucoma with surgical indication complicated by an eyesight view obstacle. His left intraocular pressure did not decrease regardless of the eye drop treatment he underwent at another hospital. At the initial visit to our hospital, his left intraocular pressure was 27 mmHg. As we noted marked tympanitic sounds in his abdomen, we prescribed hangekobokuto. After one month of his medication, his left eye intraocular pressure fell to 22 mmHg ; furthermore, the marked abdominal tympanitic sounds disappeared. Two years after his initial treatment, his left intraocular pressure still stayed generally within the normal range, and it did not require surgery. In this case, predominant sympathetic nervous system may have been the mechanism behind some cases of increased intraocular pressure ; therefore, the possibility that hangekobokuto reduces intraocular pressure by acting on this was suggested. As there have been no such reports that hangekobokuto itself has an effect on intraocular pressure decrease, this is considered as a novel case.

Objective: In the previous study, the CYP database was constructed in order to relate drug-drug interactions to the CYP metabolic information of the package inserts.  In this study, we evaluated the clinical usefulness of the CYP database by using the Pharmaceutical and Medical Devices Agency (PMDA) Drug Monitoring Information.
Methods: We examined the drugs in CYP isoform responsible for drug metabolism.  The age, sex, suspect drugs and co-administered drugs were extracted from 6,236 cases of the PMDA database of drug monitoring from January till November of 2008.
Results: Twenty-three percent of all cases had co-administered drugs.  Forty-five percent of these cases were metabolized both suspect and co-administered drugs by the same CYP isoform, and three fourths of these cases were able to be detected only by the CYP database.  In addition, the administration of substrate medicines in combination with substrate medicines was the largest (57%), followed by cases of substrate medicines in combination with inhibitor medicines (28%).  Seventy-seven percent of the suspect drugs that had a large number of reported cases of side effects were substrate medicines, and the frequency of co-administration with substrate medicines was very high.
Conclusion: These data suggest that the CYP database, being used together with package inserts, might be a clinically useful tool to avoid adverse events caused by drug-drug interactions.

Wells' syndrome (eosinophilic cellulitis), whose etiology is idiopathic, is clinically characterized by solitary or multiple cellulitis-like eruptions which occur on the extremities and trunk. Corticosteroids are usually used for palliative treatment, but relapses are often observed. We observed an 8 year-old patient with Wells' syndrome successfully treated with Kampo medicines. In 2001, skin eruptions appeared on his extremities. In 2002, a histopathologic examination determined his disease to be Wells' syndrome, and corticosteroids were subsequently used for treatment. In January 2007, his skin eruptions worsened, and he first visited our outpatient clinic in May. After oral administration with keigairengyoto, his skin eruptions were slightly improved, but afterwards, they again worsened. In June, jumihaidokuto was administered instead of the former prescription, and the skin conditions had begun to improve. Because dry skin appeared in November, keigairengyoto was again added. With these treatments, his skin eruptions stably improved. In previous reports, Kampo medicines had not been used for the treatment of Wells' syndrome. This case, however, suggests that Kampo medicines are a candidate for the treatment of Wells' syndrome.