Because of the rapid progress in genetic research, only a small part of what is known about clinical genetics is taught in medical schools. At Nippon Medical School a clinical genetics course for fourth-year students started in October 2002. In the present study, we used a questionnaire to investigate how well second-year medical school students understand clinical genetics. The results of the questionnaire suggested that many students are confused about basic concepts in clinical genetics, such as the differences between inherited disease and diseased caused by genetic disorders and between hereditary and chromosomal disorders and also suggested that education in clinical genetics is needed in medical schools. In the United States, guidelines for teaching genetics in medical schools have been established. However, in Japan, considering the lack of consensus about medical genetics terminology, to disseminate correct knowledge about clinical genetics, the present situation of medical genetics education in medical schools must be clarified, and various other measures, such as establishing what information should be taught, should be carried out.

Case 1 was a 70-year-old female patient who visited our Department mainly due to palpitations which had persisted for the previous four years. From about one year ago, paroxysmal palpitations have occurred frequently. The 24-hour Holter ECG monitoring and echocardiography indicated supraventricular arrhythmia, but there was no temporal association between the arrhythmia and the palpitations. She was very nervous and irritable. She felt fullness of the upper abdomen and palpitations in the lower abdomen. She was given Chugoho-honton-to-ka-bukuryo-byakujutsu. One week later, the palpitations became less frequent, and two weeks later they all but disappeared.
Case 2 was a 41-year-old male company employee. He visited our Department complaining of general malaise, abnormal perspiration of the upper body, and pain in the fingers. Six years previously, he had developed erythema both in the palms and in the soles of the feet and also pain in the fingers of both hands. Four years ago, swelling occurred in the tips of his fingers and toes, which then aggravated. He was diagnosed as having acromegaly accompanied by pituitary adenoma and subsequently underwent resection of the pituitary tumor. After the operation, he developed general malaise and abnormal perspiration in the upper body, which obliged him to take time off work. Based on marked feelings of heat in the upper body and cold in the lower body and also abnormal sweating attacks, he was considered to be suffering from hypochondriasis with palpitation attack. One week after he was started on Chugoho-honton-to-ka-bukuryo-byakujutsu, his legs no longer felt cold. Symptoms of the joints and abnormal sweating subsequently improved, which enabled him to return to work.
Case 3 was a 32-year-old housewife who visited our Department complaining of headache and pain in the right shoulder. She had had contusion in the scapula ten years previously and had been suffering from dull pain ever since. Seven years ago, when she had a baby, she developed severe pain in the paraspinal muscle facing the right scapula. This severe pain radiated along the dorsal muscle and was accompanied by headache. Because she felt hot in the upper body and cold in the lower body, subjective palpations in the upper abdomen, and a mass in the hypochondria and umbilical region, Chugoho-honton-to-ka-bukuryo-byakujutsu was given. This produced excellent results.
Based on the experience of these three cases together with what can be found in the literature, we believe that conditions where Chugoho-honton-to-ka-bukuryo-byakujutsu are indicated have the following features. (1) The conditions are often triggered by fright, fear, depression etc. (2) There exist paroxysmal palpitations, headache, and the sensation of hot flushes. (3) A feeling of anxiety ascends from the abdomen. (4) The disease is in the initial stage of the three Yin diseases. (5) There are signs and symptoms of a deficiency in Qi. (6) There are subjective palpitations in the upper abdomen and in the epigastrium. (7) There is fullness of the upper abdomen and epigastrium, often accompanied by a mass in the hypochondria or umbilical region.

We studied a case of bronchial asthma associated with irritable bowel syndrome which responded to Bukuryo-Keishi-Kanzo-taiso-to. The 54-year-old woman was admitted to our hospital due to recurrent abdominal pain and paroxysmal coughing. The abdominal pain was diagnosed as irritable bowel syndrome, and paroxysmal coughing as bronchial asthma. Uzu-Keishi-to, Sekiganyo, Gekyu-shokuso-to were given for abdominal pain, and Ryo-kan-kyo-mi-shin-ge-nin-to and Soshi-koko-to were given for cough. None of these, however, were effective. We consider the condition at the time of attack to be hypochondriasis with palpitation attack, including coughing and abdominal pain, based on the fact that (1) abdominal pain and paroxysmal coughing were accompanied by marked perspiration, (2) the patient felt that something was being pushed upward from the epigastrium into the throat, (3) the patient complained of coldness in the abdomen concomitant with a feeling of warmth in the head, neck, and chest, and (4) subjective palpitations in the upper and lower abdomen were significant. We then used Bukuryo-keishi-kanzo-taiso-to, and both the abdominal pain and the coughing improved using this formulation alone. Although there seem to be two different diseases, they can sometimes be treated as one in kampo medicine.

Four cases of atopic dermatitis successfully treated with the Kampo formula Tokaku-joki-to are reported. Case 1 was a 25-year-old woman who had been suffering from atopic dermatitis since she was in lower elementary school. She came to our clinic in July of 1992. She complained of intense itching of the neck and area around the mouth. Her abdominal tension was moderate, and there was para-umbilical and caecal tenderness. The patient complained of constipation and dysmenorrhea. After four weeks of Tokaku-joki-to administration, the dermatitis improved markedly. After two years of treatment with this formula, she is progressing favorably.
Case 2 was a 14-year-old girl, who had suffered from atopic dermatitis since she was 3 months old. She first came to our clinic in January of 1993. The dermatitis was located in the upper extremities, face and neck. She also had experienced flushing, para-umbilical tenderness and constipation. After two weeks of administration of Tokaku-joki-to, her dermatitis improved remarkably, although she still experienced flushing. Ryokei-mikan-to was added to the formula for the flushing.
Case 3 was a 28-year-old woman who had suffered from atopic dermatitis since she was 3 years old. She consulted our clinic in October, 1993. The dermatitis was located on her face and elbow. She had tenderness around the paraumbilical, caecal and sigmoid regions. The patient is progressing favorably with Tokaku-joki-to administration.
Case 4 was a 26-year-old woman. She had had atopic dermatitis since she was young, and came to our clinic in October of 1993. The dermatitis was on the upper extremities, face and back. At first we prescribed Toki-inshi, but this formula was not effective. The formula was changed to Tokaku-joki-to and the dermatitis improved remarkably after about three months of treatment.
This is the first report of administering Tokaku-joki-to for atopic dermatitis. Based on the clinical study involving the four cases described above, we propose the following indications for use of Tokaku-joki-to for atopic dermatitis: 1) the dermatitis is located on the upper part of the body, 2) there is flushing, with a feeling of coldness in the lower extremities, 3) there is tenderness around the para-umbilical, caecal and sigmoid regions, and 4) there is a tendency towards constipation.

The authors examined the ralationship between ‘Oketsu’ syndrome and multiple cerebral infarction. In the 59 patients (62.8±9.5 years of age; 43 male and 16 female) with multiple cerebral infarction who had undergone MRI examinations, the authors evaluated the ‘Oketsu’ score, DEA (maximum diameter of the column of intravasclar erythrocyte aggregation) and erythrocyte aggregability.
The control group, 18 subjects (61.2±9.3 years of age; 11 male and 7 female) had no findings of cerebral infaction upon MRI examination.
In the patient group, the ‘Oketsu’ score was higher than the control group (P<0.0001) and microcirculation was significantly impaired (P<0.01).
According to localization of foci in the MRI study, the microcircuation was particularly impaired when infarctions occurred in areas controlled by the cortical branches (P<0.05).
Both symptomatic and asymptomatic infarctions presented high ‘Oketsu’ scores and impairment of microcirculation.
Erythrocyte aggregability significantly increased in patients in the multiple infarction symptomatic group (P<0.05). Particulaly, patients suffering from cerebral infarctions in the cortical branches had more severe erythrocyte aggregation.

The ‘Kenjuroku’ is a book of 54 case reports written by Yoshimasu Todo in 1763. The cases studies of four Buddhist monks (Gyokutan, Soboku, the director of Seikoji temple, and the son of the director of Shorakuji temple) from Toyama prefecture are described. Through an investigation of the biographies of these men, the authors attempted to determine the disease condition and symptoms present at the time of their meeting with Todo and inclusion in his book. These four cases were unique in that they appeared to have actively accepted Todo's new medical theories. This led to a discussion of the analogous aspects between his theories and the doctrine of Jodo-shinshu.

The authors would like to report the successful treatment with Hochuekki-to and Keishibukuryo-gan of a case of chronic renal failure that had deteriorated rapidly in a short period of time.
The patient was a 29-year-old woman that had been diagnosed as having IgA renal syndrome in 1987 after a local physician had detected proteinuria and requested a renal biopsy. In November of the same year she came to the authors' clinic requesting Kampo therapy. After her kidney function was stabilized with such formulas as Gorei-san and Byakokaninjin-to, the patient stopped coming to the clinic. In February of 1992, she returned to the clinic with renal failure following an episode of acute pneumonia. She was admitted to the hospital due to hypertension (Cr 2.8mg/dl; BUN 20mg/dl). Dietary therapy and hypertension control were carried out, and administration of 40mg/day of prednisone (PSL) was commenced on the 10th day following admittance. Since the proteinuria remained unchanged, 1g/day of methyl-PSL was given for three days from the 18th day after admittance. However, by the 38th day (4 weeks after commencement of PSL administration) the Cr was 5.0mg/dl. At this point the Kampo formula was changed from Sairei-to to Hochuekki-to in conjunction with Keishibukuryo-gan-ka-kokadaio. Her kidney function began to improve, and by the 108th day the laboratory findings had decreased to Cr 2.7mg/dl and Bun 26mg/dl and the PSL dosage was reduced to 20mg/day. She was discharged from the hospital on the 110th day, and has been progressing well as an out-patient.

The characteristics of hospital selection and awareness concerning Japanese Oriental medicine were studied in patients receiving treatment at Japanese Oriental medicine clinics at the Toyama Medical and Pharmaceutical University and at the Toyama Prefecture Hospital. Selection of a hospital was found to be affected primarily by mass media, such as TV and newspapers in the case of the University Hospital and by interpersonal communications for the Prefecture Hospital. The motivations ascertained were an expectation for disease improvement using Japanese Oriental medicine and anxiety about the side effects of modern medicine. The patients showed a poor undestanding of the role of modern medicine in treatments using Japanese Oriental medicine. These data suggest that it is important to disseminate correct information about Japanese Oriental medicine to the public.