Ryokito is a Kampo formulation which has been administered for right upper quadrant pain since the Edo Era in Japan. Yet there are but a few reported cases in multiple clinical exams at one institution, on the usage of this formulation. We undertook a precise retrospective analysis of ryokito-prescribed cases at our institute over ten years, and reported cases published in the past to illuminate the clinical characteristics of ryokito effective cases.
Among the 21 cases at our institute, ryokito was effective in 11 cases and 10 of these 11 cases had right upper quadrant pain. Additionally, 7 of them reported abdominal distention.
Overall, this retrospective analysis revealed that amongst those ryokito effective cases, not a few patients had the right upper quadrant pain. This fact suggests that right upper quadrant pain is a reasonable characteristic for a usage of ryokito.
Likewise, abdominal distention was also a common symptom among the effective cases. It is likely that abdominal distention could be a characteristic for a usage of ryokito as well.

A 65-year-old woman suffered from swollen parotid and submandibular glands in July 2005, and sicca of the eyes and oral cavity arose in October 2005. We diagnosed her as having Mikulicz's disease based on magnetic resonance imaging of the head, gallium scintigraphy, and a lip biopsy in June 2006. After prednisolone 10 mg/day was commenced, her salivary glands shrank slightly. Although the amount of prednisolone had been tapered to 7 mg/day by May 2007, her serum IgG rebounded. In January 2008, hachimijiogan extract granules 7.5 g/day were introduced. Swelling of the salivary glands disappeared and her serum IgG level decreased. In May 2008, the amount of prednisolone was tapered successfully to 6 mg/day. Mikulicz's disease is a corticosteroid-sensitive disease, but in this case steroid resistance made treatment difficult. Based on this case, we performed functional assays of P-glycoprotein with calcein-AM, which demonstrated that hachimijiogan can reverse drug resistance.
seconds ; mg/d ; Prednisolone ; Serum ; Effective

Reitakutsukito is a Kampo formulation that is applied for the treatment of olfaction disorder. There have been some reports that reitakutsukito improves nasal obstructions such as allergic rhinitis and chronic sinusitis, but none have reported a neurogenic olfaction disorder successfully treated with this formulation. We report a case of olfaction disorder that was neurogenic, successfully treated with reitakutsukito. The patient was a 43-year-old male. After being bruised on the head, he presented with olfaction disorder. He went to the otorhinolaryngology department at a university hospital and received a diagnosis of neurogenic olfaction disorder. However, he did not show any improvement. Fourteen months after the head trauma, he consulted our institution. We prescribed reitakutsukito for four weeks, and his subjective symptoms improved. Treatment with reitakutsukito for almost two years then resolved his symptoms. This case suggests that reitakutsukito could be a useful formulation for the treatment of not only respiratory olfaction disorder, but also neurogenic disorder.

We report the case of a 46-year-old man with hypertension whose blood pressure decreased due to saiko-karyukotsuboreito consumption.The patient also presented with some symptoms that suggested autonomic imbalance. After consuming 7.5g/day of a spray-dried powder of saikokaryukotsuboreito (Tsumura & Co.) for 3 months, his blood pressure measured at office was considerably lower. Twenty-four hour ambulatory blood pressure monitoring revealed that the surge in morning blood pressure, which is considered to be a risk factor for cerebrovascular disease, diminished in addition to the 24-hour mean blood pressure. A postural test revealed that his autonomic balance, which had been in a sympathetic dominant state, was inversely inclined to a parasympathetic dominant state.Our case report suggests that saikokaryukotsuboreito acts on the autonomic nervous system, which in turn exerts an antihypertensive effect, and that this effect is helpful in lowering the blood pressure in hypertensive patients whose autonomic balance is impaired due to stress.
Blood Pressure ; Assessment of balance ; Hour ; Effective ; Equilibrium

We have limited evidence as to the clinical indications for Kampo medicines, especially as they relate to gastrointestinal function. Thus, we investigated the efficacy of the Kampo medicine hangekobokuto (HKT) on patients with functional dyspepsia (FD), with special reference to its clinical indications for gastrointestinal function, including gastric emptying and bowel gas volume.Gastric emptying rate (GER) in FD patients was significantly facilitated by HKT. HKT also improved the gastrointestinal symptoms of the patients. Among these, patients who had inchuusharen, or a symptom of globus sensation, and a representative indication for HKT, showed significant improvement of both their GER and gastrointestinal symptoms compared with patients who did not have inchuusharen. As for bowel gas, the bowel gas volume calculated from a plain abdominal radiogram (gas volume score, GVS) in FD patients decreased significantly, after administration of HKT. Patients who had fukuman, or a feeling that one's stomach is full or bloated, and another representative indication for HKT, showed significant decrease of their GVS to normal levels, compared with patients who did not present with fukuman.These results suggest that the presence of clinical indications, such as inchuusharen or fukuman, are strongly related to HKT efficacy in patients with FD, and that these are useful, scientifically validated markers for the efficient use of HKT.
Clinical ; Final diagnosis (discharge) ; Gases ; seconds ; Volume

Methods: Volunteers over 50 years of age underwent radiographic analysis. Radiographic parameters including pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), thoracic kyphosis, and sagittal vertical axis (SVA) were measured. The the three Scoliosis Research Society-Schwab sagittal modifiers (PT, SVA, PI–LL) were categorized and the KL grade was assessed. Differences in spinopelvic parameters and Oswestry Disability Index (ODI) scores among KL grades were evaluated. Results: A total of 396 volunteers (160 men, 236 women; mean age, 74.4 years) were analyzed. PI–LL and PT in KL4 were significantly higher compared to that in the other KL grades. However, there were no significant group differences in SVA. In women, but not in men, higher frequencies of the worst modifier grade (++) were observed for PI–LL and PT in the KL3 and KL4 groups compared to those for the other KL grades. In women, the ODI score in KL4 was worse compared to that in the other KL grades. Conclusions Individuals over 50 years of age with severe knee osteoarthritis had poor lumbo-pelvic sagittal alignment. Moreover, the progression severity of knee osteoarthritis had more impact onstronger relationship with lumbo-pelvic malalignment and disability-related low back pain in women than in men.

A commemorative lecture meeting on the inclusion of a new chapter of traditional medicine in ICD­-11 was held in Tokyo in February 2020. The head of the Collaborating Centre for WHO­-FIC in Japan explained the process of the project, which started in 2006 to increase WHO's data collection from developing countries and expressed gratitude to the concerned persons who made efforts to obtain consensus with China and Korea. WHO promoted integrated coding between traditional medicine and Western medicine. In the field of acu­puncture, meridian and collateral patterns proposed by Japan were adopted and research activities have begun. In the field of Kampo medicine, the prescription content is often used in a fixed form as a representative for­mula pattern in Japan, so clinically high­-level research will be possible under this new classification. In the field of medical information, it has been pointed out that there are high hurdles for medical information man­agers to understand traditional medicine. It is expected that the progress of mutual understanding of both medi­cines. From now on, activities in research, translation, education and dissemination of this new classification should be promoted.

According to the World Health Organization (WHO), mortality by age, sex, and cause of death is the foun­dation of public health both globally and domestically. Comparable mortality statistics over time and investi­gations of mortality were used to develop the International Statistical Classification of Diseases and Related Health Problems (ICD). In the ICD, the WHO states that morbidity statistics are also an essential foundation of public health, but they are much less widely applied. The 10th revision of the ICD (ICD-10) is now in use, but further revisions must be made in the development of the 11th revision (ICD-11) to capture advances in health science and medical practice, to make better use of the digital revolution, and to evaluate traditional medicine (TM). Revision of ICD-10 began in 2007, and an ICD-11 version for preparing implementation was released on July 18, 2018. ICD-11 features a new TM chapter on Japanese traditional medicine, known as Kampo medicine, traditional Chinese medicine, and Korean medicine. ICD-11 will be approved at the next World Health Assembly in May 2019 and will come into effect. This means that the WHO does not currently recognize the effects of TM, but that we as well as the WHO will have hard time to prepare and study the effects of TM on morbidity statistics. It is very important to the study of Kampo medicine that we will be able to properly evaluate the terms and classifications contained in ICD-11.

Objective: Cervical dystonia (CD) is a clinically under-recognized symptom occurring at the later- to end-stages of Parkinson’s disease (PD). The frequency of CD and its influence on prognosis have not been well studied. Here, we conducted an in-depth examination of CD incidence and impact on disease progression in later-stage PD. Methods: We retrospectively reviewed the clinical features of 22 deceased patients with sporadic PD treated at a hospital in Japan from 1983 to 2008. Results: The most common cause of death in PD was pneumonia. CD, in particular retrocollis, was frequent in the later stages of the disease in elderly patients (9/22, 40.9%). Pneumonia incidence increased sharply in the later period with CD. There was a positive trend between CD duration and duration of pergolide use. Conclusion: Analysis revealed that CD increases markedly in late- to end-stage PD, which may be associated with aspiration pneumonia due to dysphagia. Pathological mechanisms underlying CD might be influenced by treatments including dopamine agonists. Prevention of CD may increase quality of life and prolong survival of PD patients.