Japanese Kampo doctors usually understand amenorrhea as caused by oketsu (blood stasis) and kekkyo (blood insufficiency). In recent years, there have been a few case reports which describe patients treated only with prescriptions for junki function (the treatment of kiutsu or ki stasis). Our case was 37 year-old woman with amenorrhea from osteopathy manipulation a half year previously in London. Her usual menstruation had been normal. She had thoracic and sacral pain, joint click, epigastric pain, lower abdominal pain, hematuria and muscle stiffness but her usual daily living was not affected. No abnormality was noted with laboratory or imaging, or endocrinological tests. From a Kampo examination, she was diagnosed with hiesho (coldness) and kiutsu. We chose uyakujunkisan without white silkworm, with aconite root. Her arthralgia and hiesho improved one month later, and her menstruation re-started three months later. Uyakujunkisan is introduced in the Wazaikyokuho, and we believe this classical textbook indicates that this prescription can be used to treat amenorrhea. Ki abnormality is one of the most important complications of secondary amenorrhea and a prescription with junki function is important treatment option. Thus, in assessment of patients with amenorrhea,we feel it is important to focus on ki abnormality.

Physicians usually prescribe specific formulae which are classified as treating blood stasis for dysmenorrhea in Japanese Kampo medicine. Daisaikoto is not classified as the category and rarely used to treat dysmenorrhea. Here, we report 2 cases of dysmenorrhea that were successfully treated with daisaikoto. In case 1, the patient was a 19-year-old student. Menstrual pain worsened and accompanied premenstrual headache and vomiting, disturbing her to go college since she started her college life. Commercial non-steroidal anti-inflammatory drugs were not effective. Her Kampo abdominal findings included abdominal strength excessive, fukuman, kyokyokuman and tenderness in the peri-umbilical region. We diagnosed her as “excessive pattern”, “heat pattern”, “qi stasis”, and “blood stasis”. We prescribed extract of daisaikoto 7.5 g per day. Four weeks later, she reported improvement of premenstrual headache and vomiting. Twenty weeks later, she needed no more analgesics at menstrual period. In case 2, the patient was a 35-year-old mother. After entrance examinations of her son and moving, her menstrual pain, headache and irritability worsened. Her Kampo abdominal findings included abdominal strength slightly excessive, fukuman, kyokyokuman, shinka hiko, and tenderness in the peri-umbilical region. We diagnosed her as the same as case 1 and prescribed the same. Eight weeks later, she reported dissaperance of headache and irritability. Twenty weeks later, menstrual pain improved.

There have been few reports on an antiemetic effect of bakumondoto. An 84 year old man was referred to the department of internal medicine for Kampo treatment of intractable vomiting since having a gastrectomy 6 years previously. He had experienced persistent regurgitation of gastric fluids at dawn and antiemetic and antiacid drugs were of little help. He had had a gastrojejunostomy 4 years previously for an intestinal obstruction. After the gastrojejunostomy, vomiting persisted despite of the administration of antiacids, rikkunshito or daikenchuto. Physical examination revealed only slight edema of the legs. An upper gastrointestinal series, blood tests and head CT scan revealed no specific vomiting cause. After referral to our department, we tried hangeshashinto, and shinbuto in vain. Then we prescribed bakumondoto. He reported that the frequency of his vomiting reduced in 3 weeks, and that the vomiting disappeared in 2 more weeks. Thus we consider that not only cough but also vomiting can be treated with bakumondoto.

Typically, Japanese Kampo doctors use formulas classified for treating blood stasis, to treat pain. However,there have been few reported cases where pain was treated with formulas classified for treating qi stagnation. Here, we report a case of right lateral epicondylitis in a 48-year-old woman who was treated with a focus on qi stagnation and with uyakujunkisan. She underwent conservative treatment at an orthopedic clinic for ten months, but her pain was not relieved. Hence, she opted for Kampo treatment. She was in a state of melancholy, felt heaviness throughout her body, and had irregular menstruation. These symptoms were mainly related to qi stagnation, and hence, we chose uyakujunkisan without white silkworm, but with aconite root. One month later, the stiffness in her shoulder improved and the pain was reduced. Magnetic resonance imaging taken 2 months later showed an improvement in the lesion. Nine months later, her menstruation became regular, and 11 months later, the pain had almost completely resolved and she could comfortably perform activities of daily living. Uyakujunkisan is introduced in the classical textbooks, and we interpret uyakujunkisan as a formula that can treat pain with qi stagnation. In Kampo treatment, effective pain treatment involves consideration of not only local blood stasis but also general qi stagnation.

Here we report a case with fever, abdominal pain, frequent urination and urinary incontinence after vesicolysis, for bladder hematoma after transvaginal ultrasound-guided oocyte retrieval, that was successfully treated with Kampo medicine based on daily changing sho for acute disease.
A 44 year-old woman underwent transvaginal ultrasound-guided oocyte retrieval under venous anesthesia in the morning, in order to perform in vitro fertilization, and got home around noon. She had right lower quadrant abdominal pain, frequent urination, hemoptysis, urinary incontinence, fever and chill in that evening. Emergency room ultrasonography revealed a 45 mm size bladder hematoma. She was admitted and the vesicolysis was performed. Antibiotics and hemostatics were administered, and were followed by self-sustaining flow back into the bladder. Although she became afebrile on day 3, her right lower quadrant abdominal pain remained and fever returned on day 5. Daiobotanpito was prescribed because of the right lower quadrant abdominal pain, frequent urination, urinary incontinence, constipation and a floating pulse. Additionally, goreisan was prescribed because of her tooth mark and leg edema. On day 6, her abdominal pain had largely disappeared, and her frequent urination and urinary incontinence were also improved. However, perspiration with fever and soft stools then appeared. Keishito was prescribed because of the perspiration, a weak pulse and weak abdominal strength. Additionally choreito was prescribed for the frequent urination and urinary incontinence. She started sweating continuously with no fever. The frequent urination and urinary incontinence then also disappeared, and she was discharged on day 7.

The shortage of physicians in Japan has been a social issue since the new postgraduate clinical training system started in 2004.The difficult working conditions of hospital physicians may influence this problem.We used a questionnaire to investigate the working hours, on-call frequency, work contents, and mental health of supervisors at various residency training hospitals in Japan.
1) We surveyed 479 physicians who worked at hospitals certified as residency-training facilities and who participated in a development workshop for supervisors or for residency training program managers held at 8 locations in 2004.
2) We found that supervisors worked, on average, more than 100 hours longer than statutory working hours per month and that more than one-fifth of supervisors worked more than 160 hours longer.
3) As for mental health, more than one-fifth of supervisors showed a depressive tendency.
4) These results suggest that the working conditions of supervisors at residency-training hospitals in Japan should be improved by reducing their clinical duties or managing their work content.

The new postgraduate clinical training system that started in 2004 is expected to have positive effects on the health of residents and the quality of treatment they provide.We performed a survey to examine the effects of this training system on the mental health of residents.
1) The subjects were first-year residents (458 in 2003 and 549 in 2004) who had started postgraduate clinical training at 38 hospitals in Japan.Self-administered questionnaires, which included items about working conditions and mental health, were mailed to each subject.
2) The mean score on the 12-item version of the General Health Questionnaire was 4.8 both before and after the new training system was introduced.The mean Center for Epidemiologic Studies Depression Scale score was 15.3 before and 14.4 after the system's introduction.The results showed no significant difference in mental health of residents before and after the system was changed.
3) The results suggest that the new training system has a positive effect on residents' mental health by increasing sleep time and decreasing occupational stress; however, the new system has also decreased job satisfaction and negatively affected their mental health.
4) Job satisfaction may significantly affect the mental health of residents.

Kampo formulations can be prescribed for patients with different symptoms. We report two cases with different symptoms : a girl in her early teens and her grandmother. Case 1 was a 13-year-old girl and the grandchild of Case 2. She was unable to attend school. Case 2 was a 73-year-old woman who presented with increased fatigability. After treatment with saikokaryukotsuboreito, both cases experienced improved symptoms. It was suggested that they had the same Kamp pathology because they were related by blood and shared a common environment. Consequently, both cases were effectively treated using one formulation : saikokaryukotsuboreito.

PURPOSE: Transient receptor potential vanilloid 1 (TRPV1) is a ligand-gated nonselective cation channel, which can be activated by capsaicin and other noxious stimuli. Recently, an association between bone pain and TRPV1 has been reported. However, the influence of osteoporosis on TRPV1 in the sensory system innervating the femur has not been reported. MATERIALS AND METHODS: TRPV1-immunoreactive (ir) in dorsal root ganglia (DRG) neurons labeled with neurotracer [Fluoro-Gold (FG)] innervating the femurs of Sprague Dawley rats were examined in control, sham, and ovariectomized (OVX) rats. We evaluated osteoporosis in the femurs and compared the proportion of TRPV1-ir DRG neurons innervating femur between the 3 groups of rats. RESULTS: OVX rats showed osteoporotic cancellous bone in the femur. FG labeled neurons were distributed from L1 to L6 DRG, but there was no significant difference in the proportion of labeled neurons between the 3 groups (p>0.05). The proportions of FG labeled TRPV1-ir DRG neurons were 1.7%, 1.7%, and 2.8% of DRG neurons innervating the femur, in control, sham-operated, and OVX rats, respectively. The proportion of TRPV1-ir neurons in DRG innervating the femur in OVX rats was significantly higher than that in control and sham-operated rats (p<0.05). CONCLUSION: Under physiological conditions, DRG neurons innervating femurs in rats contain TRPV1. Osteoporosis increases the numbers of TRPV1-ir neurons in DRG innervating osteoporotic femurs in rats. These findings suggest that TRPV1 may have a role in sensory perception of osteoporotic femurs.
Animals ; Female ; Femur/*innervation/*metabolism ; Ganglia, Spinal/*metabolism ; Lumbar Vertebrae/*innervation/physiopathology ; Neurons ; Osteoporosis/complications ; Rats ; Rats, Sprague-Dawley ; Stilbamidines ; TRPV Cation Channels/*metabolism

PURPOSE: Pain from vertebral or femoral neck fractures is a particularly important problem in clinical orthopaedics. Transient receptor potential vanilloid 1 (TRPV1) is a ligand-gated nonselective cation channel, and there are recent reports on an association between bone pain and TRPV1. However, an increase in TRPV1 activity has not been reported following femoral fracture. MATERIALS AND METHODS: We applied a neurotracer [Fluoro-gold (FG)] onto femur to detect dorsal root ganglia (DRGs) innervating the cortex of the femur in 30 Sprague Dawley rats. Seven days after application, a closed mid-diaphyseal fracture of the femur was performed. FG labeled TRPV1-immunoreactive (ir) DRGs innervating the femur were examined in nonfractured controls, and 3 days, 1 week, 2 weeks, and 4 weeks after fracture. We evaluated bone healing of the femur and compared the ratio of TRPV1-ir DRG neurons innervating the femur at the time points. RESULTS: Four weeks after fracture, complete bone union was observed. There was no significant difference in the ratio of FG labeled DRG neurons to total DRG neurons at each time point. The percentages of TRPV1-ir neurons in DRGs innervating the femur at 3 days and 1 week after fracture were significantly higher than those in control, 2 weeks, and 4 weeks after fracture (p<0.05). CONCLUSION: Fracture induced an increase of TRPV1-ir neurons in DRGs innervating the fractured femur within 3 days, and decreased during bone healing over 4 weeks. These findings show that TRPV1 may play a role in sensory sensation of bone fracture pain.
Animals ; Female ; Femur/*innervation/*metabolism ; Immunohistochemistry ; Rats ; Rats, Sprague-Dawley ; TRPV Cation Channels/*metabolism