In the United States, the Family Case Study is a tool used in family medicine to teach students about clinical problems and the effects of illness on the patient and the family. Because the Family Case Study is not well known in Japan, the purpose of this paper was to introduce the Family Case Study on the basis of our experiences and to describe its implementation in the Department of Family Medicine of the University of Michigan Medical School. Although the Family Case Study must be adapted for Japan, we urge its use as a practical means of learning about family medicine and the concept of the biopsychosocial approach through practical learning experiences.

Europe has a long history with its own traditional medicines. In Germany, the practice of traditional European and Asian medicine along with modern medicine is called Integrative Medicine. The pain clinics at Munich University, TCM Klinik Bad Kotzting, Immanuel Klankenhaus and Zen Haus Klinik are well-known centers of Integrative Medicine in Germany. We visited these hospitals and clinics and report on the state of their treatment.
Four-week programs in chronic pain, traditional Chinese medicine, natural therapy, and traditional Japanese medicine with aromatherapy are given at these facilities. Moreover, Complementary and Alternative medicines are widely covered by public or private insurance. And one reason for the spread of Integrative Medicine may be these social conditions, in addition to historical background.

Fatigue is a common symptom of long COVID. Fatigue can majorly disrupt daily life and be challenging to treat. Herein, we describe the effect of saikokeishito, a Kampo medicine, on fatigue in patients with long COVID.Between October 2020 and March 2023, we prescribed saikokeishito to 22 patients with long COVID in the general medicine outpatient department of our hospital. Among them, seven patients (age: 15-58 years, two females) had fatigue, a previously confirmed diagnosis of COVID-19, and no concomitant use of other Kampo formulas. We compared their condition at the start of saikokeishito administration to that 3 months later. Five patients had a slight fever, and four had inflammatory findings on blood tests. Within 3 months, all patients had a 20% or greater reduction in fatigue on a visual analogue scale. Six patients had a 20% or greater increase in health-related QOL and were able to return to society. On the other hand, one patient required a transition to an alternative medication, and one patient's follow-up was prematurely discontinued. Fatigue after COVID-19 may be improved by saikokeishito, especially for the treatment of patients with slight fever or inflammatory findings.

The Great East Japan earthquake and tsunami disaster that occurred on March 11, 2011 seriously destroyed Japanese social activities the medical system included. We provided medical support to the damaged area, and mainly performed Oriental medicine. Traditional methods using physical diagnoses and the treatments with herbs, acupuncture, and massage were effective, where any infrastructure had suffered or any modern medical facilities had been destroyed. Acute phase infectious disease, common colds, and hypothermia were dominant. Allergies increased two weeks later, and there was much mental distress, and chronic pain symptoms one month later. We prescribed Kampo herbal medicines for common colds, hypothermia, allergies, and mental distress. Moreover, we also performed acupuncture and kneaded patients' body to reduce pain, stiffness, and edema. These treatments were effective for both physical and mental distress. Thus we believe that Oriental medicine is valuable in disaster situations.

Since students who would like to study Kampo medicine more have no opportunity to communicate each other in Northern Japanese Universities, we newly started joint study conferences held by medical students in 2013. The objectives of this paper are to report on these annually held student-based Kampo study conferences in the Hokkaido and Tohoku areas, and the ways each university studies Kampo medicine. In the conference, the students reported on their club activities. Then they studied the history of Kampo medicine and simulation of abdominal diagnosis, and performed group work on case reports together. The number of student participants in these conferences has tripled over 3 years from 18 to 58 (for a total of 111 participants). All members were satisfied with the content. And this reflects medical students' need for a wider perception of Kampo medicine, rather than a limited one gained in their university club activities. We hope this conference will play a major role in other nationwide student-based Kampo study conferences in the years to come.

Prolonged cough in coronavirus disease 2019 (COVID-19) is not only uncomfortable for patients, but also prolongs the length of stay in an isolation facility. This results in delays in patients' return to their daily life. Therefore, the prompt treatment of cough is important. In this report, we used Japanese traditional (Kampo) medicine, chikujountanto for the treatment of cases with residual cough, airway secretions, slight fever, anxiety, and insomnia, several days after the onset of coronavirus. From October 2020 to September 2021, we prescribed chikujountanto for thirty-three COVID-19 patients with prolonged cough in an isolation facility. Seven patients (6 women and 1 man with ages ranging 37-70 years) were treated with no other medication. Comorbid symptoms included slight fever, sputum, sore throat, nasal discharge, headache, anxiety/insomnia, and taste/olfactory disorders. The start date of treatment ranged from 9 to 21 days after the onset of COVID-19, and the time until cough and comorbid symptoms improved to values less than NRS 2 or less, was 2 to 6 days after treatment. Three patients had persistent cough and needed to switch to other medication. In COVID-19, chikujountanto may be useful for coughing during the period when the peak of the viral proliferative phase has passed but airway inflammation is still present.

The Japan Society for Oriental Medicine has summarized randomized controlled trials (RCTs) using Japanese traditional (Kampo) medicine in structured abstracts, named “Evidence Reports of Kampo Treatment” (EKAT). In this study, we developed a method of classification based on study design, method of intervention, study aim, journal credibility, and year of publication. Then we classified 416 RCTs in EKAT and examined the current status and evolution of RCTs using Kampo medicine in Japan. Double-­blinded RCTs (DB-RCTs) accounted for only 8.9% of the RCTs in EKAT, and 86.5% of DB-RCTs were placebo-controlled. Among the RCTs that aimed to investigate the efficacy of Kampo medicine for diseases without standard Western medical treatment, DB-­RCT accounted for 64.9%. In recent years, there have been fewer envelope RCTs and quasi-­RCTs, which are prone to an increased risk of bias. The proportion of articles reporting RCTs in journals with an impact factor ( > 0.79 points reported by Journal Citation Reports) has been increasing with each passing year. This implies that the recent research in Kampo medicine has improved its quality and has gained an appreciation in modern medicine. The present study was conducted in “Problem-based Learning” in the 2nd grade of Tohoku University School of Medicine.

We verified the educational outcomes and effects of the practice of Problem-based learning (PBL) on the theme of Kampo medicine and the continuous academic support. From 2013 to 2021, we conducted Kampo PBL for second-year medical students, and compared the results of Kampo exams in the fourth year between Kampo PBL participants and non-participants. Moreover, the learning obtained through subsequent academic activities was extracted from their free-form text. Kampo PBL was performed for a total of 26 groups. Participants who underwent Kampo PBL (n = 72) scored significantly higher than those who did not (n = 734) (p<0.05). In addition, academic support resulted in 5 academic presentations in an academic conference and 3 articles published in academic journals. The lessons learned included “concretization of understanding of Kampo medicine,” “valuable experience in academic activities,” and “promoting motivation and its impact on the future.” Kampo PBL improved knowledge about Kampo medicine, and academic activities cultivated the research mind.

OBJECTIVETo investigate the influence of the depth of skin press in blunt tip placebo acupuncture needles on patient blinding and its relationship to needle diameter.

METHODSForty healthy volunteers were enrolled as subjects for patient blinding. Four acupuncturists applied the following needles randomly at three points in each forearm: 0.18 mm and 0.25 mm diameter penetrating needles inserted to a depth of 5 mm, and 0.18 mm and 0.25 mm diameter skin-touch needles depressing the skin at the acupoint to a depth of 1 mm and 2 mm from the skin surface. The subjects reported their guesses at the nature of needles they received, and rated needle pain and de qi. A blinding index was calculated to define the success of blinding for subjects.

RESULTSThe blinding status of subjects for 1 mm press needles of 0.18 mm diameter was "random guess", but "unblinded" for 1 mm press needles of 0.25 mm diameter. For 2 mm press needles of both diameters, the blinding status was "opposite guess" and the blinding status for penetrating needles of both diameters was "unblinded." The percentages of "felt pain" with 2 mm press needles of both diameters were similar to that with penetrating needles, but those were not similar for 1 mm press needles. The frequency of de qi occurrence with 2 mm press needles of 0.18 mm diameter was similar to that of penetrating needles of both diameters.

CONCLUSIONPlacebo needles of 2 mm press made more subjects guess that the needles penetrated the skin than 1 mm press needles. The use of small diameter needles increased patient blinding.

Acupuncture Points ; Acupuncture Therapy ; instrumentation ; methods ; Adult ; Female ; Healthy Volunteers ; Humans ; Male ; Middle Aged ; Needles ; statistics & numerical data ; Placebo Effect ; Sensation ; Young Adult

The background and course of Kampo treatment in 39 patients with uncontrollable otolaryngeal symptoms treated between April 2013 and March 2016, in the Department of Kampo Medicine at Tohoku University Hospital, were analyzed retrospectively. An improvement in overall symptoms was noted with Kampo treatment in 28 of 39 cases (71%). The commonly reported subjective symptoms included glossodynia (7 cases), postnasal drip (4 cases), oral discomfort (4 cases), dizziness (3 cases), and taste disorder (3 cases). Analysis using the classification of qi, blood, and fluid revealed that cases with qi stagnation pattern (15 of 18 cases) were effectively treated with Kampo treatment. Prior reports support our finding that smoothing qi with Kampo medicine is effective in alleviating some chronic symptoms. The symptoms improved within 6 weeks after the treatment was initiated. Therefore, a 6-week period can be considered sufficient to determine the effectiveness of Kampo medicine. Many of the patients for whom Kampo treatment was not effective had depression and domestic stress. In conclusion, Kampo treatment may be effectively used to treat uncontrollable, chronic otolaryngeal symptoms in selected cases that are unresponsive to Western medicine.