Treating tinnitus with modern Western medicines is difficult. Several studies have reported that Kampo medicines are efficacious for treating tinnitus, and therefore, it is expected that these medicines will gain widespread use in the future for tinnitus treatment. We retrospectively examined the efficacy of Kampo medicines prescribed on the basis of Kampo diagnoses for chronic tinnitus patients. The study population included 331 patients (114 men, 217 women) and average age was 57.8 years. The overall effective rate of Kampo medicines in tinnitus was 38.4% and increased to 64.6% after including effects for the accompanying symptoms (e.g., dizziness, insomnia, and headache). Hangekobokuto was prescribed most frequently. The effective rate for hangekobokuto in tinnitus was 32.1% and significantly increased when it was used in combination with a herb, chotoko (Hook of Uncaria, rhynchophylla Miquel) (p < 0.05, Fisher's exact test). The effects and modern pharmacological action of chotoko indicate that it may be effective for tinnitus. Given that tinnitus was intractable in study subjects who had been treated using other therapy approaches earlier (84% of the population), the findings indicate that Kampo medicine may be partially effective for tinnitus.

The patient with atopic dermatitis is often dissatisfied with the long-term nature of treatment for his/her disease. The aims of this study were to examine the effect of Kampo therapy on the skin manifestation of atopic dermatitis as well as the patient's mental state, and to evaluate the relation between severity of symptoms and satisfaction with the Kampo therapy. Kampo medicine was administered to 15 in-patients with atopic dermatitis for 6 months. Their clinical conditions, quality of life (QOL) assessments, and psychosomatic scores before and after treatment were observed and comparatively evaluated. We evaluated patients' symptom severity with the atopic dermatitis severity classifications of the Japanese Dermatological Association, and the European SCORAD (Scoring of Atopic Dermatitis). We evaluated QOL with the SF-36 and DLQI (Dermatology Life Quality Index), and mental state with the PSS-AD (Psychosomatic Scale for Atopic Dermatitis). Clinical conditions, QOL and mental states were improved after treatment with Kampo medicine. However, when we examined individual cases, severity of symptoms and satisfaction with treatment did not correlate. Patients' satisfaction ratings and the severity of their symptoms do not necessarily correspond in patients with atopic dermatitis, because evaluations vary with each individual. Therefore, clinicians treating patients for atopic dermatitis must make an effort to recognize each patient's psychological condition.

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 encountered a patient with intractable panic disorder who responded extremely well to Ryukotsuto, a Kampo preparation. Beginning in March 2003, a 55-year-old female began to lose vigor and concentration, while developing palpitations and experiencing a rise in blood pressure (systolic pressure≥190mmHg) accompanied by sudden anxiety. When these symptoms became intense, she was brought to a hospital by ambulance. Although close examination revealed no abnormalities, on clinical diagnosis, however, autonomic imbalance was recognized. Despite treatment with antidepressants and minor tranquilizers, including selective serotonin reuptake inhibitors (SSRI), no improvement was observed. A series of medicinal Kampo preparations, prescribed one after another, also had no effect. For further treatment, she was referred to our hospital on July 22, 2005. At the first consultation, a diagnosis of panic disorder was made, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Hon-Ton disease was suspected based on clinical findings, and Ryokeikansoto was prescribed as a decoction. However, no positive effects were observed after 1 week, while marked incompetence, forgetfulness, and depression were noted. Therefore, based on the results of a self-rating depression scale (SDS), a profile of mood states (POMS), and autonomic function tests, such as pupillary dynamics at the first consultation, panic disorder accompanied by extreme tension with depression was diagnosed. Consequently, her Kampo preparation was changed to Ryukotsuto. As a result, symptoms virtually disappeared and all western drugs were discontinued. Psychological tests, autonomic function tests, and her diagnostic scores for conditions of Ki, Ketsu, and Sui also improved. We conclude that Ryukotsuto may be an effective treatment for panic disorder accompanied by depression.
Panic Disorder ; Cancer patients and suicide and depression ; Medicine, Kampo ; therapeutic aspects ; symptoms <1>

Standardizing Kampo medical findings is a significant challenge in Kampo medical circles. These findings are fundamental to Kampo diagnosis. This paper introduces our attempt to standardize these findings in a specialized Kampo medical service facility.
We started our project with verbal standardization. Nine medical doctors, all of whom were Kampo advisors or Kampo specialists, discussed issues such as subjective and objective findings, including those of the tongue, pulse, and abdomen, as well as the selection of target items, criteria for judgments on each item, and associated issues. When discussing the above issues, descriptions in prominent traditional Kampo texts were given most importance, and the wisdom of famous Kampo doctors since the Showa period was also given weight. In addition, we focused attention on clarifying the criteria for making judgments.
One hundred and twenty items were selected as subjective Kampo findings. We selected 12, 6 and 10 items as objective Kampo findings in the tongue, pulse, and abdomen, respectively, and provided criteria for judgments with each.
Our next challenge is to spread these standardizations in Kampo medical circles.

Takushato is a Kampo formula used for the treatment of dizziness and vertigo. Signs and symptoms suggestive of fluid retention have been regarded as clinical indications for takushato administration, but it is not clear if improvement of these signs and symptoms is related to the clinical efficacy of takushato, so we analyzed the correlation among these factors. Twenty patients who suffered from dizziness and vertigo were treated with takushato for 4 weeks. Before and after treatment, subjective symptoms and objective data including vestibular function tests were assessed, and correlation among the factors was analyzed. Improvement of patients' total symptoms was significantly correlated with improvement of fluid retention scores. Furthermore, improvement in vestibular function tests showed a trend toward correlation with that of fluid retention scores.These results suggest that improvement in the signs and symptoms of fluid retention is related to the clinical efficacy of takushato. We conclude that the presence of fluid retention is a reasonable clinical indication for takushato administration.

The purpose of this study was to reevaluate the sho of goshuyuto, which has been established in an unscientific manner, and to create a new concept of the sho of goshuyuto. Eighty-four patients suffering from chronic headache were instructed to orally consume 7.5g. day of a spray-dried powder of goshuyuto (TJ-31) for 4 weeks. Before consuming the TJ-31, all subjects underwent Kampo examinations that were based on 43 diagnostic items. After the 4-week period of medication, all the subjects were classified as either responders or nonresponders. After excluding insignificant items from the 43 diagnostic items, discriminant analysis, which discriminated between responders and nonresponders, was conducted. Of the 80 subjects who completed the trial period, 57 were judged to be responders and 23 to be nonresponders. “Cold feet,” “fluid and gas retention in the stomach,” “kyokyo-kuman,” “tenderness at side of navel,” and “pulsation at abdomen” were selected by stepwise selection. The results of the discriminant analysis using these 5 items suggest that 28 subjects were misclassified and that the misclassification rate was 35%. Of the actual 23 nonresponders, 20 were accurately discriminated as nonresponders. The 5 selected items are suggested to be more useful in selecting the nonresponders than the responders. In conclusion, the empirically established sho of goshuyuto seemed to not be abele to completely explain the indication of goshuyuto. However, the inclusion of “tenderness at side of navel” and “pulsation at abdomen,” as new components comprising the sho of goshuyuto, may facilitate a more accurate indication of goshuyuto.
Statistical Analysis ; Emotional tenderness ; week ; Discriminant Analysis ; Abdomen

Case reports of drug-induced liver injury caused by Kampo medicines are on the rise, but most of them are noted for related symptoms such as jaundice. Usually, severe liver injury is detected by chance upon routine medical checkup. Recently, we noted 3 cases of suspected drug-induced liver injury caused by orengedokuto, saikokeishikankyoto and bofutsushosan. In these 3 cases, maximum ALT was under 100 IU/l and no symptoms related to liver injury were observed. Early detection by blood test was useful, and appropriate treatment quickly improved and normalized the abnormal values associated with liver injury. We should always be alert for drug-induced liver injury caused by Kampo medicines, especially when prescribing formulations that include Scutellariae Radix. We also emphasize the importance of scheduling blood tests when prescribing these formulations.

We report three closely watched cases of intractable Meniere's disease in the elderly that were successfully treated with Kampo medicine. Case 1 is a 75-year-old female. At the time of the 4th Meniere's attack, we gave her western medicines such as isosorbide, but she had a significant hearing loss. Then, we administered hachimijiogan extract granules, and her hearing level improved and she had been free of Meniere's attack for 23 months. Case 2 is a 78-year-old male. We diagnosed as bilateral Meniere's disease and treated him with western medicines such as isosorbide. In September of year X, his hearing level in the left ear worsened despite the treatment, so we prescribed hachimijiogan extract granules. After the treatment, we found the patient's hearing improved and nystagmus decreased gradually. He has also been free of Meniere's attack for 9 months. Case 3 is a 70-year-old male. He had repeated episodes of vertigo in spite of the administration of western medicines. After we prescribed shimbuto extract granules, vertigo attack and nystagmus disappeared. He has been relieved from Meniere's attack for 8 months. These cases indicate that Kampo therapy is one of the useful therapeutic options for intractable Meniere's disease in the elderly.

We are planning a study focused on the gathering of clinical data for the purpose of formalizing diagnostic logic at 6 institutions specialized in Kampo-based medical examinations. However, during the planning stage, it has been recognized that there are a large number of Kampo formulas to be studied, and differences among faculties and individuals exist regarding how to identify each Kampo formula, methods of gathering findings, and the evaluation of efficacy. Here we report the solution proposal reached after building consensus among all participating faculties on these issues. After raising the issues, conferences were held for each of them, until a unanimous consensus was obtained. As a result, the following conclusions were reached. Thirty-three Kampo formulas were selected as targets for the formalization of diagnostic logic. In addition, the range of dosage forms, crude drug ingredients, and permissible dosages for each Kampo formula were determined. Regarding clinical findings for these Kampo medicines, the items to be collected and evaluation criteria were also established. The criteria for evaluating the validity and safety of each Kampo medicine were decided, together with the grading and timing of evaluation. We hope that our solution proposal reached after building consensus becomes the basis for Kampo research in the future.