We report a case of 87-year-old female with somatoform autonomic dysfunction whose complaint of oppression ranging from the left chest to the epigastrium was successfully treated with shimbuto, in whom neither antidepressants nor anxiolytic drugs had been effective. Since weak abdominal power, bilateral kyokyokuman and pulsation in the upper navel region were observed, saikokeishikankyoto was initiated, but satisfactory effect was not obtained. Thus, we re-estimated her conditions and judged as the stage of Shao yin based on symptoms such as bedridden tendency, coldness of the limbs and indigestible diarrhea, although a weak and surface pulse was noted. Shimbuto was then administered, and various symptoms including chest oppression were improved rapidly and dramatically. We speculated that her chest oppression might occur due to kiutsu (depression of ki) secondary to suitai (accumulation of sui) rather than kigyaku (regurgitation of ki), and that the improvement of suitai by shimbuto might result in the disappearance of kiutsu. Although shimbuto is not popularly used for the treatment of somatoform disorder having chest symptoms, our case suggests that there should be a certain case in which shimbuto is so effective. Also it is suggested that shimbuto might be applicable even when deep pulse or excessive strain of abdominal muscles is not necessarily observed.
Thorax ; symptoms <1> ; Social oppression ; Complaint, NOS ; Chest

To investigate the difficulties of taking Japanese traditional (Kampo) medicines, questionnaires were filled out by patients under 19 years old or their families.Forty-six questionnaires were valid for analysis. The mean age of the patients was 9.7 &qlusmn; 5.3 years old (2 to 19 years old) and the percentage of male patients was high (65%). They took extract granules (n = 40) or decoction (n = 6) and most of the patients (n = 38, 83%) took medicines twice a day. Though 69% of patients under 5 years old needed direct assistance from their family to take medicines, none of over 6 years of age needed any help except to dissolve medicines in hot water, while notably 77% of the patients over 13 years old took their medicines un-aided. It was found that patients' families gave them the concrete explanations on the necessity of their medicines regardless of patients' age, so it is important for pharmacist to guide not only families but also patients themselves. Furthermore, pharmacists should understand the taste and the constituent crude drugs of Kampo medicines to improve patients' adherence in taking medicines.

We report a case of obstructive sleep apnea syndrome effectively treated with Hange-koboku-to. A 32-year-old male suffered from globus syndrome (globus hystericus), excessive daytime sleepiness and snoring. He underwent uvulopalatopharyngoplasty at the age of 27, but the symptoms did not improve after surgery. Nocturnal polysomnography, performed before administration of Hange-koboku-to, confirmed the diagnosis of obstructive sleep apnea syndrome. After 1-month-administration of Hange-koboku-to extract (Tsumura Co. Ltd., 7.5g/day), his complaints almost disappeared. After 5-month-administration of Hange-koboku-to, nocturnal polysomnography was performed again. As a result, the apnea index fell from 19.2 events/hour to 10.3 events/hour, and the apnea-hypopnea index also fell from 19.2 events/hour to 12.8 events/hour. He was not obese (body mass index: 23.0kg/m²), and no significant body weight change was observed after administration. No adverse effect was observed. To our knowledge, there is no other report on the treatment of sleep-related breathing disorders with Hange-koboku-to. We presume that Hange-koboku-to may decrease the upper airway resistance, especially at the lower part of the upper airway.

Background : This questionnaire survey was performed to clarify the present status and especially the problems with dispensing herbal medicines and counseling patients.Objectives : To survey 15 pharmacies approved under the National Health Insurance System to dispense herbal medicines prescribed by Department of Japanese Oriental (Kampo) Medicine, Chiba University Hospital.Results : Twelve pharmacies responded that 1,900, the present fee allowed for dispensing herbal medicines, was low. The time for dispensing herbal medicine via an automatic packaging machine was half of that dispensed by humans. Many pharmacies requested a re-evaluation of the fee based on the length of a prescription and the number of herbs in a formula, and requested a re-evaluation of the drug price standards. About half of the pharmacists surveyed also had a poor knowledge of herbal medicines.Conclusion : We suggest that economical aspects of dispensing herbal medicine should be improved to secure more insurance pharmacies which can dispense herbal medicines. There is also a need to construct education systems for pregraduate and postgraduate university students in order to train pharmacists who will have a thorough knowledge of Kampo Medicine.
Medicine, Herbal ; seconds ; Surveys ; Insurance ; Analysis

The source of ryokankyomishingeninto, which has been used for chronic respiratory and nasal diseases by using “sunken pulse” as an indication, is the Jin-kui-yao-lue text. We, however, experienced a case of allergic rhinitis presenting with “floating pulse” successfully treated with ryokankyomishingeninto. On the basis of this case, we investigated efficacy with ryokankyomishingeninto in 16 other patients who visited our outpatient clinic from January 2007 to March 2008, and who had the all of same remarks in pulse diagnoses and nasal symptoms, such as nasal obstruction, and rhinorrhea or respiratory symptoms such as wheeze and shortness of breathing. As a result, ryokankyomishingeninto improved symptoms in all these patients. All the adult cases had a “stuck feeling in pit of stomach”. Furthermore, they had either a “water dabbling sound in the stomach”, or “cold area on the epigastrium”.
symptoms <1> ; Nasal ; Pulse taking ; Cases ; Respiratory

Soshikokito has long been used to treat cough in frail patients with cold sensation in their feet, based on the Japanese traditional Kampo textbook “Iryo-Shuhou-Kiku”. In many old documents including “Wazai-Kyokuho,” where soshikokito was first described, it is suggested that airways obstructed by a large quantity of watery expectoration should be the proper indication for the use of this formula. However, in the five cases that we successfully treated, the quantity of sputum was relatively small. To determine the practical indications for this, we examined their abdominal strength and the presence or absence of “cold feet” sensation. In addition, we investigated the nature of sputum in the past clinical reports in which successful treatment using soshikokito was described. It has become clear that we can prescribe soshikokito as an antitussive regardless of the patients' physical fitness as deduced from the abdominal strength. The “cold feet” sensation was not an essential symptom and was regarded as one of the symptoms of qi counterflow. Regarding the properties of sputum, it was viscous and small in quantity. In the cases where soshikokito was effective, it was speculated that viscous sputum would result in airway obstruction, coughing, and wheezing. These conditions will be ameliorated by the antitussive and expectorant effect of this formula, which improves qi counterflow and mildly tonifies water. In the treatment of cough with respiratory distress, “sputum with high viscosity and hard to discharge” is considered to be the targeted symptom in the practical usage of soshikokito.

Uzushakusekishigan is a Kampo formula described in ‘Jin Gui Yao Lue' for treatment of “heart pain that spreads out to the back, or back pain that spreads to the heart.” We successfully treated three patients with this formula. Patient 1 was a 53-year-old man suffering from precordial pain which occurred after amputation of the right forearm;patient 2 was a 46-year-old man with epigastralgia that occurred after taking cold meals;and patient 3 was a 28-year-old woman suffering from epigastralgia accompanied with panic disorder. Epigastric discomfort and resistance occurred in all three cases, prompting us to prescribe this formula. There are few reports of successful application of uzushakusekishigan, and it is not clear what symptoms and pathologies are relevant when prescribing this formula. However, our findings strongly suggest that uzushakusekishigan should be considered when treating severe chest or abdominal pain.

The Japan Society for Oriental Medicine (JSOM) has made various efforts against coronavirus disease (COVID-19) to build evidence. JSOM has launched an academic society-led clinical research project on COVID-19 based on the concept and characteristics of Kampo medicine, including (1) prevention of disease by activating the immune system to regulate body conditions (pre-symptomatic stage of illness), (2) symptom alleviation in the mild and moderate stage and prevention of aggravation (acute to subacute stage of illness), and (3) early recovery and improvement of prolonged symptoms (late stage of illness). Since the declaration of the pandemic, the special working group has conducted the following activities : enlightening academic members, lobbying other academic societies, preparing research protocols, establishing research groups, conducting ethical reviews, responding to the research disclosure system, preparing protocol papers and review articles as the basis for the research, reporting research progress, soliciting case reports, warning against Chinese medicine use, requesting for research support funding, and revising the JSOM website. We also discuss the interpretation of COVID-19 from the perspective of Kampo medicine and the direction of the selection of Kampo formulas in this report.