Background
  Dementia is defined as a decline in cognition or behavior in one or more of the following areas: memory, social-interpersonal behaviors etc. It is regarded differently depending on the society of each country. To compare the effect that it has on Japanese society, we started research in Nepal.
Methods
  We asked Medical doctors and nurses in remote areas and the capital city in Nepal about their awareness of dementia. We also examined the elderly in communities and hospitals, using the Mini-Mental State Examination (MMSE) and Hasegawa Dementia Scale Revised (HDS-R), and asked family members about the elderly’s daily life and checked Clinical Dementia Rating (CDR).
Results
  Three out of six medical staff members in remote areas did not know the word “dementia.” However, most medical staff had seen cases of suspected dementia. The averages and deviations of MMSE and HDS-R in 6 elderly in community were 16±4.2 and 17±5.0, respectively. The average of CDR was 0.9.
Conclusions
  There was a lack of awareness about dementia in remote areas. Nepali society was found to be tolerant of aging and dementia.

Case 1 : A 56-year-old woman had been suffering from insomnia for 10 years, and multiple joint pains on her shoulders, wrists and fingers for 2 years. She complained of headache, dizziness, heart palpitations, and irritable bowel syndromes. Case 2 : A 72-year-old woman presented with cold and painful feeling in her legs that she had had for 10 years, as well as insomnia, excessive sweating, alopecia and pollakiuria that she had had for two years. In both cases, organic diseases of the joints or muscles were ruled out by several doctors, and the patients had been suffering from malaise and insomnia for which they had been taking brotizolam for several years. Consequently, the patients consulted our department of traditional Japanese medicine (Kampo). Medical interviews revealed that they had been under a lot of stress for a long time because of family problems. Sansoninto (roasted Zizyphi spinosa semen 15 g, Poria 3 g, Cnidii Rhizoma 3 g, Anemarrhenae Rhizoma 3 g,Glycyrrhizae Radix 1.5 g) was prescribed, which reduced the pain in their joints and muscles, and their other complaints, in several weeks. Sansoninto seemed not to alleviate insomnia as effectively as it did the pain and other multi complaints, because the patients were not able to discontinue brotizolam. Patients with multiple complaints including insomnia with fatigue induced by long-term stressful lifestyle may sometimes possibly express non-organic joint or muscle pain. Sansoninto may be an effective prescription for non-organic joint and muscle pain.

A 45-year-old woman had been suffering from fibromyalgia, chronic fatigue syndrome, and complex regional pain syndrome (CRPS) for 2 years before admission. Non-steroidal anti-inflammatory agents, selective serotonin reuptake inhibitors and pregabalin did not affect the various symptoms. A severe feeling of Coldness, the widespread systemic pain and the severe fatigue were decreased by tsumyakushigyakuto (glycyrrihza 4 g, processed ginger 9 g, aconite root 6 g). Attacks of CRPS were relieved by a dose of daiuzusen (aconite root 1 g, honey 10 g). The CRPS attacks presented mainly on the left heart meridian and the small intestine meridian where we treated them with electroacupuncture with reference to the Shigoryuchu (子午流注) methods. Acupuncture and electroacupuncture decreased the frequency of pain attacks, and alleviated the muscles stiffness caused by the CRPS. Thus, the combination of Kampo medicine and acupuncture were effective for the severe pain and other symptoms associated with fibromyalgia, chronic pain syndrome and CRPS.

In 2013, we prescribed daiuzusen for 3 patients with intractable pain; pain from complex regional pain syndrome, colic pain of unknown origin after an abdominal operation, and colic pain from advanced colon cancer and ileus. A dose of daiuzusen (containing uzu 0.5-2 g) quickly relieved their pain in several minutes. Another common symptom was “cold” in their bowel or extremities when they were feeling pain. Aconite levels in drugs and patients' serum after taking daiuzusen were analyzed by liquid chromatography tandem mass spectrometry. Daiuzusen per 1 g of uzu contained aconitine 1.28 μg, mesaconitine 2.31 μg, and hypaconitine 92.89 μg, while jesaconitine was not detected; this was about 5 to 35 times the level of tsumyakushigyakuto per 1 g of uzu. Serum concentrations of hypaconitine peaked in the study at 1.11 ng/mL after about an hour of taking daiuzusen (1 g of uzu). We posit that the immediate effect after taking daiuzusen was due to transmucosal absorption of uzu components. However serum hypaconitine, which we are now able to monitor, is at least one practical way of indicating the use of uzu or bushi containing prescriptions.