The present experiments were performed to investigate the potential role of Kambaku taiso-to (Gan mai da zao tang) in modifying the occurrence of yawning in rats. Subcutaneous injection of talipexole, a selective dopamine D-2 receptor agonist, at 5-100μg/kg, elicits yawning behavior for over one hour, the maximal effect being observed at a dose of 25μg/kg. Kambaku-taiso-to significantly suppressed the incidence of yawning induced by talipexole. These results suggest that Kambaku-taiso-to exerts a suppressive effect on the incidence of yawning.

The present experiments were performed to investigate effects of a Kampo (Japanese herbal) medicine, Kambaku-taiso-to (Gan-mai-da-zao-tang), on incidence of yawning in rats. Physostigmine, a cholinesterase inhibitor, 0.05-0.1mg/kg s. c., induced yawning responses with a marked effect at 0.05mg/kg. Pilocarpine, a muscarinic receptor agonist, 1-2mg/kg s. c., also induced yawning responses, the maximum effect being observed at a dose of 2mg/kg. Talipexole, a dopaminergic D-2 receptor agonist, 0.02mg/kg s. c., also induced yawning. Kambaku-taiso-to, 250-1, 000mg/kg, was orally administered 30min before injection of physostigmine, pilocarpine or talipexole. The yawning induced by both cholinergic and dopaminergic agents was reduced in a dose-dependent manner by Kambaku-taiso-to. All the yawning responses to cholinergic and dopaminergic agents were also reduced by rauwolscine 0.5mg/kg, yohimbine 2.5mg/kg, α-2 adrenoceptor antagonists, and by scopolamine 0.5mg/kg—muscarinic receptor antagonist. The present findings thus suggest that Kambaku-taiso-to exerts a suppressive effect on the incidence of yawning, and dopaminergic and cholinergic suppression and the indirect suppressive mechanism mediated by the central adrenergic nerve are associated with this suppression.

We report on five patients with menstrual pain and/or other disorders, whose symptoms improved when treated with Ki-related prescriptions. Hangekobokuto improved severe epigastralgia and menstrual pain in Case 1. Saibokuto showed improvement of menstrual disorders and pain in Case 2, while Hangekobokuto also ameliorated menstrual pain in Case 3. The treatments were based on patient Ki stagnation, although the symptoms of Ketsu stagnation were also observed in these cases. In Case 4, the patient's menstrual pain and disorders were improved by changing her prescription from Kamishoyosan, to Keishikaryukotsuboreito. In Case 5, a menstrual period of more than 40 days became a regular rhythm of 30 days, while treating the patient's chief complaint of urticaria, with Keishikaryukotsuboreito. Symptoms of Ketsu stagnation were not apparent in Cases 4 and 5. We prescribed Keishikaryukotsuboreito—a prescription for Ki regurgitation—because of suggestive symptoms of nightmare, as well as palpitation in the abdomen.
Menstrual problems are often related to Ketsu abnormalities according to Kampo medicine literature. However, symptoms related to Ki regurgitation and Ki stagnation are also observed in women with menstrual problems who are under stress. Therefore, it is important to know that there have been cases, such as ours, of menstrual problems successfully treated with Ki-related prescriptions.

We would like to report on the treatment of 15 patients with floating sensation after the Great East Japan Earthquake (2011 Tohoku Earthquake) in 2011.Twelve cases were effectively treated with hangekobokuto, while two cases were effectively treated with hangebyakujutsutemmato, but not with hangekobokuto.One case was effectively treated with ryokeijutsukanto. We discuss how to treat this floating sensation, focusing on the usage of hangekobokuto.
Most patients who were successfully treated with hangekobokuto reported an uneasy feeling with a floating sensation. On the other hand, those who were successfully treated with hangebyakujutsutemmato or ryokeijutsukanto did not feel uneasy, but reported vertigo and upset stomach.Upon abdominal examination, epigastric resistance was frequently observed in the patients treated with hangekobokuto.This resistance decreased as the floating sensation was improved.
Our results indicate that hangekobokuto could be efficacious for patients with floating sensation after an earthquake, who also felt uneasy and showed epigastric resistance upon abdominal examination.

We describe three cases in which the same Kampo formulas were applied to a mother and daughter with different complaints. In cases 1 a, b, a mother with general fatigue after an operation for gastric and colon cancer, and her daughter with migraine and menopausal symptoms were effectively treated with kamishoyosan. In cases 2 a, b, a mother with menstrual disorder, and her daughter with palmar eruption were effectively treated with hangekobokuto. In cases 3 a, b, a mother with lumbago and her daughter with back pain were effectively treated with keishikaryukotsuboreito. These Kampo formulas are thought to improve qi circulation.
It is considered that improving qi disturbance is important for the Kampo treatment of female patients. Taking into account parent-child genetic similarities, it is possible that application of the same Kampo formula to familiarly related patients with different complaints could be effective. It is important to consider not only the patient's complaints, but also the patient's condition, from the Kampo viewpoint so-called “Sho”. Therefore,since our cases all involved a mother-daughter relationships, it may be reasonable to assume that Kampo formulas improving qi circulation were effective for their different complaints.

Objective: Standardized clinical data are invaluable for secondary use of medical information. We constructed a standardized database and a data warehouse called D*D, based on the Standardized Structured Medical Information Exchange(SS-MIX)scheme. D*D enables physicians and researchers to perform complex searches with combined conditions, e.g. time to event. It contains data from 1999 for approximately 400,000 individual patients. The objective of this study was to provide an overview of the features of this database system, especially from the perspective of drug safety research.
Methods: Three models of research questions were identified from established drug-risk combinations:1)gatifloxacin and hypoglycemia;2)statins and rhabdomyolysis;and 3)oral 5-fluorouracil S-1 and hepatotoxicity. D*D was searched using predefined keywords and conditions.
Results: 1)A total of 3,635 patients were treated for diabetes. Among 20 diabetic patients prescribed gatifloxacin, hypoglycemia was recorded in one patient(1/38 prescriptions). 2)Among 5,926 patients who had been prescribed any statin within 10 years in our hospital, 6 patients(0.1%)experienced rhabdomyolysis. The incidence was similar to that for fibrate (1/740, 0.1%). The most confounded diagnosis was stiff shoulder. 3)Among 244 patients prescribed S-1, 19 patients(7.8%) experienced hepatotoxicity higher than CTCAE grade3 within 2 months from the prescription.
Conclusion: With limited data items and search keys in standardized data storage, definitions of exposures and outcomes require careful assessment during protocol development. Considering that the system can be implemented at more than half of the hospitals that have already installed ordering systems, D*D can be one of the Japanese models for distributed research network.

The effect of Kampo therapy (Japanese traditional herbal medicine) on the second derivative of the photoplethysmogram (SDPTG) was investigated. The SDPTG is the second derivative of the fingertip photoplethysmogram (PTG), which expresses the characteristics of the vascular system, the properties of peripheral vessels, and the state of blood flow. The subjects comprised 13 normal volunteers, 101 patients (21 males and 80 females; mean age 53±11 years) with 1 month of Kampo therapy, and 19 patients (4 males and 15 females; mean age 60±9 years) with 3 months of medication. Control subjects showed no significant changes in their vascular age after 1 month. Patients with a higher vascular age than expected before therapy showed improvement of their vascular age, after treatment for 1 month and 3 months. The difference between the vascular age and calendar age decreased from about 10 to 7 years after 1 month of therapy (n=65. p<0.001), and from about 9 to 4 years, after 3 months (n=11, p<0.01). Vascular age not only reflects organic vessel wall sclerosis due to arteriosclerosis, but also a vascular wall tone that is closely related to the autonomic nervous system. The change of vascular age within a relatively short period suggested a functional change rather than an organic change of the vessels.

Objectives : Persistent coldness is a common complaint for which Kampo, traditional Japanese herbal medicine, is often tried, because there is no definition or objective measure of subjective coldness in Western medicine. The aim of this study was to evaluate the efficacy of a common Kampo agent, tokishigyakukagoshuyushokyoto, and to identify key symptoms that would predict positive treatment outcomes for coldness.
Design : A retrospective cohort study.
Setting : 181 patients who complained of coldness without any organic abnormalities self-surveyed their health using a Kampo questionnaire database system on their first visit. Another 28 patients were assigned to verify the discriminatory predictability of treatment efficacy.
Interventions : Patients were treated with extract product, 7.5 grams a day for a month.
Outcome measures : Treatment efficacy as a binary response.
Results : Frequency and severity scales (0 to 4) for coldness decreased from 3.2 ± 0.7 to 2.1 ± 0.1 (p < 0.01)and from 3.1 ± 0.7 to 2.2 ± 0.9 (p < 0.01), respectively. Improvements in both frequency and severity of coldness were observed in 74.0% of patients. The status of tenderness in the iliac region, without upset stom ach or depression, was obtained as an appropriate model for the prediction of treatment effect, and its discrimi natory predictability was calculated as 84.4%. The predictive accuracy of the model was validated with 82.1% for the 28 new patients.
Conclusions : Coldness susceptible to tokishigyakukagoshuyushokyoto was very frequently accompanied by tenderness in iliac region, without upset stomach or depression.

There have been some reports that keishikaryukotsuboreito improves climacteric symptoms such as palpita tion, but none have reported coldness successfully treated with this formulation. We report a case of palpita tion and coldness, successfully treated with keishikaryukotsuboreito.
The patient was a 48-year-old female. She complained of palpitation and coldness for 2 to 3 years. She had coldness of the hands and feet without hot flushes. She consulted our clinic on May 8, XXXX. We prescribed keishikaryukotsuboreito (7.5 g/day) because of suggestive symptoms of insomnia, as well as palpitation in the abdomen. Her symptoms improved in 2 weeks. Keishikaryukotsuboreito is usually prescribed for cold feet with hot flushes. The results experienced in this case suggest that keishikaryukotsuboreito may be effective for cold feet without hot flushes, especially with palpitation and pulsation at the navel, which are known symp toms of qi counterflow in Kampo medicine.

Kampo treatment is frequently effective for patients with acne vulgaris who are unresponsive to standard treatment with western medicine. We report two cases of acne vulgaris successfully treated with tokikenchuto. In the first case, a 32-year-old woman complained of mild acne, loose stool and menstrual pain. Her abdomen was soft and a pulsation above the navel was noted. These symptoms were considerably improved after taking tokikenchuto. In the second case, a 26-year-old woman presented with moderate acne, loose stool and menstrual pain with excessive strain of the abdominal muscles and objective tenderness on the sides of the abdomen. Kamishoyosan and tokishakuyakusan were first prescribed, although these caused bowel disturbances, and eventually tokikenchuto was prescribed, which improved the acne. We suggest tokikenchuto is effective for patients with mild to moderate acne who have bowel disturbance with soft abdomen or excessive strain of the abdominal muscles, which are considered indicators of gastrointestinal weakness. In addition, yokuinin has a synergistic effect in the treatment of acne.