A total of 20 chronic headache cases in which other Kampo medicines were ineffective or hardly effective were treated with Kumi-binro-to extract, and the effect of this medicine was investigated.
At the start of administration, we investigated the following items: any deficiency or excess, presence or absence of stagnation of vital energy (facial erythema, ophthalmologic injection, bitter taste in the mouth, etc.) and disease caused by contaminated water (tendency of edema, sound of fluctuating liquid in the region of the stomach, decreased urine volume) as well as the presence or absence of grasping pain (pressure pain) in the gastrocnemius muscle which is a characteristic symptom as a target of this drug. The efficacy of Kumi-binro-to was assessed by a pain score after weeks from the start of administration.
Kumi-binro-to was markedly effective in 5 cases, effective in 11 cases and ineffective in 4 cases, indicating that the ratio of markedly effective and effective cases accounted for 80% of the patients treated. There was no adverse reaction. When the characteristics of 16 cases assessed as markedly effective or effective were investigated, disease caused by contaminated water and stagnation of vital energy was observed in 13 and 14 of the 16 cases respectively. The grasping pain in the gastrocnemius muscle that is a characteristic target of this drug was noted in only one case.
The above result suggests that Kumi-binro-to promotes diuresis to eliminate wetness-evil and regulates vital energy, and is effective against chronic headache, especially when the disease caused by contaminated water is accompanied with stagnation of vital energy.

For many patients with trigeminal neuralgia, oral administration of carbamazepine is highly effective. Micro decompression surgery (Jannetta's operation) is also considered a fundamental treatment. However, there are patients who do not respond to carbamazepine and who hesitate to have surgery. Here, we report 14 cases whose pain was relieved solely by Kampo (7 cases) or by a combination of Kampo and carbamazepine (7 cases). The Kampo formulations used were Goshuyu-to (2 cases), Gorei-san (9 cases), Saiko-keishi-to (1 case), Toki-shigyaku-ka-goshuyu-shokyo-to (1 case) or Mao-bushi-saishin-to (1 case), depending on the “Zheng” of each patient. In trigeminal neuralgia, the nerve root is compressed or adhered to surrounding vessels, such as the superior cerebellar artery. It is highly possible that localized edema at the point of compression is responsible for the pain. The diuretic action of the Kampo may diminish the localized edema around the trigeminal nerve root.

We have recently seen an increasing number of patients with osteoporosis of the type that occurs as a chronic illness in the elderly, and particularly in elderly female patients. It is important not only to treat pain but to follow-up with treatments to prevent further bone mass loss. To measure bone mass in patients with osteoporosis, we employed Digital Imaging Processing (DIP). In this study, the authors examined changes in the bone mass of patients in long-term therapy with Keishi-ka-Jutsubu-to and Gosha-Jinki-Gan. As a comparative-control group, or non-treatment group, we selected 11 patients who had been diagnosed as having osteporosis in an outpatient clinic, and whose bone mass had been measured with DIP. These patients discontinued treatment, but returned to the outpatient clinic six months to one year later. The average duration of non-treatment in the control group was 9.8 months. Metacarpal index (MCI) and metacarpal bone mineral density (m-BMD) at the first visit were 0.40±0.07 and 2.22±0.38, but 10 months later they were 0.36±0.05 and 1.97±0.38, which represents a significant decrease.
In 20 cases given Keishi-ka-Jutsubu-to, the initial bone mass data were: MCI, 0.39±0.08; m-BMD, 2.07±0.32. Measurements performed after three, six, and nine months of treatment showed no difference or increase from the initial values.
In 12 cases given Gosha-Jinki-Gan, the initial data were: MCI, 0.40±0.07; m-BMD, 2.06±0.27. Measurements performed after three, six and nine months of treatment showed no difference from the initial values.
The severity of pain was equally reduced by treatment with Kampo formulation or NSAIDs (non-steroidal anti-inflammatory drugs) by four weeks, but after eight weeks low back pain in patients treated with the Kampo formulation was significantly reduced compared with low back pain in the group treated with NSAIDs.

We used questionnaires to study the present status of undergraduate clinical training at medical schools in Japan in February 1996. Completed questionnaires were returned by 81%(65) of 80 medical schools and approximately 54%(1, 328 clinical departments) of the schools. The results were as follows. Courses for early clinical exposure in the 1st or 2nd year were provided at 83% of the 65 schools; clinical clerkships in the 5th and 6th years were provided at 28%. Specific behavioral objectives for clinical training were clearly shown to students and teaching staff at 75% of schools. Clinical procedures that medical students were permitted to perform were listed and announced to students and teaching staffs at 66% of schools. Patients were informed and gave consent for clinical training of students at 77% of schools. Essential knowledge and skills of students were assessed before the start of clinical training at 40% of schools, and summative assessment was made at the end of the training at 72%. Training of clinical teaching staff for faculty development was conducted at 51% of schools. Eightynine percent of schools reported a shortage of clinical teaching staff. Similar results were obtained in the survey of clinical departments of university hospitals: most departments complained of a shortage of teaching staff, of students not being active, and of students not being competent to enter clinical training courses. To improve clinical training, the introduction of clinical clerkships and cooperation with community facilities outside universities were the main issues.

A questionnaire survey on clinical procedures performed by medical students on patients during undergraduate clinical training was conducted in february 1996. Responses were received from 1328 clinical departments of university cospitals at 80 medical schools. Basic clinical procedures that medical students were permitted to perform on patients were recommended by a committee of the Ministry of Health and Welfare. These procedures are divided into three categories: level 1; procedures that medical students are permitted to perform under the supervision of an instructor; level 2; procedures medical students are permitted to perform with supervision under certain conditions; and level 3; procedures for which medical students are generally limited to assisting instructors or to attending and observing patients. The status of performance of the procedures was investigated. Of level-1 procedures (36 procedures), 8 were performed by medical students at more than 80 % of university hospitals, 19 were performed at from 50% to 70%, 9 were performed at less than 50%. Of level-2 procedures (15 procedures), 8 were performed at from 55% to 79% of hospitals and 7 were performed at less than 50%. For level-3 procedures (15 procedures), medical students were permitted to assist and observe 4 procedures at from 82% to 86% of hospitals, 11 at from 50% to 79%, and 1 at40%. In addition, students were permitted to perform 13 level-3 procedures at from 10% to 44% of hospitals and to perform 3 at from 6% to 9%. In many clinical departments, other kinds of procedures specific to the departments were adopted. Teaching media, such as standardized patients' computer-assisted instruction models, and animal materials, were used, and facilities in the community cooperated in training. Respondents wrote many suggestions and opinions about the difficulties and concerns with the legality of students' performing clinical procedures, patients' consent or agreement, minimal essentials of clinical competence of students, the shortage of instructors, and the training and guidelines for instructors.

We surveyed in every medical university in Japan on how attitudes development is adopted in its medical educational curriculum so far. There are several universities which in some way have already adopted attitudes development into curriculum or teaching items. However, hours of lesson and the contents are so differed among them. Moreover, both evaluation of these lessons by trainees and judgement as far the educational effect by trainers are not programmed satisfactorily. Some universities complain of manpower shortage, difficulties of fixing curriculum, or shortage of total lesson hours, so that they say they cannot dare work on this attempt. But, there are still an increasing number of universities ready to start their programs, where education arranged by non-medical teachers, practical medical experience at the real front, the introduction of simulated patient (SP) into education, and so on are considerd to be carried out.
Thus, we suppose it is time to have and share some guideline for adequate attitudes development education at this moment. And at the same time, a national system to encourage the medical education, including trainning SP, is urgently required to be planned.