Obstetric and gynecologic disease cannot be analyzed without “gender” taken into account, because patients are likely to fear sterility and feel embarrassed in the delivery of medical care and treatment beside stigma against disease and treatment.　　There is the need to seriously take account of the emotion of patients with obstetric and gynecological problems particularly in a ward where a division of gynecology is juxtaposed with that of obstetrics (delivery room) and/or a gynecology division in a mutually shared ward - as is the case with such obstetrics and gynecology wards available all over the nation - as studies on privacy protection in those types of wards are barely available. That said, we studied to clarify the details of privacy protection of the sort inpatients would wish to enjoy and their impression about privacy protection and correlated factors. Made from May 2008 to May 2009, the study consisted of two researches: Research 1 employed a semi-structured interview method for 15 subjects, and Research 2 used a questionnaire survey method for 85 subjects.　　Three important items on privacy protection were derived from the results of Research 1, and an analysis of the results of Research 2 on the basis of those 3 items suggested that briefings in the early phase of hospitalization would have a favorable impact even upon the patients’ mental reaction to subsequent privacy protection.

It is not a few cases that present with fever and fatigability of an unknown cause. We report a case of fever and fatigability treated effectively with hangeshashinto. The case was 47 year-old woman who had been having fever and fatigability for three years. Sometimes she could not go to work because of this malaise. She was diagnosed with patterns of qi deficiency, upper body heat and lower body cold, qi stagnation and stagnant blood. We carefully considered shinkahiko (epigastric tightness and resistance).
Hangeshashinto was prescribed, and her complaints improved remarkably. Hangeshashinto is a well-known Kampo formulation for treating disorders of digestion. But this suggested that hangeshasinto is effective for a variety of symptoms in patients with digestional disorders, who also have a shinkahiko condition.

It is difficult to treat arthralgia of unknown cause. We report a case of polyarthralgia treated effectively with hochuekkito.
The case was a 48 year-old woman who had polyarthralgia for three months. Her joints were not swollen and reddish. There were no remarkable signs of rheumatoid arthritis or any other immune diseases. She also complained of fatigability. She was diagnosed as patterns of qi deficiency and qi stagnation. After prescribing hochuekkito for fatigability, her arthralgia as well as fatigability substantially decreased. In this case, it is suggested that hochuekkito was effective as a qi-tonifying formulation.

Bofutsushosan has recently become a well-known Kampo formulation for treating metabolic syndrome. It is effective for obesity in people who have mental disorder, but few reports suggest that it is effective for mental disorder itself. We report a case of depressive complaints treated effectively with bofutsushosan. The case was 63 years-old male who had had depression for twenty years. His depressed condition had been stable owing to antidepressant therapies. However, he had could not read books, and so had not been able to enjoy the pleasure of reading since nine months previously. He did not believe that his depression had taken a turn for the worse, but rather that he had the partial androgen decline (or deficiency) of aging males. Therefore he did not consult his psychiatrist, and he wanted to be treated with Kampo formulations. He was diagnosed with a hyperfunctional constitution, heat pattern, and a ki obstruction pattern. Bofutsushosan was prescribed, and his complaints improved remarkably. This suggests that bofutsushosan is effective for treatment of not only obesity but also mental disorder itself.

The spontaneous reporting system for adverse drug reactions(ADRs), through which information is collected on patients who experience ADRs, can lead to hypotheses on causal relationships between drugs and ADRs; however, lack of information on patient characteristics or patients who have not experienced ADRs makes quantitative, relative comparison of risks difficult. From the viewpoint of adapting pharmacoepidemiology to supplement spontaneous reporting of ADRs, RAD-AR Council Japan(RCJ) has been promoting development of a database assembling drug use-results surveillance(DURS) data under the re-examination system for secondary use. RCJ received observational DURS data on antihypertensive drug users from pharmaceutical companies and integrated to develop a database of over 100,000 patients and 19 antihypertensives in 2003. RCJ maintains the database, expanding it to 143,509 patients and 21 antihypertensives in 2007, and also developed a database of antihyperlipidemics with approximately 34,000 patients in 2011. Researchers study these databases through an application and protocol review process stipulated by RCJ, and their results have been presented at conferences and published in articles. This report summarizes DURS data collection and its underpinning regulated systems in terms of data assembly and database maintenance at RCJ. The report also introduces the example for constructing the antihyperlipidemics DURS database and summarizes its patient characteristics. The database is characterized by ADR information and treatment-related laboratory values in addition to patient backgrounds and drug use information. However, it is too small to study rare ADRs and has limited longitudinal observational data. Therefore, RCJ worked to expand the antihypertensives DURS database in 2012 by adding data that include long-term surveillance results. (Jpn J Pharmacoepidemiol 2012; 17(2): 87-97)

It is difficult to treat vulvar pain of an unknown cause. We report a case of vulvodynia with dysuria treated effectively with goshajinkigan. The case was 92 years-old female who could not sleep well because of vulvar pain. She did not have inflammation of the vulva or vagina. Moreover, she was sometimes treated with urethral catheterization for urinary retention. Goshajinkigan was prescribed, and her pain was decreased so much, that she could sleep well. Furthermore, she was relieved of her urinary retention.

The aim of the current nationwide survey was to investigate the Kampo medicine experiences of Japanese physicians working at hospitals designated as core cancer centers by the Ministry of Health, Labour and Welfare. Among the 900 physicians surveyed, 92.4% reported having prescribed Kampo medications, of whom 73.5% reported having prescribed them for cancer patients. Despite this high percentage, only 28.7% of the physicians had studied Kampo medicine.
This survey found that over 40% of physicians in each generation had no intention of learning Kampo medicine. When asked to categorize their expectation of Kampo efficacy, about 30% said they had an ‘expectation’, a ‘no and yes expectation’, and ‘no expectation’ respectively.
However, physicians who had experience learning Kampo medicine had more expectation than physicians who had not. And the same expectation tendency for prophylaxis treatment was shown in physicians with that experience and those without. This difference is disadvantageous to patients. We therefore believe it necessary to create an environment in which physicians can learn Kampo medicine and methodology, which engenders cooperation between Kampo specialists and Japanese physicians in the treatment of cancer.

We examined the clinical features, 12-leads ECG, Holter ECG, monitor ECG, and electrophysiologic study (EPS) in nine consecutive paroxysmal atrioventricular block (PAVB) patients treated in our hospital between 1995 and 2000. In some of them, parasympathetic nerve stimulating maneuvers, drug administration and head-up tilt test (HUT) were performed as provocative tests. EPS documented that the sites of AV block were within the His-Purkinje system (H-PSB) in five patients, proximal to the His bundle potential (AHB) in three patients. In the remaining one patient, the His bundle potential was not recorded. The main features of the patients with H-PSB were as follows: 1) often wide QRS complex with or without axis deviation; 2) variable degrees of AV conduction disturbance in a short period; 3) sinus tachycardia, and normal length and constant PQ intervals in a daytime being apt to precede PAVB; 4) rather long ventricular asystoles leading to abrupt syncope; 5) easy induction of the block by intravenousadministration of atropine. In the other hand, the features of the patients with AHB included: 1) narrow QRS; 2) progressively increasing or decreasing in PQ intervals preceding PAVB; 3) ventricular asystole lasting about 3 to 10 seconds; 4) the failure to induce PAVB by any probale provocative tests.
Although we treated all the patients with permanent pacemakers, there might have been other management method for AHB patients who had about 3-second ventricular asystole.

This study was conducted to assess the appropriateness of preparation fees for dispensing herbal medicines, which were revised in 2006. We investigated the amount of time needed to dispense herbal, and general medicines. For prescriptions of1to 15 days length, the average time needed for herbal prescriptions was 13.4 minutes, which was about 3 times longer than for other prescriptions, which took only 4.4 minutes. For prescriptions of over 30 days length, this was about 7 times longer. Next we comparatively investigated fees charged per minute to prepare herbal medicines, with those for other medicines. Fees for all prescriptions of 1 to 15 days length were nearly equal, while fees for herbal prescriptions of over 15 days length were approximately 1/3 to 1/5l ess. Finally, we investigated the number of prescriptions filled out at one university hospital. In 2003 the number of herbal prescriptions exceeding 30 days length was 2.7% overall, while in 2008 this had increased approximately 14 times, to 42%. We would like to recommend an increase in herbal medicine preparation fees, based on the number of days a prescription is for, as the number of long-term prescriptions is increasing.

Traditional medicine educational systems in Japan and China were compared.
In Japan, Kampo medicine has been integrated into the core curriculum of undergraduate education in all medical colleges since 2001. Japanese university medical schools give 6,000 hours of western medical educa tion, and only 30 hours of Kampo education. In China at Traditional Chinese Medicine (TCM) universities, nearly half of teaching hours are devoted to TCM, and half to Western medicine. And even at medical univer sities that specialize in Western medicine, students will usually have 80 hours in TCM courses. Usually it takes five years to graduate. In Japan, Kampo education puts a special focus on the Shang-han-lun and Jin-kui-yao lue texts, which still influence daily practice. In China, on the other hand, TCM doctors rely on traditional theories of Chinese medicine such as the Yin-Yang theory, the Five Elements theory or relationships between meridians and organs. Kampo specialists have been increasing in recent years, although in China, the number of TCM doctors has been decreasing. However, better traditional medicine education would play a role in in creasing our inheritance of both in Japan and in China.