Kippikijitsushokyoto is described in the great classical text, the Kinkiyoryaku (Jinguiyaolue) as the formulation for treating kyohi. We report seven cases of cough successfully treated with kippikijitsushokyoto. Almost all of these cases had similar symptoms, i.e., an itchy feeling in the throat, sputum that could not be expectorated easily, no feeling of dry throat, and skin findings of lighter complexion and increased moisture. Our clinical experience suggests that kippikijitsushokyoto is an effective treatment for cough accompanied by an itchy feeling in the throat.

We report a case of an 84-year-old septic patient who was treated with Ogi-kenchu-to (Huang-qj-jian-zhong-tang). The patient had remained positive for Klebsiella pneumoniae. The focus of infection had not been detected, but bacterial translocation from the digestive tract was suspected from the clinical course. After two weeks of antibiotic therapy, he still had a high fever and positive blood culture. In addition, multiple cultures showed the destruction of normal flora and an increase of antibiotics-resistant bacteria.
Antibiotics were then suspended, and he was treated with Ogi-kenchu-to alone. His fever and inflammatory signs gradually disappeared, and his blood cultures became negative without restarting antibiotic treatment. He recovered completely. Ogi-kenchu-to is indicated for treating “generally weakened” patients or patients with intestinal problems. However, we could not find any reports of its application to septic patients. Although we still need to determine the mechanism for its efficacy, we consider that this case adds further evidence that Ogi-kenchu-to may be helpful for those suffering from severe infection, especially in elder patients and immuno-suppressed patients.

Aim of the present study was to statistically evaluate the examination rule with use of a questionnaire obtained from physicians regarding treatment for chillness of the limbs, and to prove the clinical usefulness of the database. The database showed that tokishigyakukagoshuyushokyoto was the most frequently used to treat chillness of the limbs, and subsequently keishikajutsubuto, hachimijiogan, and tokishakuyakusan were ranked as drugs with wide use. When physicians determined a kampo formulation suitable for each patient, they used findings specific for the kampo formulation, but not uniform findings obtained from the four traditional examination methods (i.e., inspection, listening and smelling, interviewing, palpitation). There was a statistical difference in the selection mode of drugs among physicians. In a simulation obtained from a questionnaire, there was a positive association between time (time X) to the start of becoming physically warm in the limbs, and time (time Y) to remission (R² = 0.971, P = 0.014). The formula (Y = 4.379 X−0.519), which could predict time Y on the basis of information on time X, was able to accurately monitor the clinical courses of 7 responders to treatment for chillness of the limbs. Taken together, these results strongly suggest that the database constructed in the present study may be useful for evaluation of traditional Kampo medicine, and might allow us to perform more fittingly personalized Kampo medicine in the near future.

Fukushin, or abdominal diagnosis, is one of the characteristics of the Kampo medical examination. During the Edo period, “Fukushokiran (腹証奇覧)” became popular due to its explanations of illustrations of abdominal diagnosis and findings, focusing on the prescriptions in “Shanghanlun (傷寒論)” and “Jinguiyaolue (金匱要略).” In this study, we examined various existing editions of “Fukushokiran” and highlighted the differences in abdominal diagnosis illustrations and findings among them. According to the year indicated at the beginning and end of the volume, “Fukushokiran” is divided into pre-Kyowa and Bunka editions. Although the currently facsimile edition is based on the Bunka edition, significant differences were observed in abdominal diagnosis illustrations and other findings, which were revised from the pre-Kyowa edition. “Fukushokiran” has two parts including the first and second parts; however, differences between the pre-Kyowa and Bunka editions are particularly noticeable in the second part. Inaba Bunrei, the author of “Fukushokiran,” died in Bunka 2 (1805) ; therefore, it is unlikely that he was involved in the revision of the Bunka edition. Instead, it is assumed that the views of Wakuta Shukuko, a disciple of Bunrei, are reflected in the Bunka edition.

In Kampo medicine, a tongue examination, whereby the shape and color of the tongue is observed, is thought to reveal the constitution and condition of the patient. In Japan, numerous books on this tongue examination have been published. However, tongue findings are expressed differently in these books, and a standard description for such findings has yet to be established. A standard description would be useful when examining the tongue, and when educating students of Kampo medicine. We therefore compared how tongue colors and shapes were expressed in the Japanese literature on tongue examinations (12 publications).
Using these results, we have arrived at a standardized description for tongue findings in accordance with Kampo specialists of tongue diagnoses at many facilities. In the process, we focused on easily recognizable findings that can be noted with short clinical examination times, and that can also be understood by beginners.

We have developed and operated a browser-based questionnaire system for Kampo medicine based on conventional questionnaires and review of systems to reveal implicit Kampo wisdom both in patients' questionnaire data and in some Kampo specialists' examination data. However, the questionnaire data were found to be inaccurate because too many questions were included and cumbersome input steps were required. The purpose of the present study was to solve these problems and to develop a new patient-centered questionnaire system with fewer questions and an easier input method. After analyzing inquiry database from collaborating institutes and hospitals, we deleted, combined, and added questions. We changed the evaluation method of symptoms from a visual analogue scale to a simple staged evaluation, and introduced another method to evaluate the main symptoms in each time of visit using a visual analogue scale. At the same time, a tool for predicting Kampo pattern diagnoses based on the questionnaire data was implemented. We have already started collecting more accurate and reliable data using the new questionnaire system. It is expected to support routine practices and facilitate more precise clinical research on Kampo medicine.

We have previously reported on a predictive model for deficiency-excess pattern diagnosis that was unable to predict the medium pattern. In this study, we aimed to develop predictive models for deficiency, medium,and excess pattern diagnosis, and to confirm whether cutoff values for diagnosis differed between the clinics. We collected data from patients' first visit to one of six Kampo clinics in Japan from January 2012 to February 2015. Exclusion criteria included unwillingness to participate in the study, missing data, duplicate data, under 20 years old, 20 or less subjective symptoms, and irrelevant patterns. In total, 1,068 participants were included. Participants were surveyed using a 153-item questionnaire. We constructed a predictive model for deficiency, medium, and excess pattern diagnosis using a random forest algorithm from training data, and extracted the most important items. We calculated predictive values for each participant by applying their data to the predictive model, and created receiver operating characteristic (ROC) curves with excess-medium and medium-deficiency patterns. Furthermore, we calculated the cutoff value for these patterns in each clinic using ROC curves, and compared them. Body mass index and blood pressure were the most important items. In all clinics, the cutoff values for diagnosis of excess-medium and medium-deficiency patterns was > 0.5 and < 0.5, respectively. We created a predictive model for deficiency, medium, and excess pattern diagnosis from the data of six Kampo clinics in Japan. The cutoff values for these patterns fell within a narrow range in the six clinics.