A model core curriculum proposed by the government in 2001 outlined the core structure for undergraduate medical education, in which a kampo medicine educational program was established to teach holistic medicine. Eighty Japanese medical schools have attempted to implement this program. We presented lectures on kampo herbal medicine as part of practical training in kampo focusing on clinical pharmacology and using a team-based format. This experience-based program aims to promote active learning of kampo herbal medicine among students. 1) After 116 4th-year students at Tokai Medical University had listened to 6 units of general lectures on the basic theory of kampo medicine, they received practical training comprising 3 units of kampo medical practice, acupuncture, and kampo herbal medicines in small groups of approximately 13 students (12 students, 3 groups; 13 students, 4 groups; and 14 students, 2 groups).2)For experience-based learning about kampo herbal medicine, each group was divided into 2 teams of students who practiced and worked on assignments so that they could understand herbal medicine from the viewpoints of both physicians and patients.3) By preparing keishito using Cinnamomi Cortex, whose production areas and quality differ, students learned the fundamental mechanism of kampo medicine through team discussions of their subjective sensory assessment of the herbal medicine keishito and the objective analysis of the main ingredients of Cinnamomi Cortex. 4) Group A (40 students, 6 teams) took the examination 2 days after the practice, and group B (76 students, 12 teams) took the exam before the practice. Group A did not show any correlation between examination results and interest levels in kampo herbal medicine, and all students but 1 correctly answered 60% or less of the questions. Group B showed a positive correlation between interest levels and examination results, and 6 students correctly answered less than 60% of the questions.5)The present practice could be effective in motivating students in kampo medicine.

In order to relieve the pain accompanying colonoscopy, we gave patients “Tsumura Shakuyaku-kanzo-to extract” 5.0g 30 minutes before their examination, and investigated its effect.
We were unable to find a statistical difference in the increase in systolic blood pressure and heart rate during the examination between the group prescribed Shakuyaku-kanzo-to (n=18) and the control group (n=20). However, the mean for visual pain score, by which we estimated the pain, was 4.89±0.42 in the group prescribed Shakuyaku-kanzo-to and 6.20±0.34 in the control group. This difference was statistically significant.
These results suggest that Shakuyaku-kanzo-to is effective as a premedication for relieving the pain accompanying colonoscopy. From the literature, we assume that this is caused mainly by the sedative effect resulting from suppression of the nerve center.

A 26-year-old woman who was diagnosed with mild SLE came to our hospital with the complaints about cutaneous eruptions on her face, head and back, as well as alopecia. We treated her with Sho-saiko-to-go-Oren-gedoku-to-ka-Yokuinin. After that, skin symptoms such as erythema, alopecia and photosensitivity disappeared, and an antinuclear antibody, which had shown 640 times at the first medical examination, became negative about two years later. In addition, the skin symptoms did not relapse and the antinuclear antibody rose very little even though the patient received no further medication for the next year. Our reseach found no other case reports of SLE whose antinuclear antibodies became negative only by Kampo treatment and who was treated with Sho-saiko-to-go-Oren-gedoku-to or its modified formulations.
Overall, it seemed to be an interesting case, and it suggests that Kampo medicine may be valuable in treating some cases of mild SLE, and may make steroid treatments unnecessary in the early stages of SLE before the diagnosis has been established.

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.

Kampo medicine lectures at Tokai University School of Medicine are an elective subject this year. In order to evaluate student acceptance of this elective, we performed a questionnaire investigation prior to lectures for all fourth-year medical students (n=96). Among the 76 students who provided effective answers, 47 considered attending the Kampo medicine lectures, and 35 of these did attend them. Ten could not attend though they had wanted to. Three could not attend because applicant numbers surpassed class quotas, and 6 reported that other elective subjects were of greater interest to them. Regarding a new model core curriculum for medical education, 6 students (8%) knew that questions about Kampo medicine might be included in a medical state examination, and only 3 (4%) knew that Kampo medicine was included as a specific behavioral objective (SBO). Regarding attitudes toward Kampo medicine, 64 students (84%) were interested in it, while 47 (57%) had a good image of it. However, about two-thirds of students had skeptical or negative images of Kampo medicine citing phrases such as “lack of evidence, ” “mysterious, ” “unscientific, ” “difficult to understand, ” “doubtful” and “works slowly.” These findings suggest that a minimal knowledge of Kampo medicine should be taught to all medical students as a required subject. Furthermore, establishment of advanced programs should be considered as well, since medical students have great interest in, and expectations of Kampo medicine.

A 82-year-old patient with congestive heart failure visited our hospital complaining of dyspnea and orthopnea. Initially, treatment was given based on the western medicine. She responded very well to a diuretic, with her congestive heart failure improving in a relatively short period of time. However, she could not adhere to the restriction of water intake she was supposed to follow was hospitalized repeatedly. While she was in hospital, just rest and water restriction alone improved dyspnea. Although she was discharged from hospital and was given increased doses of a diuretic and a vasodilator, congestive heart failure recurred. Since there was moderate discomfort of the hypochondrium and disturbance of the body's fluid metabolism, we added Sairei-to to her treatment. Six weeks later, the discomfort of the hypochondrium cleared. Her appetite started to improve and she had less severe dryness of the mouth. she was therefore gradually able to follow the water restriction and has not had recurrence of heart failure since then. Although Moku-boi-to is frequently used in the treatment of heart failure, it is assumed that a formulation with a diuretic action such as Gorei-san was effective because heart failure represents a disturbance of the body's fluid metabolism.

The term “half exterior half interior” is not found in the Oriental Medical Classic, the ‘Shang Han Lun’. Rather, the phrase “half outside and half inside” appears. It was Cheng Wu Ji that first used the term “half exterior half interior” in the phrase “Those in whom the disease-causing agent is half in the exterior and half in the interior are considered to be of the fever manifestation-type” appearing in his ‘Shang Han Ming Li Lun’. In the ‘Zhu Jie Shang Han Lun’ which Cheng Wu Ji wrote shortly afterwards, he explains that the phrase “half outside and half inside” found in the ‘Shang Han Lun’ means half exterior and half interior. Since this commentary on the ‘Shang Han Lun’ was more frequently published and more widely circulated than the original text, it is thought to be this explanation that accounts for the popularization of the term “half exterior half interior”.

We examined three cases where Kampo medicine had effects on palindromic rheumatism. All the patients are men with arthralgia accompanied by redness, fever, and swelling. All cases are RF negative. Cases 2 and 3 are brothers. Case 1: A 58-year-old patient with recurrent arthralgia on shoulders, hands, and legs for 30 years. Eppi-ka-jutsu-to was administrated for arthralgia. When discomfort of the hypochondrium (Kyokyokuman) was noted, the administration of Sho-Saiko-to reduced the symptom.
Case 2: A 40-year-old patient with recurrent arthralgia on shoulders, hands and legs for nine years. Eppi-ka-jutsu-to was administrated for arthralgia. When discomfort of the hypochondrium (Kyokyokuman) and contraction of the abdominal muscles (Fukuhikokyu) was noted, the administration of Eppi-ka-jutsu-to-go-Shigyaku-san-ryo was replaced, which reduced the symptoms.
Case 3: A 46-year-old patient with recurrent arthralgia on knees and fingers, and pain in hip joints. Eppi-ka-jutsu-to was administrated for arthralgia. When discomfort of the hypochondrium (Kyokyokuman) and contraction of the abdominal muscles (Fukuhikokyu) were noted, the administration of Shigyaku-san reduced the symptoms.
All cases were typical palindromic rheumatism, and Eppi-ka-jutsu-to was effective to a certain degree. Kampo diagnosis of Saiko (Saiko-sho) was made and additional Saiko-drugs (Saiko-zai) reduced the frequency, the degree, and the length of the period of symptoms.

Patients often complaint about their health, even if nothing is wrong with them upon concise objective examination. The complaints often imply the symptoms reflect more than one organ. Kampo treatment has the advantage of curing several symptoms at the same time, with only one or a few medicines. Kampo medicines comprise Chinese herbal formulations individually tailored to the patient. Therefore, symptom reduction is one of the most essential outcome parameters in Kampo treatment. However, how these subjective symptoms should be quantified, is controversial. The purpose of the current paper is to introduce an evaluation system for subjective symptoms. The system is referred to as Tokyo Women's Medical University Oriental Medicine Research Active Support System (TOMRASS). Apart from subjective symptoms, this database contains physical examination, laboratory data, clinical diagnosis and prescribed medicines, etc. In this study, 2 cases are shown as examples of practical use with TOMRASS use. One is a case with many complaints, which is effective with one medicine, Toki-shigyaku-ka-goshuyu-shokyo-to. The other is a case, which reveals unexpected outcomes with Sho-seiryu-to.
The new approach enables us not only to give more consideration to the patient's perspective, but also to differentiate therapeutic implications. The investigation between the subjective quality of life and therapeutic relationship may contribute to further understanding of Kampo treatment.