Jiinshihoto, a Kampo formulation described in the textbook, Wanbinhuichun, is well known as a suitable formulation for patients troubled by chronic cough with qi obstruction. The components of jiinshihoto have several effects including nourishing yin, clearing empty heat, replenishing qi, and improving digestive function. We report three cases with glossodynia and abnormal sensation in the throat which were treated successfully with jiinshihoto. We therefore recommend jiinshihoto for the treatment of glossodynia and abnormal sensation in the throat associated with signs of yin deficiency including thirst, dry mouth, and viscous sputum,and signs of qi obstruction such as a tympanic sound on the right side of the abdomen.

The purpose of this symposium was to clarify clinical significance of the pulse diagnosis at the wrist used for detecting the function of various organs. Base of the literature survey and his personal experiences, the importance of reliability (reproducibility) test of the pulse diagnosis in blinded manner and necessity of clinical trials with “_??_”-specific intervention was proposed by Ogawa. A unique training program of the pulse diagnosis was introduced by Kido, and he also demonstrated a significant positive result of “_??_”-specific intervention determined by the pulse diagnosis procedure in his program and suggested the clinical significance of the pulse diagnosis. Detection of various changes in pulse waveforms at the wrist using pressure transducer was demonstrated by Maruyama, and he also suggested a possible progress of objectivity in pulse diagnosis by various sensors and biomedical devices in future. From circulatory physiological point of view, factors which may affect the pressure pulse wave at the wrist were explained with several examples of pathologic conditions by Chihara. He also suggested a possibility of reflection of general condition in the pressure pulse at the wrist although it might be partial one, and stressed the necessity of other information for the accurate diagnosis. In general discussion, it was pointed out that evidence of the pulse diagnosis was still limited, and further experimental approaches of the pulse diagnosis will be required.

Introduction: We herein report a case whose terminal refractory delirium improved after discontinuation of continuous deep sedation for several days. Case: A 57-year-old head and neck cancer woman with brain parenchymal invasion was consulted to our palliative care team for delirium accompanied by sudden abnormal behavior. Her abnormal behavior did not improve with opioid switching or drug treatment. She was diagnosed as refractory end of life delirium, and her family wanted her to be sedated. We started intermittent sedation with midazolam and then shifted to continuous deep sedation. Several days later, her family expressed the conflict of continuing sedation. Ten days later we stopped sedating her according to her family’s will. She awoke from deep sedation and her abnormal behavior disappeared, although there was mild consciousness disturbance. The patient died 2 months later while maintaining communication with her family. Discussion: Cessation of various drugs which may provoke delirium is considered to be one of the causes of delirium improvement in this case. The guidelines of the Japanese Society of Palliative Medicine do not clearly state the criteria for suspension of deep sedation other than confirming the feelings of family members. A criterion for withdrawal of sedation should be discussed based on higher evidence level.

Aims : To clarify any difficulties that pharmacists and nurses may have when prescribing Kampo medicines to newly-admitted patients with a survey questionnaire at a local hospital ward.Methods : Questions for pharmacists on the handling of Kampo herbs, any perceived risks in the preparation of Kampo formulae powder extracts/pills, or in explaining Kampo medicines, based on their experiences. Also questions for nurses on the handling of Kampo medicines, as compared to western medicines, and any perceived risks in their administration at their ward.Result : All 7 pharmacists and 14 out of the 16 nurses surveyed completed their questionnaires. The pharmacists pointed out that Kampo preparation takes more time, although none perceived an increased risk with Kampo medicines, as compared to western medicines. Only 1 pharmacist had ever had experience explaining Kampo medicines to patients. The nurses, on the other hand, felt that Kampo treatments were somewhat more difficult to use, and perceived similar risk in their administration to patients.Conclusion : Both the pharmacists and nurses surveyed believed that the handling of herb medicines was somewhat difficult, but that these difficulties could be overcome with risk management. This suggests that pharmacist, nurse and office personnel education would be useful before Kampo medicines are administered to newly-admitted hospital patients.
Medicine, Kampo ; perceived risk ; seconds ; Therapeutic procedure ; Risk

Usually, chronic pain is difficult to treat because this is often accompanied by none-organic factors such as psychiatric symptoms, which complicate the pathological condition. For this reason, the guidelines also call for coping with peripheral symptoms except pain. This time, we report that facial pain as well as peripheral symptoms such as mental anxiety gradually improved by a combination of decoction extract and acupuncture and moxibustion. The case was a man in his 60s, who received all kinds of treatments such as taking Western medicines and blocking trigger points for chronic facial pain of unknown cause with mental anxiety. However, even after one year the side effects were strong and the treatment was ineffective. Acupuncturists and Kampo specialists made the diagnosis and treatment based on a common concept of Kampo medicine. Treatment focused on shin abnormalities and oketsu suppressed the vicious cycle of pain and improved psychiatric symptoms and QOL. It was suggested that Kampo medicine based on the idea “the same in mind and body” is effective for chronic pain in which various symptoms are intricately intertwined.