Objective: Instructions contained in over-the-counter medicine package inserts can be hard to read because of the limited printing space.  Pictograms are one means of helping users to understand important information.  However, few pictogram systems have been reliably and validly evaluated.  Therefore, a new method was developed to improve the clarity of each illustration and the legitimacy as a pictogram for conveying information important.
Methods: Four creators developed 69 illustrations, each of which expressed one of 24 instructions in the package insert of an H2 blocker.  In a survey, participants (449 university undergraduate and graduate students and 103 pharmacy users) were asked to describe the possible meaning of each illustration and to provide their personal suggestions for improvement.  To evaluate comprehension of information, each instruction was broken into two or three different parts.  Comprehension level was calculated by: (number of people who answered correctly) × 100 / (total number of respondents).  Existing pictograms were included to compare comprehension levels for the same instructions.
Results: Using 67% as the minimum standard for comprehension, we classified each illustration into one of three categories: “no need for improvement,” “need for partial improvement,” and “need for total improvement.”  The students and pharmacy users tended to accurately interpret the possible meanings of illustrations that were familiar to them.
Conclusion: Breaking one instruction of the package insert into a few important pieces of information was useful for determining the level of improvement needed for each illustration.  Evaluating how well each illustration conveys important information in the instructions through two steps was also beneficial, which are to improve the illustration’s clarity with students and its legitimacy among pharmacy users for fulfilling the intended functions of a pictogram.

We report a case of sleep terrors complicated with sleepwalking. The patient was 9-year-old boy who suddenly woke up, walked, or screamed in his sleep. These symptoms were sometimes induced by such as fever elevation or school events. In order to prevent injury while sleeping, he was suggested taking medicine to suppress the nocturnal behavior. After taking shokenchuto based on his findings of qi deficiency, the episodes gradually disappeared and the frequency of fever elevation decreased. In this report, we present the improvements of sleep parameters provided by overnight polysomnography, performed before and after treatment. Shokenchuto is known as one of the curative medicines for sleep terrors, but this is the first report showing objective therapeutic effects using overnight polysomnography.

We report a case of obstructive sleep apnea improved with the treatment both of Kampo medicine and Western medicine. The patient aged 52 years old was struggling with daytime drowsiness. Through the sleep test, he was diagnosed as severe obstructive sleep apnea (OSA) and was received a continuous positive airway pressure therapy (CPAP). Generally, positive air from CPAP applies through the nose and usage reports were recorded in the device. If having nasal congestion, it may be hard to continue CPAP. In this case he had a severe nasal congestion, and he nearly became CPAP failure. It was clear from the poor usage reports. Using Eppikajutsuto for nasal congestion, he felt decrease of nasal congestion. By switching to Shoseiryuto or kakkontokasenkyusin’i from Eppikajutsuto with reference to CPAP usage and nasal CT images, CPAP was continued effectively. Eventually, his daytime sleepiness disappeared.To continue CPAP, which is one of Western medicine, Kampo medicine was useful. On the other hand, to evaluate the effectiveness of Kampo medicine, Western medicine was necessary. CPAP reports and nasal CT images, which are Western medicine, contributed to the switch to Kampo medicine. This case showed the worth of the combined therapy of Kampo medicine with Western medicine.

We report two cases in which insomnia successfully treated with sansoninto alone or in combination and the effectiveness could be objectively evaluated with the portable sleep test. Case 1 was 40-year-old man who had suffered from arousal during sleep and daytime fatigue for several years. After taking sansoninto with ninjinto, his symptoms improved. Case 2 was 60-year-old woman who had suffered from a lack of deep sleep and daytime sleepiness. After taking sansoninto, she could get a deep sleep and could have less daytime sleepiness. In this report, we present that portable sleep test conducted before and after treatment confirmed that sleep quality improved. Sansoninto is one of the curative medicines for insomnia, but we believe this is the first report showing objective therapeutic effects using portable sleep test.