Hemodialysis patients suffer from constipation, which often refractory. And they often realize anxieties over defecation urge during dialysis, or control of their body weight. Here we administered junchoto in the treatment of chronic severe constipation, and consideration of its therapeutic efficacy for constipation and for anxiety (qi stagnation). We prescribed junchoto 5.0 g or 7.5 g/day for 14 dialysis patients with chronic severe constipation regarded as a “Deficiency,” and evaluated response to constipation treatment with a constipation scoring system instrument, and Bristol Stool Chart. With a “qi stagnation score,” we also assessed improvement in qi stagnation. Median constipation scores significantly decreased from 14 to 4 after medication. Average Bristol Stool Chart scores significantly improved from 1.4 to 4.3. Median qi stagnation scores were significantly improved from 38 to 6. We believe that the Junchoto may be effective for chronic severe constipation in hemodialysis patients, who feel the improvements in qi stagnation (anxiety) with constipation.

A dialysis patient may experience shoulder disorders that are not associated with a history of dialysis treatment. We reported regarding 6 dialysis patients with shoulder disorders who were successfully treated with goshakusan. The subjective symptom was cold in 3 of the 6 patients, and the objective symptom was interior cold in 3 patients. All patients had symptoms of ketsu (blood) deficiency with skin dryness and amyotrophy and of sui (body fluids) disturbance with decreased urine volume and water metabolism with renal dysfunction. Furthermore, they had symptoms of ki (Qi) deficiency with malaise and dry mouth after dialysis treatment. If these conditions continue, the dialysis patient will experience a decline in metabolism and decreases heat production, and “the cold” condition may occur. Four of the 6 patients complained of gastrointestinal dysfunction, and 1 experienced stomachache after receiving a painkiller, and they all had dietary symptoms. All symptoms improved after prescribing goshakusan. The conditions of the ki, ketsu, sui, cold, and dietary symptoms are recognized in dialysis patients, and goshakusan may be a suitable herbal medicine in cases with repeated shoulder disorders.

Peripheral arterial disease is a serious complication that can arise in hemodialysis patients. Prognosis in critical limb ischemia (CLI) due to peripheral arterial disease is extremely poor. A dialysis patient may experience symptoms of both qi and ketsu deficiency and ketsu stagnation during the long-term treatment of CLI. Herein, we report three hemodialysis patients with refractory postoperative skin ulcers who were successfully treated with juzentaihoto and keishibukuryogan after limb amputation. Case 1 was a 68-year-old man who had skin ulcers of the right second, third, and fifth toes. After amputation of the third toe, juzentaihoto and keishibukuryogan were initiated. Case 2 was a 67-year-old man who had skin ulcers after amputation of the left fourth and fifth toes. Postoperatively, juzentaihoto and keishibukuryogan were initiated, and good granulation was observed. Case 3 was a 76-year-old man who had skin ulcers after left below-the-knee amputation. Because of the extremely poor tissue granulation, juzentaihoto and keishibukuryogan were initiated, and good granulation was gradually observed. After an operation for CLI, prompt return to activities of daily living is desirable. The appropriate addition of Kampo treatment to Western treatment may improve chronic refractory skin ulcers.

We report two cases with honton disease, also regarded as restless legs syndrome (RLS), successfully treated with a combination of goshuyuto and ryokeijutsukanto. Case 1 was an 88-year-old woman who started experiencing RLS after she received cardiac bypass graft when she was 76-years-old. Abdominal examination revealed stuck sensation in the pit of her stomach and aortic palpitation around the upper umbilical region. From these examination results as well as the deficiency pattern, cold pattern, qi deficiency, and qi stagnation, we diagnosed the case as a hontonto (Zhouhou fang) indication. A combination therapy of goshuyuto and ryokeijutsukanto was administered. Consequently, the stuck sensation and RLS disappeared. Meanwhile, Case 2 was a 62-year-old woman who experienced RLS upon going to bed after she underwent breast cancer surgery at the age of 54 years. Similarly, abdominal examination revealed stuck sensation in the pit of her stomach, aortic palpitation around the upper umbilical region, and lower abdominal numbness. These examination results as well as the slight deficiency pattern, upper heat and lower cold pattern, qi deficiency, and qi stagnation indicated hontonto (Zhouhou fang). The same combination therapy was given. Eventually, the stuck sensation disappeared, and the RLS was reduced. Therefore, for RLS that appears after a mental load with invasive therapy, the combination therapy of goshuyuto and ryokeijutsukanto may be an effective treatment choice.

Calf cramps is a complication that can arise in dialysis patients. Shakuyakukanzoto is a useful medicine that is administered at appropriate doses for calf cramps. However, this medicine has been effective at the beginning, with a subsequent progressive decrease in its effect. We came to experience invalidity cases. In five phases theory, calf cramps were recognized as a disorder of the liver, and we administered saikokeishito, including saiko and shakuyaku, which regulate the liver function. We report on 9 dialysis patients with calf cramps who were successfully treated with saikokeishito. Calf cramps were considered to occur by the ataxia of organization of lesser yang pattern resulted in periodic attack, and the ataxia of auto nervous system as the symptom of yin yang disconnection. Saikokeishito is prepared using shosaikoto which regulates the lesser yang pattern and keishito which modulates the yin yang balance. Saikokeishito has the properties of both of these medicines. Thus, it may be a suitable medicine for calf cramps that occur owing to life style in dialysis patients.

　　When a patient with acute drug intoxication is brought to our hospital, the pharmacist must immediately collect pertinent information regarding the causative agents involved, present the collected data and propose therapeutic methods to the doctors and nurses based on the basis of their earlier experience. 　　For the life-saving treatment of a 99-year-old woman who happened to swallow a large amount of diphenhyramine ointment, we proposed gastric lavage and time-lapse measurement of the diphen- hyramine concentration in the blood. The results of this therapy showed a clinical improvement with a drop in the concentration of diphenhyramine in the blood. 　　The conduct of gastric lavage and the clinical determination of diphenhyramine concentration in the blood were found useful in this case.

  In Japan, few health care professionals have a basic understanding（core competency）of the design of clinical research and statistical analysis. We developed a blended distance–learning program comprising face–to–face lectures with e–learning for busy health care professionals who work in the clinical settings to achieve core competency in clinical research. The purpose of this study was to examine the educational effects of this program.
1）Four months after the end of the program, 64％ of the participants had started to conduct clinical research.
2）This program may increase the number of research colleagues that can discuss clinical research.
3）This program could enhance the confidence（self–efficacy）of health care professionals in clinical research.