The case is a 38-year-old obese woman with complications such as idiopathic thrombocytopenic purpura, thyroid dysfunction, endometriosis, and uterine myoma. She had a wide variety of medical histories and had a long history of infertility treatment, and received various treatments. She has also undergone laparotomy for uterine myoma after the start of infertility treatment. We treated her with Kampo medicine for multiple complaints that appeared during infertility treatment. She received a combination therapy of tokishakuyakusan and shokenchuto, and after about 3 months, her symptoms improved and she became pregnant. In addition, bukuryoin and ryokankyomishingeninto, which were additionally used for hyperemesis gravidarum and cough during pregnancy, were also effective. The course of the pregnancy was uneventful and she gave birth to a girl at term. The girl is growing and developing normally without asphyxia, malformations, etc. It was suggested that it is necessary to pay attention not only to blood stasis and renal deficiency but also to spleen deficiency and consumptive disorder in Kampo medicine treatment for infertility and recurrent miscarriage.

1）To learn the techniques required immediately after the start of clinical practice, new residents were introduced to the skills laboratory during their orientation period.
2）We attempted to establish the Yanegawara style, which is an overlapping teaching style in which the second–year residents plan the entire training schedule and simultaneously teach the first–year residents while being supported in their teaching by more senior physicians.
3）Training with the new system resulted in greater rapport among all residents as well as a greater feeling of security among first–year residents.

Purpose: The basophil activation test (BAT) has been reported to be useful for the diagnosis of various food allergies, such as allergy to peanut, but not to fish. This study aimed to evaluate the diagnostic performance of the BAT for fish allergy. Methods: We performed a retrospective review of patients with fish allergy who underwent the BAT using a panel of fish extracts (15 kinds) to examine the differential reactivity to several species of fish. The BAT score for each extract was expressed as the ratio of CD203chigh% with the extract to that with anti-IgE antibody. Clinical reactivity to each fish was confirmed by positive oral food challenge or a typical history of fish-induced immediate allergy symptoms. Receiver-operating-characteristic (ROC) analysis was performed to evaluate the diagnostic performance. Results: Fifty-one patients with fish allergy were analyzed. Using extracts of 15 species of fish, the BAT was performed a total of 184 times on the patients. Clinical allergy to each species of fish was confirmed in 90 (48.9%) of those tests. ROC analysis yielded high areas under the curve for the BAT scores for the 5 most common fish species (0.72–0.88). The diagnostic accuracy ranged from 0.74 to 0.86. Using a tentative cutoff value of 0.3 deduced from the ROC analyses of the 5 fish species, the accuracy for other fish allergic reactions was generally high (0.6–1.0), except the fish tested in a small number of patients. Conclusions The BAT score based on CD203c expression may be useful for fish allergy diagnosis, especially since a large variety of fish can be tested by the BAT using fish extracts prepared by a simple method.

Purpose: The basophil activation test (BAT) has been reported to be useful for the diagnosis of various food allergies, such as allergy to peanut, but not to fish. This study aimed to evaluate the diagnostic performance of the BAT for fish allergy. Methods: We performed a retrospective review of patients with fish allergy who underwent the BAT using a panel of fish extracts (15 kinds) to examine the differential reactivity to several species of fish. The BAT score for each extract was expressed as the ratio of CD203chigh% with the extract to that with anti-IgE antibody. Clinical reactivity to each fish was confirmed by positive oral food challenge or a typical history of fish-induced immediate allergy symptoms. Receiver-operating-characteristic (ROC) analysis was performed to evaluate the diagnostic performance. Results: Fifty-one patients with fish allergy were analyzed. Using extracts of 15 species of fish, the BAT was performed a total of 184 times on the patients. Clinical allergy to each species of fish was confirmed in 90 (48.9%) of those tests. ROC analysis yielded high areas under the curve for the BAT scores for the 5 most common fish species (0.72–0.88). The diagnostic accuracy ranged from 0.74 to 0.86. Using a tentative cutoff value of 0.3 deduced from the ROC analyses of the 5 fish species, the accuracy for other fish allergic reactions was generally high (0.6–1.0), except the fish tested in a small number of patients. Conclusions The BAT score based on CD203c expression may be useful for fish allergy diagnosis, especially since a large variety of fish can be tested by the BAT using fish extracts prepared by a simple method.

Kampo medicine has been used for patients with pneumophagia to improve deficiency and stagnation of qi. Here, we report a case in which symptoms were alleviated by treating spleen yang deficiency and liver qi stagnation as the main pathogenesis. The patient was a 75-year-old woman. She was diagnosed with atrophic gastritis after a close examination of her gastric discomfort. She took antacids and proton pump inhibitors, but the condition did not improve. Her abdominal distension and belching also appeared and worsened, so she requested Kampo treatment. Since she had interior cold with qi stagnation, we prescribed tokito that is able not only to warm interior cold but also to adjust qi sufficiently. The pathology of pneumophagia is generally considered to be stagnation of qi mainly and concomitant with deficiency of qi. However, for those having interior cold like this case, a medicine that can firmly perform warm supplementation is necessary, and tokito is considered to be a candidate for the condition. Strangled pain is mentioned as the main targeted symptom of tokito, and it is often administered for abdominal or chest pain. Although, in this case, abdominal pain might have occurred if the condition had worsened further, it is important to utilize tokito in the case of qi stagnation and yang deficiency regardless whether patients have pain or not.

We had a female patient who had stagnation of qi and recovered not only by adjusting qi but also by warming interior cold. A 67-year-old woman visited our clinic for generalized anxiety disorder and whole body overstrain on the basis of domestic problems. She had taken anxiolytic, which brought about some relief. She also suffered from uterine cancer, and had operation of uterine resection. After operation, she took radiation therapy, which caused ileus. Although she took daikenchuto, ileus sometimes recurred. At first, we diagnosed her condition as stagnation of liver qi and deficiency of liver blood according to Kampo medical findings, and prescribed yokukansankachimpihange. However, she felt little effectiveness. We focused on her condition as spleen-stomach deficiency cold, and switched to anchusan, which gradually improved her symptom and led to discontinuation of daikenchuto and anxiolytic. She continued to take it for 7 years, and gradually reduced. She stopped taking medication 2 years later, and has had no recurrence ever since. It suggests that anchusan was effective in warming her latent severe interior cold. We should consider anchusan as a therapeutic candidate for stagnation of qi and interior cold, although it is well known Kampo medicine that is suitable for stomach pain.