A 25-question “Nationwide Kampo Web Test” was conducted to evaluate the basic knowledge and diagnostic ability of Kampo among medical professionals nationwide. We analyzed the scores of all 608 examinees (241 doctors, 257 pharmacists, 77 others, 12 acupuncturists, 10 nurses, and 11 dentists) and evaluated the test quality. The performance of all examinees was 67.7 ± 16.9 points (mean score ± standard deviation). Among the doctors, the mean score of Kampo medicine specialists (83.8 ± 8.7 points) was significantly higher than that of non-specialists (65.3 ± 16.3 points) (p<0.0001). The performance of doctors who prescribed 20 or more Kampo medicines (78.4 ± 11.5 points) was significantly higher than that of other doctors (p<0.0001). Among the 25 questions, the difficulty levels of 13, 8, and 4 were easy, moderate, and hard (correct answer rates: 70% or more, 40-70%, and less than 40%), respectively. The ability of 13 questions (52%) to distinguish between good and poor performers was extremely high (discrimination index of 0.5 or higher). Collectively, these results supported the good performance of our test, suggesting that it is a highly practical learning achievement evaluation system that could utilize information and communication technology and is expected to be used in future lifelong learning in the field of Kampo medicine.

Palmoplantar pustulosis (PPP) is an autoinflammatory dermatosis that causes recurrent blisters and aseptic pustules on the palms and soles, affecting patients’ quality of life. This report describes a case of a 62-year-old woman who suffered from PPP resistant to a combination therapy, including steroid ointments over ten years. She was overweight and hypertensive, with a history of smoking, sinusitis and periodontal disease as risk factors for PPP development. At her first visit to our clinic, aseptic pustules, resultant scaly lesions and bleeding from cracks on both palms and plantar surfaces were observed. Coexisting Hashimoto’s thyroiditis was found along with liver dysfunction, a high titer anti-nuclear antibody (1:1280) and an elevated blood eosinophil count. In Kampo diagnosis, she was a yang and excess pattern with blood heat. Orengedokuto and Byakkokaninjinto ameliorated her skin lesions, assessed by PPP Area and Severity Index (PPPASI) decreasing from 28.4 at initiation of treatment to 9.6 at 16 weeks. Body weight, blood pressure, liver enzymes levels and blood eosinophil count also decreased. It has been reported that orengedokuto exerts immuno-suppressive effects, while byakkokaninjinto has anti-allergic effects and an inhibitory effect on itch in animal models. Also, anti-anxiety actions of the components in orengedokuto may have helped her out of binge-eating habit and resulted in weight loss. Formula to clear blood heat may become an effective treatment for PPP associated with autoimmune diseases.

We report a case of a 38-year-old woman who initially had pain in her entire left leg and then began to feel intense pain everywhere in her body. She visited our Kampo clinic because of a poor response to the various drugs prescribed by six doctors over two years. We made the diagnosis of fibromyalgia and suggested Kampo therapy with decoction. We focused on liver qi depression, blood deficiency, and blood stasis because she had symptoms of dry skin, cold feet, deeply located fine pulses, purple tongue with thick yellow fur, fullness in her chest and hypochondrium, and pain on palpation beside her umbilicus. Therefore, we prescribed a keppuchikuoto modified formula with poor effect. Finally, we thought this might be caused by a liver-kidney yin deficiency because she had long-term symptoms and administered a dokkatsukiseito modified formula. Her symptoms markedly improved after taking this formulation. Some cases of fibromyalgia are resistant to standard Western treatments. Kampo medicine may be useful and provide relief in such cases.

Orthostatic dysregulation arises primarily from venous pooling in the lower extremities due to abnormal regulation of the autonomic nervous system. This leads to altered central blood volume, which reduces cardiac output and circulating blood volume, resulting in difficulties in rising, dizziness, fatigue, nausea, and palpitations. The treatment of orthostatic dysregulation typically involves non-pharmacological measures such as salt and water supplementation, as well as pharmacological interventions including midodrine hydrochloride. Here, we present two cases of orthostatic dysregulation that were effectively treated with shakanzoto, a Kampo medicine. Case 1 was a 15-year-old boy who had been experiencing fatigue, difficulty in rising, and palpitations in the morning for two years, resulting in his inability to attend school for six months. He was diagnosed with orthostatic dysregulation in accordance with the Japan Clinical Guidelines on Psychosomatic Diseases in Childhood and was administered shakanzoto, after which his symptoms were resolved by day 14 of the follow-up visit, enabling him to attend school. Case 2 involved a 14-year-old girl who had been experiencing fatigue, nausea, dizziness, and palpitations in the morning for five years and was also diagnosed with orthostatic dysregulation in accordance with the aforementioned guidelines. She was administered shakanzoto and her symptoms resolved by the fourth day, allowing her to return to school. To date, the effectiveness of shakanzoto for the treatment of orthostatic dysregulation has not been reported. Nonetheless, shakanzoto may be considered as a potential addition to the treatment for orthostatic dysregulation.

Hepatolithiasis is the presence of calculi within the intrahepatic bile duct and has various causes, including liver operations. In the presented case, intrahepatic stones were detected in the patient 30 years ago. Three years ago, before visiting our hospital, at the age of 68, a choledojejunal anastomotic operation was performed for the distention of the common bile duct. Intrahepatic calculi also occurred postoperatively. Percutaneous transhepatic biliary drainage and lithotripsy were conducted, but the intrahepatic stones reoccurred. This treatment was performed three times in total, last year. In the patient, hepatobiliary enzymes were elevated over the past year. To prevent hepatolithiasis recurrence, the patient visited the Kampo medicine outpatient department for inchingoreisan and shigyakusan treatment. Prior to treatment, the patient experienced abdominal discomfort in the hypochondrium. Upon treatment, a transient hepatic enzyme elevation occurred, which was assumed to be a paradoxical healing response, and drug administration was suspended. The prescription was resumed after 3 months, upon stabilization of elevated liver enzyme levels. Ten years after treatment, the patient’s condition was stable, without intrahepatic stone recurrence and apparent elevation of hepatobiliary enzymes. Inchingoreisan is reported to suppress calculi. Shigyakusan, free of the occasionally liver-damaging Scutellariae Radix, was also reported to be effective for hypochondrium discomfort. In conclusion, the combination of these treatments is suggested as a useful therapy in this case of hepatolithiasis.

We analyzed dispensing receipt data in the medical treatment in October 2019 using the Receipt Information/Specific Medical Examination Information National Database (NDB), extracted the cases of multiple combinations of Kampo prescriptions, and analyzed their frequencies. Of the 536,524 receipts, 44,731 (8.3%) included Kampo and non-Kampo crude drug preparations. Of the receipts that included Kampo and non-Kampo crude drug preparations, 38,032 receipts (7.1%) included single Kampo or non-Kampo crude drug preparation. There were 6,699 receipts (1.2%) that included multiple Kampo and non-Kampo crude drug preparations. There were 187 receipts for the decoctions containing multiple rude drugs without Kampo preparations, and the ratio was 0.035% of all receipts and 0.42% of the receipts containing Kampo and non-Kampo crude drug preparations. There was one receipt containing eight Kampo preparations, three receipts containing seven Kampo preparations, and a total of 84 receipts containing five or more Kampo preparations. Although it is unclear how many multiple Kampo preparations were prescribed at the same time, this investigation indicates the actual duplication of multiple Kampo preparations.

Some simulation-based education tools have been introduced in Kampo medicine. However, there are only a few brief simulation tools to learn qi-blood-fluid (QBF) patterns of traditional Chinese medicine (TCM). In this study, we developed a self-diagnostic questionnaire that allows students learn TCM interviews and QBF patterns by answering the questionnaire and evaluated its reliability and validity. We extracted questionnaire items to classify six QBF patterns (qi deficiency, blood deficiency, yin deficiency, qi stagnation, blood stasis, and phlegm-fluid retention) based on some textbooks of TCM and Kampo medicine. Then we developed an initial questionnaire comprising 35 items. Fifth year medical students at Tohoku University School of Medicine answered the questionnaire of small group teaching during 2017-2020. We evaluated the accuracy of the questionnaire if compared with the diagnosis of academic supervisors. To improve the accuracy, we adjusted the questionnaire’s thresholds and created a predictive model of the patterns using logistic regression analysis. The questionnaire’s sensitivity improved by adjusting the thresholds. Logistic regression analysis resulted in a predictive model that could determine QBF patterns with the same level of accuracy as the original for 20 items overall. The results suggest that the use of a simple questionnaire with ensured accuracy may contribute to better pre-graduate education by making it easier for students to understand their own Kampo medicine patterns.

As part of the studies to build evidence for the coronavirus disease-2019 (COVID-19) conducted by the Japan Society for Oriental Medicine, the observational research and the clinical trials were designed to examine the effectiveness of Kampo medicine in the treatment of COVID-19. These studies were initiated in the context of limited information about the clinical findings of COVID-19 and previous clinical study. Therefore, through literature review, we compared these studies with clinical trials on oral antiviral drugs in terms of endpoint, analysis methods, and results. Results of this review showed that the rate of severe disease and time to symptoms relief, which were focused on in observational research and clinical trials of Kampo medicines, were also used in antiviral drug trials. Furthermore, we discussed that when interpreting the results of clinical studies, it was important to take into account factors that may affect the results, such as the number of cases, the characteristics of the endpoint, and the characteristics of the target population.

Kampo treatment in the acute phase serves the following three purposes : 1) Supplementary to Western medicine. In cases of inflammatory swellings, concurrent administration of eppikajutsuto is recommended. In tetanus, shakuyakukanzoto is combined to alleviate generalized muscle spasms. Goryosan is clinically employed for fluid retention-related conditions such as headache, vertigo, motion sickness, pleural effusion, ascites, etc., to modulate water distribution within the body. 2) Kampo treatment exhibits utmost efficacy. Shakuyakukanzoto promptly alleviates painful muscle spasms. Jidabokuippo aids in resolving subcutaneous hematomas by promoting the removal of stagnant blood. Daikenchuto, which enhances intestinal peristalsis, can be utilized for paralytic ileus. 3) Utilization as an alternative to Western medicines under specific circumstances. In disaster-affected areas, Kampo treatment should be integrated into the available limited medical resources. Thus, it is crucial, even in the acute phase, to employ the advantages of diverse medical modalities, including both Western medicine and Kampo medicine, in a flexible manner to enhance patient health, rather than adhering rigidly to a single medical system.

A 76-year-old man presented with severe headache attacks with ptosis, running tears, and conjunctival redness of the eyelid appeared dozens of times daily, three weeks after the appearance of a skin rash caused by Varicella-zoster virus (VZV) in the first branch of the right trigeminal nerve area. The headache attacks demonstrated as short-lasting unilateral neuralgia-like headache attacks with conjunctival injection and tearing (SUNCT) like facial pain MRI. He was treated with valacyclovir for VZV and analgesics for severe headache attacks, but was refractory to analgesics or stellate ganglion block other than acetaminophen. Symptoms improved after treatment with kakkonto and keishikajutsubuto, which can be used for a beneficial alternative treatment for VZV associated SUNCT like facial pain.