In recent years, expectations and demand for Japanese Kampo medicines have increased in Japan. However, the self-sufficiency rate of raw materials for crude drugs in Japan is approximately 10%, with most imported from China. Although discussions on the domestic production of raw materials are gaining momentum, achieving self-sufficiency of crude drugs for Kampo preparation poses several challenges, including production costs, sales channels, and distribution prices. However, it is well-known that a diverse array of crude drugs can be cultivated in the Japanese climate. Since 2013, Ibara City in Okayama Prefecture has been promoting a medicinal plant cultivation project to utilize fallow land effectively. Currently, we have achieved successful cultivation of ‘benishizuka,’ a medicinal peony known as Paeoniae radix, with sufficient quality. However, the present circumstances in Japan limit its sales channels for medical use. The project initiated by Ibara City has evolved from its inception, primarily involving farmers, the government, and national research institutes, to now encompass an unprecedented collaboration among medical professionals as well as local construction companies and a local university. This transformation has propelled Ibara City’s various new medicinal plant cultivation businesses into a new phase of development. In this report, we investigated the local history and climate from the perspective of a Kampo medicine practitioners and discuss the path to successful peony cultivation. Additionally, we delve into the innovations and outcomes pertaining to peony cultivation. Moreover, we report the challenges and prospects for the domestic production of crude drugs for Kampo preparation from the perspective of multiple professions.

Clinical cases requiring bioethical thinking and decision-making have become more complex owing to advances in medical technology and changes in family relationships. In addition, members of medical staff are asked to acquire the ability to think in terms of bioethics. For training in such ability, the use of case studies is important and essential. For a medical ethics class we created 30 cases involving communication between patients and physicians, changes in family relationships, and advanced medical technology, such as genetic diagnosis and gene therapy. We asked all second-year medical students of the Osaka University Medical School to think about these 30 cases and answer questionnaires about bioethics. We believe the case-study method is effective for training students in the ability to think in terms of bioethics.

During the past five years, 141 cases of liver cirrohosis were hospitalized intoour clinic. The mean age of these patients was 57.8 years old, and the ratio of male to female was 2.8 to 1. HBs antigen was positive in 16 cases, and among the patients without HBs antigen 49 cases of heavy alcoholic drinker were found. Seventy patients with liver cirrhosis were dividedinto a compensatory group and a decompensatory group according to three clinical findings, ascites, hepatic encephalopathy and bleeding from gastrointestinal tract. It was suggested that five items of biochemical data for liver function were very important on discriminating these two groups. The five items were cholinesterase, indocyanine green test, albumin, prothrombin time and erythrocyte count.
Next, we studied clinical findings of eight patients with minute hepatocellular carcinoma hospitalized into our clinic during the past five years. About a definition of minute hepatocellular carcinoma, we have defined that the tumor size should be less than 3 cm in diameter. Six of these patients were male, and average age was 56.7 years old. Of these patients, five were complicated by liver cirrhosis, and only one revealed positive HBs antigen in serum. The serum alpha-fetoprotein level showed more than 400 ng/ml in three patients. And we have thought that ultrasonographic examination is most effective to diagnose minute hepatocellular carcinoma in various diagnostic imaging methods. Most of patients exhibited a decreased functional reserve in the liver, but six patients underwent hepatic resection. After operation, one patient died of acutehepatic insufficiency on the 8th day, and one died of the recurrence of tumor on the 11th month. Otherfour patients have been alive now.