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.

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.

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.

Papillary fibroelastoma (PFE) is the second most common type of benign cardiac tumor after myxoma, and is most commonly found in the left side of the heart. In this study, we report a case of PFE located in the tricuspid valve chordae. The patient was a 65-year-old woman in whom a heart murmur was detected during a routine medical examination. A follow-up examination identified a cardiac tumor, and she was subsequently referred to our medical department. Echocardiography and contrast-enhanced computed tomography indicated a mobile mass of approximately 1 cm in the right ventricle, and she was determined to be a candidate for surgery. After cardiopulmonary bypass, we instigated cardioplegic arrest, made an incision in the right atrium, and observed the right ventricle through the tricuspid valve. We observed a yellowish sea-anemone-like mass approximately 9 mm from the chordae of the anterior leaflet of the tricuspid valve. Thus, the mass was resected with the chordae and tricuspid annuloplasty. Postoperative progress was satisfactory, and the subject was discharged on the 19th day of hospitalization. Histopathological examination indicated a mixture of thick fibrous and adipose tissues, which led to the diagnosis of PFE. PFE is a relatively rare disease that comprises 8% of primary cardiac tumors. IA often occurs in the left heart and can cause cerebral infarction, myocardial infarction, and other symptoms of embolism. However, because small masses and those that occur in the right heart are not accompanied by clinical symptoms, such cases are often discovered during routine echocardiography. The present study reports a case of PFE that occurred in the tricuspid valve chordae that was diagnosed via echocardiography.

[Purpose]We report a case concerning 5 months of left elbow and knee joint pain thought to be caused by repetitive use at work. Symptoms were improved successfully (checked by M-test) by a single acupuncture treatment.
[Case]We used acupuncture to treat a 50-year-old woman who visited our Acupuncture and Moxibustion Centerwith complaints of increasing elbow and knee joint pain in the left side. Since 4 months ago, her job involved frequent stair-climbing while carrying an 18-liter can of cooking oil. The soft tissues seemed to be damaged and caused pain due to the repeated lifting of heavy cans at work. Acu-points were decided by M-Test to check limitations of movement, which identified damaged regions and provided feedback for optimal treatment. According to the specific operations of the patient's work, we identified limited movements of left-elbow joint flexion-extension, left-shoulder joint extension, and left hip joint inner rotation and external gyration. These were regarded as target motions for the treatment. Her Visual Analog Scale (VAS) scores before treatment were 90 mm in the left elbow and 80 mm in the left knee. Despite only a single round of acupuncture treatment, the respective values dropped to 18 mm and 15 mm.
[Consideration and Conclusion]The limited movement identified by M-Test could expose the affected areas and help in treating the appropriate acu-points. Therefore, acupuncture using M-Test might improve painful motions of the body.

Pouchitis is the most common complication following ileal pouch-anal anastomosis in patients with ulcerative colitis and is strongly correlated with the risk of pouch failure and malignant mucosal transformation in the pouch. Here we report a case treated successfully with the Kampo decoction, daitokato. A 41-year-old male treated with ileal pouch-anal anastomosis due to severe ulcerative colitis suffered from repeated pouchitis and stenosis of the ileal pouch post-operatively. He complained of general fatigue, chills, continuous lower abdominal pain and discomfort, and severe pain with evacuation. Initial treatment with antibiotics and painkillers was ineffective, so the patient came to our hospital's Kampo clinic, where he was initially prescribed the decoction, shokenchuto. This proved ineffective at resolving his fatigue. Subsequent treatment with ogikenchuto improved physical strength but was ineffective for pouchitis. Antibiotic resistant pouchitis occurred afterwards and we attempted treatment with saikokeishito decoction and the extracts, hochuekkito and juzentaihoto, which similarly improved fatigue but not pouchitis. Following administration of daitokato, instances of pouchitis were reduced with no recurrence 6 months post-treatment. This case illustrates the therapeutic efficacy of daitokato in improving ileal pouch disorders resistant to treatment with Western medicine.

This study was conducted to assess the appropriateness of preparation fees for dispensing herbal medicines, which were revised in 2006. We investigated the amount of time needed to dispense herbal, and general medicines. For prescriptions of1to 15 days length, the average time needed for herbal prescriptions was 13.4 minutes, which was about 3 times longer than for other prescriptions, which took only 4.4 minutes. For prescriptions of over 30 days length, this was about 7 times longer. Next we comparatively investigated fees charged per minute to prepare herbal medicines, with those for other medicines. Fees for all prescriptions of 1 to 15 days length were nearly equal, while fees for herbal prescriptions of over 15 days length were approximately 1/3 to 1/5l ess. Finally, we investigated the number of prescriptions filled out at one university hospital. In 2003 the number of herbal prescriptions exceeding 30 days length was 2.7% overall, while in 2008 this had increased approximately 14 times, to 42%. We would like to recommend an increase in herbal medicine preparation fees, based on the number of days a prescription is for, as the number of long-term prescriptions is increasing.

It is difficult to treat vulvar pain of an unknown cause. We report a case of vulvodynia with dysuria treated effectively with goshajinkigan. The case was 92 years-old female who could not sleep well because of vulvar pain. She did not have inflammation of the vulva or vagina. Moreover, she was sometimes treated with urethral catheterization for urinary retention. Goshajinkigan was prescribed, and her pain was decreased so much, that she could sleep well. Furthermore, she was relieved of her urinary retention.

1) For third-year students at Keio University Medical School, 10 lectures are given about why kampo medicine is effective, Fourth-year students receive 8 lectures on kampo medicine and participate in independent study sessions 3 times a week for 4 months.
2) In lectures entitled “Why Is kampo Medicine Effective?”we introduce the functional mechanism of action of kampo medicine and address the skepticism of medical students. In the lecture series entitled “Kampo Medicine, ”we introduce the clinical foundations of kampo practice and provide students with a checklist of the key points of each lecture.
3) In the independent study sessions, several students perform mentored basic-science research into kampo's mechanism of action.

1) Although many people all over the world are aware of traditional Chinese medicine, kampo medicine is not as well known. Kampo, traditional Japanese herbal medicine, is an integral part of medical practice in Japan and deserves greater attention. 2) In response to increasing interest in kampo we have created a web-based virtual class as a reliable source for information about kampo medicine. This virtual class incorporates the latest data on kampo and numerous features to pro- mote a basic understanding of kampo. 3) Through this website and virtual class for health professionals, knowledge of the reliability, usefulness, and safety of kampo will be shared with the world.