Inflammatory bowel disease (IBD) is a chronic inflammatory condition of unknown etiology characterized by recurrent periods of remission and relapse. Despite standard treatments, several patients continue to experience symptoms, such as abdominal pain, diarrhea, bloody stools, and inflammation of the intestinal mucosa. This report presents two cases of patients with IBD who achieved remission using Kampo decoctions instead of extract formulations. Case 1 involved a man in his forties with Crohn’s disease. He remained in remission for four years after receiving treatment with aminosalicylic acid and a Kampo decoction following partial resection of the small intestine. However, when he switched to an extract formulation with the same content as the decoction, he experienced worsened diarrhea and bloody stool. The patient’s symptoms and inflammatory markers improved following a comprehensive Kampo medical evaluation and administration of a decoction of daikenchuto and hochuekkito. Case 2 involved a woman in her forties with ulcerative colitis who had been in remission for four years with infliximab and a Kampo decoction consisting of hochuekkito, shimotsuto, and keishibukuryogan. However, four months after changing to an extract formulation with the same ingredients as the decoction, the patient experienced erosion of the rectal mucosa and bloody stool. After returning to the decoction and adding mesalazine suppositories, her symptoms improved. These cases suggest that Kampo decoctions may be useful in maintaining IBD remission, particularly when extracts are not significantly effective.

Tohoku University Hospital served as the research office for two projects of Kampo medicine treatment: an observational study and a randomized controlled study on Coronavirus Disease 2019 led by the Japanese Society for Oriental Medicine. We review the practical operations together with the results of a questionnaire survey conducted after the completion of the studies, and discuss issues and areas for improvement in the management of the multicenter research office. Questionnaire 1 surveyed the participants’ impressions and opinions of the implementation system and responses at the research-sharing facilities, as well as future issues. Comments on observational studies were dichotomized into “no particular problems” and “difficulties.” In the randomized controlled trial, most respondents answered, “It was difficult to understand the administrative procedures for specific clinical research.” Questionnaire 2 surveyed the status of clinical research support staff, their impressions and opinions of being entrusted with the work, and future issues. We were able to collect opinions about impressions, issues, and areas for improvement from a variety of perspectives. Looking back at the summary of the questionnaire survey and the practical experience, smooth promotion of research is expected through appropriate research planning and system construction, as well as improvement of research support skills.

Fatigue is a common symptom of long COVID. Fatigue can majorly disrupt daily life and be challenging to treat. Herein, we describe the effect of saikokeishito, a Kampo medicine, on fatigue in patients with long COVID.Between October 2020 and March 2023, we prescribed saikokeishito to 22 patients with long COVID in the general medicine outpatient department of our hospital. Among them, seven patients (age: 15-58 years, two females) had fatigue, a previously confirmed diagnosis of COVID-19, and no concomitant use of other Kampo formulas. We compared their condition at the start of saikokeishito administration to that 3 months later. Five patients had a slight fever, and four had inflammatory findings on blood tests. Within 3 months, all patients had a 20% or greater reduction in fatigue on a visual analogue scale. Six patients had a 20% or greater increase in health-related QOL and were able to return to society. On the other hand, one patient required a transition to an alternative medication, and one patient's follow-up was prematurely discontinued. Fatigue after COVID-19 may be improved by saikokeishito, especially for the treatment of patients with slight fever or inflammatory findings.

"Brain fog" is a symptom of long COVID. Brain fog is suspected to be a neurocognitive dysfunction; however, the underlying pathology remains to be elucidated. To provide better medical care for patients with "brain fog", we collaborated with a hospital outpatient department that specializes in the assessment and treatment of cognitive impairment. For the establishment of the collaborative system, we devised a questionnaire for "brain fog" based on medical reports, internet resources, and clinical experiments to be used as a screening tool. The questionnaire was used to calculate a "brain fog score" (BFS). A BFS of more than 5 points was established as the criterion for patient referral. The present retrospective evaluation suggests that BFS is useful for predicting prognosis and prioritizing patients within limited outpatient appointment slots.

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.

Prolonged cough in coronavirus disease 2019 (COVID-19) is not only uncomfortable for patients, but also prolongs the length of stay in an isolation facility. This results in delays in patients' return to their daily life. Therefore, the prompt treatment of cough is important. In this report, we used Japanese traditional (Kampo) medicine, chikujountanto for the treatment of cases with residual cough, airway secretions, slight fever, anxiety, and insomnia, several days after the onset of coronavirus. From October 2020 to September 2021, we prescribed chikujountanto for thirty-three COVID-19 patients with prolonged cough in an isolation facility. Seven patients (6 women and 1 man with ages ranging 37-70 years) were treated with no other medication. Comorbid symptoms included slight fever, sputum, sore throat, nasal discharge, headache, anxiety/insomnia, and taste/olfactory disorders. The start date of treatment ranged from 9 to 21 days after the onset of COVID-19, and the time until cough and comorbid symptoms improved to values less than NRS 2 or less, was 2 to 6 days after treatment. Three patients had persistent cough and needed to switch to other medication. In COVID-19, chikujountanto may be useful for coughing during the period when the peak of the viral proliferative phase has passed but airway inflammation is still present.

We verified the educational outcomes and effects of the practice of Problem-based learning (PBL) on the theme of Kampo medicine and the continuous academic support. From 2013 to 2021, we conducted Kampo PBL for second-year medical students, and compared the results of Kampo exams in the fourth year between Kampo PBL participants and non-participants. Moreover, the learning obtained through subsequent academic activities was extracted from their free-form text. Kampo PBL was performed for a total of 26 groups. Participants who underwent Kampo PBL (n = 72) scored significantly higher than those who did not (n = 734) (p<0.05). In addition, academic support resulted in 5 academic presentations in an academic conference and 3 articles published in academic journals. The lessons learned included “concretization of understanding of Kampo medicine,” “valuable experience in academic activities,” and “promoting motivation and its impact on the future.” Kampo PBL improved knowledge about Kampo medicine, and academic activities cultivated the research mind.

Ninety percent of the crude drugs consumed in Japan depend on imports. Recently, the Japanese government has been promoting the domestic production of crude drugs. We investigated the history and current situation of the cultivation of medicinal plants and the production of crude drugs in the Tohoku region, where the 71st annual meeting of the Japan Society for Oriental Medicine was held in August 2021. In the Tohoku region, the cultivation of medicinal plants expanded after the Kyoho era of the Edo period. Several medicinal plants in this region have been successfully cultivated and distributed as local specialty products and are being preserved (e.g., Panax ginseng in Aizu, Carthamus tinctorius in Dewa). In some other areas, cultivation has just begun. In each cultivation area, a contractual relationship was established in which local governments, cultivation experts, farmers, Kampo-related associations, and pharmaceutical companies collaborated to continue and expand the cultivation business. To generate revenue, they have been trying to find sales channels not only for crude drugs but also for foods, cosmetics, textiles, and processed products. Although many issues remain to be solved in the distribution of medicinal plants as the source of crude drugs, this survey clarified the ingenuity of medicinal plant cultivation in various areas of the Tohoku region. The results of the investigation are available as videos on the website for members of the Japan Society for Oriental Medicine.

The background and course of Kampo treatment in 39 patients with uncontrollable otolaryngeal symptoms treated between April 2013 and March 2016, in the Department of Kampo Medicine at Tohoku University Hospital, were analyzed retrospectively. An improvement in overall symptoms was noted with Kampo treatment in 28 of 39 cases (71%). The commonly reported subjective symptoms included glossodynia (7 cases), postnasal drip (4 cases), oral discomfort (4 cases), dizziness (3 cases), and taste disorder (3 cases). Analysis using the classification of qi, blood, and fluid revealed that cases with qi stagnation pattern (15 of 18 cases) were effectively treated with Kampo treatment. Prior reports support our finding that smoothing qi with Kampo medicine is effective in alleviating some chronic symptoms. The symptoms improved within 6 weeks after the treatment was initiated. Therefore, a 6-week period can be considered sufficient to determine the effectiveness of Kampo medicine. Many of the patients for whom Kampo treatment was not effective had depression and domestic stress. In conclusion, Kampo treatment may be effectively used to treat uncontrollable, chronic otolaryngeal symptoms in selected cases that are unresponsive to Western medicine.

The Japan Society for Oriental Medicine has summarized randomized controlled trials (RCTs) using Japanese traditional (Kampo) medicine in structured abstracts, named “Evidence Reports of Kampo Treatment” (EKAT). In this study, we developed a method of classification based on study design, method of intervention, study aim, journal credibility, and year of publication. Then we classified 416 RCTs in EKAT and examined the current status and evolution of RCTs using Kampo medicine in Japan. Double-­blinded RCTs (DB-RCTs) accounted for only 8.9% of the RCTs in EKAT, and 86.5% of DB-RCTs were placebo-controlled. Among the RCTs that aimed to investigate the efficacy of Kampo medicine for diseases without standard Western medical treatment, DB-­RCT accounted for 64.9%. In recent years, there have been fewer envelope RCTs and quasi-­RCTs, which are prone to an increased risk of bias. The proportion of articles reporting RCTs in journals with an impact factor ( > 0.79 points reported by Journal Citation Reports) has been increasing with each passing year. This implies that the recent research in Kampo medicine has improved its quality and has gained an appreciation in modern medicine. The present study was conducted in “Problem-based Learning” in the 2nd grade of Tohoku University School of Medicine.