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.

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 47-year-old woman with body temperature 35.6 ℃ took the 3rd COVID-19 vaccine shot at our clinic on Day 1. Since she felt chills and suffered from genital bleeding on Day 3, she visited our clinic to take a gynecological examination. Her temperature was 37.1 ℃ at that time. On Day 15, she suffered sustained symptoms of chills and general fatigue, and she went to another internal medicine clinic to take a medical care. However, her condition was unexplained and she was referred to a general hospital. On Day 16, she came to our clinic to confirm results of the gynecological examination. Her symptoms persisted even though the data showed no problems, so we prescribed her saikokeishikankyoto (SAKK) for only 3 days. On Day 19, SAKK dramatically improved her symptoms. On Day 37, her temperature was 36.2 ℃ without any symptoms.

Various measures are being undertaken all over the world to control the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Artificial respirators and extracorporeal membrane oxygenators (ECMO) have been introduced for severely ill patients, and antiviral pharmacotherapy has been attempted. However, in the current situation, it is not feasible to wait for evidence-based effective treatments, and it is imperative to deal with daily situations. It would be very helpful to retrospectively evaluate the doctors who worked during the Spanish flu pandemic without access to medical devices such as ventilators, or drugs including antibacterial and antiviral agents. Based on the fact that Kampo medicine was used to treat patients with the Spanish flu, this article demonstrates the high pathogenicity of the Spanish flu virus, the mechanism of action of antiviral drugs, and clinical evidence. As one of the measures against the COVID-19 pandemic, we propose the role of Kampo medicine, which has relative clinical safety with few side effects, and can be expected to induce antiviral action by autoimmune activation.

Aim of the present study was to statistically evaluate the examination rule with use of a questionnaire obtained from physicians regarding treatment for chillness of the limbs, and to prove the clinical usefulness of the database. The database showed that tokishigyakukagoshuyushokyoto was the most frequently used to treat chillness of the limbs, and subsequently keishikajutsubuto, hachimijiogan, and tokishakuyakusan were ranked as drugs with wide use. When physicians determined a kampo formulation suitable for each patient, they used findings specific for the kampo formulation, but not uniform findings obtained from the four traditional examination methods (i.e., inspection, listening and smelling, interviewing, palpitation). There was a statistical difference in the selection mode of drugs among physicians. In a simulation obtained from a questionnaire, there was a positive association between time (time X) to the start of becoming physically warm in the limbs, and time (time Y) to remission (R² = 0.971, P = 0.014). The formula (Y = 4.379 X−0.519), which could predict time Y on the basis of information on time X, was able to accurately monitor the clinical courses of 7 responders to treatment for chillness of the limbs. Taken together, these results strongly suggest that the database constructed in the present study may be useful for evaluation of traditional Kampo medicine, and might allow us to perform more fittingly personalized Kampo medicine in the near future.

Continuous suppressive antiviral medication for the treatment of repeated genital herpes is often carried out, but few treatments with Kampo have been reported. Here, we report experience with a case in which the repeated recurrence of genital herpes was treated successfully with hochuekkito.
A 34-year-old woman had experienced pregnancy twice and delivered twice. She had also had repeated recurrences of genital herpes from several years earlier, and been treated at a nearby doctor. Her recurring herpes did not resolve, however, and she visited our department. In addition to these recurrences, general fatigue and appetite loss were observed, which were regarded as Qi deficiency, and she was started on hochuekkito 7.5 g/day. The general fatigue disappeared two weeks after the treatment. Herpes recurrences also decreased gradually, and symptoms were no longer observed after medication was stopped less than a year later.
In this case, genital herpes recurrences were decreased, while symptoms such as general fatigue and appetite loss were also improved. Here, genital herpes recurrence was regarded as Qi deficiency, which was possible to treat with hochuekkito.

We treated 5 patients with painful muscle cramp due to heat injury using Shakuyakukanzoto. According to their severities, 4 patients were classified with 1 st degree and 1 patient with 3rd degree heat injury. Painful muscle cramps in 4 patients with 1st degree were cured through a single dose of Shakuyakukanzoto. On the other hand, painful muscle cramps in 1 patient with 3rd degree was managed for 4 days after administration of Shakuyakukanzoto. No Shakuyakukanzoto complications were observed in any patient, nor contribution to rhabdomyolysis in 3 patients. Shakuyakukanzoto may be useful to prevent acute kidney injury due to rhabdomyolysis by controlling painful muscle cramps in heat injury.

Inflammatory swelling after viper bite envenomation has the potential for causing multiple organ dysfunctions. We report 2 cases of viper bite that were successfully treated with saireito. A 79-year-old man suffered viper bite envenomation. Saireito was administered to reduce the swelling of the right lower leg. The patient's symptom was improved without any complications. A 68-year-old man suffered the same condition. The swelling spread over the chest and tako-tsubo-like left ventricular (= apical ballooning cardiomyopathy) dysfunction developed. Saireito was administered to reduce the swelling of the left upper limb. The patient was discharged without any severe complications. Thus, saireito may be useful for the treatment of swelling due to viper bite envenomation.

Kakkonkajutsubuto belongs to the Ephedra herb drug group and has useful properties for stiff shoulders, scapular neuralgia, and rheumatoid arthritis of the upper body. In this study, we assessed the effectiveness of kakkonkajutsubuto in patients with neck, shoulder, and upper-extremity pain from the viewpoint of decrease in a Visual Analog Scale (VAS) and adverse reactions. One hundred and twenty-four patients who had no gastrointestinal disorder, hot flashes, excessive sweating or other select symptoms were treated with kakkonkajutsubuto (5.0-7.5g/day). The VAS was used for the assessment of pain-relieving effect.Eighty-one patients improved dramatically (their pre/post administration VAS ratio was less than 50%), 21 improved (between 51 to 75%), and 22 did not improve (more than 76%). Eighty-two point three percent of patients improved in total. Five patients showed adverse reactions, such as general fatigue, stomachache, and edema, but these were not clinically significant. This study suggests that kakkonkajutsubuto can be used more widely for neck, shoulder, or upper-extremity pain.

We measured the level of derivatives of reactive oxygen metabolites (d-ROMs test) and total antioxidant capacity (OXY-adsorbent test) in adult volunteers and assessed whether jidabokuippo affects the oxidative stress regulation system. Twenty subjects received jidabokuippo 7.5 g/day, and the d-ROMs test and the OXY-adsorbent test were carried out 72 hours after taking the study drug. The subjects were also assigned to one of two groups : a Favorable response group (n = 6) or a Non-favorable response group (n = 14). The Favorable response group had improvement of such signs and symptoms as stiff shoulders, constipation, and bruises.No significant difference was observed in the d-ROMs test.However, the OXY-adsorbent test at 72 h was significantly lower than that at the pre-administration (p = 0.0290). No significant differences were observed in either the d-ROMs test or the OXY-adsorbent test in the favorable response group. On the other hand, the d-ROMs test and the OXY-adsorbent test at 72 h were significantly lower than those at pre-administration in the non-favorable response group (p = 0.0279, p = 0.0413, respectively). These results indicate that jidabokuippo affects the oxidative stress regulation system in human.